Racial/Ethnic Group Differences in Older Adults' Involvement with Adult Protective Services.

This paper represents the first study to focus on quantifying racial/ethnic group differences in older adults' involvement with adult protective services (APS).  Across 3 independent county programs, the rate of APS reports was about twice as high for Black older adults compared to White older adults.  These differences were greater for clients who were older and male but remained similar across allegation type.  The percent of reports validated was slightly but consistently lower for Black clients than for White clients, and a lower percentage of Black clients' cases were closed due to investigation or service refusal. Findings for Hispanic clients differed by county, so it was impossible to generalize about their APS experience.  Researchers should distinguish racial/ethnic group differences that persist across multiple programs from those that are program-specific.  Further studies with larger data sets are needed to guide APS practice and ensure equity for all clients served. .

Measuring the diverse characteristics of county adult protective services programs.

Adult protective services (APS) programs vary markedly, yet few studies have quantified this diversity. In 2020, a survey of Ohio's 85 county-administered APS programs incorporated subsequent feedback from staff and described the programs in a systematic manner. This process resulted in a 100% response rate and illustrated an efficient approach to measuring organizational characteristics (e.g., whether any staff are mostly dedicated to APS), resources (e.g., access to multidisciplinary teams), and practices (e.g., how often staff create a plan to meet client goals). The prevalence of many factors differed by the number of older adults the program served. For instance, 75% of programs in large counties had regular opportunities to share complex cases with a multidisciplinary team, compared to 28% of programs in small counties. Understanding the diverse characteristics of APS programs - and how to measure them - can help agencies guide quality improvement efforts and the dissemination of innovations.

Implementing Triple P during the COVID-19 pandemic with families at risk for substance use.

BACKGROUND: Many studies have examined the Positive Parenting Program (Triple P), yet few have considered its effectiveness during the twin challenges of the opioid crisis and COVID-19 pandemic. OBJECTIVE: This study examines the implementation of, and parenting outcomes associated with the Positive Parenting Program (Triple P) in 13 counties in central Ohio. PARTICIPANTS AND SETTING: The program was provided to parents who were at heightened risk for substance use. From July 2020 through June 2021, 890 parents received services from Triple P. METHODS: Parents completed pre- and post-test assessments of protective factors within their families and parenting behaviors. Parents also participated in qualitative interviews regarding their experiences in the program. CONCLUSIONS: Overall, the results were promising, with improvements seen in family functioning/resilience, nurturing and attachment, parental laxness, and parental over-reactivity. Parents reported positive experiences participating in the program and felt that their relationship with their child had improved. Despite the profound, recent challenges to parenting and service provision, Triple P continues to show promise as an approach to reducing child maltreatment. Expansion of Triple P to other areas may improve parenting behaviors and reduce child maltreatment among parents at risk for substance use.

Using administrative data from adult protective services: opportunities and considerations.

As federal agencies support the development of data systems for adult protective services (APS), researchers and practitioners are increasingly using administrative data to study types of adult maltreatment, including self-neglect, and the systems that respond to them. To date, however, APS has worked with little guidance about how best to use these data. This situation has contributed to inconsistent findings and uneven quality of research. Based on the authors' experience in multiple states and using examples from research and practice, this paper reviews practical considerations related to organizing and analyzing APS administrative data. We address concerns related to time-limited, erroneous, and missing data, as well as defining metrics and accounting for the multilevel structure of data with repeated observations. Reviewing these methodological details can help APS practitioners strengthen quality assurance processes and improve research in this important area.

How Long Do Adolescents Wait for Psychiatry Appointments?

Appointment wait times are a neglected dimension of children's access to psychiatry. We systematically examined how long an adolescent waits for a new patient appointment with a psychiatrist for routine medication management. From state directories, we identified 578 providers of adolescent psychiatric care in Ohio. Researchers posing as parents telephoned randomly selected offices, seeking care for a hypothetical 14-year-old patient under different scenarios. Overall, we measured 498 wait times at 140 unique offices. The median wait time was 50 days (interquartile range = 29-81 days). In adjusted models, adolescents with Medicaid waited longer than those with private insurance, especially during the spring (geometric mean = 50.9 vs. 41.9 days; p = 0.02). Wait times also varied markedly by region, with geometric means ranging from 22.4 to 75.1 days (p < 0.01). This study demonstrates that adolescents often experience lengthy wait times for routine care. This methodology represents a useful approach to real-time monitoring of psychiatric services.

