Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.

BACKGROUND: Given high rates of substance use among justice-involved youth, justice systems have attempted to monitor use through drug screening (DS) procedures. However, there is discretion in deciding who is screened for substance use, as not every youth who encounters the system is screened. The aim of the current study was to examine factors associated with selection for and results of oral DS among justice-involved youth assigned to probation to better inform potential DS policy. Electronic court records from 4,668 youth with first-incident records assigned to probation in a midwestern urban county's juvenile justice system between 2011 and 2016 were included in the analytical sample. Race/ethnicity, gender, age, number of charges and charge type for the current incident were included as independent variables. RESULTS: Multivariable hierarchical logistic regression analyses indicated that males were more likely to be assigned to DS (aOR = 0.40, 95%CI [0.34, 0.46]), and more likely to test positive for use (aOR = 0.43, 95% CI [0.34, 0.54]) than females. As age increased, youth were less likely to be assigned to DS (aOR = 0.91, 95% CI [0.87, 0.94]), with non-significant differences in DS results. Greater number of charges were associated with a higher likelihood of being assigned to DS (aOR = 1.55, 95% CI [1.43, 1.68]). Youth with violent offenses were more likely to be assigned to DS than those with other offense types (property offenses, drug offenses, statutory offenses, disorderly conduct, and all other offenses), but less likely to test positive for use. CONCLUSIONS: Many factors were associated with differences in DS, but these factors were not always associated with differential DS results. Demographic or charge-based decisions may not be appropriate for DS assignment.

On the Relationship Between Online Heterosexist Discrimination and Mental Health and Substance Use Among LGBTQ+ Young Adults.

LGBTQ+ individuals experience disproportionately higher rates of mental health and substance use difficulties. Discrimination is a significant factor in explaining these disparities. Meyer's (2003) minority stress theory (MST) indicates that proximal group-specific processes mediate the relationship between discrimination and health outcomes, with the effects moderated by other social factors. However, online discrimination has been understudied among LGBTQ+ people. Focusing on LGBTQ+ young adults experiencing online heterosexist discrimination (OHD), the current study aimed to investigate the effect of OHD on mental health outcomes and explore whether the effect was mediated by proximal factors of internalized heterosexism, online concealment, and acceptance concerns and moderated by social support. Path analysis was used to examine the effects. A total of 383 LGBTQ+ young adults (18-35) from an introductory psychology subject pool, two online crowdsourcing platforms, and the community completed a questionnaire assessing these constructs. OHD was associated with increased psychological distress and cannabis use. Two proximal stressors (acceptance concerns and sexual orientation concealment) mediated the relationship between OHD and psychological distress. Sexual orientation concealment also mediated the relationship between OHD and cannabis use. There was no evidence that online social support from LGBTQ+ peers moderated any of the relationships. MST is a viable guiding framework for exploring OHD. Acceptance concerns and online concealment are important constructs to consider and may be potential treatment targets for individuals experiencing psychological distress or engaging in cannabis use due to OHD.

Substance use trajectories among emerging adult Black men: Risk factors and consequences.

INTRODUCTION: Young, Black American men experience greater social, legal and economic consequences of substance use compared with White men for comparable levels of consumption. The development of tailored interventions requires prospective information on their substance use patterns, risk factors and consequences. We identified longitudinal substance use profiles and examined their links to childhood adversity, racial discrimination and young adult problem substance use and mental health. METHODS: Emerging adult Black men (n = 504, mean age = 20.26, SD = 1.08) provided fours waves of data between January 2012 and March 2021. We conducted a parallel process latent class growth analysis for three substances to explore conjoint longitudinal use patterns and investigated the risk factors and consequences of each pattern. RESULTS: Three trajectory classes emerged: non-using (n = 201, 39.9%), cannabis using (n = 202, 40.1%) and poly-substance using (n = 101, 20%) groups. Threat-based childhood adversity and racial discrimination were associated with higher odds of being members of cannabis or poly-substance groups than non-using group. Deprivation-based adversity was associated with higher odds for membership in poly-substance than non-using group. At Wave 4, elevated depressive symptoms were more prevalent among poly-substance compared with cannabis using group. DISCUSSION AND CONCLUSIONS: Heterogeneous substance use patterns emerged among Black American men and each pattern has distinct risk factors and outcomes in young adulthood. For prevention, more attention is needed for cannabis use patterns and psychosocial adversities that are unique to Black population.

Measures of self-reported identity associated with sex and gender: Relations with collegiate drinking.

