I need you to write a 6 page paper ( the first page need to be 200 word abstract and then there needs to be a 5 page literature review, which you have to compare and contrast all the dataand sources

I need you to write a 6 page paper ( the first page need to be 200 word abstract and then there needs to be a 5 page literature review, which you have to compare and contrast all the dataand sources
Name: Article Dissection Author: Ellen Meara and Shelly Greenfield Title: The Relationship between Substance Use Patterns and Economic and Health Outcomes among Low-income Caregivers and Children Journal Citation: Meara, E., & Greenfield, S. (2008). The relationship between substance use patterns and economic and health outcomes among low-income caregivers and children. Psychiatric Services, 59(9), 974-981. Quantitative or Qualitative The research is quantitative . Research Question The research question explores how trends of substance use associate with well-being, public program use, and work status. Hypothesis: The study presents that child actions problems, mental health symptoms, income assistance, and work for those who used substances did not indicate any difference from those that did not use substances. This conclusion forms a basis for further investigation. Measurement of Variables: Independent Variable(s) Several independent variables were used in this research, including race, gender, and age. Dependent Variable(s) Dependent variables in the research include level of substance use, mental health symptoms, level of use, income assistance receipt, and child behavior challenges Sampling: The researchers explored substance use patterns among female caregivers who took care of children between ages 0 and 14. The female caregivers were mainly from low-income areas from San Antonio, Chicago, and Boston. Data Collection: The information used in the research was collected via the assessment of well-being measures, public program use, and work as a substance use function of 1623 caregivers. Secondly, interviews were also used to collect relevant information. Data Analysis: The authors used longitudinal data and analyzed it based on the variable used in research, including mental well-being measures and health insurance status. Author’s Conclusions: The researchers conclude that caregivers associated with the use of substances presented poor outcomes on work and well-being relative to other caregivers. Additionally, the authors concluded that policies that enhance instead of impeding mitigations in the use of substances are likely to improve well-being and self-sufficiency. Name: Article Dissection Author: Cory Morton, Heidi Hoefinger, Rebecca Walton, Ross Aikins, and Gregory Falkin Title: What are Youth Asking about Drugs? A Report of NIDA Drug Facts Chat Day Journal Citation: Brucker, D. L. (2007). Substance abuse treatment participation and employment outcomes for public disability beneficiaries with substance use disorders. The journal of behavioral health services & research, 34(3), 290-308. Quantitative or Qualitative The article is quantitave research. Research Question What questions do the youth ask online regarding drugs? Hypothesis: The authors start an investigation concerning the kind of issues and form of information that the youth wish to understand about drugs Measurement of Variables: Independent Variable(s) This research’s independent variables include the queried drugs, including pharmaceutical drugs, tobacco, marijuana, cocaine, and the youth. Dependent Variable(s) This research’s dependent variables include drug use effects, being high experience, drug addictiveness, drug sales, and pharmacology. Sampling: The sample used in this research came from hundreds of high and middle schools in the country during Chat Day sessions between 2007-2011 and 2013. Data Collection: The data was collected through transcripts given to students across the selected schools with 67,051 questions. Data Analysis: Data analysis was carried out through several techniques, including coding scheme development, textual analysis, and content analysis to gain information on Youth’s issues. Author’s Conclusions: The authors conclude that youth asked questions regarding drug effects, general information on drugs, drug addictiveness, being high experience, and drug pharmacology. Name: Article Dissection Author: Debra L. Brucker Title: Substance Abuse Treatment Participation and Employment Outcomes for Public Disability Beneficiaries with Substance Use Disorders Journal Citation: Brucker, D. L. (2007). Substance abuse treatment participation and employment outcomes for public disability beneficiaries with substance use disorders. The journal of behavioral health services & research, 34(3), 290-308. Quantitative or Qualitative The research utilizes a quantitative approach to explore interaction of various aspects. Research Question What are the employment and treatment participation results for public disability beneficiaries with substance use disorders? Hypothesis: The authors present a study investigating whether treatment participation and employment provide any results for public beneficiaries that use substances. Measurement of Variables: Independent Variable(s) The Independent variable in the study is the disability benefit receipt Dependent Variable(s) The dependent