The crossover effect: A review of racial/ethnic variations in risk for substance use and substance use disorder across development

Purpose of Review: The "crossover" effect, a phenomenon by which some minority groups switch from low to high risk for substance use as a function of age, was first documented 25 years ago. However, rigorous methodological research examining the crossover effect has only recently emerged. The current paper reviews the past 25 years of research on the crossover effect, which has primarily examined the shift from low to high substance use risk among Blacks relative to Whites. Recent Findings: Although findings regarding the crossover effect vary based on gender, socioeconomic status, and substance, Blacks and Hispanics appear to be at lower risk for some substance use- particularly binge drinking and cigarette smoking-than Whites during adolescence and early adulthood, but at higher risk for use in later life. Research regarding the crossover effect of substance use disorder and related problems is limited but more consistent with a similar pattern of effects observed. Summary: Due to significant limitations of the extant literature examining the crossover effect, it requires additional research clarifying sociodemographic differences in the, identifying its mechanisms, and determining its clinical implications. Such research may have important implications for preventing racial/ethnic disparities in the consequences associated with disordered substance use

Racial Differences in the Link between Alcohol Expectancies and Adolescent Drinking

Introduction Alcohol expectancies are important determinants and predictors of adolescent alcohol use. Research with African Americans has shown that the endorsement of positive alcohol expectancies differs from that of Whites during childhood and predicts different alcohol outcomes during young adulthood. However, limited research has explored racial differences in the relationship between expectancy endorsement and alcohol use in school-aged adolescents. The current study examines the effect of White or African American race on the relationship between positive alcohol expectancies and alcohol use. Methods Participants were 104 adolescents ages 12–18 who identified as either non-Hispanic White or non-Hispanic African American. Participants completed self-report measures of alcohol consumption and positive social alcohol expectancies. Results Preliminary analyses revealed no racial differences in alcohol expectancies or consumption. However, race moderated the relationship between alcohol expectancies and alcohol use such that more positive expectancies predicted alcohol use among White youth, but not African American youth. Conclusions These results suggest that alcohol expectancies, which were thought to be important mediators of the relationship between social and personality factors and adolescent alcohol use may not be as impactful for African Americans. Future research should focus on identifying factors posing unique risk for alcohol consumption in this population

Examining differential relationships of substance use and risky sexual behavior among African American and white adolescents

Indiana University-Purdue University Indianapolis (IUPUI)Adolescents are at disproportionate risk for health consequences associated with risky sexual behavior (RSB), including sexually transmitted infections and unintended pregnancy. Racial disparities have also been observed with African American adolescents experiencing higher rates of such negative health outcomes than their White peers. Substance use, particularly alcohol and marijuana use, has been shown to predict RSB among adolescents of both racial groups. However, research suggests that alcohol use is more predictive of RSB in White adolescents than African American adolescents, perhaps due to significantly higher rates of alcohol use among White adolescents. Given recent trends indicating higher rates of marijuana use among African American adolescents than their White peers and a strong association between marijuana use and RSB among African American adolescents, marijuana use may better explain the relationship between substance use and risky sexual behavior among African Americans than alcohol use. Thus, the current study examined whether alcohol and marijuana use have differential effects on adolescent RSB by race at the event- and global-level of analysis. To that end, 113 adolescents ages 14-18 (African American = 93, White=20) completed self-report measures of substance use and RSB. Contrary to hypotheses, results revealed no racial differences in the relationship between substance use and RSB. However, post-hoc analyses revealed that marijuana use significantly predicted frequency of sex among African American adolescents above the effects of alcohol. These findings indicate that previously documented racial differences in the relationship between substance use and RSB may not be accounted for by marijuana use, but suggest that future studies continue to examine the unique impact of marijuana use on RSB, particularly among African American adolescents

Family and Peer Influences on Substance Attitudes and Use among Juvenile Justice-Involved Youth

Juvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation

Substance use disorder and posttraumatic stress disorder symptomology on behavioral outcomes among juvenile justice youth

BACKGROUND AND OBJECTIVES: Substance use behaviors have been identified as a risk factor that places juveniles at greater risk for engaging in delinquent behaviors and continual contact with the juvenile justice system. Currently, there is lack of research that explores comorbid factors associated with substance use, such as post-traumatic stress disorder (PTSD) symptoms, that could help identify youth who are at greatest risk. The aim of the present study was to examine if PTSD symptomology moderated the relationship between substance use disorder (SUD) symptoms and externalizing behaviors and commission of a violent crime; hypothesizing that risk would be heightened among youth with elevated SUD and PTSD symptomology compared to those with elevated SUD symptoms but lower PTSD symptoms. METHOD: The study included 194 predominantly male (78.4%), non-White (74.2%) juvenile justice youth between the ages of 9-18 (M = 15.36). Youth provided responses to assess PTSD symptoms, SUD symptoms, and externalizing behaviors. Commission of a violent crime was based on parole officer report. RESULTS: Findings indicated that SUD symptomology was associated with greater externalizing behaviors at high levels of PTSD symptomology. At low levels of PTSD symptomology, SUD symptoms were inversely associated with externalizing behaviors. An interactive relationship was not observed for commission of violent crimes. CONCLUSIONS: Findings suggest that the association between SUD symptoms and externalizing behaviors among juvenile offenders may be best explained by the presence of PTSD symptomology. SCIENTIFIC SIGNIFICANCE: Addressing PTSD rather than SUD symptoms may be a better target for reducing risk for externalizing behaviors among this population of youth (Am J Addict 2019;28:29-35)

Does a Crossover Age Effect Exist for African American and Hispanic Binge Drinkers? Findings from the 2010 to 2013 National Study on Drug Use and Health

