Health, Well-being, and Health Care Access in Rural Communities: Comparing Latino and Non-Latino White Low-income Families.

This study explores how low-income rural Latino children and their mothers differ from their non-Latino white counterparts in terms of health, well-being, and health care access. A subsample of non-Latino white (n = 201) and Latino (n = 157) children and their mothers was drawn from the Rural Families Speak about Health Project, a multistate, cross-sectional data set developed through mixed purposive sampling methods. Findings suggest that Latino children's families were disadvantaged in terms of child health and access to health care, whereas non-Latino white children's families were disadvantaged in terms of child behavior problems and maternal health and depression.

Can Universal SEL Programs Benefit Universally? Effects of the Positive Action Program on Multiple Trajectories of Social-Emotional and Misconduct Behaviors.

Behavioral trajectories during middle childhood are predictive of consequential outcomes later in life (e.g., substance abuse, violence). Social and emotional learning (SEL) programs are designed to promote trajectories that reflect both growth in positive behaviors and inhibited development of negative behaviors. The current study used growth mixture models to examine effects of the Positive Action (PA) program on behavioral trajectories of social-emotional and character development (SECD) and misconduct using data from a cluster-randomized trial that involved 14 schools and a sample of predominately low-income, urban youth followed from 3rd through 8th grade. For SECD, findings indicated that PA was similarly effective at improving trajectories within latent classes characterized as "high/declining" and "low/stable". Favorable program effects were likewise evident to a comparable degree for misconduct across observed latent classes that reflected "low/rising" and "high/rising" trajectories. These findings suggest that PA and perhaps other school-based universal SEL programs have the potential to yield comparable benefits across subgroups of youth with differing trajectories of positive and negative behaviors, making them promising strategies for achieving the intended goal of school-wide improvements in student outcomes.

Opportunities to use drugs and the transition to drug use among adolescents from Caracas, Venezuela.

Few studies have examined exposure to drug use and the lag between exposure and use. This paper estimates prevalence of opportunity to use a substance, for use, and for use given an opportunity to use among a sample of Venezuelan adolescents. Several covariates on the opportunity to use and the transition to use are also examined. Findings show that lifetime prevalence of substance use among Venezuelan adolescents increases dramatically and more closely resembles rates among US and European samples when having had an opportunity to use was taken into account. A majority of youth who transitioned to use did so the same year exposure occurred, and females had a shorter time difference compared to males. Covariates primarily predicted exposure rather than having used after controlling for exposure, and their effects varied by substance. Implications for prevention efforts are discussed.

Growth, Persistence, and Desistance of Alcohol Use for At-Risk Men in Their 30s.

BACKGROUND: Little is known about heterogeneity in men's drinking behaviors and their related consequences across mid-adulthood, and moreover, whether individual or social factors may predict such differences. This study examined 3 indicators of alcohol use, namely alcohol volume, heavy episodic drinking (HED), and drinking-related problems for men in their 30s. METHODS: Participants were 197 at-risk men from the Oregon Youth Study assessed 5 times across ages 29 to 38 years. Growth mixture modeling with count outcomes was used to examine unobserved heterogeneity in alcohol trajectories. Associations of latent classes of alcohol users with (i) classes for the other alcohol indicators, (ii) alcohol use by peers and romantic partners, (iii) alcohol classes previously extracted from ages 18 to 29 years, and (iv) past year alcohol use disorder (AUD) diagnostic status at ages 35 to 36 years were examined. RESULTS: A 3-class solution afforded the best fit for each alcohol indicator. Alcohol problems were relatively established in the 30s, with an ascending use class found only for volume. Although relatively few men were in higher classes for all 3 indicators, 45% of the sample was in the highest class on at least 2 indicators of use. Peer drunkenness was a robust predictor of the alcohol classes. Concordance among classes of alcohol users was seen from the 20s to the 30s, with prior desistance likely to be maintained for alcohol volume and HED. AUD diagnoses at ages 35 to 36 years were more common in the higher classes obtained for alcohol volume and alcohol problems. CONCLUSIONS: Many men in their 30s engaged in a high volume of alcohol use without frequent engagement in HED, likely relating to continuing alcohol problems. The convergence of men's alcohol use with that of their peers found at younger ages was maintained into early mid-adulthood.

