Validation of a measure to assess alcohol- and marijuana-related risks and consequences among incarcerated adolescents

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Abstract

Few measures exist to assess risky behaviors and consequences as they relate to substance use in juvenile delinquents. This study sought to validate such a measure on a racially and ethnically diverse sample (N = 175). Results indicate that alcohol-related risky behaviors and consequences comprise a single scale as do marijuana-related risky behaviors and consequences. Furthermore, results suggest that the retention of common items for both scales produces reliable and valid scales and maintains parsimony. Internal consistencies were more than adequate (0.72–0.83) and test–retest stabilities, even across several months were acceptable (0.52–0.50). The scales evidenced a high degree of concurrent and predictive incremental validity in predicting conduct disorder, dependence symptoms, and consumption patterns. Researchers can use these scales to measure a generalized construct tapping risks and consequences as related to alcohol and marijuana use. Ease of use may make these scales appealing to clinicians who can provide feedback to clients regarding risky behaviors involving alcohol and marijuana.

Introduction

Marijuana and alcohol are widely used substances among adolescents beginning as early as middle school. Recent national surveys found life-time alcohol consumption in middle school adolescents to be as high as 66% among 8th graders and 74% among high school adolescents (Eaton et al., 2006, Whalen et al., 2006). Similarly, marijuana life-time use for 8th graders was reported as high as 25% while 38% of high school students report life-time marijuana use (Eaton et al., 2006; Whalen et al., 2006). Incarcerated adolescents have even higher rates of substance use. A recent investigation of substance use by adolescents in the juvenile justice systems found adolescents arrested in the past year were twice as likely to have used alcohol and 3.5 times more likely to have used marijuana as compared to adolescents who were not arrested in the last year (National Center on Addiction and Substance Abuse at Columbia University, 2004). Alcohol and marijuana are the two most frequently used substances among adolescent detainees (McClelland et al., 2004).

In addition to using substances, adolescence is also a time of engaging in a variety of risky behaviors, including drinking and driving, risky sex, and other behaviors leading to injury (e.g., fighting). For example, 29% of high school adolescents nationwide (Eaton et al., 2006) and 45% of students from a rural, southern middle school reported being a passenger in a car with someone who had been drinking alcohol during the past month (Muilenburg et al., 2007). Ten percent of high school students nationwide (Eaton et al., 2006) and 17% of rural, southern middle school students had driven a motor vehicle after consuming alcohol (Muilenburg et al., 2007).

When compared to non-arrestees, adolescent arrestees reported more substance use, unprotected sexual acts, substance use during sex (both self and partner), and diagnoses of sexually transmitted infections (Tolou-Shams et al., 2007). One recent study found 98% of adolescents with substance use disorders were sexually active and 77% had multiple partners within the past 3 months (Teplin et al., 2005). When engaging in casual sex (i.e., sex with someone not known well) and unprotected sex, substance use plays a large role for incarcerated adolescents. Sixty-three percent of adolescents reported always using marijuana when engaging in sex with someone they did not know well and 40% indicated always using alcohol when having casual sex (Rosengard et al., 2006). Moreover, 46% of adolescents always used marijuana and 15% of adolescents always drank alcohol when unprotected sex was practiced (Rosengard et al., 2006).

Adolescents also sustain significant injuries while under the influence of substances (Spirito et al., 1997) with adolescents with a behavior disorder 9.4 times more at risk for injuries as compared to peers without behavior disorders (Riley et al., 1996). There is also a link between behavior disorders and substance use with findings indicating that 28% of those diagnosed with a substance use disorder at age 18 also have a behavior disorder (Lansford et al., 2008). With rates of alcohol and marijuana use disorders high among adolescent detainees (26% and 43%, respectively; Teplin et al., 2002), and the high proportion of incarcerated adolescents (over 86%; Stein et al., 2008) diagnosed with a behavior disorder, this population is at high risk for injuries.

Given the high prevalence of alcohol and marijuana use among adolescents and the impact it has on risky behaviors, especially among adolescents involved with the juvenile justice system, it is imperative that psychometrically sound instruments are available for this population. However, despite the need, there is a dearth of instruments that measure alcohol and marijuana use and risky behaviors for this population. Instruments exist to assess alcohol and drug use such as the Customary Drinking and Drug Use Record (Brown et al., 1998) and the Teen-Addictions Severity Index (Kaminer et al., 1991). There are also adolescent instruments that assess marijuana and alcohol use and related negative consequences and problems, including the Rutgers Alcohol Problem Index (RAPI; White and Labouvie, 1989), the Rutgers Marijuana Problem Index (RMPI; Johnson and White, 1989), and the Adolescent Cannabis Problems Questionnaire (CPQ-A; Copeland et al., 2005). These instruments assess substance-related behaviors putting adolescents at risk for poor outcome (going to school while high/drunk), they assess problem behavior associated with substance acquisition (pawning belongings), and they assess negative consequences (becoming ill, legal trouble).

