"I've smoked weed with my daughter": Cannabis Use within Families Affected by Parental Opioid Misuse.

Youth with parents who use opioids are more likely to engage in early substance use, especially cannabis use. The purpose of this study was to describe the context of cannabis use among families affected by parental opioid misuse. We conducted 25 in-depth interviews with families affected by parental opioid misuse. Participants were parents with a history of opioid misuse and young adults (ages 18-24) who had parents with a history of opioid misuse. Interviews were digitally recorded and professionally transcribed. Data were analyzed inductively using a qualitative content analytic approach. Familial cannabis use was common among young people and their parents. Participants described familial cannabis use as a bonding activity that felt safe and lightened the mood. Additional research is needed to understand the complex role that cannabis use may play in families affected by opioid misuse. Strategies for intergenerational substance use prevention are discussed.

Maintaining Community-engaged Research with Young People in A Virtual setting.

BACKGROUND: Partnering with young people to conduct research is fundamental to community mobilization. Recent restrictions on in-person interactions and engagement presented limitations for continued partnership with young people. OBJECTIVE: To present a practical strategy and lessons learned to facilitate community-engaged research with youth in a virtual setting. METHODS: Based on youth engagement tenets, the TEAM (tailor the compensation package, ensure meetings are accessible, accommodate personal needs, and maintain the structure of in-person meetings) strategy was used to adapt the partnership to a virtual setting. LESSONS LEARNED: Three lessons are discussed 1) the importance of maintaining social connectedness, 2) maximizing flexibility, and 3) focusing on creativity and competency building. CONCLUSIONS: The COVID pandemic forced researchers to rethink previous engagement practices that relied heavily on in-person interactions to be sustainable. The TEAM strategy is one way to successfully adapt practices and engage young people in virtual settings.

Using the intervention mapping for adaption framework to adapt an evidence-based sexual health intervention for youth affected by trauma.

BACKGROUND: Children exposed to household challenges (i.e., parental substance use, incarceration, and mental illness) are among the groups most vulnerable to sexual risk-taking in adolescence. These behaviors have been associated with a range of negative outcomes later in life, including substance abuse, low educational attainment, and incarceration. Adapting an evidence-based intervention (EBI) to be suitable for this population is one strategy to address the needs of this group. METHODS: In this study, we describe the use of the Intervention Mapping for Adaption (IM-Adapt) framework to adapt an evidence-based, sexual health intervention (Focus on Youth with Informed Children and Parents). We describe the actions taken at each step of the IM-Adapt process which are to assess needs, search for EBIs, assess fit and plan adaptions, make adaptions, plan for implementation and plan for evaluation. RESULTS: Key changes of the adapted intervention include the incorporation of trauma-informed principles and gender inclusive language, standardization of the session length, and modernization of the content to be more appropriate for our priority population. CONCLUSIONS: The adapted intervention shows promise toward meeting the behavioral health needs of Black youth exposed to household challenges. Our process and approach can serve as a model for researchers and practitioners aiming to extend the reach of EBIs.

"It's on every corner": assessing risk environments in Baltimore, MD using a racialized risk environment model.

Physical, social, economic, and political environments can increase harm and risk among people who use drugs. These factors may be exacerbated in urban environments with a history of systemic inequality toward African Americans. However, racialized risk environment models have rarely been used within substance use research. To fill this gap, the current qualitative study sought to describe the racialized risk environment of an African American sample of 21 adults with a history of illicit drug use living in Baltimore, MD. Semi-structured interviews were conducted. Data were analyzed using qualitative content analysis to identify themes related to illicit drug use, neighborhood context, violence, social interactions, and income generation. Themes related to the physical (e.g., the increased visibility of drug markets), social (e.g., normalization of drug use within social networks), and economic (e.g., financial hardships) risk environments emerged from this sample. These perceptions and themes can aid in developing and refining substance use programming within racialized settings.

When a house is never a home: Housing instability among youth affected by parental drug abuse.