Heterogeneity in men's marijuana use in the 20s: adolescent antecedents and consequences in the 30s.

Adolescent psychopathology is commonly connected to marijuana use. How changes in these adolescent antecedents and in adolescent marijuana use are connected to patterns of marijuana use in the 20s is little understood. Another issue not clearly understood is psychopathology in the 30s as predicted by marijuana use in the 20s. This study sought to examine these two issues and the associations with marijuana disorder diagnoses using a longitudinal data set of 205 men with essentially annual reports. Individual psychopathology and family characteristics from the men's adolescence were used to predict their patterns of marijuana use across their 20s, and aspects of the men's psychopathology in their mid-30s were predicted from these patterns. Three patterns of marijuana use in the 20s were identified using growth mixture modeling and were associated with diagnoses of marijuana disorders at age 26 years. Parental marijuana use predicted chronic use for the men in adulthood. Patterns of marijuana use in the 20s predicted antisocial behavior and deviant peer association at age 36 years (controlling for adolescent levels of the outcomes by residualization). These findings indicate that differential patterns of marijuana use in early adulthood are associated with psychopathology toward midlife.

Adolescent Substance Use Following Participation in a Universal Drug Prevention Program: Examining Relationships With Program Recall and Baseline Use Status.

BACKGROUND: The study examined whether adolescents receiving a universal, school based, drug prevention program in Grade 7 varied, by student profile, in substance use behaviors post program implementation. Profiles were a function of recall of program receipt and substance use at baseline. METHODS: A secondary analysis was conducted on data from the Adolescent Substance Abuse Prevention Study, a large, geographically diverse, longitudinal school-based cluster-randomized controlled trial of the Take Charge of Your Life drug prevention program. Profiles were created using self-reported substance use (preintervention) and program recall (postintervention) at Grade 7. First, characteristics of each of the 4 profiles of treatment students who varied by program recall and baseline substance use were explored. Then, multilevel logistic regression analyses were used to examine differences in the odds of substance use (alcohol, tobacco, and marijuana) among student profiles at the 6 additional study waves (Time 2 [Grade 7] through Time 7 [Grade 11]). RESULTS: Pearson's chi-square tests showed sample characteristics varied by student profile. Multilevel logistic regression results were consistent across all examined substance use behaviors at all time points. Namely, as compared with students who had no baseline substance use and had program recall (No Use, Recall), each of the remaining 3 profiles (No Use, No Recall; Use, Recall; Use, No Recall) were more likely to engage in substance use. Post hoc analyses showed that for the 2 subprofiles of baseline substance users, there were only 2 observed, and inconsistent, differences in the odds of subsequent substance use by recall status. CONCLUSIONS: Findings suggest that for students who were not baseline substance users, program recall significantly decreased the likelihood of subsequent substance use. For students who were baseline substance users, program recall did not generally influence subsequent substance use. Implications for school-based drug prevention programs are discussed.

Heterogeneity in growth and desistance of alcohol use for men in their 20s: prediction from early risk factors and association with treatment.

