Prevalence and sociodemographic correlates of lifetime substance use among a rural and diverse sample of adolescents.

BACKGROUND: Data are limited regarding the prevalence of substance use among adolescents in rural and ethnically diverse communities. This study examined rates and sociodemographic correlates of lifetime substance use among adolescents in Mississippi, a rural state that is the poorest in the country (21.3% poverty rate) and has the largest proportion of African Americans per capita (36.3%). METHODS: Participants in this cross-sectional study were 6349 adolescents (6th through 12th grade) who reported on lifetime tobacco, alcohol, marijuana, cocaine, inhalant, hallucinogen, and methamphetamine use. RESULTS: Lifetime smoking (10.2% to 44.5%), alcohol (23.2% to 72.0%), and marijuana use (7.9% to 39.2%) increased steadily when comparing students in 6th to 12th grade. Substances with more serious abuse potential (cocaine [6.7% to 11.1%], inhalants [12.2% to 17.9%], hallucinogens [4.4% to 12.1%], and methamphetamine [3.0% to 6.7%]) displayed more modest increases across grade. Adolescents who classified their race/ethnicity as "Other" (i.e., not white, black/African American, Asian, or Hispanic/Latino/Latina) demonstrated more than 2-fold increased likelihood of methamphetamine use (odds ratio [OR] = 2.42), and increased risk for use of any illicit substance (OR = 1.49). In general, males demonstrated an increased risk for use across substances (OR = 1.15-1.94), and higher income was associated with a decreased likelihood of illicit substance use (OR = 0.51-0.67). Living in a more populated area was associated with an increased likelihood of alcohol (OR = 1.43), marijuana (OR = 2.11), and cocaine use (OR = 2.06), and use of any illicit substance (OR = 1.54). CONCLUSIONS: Mississippi adolescents reported higher rates of lifetime cocaine, inhalant, hallucinogen, and methamphetamine use across all grade levels compared with national surveys. Male gender, low income, and residence in more populated areas were associated with increased use of several substances. Findings demonstrate the need for prevention and intervention programs targeting impoverished rural and ethnically diverse communities.

A measurement invariance examination of the Revised Child Anxiety and Depression Scale in a Southern sample: differential item functioning between African American and Caucasian youth.

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale in a large sample of youth from the Southern United States. The authors aimed to determine (a) if the established six-factor Revised Child Anxiety and Depression Scale structure could be replicated in this Southern sample and (b) if scores were associated with measurement invariance across African American and Caucasian youth representative of youth from this region of the United States. The established six-factor model evidenced the best fit in comparison to one-, two-, and five-factor models in the total sample (N = 12,695), as well as in the African American (n = 4,906) and Caucasian (n = 6,667) subsamples. Multigroup confirmatory factor analysis also supported measurement invariance across African American and Caucasian youth at the levels of equal factor structure and equal factor loadings. Noninvariant item intercepts were identified, however, indicating differential functioning for a subset of items. Clinical and measurement implications of these findings are discussed and new norms are presented.

Non-medical use of prescription drugs among Mississippi youth: constitutional, psychological, and family factors.

OBJECTIVE: The non-medical use of prescription drugs (NMUPD) among youth is a significant public health concern, ranking as the second most frequently used class of drug in youth after marijuana. Given the complex and multiple pathways that may lead to NMUPD in youth, this study examines predictors of NMUPD across constitutional, psychological, and family/peer domains. METHOD: An ethnically diverse sample of 6790 youth in the 6th-12th grades enrolled in public schools throughout Mississippi completed a battery of questionnaires as part of a broader school-based mental health screening initiative in Mississippi (Behavioral Vital Signs Project). RESULTS: The lifetime prevalence rate of NMUPD in our sample was 6.5%. Pain medications were the most commonly used (57%), followed by benzodiazepines (44%), prescription stimulants (e.g., Ritalin, Concerta, Focalin, Dexedrine; 37%), SSRIs (29%), and antipsychotics (24%). Almost a quarter of NMUPD youth used these drugs for 10days or more during the 30-day period prior to completing the survey, and 8% reported daily use. Binary logistic regression analyses revealed that race; grade level; anxiety, mood, and suicide-related symptoms; and substance use involvement significantly increased risk for NMUPD in youth. CONCLUSIONS: NMUPD among youth is a clinically-relevant and multi-determined phenomenon. Findings from this study identify factors relevant to understanding youth NMUPD and also highlight the need for additional research and targeted prevention and intervention programs for NMUPD among youth.

Deliberate self-harm among underserved adolescents: the moderating roles of gender, race, and school-level and association with borderline personality features.