OBJECTIVE: Quantitative research has typically relied on categorical measures of sex assigned at birth (SAAB) and gender, with heterogeneous findings in terms of their associations with alcohol-related behavior. This investigation examined continuous indices of self-identification as an alternative to categorical operationalizations in alcohol research. METHOD: Eight hundred ninety-three undergraduate students (74.6% cisgender women, 20.3% cisgender men, 3.9% nonbinary, and 1.2% transgender), recruited from the Midwest and Pacific Northwest of the United States, completed online measures of SAAB (male/female), gender (categorical), continuous indices of identification (femaleness, maleness, and bidirectional), and alcohol consumption (Cahalan Indices; Daily Drinking Questionnaire-Revised; Alcohol Use Disorders Identification Test [AUDIT]). RESULTS: Novel continuous measures of identification were associated with categorical indices of SAAB and gender as predicted. While none of the self-identification indices (continuous or categorical) predicted current drinking (consumption in the past 30 days), they evidenced relatively consistent, albeit small effects, across quantity-frequency of drinking and AUDIT scores for current drinkers. Higher scores on maleness and bidirectional indices of identification were associated with greater consumption, while greater endorsement of femaleness and being a cisgender woman (vs. a cisgender man) were related to less drinking. CONCLUSIONS: Continuous self-reported identification items performed well when describing drinking behavior in college students. The inclusion of dimensional scales of identity broadens our ability to capture differing self-conceptualizations in research.

Examining promotive and protective effects of ethnic identity on alcohol and cannabis use among Black young adults.

INTRODUCTION: Experiences of racial discrimination among Black Americans are associated with numerous adverse behavioral health outcomes, including risk for substance use. Research has shown ethnic identity to be directly related to reduced substance use risk among Black Americans, as well as mitigate substance use risk as a consequence of exposure to racial discrimination. However, whether the specific facet of ethnic identity (affirmation and exploration), is related to the relationship between racial discrimination and problem substance use based on substance type is unclear. Thus, the current study examined 1) the association between ethnic identity (affirmation and exploration) and problem alcohol and cannabis use, and 2) whether ethnic identity affirmation or exploration moderates the association between racial discrimination and problem substance use among a sample of Black young adults. METHODS: Three-hundred and ninety Black young adults ages 18-24 (M = 20.6, 62 % female, 85 % monoracial) completed an online survey that included measures on past-year experiences of racial discrimination, ethnic identity affirmation and exploration, and problem alcohol and cannabis use. Utilizing multiple linear regression and the PROCESS macro, the study examined the promotive (direct) association between ethnic identity and problem substance use, and the protective (moderating) effect of ethnic identity on the relationship between racial discrimination and problem substance use. RESULTS: After accounting for the demographic covariates of age, gender (male, female, and other), and race (monoracial and bi/multiracial), higher ethnic identity affirmation was significantly associated with lower problem alcohol, and higher ethnic identity exploration was significantly associated with lower problem alcohol and cannabis use. The study also observed a moderating effect of ethnic identity affirmation and exploration on the relationship between racial discrimination and problem alcohol use. Specifically, the association between racial discrimination and problem alcohol use weakened at higher levels of ethnic identity affirmation and exploration. Neither ethnic identity affirmation nor exploration significantly moderated the relationship between racial discrimination and problem cannabis use. CONCLUSION: Findings suggest that ethnic identity is associated with problem alcohol use and may also reduce the strength of the association between racial discrimination and problem alcohol use, although these findings need to be confirmed with longitudinal study designs. If supported, interventions focused on strengthening one's ethnic identity affirmation and exploration may offer a potential target for interventions addressing alcohol misuse among Black young adults. However, more research should seek to understand promotive and protective factors for problem cannabis use among Black young adults.

Impulsivity as a Predictor of Early Dating Initiation in 11-12-Year-Old Youth.

As early initiation of dating behaviors is associated with risky sexual behaviors (e.g., higher number of sexual partners, sex with strangers), the current study examined determinants of early dating behaviors, focusing on impulsivity. Participants were 11-12-year-old boys (n = 109) and girls (n = 61) recruited from a psychiatric clinic and ads targeted to the general public. Ordered logistic regression models were used to examine the association between each facet of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking) and dating behaviors. Youth with higher sensation seeking and negative urgency was more likely to initiate dating behaviors at early ages compared to those with lower scores on those measures. Further, we found that female gender and higher parental education were associated with lower risk of initiating dating behaviors at early age. Advanced pubertal development was associated with higher risk for early dating. Our findings can inform prevention efforts, identifying sensation seeking and negative urgency as predictors of youths' early engagement in dating behaviors, which can be a precursor of early sexual debut and risky sexual behaviors.

