Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Adolescent and Young Adult Health Outcomes

Although a number of studies examined the implications of marital disruption for adolescent well-being, few studied the implications of marital relationship quality on health outcomes for children in married-couple families. The present study examines how parent marital quality among intact families interacts with the quality of parent–adolescent relationships to predict physical health, mental health, and substance use in middle adolescence and early adulthood. The study uses data from the NLSY97 cohort, a nationally representative sample of adolescents who are being followed into adulthood. Predictors include the quality of the parent marital relationship, the quality of the parent–adolescent relationship, marital structure, and a number of contextual covariates and control variables. Combined parent marital quality and parent–adolescent relationship groups were developed using latent class analyses and were used to predict positive and negative health behaviors during the teen and early adult years. Results indicate that adolescents in families experiencing poor marital quality fared worse on physical health, mental health, and substance use outcomes. In addition, adolescents who reported poor relationships with at least one of their parents fared worse on outcomes. Adolescents whose parents have low-quality relationships and also have poor parent–adolescent relationships tended to fare least well across health measures. Adolescents whose parents have a high-quality relationship and who have a good parent–adolescent relationship with both parents consistently had the best outcomes. Overall, poor relationships consistently undermine mental health, physical health, and substance use. Family religious activities also consistently predict better health outcomes.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

The effect of social anxiety,generalized anxiety,depression and substance abuse on child support payment compliance among non-custodial parents

Millions of children live with custodial parents (CPs) who have child support court orders for the non-custodial parent (NCP) to provide payments to the CP for care of the children. Unfortunately, less than half of CPs receives full child support. A key issue influencing the failure to pay child support is NCP unemployment. Despite a clear association between unemployment and several mental disorders, the nature and prevalence of mental disorders has not been investigated in the NCP population. The purpose of this study was to explore the association between mental health and substance use problems among non-custodial parents and their payment of child support. The study also investigated whether unemployment mediated the relationship between these variables.Surveys that included validated screening instruments to assess for generalized anxiety, social anxiety, depression, and substance use disorders were administered to a convenience sample of 633 NCPs. Survey respondents were matched with state support payment information.The results indicated that depression, generalized anxiety, social anxiety and substance use problems were present at a much higher rate than 12-month rates of these conditions found in the general population. This study also confirmed the strong association between child support payments and employment. Employment mediated the relationship between mental health problems and child support payments. The findings suggest that non-compliant NCPs, particularly those who are also unemployed, may experience clinically significant mental health conditions that contribute to unemployment and potentially, payment non-compliance. Future studies could explore if providing mental health assessment and employment-focused treatment for mental health-related barriers to employment may increase employment and child support compliance for NCPs, thereby improving children's economic stability and well-being.     

Latino adolescent substance use: A mediating model of inter-parental conflict,deviant peer associations,and parenting

Substance use among Latino adolescents continues to be a growing concern for researchers and clinicians. This paper reviews relevant literature regarding the impact of inter-parental conflict (IPC), deviant peer associations (DPA) and parenting behaviors, namely as parental support, psychological control, and parental monitoring knowledge on substance use among Latino adolescents. Although mediating models of IPC and similar parenting behaviors on adolescent externalizing behaviors have been represented in empirical studies, none have included the influence of peer associations or have analyzed these factors with substance use among Latino adolescents in the U.S. This study investigated direct relationships of IPC and DPA with adolescent substance use, and tested parental support, psychological control and parental monitoring knowledge as mediators between those relationships in Latino adolescents. Structural equation modeling was used to analyze direct and indirect relationships of the variables mentioned among 744 Latino adolescents. Results indicated that DPA was positively associated with substance use, parental monitoring knowledge was negatively associated with substance use and that parental monitoring knowledge partially mediated the relationship between DPA and substance use. Implications of the findings are discussed in terms of areas of focus for interventions.     

Comparison of Treatment Response among GLB and non-GLB Street Living Youth

Researchers have found that adolescents who identify as gay, lesbian, or bisexual (GLB) are at a higher risk for increased substance use and mental health symptoms. The current study is a secondary analysis of two clinical trials for street-living youth. This analysis examines self-identification as GLB as a moderator of treatment effects and addresses whether street-living GLB youth respond differently to a therapeutic intervention than non-GLB street-living youth. Comparisons were made of treatment outcomes on two categories of variables (drug use and mental health symptoms) among 244 homeless GLB and non-GLB identified adolescents. Overall, GLB and non-GLB adolescents showed similar reductions in drug use and mental health symptoms. However, compared to non-GLB adolescents, GLB adolescents showed greater improvement in reduction of drug use and internalizing and depressive symptom scores. While both groups reported less drug use and fewer mental health symptoms from baseline to post-intervention, GLB youth's scores improved more drastically. Implications of using the identified treatment intervention are discussed.     

