- Email: [email protected]
Associations Between Multiple Dimensions of School Engagement, Peer Relationships, and Risky Health Behaviors Among Vulnerable Middle School Students
Poster Symposia / 60 (2017) S21eS38
increased stress due to prejudice, discrimination, harassment, and victimization related to their sexual minority status. School-related minority stressors may include being bullied, harassed, and attacked at school. Non-school-related sources of stress disproportionately experienced by sexual minority youth may include early sexual debut, forced sexual intercourse, and other adverse childhood experiences (ACEs). Research suggests that increased stress may help to explain the disproportionate use of substances like alcohol, tobacco, and other drugs by sexual minority youth. This study examined the effect of school-related and non-school-related minority stress on substance use disparities among sexual minority U.S. high school students. Methods: Data from the national 2015 Youth Risk Behavior Survey, a nationally representative sample of 15,624 U.S. high school students, were analyzed to determine the effect of school-related (violent threats and physical attacks, bullying, and feeling unsafe at school) and non-school-related (early sexual debut and forced sexual intercourse) minority stress on substance use disparities among sexual minority students (defined by sexual identity and sex of sexual contacts), by comparing unadjusted prevalence ratios (PR) and adjusted (for minority stressors, age, sex, and race/ethnicity) prevalence ratios (APR). Results: All school-related and non-school-related stressors were significantly more prevalent among sexual minority than sexual nonminority students. In unadjusted analyses, every category of substance use was significantly greater (95% confidence interval for PR did not include 1.0)* among students who identified as lesbian, gay, or bisexual than students who identified as heterosexual; and significantly greater among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. After controlling for minority stressors, disparities by sexual identity decreased substantially and were no longer statistically significant for cocaine use (PR¼2.52* vs. APR¼1.25), methamphetamine use (PR¼3.96* vs. APR¼1.54), heroin use (PR¼4.60* vs. APR¼0.90), and injection drug use (PR¼4.93* vs. APR¼1.38); disparities for cigarette use, alcohol use, marijuana use, and nonmedical use of prescription drugs decreased, but remained statistically significant. Disparities by sex of sexual contacts decreased substantially and were no longer statistically significant for heroin use (PR¼4.08* vs. APR¼1.57) and injection drug use (PR¼4.03* vs. APR¼1.34); disparities for use of other substances (except alcohol use) decreased, but remained statistically significant. Conclusions: These findings suggest that at least some of the disparity in substance use found among sexual minority students may occur in response to experiences of minority stress. Thus, school-based substance use prevention may benefit from inclusion of strategies to minimize minority stress by fostering environmental supports for sexual minority students, including antibullying and anti-harassment policies, and the fostering of safe spaces for sexual minority youth in the form of gay-straight alliances (GSAs) or other support groups. School- and communitybased strategies to improve access to social and mental health services may also help to reduce minority stress and substance use by preventing or mitigating the effects of physical, psychological, and sexual abuse, and other ACEs. Sources of Support: None.
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55. ASSOCIATIONS BETWEEN MULTIPLE DIMENSIONS OF SCHOOL ENGAGEMENT, PEER RELATIONSHIPS, AND RISKY HEALTH BEHAVIORS AMONG VULNERABLE MIDDLE SCHOOL STUDENTS Myriam Forster, PhD 1, Kari M. Gloppen, PhD 1, Amy L. Gower, PhD 1, Jennifer A. Oliphant, MPH 1, Renee E. Sieving, PhD 1, Barbara J. McMorris, PhD 2. 1
University of Minnesota; 2School of Nursing.