BACKGROUND: The course of men's alcohol use from ages 18 to 19 through 28 to 29 years was examined using growth mixture modeling (GMM) to determine alcohol trajectories for 3 conceptualizations of alcohol use: volume of use, heavy episodic drinking (HED), and drinking-related problems. Trajectory classes were validated against the young men's alcohol treatment history, and childhood/adolescent predictors of trajectory membership were examined. METHODS: Participants were 205 men from the Oregon Youth Study, an ongoing longitudinal study of predominantly White men recruited from higher crime neighborhoods who were assessed annually during their 20s. The multivariate association between 3 prospectively assessed risk factors-parental alcohol use, child antisocial behavior, and age at first drunken experience-and the latent classes extracted from the GMM were examined for each alcohol indicator. RESULTS: A 3-class-solution model best fit the data for each alcohol indicator. The classes for both HED and problematic drinking for the men were significantly associated with history of treatment for alcohol use. Overall, the findings indicated a relatively large class with persistently high volume of alcohol use across the 20s and a greater prevalence of desistance for HED and alcohol problems. Age at first intoxication was the best predictor of latent class membership, and men in the initially high-then-desisting alcohol classes had a high level of early risk. Concordance of trajectory class membership across alcohol indicators was moderate overall but particularly strong for higher problem groups, as almost all men in the increasing HED trajectory were also in the highest volume and alcohol problems trajectory classes. Levels of treatment were high for the higher and desisting HED and alcohol problems classes. CONCLUSIONS: Many of the men showed chronic alcohol use across the decade of the 20s and had problems resulting from their high usage. Whereas most of the men showed low and/or desisting HED across this period, desistance was less common for volume of use and for alcohol problems.

PROMIS Pediatric Psychological Stress Measure: Validity for immigrant Latino youth.

Objective: This study assesses the psychometric properties of the four- and eight-item versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Psychological Stress Measure (PPSM) for use with Latino immigrant adolescents. Background: Immigrant Latino youth are exposed to numerous stressors that can have consequences affecting health well into adulthood. However, few studies have assessed the suitability of psychosocial measures for this group. Methods: Participants included 286 first- and second-generation immigrant Latino youth in middle school in an urban school district in the United States. Analyses included tests for reliability, validity, item characteristics, and measurement invariance across differing levels of acculturation and gender groups. Results: Both the four- and the eight-item PPSM are internally consistent, have strong construct validity, and strict factorial invariance across differing levels of acculturation. The four-item PPSM demonstrates strict invariance, but the eight-item version shows only configural invariance by gender. Conclusion: The PPSM is a rigorous measure when assessing immigrant Latino youth stress level. The four-item PPSM is brief, simple to administer, and appropriate for use with Latino youth across differing levels of acculturation and gender groups. Implications: The four-item PPSM lessens respondent fatigue and may be incorporated into tools practitioners and researchers use to assess perceived stress among immigrant Latino youth.

Validation of the Family Fear of Deportation Scale for youth.

Objective: This study reports on the psychometric properties of a new instrument to assess family fear of deportation in two versions (binary and polytomous response options). Background: The impact of fear of deportation extends beyond foreign-born youth to U.S. citizen children in families with unauthorized members, and negatively affects their academic achievement and their physical, mental, and behavioral health. A measure assessing levels of fear of deportation among youth is lacking. Methods: Participants were first- and second-generation Latino immigrant youth (N = 145 in Study 1 and N = 107 in Study 2). Item response theory (IRT), confirmatory factor analysis (CFA), correlation analysis, and reliability tests were used to assess the scale's psychometric properties. Results: The results supported a five-item binary version and a six-item polytomous version of the scale. Both demonstrated excellent model fit, good reliability, and criterion validity. Conclusions: The six-item polytomous version is slightly more parsimonious than the five-item binary version scale, has better internal consistency, and captures a modestly wider range of the construct. The binary version may be preferable for immigrant youth who prefer straightforward response options. Implications: Researchers and practitioners can use either version of the Family Fear of Deportation Scale with confidence to assess deportation-related fear among Latino immigrant youth.

Effects of a social-emotional and character development program on the trajectory of behaviors associated with social-emotional and character development: findings from three randomized trials.

The effects of a school-based social-emotional and character development program, Positive Action, on the developmental trajectory of social-emotional and character-related behaviors was evaluated using data from three school-based randomized trials in elementary schools. Results come from 1) 4 years of data from students in 20 Hawai'i schools, 2) 3 years of data from students in 14 schools in Chicago and 3) 3 years of data from students in 8 schools in a southeastern state. Random intercept, multilevel, growth-curve analyses showed that students in both control and Positive Action schools exhibited a general decline in the number of positive behaviors associated with social-emotional and character development that were endorsed. However, the Positive Action intervention significantly reduced these declines in all three trials. Taken together, these analyses 1) give insight into the normative trajectory of behaviors associated with social-emotional and character development and 2) provide evidence for the effectiveness of Positive Action in helping children maintain a relatively beneficial developmental trajectory.