The dose-response relationship of adolescent religious activity and substance use: variation across demographic groups.

This article addresses two inconsistent findings in the literature on adolescent religious activity (RA) and substance use: whether a dose-response relationship characterizes the association of these variables, and whether the association varies by grade, gender, ethnicity, family structure, school type, and type of substance. Multinomial logistic regression analyses of a large, diverse data set of high school students in metropolitan Columbus, Ohio ( n = 33,007), found marked differences in alcohol, marijuana, and cigarette use among youths who never, occasionally, or regularly participated in RA. Weekly RA was consistently associated with less substance use, yet occasional RA sometimes was associated with greater use. Four groups accounted for variations in the RA-substance use relationship: African American youths, younger White youths, 12th-grade White males, and 12th-grade White females. Researchers should avoid assuming the RA-substance use relationship is dose-response and consider the implications of this complexity for theory and practice.

Demographic differences in the prevalence, co-occurrence, and correlates of adolescent bullying at school.

BACKGROUND: Despite a large literature on bullying, few studies simultaneously examine different dimensions of the phenomenon or consider how they vary by demographic characteristics. As a result, research findings in this area have been inconsistent. This article focuses on 2 dimensions of bullying behaviors--aggression and victimization--and examines demographic variation in their prevalence, co-occurrence, and association with other health outcomes. METHODS: School-based surveys were administered to a census of 6th-12th graders in 16 school districts across a large metropolitan area in the United States (n = 79,492). A 2-factor scale assessed repeated experiences with bullying aggression and victimization. RESULTS: Both dimensions of bullying tended to be more common among younger, male, African American and Native American students. There were, however, several exceptions as well as considerable variation in the magnitude of demographic differences. Most youth involved with bullying were either perpetrators or victims, but not both. For example, only 7.4% of all youths were classified as bully/victims. Substance use was more strongly associated with aggression, whereas depressive affect was more strongly associated with victimization. CONCLUSIONS: Researchers should distinguish different dimensions of bullying and consider how they vary by demographic characteristics. In particular, repeated aggression and victimization largely involve different students and may require distinct approaches to prevention.

Substance use among American Indian youth in an Eastern city.

This study represents one of the first efforts to examine substance use among American Indian (AI) youth in an Eastern city. As part of a school-based study in metropolitan Columbus, Ohio, 596 self-identified AI youth (grades 6-12) completed surveys describing their use of alcohol, cigarettes, smokeless tobacco, marijuana and inhalants. Net of gender, grade and family structure, AI youth were more likely than their white peers to regularly use most substances while overall prevalence resembled estimates from studies of urban AI youth in the Western United States. These findings highlight the complex interactions of geography, identity and risk behavior among ethnic minority adolescents.

High school students' misuse of over-the-counter drugs: a population-based study in an urban county.

A survey of high school students (n = 39,345) found 4.7% occasionally misuse over-the-counter drugs (i.e., to get high) and an additional 2.1% reported misuse during the past month. Misuse was more common among older white and Native American youths and was associated with depressive affect and other substance use, especially alcohol and illicit drugs.

Drug selling among high school students: related risk behaviors and psychosocial characteristics.

PURPOSE: To identify risk behaviors and psychosocial characteristics associated with high school students' selling drugs. METHODS: In 2000, an anonymous standardized survey assessed substance use, drug selling and related risk factors (e.g., friends' use; messages about use) among high school students (n = 38,999) in a large metropolitan area. The sample was 51% female and included adolescents who were white (70%), African-American (18%), Asian (3.3%), Hispanic (1.7%) or who reported other ethnicities (7%). Logistic regression analyses examined whether selling drugs was associated with variables from different explanatory models, net of risk behavior and demographic characteristics. RESULTS: Twelve percent of students reported selling drugs in the past year. In the final logistic regression model, selling drugs was associated with being male, violence, delinquency and marijuana use. Students who sold drugs were less involved in religious and family activities but did not differ in their perceptions of, or participation in, school. Friends and school adults' support of substance use was associated with selling drugs, as was daily employment. Social competence, but neither purposeful planning nor self-efficacy, was associated with selling drugs. CONCLUSIONS: Despite popular perceptions, drug selling is not limited to out-of-school youth but occurs frequently among students who attend high school. School-based prevention efforts should discourage drug selling in order to reduce students' access to drugs and protect young people from the dangers associated with drug selling.

