Predictors of problematic non-medical prescription pain and stimulant use

Recent results from a nationally representative sample indicated that young adults exhibited the greatest illicit drug use (SAMHSA, 2013b). The non-medical use of prescription drugs (NMUPD) is the second most commonly reported form of illicit substance use by young adults, preceded only by marijuana (SAMHSA, 2013b). This is a growing public health concern with an estimated 2.4 million Americans engaged in NUMPD for the first time within the past year in 2010, an average of 6,600 initiates per day (SAMHSA, 2013b). Prescription opioid abuse alone was estimated to cost the U.S. $55.7 billion in 2007 (Birnbaum et al., 2011). NMUPD has been linked with abuse and dependence, and a variety of other negative outcomes, including mental illness, (e.g., Bavarian et al., 2013), poor school performance (Arria et al., 2011), emergency room visits (SAMHSA, 2013a, 2013b), more frequent sexual risk behaviors (Benotsch et al., 2011), and death (CDC, 2012; Paulozzi et al., 2012). Additionally, young adults who engage in NMUPD are significantly more likely than their peers to use other illicit drugs and to combine prescription drugs with alcohol and other substances. These practices increase the risk of potentially dangerous drug interactions, and their negative outcomes (Garnier et al., 2009; McCabe et al., 2006; SAMHSA, 2006). Therefore, prevention is key to reducing this great public health concern and its grave costs to society. One way to prevent substance use and abuse is to investigate why specific groups of people use and to target interventions specifically to modifiable predictors. The current study focuses on such potential predictors. The sample included 193 undergraduate students (70.4% female) from diverse ethnic groups (55% White) attending a large public university who endorsed NMUPD of either pain or stimulant medications in the past year. Participants completed an online questionnaire that assessed their ratings of their problematic NMUPD use, sleep problems, emotion regulation difficulties, depressive symptoms, and post-traumatic stress disorder (PTSD) symptoms from reliable and valid measures. Using regression models run separately for users of pain and stimulant medications, emotion regulation difficulties and PTSD symptoms were found to predict non-medical problematic use of both pain and stimulant medications (betas ranged from .22 - .32, ps \u3c .05). Sleep problems and depressive symptoms were found to only predict problematic use of stimulants (betas = .33, ps \u3c .01). When all the significant predictors were entered into a multiple regression for each prescription category, no one predictor was significant above and beyond other predictors (see Table 1). However, PTSD symptoms explained the most variance in both models. These results suggest that all of these predictors are important to consider when investigating NMUPD in young adults. Since results from treatment research investigating abuse of other substances have found that integrated approaches that combine mental health and substance use are more effective than interventions that address substance use and mental health problems separately (e.g., Drake et al., 2008), future prevention and intervention efforts should consider all of the variables investigated. If resources are limited targeting PTSD symptoms may be the most effective.https://scholarscompass.vcu.edu/gradposters/1012/thumbnail.jp

Parental strain, mental health problems, and parenting practices: A longitudinal study

Although poor parenting practices place youth living in under resourced communities at heightened risk for adjustment difficulties, less is known about what influences parenting practices in those communities. The present study examines prospective linkages between three latent constructs: parental strain, mental health problems and parenting practices. Parental victimization by community violence and life stressors were indicative of parental strain; depressive, anxious, and hostile symptoms were indicators of parental mental health; and parental knowledge of their child’s activities and child disclosure were indicators of parenting practices. Interviews were conducted annually for 3 waves with 316 female caregivers (92% African American) parenting youth in low-income inner-city communities. Structural equation modeling revealed that parental strain, assessed at Wave 1, predicted changes in mental health problems one year later, which in turn predicted parenting practices at Wave 3. These results suggest that parental strain can compromise a caregiver’s ability to parent effectively by impacting their mental health. Opportunities for intervention include helping caregivers process trauma and mental health problems associated with parental strain

Are Parental Involvement, Religiosity, and Relationship Quality Associated with Substance Use Messages in South African Families?