Feasibility and reliability of continuously monitoring alcohol use among female adolescents and young adults.

INTRODUCTION AND AIMS: Transdermal alcohol sensors allow objective, continuous monitoring and have potential to expand current research on adolescent and young adult alcohol use. The purpose of this manuscript is to evaluate the feasibility and reliability of transdermal alcohol sensor use among female adolescents as compared to female young adults. DESIGN AND METHODS: This trial included 59 female adolescents and young adults aged 14-24 years who reported drinking during the previous month. All participants were asked to wear a Giner Wrist Transdermal Alcohol Sensor (WrisTAS)-7 over a 1 month prospective study. Participants came to the research lab weekly to complete a detailed self-report of behaviours, including day of drinking events, amounts and types of alcohol use and length of drinking events. Estimates of blood alcohol concentration (eBAC) were computed from self-report data using the Matthew and Miller, NHTSA and Zhang equations. Daily transdermal alcohol concentration (TAC) peaks and calculated eBAC peak data were analysed with paired-samples t-tests and repeated measures correlations for validity comparisons. RESULTS: All participants (100%, n = 59) completed the trial, however, two participants were removed due to greater than 50% of missing transdermal alcohol sensor data. Of the 57 participants, the data included 1,722 days of continuous alcohol monitoring. Missing data was recorded more frequently among female adolescents at about (11.78%) as compared to female young adults (8.59%; χ2  = -18.40, P < 0.001). Participant self-report of drinking occurred with greater frequency (374 events) than detected by the WrisTAS transdermal alcohol sensors (243 events). On days when self-report and sensor data indicated a drinking event, participants' eBAC was moderately correlated with TAC, after accounting for repeated measures. DISCUSSION AND CONCLUSIONS: This study finds that transdermal alcohol sensors are moderately reliable when sensor data is paired with self-report. This objective data collection method may improve the ability to collect alcohol curves among adolescents.

The Families and Schools for Health Project: A Longitudinal Cluster Randomized Controlled Trial Targeting Children with Overweight and Obesity.

This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity; Family Dynamics (FD) added parenting and healthy emotion management. A third Peer Group (PG) intervention taught social acceptance to children. Crossing interventions yielded four conditions: FL, FL + PG, FL + FD, and FL + FD + PG-compared with the control. Longitudinal BMI data were collected to determine if family- and peer-based psychosocial components enhanced the Family Lifestyle approach. Participants were 1st graders with BMI%ile >75 (n = 538: 278 boys, 260 girls). Schools were randomly assigned to condition after stratifying for community size and percent American Indian. Anthropometric data were collected pre- and post-intervention in 1st grade and annually through 4th grade. Using a two-level random intercept growth model, intervention status predicted differences in growth in BMI or BMI-M% over three years. Children with obesity who received the FL + FD + PG intervention had lower BMI gains compared to controls for both raw BMI (B = -0.05) and BMI-M% (B = -2.36). Interventions to simultaneously improve parent, child, and peer-group behaviors related to physical and socioemotional health offer promise for long-term positive impact on child obesity.

Shared Language Erosion: Rethinking Immigrant Family Communication and Impacts on Youth Development.

In this paper we make the case for Shared Language Erosion as a potential explanation for the negative outcomes described in the immigrant paradox for second- and third- generation immigrants (e.g., declines in physical, mental, and behavioral health). While not negating the important role of cultural adaptation, we posit that parent-child communication difficulties due to a process we are calling Shared Language Erosion is driving the observed affects previously attributed to changes in cultural values and beliefs. Shared Language Erosion is the process during which adolescents improve their English skills while simultaneously losing or failing to develop their heritage language; at the same time their parents acquire English at a much slower rate. This lack of a common shared language makes it difficult for parents and their adolescent children to effectively communicate with each other, and leads to increased parent-child conflict, reduced parental competence, aggravated preexisting flaws in parent-child attachment, and increased adolescent vulnerability to deviant peer influences.

Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii.

OBJECTIVES: We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students. METHODS: We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N = 1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N = 1225) substance use and violence. RESULTS: Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR] = 0.41; 90% confidence interval [CI] = 0.25, 0.66) and violence (RR = 0.42; 90% CI = 0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio = 0.24; 90% CI = 0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors. CONCLUSIONS: Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior.

Modelling opportunity: An examination of quadratic effects of adolescent Venezuelan substance use.

INTRODUCTION AND AIMS: Numerous studies have found a linear relationship between an exposure opportunity and age of first drug use. This study further tests this relationship by exploring whether a quadratic exposure opportunity best fits the data on age of first use and whether gender moderates this relationship. That is, is there a peak age in which the transition to use occurs for male compared to female adolescents? DESIGN AND METHODS: A sample of 1716 adolescents from 14 public and private schools, representative of two school districts in Caracas, Venezuela, was examined using a zero-inflated Poisson modelling approach to test for quadratic effects. A series of models were tested for each set of substances (alcohol, tobacco and other drugs) to assess whether a quadratic model has better predictive ability than linear models and to test whether gender moderates the quadratic relationship. RESULTS: After controlling for common covariates, the quadratic models for alcohol indicated the peak age of transition from an exposure opportunity to use was 10-years of age in this Venezuelan sample. Gender did not moderate these models suggesting an important move toward gender equality in substance use. DISCUSSION AND CONCLUSIONS: Focused efforts on preventing exposure to alcohol use during these windows of rapid transition is likely to have the greatest impact on delaying age of onset, which will reduce the overall prevalence of alcohol related problems among adolescents.

The Effects of Requiring Parental Consent for Research on Adolescents' Risk Behaviors: A Meta-analysis.

PURPOSE: Requiring parental consent may result in sampling biases that confound scientific conclusions and stifle the representation of children most at risk for adverse outcomes. This study aims to investigate whether active parental consent, compared with passive parental consent, creates a bias in response rate, demographic makeup, and adverse outcomes in adolescent samples. METHODS: A meta-analysis was performed on peer-reviewed articles and unpublished dissertations from 1975 to 2016 in five computerized databases ERIC, PsycINFO, MEDLINE, PubMed and ProQuest. Quantitative studies were retained if they included the following keywords: active consent (or informed consent or parental consent), passive consent (or waiver of consent), risk behavior, adolescen*. RESULTS: Fifteen studies were identified with a total number of 104,074 children. Results showed (1) response rates were significantly lower for studies using active consent procedure than those using passive consent procedure (Z = 3.05, p = .002); (2) more females, younger participants, and less African-Americans were included in studies using active consent procedures than studies using passive procedures (Z = -2.73, p = .006; Z = -12.06, p < .00001; Z = 2.19, p = .03, respectively); (3) studies with passive consent procedures showed higher rates of self-reported substance use than studies using active consent procedures (Z = 3.07, p = .002). CONCLUSIONS: Requiring active parental consent can lead to a systematic bias in the sample where the population under study is misrepresented. Institutional review board committees should collaborate with researchers to find solutions that protect minors without silencing the voice of high-risk youth in the literature.

Changes in the Associations of Heavy Drinking and Drug Use with Intimate Partner Violence in Early Adulthood.

