Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes.

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

Longitudinal patterns of adversity from childhood to adolescence: Examining associations with mental health through emerging adulthood using a random-intercept latent transition analysis.

Childhood adversity can have detrimental impacts on life course mental and physical health. Timing, nature, severity, and chronicity of adversity are thought to explain much of the variability in health and developmental outcomes among exposed individuals. The current study seeks to characterize heterogeneity in adverse experiences over time at the individual, family, and neighborhood domains in a cohort of predominantly Black children (85% Black and 15% White, 46.2% girls, 67.2% free/reduced lunch in first grade), and to examine associations with mental health from sixth grade to age 26. Participants were part of a randomized universal preventive interventions trial in first grade with prospective follow-up through early adulthood. Separate models characterized heterogeneity in adversity in elementary, middle, and high schools. Changes in adversity over time and relationships with mental health (anxiety, depression, suicidal behaviors) were investigated using a random-intercept latent transition analysis (RI-LTA). We identified three-class solutions in early childhood, middle school, and high school. Generally, both a higher and a lower poly-adversity class were observed at each time point, with varying nature of adversity characterized by the third class. RI-LTA indicated prevalent within-individual changes in adverse exposure over time and differential associations with mental health and suicidal behaviors. Results suggest that treating adverse exposures as a static construct may limit the ability to characterize salient variation over time. Identifying complexity in adverse experiences and their relation to health and well-being is key for developing and implementing effective prevention and early intervention efforts to mitigate negative effects through the life course. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychosis Symptom Trajectories Across Childhood and Adolescence in Three Longitudinal Studies: An Integrative Data Analysis with Mixture Modeling.

Psychotic-like experiences (PLEs) are common throughout childhood, and the presence of these experiences is a significant risk factor for poor mental health later in development. Given the association of PLEs with a broad number of mental health diagnoses, these experiences serve as an important malleable target for early preventive interventions. However, little is known about these experiences across childhood. While these experiences may be common, longitudinal measurement in non-clinical settings is not. Therefore, in order to explore longitudinal trajectories of PLEs in childhood, we harmonized three school-based randomized control trials with longitudinal follow-up to identify heterogeneity in trajectories of these experiences. In an integrative data analysis (IDA) using growth mixture modeling, we identified three latent trajectory classes. One trajectory class was characterized by persistent PLEs, one was characterized by high initial probabilities but improving across the analytic period, and one was characterized by no reports of PLEs. Compared to the class without PLEs, those in the improving class were more likely to be male and have higher levels of aggressive and disruptive behavior at baseline. In addition to the substantive impact this work has on PLE research, we also discuss the methodological innovation as it relates to IDA. This IDA demonstrates the complexity of pooling data across multiple studies to estimate longitudinal mixture models.

Associations of polygenic risk scores for smoking heaviness and lifetime cannabis use with tobacco and cannabis co-use trajectories among African Americans.

BACKGROUND: We aimed to identify distinct trajectories of tobacco, cannabis, and their co-use among African Americans, and to investigate whether these patterns were associated with polygenic risk scores (PRS) for tobacco and cannabis use. METHOD: Participants (N=428 participants; 50.9% male) were initially recruited for an elementary school-based prevention in a Mid-Atlantic city when they were in first grade. From ages 14-26, participants reported on their frequency of tobacco and cannabis use in the past year during annual assessments. DNA was collected from participants at age 21. PRS for smoking heaviness (i.e., cigarettes per day) and lifetime cannabis use were created based on genome-wide association study results derived from Liu et al. (2019) and Pasman et al. (2018), respectively. RESULTS: We identified five distinct trajectories of tobacco and cannabis co-use, including (1) Low Tobacco and Cannabis Use, (2) Adolescent Limited Tobacco and Cannabis Use, (3) Experimental Cannabis, Young Adult Increasing Tobacco, (4) Experimental Tobacco, Young Adult Increasing Cannabis, and (5) High, Chronic Tobacco and Cannabis Use. Compared to the Low Tobacco and Cannabis Use subgroup, individuals in the High, Chronic Tobacco and Cannabis Use subgroup had greater PRS for smoking heaviness, and individuals in the Experimental Cannabis, Young Adult Increasing Tobacco subgroup had higher PRS for lifetime cannabis use. CONCLUSIONS: Polygenic risk for lifetime cannabis use and smoking heaviness is associated with the developmental progression of tobacco and cannabis co-use among African Americans, furthering knowledge on the etiology of co-use in this population.

