Conceptualizing Community Mental Health Service Utilization for BIPOC Youth.

Historically, children and adolescents who identify as Black, Indigenous, and other people of Color (BIPOC) have had inequitable access to mental healthcare, and research shows that they are significantly less likely than their white American counterparts to utilize available services. Research identifies barriers that disproportionately impact racially minoritized youth; however, a need remains to examine and change systems and processes that create and maintain racial inequities in mental health service utilization. The current manuscript critically reviews the literature and provides an ecologically based conceptual model synthesizing previous literature relating to BIPOC youth barriers for service utilization. The review emphasizes client (e.g. stigma, system mistrust, childcare needs, help seeking attitudes), provider (e.g. implicit bias, cultural humility, clinician efficacy), structural/organizational (clinic location/proximity to public transportation, hours of operation, wraparound services, accepting Medicaid and other insurance-related issues), and community (e.g. improving experiences in education, the juvenile criminal-legal system, medical, and social service systems) factors that serve as barriers and facilitators contributing to disparities in community mental health service utilization for BIPOC youth. Importantly, we conclude with suggestions for dismantling inequitable systems, increasing accessibility, availability, appropriateness, and acceptability of services, and ultimately reducing disparities in efficacious mental health service utilization for BIPOC youth.

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.

Multigroup Ethnic Identity Measurement invariance across adolescence and diverse ethnic groups.

INTRODUCTION: Ethnic identity is an important protective factor for various ethnic groups and developmental periods. Although existing measures assessing ethnic identity are well known, less is known about the measurement invariance of the Multigroup Ethnic Identity Measure (MEIM) across adolescent ethnic groups. The present study evaluates the factor structure of MEIM (Roberts et al., 1999) and tests the measurement invariance across early and middle adolescence and ethnic background (N = 4940). METHODS: Data from an ethnic minority sample of youth (54% girls; Mage = 13.88, grades 6th - 12th; 60% African American, 22% multi-ethnic, 8% Latinx, 5% Asian, 5% American Indian) in the United States of America were examined using confirmatory factor analysis (CFA) and multi-group measurement invariance via a structural equation modeling (SEM) framework. Models for invariance were tested using full information maximum likelihood-robust (FIML-R) estimation in Mplus. RESULTS: CFA supported a three-factor solution (i.e., cognitive clarity, behavioral engagement, and affective pride). The model indicated scalar invariance across early and middle adolescence and partial scalar invariance across the five self-identified racial/ethnic minority groups. There were no grade differences on the ethnic identity factors. Among the racial/ethnic groups, multi-ethnic youth reported the lowest levels on all three ethnic identity factors compared to the other groups. CONCLUSIONS: Results of this study point to the validity of using the MEIM for meaningful comparisons of ethnic identity across ethnic groups and across early and middle adolescence. Implications for the interpretation and use of this measure with diverse adolescents are discussed.

Ethnic identity and substance use in multiracial youth: the moderating role of support networks.

Background: Substance use in multiracial adolescents exceeds rates identified in the general population. Despite this fact, there is limited research examining risk and protective factors for multiracial substance use. Objectives: The current study examined the moderating effect of social support on the relationship between ethnic identity and substance use in a sample of multiracial adolescent youth. Methods: Multiracial youth (N = 523) completed a survey that asked questions related to their ethnic identity, perceived social support, and substance use. A series of path analyses were conducted to test the hypothesized relationships between ethnic identity, social support, and substance use. Results: Analyses indicated that ethnic affirmation was negatively related to frequency of, but not quantity of substance use. Teacher support was negatively related to both frequency and quantity of substance use, while parent support was only related to frequency. Further, teacher and parent support emerged as moderators of ethnic affirmation and frequency and quantity of substance use respectively. Conclusions/Importance: Our findings add to the current understandings of the relationship between ethnic identity, social support, ethnic identity, and substance use among the understudied multiracial adolescent population.

Person-Environment Fit, Substance Use Attitudes, and Early Adolescent Substance Use.

