Testing alternative cascades from internalizing and externalizing symptoms to adolescent alcohol use and alcohol use disorder through co-occurring symptoms and peer delinquency.

Given the equivocal literature on the relationship between internalizing symptoms and early adolescent alcohol use (AU) and AU disorder (AUD), the present study took a developmental perspective to understand how internalizing and externalizing symptoms may operate together in the etiology of AU and AUD. We pit the delayed onset and rapid escalation hypothesis (Hussong et al., 2011) against a synthesis of the dual failure model and the stable co-occurring hypothesis (Capaldi, 1992; Colder et al., 2013, 2018) to test competing developmental pathways to adolescent AU and AUD involving problem behavior, peer delinquency, and early initiation of AU. A latent transactional and mediational framework was used to test pathways to AUD spanning developmental periods before AU initiation (Mage = 11) to early and high risk for AUD (Mage = 14-15 and Mage = 17-18). The results supported three pathways to AUD. The first started with "pure" externalizing symptoms in early childhood and involved multiple mediators, including the subsequent development of co-occurring symptoms and peer delinquency. The second pathway involved stable co-occurring symptoms. Interestingly, chronically elevated pure internalizing symptoms did not figure prominently in pathways to AUD. Selection and socialization effects between early AU and peer delinquency constituted a third pathway.

Internalizing symptoms and cannabis and alcohol use: Between- and within-person risk pathways with coping motives.

OBJECTIVE: To test reciprocal associations among internalizing symptoms (depression and social anxiety), using alcohol and cannabis to cope, and use-related problems. METHOD: The study utilized a community sample (N = 387, 55% female; majority non-Hispanic Caucasian (83.1%) or African American (9.1%) and a longitudinal design that spanned 17 to 20 years of age, and distinguished within- and between-person associations using latent curve models with structured residuals. RESULTS: Reciprocal prospective within-person associations were supported for alcohol, such that elevated depression symptoms were associated with increased alcohol coping motivates 1 year later, which, in turn, was associated with subsequent increased depression symptoms. Bidirectional associations were not supported for social anxiety, although high levels of social anxiety were associated with elevated levels of coping drinking 1 year later. Cannabis coping motives were associated with exacerbation of depression, but not social anxiety symptoms, 1 year later. Between- and within-person contemporaneous associations suggested that depression and social anxiety were more strongly associated with coping than social/enhancement motives, and that coping motives were associated with use-related problems. CONCLUSION: Findings suggest that alcohol coping motivates exacerbate rather than ameliorate depression symptoms, which, in turn, leads to greater reliance on alcohol to cope. There was more consistent support for associations with substance use-related problems for depression than for social anxiety. Both between- and within-person associations may be useful for identifying targets and timing of coping-oriented interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding the ecological context of mental, emotional, and behavioral health problems: A person-centered approach.

AIMS: The social/environmental context of youth is important for mental, emotional, and behavioral (MEB) health. This study used person-oriented methods to examine the influences of family, neighborhood, and poverty on late adolescent MEB outcomes. METHODS: Latent class analysis was used to discern significant clusters of at-risk, diverse young men (N = 625) based on contextual factors; differences in MEB outcomes were examined. RESULTS: Four classes emerged. Resourced and Protected youth had low risk across all indicators. Non-resourced and Protected youth lived in poverty, poor neighborhoods, but had good parenting; despite low delinquency, substance use was elevated. Resourced but High Risk youth had negative parenting but good neighborhoods. Outcomes included elevated delinquency and mental health problems. Non-resourced and High Risk youth were poor, lived in bad neighborhoods, and experienced abusive parenting; MEB outcomes were poor. CONCLUSION: Findings confirm the unique effects that negative parenting, neighborhoods, and poverty have on adolescent development. Implications are discussed.

Changes in implicit alcohol attitudes across adolescence, and associations with emerging alcohol use: Testing the reciprocal determinism hypothesis.

