Journal of Ethnicity in Substance Abuse
ISSN: 1533-2640 (Print) 1533-2659 (Online) Journal homepage: http://www.tandfonline.com/loi/wesa20
A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States Miesha Marzell, Ethan Sahker, George Pro & Stephan Arndt To cite this article: Miesha Marzell, Ethan Sahker, George Pro & Stephan Arndt (2016): A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States, Journal of Ethnicity in Substance Abuse, DOI: 10.1080/15332640.2015.1108256 To link to this article: http://dx.doi.org/10.1080/15332640.2015.1108256
Published online: 29 Jan 2016.
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Date: 31 January 2016, At: 15:18
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE http://dx.doi.org/10.1080/15332640.2015.1108256
A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States Miesha Marzella, Ethan Sahkerb, George Proa, and Stephan Arndtc
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
a
College of Public Health, The University of Iowa, Iowa City, Iowa; bIowa Consortium for Substance Abuse Research and Evaluation and College of Education, The University of Iowa, Iowa City, Iowa; c Iowa Consortium for Substance Abuse Research and Evaluation, Carver College of Medicine, and College of Public Health, The University of Iowa, Iowa City, Iowa ABSTRACT
KEYWORDS
Increases in Hispanic youth admissions to substance abuse treatment programs for marijuana use are a growing public health concern. In this study, we investigated trends in Hispanic youth from 1995 to 2012 utilizing the Treatment Episode Data Set—Admissions of the Substance Abuse Mental Health Services Administration. Hispanic youth marijuana admissions are associated with youth 15–17 years old, in high school, and living in a dependent situation. Notably, female admissions increased at greater rates than males. Results also point to decreasing tolerance of minor marijuana use by schools and community agencies. Findings highlight the need for targeted, culturally specific, and cost-effective treatment and prevention efforts.
Hispanic; marijuana use; substance abuse treatment admissions; youth
Introduction Youth marijuana admissions are on the rise while use frequency is on the decline (Marzell, Sahker, & Arndt, in press). The highest rates of illicit drug use, specifically of marijuana, are being reported for Hispanic youth (Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2015). Findings from the Youth Risk Behavior Surveillance System (YRBSS) indicated that the prevalence of ever using marijuana and current use is higher among Hispanic youth when compared to White youth (Kann et al., 2014). Higher rates of use are associated with multiple mental, physiological, and neurocognitive changes (Hadland & Harris, 2014). To develop an effective response to this public health problem, ascertaining the characteristics of such use specific to Hispanics is necessary for more culturally appropriate treatment approaches (Shih, Miles, Tucker, Zhou, & D’Amico, 2010). Some culturally specific correlates of Hispanic marijuana use in the literature have been identified as sex, family involvement (Eitle, 2006; CONTACT Miesha Marzell [email protected] Community and Behavioral Health, College of Public Health, The University of Iowa, 145 N. Riverside Drive, Iowa City, Iowa 52242. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wesa © 2016 Taylor & Francis
