寄养内外青少年物质使用模式：健康与儿童福利行政数据关联分析。
Patterns of substance use among adolescents in and out of foster care: An analysis of linked health and child welfare administrative data.
机构信息
Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
出版信息
Child Abuse Negl. 2023 Dec;146:106473. doi: 10.1016/j.chiabu.2023.106473. Epub 2023 Oct 4.
BACKGROUND
Young adults with a history of foster care have higher risk for substance use disorders. Social systems can deliver substance use prevention to youth; however, the timing of intervention delivery and how needs differ for youth in foster care are unclear.
OBJECTIVE
To compare initiation and rates of substance use among adolescents in foster care to demographically similar adolescents never in foster care as identified by the healthcare system, and identify factors associated with increased substance use.
PARTICIPANTS AND SETTING
Youth in foster care (n = 2787, ages 10-20, inclusive) and demographically matched youth never in foster care (n = 2787) were identified using linked child welfare and electronic health records from a single pediatric children's hospital and county over a five-year period (2012-2017).
METHODS
All healthcare encounters were reviewed and coded for substance use by type (alcohol, tobacco, cannabis, other). Age of first reported or documented substance use was also captured. Demographic and child welfare information was extracted from administrative records. Survival and logistic regression models were estimated.
RESULTS
In adjusted models, youth in foster care initiated substance use at earlier ages (HR = 2.50, p < .01) and had higher odds of engaging in use (AOR = 1.54; p < .01) than youth never in care. By age 12, substance use initiation was more likely while youth were in foster care than when they were not in foster care (HR = 1.42, p < .01). Placement stability and family care settings reduced odds of lifetime substance use.
CONCLUSIONS
Foster care placement is associated with substance use. Screening may be important for prevention.
背景
有寄养经历的年轻人更易患上物质使用障碍。社会系统可以向年轻人提供物质使用预防服务；然而，干预措施的实施时机以及寄养青少年的需求差异尚不清楚。
目的
比较寄养青少年与医疗系统确定的从未接受过寄养的同龄青少年在物质使用方面的起始时间和使用率，并确定与物质使用增加相关的因素。
参与者和设置
通过链接的儿童福利和电子健康记录，从一家儿科儿童医院和县内识别出在五年期间（2012-2017 年）处于寄养状态的青少年（n=2787，年龄 10-20 岁，含边界值）和从未接受过寄养的青少年（n=2787）。
方法
所有医疗保健接触均由类型（酒精、烟草、大麻、其他）进行审查和编码，以确定物质使用情况。首次报告或记录的物质使用的年龄也被捕获。从行政记录中提取人口统计学和儿童福利信息。估计生存和逻辑回归模型。
结果
在调整后的模型中，寄养青少年开始物质使用的年龄更早（HR=2.50，p<0.01），并且物质使用的可能性更高（AOR=1.54；p<0.01）比从未接受过护理的青少年。在 12 岁之前，与没有接受寄养时相比，寄养期间青少年更有可能开始使用物质（HR=1.42，p<0.01）。安置稳定性和家庭护理环境降低了终生物质使用的可能性。
结论
寄养安置与物质使用有关。筛查可能对预防很重要。
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