Implicit alcohol-related cognitions develop during adolescence and are thought to play an important role in the etiology of adolescent alcohol use. Rooted in reciprocal determinism, a developmental theory of alcohol-related cognitions, the current study sought to enhance our understanding of the development of automatic alcohol associations and their relationship with alcohol use. To provide a theoretically aligned test of reciprocal determinism, we used latent change score models to examine whether growth in automatic alcohol associations and alcohol use was related to each other (between-person effects) and whether each construct led to changes in the other over time (within-person effects). Adolescents (N = 378) completed 4 annual assessments, spanning early to middle adolescence. Automatic alcohol associations were assessed with a Single Category Implicit Association Test, and we used a quadruple processing tree model to extract a more "process pure" index of these associations. Alcohol use increased from early to middle adolescence, as negative automatic alcohol associations weakened over that same time period. Although there was no support for between-person associations, on the within-person level, weak negative automatic alcohol associations at Waves 2 and 3 were associated with increases in drinking at subsequent waves. Alcohol use did not significantly predict changes in automatic alcohol associations. Findings suggest the utility of distinguishing within- and between-person associations to understand the development of automatic alcohol associations and that automatic alcohol associations are prospectively associated with alcohol use and a potential target for intervention, one that becomes an increasingly salient influence on drinking as adolescence progresses. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Internalizing and Externalizing Problem Behavior: a Test of a Latent Variable Interaction Predicting a Two-Part Growth Model of Adolescent Substance Use.

Externalizing symptoms robustly predict adolescent substance use (SU); however, findings regarding internalizing symptoms have been mixed, suggesting that there may be important moderators of the relationship between internalizing problems and SU. The present study used a longitudinal community sample (N = 387, 55% female, 83% White) to test whether externalizing symptoms moderated the relationship between internalizing symptoms and trajectories of alcohol and marijuana use from early (age 11-12 years old) to late (age 18-19 years old) adolescence. Two-part latent growth models were used to distinguish trajectories of probability of use from trajectories of amount of use among users. Results suggested that externalizing symptoms moderated the association between internalizing symptoms and probability of alcohol, but not marijuana use. The highest probability of alcohol use was observed at high levels of externalizing symptoms and low levels of internalizing symptoms. A negative protective effect of internalizing symptoms on probability of alcohol use was strongest in early adolescence for youth high on externalizing symptoms. Although moderation was not supported for amount of use among users, both domains of symptomology were associated with amount of alcohol and marijuana use as first-order effects. High levels of externalizing symptoms and low levels of internalizing symptoms were associated with high levels of amount of use among users. These findings suggest that developmental models of substance use that incorporate internalizing symptomology should consider the context of externalizing problems and distinguish probability and amount of use.

Descriptive Epidemiology for Community-wide Naloxone Administration by Police Officers and Firefighters Responding to Opioid Overdose.

Recently implemented New York State policy allows police and fire to administer intranasal naloxone when responding to opioid overdoses. This work describes the geographic distribution of naloxone administration (NlxnA) by police and fire when responding to opioid overdoses in Erie County, NY, an area of approximately 920,000 people including the City of Buffalo. Data are from opioid overdose reports (N = 800) filed with the Erie County Department of Health (July 2014-June 2016) by police/fire and include the overdose ZIP code, reported drug(s) used, and NlxnA. ZIP code data were geocoded and mapped to examine spatial patterns of NlxnA. The highest NlxnA rates (range: 0.01-84.3 per 10,000 population) were concentrated within the city and first-ring suburbs. Within 3 min 27.3% responded to NlxnA and 81.6% survived the overdose. The average individual was male (70.3%) and 31.4 years old (SD = 10.3). Further work is needed to better understand NlxnA and overdose, including exploring how the neighborhood environment creates a context for drug use, and how this context influences naloxone use and overdose experiences.

The Prospective Association Between Internalizing Symptoms and Adolescent Alcohol Involvement and the Moderating Role of Age and Externalizing Symptoms.