Purpose: Middle school is a critical developmental period characterized by increased susceptibility to internalizing and externalizing behaviors. Adolescents’ sense of belonging at school, perceptions that teachers are supportive and caring, engagement in academic work, and bonds with prosocial friends are all potential promotive mechanisms for healthy youth development. The goal of this study was to evaluate whether three dimensions of school engagement (emotional, behavioral, cognitive) and peer relationships were differentially associated with middle school students’ reports of internalizing symptoms, delinquency, and bullying involvement to identify needs and assets that can be emphasized in prevention programming. Methods: Data are from a 2015 baseline survey of 601 6th graders participating in a comparative effectiveness study of three middle schools in the Minneapolis-St. Paul metropolitan area. Schools serve students from diverse ethnic and socioeconomic backgrounds and have experienced challenges in academic performance and school retention. Students reported on three dimensions of school engagement: emotional (student perceptions of teachers/staff at school; 9-items), behavioral (participation in learning, attentiveness; 5-items), and cognitive (willingness for effortful learning, perceptions of competency; 9-items) engagement. Prosocial peers and peer connectedness were each measured as 3-item scales. Dependent variables were past 30-day behaviors: internalizing symptoms, bullying behaviors (relational and physical victimization and perpetration) and delinquency (e.g. vandalism, skipping school). Separate logistic and linear regression models tested associations between school engagement dimensions, peer relations, and each behavior problem, adjusting for demographic characteristics. Results: Nearly a third of students reported involvement with bullying; half reported engaging in delinquency. Of the school engagement dimensions, only emotional engagement was significantly associated with lower odds of delinquency (OR .46, 95% CI: .27-.85) and bullying behaviors (including physical bullying perpetration [OR.39, 95% CI: .21-.72] and relational victimization [OR .39, 95% CI: .23-.66]). Among peer variables, higher levels of prosocial peers was uniquely associated with fewer internalizing symptoms (b ¼ -.19, p < .01), lower odds of delinquency (OR .29, 95% CI: .19-.45), and lower odds of all bullying involvement measures, controlling for peer connectedness. In contrast, peer connectedness was uniquely associated with more internalizing symptoms (b ¼ .11, p< .05), higher odds of delinquent behaviors (OR 1.60, 95% CI: 1.17-2.15), and relational bullying victimization (OR 3.7, 95% CI: 2.92-5.34), after controlling for prosocial peers.
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Poster Symposia / 60 (2017) S21eS38
Conclusions: Prosocial peers and emotional engagement to school were consistently associated with lower odds of behaviors that can undermine healthy development and school success, highlighting the importance of relationships within the school environment for students’ social and behavioral health. In contrast, peer connectedness was positively associated with several risk behaviors. Programs that provide opportunities for diverse adolescents to develop capacities and competencies for meaningful engagement in learning and to experience school as a positive environment are key elements of efforts designed to reduce health and educational disparities. Fostering positive student competencies and school engagement may be promising approaches for promoting school success and well-being among vulnerable students in urban and suburban settings. Sources of Support: Not applicable. 56. TRENDS IN SUBSTANCE USE AMONG MULTIRACIAL ADOLESCENTS: FINDINGS FROM THE NATIONAL SURVEY ON DRUG USE AND HEALTH, 2005-2014 Marvin So, MPH. Emory University School of Medicine.
Purpose: Although the mixed-race population is the fastest growing segment of the U.S. population (Humes, Jones, & Ramirez, 2011), little is known about the substance use behaviors of bi- and multi-racial people, particularly adolescents. Extant research has focused on White and monoracial minority youth (Clark, Doyle, & Clincy, 2013); what does exist suggests that multi-race individuals have substance use prevalence and initiation rates that are intermediate to and distinct from corresponding monoracial counterparts (Clark, Nguyen, & Kropko, 2013). Given the salience of racial/ ethnic self-identification during adolescence, investigation of substance use among the mixed-race group overall and stratified by specific race combinations is warranted. This study examined nationwide substance use among adolescents age 12-17 who indicated a racial/ethnic identity of two or more races. Methods: We used data from the National Survey on Drug Use and Health, a cross-sectional, nationally-representative survey of people aged 12 and above that examines levels and patterns of substance use in the U.S. Using bivariate and multivariate statistics, we estimated the age-, gender-, and race combination-specific prevalence of past month (i.e., current) substance use for several drugs. Prevalence ratios were calculated to determine mixed-race estimates relative to national averages, across time and socioeconomic status. This included use of marijuana, cigarettes, alcohol, and prescription pain relievers for non-medical reasons, as well as overall use. We limited race combination-specific analyses to groups with sufficient sample size: White-Black, White-Asian, and White-American Indian/Alaska Native (all with crosstabulations for Hispanic origin). Results: Overall prevalence of substance use for mixed-race adolescents has been consistently higher than the national average for the past decade. Prevalence for both groups declined from 2005-2014, with prevalence ratios remaining consistent throughout. Current marijuana and alcohol use fluctuated over the decade, with a recent trend below the national average.