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
2
M. MARZELL ET AL.
Lac et al., 2011), age as measured by grade, and student status (Eitle, 2006). In addition, Guerrero, Marsh, Khachikian, Amaro, and Vega (2013) identified access to treatment as a disparity associated with Hispanic treatment. Referral source may be an important indicator of community access to treatment. Substance use referrals to treatment tend to vary cross-culturally and may be an indicator of systemic issues significant to individual and multicultural differences in treatment (Sahker, Toussaint, Ramirez, Ali, & Arndt, 2015). However, little research is available on nationwide Hispanic treatment samples. The present study focused on Hispanic youths’ admission to substance abuse treatment programs, examining temporal trends and testing for differences over an 18-year period (1995–2012). The correlates of age, sex, student status, living arrangement, and source of income were of particular interest to assess the trends in Hispanic youth marijuana treatment admissions. Increases in all correlates are expected. In addition, the present study is concerned with developing an improved understanding of Hispanic youth entering treatment. Methods The present study utilized a large data set created by the Substance Abuse Mental Health Services Administration (SAMHSA), the governmental agency within the U.S. Department of Health and Human Services charged with reducing the national effect of substance abuse and mental illness. SAMHSA’s Treatment Episode Data Set (TEDS), which contains client-level data on demographic characteristics and substance abuse problems, comprises information requested from all public and private treatment facilities in the United States that receive government funding. The treatment settings are located in hospitals and freestanding agencies, in both urban and rural areas, and include detox, inpatient, and outpatient facilities. TEDS has both an admissions (TEDS-A) and a discharge data set. Although not all facilities provide data, TEDS-A comprises a significant proportion of U.S. treatment admissions. Participants and procedures
First, only those records on individuals with no prior admissions were selected, which were defined as answering “none” to the variable indicating the number of previous treatment episodes received in any drug or alcohol program. Restricting the data to first admissions provided a nonduplicative total of individuals admitted to treatment. Next, only those individuals less than 20 years of age at admission were included, arriving at 12,025,787 youth admissions. Then only records indicating race and ethnicity were included, giving a
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE
3
final sample (N ¼ 1,166,468). Finally, we categorized comparison groups of Hispanics (n ¼ 272,010) and non-Hispanics (n ¼ 1,438,478). Measures
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
Primary substance used At the time of admission to a treatment program, the primary problem substance was identified during initial interview. Admissions indicating marijuana as primary problem substance were included (N ¼ 2,682,582). Drug involvement TEDS-A data related to treatment include frequency of use, number of problem substances, referral source, and service setting at admission. Treatment agency staff also record secondary and tertiary problem substances as necessary. Data related to extent of drug involvement include number of substances and frequency of use. These data were included as variables in the final analysis. Other demographics Investigated demographic variables included age, sex, race/ethnicity, student status, living arrangement, and source of income. For confidentiality, TEDS-A categorizes the age variable (as explained in the Results section). Student status was coded as student or nonstudent. Living arrangement was recorded as homeless, dependent, or independent living. Dependent living includes institutional housing, group homes, halfway houses, and clients 17 and younger living with parents. Independent living includes living alone, living with roommates, and clients 18 and older living with parents. Because these data represent public information and have no subject identification, the Human Subjects Office exempted this study from review. Statistical analysis
Analyses were conducted using STATA version 13.1 (StataCorp, College Station, TX). Chi-square analyses were used to examine differences between admission years. Binomial logistic regression was used to discern trends over the 18 years comparing Hispanics with non-Hispanics. In addition, ordinal logistic regression was used to examine the Hispanic-only trends over the 18-year period. Because the inclusion criteria included first-admission records only, there were no multiple admissions for a given individual, satisfying the statistical assumption for independent observations. The regression treated year of admission as the linear predictor variable to test for increasing or decreasing trends over time. Graphic displays were used for interpretation. Because of the large sample size, a p value of .05 as the threshold for
4
M. MARZELL ET AL.
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
significance would make trivial effects statistically significant. To correct for a decreased possibility of a Type I error, an alpha of 0.001 was used. Given the sample sizes (even considering the unequal numbers between Hispanic and non-Hispanic admissions), the present study achieved over 90% power to detect odds ratios greater than 1.052. The accuracy of percentage estimates for binary variables were all less than �1.0 percentage points using a 95% confidence interval width. The few admissions not reporting a substance of abuse were excluded from statistical analyses (e.g., those admitted after a prolonged incarceration and abstinence). Results All youth marijuana admissions demonstrated an increasing trend over the 18 years, as shown in Figure 1. The difference between the Hispanic and nonHispanic groups is demonstrated by a significant interaction between Hispanic youth admissions by year predicting marijuana as the primary problem substance (Wald z ¼ 26.93, p < .0001). In separate regressions by year, the Hispanic group increased (OR ¼ 1.054, 95% CI ¼ 1.053, 1.055) more than the non-Hispanic group (OR ¼ 1.035, 95% CI ¼ 1.035, 1.036) for youth marijuana admissions. Hispanics made up 13% of all youth marijuana admissions in 1995; by 2012, they accounted for 27.33% of these admissions. Comparing all clients, Hispanic and non-Hispanic youth marijuana admissions across all years (n ¼ 1,438,478), revealed statistically significant differences in all demographic categories to include sex (χ2 ¼ 338.10, df ¼ 1, p < .0001), age (χ2 ¼ 11287.638, df ¼ 2, p < .0001), living arrangements (χ2 ¼ 5426.59, df ¼ 2, p < .0001), education (χ2 ¼ 12222.16, df ¼ 3, p < .0001), student status (χ2 ¼ 14811.21, df ¼ 1, p < .0001), and source of income (χ2 ¼ 51.68, df ¼ 4, p < .0001). Clinically meaningful differences showed Hispanics were less likely to be students, less likely to have completed greater levels of education, less likely to be living independently, and less likely to be between 18 and 20 years
Figure 1.