Using transcribed interviews from a GEO- and UKZN-funded study with a low-income, multi-ethnic sample in Durban, South Africa (N = 272), messages regarding what caregivers recall saying to their children about drug use were coded into one of eight categories by a trained research team. Categories included: Just the Facts, Real Examples, Resistance Tactics, Drugs are Bad, Negative Consequences, Encouraging Abstinence, Zero Tolerance, and Use Responsibly. The contributions of 1) parent religiosity, 2) parental involvement, and 3) parent-adolescent relationship quality to the message content were examined. Few overall differences in message content were found across the predictors suggesting that alternative approaches to analyses might be beneficial.https://scholarscompass.vcu.edu/uresposters/1229/thumbnail.jp

Adolescent Expressive Reluctance Exacerbates Risk for Substance Use Following Daily Hassles

Previous research has established a link between adolescent’s perceived daily hassles and subsequent adjustment, but less is known about factors that exacerbate this relationship. The purpose of the present study was to identify if adolescent’s reluctance to express emotions moderated the association between their perceived daily hassles and subsequent substance use (i.e., alcohol, marijuana, tobacco). Cross-sectional data were obtained from a larger study that examined the effects of exposure to community violence among low-income, urban adolescents (N = 260, Mage = 14.14, SD = 1.62 years; 92% African American; 54% female). Linear regression analyses controlling for adolescent age, biological sex, and previous levels of drug use and daily hassles revealed that expressive reluctance moderated the association between perceived daily hassles and adolescent substance use. Specifically, for adolescents who were least likely to express their emotions, increases in perceived daily hassles were associated with significant increases in substance use. Further examination of domain-specific hassles revealed that expressive reluctance moderated the effects of academic, parental, and general neighborhood hassles on drug use, while no significant effects were detected for hassles related to friends or neighborhood danger. The present findings clarify which perceived daily hassles adversely affect adolescents, and how emotional expression can play an integral role in determining risk for poor coping behaviors.https://scholarscompass.vcu.edu/uresposters/1280/thumbnail.jp

Adolescent attachment, family functioning and depressive symptoms

Background. Adolescence represents a challenging transitional period where changes in biological, emotional, cognitive and social domains can increase the risk of developing internalised problems including subthreshold depression. Adolescent-parent attachment style, perceived support and family functioning may increase risk for depressive symptoms or may reduce such risk. Adolescent-parent attachment, adolescent-perceived support from parents and family functioning were examined as correlates of depressive symptom presentation within this age group. Methods. Participants included a maternal parent and an adolescent (65.5% female) from each family. Adolescents were in Grade 7 (n=175) or Grade 10 (n=31). Data were collected through home interviews. The Self-Report of Family Inventory (SFI), Experiences of Close Relationships Scale (ECR), Network of Relationships Inventory (NRI), Children’s Depression Inventory (CDI) and Child Behavior Checklist (CBCL) were used to assess depression, parental support and attachment.  Results. Two models were examined: one with adolescent report of depressive symptoms as the outcome and a second with parent report of adolescent internalising symptoms as the outcome. The model predicting adolescent-reported depressive symptoms was significant with older age, higher levels of avoidant attachment, and higher levels of youth-reported dysfunctional family interaction associated with more depressive symptomatology. In the model predicting parent report of adolescent internalising symptoms only higher levels of dysfunctional family interaction, as reported by the parent, were associated with higher levels of internalising symptoms. Conclusion. Positive family communication, cohesion and support predictive of a secure parent-adolescent attachment relationship reduced the risk of a depressive symptom outcome. Secure adolescents were able to regulate their emotions, knowing that they could seek out secure base attachment relations within their family and from friends during times of stress, buffering against the development of depressive symptoms

Differentiating Sleep Problems Most Related to Depression and Anxiety in College Students