Examination of the Role of Therapeutic Alliance,Treatment Dose,and Treatment Completion in the Effectiveness of The Seven Challenges

Adolescent alcohol and illicit drug (AOD) use is a major public health concern. This longitudinal study examines the effectiveness of The Seven Challenges in reducing adolescent substance use and mental health problems, as well as the process by which it is effective. Participants were 89 adolescents (72 male, 17 female) enrolled in a 3 month intensive outpatient adolescent substance abuse treatment program using The Seven Challenges and who provided self-report data at pre- and post-treatment. Results indicated that The Seven Challenges was effective at increasing the number of days refrained from using AOD, reducing use of tetrahydrocannabinol (THC) and other drugs, and reducing substance use problems and internal mental distress. Results also indicated that The Seven Challenges drug counselors effectively established and maintained therapeutic alliance but this seems to not play a role in the effectiveness of The Seven Challenges. Both treatment dose and completion played a role in the effectiveness of The Seven Challenges; they were both positively related to post-treatment days refrained from AOD use, and negatively related to days of THC use, substance use problems, and internal mental distress. However, the strength of the influence of treatment completion was stronger when treatment dose was low than when it was high. Despite a small sample and other limitations, findings add to existing literature that suggests that The Seven Challenges is an effective substance abuse treatment for adolescents. Furthermore, findings suggest that adolescent substance abuse treatment should focus on clients meeting pre-determined program goals as well as on dose.     

Adolescents' Self-Reported Substance Risks and Need to Talk About Them in Mental Health Counseling

Summary

Although adolescents seeking mental health services may not consider them related, the prevalent co-morbidity of substance use and mental health problems makes it imperative that practitioners find ways of engaging troubled youth about substance issues. Based on their responses to a clinical self-assessment questionnaire (Adquest), this study shows that mental health service applicants are willing to disclose their substance use behaviors and are open to talking about them to intake workers. Age and gender differences in substance use patterns and willingness to talk are explored.     

Risk and protective factors for depression and substance use in an adolescent child welfare sample

Research on the mental health needs of maltreated youth in out-of-home care remains limited. The goal of the current study was to examine two common mental health concerns (i.e., depression, substance use) among 122 12-15 year olds in out-of-home placements. Specifically, we investigated potential risk and protective factors among socio-demographic, maltreatment, youth, family, and community variables. We relied on data collected through the AAR-C2, a Canadian needs assessment and outcome monitoring tool. Approximately 4 in 10 (39.2%) youth endorsed at least one mental health problem, which we defined as the youth scoring at least one standard deviation above the sample mean for the depression items and the youth indicating the presence of alcohol and/or substance use over the past year. Almost 1 in 10 (8.3%) reported struggling with both mental health issues. Results from logistic regressions indicated that adolescent females were at higher risk of experiencing depression than males, and increasing age was associated with increased risk for substance use. Turning to protective factors, results indicated that the greater the perceived quality of the youth-caregiver relationship, the lower the risk for mental health difficulties (i.e., depression, substance use). Moreover, participation in extracurricular activities appeared to protect youth against depression or substance use. Results imply that the youth-caregiver relationship and involvement in extracurricular activities are important areas to consider to promote the well-being of maltreated youth in out-of-home care.     

Adolescents’ Subjective Social Status Predicts Day‐to‐Day Mental Health and Future Substance Use

Adolescents’ subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross‐sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low‐SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18‐month follow‐up. Results showed that with each perceived step “up” the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.     

