C. Debra M. Furr-Holden

Past 15-year trends in adolescent marijuana use: Differences by race/ethnicity and sex

BACKGROUND The potential for increases in adolescent marijuana use is an important concern given recent changes in marijuana policy. The purpose of this study was to estimate trends in marijuana use from 1999 to 2013 among a national sample of US high school students. We examine changes over time by race/ethnicity and sex. METHODS Data are from the National Youth Risk Behavior Survey (YRBS), which involves biennial, school-based surveys that generate nationally representative data about 9th-12th grade students in the United States. Students self-reported sex, race/ethnicity, and marijuana use (i.e., lifetime use, past 30-day use, any use before age 13). We generated national estimates of the prevalence of marijuana use for the time period, and also tested for linear and quadratic trends (n=115,379). RESULTS The prevalence of lifetime marijuana use decreased modestly from 1999 to 2009 (44% to 37%), and has increased slightly since 2009 (41%). Other marijuana use variables (e.g., past 30-day use) followed a similar pattern over time. The prevalence of past 30-day use from 1999 to 2013 for all groups and both sexes was 22.5%, and it was lowest among Asians and highest among American Indian/Alaska Natives. Although boys have historically had a higher prevalence of marijuana use, results indicate that male-female differences in marijuana use decreased over time. CONCLUSION Despite considerable changes in state marijuana policies over the past 15 years, marijuana use among high school students has largely declined. Continued surveillance is needed to assess the impact of policy changes on adolescent marijuana use.

Emerging Adults' Substance use and Risky Behaviors in Club Settings:

This article explores the prevalence of drug and alcohol use and related risks by attendees at electronic music dance events (EMDEs) in club settings. From six events located on the East and West Coasts, anonymous data were collected via self-report questionnaires, drug bioassays, and alcohol breath tests prior to entry (N = 240) and upon exit from the venues (N = 219). EMDEs were locations for identifying young adults who were aged 18 to 25 (70%), not college students (54%), and at risk for substance use. Nearly half of the sample (45%) were positive for drug use, and 60% were positive for alcohol use at entrance. Slightly more than one third (38%) were positive for drug use, and 59% were positive for alcohol use at exit. Only a small percentage of the sample converted from no use to drug use on premises (5.4%). Future investigations need to explore targeted substance use prevention strategies within this context.

Alcohol- and drug-involved driving in the United States: methodology for the 2007 National Roadside Survey.

This article describes the methodology used in the 2007 U.S. National Roadside Survey to estimate the prevalence of alcohol- and drug-impaired driving and alcohol- and drug-involved driving. This study involved randomly stopping drivers at 300 locations across the 48 continental U.S. states at sites selected through a stratified random sampling procedure. Data were collected during a 2-hr Friday daytime session at 60 locations and during 2-hr nighttime weekend periods at 240 locations. Both self-report and biological measures were taken. Biological measures included breath alcohol measurements from 9,413 respondents, oral fluid samples from 7,719 respondents, and blood samples from 3,276 respondents.

Neighborhood Drug Markets: A risk environment for bacterial sexually transmitted infections among urban youth

We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual-level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual-level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk.

Use of mobile phones, computers and internet among clients of an inner-city community psychiatric clinic.

Objective. Recent years have witnessed an expansion of Internet- and mobile-phone-based interventions for health promotion, yet few studies have focused on the use of technology by individuals with mental illness. This study examined the extent to which patients at an inner-city community psychiatry clinic had access to information and communications technology (ICT) and how they used those resources. Methods. Patients of an outpatient, inner-city community psychiatry program (N=189) completed a survey that included questions about demographics and ICT use which were adapted from an existing local population-based health survey (community sample, N=968). Frequencies of ICT use were assessed for the clinic sample and questions common to both the surveys completed by the clinic and community samples were compared using logistic regression. Results. Among clinic cases, 105 (55.6%) reported owning or using a computer, 162 (85.7%) reported owning or using a mobile phone, and 112 (59.3%) reportedf using the Internet. Among those who used mobile phones, the majority reported using them daily; 42% of those who used the Internet reported using it several times per day. Differences in frequency of Internet use between samples were not significant, but clinic participants used the Internet more intensively to email, instant message, access health information, and use social media sites. Conclusions. A majority of patients in this community psychiatry clinic sample use ICT. Greater access to and use of the Internet by those with mental illness has important implications for the feasibility and impact of technology-based interventions. (Journal of Psychiatric Practice 2014;20:94–103)

“Unplugged”: A school-based randomized control trial to prevent and reduce adolescent substance use in the Czech Republic

