The Role of Pregnancy Concerns in the Relationship between Substance Use and Unprotected Sex among Adolescents

BACKGROUND: Substance use and unprotected sex are prevalent among adolescents. The link between substance use and unprotected sex is well-established. Research has also highlighted how adolescents' attitudes and risk perceptions regarding unprotected sex, including concerns about pregnancy ("Getting pregnant would force me to grow up too fast"), are associated with unprotected sex and unplanned pregnancy. However, less research has examined the potential relationship between pregnancy concerns and substance use among adolescents. OBJECTIVES: The study prospectively examined (1) differences in pregnancy concerns across patterns of substance use and (2) whether pregnancy concerns mediate the relationship between substance use and later unprotected sex among a sample of middle and high school students. METHOD: 98 adolescents [M(SD) age = 14.28(1.68), 59.4% female, 59.4% black/African American] completed self-report measures of marijuana and alcohol use, pregnancy concerns, and unprotected sex across three time points over 6 months (T1-T3). RESULTS: Substance users (alcohol/marijuana) reported fewer pregnancy concerns compared to non-substance users (t = 2.99, p = .04). Pregnancy concerns at T2 mediated the relationship between T1 lifetime substance use and later unprotected sex (T3) (indirect effect: b = 0.10, CI[.01-.41]; direct effect: b = 0.15, p = .32), controlling for gender, age, and race. More frequent substance use (T1) was related to fewer pregnancy concerns at T2 (b = -0.10, p = .04); fewer pregnancy concerns were related to increased likelihood of later unprotected sex (b = -1.02, p = .02). CONCLUSIONS: Findings offer new insight into associations between substance use and unprotected sex and suggest that substance use and sexual health interventions should target pregnancy concerns

Mental Health Screenings in Juvenile Detention Centers: Predictors of Mental Health Service Utilization and Recidivism

poster abstractIntroduction: About 2 in 3 detained adolescents meet criteria for mental illness. Unfortunately, the juvenile justice system does not consistently provide mental health services for juveniles in need. As a result, juvenile adolescents have low rates of treatment utilization, high rates of recidivism, and a mortality rate 4 times greater than the general population. To understand these issues, the current study tracked a sample of detained adolescents for six months post-detention. Methods: 2089 adolescents held in a detention center completed a mental health screener. The prevalence of youths with different mental health problems was calculated. Logistic regression analyses were conducted to determine predictors of service utilization and recidivism at 3- and 6-month follow-up. Results: Altogether, 1707 (81.7%) reported trauma, 561 (26.9%) endorsed alcohol/drug use, and 393 (18.8%) endorsed significant thought disturbances. Post-detention, 336 (16.1%) utilized mental health services and 770 (36.9%) re-offended. Regression analyses indicated: (1) Hispanic youths, males, and older youths were significantly less likely to utilize services (OR=.37, p=.015 for Hispanic; OR=.53, p <.001 for males; OR=.842, p <.001 for older); (2) youths with anger problems were more likely to utilize services (OR=1.08, p=.011); (3) racial/ethnic minorities were significantly more likely to recidivate (OR=1.12, p=.009); (4) alcohol/drug use increased the likelihood of recidivism (OR=1.12, p<.001); and (5) youths who utilized services were no less likely to recidivate (OR=1.22, p=.116). Conclusions: Juveniles with mental illness problems are not getting the treatment services they need. Furthermore, Hispanic, male, and older youths were less likely to utilize services, minority youths were more likely to be re-arrested, and service use did not impact recidivism. Findings suggest gaps and disparities in mental health services for juvenile adolescents. The juvenile justice system needs to improve public policies and develop mechanisms to ensure all juveniles have an equal opportunity to receive effective mental health services

Social Support as a Buffer Between Discrimination and Cigarette Use in Juvenile Offenders

