As adolescent substance use declines, internalizing symptoms increase: identifying high-risk substance using groups and the role of social media, parental supervision, and unsupervised time

摘要 多个数据来源表明，青少年精神病理学，特别是内在化症状，处于 创下美国历史上前所未有的新高。这些问题包括认知(低自尊、自尊 青少年内化的情感(贬损)、情感(抑郁情绪)和社交(孤独)维度 症状，自2009年以来一直在迅速增加。与这些趋势相吻合的是 青少年酒精和其他毒品(AOD)的使用(大麻除外)，与预期给予的相反 AOD的使用与内化症状之间历史上的密切关系。下降也很明显，在 高强度饮酒(例如，每次饮酒10多杯)，高频率使用AOD(尽管不是 (包括大麻)和同时使用AOD(包括大麻)。两国关系的强弱 青少年的内在化症状和AOD使用也在减少；第一次接近零 这对风险因素评估、预防和干预具有严重影响。分歧 然而，不同的人口子组可能会有所不同。很少有研究估计为什么这些不同的趋势 正在发生；最突出的假设是智能手机和社交媒体。这些技术是 假设是为了减少青少年之间的面对面时间，增加父母的实时监测， 以及嫉妒和自我价值低下等负面情绪。这种转变可能是AOD使用量减少(更少)的原因 无人监管的时间与其他青少年相处，更多的父母监督)，以及内化症状的增加 (消极情绪和自我价值)。然而，现有的文献并不是基于具有全国代表性的数据， 而且与AOD使用的关系还没有被调查。本研究将利用监测 未来(MTF)每年对大约45,000名青少年进行横断面调查。MTF包括广度度量 与内化症状、物质使用、青少年互动以及各种潜力有关 混血儿。我们将解决三个目标：(1)考察时间趋势与内化之间的关系 症状(缺乏自尊、自我贬低、抑郁情绪、孤独感)具有任何、高强度、高强度 使用AOD的频率，测试不同时间、种族、性别和SES之间关系的大小； 检查内化症状和同时使用AOD之间的关系中的时间趋势(例如， 酒精和大麻的使用，酒精和阿片类药物的使用，其他)，测试这种关系的程度 时间和分组；(3)测试社交媒体的使用程度、父母监督和不受监督 与朋友在一起的时间与内化症状、AOD使用、同时使用AOD以及是否 这些关联的大小解释了趋势随时间的变化。解决这些目标的方法将是 包括时变效应建模以及并行过程增长模型。这项研究将提供 通过描述AOD和内在化症状之间的关系，为公共卫生行动提供证据 时间，并通过审查新技术的作用和不断变化的青少年互动格局。

ABSTRACT Multiple data sources indicate that adolescent psychopathology, particularly internalizing symptoms, is at historically unprecedented highs in the United States. These include cognitive (low self-esteem, self- derogation), affective (depressive affect), and social (loneliness) dimensions of adolescent internalizing symptoms, which have been rapidly increasing since ~ 2009. Coinciding with these trends has been declines in adolescent alcohol and other drug (AOD) use (except marijuana), contrary to what would be expected given the historically strong relationship between AOD use and internalizing symptoms. Declines are also apparent in high intensity alcohol use (e.g. 10+ drinks per drinking occasion), high-frequency AOD use (although not marijuana), and simultaneous use of AOD (including marijuana). The strength of the relationship between internalizing symptoms and AOD use among adolescents is also decreasing; for the first time approaching null in 2016, which has serious implications for risk factor assessment, prevention and intervention. Divergences may vary across demographic subgroups, however. Little work has estimated why these diverging trends are occurring; the most prominent hypothesis is smartphones and social media. These technologies are hypothesized to underlie less face-to-face time among adolescents, increase real-time parental monitoring, and negative feelings such as envy and low self-worth. Such a shift may underlie decreases in AOD use (less unsupervised time with other adolescents, more parental monitoring) and increases in internalizing symptoms (negative feelings and self-worth). However, existing literature is not based on nationally-representative data, and the relationship with AOD use has not been investigated. The present study will utilize the Monitoring the Future (MTF) cross-sectional surveys of ~45,000 adolescents per year. MTF includes a breadth measures related to internalizing symptoms, substance use, adolescent interaction, as well as a diverse array of potential confounders. We will address three aims: (1) Examine time trends in the relationship between internalizing symptoms (low self-esteem, self-derogation, depressive affect, loneliness) with any, high-intensity, high frequency AOD use, testing the magnitude of the relationship across time and by race, sex, and SES; (2) Examine time trends in the relationship between internalizing symptoms and simultaneous use of AOD (e.g., alcohol and marijuana use, alcohol and opioid use, others), testing the magnitude of the relationship across time and by subgroups; (3) Test the extent to which social media use, parental supervision, and unsupervised time with friends are associated with internalizing symptoms, AOD use, simultaneous use of AOD, and whether the magnitude of these associations explains changes in trends over time. Methods to address these aims will include time-varying effect modeling as well as parallel process growth models. This study will provide evidence for public health action by delineating the relationship between AOD and internalizing symptoms over time, and by examining the role of new technology and the changing landscape of adolescent interaction.