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OBJECTIVE: Although emerging adult risky drinkers are generally unmotivated to change their drinking, use of protective behavioral strategies (PBS) to minimize drinking risks is associated with decreased alcohol-related harms. However, research on social influences on PBS use and associations with drinking outcomes is limited and relevant to informing interventions for this priority population. This study investigated whether emerging adults’ drinking-related behaviors were associated with social network encouragement, discouragement, or mixed messages about their drinking and with PBS use. METHOD: Risky drinkers ages 21–29 years (N = 356; 228 women; mean age = 23.6 years) were recruited from the community using digitally implemented respondent-driven sampling. A web-based survey assessed social network drinking feedback, PBS use, drinking practices and problems, and behavioral allocation of time and money to drinking. RESULTS: Negative binomial generalized linear models indicated that friend and spouse/partner discouragement of drinking was associated with greater PBS use, whereas mixed messages were associated with lower use (ps < .05). Greater PBS use was associated with fewer alcohol-related negative consequences and lower behavioral allocation to drinking (ps < .05); the latter association was most consistent for serious harm reduction PBS (e.g., use of a designated driver). Mixed drinking messages from all relationship types had direct negative associations with drinking outcomes, particularly time and money allocated to drinking. CONCLUSIONS: Assessing social network features may guide interventions to increase PBS use and reduce drinking-related harms among emerging adult risky drinkers.

Objective: Behavioral economic (BE) approaches to understanding and reducing risky drinking among college students are well established, but little is known about the generalizability of prior findings to peers who currently are not traditional college students and are more difficult to reach for assessment and intervention. This cross-sectional survey investigated whether drinking practices and negative consequences were associated with greater alcohol demand, alcohol reward value, and delay discounting in this target population. Method: Community-dwelling emerging adult drinkers aged 21 to 29 (N = 357) were recruited using Respondent-Driven Sampling adapted to a digital platform (Mage = 23.6 years, 64% women). Peers recruited peers in an iterative fashion. Participants completed a web-based survey of drinking practices, negative alcohol-related consequences, and BE measures of alcohol demand, alcohol reward value, and delay discounting. Results: Regression analyses supported the study hypotheses. Higher alcohol demand (intensity and elasticity) predicted higher drinks per drinking day, more past-month drinking days, and more negative consequences. Higher alcohol reward value (discretionary alcohol spending and alcohol-involved activities) and stronger preference for sooner smaller versus later larger rewards predicted select drinking risk variables in the hypothesized direction (p < .05). Conclusions: BE risk characteristics were generalized to community-dwelling emerging adult risky drinkers, with the most consistent associations found between alcohol demand and drinking risk measures. The findings lay a foundation for extending successful BE interventions with college drinkers to this underserved population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND: Behavioral economics predicts that recovery from Alcohol Use Disorder involves shifts in resource allocation away from drinking, toward valuable nondrinking rewards that reinforce and stabilize recovery behavior patterns. Further, these shifts should distinguish nonproblem drinking (moderation) outcomes from outcomes involving abstinence or relapse. To evaluate these hypotheses, 5 prospective studies of recent natural recovery attempts were integrated to examine changes in monetary spending during the year following the initial cessation of heavy drinking as a function of 1-year drinking outcomes. METHODS: Problem drinkers from Southeastern U.S. communities (N = 493, 67% male, 65% white, mean age = 46.5 years) were enrolled soon after stopping heavy drinking without treatment and followed prospectively for a year. An expanded Timeline Followback interview assessed daily drinking and monetary spending on alcohol and nondrinking commodities during the year before and after recovery initiation. RESULTS: Longitudinal associations between postresolution drinking and spending were evaluated using MPlus v.8. Initial models evaluated whether changes in spending at 4-month intervals predicted drinking outcomes at 1 year and showed significant associations in 6 commodity categories (alcohol, consumable goods, gifts, entertainment, financial/legal affairs, housing/durable goods/insurance; ps < 0.05). Cross-lagged models showed that the moderation outcome group shifted spending mid-year to obtain large rewards with enduring benefits (e.g., housing), whereas the abstinent and relapsed groups spent less overall and purchased smaller rewards (e.g., consumable goods, entertainment, and gifts) throughout the year. CONCLUSIONS: Dynamic changes in monetary allocation occurred during the postresolution year. As hypothesized, compared to the groups who abstained or relapsed, the moderation group shifted spending in ways that, overall, yielded higher value alcohol-free reinforcement that should reinforce recovery while they enjoyed some limited nonproblem drinking below heavy drinking thresholds. These findings add to evidence that moderation entails different behavioral regulation processes than abstinent and relapse outcomes, which were more similar to one another.

