We tested whether the proportional hazards assumption was met in all analyses using the ASSESS statement in PROC PHREG with the option PH . We conducted multiple imputation by fully conditional specification with the number of imputations set to 20 to account for covariates with missing data, based on the assumption those missing covariates were missing at random . We then conducted multivariable survival analysis based on the fully imputed datasets. Reducing early initiation of cannabis use is key to preventing negative long-term health and associated psychosocial consequences . In this large sample of first-time JIY, rates of early onset cannabis use were high and 15 % of youth newly initiated cannabis use in the year following first justice contact. Youth’s internal distress, affect dysregulation, and positive expectancies about cannabis use drove new initiation, even after accounting for known associated factors . The justice system largely focuses on interventions to address co-occurring mental health and delinquent behavior, primarily through group or family-based intervention, but our data suggest there is a critical and unique window of opportunity to prevent grow lights for cannabis use initiation among youth by addressing internalizing symptoms, teaching emotion regulation skills, and modifying expectancies.
Such interventions can be brief and feasible to implement within existing individual-based court and justice-related services . Since adolescent cannabis use can be associated with future worse public health and legal outcomes, developing effective brief primary prevention interventions for JIY is critical; these are not mutually exclusive from essential development and empirical testing of structural-level public health and legal policy interventions to delay or reduce JIY substance use. Only two studies have tested brief interventions to reduce substance use among justice-involved or diverted truant populations . Spirito and colleagues tested the preliminary efficacy of a combined family-based and individual adolescent based brief motivational enhancement therapy intervention ; the latter targeting adolescent substance use related attitudes, beliefs and norms and demonstrating feasibility, acceptability and reductions in youth cannabis use at 3 month follow-up . Dembo and colleagues tested the efficacy of a brief intervention with youth and parents compared to youth-only BI and Standard Truancy Services in reducing cannabis use and sexual risk behavior over 12 months.
No significant intervention effects were found; however, the authors note certain subgroups showed differential response to the intervention . Although mixed in success, both studies addressed individual level factors commonly associated with increased likelihood of substance use among JIY . Our data suggest with first-time JIY who have not initiated use, a brief individual youth intervention targeting internalizing symptoms, emotion regulation skills, and grow cannabis use expectancies is important for future intervention development and testing. Single session interventions are a cost-effective and feasible way to address youth internalizing symptoms and increase access to mental health interventions for underserved youth . SSIs focused on motivational enhancement therapy for sexual risk reduction have been feasible and acceptable to deliver to large numbers of detained youth . The concept of SSIs has yet to be explored for substance use prevention among JIY, but our study suggests a SSI addressing internalizing symptoms, emotion regulation, and cannabis use expectancies and intentions may be efficacious in delaying or preventing cannabis use initiation, both of which have significant positive public health implications .
SSIs could also be developed to shift expectancies and intentions about continued use for those with early onset, who are at greater risk for worse outcomes due to being younger upon first using and greater likelihood of continued use and consequences. Our results suggest incorporating alcohol use content might also be important for those already using cannabis at first-time justice contact. SSIs are also likely more feasible to implement within real-world settings already serving JIY and have strong potential to address a highly concerning gap in access to substance use intervention for community-supervised JIY . One possible approach for substance use SSIs is motivational interviewing , a communication technique used to reduce alcohol and cannabis use among school-mandated college students and in two studies of general substance using adolescent populations ; however, the limited data available suggest MI for universal prevention may not be as effective .