Youth violence has garnered the attention of researchers and policy makers alike, because of the unique risk factors associated with victimization and the poor physical, mental, and educational outcomes that stem from such experiences. In particular, sexual minority youth--those who identify as gay, lesbian, or bisexual or who have sexual contact with persons of the same or both sexes (CDC, 2016)--are among those most at risk for victimization. Research that highlights and addresses these issues is crucial. This study utilizes the 2013 Youth Risk Behavior Surveillance System (YRBSS) data in order to investigate different forms of victimization and their consequences in lesbian, gay, bisexual and questioning (LGBQ) youth. Drawing from a sample of 12,642 9th-12th grade youth, this study investigates the prevalence of bullying, homophobic bullying, dating violence and sexual assault, as well their effects on school avoidance, poor mental health, and substance use outcomes. Results reveal that differences do, in fact, exist between sexual minority and heterosexual youth, where LGBQ youth experience higher rates of every type of victimization, and are more likely to report school avoidance, depression, suicidality, and substance use. Furthermore, this study also investigates the intersections of sexual orientation and gender, and finds that females who identify as lesbian, gay, bisexual, or questioning are most at risk for every type of victimization. Findings highlight the need for recognition of the importance of sexual orientation and gender in youth victimization, and the need for policy that explicitly outlines protections for sexual minority youth within the school environment, as well as services extended to victims of IPV. / Ph. D.

As supported by ecological systems theory and the family stress model of economic hardship, socioeconomic status can directly be related to adolescent adjustment outcomes including self-regulation, academic performance, and substance use as well as be indirectly related to these outcomes through the mediator of parental monitoring. Data obtained from 220 adolescent (male = 55%, female = 45%, mean age = 15.12 years) and primary caregiver dyads participated in the study to examine the relationship between these variables. Analyses were conducted using Structural Equation Modeling, and the results of the study demonstrate that economic hardship is directly related to adolescent academic performance and also indirectly related to this outcome through maternal monitoring. Parental monitoring was also positively related to adolescent self-regulation. Therefore, this study highlights the importance of high levels of parental monitoring for beneficial adolescent self-regulation, academic, and substance use outcomes. / Master of Science

The purpose of this research project was to explore the family structural variables of cohesion and adaptability as well as extracurricular activities, peer influences, and personal attitudes as they were manifested in adolescents classified as nonusers, users, and/or abusers of alcohol/drugs. Two hundred and thirty-seven adolescents responded to written questionnaires including the Alcohol and Drug Use Index, a reduced form of the Family Adaptability and Cohesion Evaluation Scales (FACES III), the Student Attitude and Behavior Questionnaire, and a Demographic Questionnaire. Information was obtained on age and grade level, gender and ethnicity, parental characteristics, and student's educational aspirations in an effort to identify factors associated with teenage alcohol/drug use. Some of the major findings suggested that the users/abusers groups reported less involvement with their families, educational pursuits, and extracurricular activities when compared to their nondrug using counterparts. The statistical analysis also confirmed some aspects of structural family therapy theory and refuted other aspects. The results of this study were also compared to prior research on adolescent substance use. These results further expanded the understanding of factors associated with adolescent use/abuse of alcohol/drugs. / Ph. D.

Cannabis use in the United States has generally increased over the past decade as more States have legalized recreational use. In conjunction with changes to the chemical makeup, which has made available cannabis more potent, the long-term effects experienced by cannabis users may have changed, and more individuals may be effected. The current study replicated the methods used in Schreiner & Dunn (2012) and Grant et al. (2003) to conduct a meta-analysis examining the neurocognitive effects of cannabis after abstinence lasting a period of at least 25 days. Previous research has found mixed results, with some studies finding significant differences between abstinent cannabis users and matched healthy controls, and others finding no evidence of significant differences. Results of the current meta-analytical study found no significant effects within the domains of overall effects, attention, forgetting/retrieval, learning, or verbal/language. Results identified a significant small effect size within the domain of abstraction/executive function. Results continue to add to the growing evidence there are no significant long-term neurocognitive effects associated with cannabis use.