Abstract: Aims: Emerging adulthood, spanning adolescence into early adulthood, is marked by heightened substance use and sexual risk-taking, and emerging adults living in disadvantaged urban areas experience disproportionately more negative outcomes. Research on the social psychology of time perspective and the behavioral economics of substance use suggests that such impoverished environments contribute to development of a decision-making style characterized by devaluation of delayed rewards and outcomes that support adaptive functioning in favor of persistent preference for short-term rewards associated with longer term costs. This cross-sectional observational study investigated the hypothesis that substance use and sexual risk-taking among young African American women living in such communities were related to present-dominated time perspectives and higher delay discounting, which reflect relative preference for sooner typically smaller than later larger rewards. Methodology: Young African American women ages 15 – 25 ( N = 223, M age = 20.4 years) from disadvantaged urban neighborhoods in the Southern United States were recruited using Respondent Driven Sampling, a peer-driven sampling method suitable for recruiting community-dwelling participants that compensates for biases of snowball sampling. In-person structured field interviews assessed substance use, sexual practices, and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task). Multiple regression analyses were conducted to examine whether substance use and sexual risk-taking were associated with delay discounting and ZTPI present hedonistic and future time perspective subscales, controlling for several demographic characteristics. Results: As hypothesized, regression models showed that higher ZTPI present hedonism scores were significantly associated with both greater substance involvement and sexual risk-taking, whereas greater discounting was associated only with greater sexual risk-taking ( ps < .05). Future time perspectives were not associated with either risk behavior. Conclusions: Risk behaviors among young women living in disadvantaged urban areas appear to be associated with hedonistic rewards available in the present without considering future outcomes. Future research should investigate experimentally whether lengthening time perspectives and promoting enriched views of possible futures may prevent and reduce substance involvement and sexual risk-taking among disadvantaged young adults. Those living in disadvantaged communities likely have great need for such interventions because they tend to have limited rewarding economic and social opportunities that can compete with present choices to use substances and engage in risky sex.

BACKGROUND Higher problem severity contraindicates moderation drinking in treatment samples, but has not been well investigated in natural recovery samples with more prevalent moderation outcomes, nor have single studies assessed multiple severity indicators. Therefore, we integrated 5 prospective studies of recent natural recovery attempts to identify multi-indicator profiles that distinguished moderation from abstinence or unstable resolution involving relapse. The study evaluated whether moderation was distinguished by a generalized lower severity profile or whether more complex profiles better differentiated outcomes. METHODS Community-dwelling problem drinkers in the southeastern United States (N = 616, 67% male, 65% white, mean age = 46.5 years) enrolled soon after stopping alcohol misuse without treatment were followed prospectively for a year. Outcome predictors assessed at enrollment included preresolution drinking practices, alcohol-related problems, alcohol dependence, and a behavioral economic measure of the reward value of drinking based on preresolution spending on alcohol versus saving for the future. RESULTS Latent profile analysis of severity indicators supported a 4-profile solution: (i) global low risk on all indicators, (ii) global high risk on all indicators, (iii) high risk limited to drinking practices only, and (iv) high risk limited to alcohol dependence and alcohol-related problems only. Outcomes differed by profile membership (p

