BIPOC experiences of (anti-)racist patient engagement in adolescent and young adult oncology research: an electronic Delphi study.

Aims: To characterize Black, Indigenous and People of Color (BIPOC) adolescent and young adult (AYA) cancer patients' experiences of patient engagement in AYA oncology and derive best practices that are co-developed by BIPOC AYAs and oncology professionals. Materials & methods: Following a previous call to action from AYA oncology professionals, a panel of experts composed exclusively of BIPOC AYA cancer patients (n = 32) participated in an electronic Delphi study. Results: Emergent themes described BIPOC AYA cancer patients' direct experiences and consensus opinion on recommendations to advance antiracist patient engagement from BIPOC AYA cancer patients and oncology professionals. Conclusion: The findings reveal high-priority practices across all phases of research and are instructional for advancing health equity.

Driving under the influence of cannabis and alcohol: Evidence from a national sample of young drivers.

OBJECTIVE: Driving under the influence (DUI) of psychoactive substances is an important public health and criminal justice issue, impacting the lives of millions of Americans. Although recent research provides up-to-date information regarding DUI among adults, there is a pressing need for research that focuses specifically on younger/underage drivers. We draw from a large, nationally-representative sample to provide up-to-date evidence as to the prevalence and key criminal justice, substance use, and behavioral health correlates of DUI of cannabis and alcohol among drivers ages 16 to 20 in the United States. METHODS: We used data from the 2020 and 2021 National Survey on Drug Use and Health (young drivers ages 16-20; N=12,863). All analyses-survey adjusted prevalence estimates, logistic regression-were conducted using Stata SE 17.0 and weighted to account for the study's stratified cluster sampling design. RESULTS: The prevalence of DUI-cannabis for the full sample-including those not endorsing past-year use-was 6.3%. Among youth endorsing past-year cannabis use, 24.5% reported DUI of cannabis. In the full sample and among cannabis users, DUI-cannabis risk was elevated among older and male youth. The prevalence of DUI-alcohol was 2.6% among all youth and 6.1% among youth reporting past-year alcohol consumption. CONCLUSIONS: Estimates indicate that more than one million young drivers each year are placing their lives and those of others at risk by operating motor vehicles after consuming cannabis and/or alcohol. Findings underscore the importance of prevention efforts targeting underaged cannabis and alcohol-impaired driving.

Ethnoracial differences in workplace drug testing and policies on positive drug tests in the United States.

BACKGROUND: Drug testing is widely implemented as a work-based prevention strategy for employee substance use. However, it has raised concerns about its potential use as a punitive measure in the workplace where racialized/ethnic workers are over-represented. This study examines the rates of exposure to workplace drug testing among ethnoracial workers in the United States and the potential differences in the employers' responses to positive test results. METHODS: A nationally-representative sample of 121,988 employed adults was examined using the 2015-2019 National Survey on Drug Use and Health data. The rates of exposure to workplace drug testing were estimated separately for ethnoracial workers. Then we used multinomial logistic regression to test differences in employers' responses to the first positive drug test results across ethnoracial subgroups. RESULTS: Since 2002, Black workers reported 15-20% points higher rates of having a workplace drug testing policy than Hispanic or White workers. When tested positive for drug use, Black and Hispanic workers were more likely to be fired than White workers. When tested positive, Black workers were more likely to be referred to treatment/counseling services while Hispanic workers were less likely to be referred compared to White workers. CONCLUSION: Black workers' disproportionate exposure to drug testing and punitive responses in the workplace may potentially place individuals with substance use problems out of the workforce, limiting their access to treatment/other resources available via their workplaces. Also, Hispanic workers' limited accessibility to treatment and counseling services when tested positive for drug use requires attention to address unmet needs.

Photovoice as a tool for exploring perceptions of marijuana use among Appalachian adolescents.

This study explored perceptions of marijuana use and abstinence among urban and rural Appalachian high school students using photovoice, enabling this subset of youth to co-construct their perceptions of marijuana use and abstinence. Twelve adolescents, ages 14-17, participated in the study. Participants identified managing stress and feeling peer pressure as two reasons teens might use marijuana. Participants identified four reasons for adolescent marijuana abstinence including having positive relationships, identifying with religion/spirituality, participating in extracurricular activities, and avoiding negative outcomes. Findings suggest that participants may smoke marijuana due to peer pressure and to cope with stress. Collective approaches including families, communities, and faith organizations may be important marijuana use prevention approaches for Appalachian adolescents.

Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

Toward a typology of driving under the influence of alcohol and drugs.