Perceived Neighborhood Safety and Depressive Symptoms: The Role of Perceived Neighborhood Cohesion and Perceived Control.

Few have examined mechanisms explaining the link between perceived neighborhood unsafety, neighborhood social processes, and depressive symptoms for Black adolescents. The goal of this study was to examine the role of perceived control as a mechanism linking perceptions of neighborhood unsafety and depressive symptoms, and neighborhood cohesion as a protective factor. Participants were 412 Black adolescents living in a major Mid-Atlantic urban center in the United States (49% female, Mage = 15.80, SD = 0.36). Participants reported perceptions of neighborhood unsafety at grade 10, neighborhood cohesion at grade 10, perceived control at grades 10 and 11 and depressive symptoms in grades 10 and 12. High neighborhood unsafety was associated with low perceived control and in turn high depressive symptoms only when neighborhood cohesion was high. The results highlight the role of neighborhood unsafety and perceived control in the development of depressive symptom and the possible downsides of neighborhood social factors.

Predicting implementation of the PAX Good Behavior Game + MyTeachingPartner interventions.

Introduction: Effective classroom management is critical to creating a classroom environment in which social, emotional, and academic learning can take place. The present study investigated the association between early career, early elementary teachers' occupational health (job stress, burnout, and perceived teaching ability) and perceptions of program feasibility in relation to their implementation dosage and quality of two evidence-based classroom management programs implemented together: the PAX Good Behavior Game (GBG) and MyTeachingPartner (MTP) intervention. Methods: Teachers provided information on their occupational health at the start of the school year and were then randomized to the PAX GBG + MTP condition or control condition. Teachers' perceptions of the feasibility of the program, implementation dosage, and implementation quality of the intervention were measured at the end of the school year for the 94 intervention teachers. Results: Teachers participated in more MTP coaching cycles when they reported that the combined PAX GBG + MTP program was feasible. Although there were no main effects of occupational health on implementation, the associations between job stress and implementation quality were moderated by perceptions of feasibility. Discussion: Findings highlight the complexity of factors influencing the implementation of evidence-based programs in school settings.

Longitudinal associations between age 20 problematic substance use and opioid use disorder incidence at age 30 - findings from an urban cohort.

This study used data from a longitudinal prevention study in an urban cohort to examine associations between nicotine dependence, alcohol, and cannabis use disorder and disorder criteria at age 20, with opioid use disorder (OUD) incidence or criteria onset by age 30. The study sample included 1408 participants (57.5% female, 72.5% African American) drawn from two cohorts of participants in a mid-Atlantic region of the U.S. as part of a series of randomized controlled trials of elementary school-based universal prevention interventions. Lifetime cannabis use disorder (CUD), alcohol use disorder (AUD; both DSM-IV), and current nicotine dependence (Fagerstrom Test for Nicotine Dependence, FTND) assessed at age 20 were used to predict (1) DSM-IV lifetime OUD at age 30, and (2) OUD criteria between ages 20 and 30 in multivariable logistic regression models. Covariates for all analyses included sociodemographics (sex, race, and free/reduced-priced lunch status), community disadvantage, and intervention status. Nicotine dependence (FTND≥3) at age 20 predicted age 30 DSM-IV lifetime OUD (aOR = 2.37; 95% CI 1.02,5.54). The number of CUD criteria (aOR = 1.30; 95% CI 1.09,1.57) and nicotine dependence severity scores (aOR = 1.22; 95% CI = 1.05,1.41) at age 20 predicted any OUD criteria between the ages of 20 and 30. Findings are consistent with previous research on opioid use behavior in young adulthood and suggest that nicotine dependence and CUD criteria among urban young people predict onset of OUD and OUD criteria in young adulthood.

Positive associations between cannabis and alcohol use polygenic risk scores and phenotypic opioid misuse among African-Americans.