Examining the unique and additive effect of trauma and racial microaggressions on substance use risk among Black young adults.

OBJECTIVE: Exposure to traumatic events is linked to adverse health outcomes, including substance use. Contemporary models have conceptualized racism, including racial microaggressions, as a form of trauma. However, few studies have been conducted examining the unique and additive effect of racial microaggressions within models that include exposure to traditional forms of trauma on substance use outcomes, as well as whether effects vary by gender. METHOD: Three hundred and ninety-nine Black young adults between 18 and 29 (61% female, mean age 20.7) completed measures on problem alcohol and cannabis use, and experiences of trauma and racial microaggressions. RESULTS: Controlling for age, gender, income, race (i.e., monoracial vs. multiracial), and recruitment source, regression analyses showed that racial microaggressions predicted problem substance use above the effect of trauma exposure. Moreover, exoticization/assumptions of similarity and workplace/school microaggressions primarily accounted for the effect of racial microaggressions on substance use risk. One gender effect was found, with trauma exposure associated with lower cannabis use for Black males and a nonsignificant effect found for Black females. CONCLUSIONS: Racial microaggressions provide unique and additive understanding in risk for substance use outcomes among Black young adults above effects observed from exposure to traditional forms of trauma. This finding highlights the significance of racial microaggression on health outcomes for Black young adults and can inform future research in the area of trauma exposure and substance use risk among this population of young people. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Depression as a Risk Factor for Cardiovascular Disease in People with HIV: A Systematic Review.

BACKGROUND: People with human immunodeficiency virus (HIV) have an increased risk of cardiovascular disease (CVD) not fully accounted for by traditional or HIV-specific risk factors. Successful management of HIV does not eliminate this excess risk. Thus, there is a need to identify novel risk factors for CVD among people with HIV (PWH). PURPOSE: Our objective was to systematically review the literature on one such candidate CVD risk factor in PWH-depression. METHODS: A systematic literature search of PubMed, PsycINFO, EMBASE, Web of Science, and CINAHL was performed to identify published English-language studies examining associations of depression with clinical CVD, subclinical CVD, and biological mechanisms (immune activation, systemic inflammation, altered coagulation) among PWH between the earliest date and June 22, 2021. RESULTS: Thirty-five articles were included. For clinical CVD (k = 8), findings suggests that depression is consistently associated with an increased risk of incident CVD. For subclinical CVD (k = 5), one longitudinal analysis reported a positive association, and four cross-sectional analyses reported null associations. For immune activation (k = 13), systemic inflammation (k = 17), and altered coagulation (k = 5), findings were mixed, and there was considerable heterogeneity in sample characteristics and methodological quality across studies. CONCLUSIONS: Depression may be an independent risk factor for CVD among PWH. Additional research is needed to confirm depression's association with clinical CVD and to determine whether depression is consistently and meaningfully associated with subclinical CVD and biological mechanisms of CVD in HIV. We propose a research agenda for this emerging area.

Exploring the promotive pathway between ethnic-racial identity, depression and anxiety symptoms, and substance use among African American emerging adults.

OBJECTIVE: Ethnic-racial identity (ERI) has been shown to have a promotive effect on substance use; however, the factors impacting this relationship have been explored less. The present study examined whether a promotive pathway exists between ERI, depression and anxiety symptoms, and problem substance use (i.e., alcohol and cannabis use) among a sample of African American emerging adults. METHOD: Participants were 388 African American or Black emerging adults aged 18-24 (M = 20.6), mostly female (62%) attending a Midwestern university or residing in the neighboring community. Data on demographics, ERI based on a total score and affirmation and exploration subscales, depression and anxiety symptoms, and problem alcohol and cannabis use were collected. The PROCESS macro for simple mediation was conducted to examine the role of depression and anxiety symptoms in the relationship between ERI and problem alcohol and cannabis use. RESULTS: A significant indirect effect was found for the pathway between ERI, depression and anxiety symptoms, and each substance use outcome. CONCLUSIONS: Among African American emerging adults, ERI may reduce the risk for problem alcohol and cannabis use through reductions in depression and anxiety symptoms. Therefore, implementation of substance use interventions that strengthen ERI may be particularly beneficial to reduce risk, as well as promote psychological well-being among African American emerging adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The relationship between racial discrimination and substance use: Does locus of control help explain risk?

