The Social Ecology of Urban Adolescent Substance Use

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The Social Ecology of Urban Adolescent Substance
Use

• Michael Mason, Ph.D.
• Assistant Professor,
• Georgetown University Medical Center
• Department of Psychiatry

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Social Ecological Approach to Urban Adolescent
Health Behaviors

• Explores the significant connections between
  teens mental health, co-participants of their
  lives, and the everyday settings in which their
  health behaviors are expressed.

Mental Health
Urban Teens
Geography of Risk Protection
Social Network
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Developmental Underpinnings

• Social networks represent the developmental
  mechanism of adolescents social development
• These networks are embedded in ecological
  settings that serve as the context for
  manifestation of healthful and problematic
  behaviors

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Environmental Linkage to Social Networks

• Variables related to social networks are
  spatially differentiated at the neighborhood
  level
• These environmental variables are linked to
  individuals and can be mapped for analysis
• Environmental risk characteristics potentiate
  different outcomes of substance use, depression,
  and stress

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Social Ecology of Urban Adolescent Substance Use
Pilot Study

• Sample drawn from GU primary care clinic
• 40 adolescents aged 14-18, with a mean age of
  15.5.
• 51 female
• 49 African American, 37 White, 12 other
  international origin
• Participants were from predominantly impoverished
  areas with high crime rates.
• 50 substance users

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Study Measures

• Substance Use (GAPS ADIS)
• Depression (CDI)
• Stress (A-FILE)
• Social Network (ASNA)
• Social Ecology (Ecological Interview)
• Typical time is less than 60 minutes to complete
  all measures

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Adolescent Social Network Assessment

• Captures information on each persons close
  personal contacts, their strong ties
• Characterizes ego-centric social network data on
  multiple dimensions

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Social Network ResultsOdds Ratios (OR) and 95
Confidence Intervals (CI) Associated with
Substance Use, Depression, Stress
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Geographic Information
Ecological Interview
Residence
Free listing Typical Week Locations
Other places
Risky
Subjective Rating of Locations
Safe
Important
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Geographic Analyses Results
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Natashas Social Network
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Natasha
119, AA, Hangs out at Natashas most Important
Safe locations
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Never feels pressured to use is encouraged not
to use daily perceives her to be very
influential on her life
520 positive to negative monthly activities

Known each other 5 years Primary domain
Neighborhood Church Weekly contact 11
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Natashas Ecological Risk Profile
Substance Use
Depression
Stress
Personal Risk
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H.S Grad
User
Negative Activities
User
Social Network Risk
Satisfaction/Desire to Change
Non User
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Use Pressure
Non user
Non User
Alcohol Outlets
High Crime
Drug Use
Environmental Risk
53
Clinic Connected
Poverty
Unemployment
Church Connected
Total 119
Library
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Georgetown University Adolescent Health Program

• Michael Mason, Principal Investigator
• Substance Abuse Mental Health Services
  Administration Center for Substance Abuse
  Treatment
• 10/03-9/30
• Targeted Expansion Grant TI 15433-01

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Project Description

• Our program is a brief, manualized,
  evidence-based substance use treatment program
  for DC area teens.
• Treatment Motivational Enhancement
  Therapy/Cognitive Behavioral Therapy-5 (MET/CBT-5)

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Georgetown University Adolescent Health Program
Treatment Structure

• Comprehensive evaluation (2 hours)
• Two individual and three group sessions (5.5
  hours)
• MET/CBT-5
• Parent Support Meeting (2.5 hours)
• Three follow-up meetings over 12 months after
  treatment (1.5 hours)

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Parent Support Meeting

• Psycho-Educational, video, role-play, discussion,
  2 hour meeting
• Adolescent development
• Substance use information
• Communication/Problem Solving Skills
• Mental Health (Depression)
• Adapted from Family Support Network (CSAT)

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GUAHP Sample Description

• 16 years old
• 87 male
• 44 African American 42 White 11 Hispanic 2
  Asian
• Referrals Health system, Courts, Schools
• 76 have had no Tx history
• 62 Marijuana primary drug 33 alcohol primary
  substance
• 20 have 2 dxs 20 have 3 dxs Conduct dx,
  depression, ADHD

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Longitudinal Naturalistic Design With
Quantitative Qualitative Data

• Outcome measures
• GAIN substance use, health, risk behaviors,
  mental health, environment, legal,
  vocational/educational, spiritual support
• In-depth Social Network Assessment
• Personalized Geographical assessment
• Teen-Parent communication scale (Barnes Olson,
  2003)
• Family Typology assessment resilience,
  hardiness, coherence, stress, resources, etc.
  (McCubbin Thompson,1991)
• Case Studies (25 of sample)
• Phenomenology of substance use treatment
• Self-narrative development

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INTERVIEWS Baseline 3-mos Follow-up 6-mos
Follow-up
Aspatial Attributes (e.g. Social Network)
Ancillary Information (e.g. Roads ve/-ve
locations Crime)
Spatial Attributes (e.g. address/place name)
Integrated Analysis
Geographic Analyses (GIS)
Spatial Data Matrix (subj x resource)
Geovisualization
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Treatment Satisfaction
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Percent Not Using Illegal Drugs-past 30 days
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Percent Not Using by Substance-past 30 days
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Percent Not Using Substances-past 30 days
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Conclusions

• Preliminary data suggests reduction of substance
  use at 3 6 month follow-up
• Monitor mental health outcomes
• Use case study data for implementation
• Compare with other cohort project outcomes
• Use social network and geo-data to examine change
  over time.

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The End

• Thank You

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Why Study This?

• Relatively little substance use research on
• detailed effects of neighborhood and communities
  of urban adolescents
• their social networks
• their health promoting health compromising
  behaviors
• GOAL develop targeted, relevant, and culturally
  appropriate interventions that are
  social-ecological in nature.

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Children in the City

• By 2025 60 of worlds children will live in
  cities- U.N.
• Children experience the urban environment in
  similar and dissimilar ways than adults
• Effects vary by SES status
• For poorer kids, street/public space is still
  important- homes can be less static

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Kids Living in Distressed Neighborhoods by Race
Ethnicity