BACKGROUND: This study examined whether polygenic risk scores (PRS) for lifetime cannabis and alcohol use were associated with misusing opioids, and whether sex differences existed in these relations in an urban, African-American sample. METHODS: Data were drawn from three cohorts of participants (N = 1,103; 45% male) who were recruited in first grade as part of a series of elementary school-based, universal preventive intervention trials conducted in a Mid-Atlantic region of the U.S. In young adulthood, participants provided a DNA sample and reported on whether they had used heroin or misused prescription opioids in their lifetime. Three substance use PRS were computed based on prior GWAS: lifetime cannabis use from Pasman et al. (2018), heavy drinking indexed via maximum number of drinks from Gelernter et al. (2019), and alcohol consumption from Kranzler et al. (2019). RESULTS: Higher PRS for lifetime cannabis use, greater heavy drinking, and greater alcohol consumption were associated with heightened risk for misusing opioids among the whole sample. Significant sex by PRS interactions were also observed such that higher PRS for heavy drinking and alcohol consumption were associated with a greater likelihood of opioid misuse among males, but not females. CONCLUSION: Our findings further elucidate the genetic contributions to misusing opioids by showing that the genetics of cannabis and alcohol consumption are associated with lifetime opioid misuse among young adults, though replication of our findings is needed.

Residential mobility, neighborhood cohesion, and depressive symptoms among urban-dwelling African American adolescents.

Mechanisms linking residential mobility and depressive symptoms among urban-dwelling African American adolescents have received little attention. This study examined neighborhood cohesion as a possible mechanism. Participants were 358 urban-dwelling African American adolescents (Mage = 14.78; SD = 0.34) who reported their neighborhood cohesion in Grade 10 and depressive symptoms in Grades 9 and 11, and for whom residential address information was available. There was a significant indirect effect of past moves in middle school on depressive symptoms 1 year later through reduced neighborhood cohesion. However, the indirect effect was not significant in a propensity score-matched sample. Results from the full sample of adolescents suggest that neighborhood cohesion may play a role in the experience of depressive symptoms following past moves in middle school. Different findings for the propensity score-matched sample highlight the need for future studies of residential mobility to employ strategies to correct for possible selection bias.

Protective factors for suicidal ideation among Black adolescents indirectly exposed to community violence.

OBJECTIVE: Community violence exposure has been identified as a risk factor for Black youth suicide ideation. However, little is known about factors that protect community violence exposed youth against suicide ideation. The current study examined associations between knowledge of family member and peers' community violence exposure and Black youth's subsequent suicidal ideation, and investigated self-worth and social support as protective factors. METHOD: Participants were a community sample of Black youth (N = 447, 47.4% female; Mage = 11.77, SD = 0.35) who reported about community violence exposure, self-worth, social support, and suicide ideation in grades 6 and 7. RESULTS: Regression analyses revealed that grade 6 knowledge of family member and peers' community violence exposure was associated with increases in suicide ideation assessed in grade 7. Self-worth attenuated the association between knowledge of others' community violence exposure and suicide ideation for male adolescents. For female adolescents, social support attenuated the association between knowledge of others' community violence and suicide ideation. CONCLUSIONS: Findings highlight the consequential impact of knowledge about community violence for Black youth's suicidal ideation. Enhancing protective factors for Black youth is an important target for intervening with exposure to violence and reducing suicide ideation.

Promoting Voter Turnout: an Unanticipated Impact of Early-Childhood Preventive Interventions.

Preventive interventions in early childhood have a range of behavioral and health effects. However, there is an emerging literature extending this work to include acts of civic engagement, such as voting. Given that America has one of the lowest and most disparate rates of voter turnout in the world-and most of the current efforts aimed at boosting voter turnout and making the electorate more representative of the general public are proximal to the voting experience-there is a need for a better understanding of the potential long-term impact of early-childhood programming on civic engagement in adulthood. This paper builds on theories of political socialization and prior research demonstrating significant impacts of the Fast Track preventive intervention on voter turnout to examine the extent to which there are positive impacts on voter participation for other evidence-based preventive interventions targeting children's social and emotional capacities. Specifically, we leveraged data from a randomized controlled trial of the classroom-centered (CC) and the family school partnership (FSP) preventive interventions delivered in first grade. We analyzed data from approximately 700 urban, predominately African American, public school students who were randomly assigned to classrooms that either implemented (1) the classroom-centered intervention (which included the good behavior game), (2) the FSP intervention, or (3) the business as usual (i.e., control group). Data from the trial were combined with archival voter data when the youth were in their early 30s. Analyses demonstrated positive impacts of the CC preventive intervention on voter turnout more than two decades after exposure to the prevention program. Taken together, these findings provide additional evidence that some of the attributes that promote active participation in democracy can be fostered in early childhood-long before most interventions that have previously tried, and often failed, to increase voter turnout.

Early Childhood Behavioral and Academic Antecedents of Lifetime Opioid Misuse among Urban Youth.