Hispanic and non-Hispanic youth marijuana admissions.
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE
5
old than non-Hispanics. Hispanics also displayed greater percent increase trends than non-Hispanics in all treatment and demographic variables. Both demographic and treatment variables of the Hispanic youth admissions trends were analyzed. The majority of admissions were male, but the percentage of females was increasing (χ2 ¼ 174.25, df ¼ 17, p < .0001). Males represented a 244% increase in admissions from 1995 to 2012, but admissions of females grew at an even greater rate, with a 29,801% increase. TEDS-A categorizes age as 12–14, 15–17, or 18–20. Hispanic youth in these three age groups differed in treatment admission trends (χ2 ¼ 708.86, df ¼ 34, p < .0001), as shown in Figure 2. The 15- to 17-year-olds had the largest number of admissions every year and experienced the most dramatic increase (287%) over the 18 years. Admissions of 18- to 20-year-olds increased 193%, and admissions of 12- to 14-year-olds increased by 234%. Education level of Hispanic youth admitted to treatment programs shifted significantly over the 18 years (χ2 ¼ 1222.04, df ¼ 51, p < .0001). The group with 8 or fewer years of education demonstrated a 158% increase, while those with 9–11 years and the high school graduate/GED group both increased, 301% and 387%, respectively. There were just over twice as many nonstudents as students admitted in 2012 (χ2 ¼ 10059.91, df ¼ 17, p < .0001). However, admissions of students increased 531% over the 18 years, compared to 193% for nonstudents, indicating growing admissions of Hispanic youth who were in school. In regard to living arrangements, we found the largest increase (968%) among those indicating dependent living. Those in the independent living category increased by 155%, while the homeless category showed a 57% decrease. All living arrangement trends were significant (χ2 ¼ 23632.93, df ¼ 34, p < .0001). Source of income also changed over the 18 years (χ2 ¼ 9686.65, df ¼ 68, p < .0001), as admitted youth who reported no source of income increased by 636% compared to a 151% increase of those reporting some income. There was also a large shift in admitted Hispanic youths’ referral source 2 (χ ¼ 7425.23, df ¼ 102, p < .0001), as shown in Figure 3. The largest percent
Figure 2.
Number and age of Hispanic youth marijuana admissions.
6
M. MARZELL ET AL.
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
Figure 3.
Number and referral source of Hispanic youth marijuana admissions.