variable in the research was the treatment receipt Sampling: The sample used in the research included public disability beneficiaries among US adults. Data Collection: The researchers used a data subset from 2002 and 2003 combined data from the National Survey of Drug Use and Health (NSDUH). Data Analysis: The researchers used a logistic regression technique to analyze the treatment outcomes based on the independent variable and other relevant variables. Author’s Conclusions: The authors conclude that US adults who are disability beneficiaries and with substance use complications displayed higher chances of seeking treatment compared to those with substance use disorders that do not benefit from public disability programs. Name: Article Dissection Author: Melissa A. Kowalski Title: Mental Health Recovery: The Effectiveness of Peer Services in the Community Journal Citation: Kowalski, M. A. (2020). Mental health recovery: the effectiveness of peer services in the community. Community mental health journal, 56(3), 568-580. Quantitative or Qualitative The research is a quantitative study exploring peer services effectiveness. Research Question What are the effects of peer services in the community? Hypothesis: Based on minimal research on the effect of peer services, the author explores the impact associated with peer services regarding general wellness, life quality, and recovery capital. Measurement of Variables: Independent Variable(s) The independent variable in the research involves peer services in the community Dependent Variable(s) The dependent variable entails the outcomes of peer services Sampling: The researchers recruited peer mentors and included 108 people from the community who participated in peer recovery services. Data Collection: The study data was collected via three surveys that assessed wellness, life quality, and recovery capital. Additionally, semi-structured interviews were used when collecting more information on peer services. Data Analysis: The data collected was analyzed on three different approaches, including an interclass correlation and a linear regression analysis. Author’s Conclusions: The authors conclude that peer service providers regarded the services positively but required more training for better service provisions. Additionally, the authors concluded that peer services contributed significantly to community well-being. Name: Article Dissection Author: Beth S. Russel and Mellissa Gordon Title: Parenting and Adolescent Substance Use: Moderation Effects of Community Engagement Journal Citation: Russell, B. S., & Gordon, M. (2017). Parenting and adolescent substance use: Moderation effects of community engagement. International Journal of Mental Health and Addiction, 15(5), 1023-1036. Quantitative or Qualitative The research utilized a quantitative approach. Research Question What are the moderation consequences of substance abuse incommunity engagement? Hypothesis: The study investigates the moderation impacts of community engagement based on two factors, including adolescent substance use and parenting. Measurement of Variables: Independent Variable(s) The independent variables include parenting and adolescent substance abuse Dependent Variable(s) The dependent variable in the study includes the consequences of community engagement moderation. Sampling: The researchers utilized an adolescent sample from across the country involving those in grades 7 to 12. Data Collection: The data was collected through a cluster design. Moreover, the researchers also used contextual data from national databases. Interviews and an in-school survey were also used for the selected sample. Data Analysis: The collected data was analyzed through the statistical software STATA. Author’s Conclusions: The authors reached several conclusions based on the study. First, they concluded that community advantage was one of the core risk elements that influenced adolescents’ use of substances. Secondly, the authors also concluded that substance use among adults was on the rise depending on community engagement levels.
I need you to write a 6 page paper ( the first page need to be 200 word abstract and then there needs to be a 5 page literature review, which you have to compare and contrast all the dataand sources
The following is a list of rules for writing well. This is list is not exhaustive, nor mutually exclusive. It is intended to be a checklist for improving the student’s writing abilities and skills. There is no particular order to the following suggestions. Never use first or second person when writing a paper. The use of “I,” “me,” “we,” “you,” etc. is not acceptable in academic papers. You are expected to make your argument and state your position without directly relating it to yourself or your reader. Don’t attribute any feelings/thoughts to the authors you are citing. Statements such as “the author feels” or “Smith thinks” are inaccurate. If you are citing a work, you do not have any idea how the author thinks or feels, only what he/she wrote and got published. Statements such as these are presumptive and wrong. Abbreviations should be spelled out the first time you use them. When using abbreviations (which should be used sparingly), spell them out first. Example- The Bureau of Alcohol, Tobacco and Firearms (ATF) states…… After this