BACKGROUND: As predicted by self-medication theories that drinking is motivated by a desire to ameliorate emotional distress, some studies find internalizing symptoms (e.g., anxiety, depression) increase risk of adolescent drinking; however, such a risk effect has not been supported consistently. Our prior work examined externalizing symptoms as a potential moderator of the association between internalizing symptoms and adolescent alcohol use to explain some of the inconsistencies in the literature. We found that internalizing symptoms were protective against early adolescent alcohol use particularly for youth elevated on externalizing symptoms (a 2-way interaction). Our sample has now been followed for several additional assessments that extend into young adulthood, and the current study tests whether the protective effect of internalizing symptoms may change as youth age into young adulthood, and whether this age-moderating effect varied across different clusters of internalizing symptoms (social anxiety, generalized anxiety, and depression). Internalizing symptoms were hypothesized to shift from a protective factor to a risk factor with age, particularly for youth elevated on externalizing symptoms. METHODS: A community sample of 387 adolescents was followed for 9 annual assessments (mean age = 12.1 years at the first assessment and 55% female). Multilevel cross-lagged 2-part zero-inflated Poisson models were used to test hypotheses. RESULTS: The most robust moderating effects were for levels of alcohol use, such that the protective effect of all internalizing symptom clusters was most evident in the context of moderate to high levels of externalizing problems. A risk effect of internalizing symptoms was evident at low levels of externalizing symptoms. With age, the risk and protective effects of internalizing symptoms were evident at less extreme levels of externalizing behavior. With respect to alcohol-related problems, findings did not support age moderation for generalized anxiety or depression, but it was supported for social anxiety. CONCLUSIONS: Findings highlight the importance of considering the role of emotional distress from a developmental perspective and in the context of externalizing behavior problems.

Cognitive appraisals of alcohol use in early adolescence: Psychosocial predictors and reciprocal associations with alcohol use.

Early adolescence is a dynamic period for the development of alcohol appraisals (expected outcomes of drinking and subjective evaluations of expected outcomes), yet the literature provides a limited understanding of psychosocial factors that shape these appraisals during this period. This study took a comprehensive view of alcohol appraisals and considered positive and negative alcohol outcome expectancies, as well as subjective evaluations of expected outcomes. Developmental-ecological theory guided examination of individual, peer, family, and neighborhood predictors of cognitive appraisals of alcohol and use. A community sample of 378 adolescents (mean age 11.5 years at Wave 1, 52% female) was assessed annually for 4 years. Longitudinal path analysis suggested that the most robust predictors of alcohol appraisals were peer norms. Furthermore, perceived likelihood of positive and negative alcohol outcomes prospectively predicted increases in drinking. There was limited support for appraisals operating as mediators of psychosocial risk and protective factors.

Predictors of Problem Gambling in the U.S.

In this article we examine data from a national U.S. adult survey of gambling to determine correlates of problem gambling and discuss them in light of theories of the etiology of problem gambling. These include theories that focus on personality traits, irrational beliefs, anti-social tendencies, neighborhood influences and availability of gambling. Results show that males, persons in the 31-40 age range, blacks, and the least educated had the highest average problem gambling symptoms. Adults who lived in disadvantaged neighborhoods also had the most problem gambling symptoms. Those who attended religious services most often had the fewest problem gambling symptoms, regardless of religious denomination. Respondents who reported that it was most convenient for them to gamble had the highest average problem gambling symptoms, compared to those for whom gambling was less convenient. Likewise, adults with the personality traits of impulsiveness and depression had more problem gambling symptoms than those less impulsive or depressed. Respondents who had friends who approve of gambling had more problem gambling symptoms than those whose friends did not approve of gambling. The results for the demographic variables as well as for impulsiveness and religious attendance are consistent with an anti-social/impulsivist pathway to problem gambling. The results for depression are consistent with an emotionally vulnerable pathway to problem gambling.

The Relationship Between Distance from Gambling Venues and Gambling Participation and Problem Gambling Among U.S. Adults.

In this article we examine the relationship between extent of gambling for U.S. adults and the distance from their residence to the nearest casino or track. We employ data from a telephone survey of U.S. adults conducted in 2011-2013. The chances that the respondents gambled in the past year, were frequent gamblers, or were problem gamblers were greater if they lived close to a casino. The chances that the respondents gambled in the past year or were frequent gamblers were greater if they lived close to a horse or dog track. The effects of closeness to a casino on the likelihood of past-year gambling, frequent gambling, and problem gambling, as well as the effect of closeness to a track on past-year gambling, extended to about 30 miles from the respondent's home. In addition, the concentration of casinos within 30 miles of the respondent's home was positively related to the respondents' chance of being a frequent or problem gambler. If a respondent had no casinos within 30 miles, he or she had a 2.7 % chance of being a problem gambler; if one casino, a 3.9 % chance; if six or more, a 6.2 % chance. The authors estimate that at least part of this effect is causal.

The Relationship Between the Number of Types of Legal Gambling and the Rates of Gambling Behaviors and Problems Across U.S. States.

