Substance Use Among Adolescents of Parents Living With HIV in New York City

Abstract

We examined the relationship of community, interpersonal, and personal risk and protective factors to substance use among adolescents of parents with HIV (PWH). Families with HIV (n = 269 PWH and 409 adolescents) from New York City were recruited, and multivariate models were used to examine the associations. Adjusting for age, gender, and ethnicity, substance use was positively associated in univariate analyses with parental substance use, family conflict, adolescent emotional distress, and adverse life events; having academically oriented friends and religiosity were protective. In the multivariate model, multiple problem behaviors (e.g., delinquency) and substance-using peers were significantly associated with substance use. The patterns of associations between the risk factors and substance use are similar to those of adolescents in families not impacted by HIV. Interventions aimed at improving parental care, reducing maladaptive peer networks, and decreasing problem behaviors are important strategies to explore in future prevention studies.

RÉSUMÉ

Consommation de drogue chez les adolescents issus de parents porteurs du VIH à New-York.

Nous avons étudié la relation entre les risques et les facteurs de protection, à la fois personnels, interpersonnels et communautaires, contre la consommation de drogue, chez les adolescents issus de parents porteurs du VIH (PPV). Des familles séropositives (n = 269 PPV et 409 adolescents) de New-York ont été recrutées, et des modèles à variables multiples ont été utilisés pour l'examen des associations. Après ajustement de l’âge, du sexe et de l'appartenance ethnique, il est apparu une association positive, dans des analyses à variante unique, entre la consommation de drogue par les adolescents, la consommation de drogue par leurs parents, les conflits familiaux, la crise émotionnelle de l'adolescence, et des événements de vie adverse; la possession de croyances religieuses et de camarades valorisant la réussite scolaire constituaient des facteurs de protection. Dans le modèle à variables multiples, divers comportements problématiques à risque (ex: la délinquence), ainsi que la consommation de drogue par l'entourage (notamment scolaire), étaient associés de façon significative à la consommation de drogue par ces adolescents. Les schémas d'association entre les facteurs de risque et la consommation de drogue sont semblables à ceux d'adolescents issus de familles qui ne sont pas affectées par le VIH. Dans le cadre de futures études de prévention, il sera important d'explorer des stratégies visant à améliorer l'implication des parents dans l’éducation de leurs enfants, à réduire l'appartenance à des réseaux d'amis délinquents, et à diminuer les comportements à risque.

Mots-clés: consummation de drogue, VIH, facteurs de risque, facteurs de protection, divers comportements à risque

RESUMEN

El uso de sustancias tóxicas entre adolescentes de padres con VIH de Nueva York

Examinamos la relación entre la comunidad, el riesgo interpersonal y personal y los factores protectores con el uso de sustancias tóxicas entre adolescentes de padres con VIH (PCV). Se reclutó familias con VIH (n = 269 PCV y 409 adolescentes) de Nueva York, y modelos multivariables fueron usados para examinar estas asociaciones. El uso de sustancias tóxicas fue asociado de manera positiva en análisis univariables al uso de substancias tóxicas en padres, al conflicto familiar, al estrés emocional de la adolescencia, y a eventos adversos en la vida, haciendo ajustes para la edad, género y etnicidad. El tener amigos académicamente orientados y la religiosidad son factores protectores. En el modelo multivariable, múltiples problemas de comportamiento (p. ej. delincuencia) y el tener amigos que usan sustancias tóxicas fueron asociados significativamente con el uso de sustancias tóxicas. Los patrones de las asociaciones entre los factores de riesgo y el abuso de sustancias son similares a los de adolescentes en familias no afectadas por el VIH. Estrategias importantes ha explorar en futuros estudios de prevención son intervenciones enfocadas a mejorar el cuidado que los padres dan a los hijos, el reducir grupos sociales paritarios con conductas sociales inadaptadas y el disminuir problemas de comportamiento.

Palabras claves: uso de sustancias tóxicas, adolescentes, VIH, factores de riesgo, factores protectores, problemas de comportamiento múltiples

Keywords :

• substance use
• adolescents
• HIV
• risk factors
• protective factors
• multiple problem behaviors

THE AUTHORS

Nancy Wu, M.D., is a Research Scientist at the Center for Community Health and a Child Psychiatrist at the Department of Child & Adolescent Psychiatry at the University of California, Los Angeles. Her research pursuits reflect a longstanding commitment to studying trauma and substance abuse and their impact on normal adolescent development. She has worked with at-risk adolescents and their families, examining such processes as family conflict, bonding, and monitoring and their relationships to adolescent substance abuse. Dr. Wu's long-term career objectives are to design and implement evidence-based intervention programs to prevent and treat co-morbid substance abuse and psychiatric disorders in high-risk adolescents.

Patricia Lester, M.D., is a Child Psychiatrist and Researcher at the Department of Psychiatry, University of California, Los Angeles. She is also the Medical Director of UCLA Child and Family Trauma Psychiatry Service at the UCLA School of Medicine. Her interests focus on the interface between physical and mental illness in children and adolescents, and on the impact of parental chronic illness and death on child development and attachment. For the past decade, her work has been dedicated to the development, evaluation and dissemination of family centered prevention and treatment for families facing the impact of serious medical illness, traumatic events, and parental loss. She also co-developed FOCUS (Families OverComing Under Stress), an evidence informed resiliency training program, currently being employed for military families affected by multiple deployments, combat operational stress and physical injuries.

Luohua Jiang, M.S., is an assistant professor in the Department of Psychiatry at University of Colorado Denver. Her research interests include applying and developing statistical methodologies for bio-medical research, understanding the relationship between mental health and physical health, and clinical translational research to understand and reduce health disparities.

Robert Weiss, Ph.D., is Professor in the Department of Biostatistics in the UCLA School of Public Health. His research emphasizes longitudinal data modeling, Bayesian methods, applications to HIV, and the analysis of self-reported sex and drug behaviors. He is author of the text Modeling Longitudinal Data (2005, Springer-Verlag).

Suzanne Slocum, Ph.D., is a Canadian Institute of Health Research (CIHR) Investigator in the Department of Health Care and Epidemiology, Faculty of Medicine, at the University of British Columbia, Canada. She is also a Research Scientist for the BC Cancer Agency (BCCA) Sociobehavioural Research Centre. Her education and expertise is primarily rooted in measurement and psychometrics, with an overall focus on the measurement of mental health and psycho-social factors, including spirituality and acculturation. Dr. Slocum is also a practicing yoga therapist for individuals with chronic illnesses. Suzanne has held academic and research positions in universities in both Canada and the USA. In addition, Dr. Slocum has acted as a co-investigator on NIH and CIHR research projects and a project manager for CIHR funded research.

Mary Jane Rotheram-Borus, Ph.D., has spent the past 20 years developing, evaluating, and disseminating evidence-based interventions for children and families. She has worked extensively with adolescents, especially those at risk for substance abuse, HIV, homelessness, depression, suicide, and long-term unemployment. Dr. Rotheram-Borus has directed and implemented several landmark intervention studies that have demonstrated the benefits of providing behavior change programs and support to families in risky situations. Several of these programs have received national and international recognition, including designation as model programs by the American Psychological Association, the American Medical Association, and the Centers for Disease Control and Prevention. Currently, Dr. Rotheram-Borus has ongoing projects in Uganda, China, and South Africa, as well as the United States. Dr. Rotheram-Borus has authored or co-authored more than 200 journal articles. In 2001, Science identified her as number two of the top-funded NIH multi-grant recipients; she was the only woman in the top ten.