African American women in the Southern United States have disproportionately high HIV infection rates, and increasing HIV testing is a prevention priority in communities of color. Research suggests that optimal conditions for promoting testing involve reaching out to community members and offering free tests in private, supportive contexts with minimal delays to receiving results. These conditions were implemented with young African American women (N = 223, M age = 20.4 years) living in disadvantaged areas of a Southern U.S. city to identify participant characteristics associated with declining and accepting testing in this low threshold context. Participants were recruited using Respondent Driven Sampling, a peer-driven method useful for recruiting young adults in community settings. Structured field interviews assessed personal and social network characteristics, sexual practices, substance use, and behavioral impulsivity (assessed by a delay discounting task). A free HIV test was then offered. Participants were free to accept or decline testing, which was the outcome variable. Testing was accepted by 69%, which exceeded the national lifetime test rate for this population by 7.4% (p < .05). All were sero-negative. Test refusal (31%) was associated with poorer educational performance, higher delay discounting rates indicative of greater impulsivity, less social network encouragement to use birth control (ps < .05), and lower engagement in sexual risk behaviors (p < .10). Substance involvement did not differ as a function of test choice. Thus, low threshold community testing promoted acceptance among the majority of the priority population, but a sizeable minority with specific characteristics likely need additional incentives to fulfill the prevention potential of “know your status” through HIV testing.

Advancing HIV prevention and treatment among at-risk Southern communities of color requires understanding why voluntary HIV testing is accepted or declined. Reasons for testing decisions were investigated among young African American women (n = 223, mean age = 20.4 years) recruited from disadvantaged areas in a Southern US city. A free HIV test was offered following field interviews that assessed HIV risk behaviors and personal and social network characteristics; 69.1% accepted testing, and all were seronegative. After their decision, participants rated reasons for their choice, which were factor analyzed. A four-factor solution showed that test acceptance was related to (1) current sexual relationships and HIV risk concerns, (2) knowledge of HIV medical treatment benefits, (3) awareness of persons living with HIV, and (4) health protection and HIV test convenience. A three-factor solution showed that test refusal was related to (1) negative consequences of a positive test and privacy concerns, (2) low perception of HIV risk, and (3) anticipated social rejection if the test was positive. Comparisons of factor-based average item scores showed that health protection/HIV test convenience was rated as most influential in test acceptance decisions, whereas low perception of HIV risks was rated as most influential in test rejection decisions. The findings suggest that test acceptance can be promoted by offering free, convenient HIV testing as a health check in a testing context that assesses and provides feedback about participants' HIV risk levels.

BACKGROUND. Alcohol use and related problems often increase during emerging adulthood and are influenced by social networks. Investigating alcohol-specific feedback from network members may be useful for understanding social influences and designing interventions to reduce risky drinking among emerging adults. PURPOSE/OBJECTIVES. This study examined whether drinking practices and consequences among emerging adult risky drinkers living in disadvantaged urban communities were influenced by receipt of encouragement, discouragement, or mixed messages about drinking from network members. METHODS. Risky drinkers ages 21 to 29 (N = 356; 228 females; mean age = 23.6 years) residing in the community were recruited using digitally implemented Respondent Driven Sampling, a peer-driven chain referral method. A web-based survey assessed drinking practices, negative alcohol-related consequences, and drinking feedback from social network members including friends, spouse/partner, and other family members. RESULTS. Negative binomial generalized linear modeling showed that discouragement of drinking by friends was associated with fewer drinking days and negative consequences, whereas discouragement by family members (excluding spouse/partner) was associated with more drinks per drinking day. Mixed feedback (sometimes encouraging, sometimes discouraging drinking) from friends and spouse/partner was associated with more drinking days and negative consequences. CONCLUSIONS/IMPORTANCE. Social network feedback had both risk and protective associations with drinking practices and problems among emerging adults, with discouragement to drink by friends appearing to serve a protective function. The findings suggest the utility of interventions delivered through social networks that amplify the natural protective function of friend discouragement of drinking, in addition to addressing established risks associated with peers.