The opioid epidemic in Philadelphia has evolved into a complex polysubstance crisis with the emergence of xylazine alongside fentanyl, reshaping substance use dynamics. Xylazine's rising prevalence introduces unique health risks due to its sedative properties, compounded when combined with fentanyl, leading to heightened potency and toxicity. This combination contributes to severe medical complications, notably injection-related infections driving hospitalizations. Ethical care for individuals with substance use disorder necessitates prioritizing patient autonomy in healthcare decision-making. Critical discussions on care goals with hospitalized drug users are imperative, encompassing pain management, withdrawal mitigation, and medication for opioid use disorder, aligning with patient preferences. Open and transparent communication fosters trust, enabling healthcare providers to effectively support substance use disorder patients and enhance their overall quality of life. / Urban Bioethics

Substance use is characterized by use of licit and illicit substances, paired with adverse consequences. Substance use and abuse are major concerns among the adolescent population. Some of the most popular substances used among adolescents include alcohol and marijuana. Adolescents who use substances have often demonstrated risky behaviors. These risky behaviors include delinquency and antisocial behaviors, such as decreased commitment to school, burglary, and theft. Behaviors such as unprotected sexual intercourse while under the influence of substances places the adolescent at risk for pregnancy and STis. Adolescents may develop depressive symptoms related to substance use, as well as attempt to commit suicide while using substances when feeling sad. Effective nursing interventions are needed to target these adolescents and prevent or cease substance use. The purpose of this integrated literature review was to explore current nursing interventions for adolescent substance use. Another aim was to determine the need for improvement on these interventions or the need for a new action plan. Findings showed that brief motivational interviewing is an effective intervention method for adolescent substance use. The advantage to brief motivational interviewing is - that it is non-confrontational, short in duration, promotes reduced substance use, and leads to complete cessation. With the use of evidence-based interventions, nurses and other health care providers can take part 1~ early preveritioh and cessation of adolescent substance use.

Magister Psychologiae - MPsych (Psychology) / Substance abuse is a global concern, particularly amongst adolescents. Research shows that secondary school learners in the Western Cape are susceptible to substance use due to the ease of access to and constant use of drugs and alcohol by their peers. The use of substances by adolescents has been linked to a number of negative consequences. The South African Substance Use Contextual Risk Instrument (SASUCRI) is an instrument developed for the purpose of identifying factors that lead to adolescent substance use and communities at risk of substance abuse. In the identification of these factors, appropriate interventions can be informed in terms of the areas that need to be focused on when dealing with the reduction of substance use. Two versions of the SASUCRI exist. However, in the investigation of the larger validation study, IsiXhosa mother-tongue learners were found to have responded to the English version of the SASUCRI. A sub-study to the larger study found that certain scales of the English version of the SASUCRI proved to be in-equivalent across the English and isiXhosa mother-tongue speakers. Recommendations were made for a further validation of the instrument by investigating the level of item bias within the in-equivalent scales, to determine the extent to which it measures what it was intended to measure. Using secondary data from the larger study, the current study investigated item bias on the identified inequivalent scales of the English version of the SASUCRI across the two language groups, using a differential research design and two statistical techniques (Mantel-Haenszel and logistic regression). The theoretical framework was that of Bias and Equivalence. Permission to conduct the study and use the data was granted from various institutions and people: the Western Cape Education Department and school principals, Committees at UWC, and the researcher of the larger study. Results revealed that bias was found in some of these scales which limit its ability to be used for its intended purpose. Therefore, recommendations for the adaptation of the English version were made.