In this article, we examine the relationship between the total number of types of gambling that are legal in a state and the gambling involvement of state residents. Of particular interest is whether more types of legal gambling are associated with higher rates of problem gambling. Telephone surveys of U.S. adults were conducted in 1999-2000 and 2011-2013. The same questions were used and the data sets were combined for most of the analyses. Gambling exposure was defined as the sum of the number of years that all types were legal. Results tabulated by state showed progressively higher rates of problem gambling, frequent gambling and any past year gambling as the number of legal types of gambling increased. Holding constant the number of legal types, problem gambling rates increased as exposure increased. States with longer exposure to legal lotteries or casinos tended to have higher rates of problem gambling. An analysis was also conducted in which the data sets from 1999 to 2000 and from 2011 to 2013 were compared. Among the states, there was a striking positive relationship between changes in the number of legal types of gambling between the two studies and changes in rates of frequent gambling between the two studies. For states that had fewer types of legal gambling in 2011 than in 1999, the rates of frequent gambling went down. For states that increased their types of legal gambling, rates of frequent gambling typically, but not always, went up. Possible explanations for these results were discussed.

Gambling and Problem Gambling in the United States: Changes Between 1999 and 2013.

Telephone surveys of US adults were conducted in 1999-2000 and again in 2011-2013. The same questions and methods were used so as to make the surveys comparable. There was a reduction in percentage of past-year gambling and in frequency of gambling. Rates of problem gambling remained stable. Lottery was included among the specific types of gambling for which past year participation and frequency of play declined. Internet gambling was the only form of gambling for which the past-year participation rate increased. The average win/loss increased for several forms of gambling, providing a modest indication that gamblers were betting more, albeit less frequently. Between the two surveys, the rates of past-year participation in gambling declined markedly for young adults. In both surveys, rates of problem gambling were higher for males than females, and this difference increased markedly between surveys as problem gambling rates increased for males and decreased for females. For the combined surveys, rates of problem gambling were highest for blacks and Hispanics and lowest for whites and Asians. In both surveys, the rates of problem gambling declined as socio-economic status became higher. Possible explanations for these trends are discussed.

Internalizing and externalizing problem behavior and early adolescent substance use: a test of a latent variable interaction and conditional indirect effects.

Externalizing problem behavior is a robust predictor of early adolescent substance use (SU); however, findings regarding internalizing problems have been mixed, suggesting that there may be important moderators of the relationship between internalizing problems and SU. The present study used a community sample (mean age was 12.1 at the first assessment, 55% women, 83% White) to test a longitudinal latent variable interaction structural equation model to examine whether externalizing problems moderated the relationship between internalizing problems and SU. Peer delinquency was tested as a mediator in the model and prior levels of the mediator and outcome were controlled at each wave to establish temporal precedence. Results suggested that (1) internalizing problems were protective against associating with deviant peers, but only at high levels of externalizing symptomatology, (2) higher levels of peer delinquency were associated with increases in SU, and (3) peer delinquency mediated the effect of the problem behavior interaction on SU. Our findings suggest that the impact of internalizing problems on peer delinquency and SU needs to be considered in the context of externalizing problems. Moreover, developmental models involving internalizing symptoms should consider that internalizing symptoms are generally protective against substance use in early adolescence.

Growth trajectories of alcohol information processing and associations with escalation of drinking in early adolescence.

This longitudinal study provided a comprehensive examination of age-related changes in alcohol outcome expectancies, subjective evaluation of alcohol outcomes, and automatic alcohol associations in early adolescence. A community sample (52% female, 75% White/non-Hispanic) was assessed annually for 3 years (mean age at the first assessment = 11.6 years). Results from growth modeling suggested that perceived likelihood of positive outcomes increased and that subjective evaluations of these outcomes were more positive with age. Perceived likelihood of negative outcomes declined with age. Automatic alcohol associations were assessed with an Implicit Association Task (IAT), and were predominantly negative, but these negative associations weakened with age. High initial levels of perceived likelihood of positive outcomes at age 11 were associated with escalation of drinking. Perceived likelihood of negative outcomes was associated with low risk for drinking at age 11, but not with changes in drinking. Increases in positive evaluations of positive outcomes were associated with increases in alcohol use. Overall, findings suggest that at age 11, youth maintain largely negative attitudes and perceptions about alcohol, but with the transition into adolescence, there is a shift toward a more neutral or ambivalent view of alcohol. Some features of this shift are associated with escalation of drinking. Our findings point to the importance of delineating multiple aspects of alcohol information processing for extending cognitive models of alcohol use to the early stages of drinking.