Decreasing risk factors for later alcohol use and antisocial behaviors in children in foster care by increasing early promotive factors

Children in foster care are at high risk for poor psychosocial outcomes, including school failure, alcohol and other substance abuse, and criminal behaviors. Promoting healthy development by increasing broad-impact positive skills may help reduce some of the risk factors for longer-term negative outcomes. School readiness has been linked to a number of positive outcomes across childhood, adolescence, and adulthood, and may also boost intermediary positive skills such as self-competence. This paper presents findings from a longitudinal study involving 192 children in foster care who were 5 years old at the start of the study. They participated in a randomized controlled trial of a school readiness program to prepare them for kindergarten. Outcomes were assessed at third grade (9 years old) on variables associated with risk for later involvement in substance use and delinquency. These included positive attitudes towards alcohol use, positive attitudes towards antisocial behaviors, and involvement with deviant peers. Results showed that the intervention decreased positive attitudes towards alcohol use and antisocial behaviors. Further, the mediating role of children's self-competence was tested. The intervention positively influenced children's third-grade self-competence, which in turn, decreased their involvement with deviant peers. Findings suggest that promoting school readiness in children in foster care can have far-reaching, positive effects and that increased self-competence may be a mechanism for reducing risk.     

Association of Sexual Abstinence in Adolescence with Mental Health in Adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. A total of 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not for males; three adolescent factors, educational prospects, family bonding, and unconventionality, were investigated as explanatory variables of this relationship. The abstinence–mental health relationship was nonsignificant when educational prospects were included in multivariate models, and was marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.     

Harsh Parenting,Deviant Peers,Adolescent Risky Behavior: Understanding the Meditational Effect of Attitudes and Intentions

Although research supports the influence of parents and peers on adolescent risky behavior, less is known about mechanisms proposed to explain this relation. This study examined the influence of adolescent attitudes and intentions about such behaviors. Prospective, longitudinal data came from rural youth who participated throughout adolescence (n = 451). Observed harsh parenting and relationship with deviant peers was assessed in early adolescence, attitudes and intentions were measured during middle adolescence, and risky behavior was assessed in late adolescence. Results indicated that parenting and deviant peers was related to engagement in tobacco use, alcohol use, and risky sexual behaviors. Moreover, attitudes and intentions mediated this relationship even after parent use and adolescent early involvement in these behaviors were taken into account.     

Association of sexual abstinence in adolescence with mental health in adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.     

Lesbian,Gay, Bisexual,Sexual-Orientation Questioning Adolescents Seeking Mental Health Services

Summary

Lesbian, gay, bisexual, and sexual-orientation questioning (LGBQ) adolescents have many of the same health needs as straight adolescents. In addition, they must learn to manage a stigmatized identity that may create confusion, anxiety, and emotional turbulence for them. Beyond stigma, LGBQ youth are often found to be at higher risk for substance abuse, violence, depression, suicide, and sexual health problems. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this article examines the relationship between sexual identity and risk factors related to safety, health, sex, substance use, family and friends, worries, and their desire to talk about these in counseling. Findings indicate that LGBQ youth are at higher risk than straights, and express greater desire to talk about substance use, health, their personal lives, and their friends. Mental health practitioners working with these young persons must properly assess and address their risks by creating a sense of community and safe environment for open discussion.     

The Interplay of Syndemic Production and Serosorting in Drug-Using Gay and Bisexual Men

The relationships between mental health, substance use, and sexual behaviors among gay and bisexual men in a sample of 450 club drug-using men from New York City were examined using syndemics theory. Risk scores for each participant were based on variables measuring substance use and mental health burden. Participants with higher risk scores were significantly more likely to engage in risk behaviors. Risk taking was also explained by serosorting, suggesting that syndemics theory in and of itself, while significant in explaining risk, is not sufficient. These findings suggest we need to understand the interplay between social, emotional, and cognitive factors to understand sexual risk taking.     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

Risk Factors of Sexual Harassment by Peers: A Longitudinal Investigation of African American and European American Adolescents

The present research explores risk factors for, and longitudinal associations of, sexual harassment by peers during adolescence. Eight‐hundred and seventy‐two African American and European American adolescents (65.4% African American, 51.1% females) were assessed during the summer after the eighth grade (mean age=14.2 years) and then again in the 11th grade (mean age=17.1 years). At the first assessment, adolescents were asked about their experiences with sexual harassment, their psychological reactions to sexual harassment, and also about their peer relationships, perceived pubertal timing, problem behavior, and mental health. At the second assessment, adolescents reported on their problem behavior and mental health. In general, youth who associated with peers who were involved in problem behavior were at risk for victimization. Among females, those who perceived themselves to be experiencing early pubertal development were also at risk. Additionally, for some adolescents, sexual harassment predicted later adjustment difficulties.     

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.