Sleep problems, anxiety and depression are common amongst college students. Researchers examined the specific sleep problems correlated with anxiety and depression. These sleep problems included sleep duration, sleep disturbances, sleep latency, daytime dysfunction, habitual sleep efficiency, overall sleep quality, and use of sleep medication. Researchers predicted that daytime dysfunction was the most important sleep problem related to greater anxiety symptoms, followed by overall quality of sleep, and sleep duration. Meanwhile, it was also predicted that daytime dysfunction would be the most important sleep problem and sleep latency the second most important sleep problem related to greater depressive symptoms. The study consisted of 561 undergraduate students (55% White, 69.9% female). Two multiple regression analyses were conducted. The first examined the most pertinent sleep problems related to greater anxiety symptoms in college students. The seven sleep problems described above were simultaneously entered into the model. The overall model showed significantly greater anxiety symptoms, F(7, 513) = 19.19, p \u3c .05. Together, these sleep problems accounted for 20.7% of the variance in greater anxiety symptoms. Daytime dysfunction due to sleepiness was the most strongly related to greater anxiety symptoms t(513) = 6.25, p \u3c .05, followed by overall sleep quality, t(513) = 2.27, p \u3c .05, followed by habitual sleep efficiency, t(513) = 2.26, p \u3c .05. The second multiple regression analysis was conducted to examine the relationship between sleep problems and depression symptoms. The same sleep problems were simultaneously entered into the model. The overall model showed the sleep problems significantly predicted depressive symptoms, F(7, 512) = 34.89, p \u3c .001. Together, these sleep problems accounted for 32.3% of the variance in depression symptoms. In order of importance, sleep duration, t(512) = 2.84, p \u3c .05, sleep disturbances, t(512) = 3.82, p \u3c .001, daytime dysfunction due to sleepiness, t(512) = 8.90, p \u3c .001, and overall sleep quality, t(512) = 2.14, p \u3c .05, were all significantly related to depression symptoms. These findings suggest that for individuals with anxiety or depressive symptoms targeting treatments that focus on daytime dysfunction and overall sleep quality may lead to a reduction in these symptoms. Additionally, specific to anxiety, we should focus on ameliorating habitual sleep efficiency by improving the amount of sleep individuals consistently receive. Conversely, in relation to depressive symptoms, future work should focus on increasing the amount of time people sleep and decreasing how much people awake while they are sleeping.https://scholarscompass.vcu.edu/uresposters/1183/thumbnail.jp

Use of prescription drugs and future delinquency among adolescent offenders

Non-medical use of prescription drugs (NMUPD) by adolescents is a significant public health concern. The present study investigated the profile of NMUPD in 1349 adolescent offenders from the Pathways to Desistance project, and whether NMUPD predicted future delinquency using longitudinal data. Results indicated that increased frequency and recency of NMUPD in adolescent offenders are related to some demographic factors, as well as increased risk for violence exposure, mental health diagnoses, other drug use, and previous delinquency, suggesting that severity of NMUPD is important to consider. However, ANCOVA analyses found that NMUPD was not a significant predictor of drug-related, non-aggressive, or aggressive delinquency 12 months later beyond other known correlates of delinquency. Age, sex, exposure to violence, lower socioeconomic status, more alcohol use, and having delinquency histories were more important than NMUPD in predicting future delinquency. These findings suggest that although NMUPD is an important risk factor relating to many correlates of delinquency, it does not predict future delinquency beyond other known risk factors

Post Traumatic Stress and Externalizing Behaviors in At Risk Urban Adolescents: A Prospective Study