The hypothesis that the disinhibitory effects induced by alcohol consumption contribute to domestic violence has gained support from meta-analyses of mainly cross-sectional studies that examined the association between alcohol abuse and perpetration of intimate partner violence (IPV). However, findings from multilevel analyses of longitudinal data investigating the time-varying effects of heavy episodic drinking (HED) on physical IPV have been equivocal. This 12-year prospective study used multilevel analysis to examine the effects of HED and illicit drug use on perpetration of both physical and psychological IPV during early adulthood. Participants were 157 romantic couples who were assessed biennially 2 to 6 times for substance misuse and IPV. The analyses found no significant main effect of either HED or drug use on perpetration of IPV but there were significant interactions of both HED and drug use with age. Moreover, the developmental trends in substance use effects on IPV typically varied by gender and type of IPV.

Event-Level Associations of Marijuana and Heavy Alcohol Use With Intercourse and Condom Use.

OBJECTIVE: The associations substance use has with sex and condom use among college students appear to be well documented and of clear public health significance. However, few event-level studies examine marijuana or heavy alcohol use, control for temporal patterns shared among these behaviors, or consider differences by relationship status. METHOD: We recruited 284 18- to 22-year-old undergraduate men and women (79%), 61% of whom were in a serious relationship. For 24 consecutive days, participants reported on their prior day marijuana use, heavy alcohol use, vaginal intercourse, and condom use. RESULTS: Most intercourse events (86%) were reported by participants in a serious relationship, and most (62%) were not protected by a condom. Hierarchical generalized linear models indicated that participants in a serious relationship were more likely to report intercourse than were others. Adjusting for weekly patterns in intercourse, odds of intercourse were higher on days participants reported marijuana or heavy alcohol use; the latter effect was stronger for single participants. Being drunk during sex, being in a serious relationship, and using noncondom birth control were associated with less condom use. CONCLUSIONS: Models distinguish among multiple potential influences on undergraduates' sexual behavior. Findings suggest that greater attention to the relationship and other contexts of marijuana and alcohol use may be relevant to understanding young adults' sexual behavior and preventing health-risking or nonconsensual sex.

Influences on Boys' Marijuana Use in High School: A Two-Part Random Intercept Growth Model.

This study examined differences in predictors of marijuana use versus quantity of marijuana use across the high school years, using annual assessments from the Oregon Youth Study (OYS) and a two-part model for semicontinuous data. The OYS is a community sample of at-risk boys followed from age 10 years. In order to capture dynamic prediction effects, change scores of predictors, as well as baseline scores, were included. Baseline predictors predominantly showed associations with the intercepts but not with the slopes of growth models. Change scores for parental monitoring, peer substance use, and antisocial behavior and deviant associations were associated with both parts of the model. Findings highlight the importance of looking at marijuana use compared to quantity of marijuana use.

Alcohol and marijuana use in early adulthood for at-risk men: time-varying associations with peer and partner substance use.

BACKGROUND: Time-varying associations of 185 at-risk men's (from the Oregon Youth Study) substance use with that of their peers and partner over a 10-year period (ages 23 to 32 years) were examined. Moderation of effects by time with peers and partner and their age were tested. METHOD: Growth models were used to predict changes in heavy episodic drinking (HED) alcohol use and marijuana use as a function of substance use by their female partners and male peers. RESULTS: Time with peers and peer substance use significantly predicted HED (ORs=1.6, 2.3), alcohol use (ORs=1.6, 2.1), volume of alcohol use (IRRs=1.5, 1.3), and marijuana use (ORs=12.8, 1.7); peer marijuana use predicted volume of marijuana use (B=2.5). Partner substance use significantly predicated marijuana volume (B=2.7). Partner alcohol use predicted alcohol volume (IRR=1.1), but was moderated by time with partner and age (IRR=1.0). Time with partner and partner marijuana use predicted marijuana use (OR=0.5, 2.7), as did the interaction of the two (OR=3.8). CONCLUSIONS: Outcome-specific substance use of peers and partners was significantly associated with indicators of alcohol and marijuana use in men's early adulthood, with robust effects of peer substance use through age 30 years and with time spent with peers influencing alcohol use. Time with partner was protective against marijuana use unless the partner used marijuana. Peers and partners should be considered in intervention efforts to effectively reduce men's substance use in early adulthood.