OBJECTIVE: Opioid misuse has become an epidemic in the United States. In the present study, we examine potential malleable early childhood predictors of opioid misuse including whether childhood achievement, aggressive behavior, attention problems, and peer social preference/likability in first grade predicted opioid misuse and whether these relationships differed depending on participant sex. METHOD: Data are drawn from three cohorts of participants (N = 1,585; 46.7% male) recruited in first grade as part of a series of elementary school-based, universal preventive interventions conducted in a Mid-Atlantic region of the US. In first grade, participants completed standardized achievement tests, teachers reported on attention problems, and peers nominated their classmates with respect to their aggressive behavior and social preference/likability. At approximately age 20, participants reported on their misuse of opioids defined as lifetime use of heroin or misuse of prescription opioids. RESULTS: Higher levels of peer nominations for aggressive behavior in first grade predicted a greater likelihood of opioid misuse. An interaction between participant sex and attention problems was observed such that females higher in attention problems were more likely to misuse opioids, particularly prescription opioids, than females lower in attention problems. An interaction was also found between participant sex and peer likability such that males lower in peer-nominated likability were more likely to misuse opioids relative to males higher in likability. CONCLUSION: Given the malleable nature of attention problems, aggression, and social skills in early childhood, prevention programs that target these behaviors during this developmental period may attenuate risk for opioid misuse.

Differential Impact of a Universal Prevention Program on Academic Self-Efficacy: the Moderating Role of Baseline Self-Control.

Self-control (SC) plays a critical role in development across the life course; poor SC is a common antecedent of outcomes with high public health and societal burden including lower educational and occupational attainment, problem substance use, depression, obesity, and antisocial behavior. Further, SC is associated with academic self-efficacy and academic success; therefore, optimizing SC in early childhood could have long-term health and educational implications. However, it remains unknown whether the impact of early childhood prevention programs varies by baseline levels of SC, and whether better SC in early childhood leads to better self-efficacy in adolescence. This study leverages a sample of predominately low-/middle-income Black participants (n = 678) who were part of a randomized universal preventive trial in first grade (1993-1995). Teacher-reported SC was measured at baseline. Utilizing a three-step latent transition analysis, transitions between SC classes and academic self-efficacy trajectories were explored. Intervention status was explored as a predictor of the transition. Results suggest that teacher-rated SC in early childhood predicts academic self-efficacy up to 11 years later. Moderation analyses suggest that there are individual differences in prevention program effectiveness by baseline behavioral regulation skills. Implications for school-based universal prevention programming having an impact on low risk children and methods for exploring moderation within a prevention context are discussed.

Genetic propensity for risky behavior and depression and risk of lifetime suicide attempt among urban African Americans in adolescence and young adulthood.

Suicide attempts (SA) among African Americans have increased at a greater rate than any other racial/ethnic group. Research in European ancestry populations has indicated that SA are genetically influenced; however, less is known about the genetic contributors that underpin SA among African Americans. We examined whether genetic propensity for depression and risky behaviors (assessed via polygenic risk scores; PRS) independently and jointly are associated with SA among urban, African Americans and whether sex differences exist in these relations. Participants (N = 1,157, 45.0% male) were originally recruited as part of two first grade universal school-based prevention trials. Participants reported in adolescence and young adulthood on whether they ever attempted suicide in their life. Depression and risky behaviors PRS were created based on large-scale genome-wide association studies conducted by Howard et al. (2019) and Karlson Línner et al. (2019), respectively. There was a significant interaction between the risky behavior PRS and depression PRS such that the combination of high risky behavior polygenic risk and low/moderate polygenic risk for depression was associated with greater risk for lifetime SA among the whole sample and African American males specifically. In addition, the risky behavior PRS was significantly positively associated with lifetime SA among African American males. These findings provide preliminary evidence regarding the importance of examining risky behavior and depression polygenic risk in relation to SA among African Americans, though replication of our findings in other African American samples is needed.

Alcohol trajectories and subsequent risk for opioid misuse in a cohort of urban adolescents.