Introduction: Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of externalizing and affect-based factors, few other mechanisms have been examined. One potential candidate is locus of control, a learning processes that involves the degree to which one attributes rewards as resulting from their own control (internal locus of control) versus outside control (external locus of control). There is evidence that exposure to stressors is associated with locus of control, with a separate body of literature linking locus of control with substance use. Thus, it is plausible that locus of control may be a mechanism underlying the relationship between racial discrimination and substance use. Methods: The current study investigated this pathway among 503 racial/ethnic minority adults aged 18-35 who completed an online questionnaire including measures on racial discrimination related stress, locus of control, and substance use. Results: Results indicated a significant indirect effect between racial discrimination related stress, two external domains of locus of control (i.e., powerful others and chance), and substance use. A significant indirect effect was not found for internal locus of control. Conclusion: These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming.

Racial discrimination and substance use among African American youth: Personal and collective self-esteem as mechanisms.

Little is known about the mechanisms of the relationship between racial discrimination and substance use among Black youth. The current study examined the role of collective self-esteem and personal self-esteem in this relationship among Black adolescents in grades 5 through 12 (N = 1514; 57% female). Regression analyses estimated direct effects of perceived racial discrimination on substance use and indirect effects of discrimination on substance use through personal and collective self-esteem. Controlling for grade and sex, results revealed significant indirect effects such that experiences of discrimination were positively associated with substance use through lower reports of collective and personal self-esteem. Findings suggest that bolstering personal and race-related esteem may mitigate the deleterious influence of discrimination among Black youth.

Intersection of minority health, health disparities, and social determinants of health with psychopharmacology and substance use.

These articles provide a window into the breadth of issues at the intersection of MHDS with psychopharmacology and substance use. Integrating the fields of psychopharmacology and basic behavioral addictions science with research on MHDS is not only of public health importance, but can help further elucidate our understanding of human behavior in all of its complexity. As demonstrated here, a better understanding of the synergy between societal context(s) and individual-level processes can lead to interventions tailored to specific risk and resilience factors; interventions that are personalized and contextualized have the potential to improve the health of our society. We are very grateful to the authors for their contributions to this special issue. We hope that professionals from various disciplines who read this special issue become inspired to bridge psychopharmacological and social determinants perspectives in their own work, and, in turn, accelerate scientific progress within each field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the effects of implicit and explicit racial identity on psychological distress and substance use among Black young adults.

Racial identity is an aspect of self-concept that is important to the mental and behavioral health of Black individuals. Yet, much of the current research on racial identity is based on self-report measures which may impact findings due to reporting biases. One way to alleviate some of the measurement concerns is to use implicit measures to assess racial identity. The purpose of the present study was to examine whether an implicit assessment of racial identity, specifically racial centrality, provided a unique contribution to the understanding of risk for psychological distress and substance use among Black young adults above potential effects observed from an explicit measurement of racial identity. Additionally, the potential moderating effect of implicit racial identity, controlling for explicit racial identity, on the association between racial discrimination and these health outcomes was also examined. One hundred and forty-seven Black young adults participated in this study. Contrary to our hypothesis, there was no significant main effect of implicit racial centrality on depressive symptoms or substance use after accounting for explicit racial centrality. However, after controlling for explicit racial centrality, a significant moderating effect of implicit racial centrality on the relationship between racial discrimination and substance use was observed. Although support for all of our hypotheses was not definitively found, our findings can be added to this emerging area of study. Additionally, potential explanations for the findings are provided that can be used to inform future research in this area to better understand the utility of assessing for implicit racial identity among Black young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dieting and substance use among White and Black adolescent girls.

OBJECTIVE: Previous research has found an increasing co-occurrence of dieting and substance use behavior among adolescent girls. However, to date few studies have examined the temporal ordering of these behaviors. Further, limited research has been conducted to explore whether the pathways are similar among both White and Black girls. METHOD: For the current study 1580 girls (grade 6-11; 78.2% White; 21.8% Black) provided data on their dieting behavior and substance use. A cross-lagged panel design was used to examine the concurrent and prospective relationship between dieting behavior and substance use across one year, then by race. RESULTS: Among the full sample of girls, there was a significant concurrent relationship. Additionally, dieting behavior predicted substance use one year later, but the inverse relationship was not found. For the stratified analysis, dieting behavior and substance use were not correlated among Black girls at either time point, however concurrent relationships were found for White girls. For the prospective pathways non-significant effects were found for both groups. DISCUSSION: These findings provide support for a temporal relationship between dieting behavior and substance use, such that the former predicts risk for the latter. However, when examined by race, some pathways of the full sample were found for White girls, whereas Black girls did not report an association between study variables. Thus, future studies should consider the impact of race within risk pathways.

Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities.

BACKGROUND: Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN: ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION: Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.

Discrimination and Substance Use: Examining the Moderating Role of Impulsivity among Racial-Ethnic Minority Adolescents.

BACKGROUND: Research on substance use among racial-ethnic minority populations notes that discrimination experiences predict substance use outcomes. Individual-level factors, such as impulsivity, are also known risk factors for substance use. However, little is known about the direct and interaction effects between discrimination experiences and impulsivity among racial-ethnic minority youth. The current study examines the effects of perceived experiences of discrimination on alcohol and marijuana use among racial-ethnic minority youth, and whether individual differences in impulsivity traits help to further understand potential risk for substance use. METHODS: Participants were 112 racial-ethnic minority adolescents (Mage = 15.27; African American, Hispanic, Multiracial, Native American/Alaskan Native, or Other). Adolescents completed self-report measures of perceived experiences of discrimination, alcohol and marijuana use (past year occurrence and problematic use), and five impulsivity traits (i.e., sensation seeking, lack of planning, lack of perseverance, negative urgency, and positive urgency). RESULTS: A significant main effect of perceived discrimination on problem marijuana use was found, as well as a significant main effect of lack of premeditation on current marijuana use. Several marginally significant main effects emerged for alcohol use and problem alcohol use (i.e., positive urgency and sensation seeking, respectively). CONCLUSION: While no significant moderation effects emerged, marginal findings suggest a potential interactive effect of discrimination and impulsivity traits on problem alcohol and marijuana use among racial-ethnic minority youth. Further research is needed in this area to replicate findings, which is critical to informing effective intervention and prevention efforts for this population of youth.

Insomnia symptoms and biomarkers of monocyte activation, systemic inflammation, and coagulation in HIV: Veterans Aging Cohort Study.

BACKGROUND: Insomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated. METHODS: We examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, "Difficulty falling or staying asleep?," with the following response options: "I do not have this symptom" or "I have this symptom and…" "it doesn't bother me," "it bothers me a little," "it bothers me," "it bothers me a lot." Circulating levels of the monocyte activation marker soluble CD14 (sCD14), inflammatory marker interleukin-6 (IL-6), and coagulation marker D-dimer were determined from blood specimens. Demographic- and fully-adjusted (CVD risk factors, potential confounders, HIV-related factors) regression models were constructed, with log-transformed biomarker variables as the outcomes. We present the exponentiated regression coefficient (exp[b]) and its 95% confidence interval (CI). RESULTS: We observed no significant associations between insomnia symptoms and sCD14 or IL-6. For D-dimer, veterans in the "Bothers a Lot" group had, on average, 17% higher D-dimer than veterans in the "No Difficulty Falling or Staying Asleep" group in the demographic-adjusted model (exp[b] = 1.17, 95%CI = 1.01-1.37, p = .04). This association was nonsignificant in the fully-adjusted model (exp[b] = 1.09, 95%CI = 0.94-1.26, p = .27). CONCLUSION: We observed little evidence of relationships between insomnia symptoms and markers of biological mechanisms of HIV-CVD. Other mechanisms may be responsible for the insomnia-CVD relationship in HIV; however, future studies with comprehensive assessments of insomnia symptoms are warranted.

Treatment of Adolescent e-Cigarette Use: Limitations of Existing Nicotine Use Disorder Treatment and Future Directions for e-Cigarette Use Cessation.

Electronic cigarette use ("vaping") has surged in the United States since the mid-2010s. From 2011 to 2018, current e-cigarette use among high school students escalated from 1.5% to 20.8% (∼3.05 million youths),1 countering downward trends in combustible nicotine product use (21.8% in 2011 to 13.9% in 2018).1 Although preventing the initial uptake of vaping is crucial, for the millions of adolescents who have taken up this behavior-many of whom express interest in quitting (eg, 44.5% of current, adolescent non-light e-cigarette users in one US national representative sample)2-it is critically important to help them quit vaping so as to curtail future substance use disorders and other health consequences. Here, we discuss several challenges around adolescent vaping treatment, and highlight research areas in urgent need of attention.