PURPOSE: Most research on driving under the influence (DUI) has relied upon variable-centered methods that examine predictors/correlates of DUI. In the present study, we utilize a person-level approach-latent class analysis (LCA)-to model a typology of individuals reporting DUI. This allows us to understand the degree to which individuals drive under the influence of a particular substance or do so across multiple substance types. METHODS: We use public-use data collected between 2016 and 2019 from the National Survey on Drug Use and Health. The analytic sample was 189,472 participants with a focus on those reporting DUI of psychoactive substances in the past-year (n = 24,619). LCA was conducted using self-reported DUI of past-year alcohol, cannabis, cocaine, heroin, hallucinogens, and methamphetamine as indicator variables. RESULTS: More than 1 in 10 Americans reported a DUI within the past-year. One in five people who reported DUI of one substance also reported DUI of at least one additional substance. Using LCA to model heterogeneity among individuals reporting DUI, four classes emerged: "Alcohol Only" (55%), "Cannabis and Alcohol" (36%), "Polydrug" (5%), and "Methamphetamine" (3%). Rates of risk propensity, drug involvement, illicit drug use disorders, and criminal justice system involvement were highest among members of the "Polydrug" and "Methamphetamine" classes. CONCLUSION: Drug treatment centers should take care to include discussions of the dangers and decision-making processes related to DUI of the full spectrum of illicit substances. Greater investment in drug treatment across the service continuum, including the justice system, could prevent/reduce future DUI episodes.

Contextual risks and psychosocial outcomes among rural African American emerging adults: A latent profile analysis.

African American emerging adults face unique contextual risks that place them at heightened risk for poor psychosocial outcomes. The purpose of this study was to identify profiles of contextual risks among rural African American emerging adults and determine how risk profiles relate to psychosocial outcomes. Our representative sample included 667 fifth graders who live in the rural South and were followed from preadolescence into emerging adulthood. Contextual risks were assessed at ages 19-21 years via six indicators: perceived stress, daily stress, community disadvantage, parent-child conflict, racial discrimination, and childhood trauma. Four psychosocial variables were also assessed at ages 19-21 years: self-regulation, racial identity, parent support, and friend support. Psychosocial outcomes were assessed at age 25 years: education, substance use, future orientation, depressive symptoms, and externalizing behaviors. Latent profile analysis results indicated that the sample could be characterized by three patterns of contextual risk: low contextual risk, high contextual risk, and high contextual risk-childhood trauma. Risk profiles were associated with psychosocial outcomes, with the childhood trauma and high-risk profiles faring worse than the low-risk profile. Further, childhood trauma was particularly predictive of worse outcomes for emerging adults. Findings highlight the need for research and prevention programs that mitigate the effects of contextual risks on psychosocial outcomes for African American emerging adults in rural areas.

Far from a monolith: a typology of externalizing behavior among African American youth.

PURPOSE: Previous studies have examined externalizing behaviors among African American youth using variable-centered approaches that study aggression and delinquency separately. However, aggression and delinquency often operate together in shaping adolescent behavior. For this reason, person-centered approaches are essential for identifying subgroups of African American youth using multiple indicators of aggression and delinquency to model the behavioral heterogeneity within this population. We examined the relationship between interpersonal, school, and parenting factors and externalizing behaviors among African American youth. METHOD: Drawing from the National Survey on Drug Use and Health 2015-2018, we conducted latent class analysis based on 5 externalizing behavior indicator variables (i.e., serious fight, attack to harm, stealing, drug selling, handgun carrying) using a sample of 7,236 African American adolescents, aged 12-17. RESULTS: We identified a three class solution: Class #1-No Involvement (74.4%), characterized by very low levels of involvement in all of the externalizing behaviors examined; Class #2-Serious fight (23.3%), which is characterized by near-universal involvement in a serious fight, far lower levels of attack to harm, and negligible levels of stealing, drug selling, and handgun caring; and Class #3-Multidimensional externalizing (2.3%), characterized by very high levels of involvement in all of the externalizing variables examined. CONCLUSION: Most African American youth are not involved in externalizing behaviors. It is vital to support both the large majority of African-American youth who are abstaining from externalizing behaviors and to develop/implement programs to address the contextual and interpersonal needs of youth at elevated risk for consequences related to externalizing.

Margin for error: examining racial and ethnic trends in adolescent risk propensity.