Current cigarette and non-medical prescription pain reliever use remained elevated and persist, with prevalence ratios between (PR: 1.3-2.4) over the study period. We observed increasing prevalence ratios for overall substance use and all four specific substances, for males, older adolescents, and low-income subgroups over time. Prevalence ratios for specific race combinations remained consistent over time, but remain high, particularly for White-Black people (PR: 1.6-2.2) and White-American Indian/ Alaska Natives (PR: 2.3-3.8). Conclusions: Although mixed-race individuals constitute a small, heterogeneous subpopulation, clear and persistent disparities in measures of substance use, particularly for cigarettes and prescription pain relievers, among these youth are concerning. Contextualized with what is known about elevated mental health problems in this population (Whaley, et al., 2006), our findings suggest that extant research on racial/ethnic health disparities has hitherto neglected the growing mixed-race adolescent population. Breaking down the “general multiracial group” (Charmaraman, et al., 2014) is an important next step for advancing understanding of the behavioral health needs of specific multiracial groups. We discuss the implications of racial socialization and code-switching for disentangling the relationship between mixed-race identity and substance use, and offer research needed to formulate prevention and treatment programs for this group. Sources of Support: Not applicable. 57. VALIDITY AND RELIABILITY OF ALCOHOL AND MARIJUANA USE SUSCEPTIBILITY AMONG LATINO YOUTH Diego Garcia-Huidobro, MD, PhD 1, Cynthia Davey, MS 1, Maria Veronica Svetaz, MD, MPH, FSAHM 2, MIchele Allen, MD, MPH, FSAHM 1. 1
University of Minnesota; 2Aqui Para Ti, Hennepin County Medical Center.
Purpose: Latino youth experience high substance use rates that for some ages and substances surpass other race/ethnic groups. Preventive interventions are critical to reduce substance use inequities experienced by Latino youth. An important step is to develop sound measures that will identify youth at-risk before engaging in these behaviors. Measures of youth smoking susceptibility have been evaluated for Latino adolescents, however measures to identify Latino teens who are at risk of alcohol and other illicit substance use are needed. This study aims to determine the test-retest reliability and validity of measures to identify alcohol and marijuana use susceptibility of Latino adolescents. Methods: Padres Informados, Jovenes Preparados was a randomized trial of a parenting intervention to prevent tobacco and illicit substance use on Latino adolescents aged 10 to 14. Only participants randomized to the control group (n¼172), and reported complete data at baseline, 4-month, and 10-month follow ups (n¼139, 81%) were included in this study. Youth were asked 3 questions to determine alcohol susceptibility: 1) Do you think you will try to drink alcohol (more than a few sips) soon?, 2) If one of your best friends were to offer you a drink of alcohol would you drink it?, and 3) Do you think you will be having a drink of alcohol one year from now? Youth were classified as susceptible if they answered yes to any of those questions. Similar questions and
increased stress due to prejudice, discrimination, harassment, and victimization related to their sexual minority status. School-related minority stressors may include being bullied, harassed, and attacked at school. Non-school-related sources of stress disproportionately experienced by sexual minority youth may include early sexual debut, forced sexual intercourse, and other adverse childhood experiences (ACEs). Research suggests that increased stress may help to explain the disproportionate use of substances like alcohol, tobacco, and other drugs by sexual minority youth. This study examined the effect of school-related and non-school-related minority stress on substance use disparities among sexual minority U.S. high school students. Methods: Data from the national 2015 Youth Risk Behavior Survey, a nationally representative sample of 15,624 U.S. high school students, were analyzed to determine the effect of school-related (violent threats and physical attacks, bullying, and feeling unsafe at school) and non-school-related (early sexual debut and forced sexual intercourse) minority stress on substance use disparities among sexual minority students (defined by sexual identity and sex of sexual contacts), by comparing unadjusted prevalence ratios (PR) and adjusted (for minority stressors, age, sex, and race/ethnicity) prevalence ratios (APR). Results: All school-related and non-school-related stressors were significantly more prevalent among sexual minority than sexual nonminority students. In unadjusted analyses, every category of substance use was significantly greater (95% confidence interval for PR did not include 1.0)* among students who identified as lesbian, gay, or bisexual than students who identified as heterosexual; and significantly greater among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. After controlling for minority stressors, disparities by sexual identity decreased substantially and were no longer statistically significant for cocaine use (PR¼2.52* vs. APR¼1.25), methamphetamine use (PR¼3.96* vs. APR¼1.54), heroin use (PR¼4.60* vs. APR¼0.90), and injection drug use (PR¼4.93* vs. APR¼1.38); disparities for cigarette use, alcohol use, marijuana use, and nonmedical use of prescription drugs decreased, but remained statistically significant. Disparities by sex of sexual contacts decreased substantially and were no longer statistically significant for heroin use (PR¼4.08* vs. APR¼1.57) and injection drug use (PR¼4.03* vs. APR¼1.34); disparities for use of other substances (except alcohol use) decreased, but remained statistically significant. Conclusions: These findings suggest that at least some of the disparity in substance use found among sexual minority students may occur in response to experiences of minority stress. Thus, school-based substance use prevention may benefit from inclusion of strategies to minimize minority stress by fostering environmental supports for sexual minority students, including antibullying and anti-harassment policies, and the fostering of safe spaces for sexual minority youth in the form of gay-straight alliances (GSAs) or other support groups. School- and communitybased strategies to improve access to social and mental health services may also help to reduce minority stress and substance use by preventing or mitigating the effects of physical, psychological, and sexual abuse, and other ACEs. Sources of Support: None.