Despite increasing research on the correlates and functions of deliberate self-harm (DSH) among community youth, less is known about the subsets of youth most at-risk for DSH or the relevance of borderline personality (BP) pathology to DSH within this population. This study sought to extend research on the characteristics associated with DSH by examining the ways in which gender, racial/ethnic background, and school-level interact to influence DSH among ethnically diverse youth in a relatively poor and underserved area, as well as the extent to which levels of BP features account for differences in rates of DSH across subsets of youth. Middle- and high-school students (N = 1931) from six public schools in Mississippi completed self-report measures of DSH and BP features. Consistent with past research, 39% of the youth in our sample reported engaging in DSH. However, rates of DSH varied as function of gender, racial/ethnic background, and school-level (as well as their interactions), with African American boys reporting higher rates of most DSH behaviors than their peers (particularly in middle-school). One notable exception to this pattern pertains to the specific behavior of cutting, for which both White girls and African American boys reported the highest rates. Further, although BP features were reliably associated with DSH status (above and beyond these demographic characteristics), they did not account for the interactive effect of gender and race on rates of DSH. Findings highlight the importance of continuing to examine DSH and its correlates among more diverse groups of youth.

The Loneliness Questionnaire-Short Version: an evaluation of reverse-worded and non-reverse-worded items via item response theory.

Although reverse-worded items have often been incorporated in scale construction to minimize the effects of acquiescent reporting biases, some researchers have more recently begun questioning this approach and wondering whether the advantages associated with incorporating reverse-worded items is worth the complexities that they bring to measures (e.g., Brown, 2003 ; Marsh, 1996 ). In this study, we used item response theory (IRT) to determine whether there is statistical justification to eliminate the reverse-worded items (e.g., "I have lots of friends") from the Loneliness Questionnaire (LQ; Asher, Hymel, & Renshaw, 1984) and retain only the non-reverse-worded items (e.g., "I'm lonely") to inform the provision of a shortened LQ version. Using a large sample of children (Grades 2-7; n = 6,784) and adolescents (Grades 8-12; n = 4,941), we examined the psychometric properties of the 24-item LQ and found support for retaining the 9 non-reverse-worded LQ items to make up a shortened measure of loneliness in youth. We found that the non-reverse-worded items were associated with superior psychometric properties relative to the reverse-worded items with respect to reliability and IRT parameters (e.g., discrimination and item information). A 3-point Likert-type scale was also found to be more suitable for measuring loneliness across both children and adolescents compared to the original 5-point scale. The relative contributions of reverse-worded and non-reverse-worded items in scale development for youth instruments are also discussed.

The importance of modeling method effects: resolving the (uni)dimensionality of the loneliness questionnaire.

This study sought to resolve the dimensionality of the Loneliness Questionnaire (LQ; Asher, Hymel, & Renshaw, 1984) by applying recommended confirmatory factor analytic procedures that control for method effects (Brown, 2003). This study was needed given that inconsistent findings have been reported recently regarding the structure of this instrument (Bagner, Storch, & Roberti, 2004) and all models to date have not accounted for method effects due to the non-reversed-worded and reversed-worded items of this instrument. Using a large sample of youth in Grades 2 through 12 (N = 11,725), we compared the previously reported 1- and 2-factor models with a newly posited 1-factor model that incorporated correlated error terms to account for method effects. We found that the 1-factor model that included correlated error terms fit the data best, and that this factor structure evidenced measurement invariance across boys and girls in childhood, but not in adolescence. The meaning of the LQ indicators was also consistent for boys across development, but evidenced differences for girls in childhood versus adolescence. More generally, it was demonstrated that modeling method effects is vital to accurately understanding the dimensionality of loneliness when reversed-worded and non-reversed-worded items are used as indicators. The measurement and clinical implications of these findings are discussed.

Racial differences in symptoms of anxiety and depression among three cohorts of students in the southern United States.

The present study aimed to extend the literature on mental health disparities in underserved areas by investigating racial differences in symptoms of anxiety and depression in three cohorts of school children in the Southern United States. White and African American students attending elementary, middle, and high school (n = 3,146) were administered a multi-dimensional measure of anxiety and depression. Racial differences were examined using categorical, dimensional, and latent-variable analytic methods. Although effect sizes were small across all levels of analysis, the categorical and dimensional approaches produced different patterns of significant anxiety-related findings. Additionally, confirmatory factor analysis indicated that the dimensional findings were not due to racial differences in the measurement of anxiety. The results of the current investigation suggest that, among school children, race has modest effects on symptoms of anxiety, but not depression. Further, the differential findings observed across analytic approaches reinforce the importance of measurement and methodology when studying psychopathology in children and adolescents.

Self-injurious thoughts and behaviors among youth in an underserved area of the Southern United States: exploring the moderating roles of gender, racial/ethnic background, and school-level.

Despite the clinical relevance of self-injurious thoughts and behaviors (SITB) among youth, little is known about the subset of youth most at-risk for SITB. This study examined the moderating roles of gender, racial/ethnic background, and school-level (and their interactions) on rates of SITB within a large (N = 2638, 52.2% female), ethnically-diverse sample of middle- and high-school youth in a relatively poor and underserved area of the Southern United States. Extending extant research in this area, findings indicated a significant interaction between gender and race for self-injurious behaviors, with African-American boys reporting higher rates than all other groups. Findings also indicated significant interactions between school-level and both gender and race for self-injurious thoughts. Whereas comparable levels of self-injurious thoughts were reported across middle- and high-schools for girls and African-American youth, the frequency of these thoughts was higher among both boys and White students in high-school (vs. middle-school). Results highlight the need for further research on SITB among diverse youth in underserved areas.