High Hopes and Poor Sleep: Effect of Marijuana Use Among Former Foster Care Youth

Background: Youth who age out of foster care face greater challenges to healthy development than their peers. In addition to the effects of child maltreatment, these youth have experienced the loss of their birth parents, extended family, and familiar environments. They have also had to adjust to life in care, which can contribute to or exacerbate socioemotional problems.

Youth who have been in foster care may be especially vulnerable to substance use during late adolescence as they transition out of the child welfare system since they often have little social support. Young adults use marijuana for recreational reasons, but some also use it for mental health and sleep difficulties. The relationship between substance use and insomnia is bidirectional; there is evidence that each issue exacerbates the other. Three research questions were explored:  1) Do former foster care youth use more marijuana than a comparison group of low-income youth? 2) Do former foster care youth show poorer sleep than a comparison group? 3) How are former foster youths’ experiences in care, marijuana use, and mental health related to their sleep?

Methods: Youth aged 18-24 were recruited from two agencies that provide workforce development services (N=162). All participants had a regular place to sleep. More than a third of the total sample spent time in foster care (n=102). Youth completed surveys about their life histories, maltreatment, trauma exposure, anxiety, depression, and substance use. Youth formerly in care were asked about their number of placements, total time spent in care, and age they first entered care. Participants wore sleep monitors for four consecutive nights and three aspects of sleep were measured: sleep onset latency, total time asleep, and number of nighttime awakenings.

Descriptive statistics were used for the total sample, and logistic regression was used to examine the relationship between marijuana use and total time in care, number of placements, age of foster care entry, trauma history, depression, and anxiety in former foster care youth. T tests examined differences in the three elements of sleep in youth who used marijuana compared to non-users.

Results: Former foster care youth used significantly more marijuana than the comparison group. Both groups reported similar rates of child maltreatment and mental health problems.

Among the former foster care youth, logistic regression showed that more time spent in care, physical abuse, and trauma were all related to marijuana use. In terms of sleep, youth who used marijuana had a shorter sleep onset latency but showed fewer total sleep hours compared to non-users.

Conclusions and Implications: Youth formerly in care show higher marijuana use than their peers. Marijuana use contributes to falling asleep more quickly, but youth are getting less sleep overall. There is a complex relationship between sleep and substance use and both have been found to contribute to mental health and well-being, as well as issues related to economic and social stability. Given that there is less stigma around sleep issues, insomnia interventions may be a pathway to engage youth in treatment that could also reduce substance use.