increase (674%) was other community sources, followed by school referrals (408% increase). All other referral sources showed less dramatic increases: individual (260%), criminal justice (181%), other substance abuse agency (179%), health care (134%); employer referrals decreased 76%. The TEDS-A data set indicates severity of an admitted youth’s drug involvement in terms of the extent and frequency of substance use. There was a significant change in the extent of drug use, as defined by the number of problem substances reported at admission (χ2 ¼ 8599.30, df ¼ 34, p < .0001). The percentage of admitted Hispanic youth reporting only a single problem substance increased 555%. The percentage of those reporting two problem substances increased 213%, and the percent of those reporting three problem substances remained the same (1% increase). In other words, in 1995, less than a third (38%) of admitted Hispanic youth used marijuana only, but in 2012 over half (51%) were admitted for marijuana only. Frequency of use also showed significant change (χ2 ¼ 4161.23, df ¼ 68, p < .0001), with the greatest increase (351%) shown by those using marijuana the least often (reporting no use in the past 30 days). Other increases followed this inverse relationship, with those reporting use of 1 to 3 times in the past 30 days increasing by 322%, 1 to 2 times in the past week 275%, 3 to 6 times in the past week by 270%, and daily use showing the smallest increase (120%). The overall ordinal logistic regression model predicted yearly admissions from Hispanic (versus non-Hispanic) ethnicity, sex, age, education, student status, referral source, and living arrangement. In addition, the Hispanic versus non-Hispanic interaction with each of the demographic items was included. The ordinal regression model significantly predicted yearly youth marijuana admissions (χ2 ¼ 84075.86, df ¼ 31, p < .0001). Table 1 provides tests of each variable including their interactions with Hispanic versus non-Hispanic. The interactions are of particular interest. All of the interactions with the Hispanic group were significant except for the two variables of gender by ethnicity (χ2 ¼ 0.45, df ¼ 1, p ¼ .50), demonstrating that differences in gender changes were not unique to the Hispanic group. In addition, changes in student status were not unique to the Hispanic group (χ2 ¼ 16.29, df ¼ 1, p ¼ .0001).
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE
Table 1.
Contrasts of marginal linear predictions.
Predicting year
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
7
Covariate Hispanic Gender Age Student Referral Source Education Living Arrangement Interaction Hispanic × Gender Hispanic × Age Hispanic × Student Hispanic × Referral Source Hispanic × Education Hispanic × Living Arrangement
df
χ2
p value
1 1 2 1 6 3 2
1090.03 41.01 326.91 8990.45 7102.60 6647.68 15931.60
ISSN: 1533-2640 (Print) 1533-2659 (Online) Journal homepage: http://www.tandfonline.com/loi/wesa20
A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States Miesha Marzell, Ethan Sahker, George Pro & Stephan Arndt To cite this article: Miesha Marzell, Ethan Sahker, George Pro & Stephan Arndt (2016): A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States, Journal of Ethnicity in Substance Abuse, DOI: 10.1080/15332640.2015.1108256 To link to this article: http://dx.doi.org/10.1080/15332640.2015.1108256
Published online: 29 Jan 2016.
Submit your article to this journal
Article views: 2
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=wesa20 Download by: [Orta Dogu Teknik Universitesi]
Date: 31 January 2016, At: 15:18
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE http://dx.doi.org/10.1080/15332640.2015.1108256
A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States Miesha Marzella, Ethan Sahkerb, George Proa, and Stephan Arndtc
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
a
College of Public Health, The University of Iowa, Iowa City, Iowa; bIowa Consortium for Substance Abuse Research and Evaluation and College of Education, The University of Iowa, Iowa City, Iowa; c Iowa Consortium for Substance Abuse Research and Evaluation, Carver College of Medicine, and College of Public Health, The University of Iowa, Iowa City, Iowa ABSTRACT
KEYWORDS
Increases in Hispanic youth admissions to substance abuse treatment programs for marijuana use are a growing public health concern. In this study, we investigated trends in Hispanic youth from 1995 to 2012 utilizing the Treatment Episode Data Set—Admissions of the Substance Abuse Mental Health Services Administration. Hispanic youth marijuana admissions are associated with youth 15–17 years old, in high school, and living in a dependent situation. Notably, female admissions increased at greater rates than males. Results also point to decreasing tolerance of minor marijuana use by schools and community agencies. Findings highlight the need for targeted, culturally specific, and cost-effective treatment and prevention efforts.