S31
55. ASSOCIATIONS BETWEEN MULTIPLE DIMENSIONS OF SCHOOL ENGAGEMENT, PEER RELATIONSHIPS, AND RISKY HEALTH BEHAVIORS AMONG VULNERABLE MIDDLE SCHOOL STUDENTS Myriam Forster, PhD 1, Kari M. Gloppen, PhD 1, Amy L. Gower, PhD 1, Jennifer A. Oliphant, MPH 1, Renee E. Sieving, PhD 1, Barbara J. McMorris, PhD 2. 1
University of Minnesota; 2School of Nursing.
Purpose: Middle school is a critical developmental period characterized by increased susceptibility to internalizing and externalizing behaviors. Adolescents’ sense of belonging at school, perceptions that teachers are supportive and caring, engagement in academic work, and bonds with prosocial friends are all potential promotive mechanisms for healthy youth development. The goal of this study was to evaluate whether three dimensions of school engagement (emotional, behavioral, cognitive) and peer relationships were differentially associated with middle school students’ reports of internalizing symptoms, delinquency, and bullying involvement to identify needs and assets that can be emphasized in prevention programming. Methods: Data are from a 2015 baseline survey of 601 6th graders participating in a comparative effectiveness study of three middle schools in the Minneapolis-St. Paul metropolitan area. Schools serve students from diverse ethnic and socioeconomic backgrounds and have experienced challenges in academic performance and school retention. Students reported on three dimensions of school engagement: emotional (student perceptions of teachers/staff at school; 9-items), behavioral (participation in learning, attentiveness; 5-items), and cognitive (willingness for effortful learning, perceptions of competency; 9-items) engagement. Prosocial peers and peer connectedness were each measured as 3-item scales. Dependent variables were past 30-day behaviors: internalizing symptoms, bullying behaviors (relational and physical victimization and perpetration) and delinquency (e.g. vandalism, skipping school). Separate logistic and linear regression models tested associations between school engagement dimensions, peer relations, and each behavior problem, adjusting for demographic characteristics. Results: Nearly a third of students reported involvement with bullying; half reported engaging in delinquency. Of the school engagement dimensions, only emotional engagement was significantly associated with lower odds of delinquency (OR .46, 95% CI: .27-.85) and bullying behaviors (including physical bullying perpetration [OR.39, 95% CI: .21-.72] and relational victimization [OR .39, 95% CI: .23-.66]). Among peer variables, higher levels of prosocial peers was uniquely associated with fewer internalizing symptoms (b ¼ -.19, p < .01), lower odds of delinquency (OR .29, 95% CI: .19-.45), and lower odds of all bullying involvement measures, controlling for peer connectedness. In contrast, peer connectedness was uniquely associated with more internalizing symptoms (b ¼ .11, p< .05), higher odds of delinquent behaviors (OR 1.60, 95% CI: 1.17-2.15), and relational bullying victimization (OR 3.7, 95% CI: 2.92-5.34), after controlling for prosocial peers.
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Poster Symposia / 60 (2017) S21eS38
Conclusions: Prosocial peers and emotional engagement to school were consistently associated with lower odds of behaviors that can undermine healthy development and school success, highlighting the importance of relationships within the school environment for students’ social and behavioral health. In contrast, peer connectedness was positively associated with several risk behaviors. Programs that provide opportunities for diverse adolescents to develop capacities and competencies for meaningful engagement in learning and to experience school as a positive environment are key elements of efforts designed to reduce health and educational disparities. Fostering positive student competencies and school engagement may be promising approaches for promoting school success and well-being among vulnerable students in urban and suburban settings. Sources of Support: Not applicable. 56. TRENDS IN SUBSTANCE USE AMONG MULTIRACIAL ADOLESCENTS: FINDINGS FROM THE NATIONAL SURVEY ON DRUG USE AND HEALTH, 2005-2014 Marvin So, MPH. Emory University School of Medicine.