Cigarette use is a prominent problem in juvenile offenders, leading to negative health outcomes and substance use. One interesting precipitator of cigarette use in this population is discrimination. Social support could potentially buffer the positive relationship between cigarette use and discrimination in juvenile offenders, which could be dependent on the context in which the discrimination is experienced, such as peer, institutional (e.g., stores, restaurants), or educational contexts. The present study explored the relationship between three types of discrimination, social support, and smoking outcomes among 112 detained and probated juvenile offenders (mean age = 16.24, SD = 2.11, 29.2% female, 54.9% Caucasian, 40.4% detention, 53.8% smokers). Results indicated that the relationship between institutional discrimination (OR = − 0.10, p = 0.005) and peer discrimination (OR = − 0.11, p = 0.01) were significantly moderated by social support, with a higher likelihood of being a smoker, compared to a non-smoker at higher levels of peer and institutional discrimination. Further, based on a moderated regression analysis, results indicated that youth who experienced greater educational discrimination and lower levels of social support, they were at higher risk of nicotine addiction (b = − 0.09, p = 0.03). Overall, results indicate that varying avenues of social support, such as parent, peer, and teacher support, can mitigate negative effects of discrimination on juvenile offenders, particularly cigarette use. Addressing discrimination in smoking treatment and prevention in juvenile offenders may be of great utility. Future studies should examine the potential mechanisms underlying the discrimination and cigarette use connection in juvenile offenders

Improving police officer and justice personnel attitudes and de-escalation skills: A pilot study of Policing the Teen Brain

This pilot study assessed whether police officers and juvenile justice personnel reported improved attitudes toward youth and knowledge about de-escalation skills after attending Policing the Teen Brain, a training created to prevent arrests by improving officer-youth interactions. Pre- and post-intervention surveys asked about participant attitudes toward adolescents, adolescence as a stressful stage, and punishing youth in the justice system. Among the 232 participants, paired sample t-tests indicated significant differences between mean pre- and post-survey responses on nearly all survey subscales. A hierarchical regression model significantly predicted improvement in knowledge, with educated, female participants most likely to improve knowledge of de-escalation skills

Associations between child and sibling levels of vigorous physical activity in low-income minority families

AbstractBackground and objectivesA child's level of habitual physical activity is partly determined by a familial component, but the literature is limited regarding sibling influences. Multiple studies suggest that targeting siblings is an effective strategy for improving child health behaviors.Patients and methodsWe analyze Moving to Opportunity for Fair Housing (MTO) data to study associations between the odds of a child attaining 20 min or more of vigorous physical activity at least 3 days every week and parallel measures from an older sibling and a parent. We include covariates representing the social environment such as household income and neighborhood safety.ResultsThere were 1347 study units that consisted of a child (age 11.2 y ± 2.6), an older sibling (age 14.8 y ± 2.8), and a parent (age 38.3 y ± 7.5). A child's odds of vigorous physical activity for 20 min or more was increased if the older sibling (OR 1.67; 95% CI 1.32–2.11) or parent (OR 1.36; 95% CI 1.08–1.72) had a comparable activity level compared to children whose older siblings or parents did not exhibit a comparable level of activity.ConclusionsA younger sibling's level of physical activity is positively associated with an older sibling's and/or parent's level of physical activity. Family-based approaches, especially those incorporating siblings, may be effective at increasing physical activity in children

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)

Detained Adolescents: Mental Health Needs, Treatment Use, and Recidivism

Objective: Although approximately 60%-70% of detained adolescents meet criteria for a mental disorder, few receive treatment upon community reentry. Given that mental health treatment can potentially reduce recidivism, the study examined detained adolescents’ mental health needs and their post-detention mental health treatment and recidivism. Method: Altogether, 1574 adolescents (<18 years) completed a mental health screener at a detention center. Scores on the screener, mental health treatment utilization (60-days post-detention), and recidivism (6-months post-detention) were measured. Results: About 82.2% of adolescents earned elevated scores on the mental health screener, but only 16.4% utilized treatment and 37.2% recidivated. Logistic regression models revealed adolescents with insurance and higher Angry-Irritable scores were significantly more likely to obtain treatment, whereas males, Black adolescents, older adolescents, and adolescents endorsing a trauma history were less likely. Black adolescents, insured adolescents, and adolescents with higher Alcohol/Drug Use scores were significantly more likely to recidivate. Mental health treatment increased the likelihood of recidivism. Discussion: The prevalence of mental health needs among DAs was high, but treatment utilization was low, with notable treatment disparities across race, gender, and age. The use of mental health treatment predicted recidivism, suggesting treatment may act as a proxy measure of mental health problems. Future research should assess the impact of timely and continuous mental health services on recidivism