Hispanic; marijuana use; substance abuse treatment admissions; youth
Introduction Youth marijuana admissions are on the rise while use frequency is on the decline (Marzell, Sahker, & Arndt, in press). The highest rates of illicit drug use, specifically of marijuana, are being reported for Hispanic youth (Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2015). Findings from the Youth Risk Behavior Surveillance System (YRBSS) indicated that the prevalence of ever using marijuana and current use is higher among Hispanic youth when compared to White youth (Kann et al., 2014). Higher rates of use are associated with multiple mental, physiological, and neurocognitive changes (Hadland & Harris, 2014). To develop an effective response to this public health problem, ascertaining the characteristics of such use specific to Hispanics is necessary for more culturally appropriate treatment approaches (Shih, Miles, Tucker, Zhou, & D’Amico, 2010). Some culturally specific correlates of Hispanic marijuana use in the literature have been identified as sex, family involvement (Eitle, 2006; CONTACT Miesha Marzell [email protected] Community and Behavioral Health, College of Public Health, The University of Iowa, 145 N. Riverside Drive, Iowa City, Iowa 52242. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wesa © 2016 Taylor & Francis
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
2
M. MARZELL ET AL.
Lac et al., 2011), age as measured by grade, and student status (Eitle, 2006). In addition, Guerrero, Marsh, Khachikian, Amaro, and Vega (2013) identified access to treatment as a disparity associated with Hispanic treatment. Referral source may be an important indicator of community access to treatment. Substance use referrals to treatment tend to vary cross-culturally and may be an indicator of systemic issues significant to individual and multicultural differences in treatment (Sahker, Toussaint, Ramirez, Ali, & Arndt, 2015). However, little research is available on nationwide Hispanic treatment samples. The present study focused on Hispanic youths’ admission to substance abuse treatment programs, examining temporal trends and testing for differences over an 18-year period (1995–2012). The correlates of age, sex, student status, living arrangement, and source of income were of particular interest to assess the trends in Hispanic youth marijuana treatment admissions. Increases in all correlates are expected. In addition, the present study is concerned with developing an improved understanding of Hispanic youth entering treatment. Methods The present study utilized a large data set created by the Substance Abuse Mental Health Services Administration (SAMHSA), the governmental agency within the U.S. Department of Health and Human Services charged with reducing the national effect of substance abuse and mental illness. SAMHSA’s Treatment Episode Data Set (TEDS), which contains client-level data on demographic characteristics and substance abuse problems, comprises information requested from all public and private treatment facilities in the United States that receive government funding. The treatment settings are located in hospitals and freestanding agencies, in both urban and rural areas, and include detox, inpatient, and outpatient facilities. TEDS has both an admissions (TEDS-A) and a discharge data set. Although not all facilities provide data, TEDS-A comprises a significant proportion of U.S. treatment admissions. Participants and procedures
First, only those records on individuals with no prior admissions were selected, which were defined as answering “none” to the variable indicating the number of previous treatment episodes received in any drug or alcohol program. Restricting the data to first admissions provided a nonduplicative total of individuals admitted to treatment. Next, only those individuals less than 20 years of age at admission were included, arriving at 12,025,787 youth admissions. Then only records indicating race and ethnicity were included, giving a
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE
3
final sample (N ¼ 1,166,468). Finally, we categorized comparison groups of Hispanics (n ¼ 272,010) and non-Hispanics (n ¼ 1,438,478). Measures
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
Primary substance used At the time of admission to a treatment program, the primary problem substance was identified during initial interview. Admissions indicating marijuana as primary problem substance were included (N ¼ 2,682,582). Drug involvement TEDS-A data related to treatment include frequency of use, number of problem substances, referral source, and service setting at admission. Treatment agency staff also record secondary and tertiary problem substances as necessary. Data related to extent of drug involvement include number of substances and frequency of use. These data were included as variables in the final analysis. Other demographics Investigated demographic variables included age, sex, race/ethnicity, student status, living arrangement, and source of income. For confidentiality, TEDS-A categorizes the age variable (as explained in the Results section). Student status was coded as student or nonstudent. Living arrangement was recorded as homeless, dependent, or independent living. Dependent living includes institutional housing, group homes, halfway houses, and clients 17 and younger living with parents. Independent living includes living alone, living with roommates, and clients 18 and older living with parents. Because these data represent public information and have no subject identification, the Human Subjects Office exempted this study from review. Statistical analysis
Analyses were conducted using STATA version 13.1 (StataCorp, College Station, TX). Chi-square analyses were used to examine differences between admission years. Binomial logistic regression was used to discern trends over the 18 years comparing Hispanics with non-Hispanics. In addition, ordinal logistic regression was used to examine the Hispanic-only trends over the 18-year period. Because the inclusion criteria included first-admission records only, there were no multiple admissions for a given individual, satisfying the statistical assumption for independent observations. The regression treated year of admission as the linear predictor variable to test for increasing or decreasing trends over time. Graphic displays were used for interpretation. Because of the large sample size, a p value of .05 as the threshold for
