Alcohol and substance use outcomes among emerging adults living in marginalized communities: A secondary data analysis

Background: The transition period between adolescence and adulthood is associated with higher propensity for risk-taking behaviors than the periods of childhood and established adulthood. In particular, prevalence rates of alcohol and substance misuse (ASM) are highest among emerging adults (EA, ages 18-29). Emerging adult men living in marginalized communities (EAMMC) are rarely studied, despite having higher ASM rates than EA women. EAMMC face more serious consequences for their ASM than EA men living in privileged communities. These worse consequences are largely due to social determinants of health (SDH) including longstanding discrimination in housing, education, health care, criminal justice system and employment. Thus, it is critical for research to develop and test ASM interventions that are effective in reducing ASM among EAMMC to achieve health equity in United States. The core values of social work profession set forth by the National Association of Social Workers (NASW) are the foundation of this dissertation’s unique purpose and perspective to promote social justice. Aim: The intent of this doctoral dissertation was to conduct secondary data analyses using data from a large randomized controlled trial (RCT) that optimized a behavioral intervention to reduce ASM among formerly incarcerated men with a history of substance use disorder (SUD) living in a marginalized community. The dissertation examined if and how age impacts ASM over time among men from marginalized communities. This aim was accomplished by answering two research questions: a. Does age moderate the relationship between the ASM treatment intervention (i.e., Community Wise) and ASM over time among men from marginalized communities?; b. Are there distinctive ASM trajectories among EAMMC who were randomized to receive the intervention over time? Methods: Moderation effect of age on the relationship between Community Wise and ASM among men from marginalized communities was examined using Growth Mixture Model (GMM) analysis with known class (i.e. age groups, EA vs. MA). Group-based trajectory modeling approach was also conducted to explore distinctive outcome trajectory groups and confirm the best number of groups that fit the data over six-data points for EAs within the sample. Results: It was hypothesized that age-group (i.e., EA, 18-29 and MA, 30+) will moderate the relationship between the intervention and treatment outcomes over time, with EAMMC having worse outcomes consistent with current literature. However, no statistical difference in intervention effect was detected during GMM analysis. Further examination of ASM trajectories among EAMMC revealed multiple group trajectories as hypothesized. Five distinctive ASM trajectories among EAMMC who were assigned to the treatment group were confirmed. Conclusion: With some limitations, this dissertation had several implications for ASM treatment intervention research and social work practice in achieving health equity including: a. confirmation of marginal support for applying Emerging Adulthood Theory to EAMMC population, b. demonstration of how individual-level interventions are less effective for EAMMC due to the socio-environmental factors that strongly dictate their ASM treatment outcomes, c. recommendation not to assume individual-level ASM treatments will work the same way it works for the general emerging adults from non-marginalized communities, and d. follow up intervention strategy specific to Community Wise. Policy recommendations in supporting these efforts were also offered. Importance of differentiating EAs from adolescents and MAs whenever permitted by law and programmatically appropriate was emphasized. Recommendation for the laws and regulations to create accountability for achieving improvement on a limited set of key outcomes be reconsidered for marginalized EAs. Outcomes to consider for EAs from marginalized communities included employment, education, housing stability, safety, health, connections to responsible adults, and effective parenting. Findings will inform the development of an ASM intervention that explicitly addresses concepts informed by SDH on EAMMC. Second, post-intervention trajectory modeling and analyses will inform appropriate follow up treatment.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Social Work

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2022

Author dc:creator

• Lee, Carol Ann

Contributors dc:contributor

• Windsor, Liliane C
• Smith, Dougals C
• Liechty, Janet
• Pinto, Rogério M
• Loughran, Thomas A

• Substance Use Disorder
• Substance Use Intervention
• Alcohol Misuse
• Substance Misuse
• Social Determinants Of Health
• Emerging Adults
• Critical Consciousness Theory

Statement dc:rights

• Copyright 2022 Carol Lee

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/117777

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F117777