sentence, you can use the abbreviation of ATF. Be careful though. Some abbreviations need explanation (e.g., NATO) which brings us to #4. If using a term, organization, or jargon that is commonplace in your field, footnote an explanation. Many people may not know what the DNC is. You may need to explain what the Democratic National Committee (DNC) is in a footnote. This can apply to various terms such as recidivism, NIMBY, etc. When in doubt, explain it. Remember that you are writing to an audience that has no idea what you are talking about. You also need to state why this term is important to your paper/topic. Write at the eighth grade level. One sign of a good author is the ability to make complex terms and concepts simple. Think of your audience as being in the eighth grade. Now, write your paper to them so that they can understand it. Lengthy, complicated words are often not used correctly. Don’t write a “they,” “this,” “she,” “he,” etc. in a sentence without specification. This is a big one! When reading a piece of written work, there are many concepts in a specific sentence. I, as your audience, can not ask you for clarification. Therefore, you need to be as clear as possible. Here is an example: The lawyer met with his client and the parole officer. He decided to change his mind. My question becomes who are you talking about? The lawyer met with his client and the parole officer. The client decided to change his mind. Another example: The United Nations has decided to initiate a policy of human rights to protect the rights of women. This will be beneficial to many people. My question is what is beneficial: the policy or the protection of rights. The United Nations has decided to initiate a policy of human rights to protect the rights of women. This policy will be beneficial to many people. When using string cites, pay attention to their order. String cites should be put in alphabetical order. If an author has more than one citation, then put cites in alphabetical, then chronological order. Example (Andrews and Bonta 1998, 2001; Bonta 1999; Gendreau 1996). The word “prove” – when you are discussing social science research, the word “prove” should not be used. You can’t prove a hypothesis. Therefore, opt for another less restrictive word – show, found, discuss, state, declare, announce, report, etc. Cite the author, not the work – the author has made the contribution of knowledge, not the book. Therefore, cite the author. Also, there is little need to put the author and book in the same sentence. Once you have the author’s name and year, your audience can go to your bibliography and find the source. Example- J. Petersilia in Probation and Parole in the 21st Century states that….. Would be better to say: Petersilia (2004) states…. Don’t start two sentences in the same paragraph with the same word. Redundancy can be confusing. Example – Abuse is a crime. Abuse can cause serious harm to the victim. This victimization can continue throughout the life of the individual. Abuse is a bad thing. Preferred would be: Abuse is a crime. These types of crimes can cause serious harm to the victim. This victimization can continue throughout the life of the individual. Domestic violence is a grave matter. Don’t put adjectives before works or authors. Statements such as “the most famous author” or “the most important work” or “the first piece of literature” open you up to being wrong. First, comments that suggest authors are famous or important may isolate a member of the audience who does not agree. Additionally, when you say “the first work” or “the most important work,” it may be incorrect. This writing technique is similar to using “always” or “never” (which you should not do either). Don’t use contractions in your writing. Spell them out – it’s should be it is; don’t should be do not. Spelling these out just makes your paper look more academic and proper. Academic citations – Non academic citations are everywhere. I do not accept them. Newsweek, USA Today, and most internet sites are examples of non academic citations. The rule of thumb is that academic cites come from journals without any pictures and articles should be no less than 15- 20 pages long. This is not a rule set in stone, but it may help the student decide what to use or exclude. Cite court cases. If you use court cases in your paper, you must cite them in text and in your bibliography. Furman v. Georgia is not correct. Furman v. Georgia, 408 U.S. 238 (1972) is correct. Watch the congruence of in-text and bibliographic citations. Citing Smith in your text and Smith and Wilson on your bibliography is unacceptable. These are not the same citation. Also, be careful of Smith and Wilson in text and then Wilson and Smith in your bibliography or another part of your text. These are not the same. Periods after citations. Periods (to end a sentence) should go after the citation. Additionally, punctuation should be included in a direct quote. Example – “A civil rights action for damages is not merely a private tort suit benefiting only the individual plaintiffs whose rights were violated” (Palmer, 1977: 206). Don’t put direct quotes after one another. Direct quotes should be used as support for your position, not paper content. Direct quotes should only be used when you can’t think of anyway to paraphrase the quote. Therefore, you should “introduce” each quote with at least one sentence (e.g., put the sentences between the quotes). It would be even better to put 2, 3 or even 4 or 5 sentences between each quote. Intentional “fluff” is unacceptable. When you are trying to “lengthen” a paper by adding words or irrelevant information, it makes for a very confusing argument. I would rather have a clear and concise argument that is shorter than a confusing, rambling, incoherent paper. 2