4
M. MARZELL ET AL.
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
significance would make trivial effects statistically significant. To correct for a decreased possibility of a Type I error, an alpha of 0.001 was used. Given the sample sizes (even considering the unequal numbers between Hispanic and non-Hispanic admissions), the present study achieved over 90% power to detect odds ratios greater than 1.052. The accuracy of percentage estimates for binary variables were all less than �1.0 percentage points using a 95% confidence interval width. The few admissions not reporting a substance of abuse were excluded from statistical analyses (e.g., those admitted after a prolonged incarceration and abstinence). Results All youth marijuana admissions demonstrated an increasing trend over the 18 years, as shown in Figure 1. The difference between the Hispanic and nonHispanic groups is demonstrated by a significant interaction between Hispanic youth admissions by year predicting marijuana as the primary problem substance (Wald z ¼ 26.93, p < .0001). In separate regressions by year, the Hispanic group increased (OR ¼ 1.054, 95% CI ¼ 1.053, 1.055) more than the non-Hispanic group (OR ¼ 1.035, 95% CI ¼ 1.035, 1.036) for youth marijuana admissions. Hispanics made up 13% of all youth marijuana admissions in 1995; by 2012, they accounted for 27.33% of these admissions. Comparing all clients, Hispanic and non-Hispanic youth marijuana admissions across all years (n ¼ 1,438,478), revealed statistically significant differences in all demographic categories to include sex (χ2 ¼ 338.10, df ¼ 1, p < .0001), age (χ2 ¼ 11287.638, df ¼ 2, p < .0001), living arrangements (χ2 ¼ 5426.59, df ¼ 2, p < .0001), education (χ2 ¼ 12222.16, df ¼ 3, p < .0001), student status (χ2 ¼ 14811.21, df ¼ 1, p < .0001), and source of income (χ2 ¼ 51.68, df ¼ 4, p < .0001). Clinically meaningful differences showed Hispanics were less likely to be students, less likely to have completed greater levels of education, less likely to be living independently, and less likely to be between 18 and 20 years
Figure 1.
Hispanic and non-Hispanic youth marijuana admissions.