BACKGROUND: Relatively little research has accrued examining risk propensity across racial and ethnic groups, especially across time and at the population level. AIMS: Using a margin for error framework to conceptualize risk variation among major racial and ethnic groups, we hypothesize that African American and Hispanic adolescents will be less likely to report engaging in dangerous risk taking acts compared to White adolescents. METHODS: This study examines public-use data collected on risk propensity and risky behaviors among adolescents 12-17 between 2002 and 2018 as part of the National Survey on Drug Use and Health (NSDUH). RESULTS: While we observed decreased trends in risk propensity, controlling for demographic factors, we see significantly greater odds of reporting "never" engaging in risk for fun among NH Black (AOR 2.01, 95% CI 1.85-2.18) and Hispanic youth (AOR 1.47, 95% CI 1.37-1.58) as compared to NH White youth. NH Black (AOR 0.74, 95% CI 0.61-0.89) and Hispanic (AOR 0.83, 95% CI 0.71-0.98) youth are also less likely than NH White youth to report "always" taking risks for fun. Moreover, the risk propensity-risky behaviors link was weaker among African American and Hispanic adolescents. CONCLUSIONS: We find compelling evidence that African American and Hispanic adolescents are less likely to endorse deriving positive reinforcement from potentially dangerous risk taking acts compared to White adolescents. These findings suggest that African American and Hispanic youth may perceive less "margin for error" when navigating their environments.

Toward a Typology of Transnational Communication among Venezuelan Immigrant Youth: Implications for Behavioral Health.

We identify subtypes of Venezuelan youth based on patterns of technology-based communication with friends in their receiving (US) and sending (Venezuela) countries and, in turn, examine the behavioral health characteristics among different "subtypes" of youth. Using data from 402 recently-arrived Venezuelan immigrant youth (ages 10-17), latent profile analysis and multinomial regression are employed to examine the relationships between technology-based communication and key outcomes. We identified a four-class solution: [#1] "Daily Contact in US, In Touch with Venezuela" (32%), [#2] "Daily Communication in Both Countries" (19%), [#3] "Weekly Contact: More Voice/Text Than Social Media" (35%), and [#4] "Infrequent Communication with US and Venezuela" (14%). Compared to Class #1, youth in Classes #2 and #3 report elevated depressive symptomatology and more permissive substance use views. Findings suggest that how youth navigate and maintain transnational connections varies substantially, and that technology-based communication is related to key post-migration outcomes.

Alcohol trajectories among biracial black subgroups: Testing the intermediate substance use hypothesis.

OBJECTIVE: This study tests the intermediate biracial substance use hypothesis, which suggests that the prevalence of substance use among biracial individuals fall intermediate to their corresponding mononoracial counterparts. Using National Longitudinal Study of Adolescent and Adult Health (Add Health) data, we examine alcohol-use trajectories of a de-aggregated sample of biracial Black youth and compare them with the trajectories of the corresponding monoracial counterparts. METHOD: The sample consists of 9421 adolescents and young adults who self-identified as 1 of 4 monoracial groups (i.e., Black, White, Hispanic, American Indian) or 1 of 3 biracial Black groups (i.e., Black-American Indian, Black-Hispanic, and Black-White). Study hypotheses are tested using latent growth curve modeling for first use, number of drinks, and binge drinking. RESULTS: We found partial support for the intermediate substance use hypothesis, with the alcohol use rates of biracial Blacks more closely resembling the non-Black corresponding group than the monoracial Black group. Black-American Indians face particularly high risk of problematic drinking. CONCLUSIONS: These findings demonstrate the need for additional research clarifying the onset and maintenance of alcohol use and misuse among biracial individuals and subgroups.

Trends and mental health correlates of discrimination among Latin American and Asian immigrants in the United States.

PURPOSE: To examine the national trends and mental health correlates of discrimination among Latin American and Asian immigrants in the United States. METHODS: We examine data from the National Epidemiologic Survey on Alcohol and Related Conditions collected between 2004 and 2013. Recurrent discrimination was measured by respondent reports of adverse experiences such as receiving poor treatment in restaurants or being called a racist name. RESULTS: Rates of perceived discrimination increased by more than 80 percent among immigrants from Latin America (from 14% in 2004 to 25% in 2013), but remained unchanged among Asian immigrants (20-22%). Large percentage point (pp) increases were observed among Latin American immigrants with less than a high school education (pp increase = 13.5) and residing in households earning $20-35,000 annually (pp increase = 14.0). CONCLUSIONS: Findings raise concern both because of the inherent iniquitousness of discrimination and because identity-based mistreatment is linked with mental health problems.

Alcohol-related problem behaviors among Latin American immigrants in the US.

