Lynn Hernandez

Identity Distress and Adjustment Problems in At-Risk Adolescents

This study assessed the usefulness of the Identity Distress Scale (IDS), a measure modeled after the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM–III–R]; American Psychiatric Association, 1987) defined Identity Disorder, by investigating links between identity distress and poor psychological adjustment in at-risk middle adolescents. A significant proportion (16%) met DSM–III–R criteria for Identity Disorder, and 34% met the more liberal criteria for Identity Problems as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Significant associations were found between identity distress and both internalizing and externalizing symptoms. The IDS appears to be useful for identifying youth experiencing significant difficulties in developing an identity and for exploring links between Identity Problems and other areas of psychological functioning.

Alcohol Use Among Hispanic Early Adolescents in the United States: An Examination of Behavioral Risk and Protective Profiles

Few studies have examined the behavioral and protective correlates of alcohol use among young Hispanics. Using a national sample (N = 7,606), logistic regression and latent profile analysis (LPA) are employed to examine the relationships between alcohol use, psychosocial factors, and externalizing behavior among Hispanics during early adolescence. Early drinkers are more likely to report truancy, fighting, smoking, and drug use. LPA results revealed a three class solution. Classes identified included: psychosocial risk (41.11%), moderate protection (39.44%), and highly religious (19.44%). Alcohol use is clearly associated with externalizing behavior; however, an important degree of psychosocial and behavioral heterogeneity nevertheless exists.

The Significance of Marijuana Use Among Alcohol-using Adolescent Emergency Department Patients

OBJECTIVES The objective was to determine if adolescents presenting to a pediatric emergency department (PED) for an alcohol-related event requiring medical care differ in terms of substance use, behavioral and mental health problems, peer relationships, and parental monitoring based on their history of marijuana use. METHODS This was a cross-sectional comparison of adolescents 13-17 years old, with evidence of recent alcohol use, presenting to a PED with a self-reported history of marijuana use. Assessment tools included the Adolescent Drinking Inventory, Adolescent Drinking Questionnaire, Young Adult Drinking and Driving Questionnaire, Center for Epidemiologic Studies Depression Scale, Behavioral Assessment System for Children, and Peer Substance Use and Tolerance of Substance Use Scale. RESULTS Compared to adolescents using alcohol only (AO), adolescents who use alcohol and marijuana (A+M) have higher rates of smoking (F = 23.62) and binge drinking (F = 11.56), consume more drinks per sitting (F = 9.03), have more externalizing behavior problems (F = 12.53), and report both greater peer tolerance of substance use (F = 12.99) and lower parental monitoring (F = 7.12). CONCLUSIONS Adolescents who use A+M report greater substance use and more risk factors for substance abuse than AO-using adolescents. Screening for a history of marijuana use may be important when treating adolescents presenting with an alcohol-related event. A+M co-use may identify a high-risk population, which may have important implications for ED clinicians in the care of these patients, providing parental guidance, and planning follow-up care.

Identity Development and Intervention Studies: The Right Time for a Marriage?

A cohesive identity plays a key role in mental health and well-being. Yet, few studies involving identity have been intervention studies, and few intervention studies have included identity-related variables. In this article, we speculate about why this might be so. We argue that intervention research with young people will be more informative when variables tapping key developmental processes and outcomes such as identity cohesion, style, distress, and turning points are included. Such research can (a) promote positive identity development as an important aim, (b) illuminate processes of identity-related change, and (c) add knowledge about for whom interventions work and why they work, through identitys mediating or moderating effects. We argue that these integrative steps will make treatment and prevention interventions for young people more effective and potent.

Acculturation Stress and Drinking Problems Among Urban Heavy Drinking Latinos in the Northeast

This study investigates the relationship between the level of acculturation and acculturation stress and the extent to which each predicts problems related to drinking. Hispanics who met criteria for hazardous drinking completed measures of acculturation, acculturation stress, and drinking problems. Sequential multiple regression was used to determine whether the levels of self-reported acculturation stress predicted concurrent alcohol problems after controlling for the predictive value of the acculturation level. Acculturation stress accounted for a significant variance in drinking problems, while adjusting for acculturation, income, and education. Choosing to drink in response to acculturation stress should be an intervention target with Hispanic heavy drinkers.

Culturally adapted motivational interviewing for Latino heavy drinkers: results from a randomized clinical trial.