Alcohol is the most widely used psychoactive drug on earth and continues to be responsible for a substantial burden of death and disability. Mitigating these harms is an important focus of any healthful society. Population-level alcohol policy strategies may be employed to decrease these harms and improve population health. To assist towards these goals, this dissertation has two research objectives relating to the estimation and mitigation of alcohol harms: (1) to complete a series of studies regarding the Alcohol Total Consumption Model (TCM) and (2) to specify and test a novel alcohol health harms estimator and alcohol policy scenario modeler, the International Model of Alcohol Harms and Policies (InterMAHP). The TCM is an important theory in alcohol studies and connects alcohol policies, per capita alcohol consumption and alcohol-attributable (AA) harms in a unified social theory. In brief, policies are expected to reflect on population-level consumption, which in turn is the most important predictor of alcohol harms. The TCM theorizes that change should flow directionally through the model – a policy expected to decrease consumption would be predicted to decrease alcohol harms. This theory has been critical towards informing alcohol control policies in the past five decades. In this dissertation, a series of studies were conducted to test the assumptions of the TCM, to test their continued viability. Study A is a comprehensive systematic review and series of meta-analyses that established the link between alcohol policies influencing day/hours of sale and outlet density and per capita consumption. Study B is a primary research study that examined the direct effect of a changed alcohol policy on alcohol-related ED visits, in the context of Saskatchewan. Studies C and D establish the link between alcohol consumption and AA mortality and morbidity through mathematical specification of InterMAHP. Next, the model was applied to the exemplar of AA mortality in Canada in 2016. Last, Study E extended InterMAHP functionalities to include modeling changes in AA harms expected from potential or realized per capita consumption changes resulting from policy change. An application was provided in the context of Québec. The results of this dissertation research provide some support, in a modern context, to the relationships defined in the TCM. The findings suggest that the TCM continues to be a largely appropriate conceptual model in consideration of alcohol policy-making. InterMAHP provides global alcohol researchers with a novel model towards estimating the health harms of alcohol. / Graduate / 2020-04-09

Objective: We present the prevalence and incidence rates of alcohol, nicotine, and illicit substance use, abuse, and dependence in a sample of German adolescents and young adults. Patterns of onset, cohort trends, and use of various substance classes are also analyzed. Method: A prospective longitudinal epidemiological study with a representative sample of adolescents and young adults (n = 3,021; baseline age range = 14–24 years) was conducted in Munich, Germany. Participants were assessed between 1995 and 1999 with the Munich-Composite International Diagnostic Interview. Results: Cumulative lifetime incidence (up to age 28) of any substance abuse or dependence was 43.8%, and 12-month prevalence of any substance abuse or dependence was 24.4%. The lifetime incidence of nicotine dependence was most frequent (24.8%), followed by alcohol abuse (19.3%) and alcohol dependence (9.2%); 61.7% endorsed the regular use of a substance for at least one circumscribed period during their lifetime. Age-specific incidence rates and age at onset of substance use disorders differed by age cohorts. Furthermore, nicotine dependence was significantly associated with illicit substance use disorders (HR = 2.6, 95% CI 1.7–4.0). An interactive relationship between age, age at onset of nicotine dependence, and subsequent onset of illicit substance use disorders was found. Conclusions: Since the baseline investigation in 1995, high incidence rates of substance use disorders and substance use have been observed in this young German sample. Especially younger cohorts report significantly earlier ages at onset of abuse and dependence. There also seems to be a trend towards a secondary age at onset peak of nicotine dependence after the onset of illicit drug use disorders. Further investigations are needed to study these patterns in younger samples. However, results emphasize the need for a combined prevention of illicit drugs and nicotine dependence. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Given the increasing number of military deployments in modern forces and the high individual and social costs of substance use disorders, the risk of substance use (alcohol, nicotine, illegal drugs) and substance use disorders (abuse, dependence) associated with deployment and deployment-related stressful experiences is an important area of research. Main questions in this area are: Are deployment and deployment-related stressful experiences associated with problematic substance use patterns and substance use disorders? Are there high-risk groups for deploymentrelated increases in substance use and the occurrence of substance use disorders? Do other mental disorders such as posttraumatic stress disorder play a role for the risk of substance use disorders? This dissertation thesis aims to contribute to these questions. The thesis is based on a research program in German military personnel deployed to Afghanistan. The program includes a crosssectional and a prospective-longitudinal study component. In the cross-sectional component, a random, stratified sample of 1483 was assessed twelve months after return from deployment. As a control group, 889 never deployed soldiers were also assessed. In the prospective-longitudinal component, another sample of 358 male soldiers was assessed directly before and twelve months following deployment. Information about substance use and substance use disorders was obtained using a standardized diagnostic interview. Deployment-related stressful experiences and other relevant variables were assessed with additional scales and questionnaires. Based on this study program, the following research questions were addressed: (1) Do deployed and never deployed soldiers differ regarding the prevalence of problematic substance use patterns (alcohol, nicotine, illegal drugs) and substance use disorders (alcohol, nicotine)? (2) How are soldiers with deployment-related changes in alcohol use characterized? (3) Are posttraumatic stress disorder symptoms related to the risk for substance use disorders (alcohol, nicotine)? (4) Are soldiers with prior mood and anxiety disorders at higher risk for the onset of substance use disorders (alcohol, nicotine) following deployment-related stressful experiences? Main results: Regarding these research questions, the following main results were observed: (1) Deployed and never deployed do not differ considerably regarding the prevalence of substance use and substance use disorders. (2) There was evidence for both deployment-related increases and decreases in alcohol use in specific subgroups. Compared to soldiers with a stable consumption, soldiers with increased alcohol use were characterized by lower ranks, less acceptance, less social support, more sleeping problems after deployment and more deployment-related negative cognitions. Soldiers with deployment-related decreases in alcohol use were characterized by fewer posttraumatic stress disorders symptoms prior deployment and less childhood emotional neglect. (3) Posttraumatic stress disorder symptoms were related to the risk for substance use disorders. These associations were partially attributable to other comorbid mental disorders. However, several posttraumatic stress disorder symptoms were related to substance use disorders above the contribution of comorbidity. (4) Specific constellations of prior mood and anxiety disorders and high degrees of certain deploymentrelated stressful experiences predicted the onset of alcohol use disorders. Conclusions: Based on these findings it can be concluded that German soldiers deployed to Afghanistan do not have an overall elevated risk for substance use and substance use disorders. However, several subgroups with a deployment-related increase in substance use and substance use disorders could be identified for specific substances. These subgroups include soldiers with low ranks, low social support and other mental disorders, of which several posttraumatic stress disorder symptoms might be particularly relevant. In addition, soldiers who experience mood and anxiety disorders prior to deployment as well as high degrees of specific deployment-related stressful experiences might be at higher risk for the onset of alcohol use disorders. It is also noteworthy that some soldiers show a deployment-related decrease in alcohol consumption. These findings might contribute to an improved identification of high-risk groups and suggest targets for possible interventions and preventive efforts. Because of some limitations, mainly regarding crosssectional designs and limited statistical power, some observed associations have to be interpreted with caution. Further prospective studies in high-risk populations or larger samples are necessary to replicate and extend the suggested findings. Moreover, the generalizability of findings to non-military samples and other types of stressful experiences should be investigated. These investigations might help to further reduce the prevalence of excessive substance use and substance use disorders. / Hintergrund: Das Risiko für den Konsum psychotroper Substanzen (Alkohol, Nikotin, illegale Drogen)und das Auftreten von Substanzstörungen (Missbrauch, Abhängigkeit) im Zusammenhang mit Belastungen in militärischen Einsätzen ist angesichts der Zunahme militärischer Einsätze sowie der hohen individuellen und sozialen Kosten von Substanzstörungen ein Forschungsthema von hoher Relevanz. Wichtige Fragen sind dabei: Stehen Auslandseinsätze generell im Zusammenhang mit problematischen Konsummustern und