Purpose: Although the mixed-race population is the fastest growing segment of the U.S. population (Humes, Jones, & Ramirez, 2011), little is known about the substance use behaviors of bi- and multi-racial people, particularly adolescents. Extant research has focused on White and monoracial minority youth (Clark, Doyle, & Clincy, 2013); what does exist suggests that multi-race individuals have substance use prevalence and initiation rates that are intermediate to and distinct from corresponding monoracial counterparts (Clark, Nguyen, & Kropko, 2013). Given the salience of racial/ ethnic self-identification during adolescence, investigation of substance use among the mixed-race group overall and stratified by specific race combinations is warranted. This study examined nationwide substance use among adolescents age 12-17 who indicated a racial/ethnic identity of two or more races. Methods: We used data from the National Survey on Drug Use and Health, a cross-sectional, nationally-representative survey of people aged 12 and above that examines levels and patterns of substance use in the U.S. Using bivariate and multivariate statistics, we estimated the age-, gender-, and race combination-specific prevalence of past month (i.e., current) substance use for several drugs. Prevalence ratios were calculated to determine mixed-race estimates relative to national averages, across time and socioeconomic status. This included use of marijuana, cigarettes, alcohol, and prescription pain relievers for non-medical reasons, as well as overall use. We limited race combination-specific analyses to groups with sufficient sample size: White-Black, White-Asian, and White-American Indian/Alaska Native (all with crosstabulations for Hispanic origin). Results: Overall prevalence of substance use for mixed-race adolescents has been consistently higher than the national average for the past decade. Prevalence for both groups declined from 2005-2014, with prevalence ratios remaining consistent throughout. Current marijuana and alcohol use fluctuated over the decade, with a recent trend below the national average.
Current cigarette and non-medical prescription pain reliever use remained elevated and persist, with prevalence ratios between (PR: 1.3-2.4) over the study period. We observed increasing prevalence ratios for overall substance use and all four specific substances, for males, older adolescents, and low-income subgroups over time. Prevalence ratios for specific race combinations remained consistent over time, but remain high, particularly for White-Black people (PR: 1.6-2.2) and White-American Indian/ Alaska Natives (PR: 2.3-3.8). Conclusions: Although mixed-race individuals constitute a small, heterogeneous subpopulation, clear and persistent disparities in measures of substance use, particularly for cigarettes and prescription pain relievers, among these youth are concerning. Contextualized with what is known about elevated mental health problems in this population (Whaley, et al., 2006), our findings suggest that extant research on racial/ethnic health disparities has hitherto neglected the growing mixed-race adolescent population. Breaking down the “general multiracial group” (Charmaraman, et al., 2014) is an important next step for advancing understanding of the behavioral health needs of specific multiracial groups. We discuss the implications of racial socialization and code-switching for disentangling the relationship between mixed-race identity and substance use, and offer research needed to formulate prevention and treatment programs for this group. Sources of Support: Not applicable. 57. VALIDITY AND RELIABILITY OF ALCOHOL AND MARIJUANA USE SUSCEPTIBILITY AMONG LATINO YOUTH Diego Garcia-Huidobro, MD, PhD 1, Cynthia Davey, MS 1, Maria Veronica Svetaz, MD, MPH, FSAHM 2, MIchele Allen, MD, MPH, FSAHM 1. 1
University of Minnesota; 2Aqui Para Ti, Hennepin County Medical Center.
Purpose: Latino youth experience high substance use rates that for some ages and substances surpass other race/ethnic groups. Preventive interventions are critical to reduce substance use inequities experienced by Latino youth. An important step is to develop sound measures that will identify youth at-risk before engaging in these behaviors. Measures of youth smoking susceptibility have been evaluated for Latino adolescents, however measures to identify Latino teens who are at risk of alcohol and other illicit substance use are needed. This study aims to determine the test-retest reliability and validity of measures to identify alcohol and marijuana use susceptibility of Latino adolescents. Methods: Padres Informados, Jovenes Preparados was a randomized trial of a parenting intervention to prevent tobacco and illicit substance use on Latino adolescents aged 10 to 14. Only participants randomized to the control group (n¼172), and reported complete data at baseline, 4-month, and 10-month follow ups (n¼139, 81%) were included in this study. Youth were asked 3 questions to determine alcohol susceptibility: 1) Do you think you will try to drink alcohol (more than a few sips) soon?, 2) If one of your best friends were to offer you a drink of alcohol would you drink it?, and 3) Do you think you will be having a drink of alcohol one year from now? Youth were classified as susceptible if they answered yes to any of those questions. Similar questions and