Highlights • Efficacious alcohol interventions with college drinkers are well established. • Emerging adult (EA) risky drinkers in communities are harder to reach. • Peer-driven Respondent Driven Sampling was adapted to a digital platform (d-RDS) • d-RDS recruited EAs at risk on drinking practices and alcohol-related consequences. • d-RDS offers a tool to extend alcohol interventions to this underserved risk group., Introduction Emerging adulthood often entails heightened risk-taking, including risky drinking, and research is needed to guide intervention development and delivery. This study adapted Respondent Driven Sampling, a peer-driven recruitment method, to a digital platform (d-RDS) and evaluated its utility to recruit community-dwelling emerging adult (EA) risky drinkers, who are under-served and more difficult to reach for assessment and intervention than their college student peers. Materials and methods Community-dwelling EA risky drinkers (N = 357) were recruited using d-RDS (M age = 23.6 years, 64.0% women). Peers recruited peers in an iterative fashion. Participants completed a web-based cross-sectional survey of drinking practices and problems and associated risk and protective factors. Results d-RDS successfully recruited EA risky drinkers. On average, the sample reported recent drinking exceeding low-risk drinking guidelines and 8.80 negative consequences in the past three months. Compared to age-matched respondents from the representative U.S. National Survey on Drug Use and Health, the sample reported more past month drinking days and more drinks consumed per drinking day (ps < .001). At higher consumption levels, predicted positive associations were found with lower education and receipt of public assistance. Conclusions Results supported the utility of d-RDS as a sampling method and grassroots platform for research and intervention with community-dwelling EA drinkers who are harder to reach than traditional college students. The study provides a method and lays an empirical foundation for extending efficacious alcohol brief interventions with college drinkers to this underserved population.

Almost one-third of the U.S. population meets alcohol use disorder (AUD) criteria on a lifetime basis. This review provides an overview of recent research on the prevalence and patterns of alcohol-related improvement and selectively reviews nationally representative surveys and studies that followed risk groups longitudinally with a goal of informing patients with AUD and AUD researchers, clinicians, and policy-makers about patterns of improvement in the population. Based on the research, alcohol use increases during adolescence and early adulthood and then decreases beginning in the mid-20s across the adult life span. Approximately 70% of persons with AUD and alcohol problems improve without interventions (natural recovery), and fewer than 25% utilize alcohol-focused services. Low-risk drinking is a more common outcome in untreated samples, in part because seeking treatment is associated with higher problem severity. Sex differences are more apparent in help-seeking than recovery patterns, and women have lower help-seeking rates than men. Whites are proportionately more likely to utilize services than are Blacks and Hispanics. Improving recovery rates will likely require offering interventions outside of the health care sector to affected communities and utilizing social networks and public health tools to close the longstanding gap between need and utilization of AUD-focused services.

Background Functional measures indicating lower drinking problem severity predict stable low-risk drinking outcomes of recovery attempts, but findings for drinking practices are mixed. Because low-risk drinking outcomes are more common in natural than treatment-assisted recovery attempts, five studies of natural recovery attempts were integrated. Multiple dimensions of drinking practices during the year before recovery initiation were evaluated as predictors of post-recovery drinking (continuous abstinence, stable low-risk drinking, or unstable recovery involving relapse). Methods Community-dwelling problem drinkers (N = 616, 68% male, mean age = 46.5 years) were enrolled soon after stopping alcohol misuse and followed prospectively for one year. A Timeline Followback interview assessed daily drinking during the year before recovery initiation and yielded four dimensions for analysis: frequency of heavy drinking days (4+/5+ drinks for females/males), mean ethanol consumption per drinking day, variability in days between heavy drinking days, and variability in ethanol consumed per drinking day. Results Multinomial logistic regression models showed that variability in ethanol consumed per drinking day was the sole significant predictor of 1-year outcomes when all dimensions were evaluated together. The low-risk drinker group showed less fluctuation in quantities consumed on pre-recovery drinking days compared to the groups that abstained or relapsed (ps Conclusions Even when drinking heavily, problem drinkers who maintained low-risk drinking recoveries limited their quantities consumed within a relatively narrow range, a pattern they maintained post-recovery at much lower consumption levels. Assessing variability in quantities consumed may aid drinking goal selection.

