Demographic Patterns of Early Use and Initiation of Substances Among Youth in the Child Welfare System

Background and Purpose: Youth investigated by child protective services (CPS) experience multiple risk factors for adverse substance use outcomes.  However, there is a lack of research regarding patterns of early substance use (i.e., by 13 years), which has strong ties to trauma and is associated with higher risk of enduring substance use problems, within this population.  Furthermore, patterns of substance use initiation risk after CPS investigation remain largely unknown.  The current study addresses these gaps through two research questions: 1) what is the prevalence of early substance use and subsequent substance use initiation among youth investigated by CPS and 2) do these rates vary by gender, race/ethnicity (Black, White, American Indian, Other; Hispanic, non-Hispanic), and placement type (out of home, in home)?

Methods:  A subsample of 796 youth who were 11-13 years at wave 1 (investigation) was drawn from the National Survey of Child and Adolescent Wellbeing I, a longitudinal nationally-representative study of children investigated by CPS.  Youth endorsement of lifetime use of substances (alcohol, cannabis, hard drug, solvent, cigarette, and nonmedical prescription drug) at wave 1 indicated early use, and at follow-up waves indicated initiation (when no baseline use was reported).  Frequencies and chi-square tests adjusting for sample weights assessed overall prevalence rates and demographic group differences.  Confidence intervals (95%) were used to compare CPS estimates of early use to general population benchmarks of substance use initiation by 8^th grade from the Monitoring the Future Study.

Results:  Analyses revealed early use of alcohol by 33.1% (SE=3.2%), cigarettes by 30.6% (SE=3.2%), cannabis by 13.0% (SE=3.9%), solvents by 9.4% (SE=1.9%), nonmedical prescription drugs by 9.0% (SE=2.0%) and hard drugs by 4.1% (SE=1.3%).  More than half (53.6%, SE = 4.0%) of baseline nonusers subsequently initiated alcohol use.  Similarly, 41.5% (SE=3.7%) initiated cigarettes, 30.3% (SE=4.0%) cannabis, 16.8% (SE=2.4%) nonmedical prescription drugs, 6.5% (SE=1.6%) solvents, and 5.4% (SE=1.2%) hard drugs.  Out of home placement was associated with higher early hard drug use and higher alcohol, hard drug, cigarette, solvent, and nonmedical prescription drug initiation.  Hispanic youth reported lower rates of early hard drug use and solvent initiation. No significant gender differences were found.

Conclusions and Implications: Results suggest higher rates of early alcohol, solvent, and cigarette use among youth investigated by CPS than the general population, and unique race/ethnicity and gender patterns.  Substantial youth initiate substances after investigation, indicating the continued need for intervention after system contact.  Findings of lower risk among Hispanic youth correspond with previously identified “paradoxical” patterns of higher health outcomes despite risk factors within this population.  Future research should examine how higher risk of early substance use and initiation among youth in out of home care relates to risk factors such as maltreatment severity, mental/behavioral health problems, and placement instability.  This study demonstrates the need to systematically assess and treat youth in the child welfare system for substance use at investigation, and beyond, as well as the need for targeted prevention, particularly for youth in out of home care, to interrupt the development of potentially debilitating substance use problems.