I need you to write a 6 page paper ( the first page need to be 200 word abstract and then there needs to be a 5 page literature review, which you have to compare and contrast all the dataand sources
Article What Are Youth Asking About Drugs? A Report of NIDA Drug Facts Chat Day Cory M. Morton 1, Heidi Hoefinger 2, Rebecca Linn-Walton 3, Ross Aikins 4, and Gregory P. Falkin 5 Abstract The current study analyzes a sample of questions about drugs asked online by youth who participated in the National Institute on Drug Abuse’s (NIDA)“Drug Facts Chat Day.”The types of drugs youth asked about were coded into 17 substance categories, and the topics they raised were coded into seven thematic categories. The top five queried drugs were marijuana (16.4%), alcohol (8.5%), tobacco (6%), cocaine (5.7), and pharmaceutical drugs (4.5%). The effects of drug use, experience of being high, the addictiveness of drugs, pharmacology, and drug sales were among the more common types of questions to emerge but varied depending on the substance. These findings show the types of information young people are seek- ing about drugs and have clear implications to inform youth drug education programs. Keywords adolescent attitudes, drug abuse, information dissemination Journal of Drug Education: Substance Abuse Research and Prevention 2015, Vol. 45(3-4) 195–210 !The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0047237915622084 dre.sagepub.com 1Department of Social Work, University of New Hampshire, Durham, NH, USA2School of Liberal Arts, Berkeley College, New York, NY, USA3The Center for Alternative Sentencing and Employment Services, New York, NY, USA4Higher Education Division, Graduate School of Education, University of Pennsylvania, Philadelphia, USA5Public Health Solutions, New York, NY, USA Corresponding Author: Cory M. Morton, Department of Social Work, University of New Hampshire, 55 College Road, 119B Pettee Hall, Durham, NH 03824, USA. Email: [email protected] Introduction Since 2007, the National Institute on Drug Abuse (NIDA) has sponsored Drug Facts Chat Day, an event that allows high school students to pose questions to experts in the field of substance abuse and addiction (National Institute on Drug Abuse, 2015b). In 2010, NIDA launched National Drug Facts Week (NDFW) as a way to counteract the myths surrounding substance abuse and addiction by facilitating community and school events across the United States to educate youth on the science of how drugs affect the brain, body, and behavior. “Chat Day” has been an integral part of National Drug Facts Week, providing an opportunity for youth to directly connect with drug abuse professionals in a full-day online event. During the 10-hr session, youth in participating schools pose questions anonymously through a web interface and have their questions answered by NIDA scientists. The present study is a content analysis of a large sample of their questions, which were codified and analyzed to shed light on thedrug-related thoughts, curiosities, and misperceptions of adolescents. Understanding what adolescents want to know about drugs may suggest new directions for youth health interventions, education, and programming. There is increasing recognition of the need for young people to be given the opportunity to share ideas, feelings, and questions about drug-related issues that affect them, and that they are social actors in their own right who possess unique competencies that are different, but no less valid than those of adults (Claveirole, 2004; Coyne, 1998; James & Prout, 1997; Morrow & Richards, 1996). Paying attention to the way young people voice their concerns and questions is an essential component of research ethics, and accounting for knowledge of their world and argot can significantly affect the efficacy of interventions (Claveirole, 2004; Coyne, 1998; Greig & Taylor, 1999). Research questions identified from these types of ground-up user-generated queries reflect contemporary issues of concern, which are useful to substance abuse researchers in particular because adolescent drug use trends are especially prone to change over time (Aikins, 2014; Botvin, 2000; Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2014). Specifically, noting the types of drugs and concerns that youth have about them is a practical step toward identifying what information could use- fully be disseminated to both teens and adults. This article analyzes the ques- tions teens had about drugs and alcohol and related issues. For these reasons, the following review of the literature relates mostly to how adolescents receive information about drugs, and what they do and do not know about drugs. NIDA has long established that the beliefs and attitudes held by adolescents about drugs are important when explaining trends in adolescent drug use (Johnston et al., 2014). Adolescents