BACKGROUND: Adolescent substance use is a national health concern. While the literature is clear on the prevalence of substance use during the adolescent developmental period, a dearth of literature is available on the developmental contexts, particularly the influence of school factors, in which substance use occurs. OBJECTIVES: This study examined the intermediary role of substance use attitudes on the relationship between school racial composition and alcohol and marijuana use in a sample of sixth to eighth graders. METHODS: The sample consisted of 4228 middle school students (89% White; 53% female) in the Midwest. A moderated mediation analysis was conducted on the relationship between school racial composition, substance use attitudes, and substance use, with race as the moderator. RESULTS: Results indicated a significant relationship between the percentage of White or Black students in a school and alcohol or marijuana use and that this relationship was mediated by substance use attitudes. These relationships did not differ significantly by student race. Conclusions/Importance: Preliminary findings indicate the importance of considering school racial composition as a systems level risk or promotive factor for attitudes toward substance use as well as substance use outcomes.

Collective ethnic-racial identity and health outcomes among African American youth: Examination of promotive and protective effects.

OBJECTIVES: Racial discrimination is associated with numerous negative health outcomes, including increased risk for depression and anxiety symptoms and substance use. Positive affect toward of one's ethnic or racial group (i.e., ethnic-racial identity affirmation) has been shown to buffer the negative effects of racial discrimination on health outcomes. The extent to which one believes his or her group is valued by others (i.e., positive collective ethnic-racial identity) has also been proposed to be protective. However, to date a limited body of research has examined the moderating effect of collective ethnic-racial identity on health, and among available studies, findings are mixed. METHOD: African American youth (N = 612; 58.2% female, M grade = 8) completed measures on experiences of discrimination, mood symptoms, substance use, ethnic-racial identity affirmation, and collective ethnic-racial identity (assessed using the Collective Self-Esteem Scale). RESULTS: Controlling for demographic variables and affirmation, a significant main effect was found for collective ethnic-racial identity, such that believing that others viewed your group positively was associated with better health outcomes among African American youth. However, collective ethnic-racial identity was not found to buffer the effects of discrimination on health outcomes. CONCLUSIONS: These findings highlight the importance of examining collective ethnic-racial identity and the promotive effect it can have on health outcomes for African Americans. More research is needed to better understand if there are health outcomes in which collective ethnic-racial identity may also mitigate risk as a consequence of racial discrimination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Peer Victimization, Mood Symptoms, and Alcohol Use: Examining Effects among Diverse High School Youth.

Peer victimization is associated with alcohol use among adolescents. However, few studies have examined the mediating role of depression and anxiety, or differences by race. The current study examined the prospective relationship of peer victimization, depressive and anxiety symptoms, and alcohol use across two timeframes: 9th to 11th grade and 10th to 12th grade among African American and White youth. Two thousand two hundred and two high school youth (57.6% female) who identified as either African American (n = 342, 15.2%) or White (n = 1860, 82.6%) provided data on study variables. Path analysis among the overall sample indicated that anxiety symptoms was a significant mediator for both timeframes, with depressive symptoms mediating the pathway during the 10th to 12th grade timeframe. The findings were most consistent among White youth, with no significant indirect effects observed for African American youth. Thus, addressing depressive and anxiety symptoms may be effective targets to decrease alcohol use risk as a result of peer victimization among White youth. However, further research is needed to better understand risk models for peer victimization exposure on substance use outcomes among racial/ethnic minority youth.

The Indirect Effect of Ethnic Identity on Marijuana Use Through School Engagement: An African American High School Sample.

BACKGROUND: African American marijuana use is associated with many negative social, emotional, and health-related consequences. Of significance, over recent years this population has shown an increase in use. In the literature, ethnic identity and school engagement are prominent protective factors against substance use. OBJECTIVE: This study will examine how these protective factors are related, specifically whether ethnic identity mitigates risk through school engagement to reduce marijuana use. METHOD: A path analysis was conducted with 437 African American high school students (41% male) from Midwestern schools to examine the role of school engagement in the relationship between ethnic identity and marijuana use. RESULTS: The results revealed that students high in ethnic identity have higher school engagement, which lessens their frequency of marijuana use. Therefore, ethnic identity reduces marijuana use by increasing student's school engagement. Conclusions/Importance: The results offer a clearer picture of how ethnic identity and school engagement protect against marijuana use. The results also present insight into how to protect students who are low in ethnic identity.

A prospective examination of anxiety as a predictor of depressive symptoms among Asian American early adolescent youth: The role of parent, peer, and teacher support and school engagement.