In addition, longer and more comprehensive instruments exist to evaluate substance use along with other potential problem areas for adolescents. These include the Personal Experiences Inventory (PEI; Winters and Henly, 1989) which is comprised of two parts, the Problems Severity section (153 questions) and the Psychosocial section (147 questions); and the 139-item Problem Oriented Screening Instrument for Teenagers (POSIT; Rahdert, 1991), which assesses 10 problem areas: Substance use, physical health, mental health, family relations, peer relationships, educational status, vocations status, social skills, leisure and recreation, and aggressive behavior/delinquency.

Although longer instruments like the POSIT and PEI have been used with delinquent populations (Dembo et al., 1997, Latimer et al., 1997), in general the above measures have been validated and used in general and clinical adolescent populations. Well-validated, briefer measures, developed in ethnically diverse samples of juvenile delinquents are needed to assist in assessment and treatment planning. As Winters (2004) indicates, many of the substance use instruments lack important validity data among subpopulations of adolescents (i.e., identified by race, ethnicity, age, and/or type of setting) indicating that an instrument that is validated on a racially and ethnically diverse population of incarcerated adolescents would add to the existing resources. Moreover, none of the above instruments have been validated using incremental validity. Incremental validity addresses whether a measure adds to the prediction of a criterion above what can be predicted by other sources of data. A number of investigators over the decades have indicated that newly developed tests should demonstrate an ability to add to the prediction of outcomes beyond that which was possible with other available strategies (Cronbach and Gleser, 1957). Sechrest (1963) argued that a psychological test that was intended for applied use (i.e., academic, clinical, or personnel applications) must yield an improvement in prediction compared with the result derived from using data that are easily and routinely obtained as part of the process of assessment. This requirement presents a rather stringent test of validity (Hunsley and Meyer, 2003).

The Risks and Consequences Questionnaire (RCQ) is a 26-item questionnaire that fills this void. The adolescent is asked (1) how many times the risky behavior or consequence occurred, (2) the number of times it occurred with alcohol involved, and (3) the number of times it occurred with marijuana involved. Some items target consequences of substance use (missed time from school), whereas others assess risky behaviors related to use (willing rode in a car with someone who was driving dangerously). The RCQ adds to existing adolescent substance use instruments in the following ways: (1) It assesses the frequency of risky behaviors and consequences related to substance use; (2) it does so specifically for ethnically diverse incarcerated populations; (3) on a single instrument, it efficiently assesses for the target behavior, the relationship of alcohol to the behavior, and the relationship of marijuana to the target behavior; and (4) it is validated using rigorous methodology that has not been utilized in the validation of the above instruments. Moreover, due to time constraints and limited resources often evident in juvenile correctional facilities, the ease of the administration of the RCQ makes it suitable for use in this environment. The current study aims to validate this measure with a racially and ethnically diverse sample of incarcerated adolescents. Specific aims include assessing internal validity and concurrent and predictive incremental validity.

Section snippets

Participants

The participants in this study were 175 adjudicated youth residing in a state juvenile correctional facility. The youth in the facility were sentenced for committing crimes ranging in severity from truancy to murder. Approximately 1100 adolescents are detained at this facility annually. Of these, 500–600 of the youth are adjudicated and serve sentences at the facility, which estimates its annual recidivism rate to be 35%. The youth receive both individual and group interventions, as needed,

Results

All variables were checked for distributional assumptions and transformed as needed (one outlier was recoded on “number of days drank in the 3 months after release”). Items 6 (nearly drowned) and 22 (trouble at work) were removed because the number of teens endorsing each of these items was n  5 for alcohol and marijuana; item 4 (injured while playing sports) was removed because n  5 for alcohol, and we sought to retain parsimony across scales. Next each dichotomized item was correlated with the

Discussion

Few measures exist to assess risky behaviors and consequences as they relate to substance use in juvenile delinquents. This study sought to validate such a measure on a racially and ethnically diverse sample. Results indicate that alcohol-related risky behaviors and consequences comprise a single scale as do marijuana-related risky behaviors and consequences. Furthermore, results suggest that the retention of common items for both scales produces reliable and valid scales and maintains

Role of funding source

Funding for this study was provided by NIDA (R01 DA13375). NIDA had no further role in study design; in the collection, analysis and interpretation of data; in writing of the report; or in the decision to submit the paper for publication. Support was also provided by the Rhode Island Department of Youth and Families.

Contributors

R. Lebeau, M. Clair, J. Rossi, R. Martin, C. Golembeske. Author L.A.R. Stein conceptualized and wrote. Author R. Lebeau undertook analysis. Author Mary Clair wrote and conceptualized. J. Rossi and M. Martin both advised on statistical approach and C. Golembeske, assisted in running project. All authors contributed to and have approved the final manuscript.

Conflict of interest

None.

Acknowledgements

The authors would like to gratefully acknowledge Christopher Kahler for his assistance in formulating the methodological approach. We would also like to thank Suzanne Sales for her analytic expertise; and we thank Ohianna Torrealday for her initial interest in participating in this study.

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    A copy of the questionnaire is available with the online version of the paper at doi:10.1016/j.drugalcdep.2009.12.015.

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