Substanzstörungen? Gibt es bestimmte Risikogruppen für Anstiege im Substanzkonsum und das Auftreten von Substanzstörungen? Welche Rolle spielen andere psychische Störungen, wie z.B. die posttraumatische Belastungsstörung (PTBS), für das Auftreten einer Substanzstörung? Diese Dissertationsschrift behandelt verschiedene Aspekte dieser Fragestellungen auf der Grundlage eines Forschungsprogramms zur psychischen Gesundheit bei in Afghanistan eingesetzten deutschen Soldaten. Das Programm umfasste eine querschnittliche und eine prospektiv-longitudinale Studie. In der Querschnittstudie wurde eine randomisierte, stratifizierte Stichprobe von 1483 Soldaten zwölf Monate nach Rückkehr aus einem Einsatz in Afghanistan untersucht. Als Kontrollgruppe wurden zudem 889 Soldaten untersucht, welche niemals im Einsatz waren. In der prospektiv-longitudinalen Studie wurde eine weitere Stichprobe von 358 männlichen Soldaten unmittelbar vor und zwölf Monate nach Einsatzrückkehr aus Afghanistan untersucht. Information zu Substanzkonsum und Substanzstörungen nach DSM-IV wurden mittels standardisierter diagnostischer Interviews erfasst. Einsatzbezogene belastende Ereignisse und andere relevante Variablen wurden mit zusätzlichen Skalen und Fragebögen erhoben. Auf Basis dieses Studienprogramms wurden unter anderem die folgenden Fragestellungen bearbeitet: (1) Unterscheiden sich Soldaten mit und ohne Auslandseinsatz hinsichtlich der Prävalenz von kritischen Konsummustern (Alkohol, Nikotin, illegale Drogen) und Substanzstörungen (Alkohol, Nikotin)? (2) Durch welche Merkmale sind Soldaten mit einsatzbezogenen Veränderungen im Alkoholkonsum gekennzeichnet? (3) Sind Symptome der PTBS mit dem Risiko für Substanzstörungen (Alkohol, Nikotin) assoziiert? (4) Haben Soldaten mit bereits vor dem Einsatz bestehenden Angst- und affektiven Störungen ein höheres Risiko für das Auftreten einer Substanzstörung (Alkohol, Nikotin) nach belastenden Einsatzereignissen? Hauptergebnisse: In Bezug auf diese Fragestellungen ergaben sich folgende Ergebnisse: (1) Soldaten mit und ohne Auslandseinsatz unterschieden sich kaum hinsichtlich der Prävalenz von Substanzkonsum und Substanzstörungen. (2) Allerdings ergaben sich Hinweise auf Zu-, wie auch Abnahmeeffekte im Alkoholkonsum in unterschiedlichen Subgruppen. Soldaten mit einem Anstieg im Alkoholkonsum waren im Vergleich zu Soldaten mit stabilem Konsum durch einen niedrigeren Dienstgrad, ein geringeres Ausmaß an Akzeptanz, weniger soziale Unterstützung, mehr Schlafprobleme nach Einsatzrückkehr sowie ein höheres Ausmaß an negativen einsatzbezogenen Bewertungen gekennzeichnet. Bei Soldaten mit einer einsatzbezogenen Reduktion im Alkoholkonsum fanden sich weniger PTBS-Symptome vor dem Einsatz sowie ein geringeres Ausmaß an emotionaler Vernachlässigung in der Kindheit. (3) Es gab Zusammenhänge zwischen PTBS-Symptomen und Substanzstörungen, die jedoch teilweise durch andere komorbide psychische Störungen erklärt werden konnten. Allerdings blieben einige PTBS-Symptome über andere komorbide Störungen hinaus mit Substanzstörungen assoziiert. (4) Bestimmte Konstellationen von bereits vor dem Einsatz bestehenden Angst- und affektiven Störungen sagten bei hohem Ausmaß an einigen einsatzbezogenen Belastungen das Auftreten einer Störung durch Alkoholkonsum vorher. Schlussfolgerungen: Auf Grundlage dieser Befunde lässt sich schlussfolgern, dass in Afghanistan eingesetzte Bundeswehrsoldaten kein generell erhöhtes Risiko für kritische Konsummuster und das Auftreten von Substanzstörungen aufweisen. Allerdings konnten Subgruppen identifiziert werden, die in Bezug auf bestimmte Substanzen ein erhöhtes Risiko für einen erheblichen Anstieg im Substanzkosum oder das Auftreten einer Substanzstörung haben. Dazu gehören unter anderem Soldaten mit niedrigen Dienstgrad, geringer sozialer Unterstützung und anderen psychischen Störungen, wobei bestimmte Symptome der posttraumatischen Belastungsstörung von besonderer Relevanz sein könnten. Zudem scheint das Risiko für Störungen durch Alkoholkonsum bei Soldaten erhöht, bei denen bereits vor dem Einsatz Angst- und affektive Störungen auftraten und die gleichzeitig ein hohes Ausmaß an bestimmten Einsatzbelastungen erleben. Bemerkenswert ist aber auch, dass einige Soldaten nach dem Einsatz eine erhebliche Reduktion des Alkoholkonsums aufweisen. Die Befunde könnten zu einer verbesserten Identifikation von Risikogruppen beitragen und Ansatzpunkte für mögliche Interventionen und präventive Maßnahmen liefern. Aufgrund einiger Limitationen, die vor allem querschnittliche Designs und eine eingeschränkte statistische Power betreffen, sollten einige der beobachteten Zusammenhänge vorsichtig interpretiert werden. Weitere prospektive Untersuchungen an größeren Stichproben sowie Hochrisikokohorten sind nötig, um die Befunde zu replizieren und zu erweitern. Weiter sollte die Übertragbarkeit der Befunde auf nichtmilitärische Stichproben unter Einbezug anderer Arten von belastenden Ereignissen untersucht werden. Diese Untersuchungen könnten langfristig zur Senkung von problematischen Substanzkonsum und Substanzstörungen beitragen.