BACKGROUND: Among general population studies, lower rates of binge drinking tend to be found among African Americans and Hispanics compared to Whites. However, among older adult populations, minority groups have been shown to be at higher risk for binge drinking, suggesting the presence of a crossover effect from low to high risk as a function of age. To date, limited research has examined the crossover effect among African American and Hispanic populations compared to non-Hispanic Whites across large developmental time frames or explored variation in risk based on income or gender. This study aimed to fill these gaps in the literature. METHODS: Data were compiled from the 2010 to 2013 National Survey on Drug Use and Health surveys, which provide annual, nationally representative data on substance use behaviors among individuals aged 12 and older. Hispanic, non-Hispanic African American, and non-Hispanic White respondents were included (N = 205,198) in the analyses. RESULTS: A crossover effect was found for African American males and females among the lowest income level (i.e., incomes less than $20,000). Specifically, after controlling for education and marital status, compared to Whites, risk for binge drinking was lower for African American males at ages 18 to 24 and for females at ages 18 to 34, but higher for both African American males and females at ages 50 to 64. No crossover effect was found for Hispanic respondents. CONCLUSIONS: Although African Americans are generally at lower risk for binge drinking, risk appears to increase disproportionately with age among those who are impoverished. Explanatory factors, such as social determinants of health prevalent within low-income African American communities (e.g., lower education, violence exposure, housing insecurity) and potential areas for intervention programming are discussed

Trends in typologies of concurrent alcohol, marijuana, and cigarette use among US adolescents: An ecological examination by sex and race/ethnicity

Substance use during adolescence is a public health concern due to associated physical and behavioral health consequences. Such consequences are amplified among concurrent substance users. Although sex and racial/ethnic differences in single-substance use have been observed, the current literature is inconclusive as to whether differences exist in the prevalence of concurrent use. The current study used data from the 2011–2014 National Survey on Drug Use and Health to examine typologies (single and concurrent patterns) of alcohol, marijuana, and cigarette use among current adolescent users age 12–18 by sex and race/ethnicity. Participants were 14,667 White, Hispanic, African American, Asian, and Native American adolescents. The most common typology was alcohol only, followed by concurrent use of alcohol and marijuana. Weighted prevalence estimates indicated that adolescent females were more likely to be current users of alcohol only, whereas male adolescents were more likely to belong to all other typologies. Compared to Whites, racial/ethnic minorities had larger proportions of marijuana only users and were generally less likely than or equally likely to be concurrent users. One exception was for African American adolescents, who were more likely to be alcohol and marijuana users than their White counterparts. Results suggest that concurrent substance use is common among U.S. adolescents, making up over 40% of past-month use, but typologies of use vary by sex and race/ethnicity. Preventive interventions should consider all typologies of use rather than only single substance exposures and address patterns of use that are most pertinent to adolescents based on sex and race/ethnicity

Perceived Police Injustice, Moral Disengagement, and Aggression Among Juvenile Offenders: Utilizing the General Strain Theory Model

Although many juvenile offenders report experiencing police injustice, few studies have examined how this source of strain may impact youths' behavioral outcomes, including risk for future recidivism. This study begins to address that gap in the literature. We applied the general strain theory as our theoretical framework to examine the interactive effect of perceived police injustice and moral disengagement on juvenile aggressive behavior. Our sample included 95 juvenile offenders who completed questionnaires on measures of perceived police injustice and moral disengagement. Results supported our hypothesis, such that moral disengagement predicted past month aggression among juvenile offenders, but only by youth who reported mean and high levels of perceived police injustice. While more research is needed in this area, this study's findings underscore the need to address both perceived police engagement and moral disengagement among youth at-risk of engaging in delinquent behaviors. Implications for intervention programs are also presented

Racial/ethnic differences in the time-varying association between alcohol expectancies and drinking during the transition from childhood to adolescence

Alcohol expectancies are important determinants of adolescent drinking, but this relationship may differ based on race/ethnicity. This study used time-varying effect modeling to examine racial/ethnic differences in positive and negative alcohol expectancies and their relationship with drinking among White, African American, and Hispanic youth. Youth reported alcohol expectancies and drinking frequency from 5th-10th grade. African Americans initially endorsed higher positive alcohol expectancies than Whites, but its relationship with drinking was stronger among Whites. Hispanic youth reported slightly higher negative alcohol expectancies in high school, but the relationship between negative expectancies and alcohol use was comparable across groups. The effect of expectancies on alcohol use outcomes may be more robust for Whites, which warrants investigation of risk factors for minority youth

Negative urgency and emotion regulation predict positive smoking expectancies in non-smoking youth

INTRODUCTION: The purpose of the study was to better understand early risk for positive smoking expectancies, which have been shown to be consistent predictors of smoking initiation among youth. Two affect-based risk factors-negative urgency and emotion dysregulation-associated with smoking behaviors among youth, were examined for unique and interactive effects on positive smoking expectancies among substance-naïve youth. METHODS: Participants were 61 10-14-year-old children with virtually no drug use (less than 5 substance use incidents across the lifetime), who were drawn from the community. RESULTS: Both negative urgency and emotion dysregulation were significantly associated with positive social facilitation smoking expectancies. Further, negative urgency was significantly related to positive social facilitation smoking expectancies at higher levels of emotion dysregulation (b=.09, p=.001). CONCLUSION: The findings provide evidence that both emotion dysregulation and negative urgency are positively associated with positive social-related smoking expectancies among a sample of 10-14-year-olds. Children who are emotionally dysregulated and who act rashly in response to negative emotions appear more likely to endorse beliefs regarding the socially enhancing effects of smoking, suggesting that these youth may be at high risk for smoking initiation