Background As interventions have expanded beyond clinical treatment to include brief interventions for persons with less severe alcohol problems, predicting who can achieve stable moderation drinking has gained importance. Recent behavioral economic (BE) research on natural recovery has shown that active problem drinkers who allocate their monetary expenditures on alcohol and saving for the future over longer time horizons tend to have better subsequent recovery outcomes, including maintenance of stable moderation drinking. This study compared the predictive utility of this money-based “Alcohol-Savings Discretionary Expenditure” (ASDE) index with multiple BE analogue measures of behavioral impulsivity and self-control, which have seldom been investigated together, to predict outcomes of natural recovery attempts. Methods Community-dwelling problem drinkers, enrolled shortly after stopping abusive drinking without treatment, were followed prospectively for up to a year (N = 175 [75.4% male], M age = 50.65 years). They completed baseline assessments of preresolution drinking practices and problems, analogue behavioral choice tasks (Delay Discounting, Melioration-Maximization, and Alcohol Purchase Tasks), and a Timeline Followback interview including expenditures on alcohol compared to voluntary savings (ASDE index) during the preresolution year. Results Multinomial logistic regression models showed that, among the BE measures, only the ASDE index predicted stable moderation drinking compared to stable abstinence or unstable resolutions involving relapse. As hypothesized, stable moderation was associated with more balanced preresolution allocations to drinking and savings (odds ratio = 1.77, 95% confidence interval = 1.02 to 3.08, p

BACKGROUND AND AIMS: Research using different behavioral economic (BE) and time perspective (TP) measures suggests that substance misusers show greater sensitivity to shorter term contingencies than normal controls, but multiple measures have seldom been investigated together. This study evaluated the extent to which multiple BE and TP measures were associated with drinking problem severity, distinguished initial outcomes of natural recovery attempts, and shared common variance. Hypotheses were (1) greater problem severity would be associated with greater impulsivity and demand for alcohol and shorter TPs; and (2) low-risk drinking would be associated with greater sensitivity to longer term contingencies compared with abstinence. DESIGN: Cross-sectional naturalistic field study. SETTING: Southern United States. PARTICIPANTS: Problem drinkers, recently resolved without treatment (N = 191 [76.4% male], M age = 50.1 years) recruited using media advertisements. MEASUREMENTS: Drinking practices, dependence levels, and alcohol-related problems prior to stopping problem drinking were assessed during structured field interviews. Measures included the Zimbardo Time Perspective Inventory; BE analogue choice tasks (Delay Discounting [DD], Melioration-Maximization [MM], Alcohol Purchase Task [APT]); and the Alcohol-Savings Discretionary Expenditure (ASDE) index, derived from real spending on alcohol and voluntary savings during the year before problem cessation. FINDINGS: Measures of demand based on real (ASDE) and hypothetical (APT) spending on alcohol were associated with problem severity (ps CONCLUSIONS: Two behavioural assessment tools that measure spending on alcohol, the Alcohol Purchase Task and the Alcohol-Savings Discretionary Expenditure index, appear to be reliable in assessing the severity of drinking problems.This article is protected by copyright. All rights reserved. Language: en

Natural health information sources used by African-American emerging adults were investigated to identify sources associated with high and low substance-related risk. Participants (110 males, 234 females; M age = 18.9 years) were recruited using respondent-driven sampling, and structured interviews assessed substance use, sources of health information, and preferences for help. Friends and social network sites were associated with higher risk, whereas teachers/schools were associated with lower risk (ps < .025). Despite risks associated with friends, more participants preferred receiving help from friends than the other sources. The findings inform targeted prevention messages that are sensitive to contextual and audience characteristics.

