Background: Research suggests sexual minority women have higher rates of substance use and mental health problems than straight women. Specifically, past studies have shown alcohol consumption and dependence rates are higher among sexual minority women, in addition to use of some drugs. Similarly, research shows mental health problems such as anxiety, depression and suicide rates are elevated among sexual minority women. These differences in mental health and substance use characteristics by sexual orientation may be explained by the negative health effects of social marginalization and the common use of drinking establishments for sexual minorities. Objective: The objective of this thesis is to compare substance use and mental health characteristics between lesbian/bisexual women and straight women, including: a) demographic variables; b) alcohol and drug consumption and dependence; c) the social context of substance use (i.e., use with others, motivations to use and locations of use); and, d) mental health characteristics. Methods: Data were obtained from a sample of residential treatment clients in treatment for primarily alcohol and/or cocaine problems. Respondents were asked to fill out self-administered questionnaires, which included details on demographics, substance use, mental health and the social context of use, as well as information on sexual orientation and gender identity. Bivariate and logistic regression analyses were performed to examine differences by sexual orientation. Results: Some sexual orientation differences were found regarding alcohol consumption and dependence during bivariate analysis. In logistic regression results, methamphetamine use was significantly (p<.01) elevated among bisexual women and tranquilizers use was elevated among lesbian and bisexual women when compared to straight women. Bivariate analysis revealed lesbian and bisexual women reported higher levels on motivations to use, but this difference was not significant in multivariate regression results. After regression adjustments, lesbian and bisexual women had higher levels of anxiety and higher rates of suicide attempts. Lastly, lesbian and bisexual women reported substance use with sex workers and sex clients more often than straight women, but no other differences in location and motivations to use were seen in the regression results. Conclusion: Among this sample of residential treatment clients, some mental health and substance use characteristic differences were found. These finding can assist in determining the best treatment practices for sexual minority women. / Graduate / 0347

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.

The accurate evaluation of substance use is a critical component of forensic assessment due to the well-established link between drug use sentencing issues and risk of recidivism. Due to limited resources and chronic time constraints, practitioners typically rely only on self-report measures to assess substance use (SU) patterns. As these measures directly inquire about SU patterns, they remain vulnerable to response distortion. This can lead to ineffective treatment recommendations made to the Court and misuse of resources. The present study investigated the utility of the PAI and SASSI-3 in identifying SU patterns in offenders mandated to a long-term treatment facility. As a second major component, offenders were examined post-release to identify predictors for poor treatment outcomes. Results found the direct questioning approach best identified SU patterns in the present sample. In addition, while statistically significant differences in treatment outcomes were not observed between offenders who endorsed a more severe course of their SU problem versus those who endorsed a much less problematic pattern of use, they were trending in the expected direction. Specifically, offenders who used "hard" drugs regularly (e.g., cocaine, heroin), had more negative consequences directly related to their use (e.g., more arrests, prior treatment), and had a more complex clinical presentation (e.g., endorsing more personality pathology) did have worse outcomes by follow up. Methodological and statistical limitations are discussed in depth, and future directions to improve on this study and clarify these relationships are emphasized.

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Using questionnaire survey generated data from a single school district, this study investigated the effects of family factors, peer factors, school problem behaviors, and psychosocial factors on adolescents' use of or abstinence from alcohol, marijuana, and other drugs. Following a review of literature, a theoretical framework incorporating family socialization theory was use to operationalize variables, develop indices, and generate hypotheses to be tested, as well as develop a general model of adolescent alcohol and other drug use and abstinence, incorporating the predictor variables. Using SPSSx procedures, factor analysis was used to develop the indices; the hypotheses were tested using Oneway Analysis of Variance (ANOVA) and F-ratio tests associated with regression analysis. The path analysis models were developed using multiple regression analysis and bivariate decomposition tables. For both junior high school students and high school students, users of alcohol, marijuana, and other drugs were found to score higher on the Family Factors index, the Peer Factors index, School Problems index, and the Psychosocial Factors index. The model differed between alcohol and marijuana users, defining the conditions under which an adolescent is more likely to use or abstain from marijuana. While both family and peer factors effected the adolescents' choices of use or abstinence, the strongest predictor of use/abstinence was the peer use and attitudes factor. Family factors tended to be stronger in the younger age/grade levels than in the higher age/grade levels, as predicted from the theoretical framework.

Background: Substance use can have lifelong consequences for adolescents and the rates of substance use in Canadian adolescents are increasing. This is a serious public health issue which needs to be addressed. The purpose of this study is to determine the impact of public health unit (PHU) engagement in school-based substance use prevention programs on student substance use. Methods: Data was collected from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour (COMPASS) study over the 2018/19 data collection year. A multi-level logistic regression was used to analyze the associations between PHU engagement and student substance use. Results: The analyses found that 70% of schools had PHU engagement in substance use prevention programs. Overall, PHU engagement made no difference on student substance use. However, when PHU engagement was divided into five levels of engagement (with zero being no engagement and five being the highest level of engagement) it was found that students from schools where PHUs solved problems jointly (level two) had statistically significantly greater odds of binge drinking, alcohol use and cannabis use. Schools were also divided into low and high-use schools for each substance. It was found that students in low-use schools had statistically significantly greater odds of binge drinking, alcohol and cannabis use with some levels of PHU engagement and students from high-use schools had statistically significantly lower odds of cannabis and cigarette use with some levels of PHU engagement compared to a similar student from a school without PHU engagement. Conclusions: Our findings show that there is opportunity for greater PHU engagement with schools in substance use prevention programming. Furthermore, it is important that PHUs are working with schools to ensure school-based substance use prevention programs are evidence-based and tailored to the specific needs and risk-levels of the students. / Thesis / Master of Science in Nursing (MSN) / The purpose of this study is to determine the impact of public health unit (PHU) engagement in school-based substance use prevention programs on student substance use. Data for this study was collected from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour (COMPASS) study. The results show that 70% of schools had PHU engagement in substance use prevention programs. Across all schools, when PHUs and schools solved problems jointly an increase in student binge drinking, alcohol and cannabis use was found. When schools were divided into low and high-use schools, similar results were found when PHUs engaged with low-use schools whereas when PHUs engaged in high-use schools a reduced odds of student cannabis and cigarette use was found in some situations. These findings highlight the importance for PHUs to consider the specific needs and risk-levels of the students and schools they are engaging with.

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