OBJECTIVE: The current study sought to examine the prospective relationship between anxiety and depressive symptoms among Asian American (AA) early adolescents, a crucial period for the development of depression among youth. Further, as guided by cultural-ecological frameworks, a second aim of this study was to identify protective factors (i.e., parent support, peer support, teacher support, and school engagement) that might buffer the relationship between anxiety and depressive symptoms among this understudied population. METHOD: Participants included AA youth (N = 186; Mage = 12.50, SD = 1.16; 51.1% male) who completed questionnaires on 2 occasions with a 1-year interval. RESULTS: Results from path analysis indicated that high anxiety symptoms were related to increased depressive symptoms over time. Further, teacher support was related to decreased depressive symptoms over time. Additionally, teacher and parent support moderated the association between adolescents' anxiety and depressive symptoms. CONCLUSIONS: Findings contribute to our understanding of the development of depression among early adolescent youth and have implications for the development of programming for Asian American youth with anxiety and depression. (PsycINFO Database Record

Examining the Protective Effect of Ethnic Identity on Drug Attitudes and Use Among a Diverse Youth Population.

Ethnic identity is an important buffer against drug use among minority youth. However, limited work has examined pathways through which ethnic identity mitigates risk. School-aged youth (N = 34,708; 52 % female) of diverse backgrounds (i.e., African American (n = 5333), Asian (n = 392), Hispanic (n = 662), Multiracial (n = 2129), Native American (n = 474), and White (n = 25718) in grades 4-12 provided data on ethnic identity, drug attitudes, and drug use. After controlling for gender and grade, higher ethnic identity was associated with lower past month drug use for African American, Hispanic, and Multiracial youth. Conversely, high ethnic identity was associated with increased risk for White youth. An indirect pathway between ethnic identity, drug attitudes, and drug use was also found for African American, Hispanic, and Asian youth. Among White youth the path model was also significant, but in the opposite direction. These findings confirm the importance of ethnic identity for most minority youth. Further research is needed to better understand the association between ethnic identity and drug use for Multiracial and Hispanic youth, best ways to facilitate healthy ethnic identity development for minority youth, and how to moderate the risk of identity development for White youth.

Perceived Risk of HIV Infection Among Drug-Using African American Male Prisoners: One Year After Community Re-entry.

BACKGROUND: African Americans represent 13% of the U.S. population but 46% of people living with HIV and nearly 40% of state and federal prisoners. Disproportionate rates of HIV among African American males involved in the criminal justice system have been associated with risk factors, including: contracting sexually transmitted infections (STIs), substance misuse, and inconsistent condom use. However, many African American males may not perceive an elevated risk of HIV upon re-entering the community. OBJECTIVE: The current study examines correlates of perceived HIV risk among incarcerated African American drug-using males about one year after release from prison. METHODS: Derived from a larger Health Services Utilization study, interviewing (N = 661) incarcerated men at baseline with a 92% follow-up rate approximately one year after community re-entry, the current study is a secondary data analyses from self-identified African American men (N = 250). After list-wise deletion, the total N = 221 for the final study results. RESULTS: An ordered logistic regression model examining perceived risk of HIV as the dependent variable found age, cocaine use before sex, and condom use were significant correlates in the model. Alcohol use before sex mediated the relationship between cocaine use before sex and perceived HIV risk. CONCLUSIONS: Results suggest men in this study are engaged in HIV risk behaviors and risk perception varies. Implications for individual-level, community-level and policy interventions are discussed.

Not just black and white: peer victimization and the intersectionality of school diversity and race.

Although bullying is a prevalent issue in the United States, limited research has explored the impact of school diversity on types of bullying behavior. This study explores the relationship between school diversity, student race, and bullying within the school context. The participants were African American and Caucasian middle school students (n = 4,581; 53.4% female). Among the participants, 89.4% were Caucasian and 10.6% were African American. The research questions examined the relationship between school diversity, student race and bullying behaviors, specifically race-based victimization. The findings suggested that Caucasian middle school students experience more bullying than African American students generally, and specifically when minorities in school settings. Caucasian students also experienced almost three times the amount of race-based victimization than African American students when school diversity was held constant. Interestingly, African American students experienced twice the amount of race-based victimization than Caucasian students when in settings with more students of color. The present study provides insight into bullying behaviors across different contexts for different races and highlights the need to further investigate interactions between personal and environmental factors on the bulling experiences of youth.

Examining multiracial youth in context: ethnic identity development and mental health outcomes.