BACKGROUND: The negative consequences of parental substance abuse are significant and longstanding for children. Among other risks, these youth are more likely to experience housing instability. The most common predictor of a child not living with their biological parent is parental substance use. Research shows that these youth are at higher risks of housing instability; however, little is known about their housing experiences, from their perspective. This study explored the housing experiences of youth affected by parental substance abuse. PARTICIPANTS AND SETTING: Fourteen African American young adults ages 18 to 24 years old who identified having at least one biological parent with a history of substance use participated in this study. The study is based in Baltimore, MD, USA; an urban city with one of the highest rates of drug overdose and substantial disadvantage. METHODS: In-depth interviews were conducted among fourteen young adults (18-24) affected by parental drug use to discuss their housing experiences throughout childhood and adolescence. Five research team members developed a codebook, double coded all transcripts and analyzed inductively using a qualitative content analytic approach. RESULTS: Three themes emerged to characterize housing experiences: frequent housing transitions, repeated trauma exposures related to housing instability, and the lasting effects of housing instability. CONCLUSION: The residual impacts of parental substance use have caused youth to experience the toxic stress and trauma associated with housing instability. It is important that young people have safe, stable and reliable housing to promote child health and normative development.

"Don't Close the Door on Them": Recruiting and retaining vulnerable Black adolescents in prevention research.

There is a need to understand why some strategies work better than others for engaging vulnerable Black adolescents in prevention research, especially those who are affected by parental drug use. The current study sought to fill this gap. Thirty in-depth interviews were conducted with parents who reported a history of illicit drug use (N = 11), young adults who had a biological parent with a history of illicit drug use (N = 14), and service providers who work with families affected by illicit drug use (N = 5). Nearly all participants were Black and lived or worked in Baltimore, Maryland. Over half of the participants were female (62%). Interviews were recorded and ranged from 30 to 92 minutes in length. Data were analyzed using an inductive, content analysis approach. Four themes emerged (coined STAR): SAFE people and places minimize retraumatization; TEAMING UP with community partners increases acceptability; ADDRESSING a range of needs helps adolescents survive; and RELATABLE facilitators understand and listen to adolescents. Findings build onto and extend previous research that highlights strategies to recruit and retain vulnerable Black adolescents in prevention research.

"I missed open arms": The Need for Connectedness among Black Youth Affected by Parental Drug Use.

Parental drug use has significant impacts on the physical, behavioral and social well-being of adolescents, particularly those from disenfranchised communities. We conducted a qualitative study to understand connectedness among Black adolescents affected by parental drug use in Baltimore, Maryland. In-depth interviews (N=30) were conducted with three groups: parents with a history of drug use, youth (18-24yo) who had a biological parent with a history of drug use and youth providers with experience working with families affected by drug use. Data were analyzed inductively using a content analytic approach. Three salient themes emerged: (1) missing parental connections, (2) the desire for consistent, trusted adults and (3) the consequences of missed connections. All participants emphasized the limited emotional support and guidance provided to youth affected by parental drug use. However, extended family members (e.g., grandmothers, aunts, and older siblings) and community mentors stepped in to fulfill unmet needs, when possible. The consequences of missed connections were increased involvement in risky behaviors, fewer basic necessities and a missed childhood. Findings from the study deepen the understanding of how to support the well-being of youth impacted by parental drug use and highlight the value of including the voices of vulnerable families in research.

Making success tangible: reengaging female opportunity youth in Baltimore, MD.

Opportunity Youth represents over four million young people who are not in school and are unemployed. In Maryland, Baltimore City has the highest rate of youth disconnection. In spite of this, there are limited culturally relevant program models specific to the experiences of urban, African American youth. None focus on the unique needs of young women who are disconnected from school and work. In partnership with two local youth organizations, a 6-week program was co-developed and implemented to address the social and emotional needs of female opportunity youth in Baltimore. The program promoted self-efficacy, fostered a supportive network of trusted adults and increased awareness of resources. Lessons learned included the importance of program flexibility, the value of youth voice in program development, and the need to reframe how success is measured. This case study highlights a novel approach to bolstering the development of female opportunity youth.