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE
5
old than non-Hispanics. Hispanics also displayed greater percent increase trends than non-Hispanics in all treatment and demographic variables. Both demographic and treatment variables of the Hispanic youth admissions trends were analyzed. The majority of admissions were male, but the percentage of females was increasing (χ2 ¼ 174.25, df ¼ 17, p < .0001). Males represented a 244% increase in admissions from 1995 to 2012, but admissions of females grew at an even greater rate, with a 29,801% increase. TEDS-A categorizes age as 12–14, 15–17, or 18–20. Hispanic youth in these three age groups differed in treatment admission trends (χ2 ¼ 708.86, df ¼ 34, p < .0001), as shown in Figure 2. The 15- to 17-year-olds had the largest number of admissions every year and experienced the most dramatic increase (287%) over the 18 years. Admissions of 18- to 20-year-olds increased 193%, and admissions of 12- to 14-year-olds increased by 234%. Education level of Hispanic youth admitted to treatment programs shifted significantly over the 18 years (χ2 ¼ 1222.04, df ¼ 51, p < .0001). The group with 8 or fewer years of education demonstrated a 158% increase, while those with 9–11 years and the high school graduate/GED group both increased, 301% and 387%, respectively. There were just over twice as many nonstudents as students admitted in 2012 (χ2 ¼ 10059.91, df ¼ 17, p < .0001). However, admissions of students increased 531% over the 18 years, compared to 193% for nonstudents, indicating growing admissions of Hispanic youth who were in school. In regard to living arrangements, we found the largest increase (968%) among those indicating dependent living. Those in the independent living category increased by 155%, while the homeless category showed a 57% decrease. All living arrangement trends were significant (χ2 ¼ 23632.93, df ¼ 34, p < .0001). Source of income also changed over the 18 years (χ2 ¼ 9686.65, df ¼ 68, p < .0001), as admitted youth who reported no source of income increased by 636% compared to a 151% increase of those reporting some income. There was also a large shift in admitted Hispanic youths’ referral source 2 (χ ¼ 7425.23, df ¼ 102, p < .0001), as shown in Figure 3. The largest percent
Figure 2.
Number and age of Hispanic youth marijuana admissions.
6
M. MARZELL ET AL.
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
Figure 3.
Number and referral source of Hispanic youth marijuana admissions.
increase (674%) was other community sources, followed by school referrals (408% increase). All other referral sources showed less dramatic increases: individual (260%), criminal justice (181%), other substance abuse agency (179%), health care (134%); employer referrals decreased 76%. The TEDS-A data set indicates severity of an admitted youth’s drug involvement in terms of the extent and frequency of substance use. There was a significant change in the extent of drug use, as defined by the number of problem substances reported at admission (χ2 ¼ 8599.30, df ¼ 34, p < .0001). The percentage of admitted Hispanic youth reporting only a single problem substance increased 555%. The percentage of those reporting two problem substances increased 213%, and the percent of those reporting three problem substances remained the same (1% increase). In other words, in 1995, less than a third (38%) of admitted Hispanic youth used marijuana only, but in 2012 over half (51%) were admitted for marijuana only. Frequency of use also showed significant change (χ2 ¼ 4161.23, df ¼ 68, p < .0001), with the greatest increase (351%) shown by those using marijuana the least often (reporting no use in the past 30 days). Other increases followed this inverse relationship, with those reporting use of 1 to 3 times in the past 30 days increasing by 322%, 1 to 2 times in the past week 275%, 3 to 6 times in the past week by 270%, and daily use showing the smallest increase (120%). The overall ordinal logistic regression model predicted yearly admissions from Hispanic (versus non-Hispanic) ethnicity, sex, age, education, student status, referral source, and living arrangement. In addition, the Hispanic versus non-Hispanic interaction with each of the demographic items was included. The ordinal regression model significantly predicted yearly youth marijuana admissions (χ2 ¼ 84075.86, df ¼ 31, p < .0001). Table 1 provides tests of each variable including their interactions with Hispanic versus non-Hispanic. The interactions are of particular interest. All of the interactions with the Hispanic group were significant except for the two variables of gender by ethnicity (χ2 ¼ 0.45, df ¼ 1, p ¼ .50), demonstrating that differences in gender changes were not unique to the Hispanic group. In addition, changes in student status were not unique to the Hispanic group (χ2 ¼ 16.29, df ¼ 1, p ¼ .0001).
JOURNAL OF ETHNICITY IN SUBSTANCE ABUSE
Table 1.
Contrasts of marginal linear predictions.
Predicting year
Downloaded by [Orta Dogu Teknik Universitesi] at 15:18 31 January 2016
7
Covariate Hispanic Gender Age Student Referral Source Education Living Arrangement Interaction Hispanic × Gender Hispanic × Age Hispanic × Student Hispanic × Referral Source Hispanic × Education Hispanic × Living Arrangement
df
χ2
p value
1 1 2 1 6 3 2
1090.03 41.01 326.91 8990.45 7102.60 6647.68 15931.60