Religious activity and risk behavior among African American adolescents: concurrent and developmental effects.

This study examines how religious activity is associated with risk behaviors, concurrently and developmentally among urban African American adolescents. Seven hundred and five African American youths were interviewed annually during high school. Retention rates for the study exceeded 90%. Frequency of religious activity, sexual intercourse, and alcohol, cigarette, and marijuana use were assessed at each wave. Growth curve analyses found negative concurrent associations between religious activity and each of the four risk behaviors. The developmental effects of religious activity varied by gender. Higher levels of religious activity in 9th grade predicted smaller increases in marijuana use among males and cigarette use among females. In addition, larger decreases in religious activity during high school were associated with greater increases in alcohol use among males and sexual intercourse among females. During high school, religious activity limits the development of certain types of risk behavior among African American youth, even after controlling for reciprocal effects.

College students' early cessation from episodic heavy drinking: prevalence and correlates.

The author surveyed 788 undergraduates at a large public university (overall response rate 54%) to (1) estimate the proportion of college students who cease engaging in a pattern of episodic heavy drinking (EHD) and (2) identify individual and contextual factors associated with early cessation. He used a staging algorithm to classify respondents into 4 stages of EHD cessation. Of the 60% who had engaged in EHD, 64% continued to drink heavily with no intention of stopping, 12% continued to drink heavily but were thinking about stopping, 14% had ceased temporarily, and 9% had ceased permanently. Students who had stopped EHD perceived more risks and fewer benefits associated with alcohol misuse, but they did not differ in their perceptions of normative alcohol use on campus. Many collegiate heavy drinkers cease EHD before graduation, and others may be predisposed to moderate their alcohol use. Tailored interventions that alter alcohol expectancies may facilitate early cessation from EHD.

Episodic and persistent gun-carrying among urban African-American adolescents.

PURPOSE: To examine whether similar risk factors influenced episodic and persistent gun-carrying among urban African-American adolescents. METHODS: The sample consisted of 705 African-American youths (48.9% male; mean age at baseline = 14.56 years) who were interviewed annually throughout high school as part of a larger study on students who leave school before graduation. Episodic gun-carrying was defined as carrying a gun during one or two waves of the study. Persistent gun-carrying involved carrying a gun during three or four waves. Data were analyzed using multinomial logistic regression to test how risk factors assessed at ninth grade influenced the persistence of gun-carrying. RESULTS: Fifteen percent of students reported carrying a gun episodically, and 5% persistently. "Male gender" (OR = 3.61, 95% CI = 2.16-6.04), "adult weapon-carrying" (OR = 1.58, 95% CI = 1.20-2.09), "marijuana use" (OR = 1.03, 95% CI = 1.01-1.06), "selling drugs" (OR = 3.24, 95% CI = 1.52-6.92), and "fighting" (OR = 1.57, 95% CI = 1.14-2.15) distinguished noncarriers from episodic carriers. Frequency of fighting (OR = 1.60, 95% CI = 1.00-2.57) and selling drugs (OR = 3.29, 95% CI = 1.16-9.35) distinguished episodic gun-carriers from persistent gun-carriers. Variables associated with victimization did not uniquely differentiate among the patterns of gun-carrying. These results were similar for males and females. CONCLUSIONS: Similar risk factors characterize episodic and persistent gun-carrying. Specifically, selling drugs and fighting had a strong dose-response relationship with the persistence of gun-carrying. In this population, episodic gun-carrying should be viewed as very risky and not merely as youthful experimentation or a defensive behavior.