BACKGROUND AND AIMS: Substance use and risk-taking are common during emerging adulthood, a transitional period when peer influences often increase and family influences decrease. Investigating relationships between social network features and substance use can inform community-based prevention programs. This study investigated whether substance use among emerging adults living in disadvantaged urban was influenced by peer and family social network messages that variously encouraged and discouraged substance use. DESIGN: Cross-sectional, naturalistic field study. SETTING/PARTICIPANTS: Lower income neighborhoods in Birmingham, Alabama, USA with 344 participants (110 males, 234 females ages 15 to 25 years; M = 18.86), recruited via Respondent Driven Sampling. MEASUREMENTS: During structured interviews conducted in community locations, the Alcohol, Smoking and Substance Involvement Screening Test assessed substance use and related problems. Predictor variables were network characteristics, including presence of substance-using peers, messages from friends and family members about substance use, and network sources for health information. FINDINGS: Higher substance involvement was associated with friend and family encouragement of use and having close peer network members who used substances (ps CONCLUSIONS: Social networks appear to be important in both promoting and preventing substance use in disadvantaged young adults in the USA. Language: en

Transitioning from adolescence to full-fledged adulthood is often challenging, and young people who live in disadvantaged urban neighborhoods face additional obstacles and experience disproportionately higher negative outcomes, including substance abuse and related risk behaviors. This study investigated whether substance use among African Americans ages 15 to 25 (M=18.86 years) living in such areas was related to present-dominated time perspectives and higher delay discounting. Participants (N=344, 110 males, 234 females) living in Deep South disadvantaged urban neighborhoods were recruited using Respondent Driven Sampling, an improved peer-referral sampling method suitable for accessing this hard-to-reach target group. Structured field interviews assessed alcohol, tobacco, and illicit drug use and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task). As predicted, substance use was positively related to a greater ZTPI orientation toward present pleasure and a lower tendency to plan and achieve future goals. Although the sample as a whole showed high discounting of delayed rewards, discount rates did not predict substance use. The findings suggest that interventions to lengthen time perspectives and promote enriched views of future possible selves may prevent and reduce substance use among disadvantaged youths. Discontinuities among the discounting and time perspective variables in relation to substance use merit further investigation.

Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial "seed" participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.

Background As part of a randomized controlled trial, problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response (IVR) self-monitoring (SM) system as a sobriety maintenance tool during early recovery when relapse risk is high. Because observed IVR utilization was variable, predictors of utilization were evaluated to inform knowledge of populations likely to access and use IVR services. Methods Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longstanding high-risk drinking practices and alcohol-related problems ( M = 16.58 years, SD = 10.95). Baseline interviews assessed pre-resolution drinking practices and problems, and behavioral economic (BE) measures of reward preferences (delay discounting, pre-resolution monetary allocation). Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages. Results IVR use ranged from 0 to 100%. Frequent ( n = 28), infrequent ( n = 42), and non-caller ( n = 17) groups were identified. Non-callers tended to be younger and to report heavier pre-resolution drinking. Frequent callers (≥70% of IVR days) tended to be older, male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers. Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking. Conclusions Characteristics common in the untreated problem drinker population were associated with higher IVR utilization. This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform.

