Pilot Study: Implementing a Brief DBT Skills Program in Schools to Reduce Health Risk Behaviors Among Early Adolescents

A significant proportion of youth engage in health risk behaviors, which are of concern, as they are associated with adverse health consequences across development. Two factors associated with engagement in such behaviors are emotion dysregulation and impulsivity. Dialectical behavioral therapy (DBT) is an effective intervention that enhances emotion regulation skills to reduce problem behaviors among adolescent populations; however, limited research has been conducted implementing the program within school settings. The current study was a 9-week DBT skills group conducted among 80 middle school youth, with pre–posttest data among 53 students. Findings indicated feasibility to implement the program in schools and preliminary evidence of efficacy in decreasing youth’s likelihood to engage in risky, particularly among youth high on an emotion-based impulsivity trait. Brief DBT skills group may be an effective program to be utilized by school nurses and health-care teams to reduce health risk behaviors among school-aged youth

A longitudinal test of impulsivity and depression pathways to early binge eating onset

OBJECTIVE: The very early engagement in bulimic behaviors, such as binge eating, may be influenced by factors that dispose individuals to impulsive action as well as by factors that dispose individuals to depressive symptomatology. Using a longitudinal design, we conducted the first test of the simultaneous operation of both risk factors as children transition from elementary to middle school. METHOD: In a sample of 1,906 children, we assessed risk for impulsive action (negative urgency, which is the tendency to act rashly when distressed, and eating expectancies, which are learned anticipations that eating will alleviate negative mood) and risk for depression (negative affect and depressive symptomatology) and binge eating behavior at three time points using a longitudinal design: the end of fifth grade (last year of elementary school: T0), the beginning of sixth grade (first year of middle school: T1), and the end of sixth grade (T2). RESULTS: Both the impulsive action and depression pathways predicted very early engagement in binge eating: each accounted for variance beyond the other. Mediation tests found that T1 eating expectancies mediated the predictive influence of T0 negative urgency on T2 binge eating (z = 2.45, p < .01) and that T1 depressive symptoms mediated the influence of T0 negative affect on T2 binge eating (z = 2.04, p < .05). DISCUSSION: In children, elevated levels of both negative urgency and negative affect predict early binge eating. This finding has important clinical implications because there are different interventions for the two different risk processes

Racial Differences in the Transactional Relationship Between Depression and Alcohol Use From Elementary School to Middle School

Objective: The aim of this investigation was to test hypothesized reverse prospective relationships between alcohol consumption and depressive symptomatology as a function of race among youth. Method: In a two-wave prospective study, 328 European American, 328 African American, and 144 Hispanic American youth were studied at the end of fifth grade (last year of elementary school) and the end of sixth grade (first year of middle school). Results: A positive correlation was observed between alcohol consumption and depressive symptoms among all youth. However, the predictive relationship differed based on race. For European American and Hispanic American youth, depressive symptom levels at the end of elementary school predicted alcohol consumption at the end of the first year of middle school, but the converse relationship was not observed. For African American youth, the opposite pattern was found. Alcohol consumption at the end of elementary school predicted depressive symptom levels at the end of the first year of middle school, and the converse relationship was not observed. Conclusions: These findings suggest the possibility that etiological relationships between depression and alcohol use vary by race, thus highlighting the importance of considering race when studying the risk process

The Experience of Racism on Behavioral Health Outcomes: the Moderating Impact of Mindfulness

Research shows that racial discrimination results in adverse behavioral health outcomes for African–American young adults, including risk for depression, anxiety, and substance use. Although high levels of mindfulness have been shown to reduce risk for such health outcomes, it is unknown whether mindfulness can reduce risk as a consequence of racial discrimination, particularly among African Americans. Three-hundred and eighty-eight African–American young adults between the ages of 18 and 24 (M = 20.6, 62% female) completed measures assessing past-year experiences of racial discrimination, depressive symptoms, anxiety symptoms, alcohol use, and trait mindfulness. A positive correlation was found between racial discrimination and the behavioral health outcomes, as well as a negative correlation between mindfulness and the behavioral health outcomes. Moreover, mindfulness was found to significantly moderate the effect of racial discrimination on mood symptoms. Although mindfulness was found to lessen the effect of racial discrimination on alcohol use, this difference was not statistically significant. In line with previous literature, racial discrimination was shown to have a negative impact on behavioral health outcomes among African Americans. Moreover, our findings provide support for the buffering effect of mindfulness on mood symptoms as a consequence discrimination. This suggests that increasing mindfulness may be an effective strategy to include in interventions targeting improvement in mood symptoms for African–American young adults. However, alternative strategies may be more appropriate to address outcomes, such as alcohol use, as a consequence of racial discrimination

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

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

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

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. 2,202 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

Assessment and Treatment Recommendations for Pediatric Pain: The Influence of Patient Race, Patient Gender, and Provider Pain-Related Attitudes

Previous studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as "providers"), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers’ pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups

Impulsivity and self-harm in adolescence: a systematic review

Research supports an association between impulsivity and self-harm, yet inconsistencies in methodology across studies have complicated understanding of this relationship. This systematic review examines the association between impulsivity and self-harm in community-based adolescents aged 11-25 years and aims to integrate findings according to differing concepts and methods. Electronic searches of EMBASE, MEDLINE, PsychINFO, CINAHL, PubMed and The Cochrane Library, and manual searches of reference lists of relevant reviews, identified 4,496 articles published up to July 2015, of which 28 met inclusion criteria. Twenty-four of the studies reported an association between broadly specified impulsivity and self-harm. However, findings varied according to the conception and measurement of impulsivity and the precision with which self-harm behaviours were specified. Specifically, lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity related traits. However, cognitive facets of impulsivity (relating to difficulties maintaining focus or acting without forethought) differentiated current self-harm from past self-harm. These facets also distinguished those with thoughts of self-harm (ideation) from those who acted on thoughts (enaction). The findings suggested that mood-based impulsivity is related to the initiation of self-harm, while cognitive facets of impulsivity are associated with the maintenance of self-harm. In addition, behavioural impulsivity is most relevant to self-harm under conditions of negative affect. Collectively, the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm. From a clinical perspective, the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision-making may offer most benefit in supporting those who self-harm