Although multiracial individuals are the fastest growing population in the United States, research on the identity development of multiracial adolescents remains scant. This study explores the relationship between ethnic identity, its components (affirmation, exploration), and mental health outcomes (anxiety, depressive symptoms) within the contexts of schools for multiracial adolescents. The participants were multiracial and monoracial minority and majority high school students (n = 4,766; 54.6% female). Among the participants, 88.1% were Caucasian, 7.4% were African American, and 4.5% were multiracial. The research questions examined the relationship between ethnic identity exploration and affirmation on mental health outcomes and explored the role school context plays in this relationship. The findings suggested that multiracial youth experience more exploration and less affirmation than African Americans, but more than Caucasians. In addition, multiracial youth were found to have higher levels of mental health issues than their monoracial minority and majority peers. Specifically, multiracial youth had higher levels of depressive symptoms than their African American and Caucasian counterparts. Multiracial and Caucasian youth had similar levels of anxiety but these levels were significantly higher than African Americans. School diversity did not influence mental health outcomes for multiracial youth. These findings provide insight into the experiences of multiracial youth and underscore the importance of further investigating factors that contribute to their mental health outcomes.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Urban Settings: Barriers and Facilitators to Implementation With Minoritized Youth.

BACKGROUND: Substance use in minoritized youth is associated with negative long-term health and life outcomes. The present study explores perspectives of school stakeholders at urban minority-serving schools regarding integration of an evidence-based intervention, screening, brief intervention, and referral to treatment (SBIRT) into existing school prevention models. METHODS: Twenty-two participants were interviewed using the Consolidated Framework for Implementation Research to identify barriers and facilitators to SBIRT implementation. Qualitative data were transcribed, coded, and analyzed. RESULTS: Four major themes related to barriers to SBIRT implementation included: lack of training, unclear role expectations, student confidentiality, and punitive school climates. The 3 major facilitators included: the feasibility of the intervention, its fit within multi-tiered systems of support, and the districts increasing collaboration with community mental health providers. These major themes along with other minor themes are discussed. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: SBIRT implementation within low-income, minority-serving schools may reduce substance use disparities among minoritized youth, improving health and life outcomes. Recommendations addressed training, school climate, and student engagement, highlighting a collaborative and supportive approach involving all stakeholders. CONCLUSIONS: While SBIRT implementation has barriers and facilitators, overall, school staff were optimistic about implementation. In light of these findings, additional research should embed SBIRT in these settings.

Different Mechanisms Link Internalized Racism to Externalizing Symptomology Among Black American Adolescent Boys and Girls.

OBJECTIVE: Emerging research and theory suggests that the internalization of racist ideas and attitudes, internalized racism, poses a significant threat to Black American adolescents' and increases their risk of externalizing symptomology. Prospective, empirical research linking internalized racism to externalizing symptoms among Black American adolescents and the mechanisms explaining this link is scarce. We hypothesize that internalized racism will forecast externalizing symptoms indirectly, via effects on poor self-regulation and depressive symptoms. We also examine potential sex differences in the pathways linking internalized racism to externalizing symptoms. METHOD: A random sample of 445 Black American adolescents and their primary caregivers were recruited from 8 counties in rural Georgia. Participants provided survey data annually when adolescents were aged 13, 14, 15, and 16 years. Direct, indirect, and multigroup hypotheses were tested with structural equation modeling. RESULTS: Internalized racism assessed at ages 13 and 14 years forecast increased externalizing at age 16, both directly, and indirectly, via increases in poor self-regulation and depressive symptoms. Sex moderated the indirect pathways linking internalized racism and externalizing. Poor self-regulation significantly mediated the path between internalized racism and externalizing symptoms among Black American male youth. Depressive symptoms significantly mediated the pathway between internalized racism and externalizing symptoms among Black American female adolescents. CONCLUSION: Findings suggest behavioral treatment directions for male and female Black American adolescents experiencing depressive symptoms. PLAIN LANGUAGE SUMMARY: Little is known about the influence of internalization of racist ideas and attitudes, often referred to as internalized racism, on Black youths' development of externalizing symptoms. In this study, the authors surveyed 445 Black youths annually at ages 13, 14, 15, and 16 years. Internalized racism at ages 13 and 14 predicted increased externalizing symptoms at age 16. Among boys, depressive symptoms mediated the path between internalized racism and externalizing symptoms. Among girls, struggles with self-regulation mediated the path between internalized racism and externalizing symptoms.

Racial discrimination, childhood adversity, and depression among Black men: Tests of stress sensitization hypotheses.

Racial discrimination has been linked to depression among Black American men. Racial discrimination, however, does not uniformly confer risk for depression. According to the stress sensitization theory, racial discrimination can be particularly harmful for those with histories of adversity in childhood. Existing research on stress sensitization is limited in that it has conceptualized childhood adversity as a unidimensional construct composed of a broad range of stressful experiences. To fill this gap in the literature, the current study investigated stress sensitization hypotheses, focusing on how different dimensions of adverse childhood experiences moderate the association between racial discrimination and depression. Study sample was 504 young Black men (mean age at baseline = 20.3, SD = 1.08) living in rural counties in South Georgia where childhood adversity is disproportionately high. The association between racial discrimination and increased risk for depressive symptoms varied by the degree of childhood experience of deprivation, but not threat. Our findings suggest that no or low levels of childhood deprivation, which is commonly regarded as a protective factor, can elevate the negative effects of discrimination on depression. This finding emphasizes that clinicians should consider developmental risk and protective factors that are unique to Black American men.

The effect of impulsivity and drinking motives on alcohol outcomes in college students: a 3-year longitudinal analysis.

Objective: Substance use is a public health concern and cross-sectional studies have found that impulsivity and drinking motives influence substance use in emerging adults. Despite these findings, longitudinal studies with nuanced measures of impulsivity and drinking motives are needed. Participants: The current study investigated the three-year relationship between impulsivity-related traits, drinking motives, sex, and drinking outcomes in a sample of 509 college students (47.47% male; 81% White). Methods: The effects of impulsivity traits and drinking motives on problematic drinking outcomes were evaluated using linear mixed effects models. Results: The results confirmed the hypothesized relationship between traits of impulsivity, drinking motives, and alcohol outcomes over time. Further, sex significantly interacted with drinking motives longitudinally in its relationship with alcohol use outcomes. Conclusions: These results indicate that intervention efforts may need to be tailored to specific individual attributes to target direct correlates of alcohol use behavior to increase effectiveness.

Traditional risk and cultural protection: Correlates of alcohol and cannabis co-use among African-American adolescents.

OBJECTIVE: Previous work indicates that African-American adolescents are at high risk for concurrent alcohol and cannabis use. The present study examines the associations of traditional ecological predictors of substance use with concurrent alcohol and cannabis use among African-American adolescents. It also examines whether racial identity, a culturally relevant factor, is associated with concurrent use beyond the influence of traditional factors. METHOD: Secondary analyses were conducted based on a large survey of high school adolescents. Responses on self-report measures of substance use and psychosocial determinants of health were examined for those respondents in grades 9-12 who identified as African American (N = 465; 59.8% female). RESULTS: Findings demonstrated that traditional risk and resilience factors, including externalizing symptoms and substance use beliefs, were related to alcohol and cannabis co-use relative to other patterns of use among African-American adolescents. Racial identity dimensions were also associated with alcohol and cannabis co-use beyond the influence of traditional factors. However, the direction of these associations varied by dimension. CONCLUSIONS: Findings from the present study assist in advancing the current knowledge base by identifying potential risk and protective factors for alcohol and cannabis co-use among African-American youth, who face increasing rates of this substance use pattern. They also underscore the importance of accounting for cultural variability in models of adolescent substance use among this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III.

BACKGROUND: Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults. METHODS: The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups. RESULTS: Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment. CONCLUSIONS: Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.

Peer victimization and substance use: Understanding the indirect effect of depressive symptomatology across gender.

OBJECTIVE: Peer victimization in school is common, with emerging literature suggesting that it may also increase risk for substance abuse. Yet, little is known about the underlying mechanisms within this risk pathway. The objective of this study is to use a prospective 3-wave design to examine the mediating role of depressive symptomatology on the relationship between peer victimization and substance use, as well as examine if the pathway varies based on gender. METHOD: 801 youth between 6th and 12th grade completed surveys across three years, which included measures on school peer victimization, depression symptomatology and substance use. Models tested the mediational pathway between victimization, depressive symptoms, and substance use. Models were stratified by gender. RESULTS: Controlling for grade and the effect of each variable across waves, a significant indirect effect of peer victimization on substance use through depressive symptoms was found for females, with a non-significant indirect effect for males. CONCLUSION: Results suggest that female youth who are victimized by peers engage in substance use behaviors, at least in part, due to increases in depressive symptoms. Given its effect on depression, female victims may therefore benefit from coping skills training that targets emotion regulation and distress tolerance skills in order to combat increased risk for substance use behaviors as a coping response to their victimization. Further research is warranted to better understand the risk pathway for male youth who also experience peer victimization.