Objectives Identifying sexual risk patterns associated with HIV/sexually transmitted infections (STI) and early parenthood within population subgroups is critical for targeting risk reduction interventions. Methods Latent Class Analysis (LCA) was used to identify sexual behaviour typologies to predict sexual risk outcomes among 274 (63% female) unmarried, sexually active African–American emerging adults (M age=19.31 years) living in disadvantaged urban neighbourhoods. Participants were enrolled in a larger cross-sectional observational study of risk and protective behaviours. LCA defined membership into discrete risk classes based on reported sex risk behaviours. Results Three groups were identified: The ‘low contraception use’ risk class (32%) had low rates of condom or other birth control use, moderate rates of sexual initiation before age 16 years, and the highest pregnancy/early parenthood and STI rates. The predominately male ‘early sex’ risk class (32%) had higher rates of early initiation and multiple partners, risks that were countered by higher contraception and condom use. Both these risk groups showed higher probability to use substances before sex relative to the ‘low sex risk’ class (36%), which showed low rates on all risk behaviours. Conclusions LCA identified distinct risk clusters that predicted sexual health outcomes and can inform targeted interventions for a minority youth population disproportionately affected by HIV, other STIs, and early parenthood.

Substance use and risk-taking are common during emerging adulthood, a transitional period when peer influences often increase and family influences decrease. Investigating relationships between social network features and substance use can inform community-based prevention programs. This study investigated whether substance use among emerging adults living in disadvantaged urban areas was influenced by peer and family social network messages that variously encouraged and discouraged substance use.Cross-sectional, naturalistic field study.Lower-income neighborhoods in Birmingham, Alabama, USA with 344 participants (110 males, 234 females, ages 15-25 years; mean = 18.86 years), recruited via respondent-driven sampling.During structured interviews conducted in community locations, the Alcohol, Smoking and Substance Involvement Screening Test assessed substance use and related problems. Predictor variables were network characteristics, including presence of substance-using peers, messages from friends and family members about substance use and network sources for health information.Higher substance involvement was associated with friend and family encouragement of use and having close peer network members who used substances (Ps 0.001). Peer discouragement of substance use was associated with reduced risk (b = - 1.46, P 0.05), whereas family discouragement had no protective association.Social networks appear to be important in both promoting and preventing substance use in disadvantaged young adults in the United States.

Identifying sexual risk patterns associated with HIV/sexually transmitted infections (STI) and early parenthood within population subgroups is critical for targeting risk reduction interventions.Latent Class Analysis (LCA) was used to identify sexual behaviour typologies to predict sexual risk outcomes among 274 (63% female) unmarried, sexually active African-American emerging adults (M age=19.31 years) living in disadvantaged urban neighbourhoods. Participants were enrolled in a larger cross-sectional observational study of risk and protective behaviours. LCA defined membership into discrete risk classes based on reported sex risk behaviours.Three groups were identified: The 'low contraception use' risk class (32%) had low rates of condom or other birth control use, moderate rates of sexual initiation before age 16 years, and the highest pregnancy/early parenthood and STI rates. The predominately male 'early sex' risk class (32%) had higher rates of early initiation and multiple partners, risks that were countered by higher contraception and condom use. Both these risk groups showed higher probability to use substances before sex relative to the 'low sex risk' class (36%), which showed low rates on all risk behaviours.LCA identified distinct risk clusters that predicted sexual health outcomes and can inform targeted interventions for a minority youth population disproportionately affected by HIV, other STIs, and early parenthood.

Adolescent development is a complex, interactive process that involves individuals, families, peer groups, institutions, and communities. Resilience is a process reflecting one's ability to respond positively to the multitude of risks inherent in growth and development. This article focuses on strategies for enhancing resilience and health outcomes among young people. We explore the conditions under which young people, their families, and community institutions promote positive health outcomes. We review emerging issues with an emphasis on building social capital and cohesion to foster resilience through family and community relationships and resources. We provide examples of evidence-based interventions, including those with demonstrated cost-effectiveness. Informed by these data, we make recommendations for the practice of adolescent medicine and further research focused on physician involvement in strengthening family and community resilience and social capital to improve the lives of young people.

Background Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV. Methods A sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]). Results HIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV-positive person. More than half (51.1%) reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not. Conclusion Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine.