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，青少年的精神病理学，特别是内化症状，是在 美国历史上前所未有的高。这些包括认知（低自尊，自我， 贬低），情感（抑郁情绪），和社会（孤独）的青少年内化维度 症状，自2009年以来迅速增加。与这些趋势相一致的是， 在青少年酒精和其他药物（AOD）使用（大麻除外）， 历史上AOD的使用和内在症状之间的密切关系。下降也很明显， 高强度酒精使用（例如每次饮酒10杯以上），高频率使用AOD（尽管不 大麻），以及同时使用AOD（包括大麻）。之间的关系的强度 青少年的内化症状和AOD使用也在减少;首次接近零 这对风险因素评估、预防和干预具有严重影响。分歧 但是，在不同的人口统计分组中可能有所不同。很少有研究能估计出为什么这些不同的趋势 发生;最突出的假设是智能手机和社交媒体。这些技术 据推测，这可能会减少青少年之间的面对面时间，增加父母的实时监控， 以及嫉妒和自卑等负面情绪。这种转变可能是减少AOD使用的基础（ 与其他青少年的无监督时间，更多的父母监控）和内化症状的增加 （负面情绪和自我价值）。然而，现有的文献不是基于全国代表性的数据， 与AOD使用的关系尚未研究。本研究将利用监测 未来（MTF）每年对约45，000名青少年进行横断面调查。MTF包括宽度测量 与内化症状、物质使用、青少年互动以及各种潜在的 混杂因素。我们将解决三个目标：（1）检查时间趋势的关系，内化 症状（低自尊，自我贬低，抑郁情绪，孤独）与任何，高强度，高 频率AOD使用，测试跨时间和种族，性别和SES的关系的大小;（2） 检查内化症状与同时使用AOD之间关系的时间趋势（例如， 酒精和大麻的使用，酒精和阿片类药物的使用，其他），测试的关系的大小， （3）测试社交媒体使用，父母监督和无人监督的程度 与朋友在一起的时间与内化症状、使用AOD、同时使用AOD以及是否 这些关联的程度说明了趋势随时间的变化。实现这些目标的方法将 包括时变效应建模以及并行过程增长模型。本研究将提供 通过描述AOD和内化症状之间的关系，为公共卫生行动提供证据， 时间，并通过研究新技术的作用和不断变化的青少年互动景观。

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.