A randomized clinical trial of culturally adapted and unadapted motivational interviewing to reduce drinking and related problems among heavy drinking Latinos assessed 57 participants at baseline and at 2 (86% retention) and 6 months (84% retention) after treatment. Significant decreases across both treatments were found in heavy drinking days per month and drinking consequences (p < .001), with greater reductions for drinking consequences for culturally adapted motivational interviewing at 2 months (p = .009) and continuing reductions in culturally adapted motivational interviewing at 6 months. Findings provide preliminary support for the value of cultural adaptation to enhance the efficacy of motivational interviewing with Latino heavy drinkers.

Alcohol Use History Differentiates Adolescents Treated in the Emergency Department After an Alcohol-Related Incident

Objectives: The current study compared 3 groups of adolescents identified in an emergency department (ED) following an alcohol-related event: (1) alcohol-positive adolescents scoring at or above the clinical cutoff on a measure of problematic drinking, the Adolescent Drinking Inventory (ADI) (n = 45); (2) alcohol-positive adolescents scoring below the clinical cutoff on the ADI (n = 68), and (3) alcohol-negative adolescents (n = 64). We examined whether these 3 groups of adolescents differed on measures of substance use as well as psychosocial factors. Methods: Participants were recruited as part of a larger clinical trial. Alcohol-positive adolescents were recruited from a level I regional trauma center for treatment related to an alcohol-related incident. Alcohol-negative adolescents were recruited from the ED and the community. The data reported here were from the baseline adolescent and parent assessments. Before completing assessments, adolescents were required to pass a brief mental status examination. Results: Adolescents in the alcohol-positive, high-ADI group reported significantly more substance use, peer substance use, and peer tolerance of substance use than adolescents in the alcohol-positive, low-ADI group followed by adolescents in the alcohol-negative group. Adolescents in the alcohol-positive, high-ADI group reported significantly less parental supervision than adolescents in the other 2 groups. Conclusions: These findings underscore that alcohol-positive adolescents being treated in an ED are a heterogeneous group with respect to substance use as well as parent and peer risk factors. Physicians need to consider relevant background factors when making individualized discharge recommendations.

Improving parenting and parent-teen communication to delay or prevent the onset of alcohol and drug use in young adolescents with emotional/behavioral disorders: A pilot trial.

This study examined the feasibility and preliminary efficacy of a brief parent-based prevention intervention to delay or prevent the initiation of alcohol and drug use in young adolescents with emotional/behavioral disorders. Findings from a small randomized clinical trial comparing the individualized family substance use preventive intervention based on the Family Check-Up model (FCU condition) to a Psychoeducation (PE) session revealed that parents in both conditions reported an increase in alcohol-related communication at three and six months as well as an increase in general family communication. Parents in the FCU condition reported an increase on overall substance-related communication, and reported experiencing less problematic family communication compared to those in PE. Parents in the PE condition reported greater increases in parental monitoring than parents in the FCU condition. Study findings suggest a larger trial is indicated to test individual and family factors that lead to differential efficacy of these preventive interventions.

Brief Family-Based Intervention for Substance Abusing Adolescents

Research has shown that a lack of parental involvement in their childrens activities predicts initiation and escalation of substance use. Parental monitoring and supervision, parent-child communication including communication regarding beliefs and disapproval of substance use, positive parenting, and family management strategies, have been shown to protect against adolescent substance abuse and related problems. Family and parenting approaches to preventing and intervening on adolescent substance abuse have received support in the literature. This article discusses the theoretical foundations as well as the application of the Family Check-up, a brief, family-based intervention for adolescent substance use.

Effects of a brief, parent-focused intervention for substance using adolescents and their sibling

The purpose of this study was to evaluate the efficacy of the Family Check-up (FCU), a parent-focused brief motivational intervention, in families where parents were concerned about one adolescents alcohol or marijuana use and the referred adolescent also had a sibling close in age. The primary goal of the FCU was to provide individualized feedback on specific parenting skills, including monitoring and supervision, limit setting, and alcohol-related communication. A total of 92 adolescents (37 female) between the ages of 12-19years of age along with a sibling (48 female) between the ages of 11-21years old, were randomized to the FCU or a psychoeducation (PE) comparison condition. Findings indicated that the FCU did not produce better effects on alcohol and other drug use outcomes than the PE condition, in either the adolescent or sibling. Brief interventions addressing parenting behaviors may not be sufficient to reduce alcohol use in adolescent drinkers not referred due to an alcohol-related incident. Future research might be conducted to explore whether brief parent interventions, such as those in the present study, could be useful as a preventive intervention for parents whose teens report low levels of substance use.