Background: The opioid epidemic is a public health emergency in the US. Alcohol is the most widely used addictive substance among all age groups; however, the contribution of different alcohol use trajectories throughout adolescence and young adulthood to the development of opioid misuse in young adulthood among urban minority youth has not been investigated. Methods: Data are from a study of 580 youth (85% African American, 67% low SES) residing in Baltimore City followed from ages 6-26. Alcohol trajectories were identified between ages 14 and 26 using group-based trajectory modeling. Opioid misuse was defined as using opioid painkillers without a prescription or using heroin between ages 19 and 26. Opioid misuse outcomes were also investigated separately. Logistic regression examined associations of alcohol trajectories with opioid misuse in young adulthood adjusting for socio-demographics, early use of tobacco and cannabis, neighborhood, and peer factors. Results: Six alcohol use trajectories were identified: Young adult increasing (21.4%), adult increasing (19.1%), abstaining (19.1%), experimenting (15.3%), adolescent increasing (14.8%), and adolescent limited (10.2%). In models fully adjusted for covariates, relative to the abstaining trajectory, the adolescent increasing trajectory was associated with an elevated risk of opioid misuse (aOR = 3.3, 95%CI = 1.4, 7.8) and prescription opioid misuse (aOR = 3.9, 95%CI = 1.4, 10.8) in young adulthood. Conclusions: Escalating alcohol use in adolescence and young adulthood is associated with an elevated risk of opioid misuse in young adulthood in a cohort of predominantly African American and socio-economically disadvantaged young people. Tailored interventions should target high levels of alcohol use during these developmental periods to reduce risk for opioid misuse among disadvantaged youth.

Individual Differences in Patterns of Community Violence Exposure and Internalizing and Externalizing Behaviors.

Youth community violence has been linked with depressive and anxious symptoms, and aggressive behavior; however, little research has examined different combinations of emotional and behavioral adjustment among community-violence-exposed youth, or individual characteristics that may account for different patterns of emotional and behavioral adjustment in community-violence-exposed youth. This research used person-centered methods to examine how gender, temperament characteristics, and prior exposure to community violence were linked with classes of community violence exposure and internalizing and externalizing adjustment among a sample of urban African American youth. Participants were 464 African American adolescents (46.7% female; mean age = 14.83, SD = .43) who reported their community violence exposure in Grade 9 and for whom reports of depressive and anxious symptoms, and aggressive behavior were available. Latent class analysis identified four classes of adolescents distinguished by their exposure to community violence exposure and internalizing and externalizing behavior. The two classes with high community violence exposure were characterized by internalizing symptoms or aggressive behavior; the two classes with low community violence exposure had low internalizing symptoms with moderate aggression or had all moderate symptoms. These community violence adjustment classes were distinguished by gender, history of community violence exposure, behavioral inhibition, and fight-flight-freeze systems. Findings highlight heterogeneity in internalizing and externalizing responses of community-violence-exposed youth and suggest factors that explain community violence exposure, repeat exposure, and responses to community violence exposure.

Adolescent cannabis and tobacco use are associated with opioid use in young adulthood-12-year longitudinal study in an urban cohort.

BACKGROUND AND AIMS: Cannabis, tobacco and alcohol use are prevalent among youth in the United States and may be risk factors for opioid use. The current study aimed at investigating associations between developmental trajectories of cannabis, tobacco and alcohol use in adolescence and opioid use in young adulthood in an urban cohort over the span of 12 years. DESIGN: Cohort study of adolescents originally recruited for a randomized prevention trial with yearly assessments into young adulthood. SETTING: Nine urban elementary schools in Baltimore, MD in the United States. PARTICIPANTS: Participants (n = 583, 86.8% African American, 54.7% male) were originally recruited as first grade students. MEASUREMENTS: Cannabis, tobacco and alcohol use were assessed annually from ages 14-18 years and opioid use from ages 19-26. Socio-demographics were assessed at age 6. Intervention status was also randomly assigned at age 6. Gender, race, free/reduced-priced lunch and intervention status were included as covariates in individual and sequential growth models. FINDINGS: There were significant positive associations between the cannabis use intercept at age 14 and the opioid use intercept at age 19 (beta = 1.43; P = 0.028), the tobacco use intercept at age 14 and the opioid use intercept at age 19 (beta = 0.82; P = 0.042). Specifically, more frequent use of cannabis or tobacco at age 14 was associated with more frequent use of opioids at age 19. CONCLUSIONS: Cannabis and tobacco use in early adolescence may be risk factors for opioid use in young adulthood among African Americans living in urban areas.

The Role of Depressive Symptoms in Substance Use Among African American Boys Exposed to Community Violence.