The link between early onset drinking and early onset alcohol-impaired driving in young males.

BACKGROUND: Young drivers represent a disproportionate number of the individuals involved in alcohol-impaired driving. Although there is a known association between drinking and alcohol-impaired driving in young drivers, the link between early onset drinking and early onset alcohol-impaired driving has not been explored. OBJECTIVES: The present study aimed to assess this link along with potentially confounding factors. METHODS: The assessment used a proportional hazards model with data collected from the Buffalo Longitudinal Study of Young Men, a population-based sample of 625 males at aged 16-19. RESULTS: Controlling for the effects of potentially relevant confounds, the early onset of drinking was the most influential factor in predicting the early onset of alcohol-impaired driving. Race and the early onset of other forms of delinquency also played a significant role in the early onset of alcohol-impaired driving. CONCLUSION: Preventing an early start of drinking among adolescents may be the most critical factor to address in preventing an early start of alcohol-impaired driving.

Early adolescent alcohol use in context: how neighborhoods, parents, and peers impact youth.

Developmental-ecological models are useful for integrating risk factors across multiple contexts and conceptualizing mediational pathways for adolescent alcohol use, yet these comprehensive models are rarely tested. This study used a developmental-ecological framework to investigate the influence of neighborhood, family, and peer contexts on alcohol use in early adolescence (N = 387). Results from a multi-informant longitudinal cross-lagged mediation path model suggested that high levels of neighborhood disadvantage were associated with high levels of alcohol use 2 years later via an indirect pathway that included exposure to delinquent peers and adolescent delinquency. Results also indicated that adolescent involvement with delinquent peers and alcohol use led to decrements in parenting, rather than being consequences of poor parenting. Overall, the study supported hypothesized relationships among key microsystems thought to influence adolescent alcohol use, and thus findings underscore the utility of developmental-ecological models of alcohol use.

Social and generalized anxiety symptoms and alcohol and cigarette use in early adolescence: the moderating role of perceived peer norms.

This study prospectively examines the association between social and generalized anxiety symptoms and alcohol and cigarette use in early adolescence and how injunctive (perceived peer approval of use) and descriptive (perceived peer use) norms may moderate the association. Sex differences were also examined. Data were taken from a longitudinal study investigating problem behavior and adolescent substance use. The community sample (N=387) was assessed annually, and data from the first two waves of assessment were used for this study. Early adolescents were between the ages of 11 and 13 at the first assessment (mean age=11.05, SD=0.55, 55% female). Peer norms moderated the association between both social and generalized anxiety symptoms and the likelihood of alcohol and cigarette use for girls, but not for boys. Specifically, girls with elevated levels of generalized anxiety symptoms were at risk for use when perceived peer use was low, and protected from use when perceived peer use was high. Girls with elevated levels of social anxiety symptoms were at risk for use when perceived peer approval of use was high, and protected from use when perceived peer approval of use was low. Past studies have found inconsistent support for an association between anxiety and adolescent substance use, and our findings provide some clarity regarding for whom and when anxiety operates as a risk/protective factor. Social context and sex are critical for understanding the role of different forms of anxiety in the etiology of adolescent alcohol and cigarette use.

Depression, anxiety, and suicidal ideation among Chinese Americans: a study of immigration-related factors.

The aim of this study was to identify anxiety, depression, and suicidal ideation disparities among Chinese Americans and how immigration-related factors affected the outcomes. We tried to explain the differences as a function of the Chinese culture. Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of these populations in the United States. We used only the Chinese sample (N = 600) and focused on depressive disorder, anxiety disorder, and suicidal ideation. The United States-born Chinese and those Chinese who immigrated to the United States at 18 years or younger were at higher risk for lifetime depressive or anxiety disorders or suicidal ideation than were their China-born counterparts who arrived in the country at or after 18 years of age. For Chinese Americans, immigration-related factors were associated with depression and anxiety disorders and suicidal ideation. The higher prevalence of these disorders might be attributed to the psychological strains experienced by those who are at higher risk of cultural conflicts.