BACKGROUND The Czech Unplugged Study, inspired by the European Drug Addiction Prevention Trial, is a prospective, school-based, randomized controlled prevention trial designed to reduce the risk of alcohol, tobacco, inhalant, and illegal drug use in 6th graders in the Czech Republic. The intervention uses the comprehensive social influence model to affect alcohol and drug using norms among primary school students. METHODS Descriptive statistics and chi-square analyses were used to assess differences between the experimental and control groups on demographic characteristics and study outcomes. Multilevel techniques were used to take the hierarchical structure of the data into account. Prevalence odds ratios using the Bonferroni correction were calculated to assess the differences between the experimental (N = 914) and control (N = 839) groups on each outcome 1, 3, 12, 15, and 24 months after the end of the intervention. RESULTS Multilevel analysis using the Bonferroni correction showed statistically significant intervention effects at the final follow-up for any smoking (OR = 0.75, 99.2% CI 0.65-0.87), daily smoking (OR = 0.62, 99.2% CI 0.48-0.79), heavy smoking (OR = 0.48, 99.2% CI 0.28-0.81), any cannabis use (OR = 0.57 99.2% CI 0.42-0.77), frequent cannabis use (OR = 0.57, 99.2% CI 0.36-0.89), and any drug use (OR = 0.78, 99.2% CI 0.65-0.94). CONCLUSIONS This study adds new evidence on the effectiveness of the Unplugged school-based prevention program for primary school students in the Czech Republic.

Finding Significant Stress Episodes in a Discontinuous Time Series of Rapidly Varying Mobile Sensor Data

Management of daily stress can be greatly improved by delivering sensor-triggered just-in-time interventions (JITIs) on mobile devices. The success of such JITIs critically depends on being able to mine the time series of noisy sensor data to find the most opportune moments. In this paper, we propose a time series pattern mining method to detect significant stress episodes in a time series of discontinuous and rapidly varying stress data. We apply our model to 4 weeks of physiological, GPS, and activity data collected from 38 users in their natural environment to discover patterns of stress in real life. We find that the duration of a prior stress episode predicts the duration of the next stress episode and stress in mornings and evenings is lower than during the day. We then analyze the relationship between stress and objectively rated disorder in the surrounding neighborhood and develop a model to predict stressful episodes.

Neighborhood Environment and Urban African American Marijuana Use during High School

African American male high school students have the highest rates of marijuana use among all racial, ethnic, and gender groups, yet there is limited research examining contextual factors salient to the African American community. The purpose of this study was to examine how neighborhood environment measured in 8th grade is related to longitudinal transitions in marijuana use during high school (9th to 12th grades) in a sample of urban African Americans. Four hundred and fifty-two African American children were interviewed annually beginning in 1st grade as part of a longitudinal field study in Baltimore city. Latent transition analysis indicated early in high school posed the greatest risk for initiation and progression of marijuana use. Community violence exposure was associated with an increased likelihood of transitioning from no marijuana use to infrequent use (adjusted odds ratios (AOR) = 2.40, p < 0.001). Higher perceived neighborhood disorder (AOR = 3.20, p = 0.004), drug activity and sales in the neighborhood (AOR = 2.28, p = 0.028), and community violence exposure (AOR = 4.54, p < 0.001) were associated with an increased risk of transitioning from no use to frequent/problematic marijuana use. There was evidence for partial mediation of these associations by perceptions of harm and depressed mood. Drug activity and sales was associated with progression from infrequent to frequent and problematic use (AOR = 2.87, p = 0.029). African American youth living in urban environments with exposure to drug activity, violence, and neighborhood disorder are at increased risk for both initiation and progression to more frequent and problematic marijuana use during high school. These findings highlight the need to develop interventions for African American youth that are mindful of the impact of the additional stressors of living in a high-risk urban environment during a critical developmental transition period. Reducing exposure to drug activity and violence in high-risk urban neighborhoods may be the first step to potentially halt increasing rates of marijuana use among African Americans.

Disordered Neighborhood Environments and Risk-Taking Propensity in Late Childhood Through Adolescence

PURPOSE/METHODS To investigate the relationship between childhood neighborhood environment and risk-taking propensity in adolescence by using an objective environmental measure and a laboratory-based risk-taking propensity measure. RESULTS Childhood neighborhood disorder predicted risk-taking propensity on a behavioral measure during early adolescence (β = 1.8, p < .01). CONCLUSION Early toxic environments affect laboratory-based behavioral manifestations of risk.

Neighborhood Environment and Marijuana Use in Urban Young Adults

Risk factors for marijuana use in older adolescents and young adults have focused primarily on family environment and peer affiliation. A growing body of work has examined the relationship between environmental context and young adult substance use. This study builds on previous research linking neighborhood environment to young adult marijuana use by exploring two distinct features of neighborhoods, namely the physical (e.g., broken windows) and social environment (e.g., adults watching youth). Data were obtained from a longitudinal sample of 398 predominately African American young adults living in an urban environment. The data also included observational measures of physical and social order and disorder collected on the young adult’s residential block. Exploratory structural equation modeling (ESEM) was utilized to test hypothesized relationships between these two features of the neighborhood environment and past year young adult marijuana use. A two-factor model of neighborhood environment with good fit indices was selected (CFI = 0.97, RMSEA = 0.037). There was a positive and significant direct effect from neighborhood physical disorder to marijuana use (0.219, p < 0.05) controlling for gender, race, and free and reduced price meal (FARPM) status. The direct effect from neighborhood social environment to marijuana use was not significant. These results converge with previous research linking vacant housing with young adult marijuana use but do not provide empirical support for the neighborhood social environment as a determinant of drug taking. Better explication of the social environment is needed to understand its relationship to drug use.