Sarah A. Stoddard

Adolescent Resilience: Promotive Factors That Inform Prevention

Resilience theory provides a framework for studying and understanding how some youths overcome risk exposure and guides the development of interventions for prevention using a strengths-based approach. In this article, we describe basic concepts of the theory, such as promotive factors, and distinguish assets and resources that help youths overcome the negative effects of risk exposure. We also present three models of resilience theory-compensatory, protective, and challenge-and review empirical research on three promotive factors-ethnic identity, social support, and prosocial involvement-that include individual, family, and community levels of analysis and have modifiable qualities for informing interventions. Finally, we present examples of how research findings from the three promotive factors can be translated into interventions to enhance youth development.

Social Connections, Trajectories of Hopelessness, and Serious Violence in Impoverished Urban Youth.

Youth living in impoverished urban neighborhoods are at risk for becoming hopeless about their future and engaging in violent behaviors. The current study seeks to examine the longitudinal relationship between social connections, hopelessness trajectories, and subsequent violent behavior across adolescence. Our sample included 723 (49% female) African American youth living in impoverished urban neighborhoods who participated in the Mobile Youth Survey from 1998 through 2006. Using general growth mixture modeling, we found two hopelessness trajectory classes for both boys and girls during middle adolescence: a consistently low hopelessness class and an increasingly hopeless class with quadratic change. In all classes, youth who reported stronger early adolescent connections to their mothers were less hopeless at age 13. The probability of later adolescent violence with a weapon was higher for boys and was associated with the increasingly hopeless class for both boys and girls. Implications for new avenues of research and design of hope-based prevention interventions will be discussed.

Clinical measurement of limb spasticity in adults: state of the science.

ABSTRACT Spasticity is a neuromuscular dysfunction characterized by tight or stiff muscles. Spasticity occurs across the spectrum of upper motor neuron disease and complicates the course and quality of life of those affected. Accurate and precise assessment of spasticity is the first step in providing safe and effective treatments to patients for management of spasticity. Examiner evaluations (Ashworth Scale, Modified Ashworth, and Visual Analog Scale) and patient self-reports (Visual Analog Scale and Numeric Rating Scale) are used to assess spasticity in clinical practice. We reviewed the biology of spasticity and summarized research that assessed properties of scores obtained from clinical scales when used in a variety of upper motor neuron diseases. The definition of spasticity was inconsistent. Rater reliability or agreement on clinical scales varied widely. Correspondence with electromyogram results was mixed. There was dissimilarity in patient reports and examiner assessments. Scores from clinical scales are responsive (decrease after initiation of treatment with known effectiveness), but the utility of scores for indexing individual change associated with the natural history of upper motor neuron disease is unknown. Future research incorporating patient reports and examiner findings over time will help to clarify the definition and capture the essence of spasticity.

Depressive symptoms, social support, and violence exposure among urban youth: a longitudinal study of resilience

Depression is a serious mental health concern among adolescents. Violence exposure is a potent risk factor for depression. Social support may help reduce depression risk, even when adolescents are exposed to violence. Using a compensatory model of resilience, we investigate the influence of violence exposure and social support on depression over time in a sample of urban youth during the high school years (N = 824, 52% female, mean age Year 1 = 14.9). We used growth curve modeling to examine depressive symptoms across adolescence and its association with violence exposure and social support, accounting for important sociodemographic characteristics (sex, socioeconomic status, and race/ethnicity). Depressive symptoms on average increase from Year 1 to 2 of high school and then are stable or decline from Years 2 to 4. Violence observation and conflict in the family were each associated with increased depressive symptoms during the high school years. Mother support was associated with decreased depressive symptoms over time. Our results support a compensatory model of resilience. Promoting positive parent-child communication among urban youth living in disadvantaged contexts may help reduce the probability that exposure to violence will result in depressive symptoms.

Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976–2015

National trends in medical and nonmedical use of prescription opioids among US adolescents overall and in different sociodemographic subgroups were examined between 1976 and 2015. OBJECTIVES: Most US studies of national trends in medical and nonmedical use of prescription opioids have focused on adults. Given the limited understanding in these trends among adolescents, we examine national trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015. METHODS: The data used for the study come from the Monitoring the Future study of adolescents. Forty cohorts of nationally representative samples of high school seniors (modal age 18) were used to examine self-reported medical and nonmedical use of prescription opioids. RESULTS: Lifetime prevalence of medical use of prescription opioids peaked in both 1989 and 2002 and remained stable until a recent decline from 2013 through 2015. Lifetime nonmedical use of prescription opioids was less prevalent and highly correlated with medical use of prescription opioids over this 40-year period. Adolescents who reported both medical and nonmedical use of prescription opioids were more likely to indicate medical use of prescription opioids before initiating nonmedical use. CONCLUSIONS: Prescription opioid exposure is common among US adolescents. Long-term trends indicate that one-fourth of high school seniors self-reported medical or nonmedical use of prescription opioids. Medical and nonmedical use of prescription opioids has declined recently and remained highly correlated over the past 4 decades. Sociodemographic differences and risky patterns involving medical and nonmedical use of prescription opioids should be taken into consideration in clinical practice to improve opioid analgesic prescribing and reduce adverse consequences associated with prescription opioid use among adolescents.

Substance use and Violence among Youth: A Daily Calendar Analysis

Background: While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. Objective: This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. Methods: Data were collected from Emergency Department (ED) patients (ages 14–24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). Results: Conflict over ‘personal belongings’ was a common reason for violence among males; ‘jealousy’/‘rumors’ were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. Conclusions: Results suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.

Dating Violence Among Male and Female Youth Seeking Emergency Department Care

STUDY OBJECTIVE We determine prevalence and correlates of dating violence, dating victimization, and dating aggression among male and female patients aged 14 to 20 years seeking emergency department (ED) care. METHODS This was a systematic sampling of subjects aged 14 to 20 years seeking care at a single large academic ED between September 2010 and March 2013. Participants completed a computerized, self-administered, cross-sectional survey of demographics, dating violence from physical abuse measures of the Conflict in Adolescent Dating Relationships Inventory, associated behaviors, and ED health service use. Separate analyses were conducted for male and female patients. RESULTS Four thousand three hundred eighty-nine youths (86.1% participation rate) were screened, and 4,089 (mean age 17.5 years; 58% female patients) were eligible for analysis. Almost 1 in 5 female patients (n=215; 18.4%) and 1 in 8 male patients (n=212; 12.5%) reported past-year dating violence. Of female patients, 10.6% reported dating victimization and 14.6% dating aggression, whereas of male patients, 11.7% reported dating victimization and 4.9% reported dating aggression. Multivariate analyses showed that variables associated with any male dating violence were black race (adjusted odds ratio [AOR] 2.26; 95% CI 1.54 to 3.32), alcohol misuse (AOR 1.03; 95% CI 1.00 to 1.06), illicit drug use (AOR 2.38; 95% CI 1.68 to 3.38), and depression (AOR 2.13; 95% CI 1.46 to 3.10); any female dating violence was associated with black race (AOR 1.68; 95% CI 1.25 to 2.25), public assistance (AOR 1.64; 95% CI 1.28 to 2.09), grades D and below (AOR 1.62; 95% CI 1.07 to 2.43), alcohol misuse (AOR 1.04; 95% CI 1.02 to 1.07), illicit drug use (AOR 2.85; 95% CI 2.22 to 3.66), depression (AOR 1.86; 95% CI 1.42 to 2.44), and any past year ED visit for intentional injury (AOR 2.64; 95% CI 1.30 to 5.40). CONCLUSION Nearly 1 of 6 male and female patients aged 14 to 20 years and seeking ED care report recent dating violence, and health disparities remain among this population. Dating violence was strongly associated with alcohol, illicit drug use, and depression and correlated with previous ED service use among female youths. ED interventions should consider addressing these associated health conditions, as well as improving screening protocols to address dating violence among male and female youths.

Association of Interpersonal Violence With Self-Reported History of Head Injury

OBJECTIVE: The purpose of this study was to examine differences in interpersonal violence among individuals who reported a head injury compared with those who did not report a head injury. METHODS: We used data from an 8-year longitudinal study of youth selected by their grade point average to study those at-risk for high school dropout in 4 public high schools in a Midwestern city (N = 850). Participants were followed up from mid-adolescence to the transition into young adulthood. One-way analyses of variance were used to test for differences in levels of interpersonal violence, and repeated measures multivariate analyses of variance were used to assess differences in levels of violence over time among participants based on reports of head injury. A series of multivariate regression analyses examined whether head injury was associated with subsequent violent behavior. RESULTS: Participants who had ever experienced a head injury before young adulthood reported more interpersonal violence in young adulthood than participants who had never had a head injury. In multivariate analyses, respondents who had a head injury in the past year reported more subsequent interpersonal violence than respondents who had not had a head injury. CONCLUSION: Our findings support other studies that link history of head injury to later interpersonal violence.

Adolescent condom use consistency over time: global versus partner-specific measures.

Background: The conundrum of measuring condom use consistency, particularly with adolescents, has left researchers with a cacophony of strategies, thereby limiting comparability and interpretation. Objective: The aim of this analysis was to compare and contrast two measures of condom use consistency, global versus partner specific, and their relationships with key covariates, using trajectory groups differentiated by stability of condom use consistency over three time points. Method: Using self-report data from sexually active girls (aged 13-17 years) in a clinic-based intervention study aimed at lowering risk for early pregnancy, this analysis compared two measures of self-reported condom use consistency: (a) a global measure: overall condom use consistency in the past 6 months and (b) a partner-specific measure: condom use consistency with the most recent sex partner in the last 6 months. Using a subjective rule-based approach, the adolescent girls in the study (n = 151) were classified into trajectory groups representing their condom use consistency at three time points (baseline and 6 and 12 months). Then, using bivariate methods, trajectory groups were compared on four baseline covariates (age, treatment condition, hormonal use in the last 6 months, and number of sex partners in the last 6 months) and three time-varying covariates measured at baseline and at 6 and 12 months (hormonal use stability, stability of primary sex partner, and stability of number of sex partners). Results: For the trajectory groups formed using the global measure of condom use consistency, stability of the primary sex partner differed significantly between trajectory groups. For the partner-specific trajectory groups, two baseline and one time-varying covariate relationships were significant: hormonal use in the 6 months prior to baseline, number of sex partners in the past 6 months (baseline), and stability of the primary sex partner (time varying), with hormonal use stability (time varying) trending toward significance. Discussion: The larger number of significant covariate relationships with the partner-specific trajectory groups suggests greater utility in assessing partner-linked behavior rather than a global measure. Despite limitations of the analytic strategy, this study sheds light on a measurement conundrum that has been an obstacle to comparing and contrasting indicators of condom use consistency during adolescence.

The effect of neighborhood context on the relationship between substance misuse and weapons aggression in urban adolescents seeking ED care

Background: Frameworks for studying the ecology of human behavior suggest that multiple levels of the environment influence behavior and that these levels interact. Applied to studies of weapons aggression, this suggests proximal risk factor (e.g., substance use) effects may differ across neighborhoods. Objectives: To estimate how the association between weapons aggression and substance use varies as a function of several community-level variables. Methods: Individual-level measures (demographics, behavioral measures) were obtained from a survey of youth aged 14–24 years old seeking care at a Level-1 ED in Flint, Michigan. Community-level variables were obtained from public sources. Logistic generalized additive models were used to test whether community-level variables (crime rates, alcohol outlets, demographics) modify the link between individual-level substance use variables and the primary outcome measure: self-reported past 6-month weapon (firearm/knife) related aggression. Results: The effect of marijuana misuse on weapons aggression varied significantly as a function of five community-level variables: racial composition, vacant housing rates, female headed household rates, density of package alcohol outlets, and nearby drug crime rates. The effect of high-risk alcohol use did not depend on any of the eight community variables tested. Conclusions: The relationship between marijuana misuse and weapons aggression differed across neighborhoods with generally less association in more disadvantaged neighborhoods, while high-risk alcohol use showed a consistently high association with weapons aggression that did not vary across neighborhoods. The results aid in understanding the contributions of alcohol and marijuana use to the etiology of weapon-related aggression among urban youth, but further study in the general population is required.