Adolescents exposed to community violence (CV) are at increased risk for alcohol, marijuana, and tobacco use. The disproportionate exposure to CV among African American boys heightens their susceptibility to substance use and related problems. Depressive symptoms are linked to both CV exposure and adolescent substance use; however, their role in the link between CV exposure and substance use in African American male adolescents has received little attention. The current study examined whether depressive symptoms mediate or moderate the associations between CV exposure and substance use among African American male adolescents. Participants were 225 African American adolescent boys in Baltimore, Maryland who completed measures of CV exposure and depressive symptoms in 10th grade and measures of substance use in 10th and 11th grades. Hierarchal linear regression analyses indicated that depressive symptoms moderated associations between violent victimization and alcohol and tobacco use, R2 = .21-.30, ps < .001. There was a positive association between CV victimization and alcohol and tobacco use among those who reported high levels of depressive symptoms but not low levels. Depressive symptoms also moderated the link between witnessing CV and alcohol use such that witnessing CV was negatively related to alcohol use among those who reported high levels of depressive symptoms only. The findings suggest that depressive symptoms may play an important role in differentiating alcohol and tobacco use outcomes in CV-exposed African American boys. Prevention efforts should assess for depressive symptoms to identify adolescent boys with the highest risk of substance use.

Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort.

BACKGROUND: Although much of the attention surrounding the opioid epidemic has focused on rural and suburban Whites and prescription opioids, heroin overdoses among urban Blacks are on the rise. While some argue that legalization of cannabis will combat the epidemic, there are concerns it ignores the shift in the epidemic and could increase vulnerability to opioid misuse. The goal of this study is to examine the association between cannabis use from adolescence to young adulthood with opioid misuse in a primarily urban Black cohort. METHODS: Data are from a study of 580 youth (87 % Black and 71 % low SES) residing in Baltimore City followed from ages 6-26. Cannabis trajectories were identified between ages 14-26 using group-based trajectory modeling. Logistic regressions were conducted to examine the impact of trajectories on opioid misuse in young adulthood adjusting for individual, neighborhood and peer factors. Opioid misuse was defined as using heroin or narcotics or painkillers without a prescription between ages 19-26. RESULTS: Four cannabis trajectories were identified: Low/Non-Users (59.7 %), Adolescent Onset Limited (19.5 %), Young Adult Onset (10.8 %), and Adolescent Onset Chronic (10.0 %). Adolescent Onset Chronic cannabis users had the highest rate of opioid misuse (44.8 %) followed by Adolescent Onset Limited (18.8 %), Young Adult Onset (14.8 %) and Low/Non-Users (8.3 %). Prevalences were significantly higher for Adolescent Onset groups relative to Low/Non-Users even after adjustment for individual, neighborhood and peer factors. CONCLUSIONS: Adolescent onset cannabis use is associated with opioid misuse in young adulthood among urban Blacks even after adjustment for socioecological factors associated with opioid misuse.

Using Complier Average Causal Effect Estimation to Examine Student Outcomes of the PAX Good Behavior Game When Integrated with the PATHS Curriculum.

A growing body of research has documented a link between variation in implementation dosage and outcomes associated with preventive interventions. Complier Average Causal Effect (CACE; Jo in J Educ Behav Stat 27:385-409, 2002) analysis allows for estimating program impacts in light of variation in implementation. This study reports intent-to-treat (ITT) and CACE findings from a randomized controlled trial (RCT) testing the impacts of the universal PAX Good Behavior Game (PAX GBG) integrated with Promoting Alternative Thinking Strategies (i.e., PATHS to PAX) and PAX GBG only compared to a control. This study used ratings by 318 K-5 teachers of 1526 at-risk children who, at baseline, were rated as displaying the top 33rd percentile of aggressive-disruptive behavior. Leveraging a prior study on these data (Berg et al. in Admin Policy Ment Health Ment Health Serv Res 44:558-571, https://doi.org/10.1007/s10488-016-0738-1 , 2017), CACE was defined as the effect of intervention assignment for compliers, using two compliance cut points (50th and 75th percentile), on posttest ratings of student academic engagement, social competence, peer relations, emotion regulation, hyperactivity, and aggressive-disruptive behavior. The ITT analyses indicated improvements for students in the integrated condition on ratings of social competence compared to the control condition. The CACE analyses also indicated significant effects of the integrated intervention on social competence, as well as academic engagement and emotion regulation for students in high compliance classrooms. These findings illustrate the importance of considering variation in implementation within the context of RCTs.