have curiosity about drugs and currently are especially curious about drug policy issues surrounding recreational and medicinal marijuana (D’Amico, Miles, & Tucker, 2015), as well as smokeless tobacco and e-cigarettes, among other recent trends (Ahern & Mechling, 2014; 196Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) Portnoy, Wu, Tworek, Chen, & Borek, 2014). Young people often turn to sources for information on substance use that may or may not be reliable or evidence-based. Common sources of information include parents (Stoelben, Krappweis, Rossler, & Kirch, 2000), television (Strasburger, 1990), the internet (Belenko et al., 2009; Gray, Klein, Noyce, Sesselberg, & Cantrill, 2005; Lenhart, Purcell, Smith, & Zickuhr, 2010), peers (Boyer, Shannon, & Hibberd, 2005), and in-school drug education and drug abuse prevention programs such as DARE—which were found to be less effective among youth due to the perceived condescension of its tone and presentation of irrelevant or dated information (Botvin, 2000). Misinformation is a problem. Studies have found that the information ado- lescents access about drug effects and abuse is often incorrect (Ames, Sussman, & Dent, 1999; Belenko et al., 2009), and misconceptions about drugs can lead to increased usage by adolescents (D’Amico et al., 2015). In particular, Ames et al. (1999) found that obtaining incorrect information about drug effects led ado- lescents to try drugs they otherwise might not have. In addition, the majority of teens gather information about drugs from search engines, such as Google, which then direct them to forums and websites that are not monitored for the accuracy of their information. The consensus from the above literature is that it is a persistent public-health need to know what adolescents do and do not know about drugs, which is one aim propelling this article. During Chat Day, youth build their knowledge about drugs by interacting directly with NIDA drug experts and researchers. This is in contrast to other approaches, such as the “NIDA for Teens” website (National Institute on Drug Abuse, 2015b), which provides youth-oriented information about drugs aimed toward general consumers, parents, teachers, and adolescents. Interacting dir- ectly with NIDA Chat Day experts is important because it captures large fre- quencies of unanticipated questions, and students receive answers tailored directly to their concerns. Our study focuses on the questions asked by students, using the Chat Day data to examine specific youth drug information needs. These data may help illuminate possible youth-drug education and program- ming needs. For example, while the NIDA for Teens section on “Real Questions from Real Teens” addresses a broad range of issues about addiction and pre- vention, it does not directly address concerns such as how to deal with family and friends who may either influence them to use drugs or who they want to help stop using, the experience of being high, how it might be safe(r) to experiment with drugs, or the benefits of using some drugs medically (e.g., to enhance sexual pleasure)—questions our forthcoming analyses suggest are common. Since Chat Day began in 2007, students from across the country have posed nearly 70,000 questions to NIDA. Yet to date, these data have not been systematically analyzed. The purpose of this study, therefore, is to provide a content analysis of the types of questions young people ask about drugs. More specifically, this article categorizes students’ questions in terms of the Morton et al.197 types of substances and topics queried (e.g., effects of drugs, prevention, recov- ery). The authors also assessed whether the topics of interest varied by type of drug and analyzed whether the type of drug asked about changed over time. This article describes the questions students asked drug experts by providing the percent of questions pertaining to various types of drugs and topics of interest. Methods Data for this analysis come from transcripts of 67,051 questions asked by stu- dents from hundreds of middle and high schools across the country in 6 years of Chat Day sessions from 2007 to 2011 and 2013 (NIDA did not conduct a Chat Day in 2012). A general inductive approach to the qualitative analysis was employed in the development of the coding scheme detailed later (Thomas, 2006). Textual analysis was used to determine the frequency of the specific drug types youth asked about, and a content analysis was performed on a random sample of questions to gain insight into the kinds of concerns youth had about drugs. Code Development First, a coding scheme was developed to be applied in the identification of drug types and the main concern posed in the questions. The scheme was developed, and questions were coded, by 16 graduate students and postdoctoral fellows as part of their training in the NIDA-funded Behavioral Science Training in Drug Abuse Research program (which is housed at National Development and Research Institutes, Inc.). Over a series of weekly meetings lasting approxi- mately 2 months, the group developed and refined the coding scheme on a set of 1,451 questions. For drug type, substances were essentially classified accord- ing to on NIDA’s list of drugs of abuse (NIDA, 2015a). This list was modified in a few ways. Hallucinogens and