BACKGROUND: Prior research indicates that Latino immigrants are less likely than US-born individuals to use alcohol and meet criteria for an alcohol use disorder. However, our understanding of alcohol-related problem behaviors among Latino immigrants remains limited. We report the prevalence of alcohol-related problem behaviors among Latino immigrants vis-à-vis the US-born and examine the relationship between alcohol-related problem behavior and key migration-related factors and injury/receipt of emergency medical care. METHODS: The data source used for the present study is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, 2012-2013), a nationally representative survey of 36,309 civilian, non-institutionalized adults ages 18 and older in the US. Logistic regression was employed to examine the relationship between immigrant status and key outcomes. RESULTS: Foreign-born Latinos were less likely to report one or more alcohol-related problems compared to US-born Latinos (AOR = 0.41, 95% CI = 0.33-0.50) and the US-born general population (AOR = 0.38, 95% CI = 0.32-0.46). Latino immigrants arriving as children were, compared to those arriving later in life, significantly more likely to report alcohol-related problem behaviors, and experiences of discrimination were linked with greater risk of alcohol-related problem behavior as well. Latino immigrants reporting recurrent injury/emergency medical care utilization were more likely to report alcohol-related problem behavior. CONCLUSIONS: Latino immigrants are significantly less likely than US-born Latinos and the US-born general population to operate a vehicle under the influence of alcohol, take part in risky behaviors or fight while drinking, or to be arrested due to alcohol consumption.

Substance use among bi/multiracial youth in the United States: Profiles of psychosocial risk and protection.

BACKGROUND: Bi/multiracial youth face higher risk of engaging in substance use than most monoracial youth. OBJECTIVES: This study contrasts the prevalence of substance use among bi/multiracial youth with that of youth from other racial/ethnic groups, and identifies distinct profiles of bi/multiracial youth by examining their substance use risk. METHODS: Using data from the National Survey on Drug Use and Health (collected between 2002 and 2014), we analyze data for 9,339 bi/multiracial youth ages 12-17 living in the United States. Analyses use multinomial regression and latent class analysis. RESULTS: With few exceptions, bi/multiracial youth in general report higher levels of tobacco, alcohol, marijuana, and other illicit drug use compared to other youth of color. Bi/multiracial youth also report higher levels of marijuana use compared to non-Hispanic white adolescents. However, latent class modeling also revealed that a majority (54%) of bi/multiracial youth experience high levels of psychosocial protection (i.e., strong antidrug views and elevated parental engagement) and low levels of psychosocial risk (i.e., low peer substance use, school-related problems, and social-environmental risk), and report very low levels of substance use. Substance use was found to be particularly elevated among a minority of bi/multiracial youth (28%) reporting elevated psychosocial risk and low levels of protection. Bi/multiracial youth characterized by both elevated psychosocial risk and elevated psychosocial protection (22%) reported significantly elevated substance use as well. CONCLUSIONS: While bi/multiracial youth in general exhibit elevated levels of substance use, substantial heterogeneity exists among this rapidly-growing demographic.

Cigarette-smoking trajectories of monoracial and biracial Blacks: Testing the intermediate hypothesis.

Research on the cigarette-smoking patterns of biracial adolescents and young adults is severely limited. In this study, we tested the intermediate biracial substance-use hypothesis, which suggests that the prevalence of substance use among biracial individuals falls intermediate to their monoracial counterparts. We examined cigarette-smoking trajectories of a de-aggregated sample of biracial Black adolescents and young adults. We used longitudinal data from the National Longitudinal Study of Adolescent and Adult Health (Add Health; Harris et al., 2009). Our sample (N = 9,421) included 4 monoracial groups (Black, White, Hispanic, and American Indian [AI]) and 3 biracial groups (Black-AI, Black-Hispanic, and Black-White). Study hypotheses were tested using latent growth-curve modeling. We found some support for the intermediate biracial substance-use hypothesis for 2 of 3 biracial groups (Black-American Indian, Black-Hispanic) and 2 of 4 cigarette-use outcomes (lifetime cigarette use, number of cigarettes smoked during past month for regular smokers). The cigarette-use trajectories of biracial Blacks were significantly different from only 1 corresponding monoracial group. Black-AIs and Black Hispanics engage in lifetime cigarette use at comparable rates to monoracial Blacks. Black-Hispanic regular smokers' rate of cigarette smoking is comparable to the higher rates of Hispanics and not to the lower rates of Blacks. Knowledge of the origins, developmental course, and consequences of tobacco use among the biracial population may lead to effective intervention programs and policies for this group. (PsycINFO Database Record

Trends in Perceived Access to Marijuana Among Adolescents in the United States: 2002-2015.