Adolescents in in urban areas are at a higher risk for experiencing direct victimization as well as witnessing violence directed towards others, which increases the amount of post-traumatic stress (PTS) they face (Joseph, S., Mynard, H., & Mayall, M. 2000). Experiencing Post Traumatic Stress Disorder (PTSD) has been associated with a number of negative externalizing behaviors, such as increased delinquency, drug use and aggressive behavior in adolescents (Dierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., & Pynoos, R. S. 2013). This association is especially relevant, as adolescence is a stage where youth are beginning to experiment and form life-long habits to manage life stressors. However, previous research has been limited regarding gender differences in PTS as males and females often have different ways of coping with traumatic events (Stevens, Murphy, & McKnight, 2003). This study closes this gap by investigating the connection between PTS and externalizing behaviors in the form of delinquency, drug use, and aggression in a sample of urban, predominantly African American adolescents. Data for this study comes from the first two waves of Project COPE, a four-year longitudinal study on violence exposure, stress responses and adjustment who were recruited from low SES neighborhoods in Richmond, Virginia. The sample included 166 males (46.4%) and 192 females (53.6%), all of whom were in grades five or eight and between the ages of nine and sixteen (M=12.13, SD=1.62) at wave 1 of the study. The participants consisted primarily of African Americans (91%). During annual in home interviews, participants provided assessments of PTS using the Trauma Symptom Checklist for Children (TSCC) scale, and delinquency, aggressive behavior and drug use were assessed using the Problem Behavior Frequency Scales (PBFS). Linear regression analyses were conducted with and without gender as moderator. Results from this sample found no significant relationship between PTS and Delinquency (Beta=.074, p\u3e.05) or Drug use (Beta=.035, p\u3e.05) one year later. However, a significant relationship was found between PTS and aggressive behavior at year two (Beta=.185, p\u3c.05). Interactions with gender revealed that the patterns of association between PTS and aggressive behavior were similar for males and females. Contrary to previous research, our results show no increased risk of drug use or rule-breaking behavior in this sample of adolescents from high violence neighborhoods, for either males or females. It is possible that the effects were short-term in this case rather than lasting. However, the significant relationship of PTS with increased physical aggression for all youth sheds light on possible long-term consequences of PTS and underscores a need to address this specific risk in low SES, urban samples with high prevalence of PTS. The data from our research further adds to the existing consensus suggesting that low SES, urban adolescents, due to unavailable resources, has the possibility of behaviors reemerging as delinquent behaviors.https://scholarscompass.vcu.edu/uresposters/1179/thumbnail.jp

Whose depression relates to discrepancies? Testing relations between informant characteristics and informant discrepancies from both informants' perspectives

This study examined whether mothers’ and children’s depressive symptoms were each uniquely related to mother– child rating discrepancies on a multidimensional dyadic construct: domains associated with parental monitoring (i.e., Child Disclosure, Parental Knowledge, and Parental Solicitation). Participants included a community sample of 335 mother/female-caregiver and child dyads (182 girls, 153 boys; 9–16 years old). Children’s depressive symptoms were consistently related to each of the three domains of mother– child discrepancies. Mothers’ depressive symptoms were related to perceived discrepancies in two domains (Child Disclosure and Parental Knowledge). Furthermore, these relations could not be accounted for by other informant characteristics (maternal stress, child age, child gender, child ethnicity). Findings provide important empirical support for theory suggesting that both informants’ perspectives meaningfully contribute to their discrepancies in perceived behavior. Consideration of both informants’ perspectives leads to valuable information as to whether any particular characteristic is an important correlate of discrepancies.This work was supported, in part, by National Institute of Mental Health Grant F31 MH67540 (awarded to Andres De Los Reyes). It was also supported by National Institute on Drug Abuse Grant K01 DA015442 01A1 of the National Institutes of Health (awarded to Wendy Kliewer)

The Longitudinal Consistency of Mother–Child Reporting Discrepancies of Parental Monitoring and Their Ability to Predict Child Delinquent Behaviors Two Years Later

Correspondence regarding this manuscript should be addressed to Andres De Los Reyes, Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123H, College Park, MD 20742; 301-405-7049 (office); 301-314-9566 (fax); E-mail: [email protected] study examined the longitudinal consistency of mother–child reporting discrepancies of parental monitoring and whether these discrepancies predict children’s delinquent behaviors 2 years later. Participants included 335 mother/female-caregiver and child (46% boys,[90% African American; age range 9–16 years [M = 12.11, SD = 1.60]) dyads living in moderate-to-high violence areas. Mother–child discrepancies were internally consistent within multiple assessment points and across measures through a 2-year follow-up assessment. Further, mothers who at baseline consistently reported higher levels of parental monitoring relative to their child had children who reported greater levels of delinquent behaviors 2 years later, relative to mother–child dyads that did not evidence consistent discrepancies. This finding could not be accounted for by baseline levels of the child’s delinquency, maternal and child emotional distress, or child demographic characteristics. This finding was not replicated when relying on the individual reports of parental monitoring to predict child delinquency, suggesting that mother–child reporting discrepancies provided information distinct from the absolute frequency of reports. Findings suggest that mother–child discrepancies in reports of parental monitoring can be employed as new individual differences measurements in developmental psychopathology research.This work was supported, in part, by National Institutes of Health, National Institute on Drug Abuse Grants K01 DA015442 01A1 and R21DA020086-02 (awarded to Wendy Kliewer)