OBJECTIVE: There is concern that changes in marijuana-related policy and public opinion may lead to increased access to marijuana among young people in the United States. However, little research has been conducted on changes in youth's perceptions of marijuana access, and studies have yet to systematically examine trends in perceived access across key sociodemographic and externalizing behavioral subgroups. METHOD: Using population-based data collected between 2002 and 2015 as part of the National Survey on Drug Use and Health, we examined trends in perceived marijuana access among non-Hispanic White, African American, and Hispanic adolescents (ages 12-17, n = 221,412). Following the trend analysis method outlined by the Centers for Disease Control and Prevention, we conducted logistic regression analyses to test for secular trends. RESULTS: Between 2002 and 2015, we observed a 27% overall reduction in the relative proportion of adolescents ages 12-17-and a 42% reduction among those ages 12-14-reporting that it would be "very easy" to obtain marijuana. This pattern was uniformly observed among youth in all sociodemographic subgroups (i.e., across age, gender, race/ethnicity, household income) and among youth reporting involvement/no involvement in most measures of substance use (alcohol, marijuana) and delinquency (handgun carrying, attacks). However, perceived very easy access remained stable among youth reporting tobacco use and criminal justice system involvement. CONCLUSIONS: Despite the legalization of recreational and medical marijuana in some states, our findings suggest that, with the notable exception of adolescent tobacco users and juvenile offenders, perceptions that marijuana would be very easy to obtain are on the decline among American youth.

Immigrants from Mexico experience serious behavioral and psychiatric problems at far lower rates than US-born Americans.

PURPOSE: To examine the prevalence of self-reported criminal and violent behavior, substance use disorders, and mental disorders among Mexican immigrants vis-à-vis the US born. METHODS: Study findings are based on national data collected between 2012 and 2013. Binomial logistic regression was employed to examine the relationship between immigrant status and behavioral/psychiatric outcomes. RESULTS: Mexican immigrants report substantially lower levels of criminal and violent behaviors, substance use disorders, and mental disorders compared to US-born individuals. CONCLUSION: While some immigrants from Mexico have serious behavioral and psychiatric problems, Mexican immigrants in general experience such problems at far lower rates than US-born individuals.

Changing perspectives on marijuana use during early adolescence and young adulthood: Evidence from a panel of cross-sectional surveys.

INTRODUCTION: Prior research has often overlooked potential cohort differences in marijuana views and use across adolescence and young adulthood. To begin to address this gap, we conduct an exploratory examination of marijuana views and use among American youth using a panel of cross-sectional surveys. METHOD: Findings are based on repeated, cross-sectional data collected annually from adolescents (ages 12-17; n=230,452) and young adults (ages 18-21; n=120,588) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014. For each of the birth years between 1986 and 1996, we combined a series of nationally representative cross-sections to provide multi-year data strings designed to approximate nationally representative cohorts. RESULTS: Compared to youth born in the mid-to-late 1980s, youth born in the mid-1990s reported significantly higher levels of marijuana disapproval during the early adolescent years (Age 14: 1988=64.7%, 1994=70.4%) but lower levels of disapproval during the young adult years (Age 19: 1988=32.0%, 1994=25.0%; Age 20: 1988=27.9%, 1994=19.7%). Moreover, the prevalence of marijuana use among youth born in 1994 was significantly lower-compared to youth born in 1988-at age 14 (1988: 11.39%, 1994: 8.19%) and significantly higher at age 18 (1988: 29.67%, 1994: 34.83%). This pattern held even when adjusting for potential confounding by demographic changes in the population across the study period. CONCLUSIONS: We see evidence of changes in the perceptions of marijuana use among youth born during the late twentieth century.

Prevalence and correlates of substance use in Black, White, and biracial Black-White adolescents: Evidence for a biracial intermediate phenomena.

Most substance-use prevention interventions are based on the implicit assumption that risk and protective factors for substance use are the same for biracial and monoracial youth. However, preliminary research suggests this assumption may be untrue. This study compared the prevalence and correlates of substance use among Black, White, and biracial Black-White youth. Data were derived from the National Longitudinal Study of Adolescent and Adult Health, which is a longitudinal investigation using stratified random sampling to study health behaviors. After controlling for sociodemographic factors and using weighted Poisson and logistic regression, the authors found the substance-use prevalence rates of Black-White youth to be intermediate to the higher rates of Whites and lower rates of Blacks. In addition, Black-White youth's scores on most covariates were intermediate to those of the monoracial groups. Family factors were more important in explaining higher substance use than other contextual factors. School factors seem to be important in explaining lower substance use for Black-White youth. Correlates of substance use for Black-White youth were not identical to those of either Black or White youth. More research on the observed intermediate phenomena among biracial youth vis-à-vis prevalence, correlates, and causes of substance use is needed. (PsycINFO Database Record