salvia were merged into one category: psyche- delics. We also added three categories to the list due to their occurrence in the questions during Chat Day: caffeine, any drug, and other drug. Questions that only mentioned drugs generically were placed in the “any drug” category. Questions about drugs that did not fit into any existing category (e.g., kitty litter) were classified as “other drugs.” The group then used this list to aid in the classification of slang and alternate terms for drugs of abuse (e.g., the mari- juana category contained mentions of “marijuana,” “pot,” “weed,” “Mary Jane,” and so forth, and the alcohol category included mentions of “beer,” “hooch,” and “booze”), and questions were analyzed until no new drug names appeared in the data. Table 1 lists the 17 drug categories identified in this process. 198Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) Second, the group developed a coding scheme for the content of questions where emergent themes were identified until saturation was achieved. The final set of codes reflected eight domains: reasons for using drugs, general drug infor- mation (e.g., pharmacology, the experience of being high, causes of addiction), effects of drug use, prevention, quitting, legal issues, environment or epidemi- ology of drug use, and “other” (i.e., questions that did not fit in the previous categories). The codes developed in the above were then applied to determine their relative frequency in the data during the content analysis described later. Textual Analysis Using the list of drug types discussed earlier, Wordstat 6 (WordStat (Version 6), 2005) was used to count the frequency of each mention of a particular drug type for the full set of 67,051 questions. The data were used to describe the overall frequency of mentions of drug types and if there were any trends over time. After obtaining the frequency of each drug category, percentages were calculated using the number of questions as the denominator. Since questions often contained mentions of several substances—and some questions were not about any drugs Table 1.Substances Mentioned in Chat Day Questions. All questions (N¼67,051) Drug type PercentN Any drug 44.3 28,928 Marijuana 16.4 10,697 Alcohol 8.5 5,572 Tobacco 6.0 3,905 Cocaine 5.7 3,728 Pharmaceutical drugs 4.5 2,912 Methamphetamine 3.6 2,357 Psychedelics 2.4 1,556 Steroids 2.1 1,362 Heroin 1.4 906 Inhalants 1.3 837 MDMA or Ecstasy 1.2 813 PCP .7 425 Caffeine .6 398 Other drugs .6 419 Bath salts .4 287 Synthetic marijuana .2 126 Morton et al.199 at all (e.g., “What’s your name?,” “y is this takin so long?”)—the percentages obtained do not add up to 100. Content Analysis The coding scheme developed above was applied to a random sample of ques- tions from each year of Chat Day. Sample selection proceeded in two main steps. In the 2007 inaugural year of Chat Day, NIDA did not require schools to register before the event and participation was very high. Of the 67,051 unique questions asked from 2007 to 2013, 34,910 (52%) were asked in 2007 alone. A 25% random sample was selected from the 2007 questions to bring the number of questions asked the first year in line with the other years (which averaged about 6,428 questions). Then, an approximately 20% random sample of ques- tions was selected from each year for the content analysis. The final sample comprises 6,098 questions. Eight pairs of coders analyzed the sample questions according to two main criteria: drug type and theme or domain of the question. While drug type was identified via the textual analysis with Wordstat, it was coded in the sample questions to investigate whether differences existed in terms of question content by drug type as well as to compare against the results obtained in the textual analysis. Interrater reliability was calculated using Cohen’s kappa (i) and was deter- mined to be .90 (almost perfect agreement) for drug type and .76 (substantial agreement) for domain (Landis & Koch, 1977). Coding discrepancies were dis- cussed as a group and consensus among and between pairs of coders was ultim- ately reached for 5,577 (91.4%) of the questions. Results Substances Mentioned in Chat Day Questions Table 1 presents the overall frequencies of the substances mentioned in youths’ questions during the Chat Day sessions based on the textual analysis. The five most frequently mentioned substances in order were marijuana, alcohol, tobacco, cocaine, and pharmaceutical drugs. Although marijuana was men- tioned most frequently each year from 2007 to 2013, there were some fluctu- ations in mentions of the other drugs, as depicted in Figure 1. While tobacco was the second most frequently mentioned substance in 2007 and 2008, alcohol was for the remaining years. Cocaine and prescription or over the counter drugs were relatively close most years with the exception of 2010 when there was a spike in the mentions of pharmaceutical drugs. The percentage change from the lowest to highest point from 2007 and 2013 was calculated for each drug mentioned in the questions. Alcohol experienced 200Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) the greatest increase (67%), followed by marijuana (65%), pharmaceutical drugs (23%), and tobacco (16%). Questions about cocaine declined by 9%. Although not depicted in Figure 1, interest in bath salts (i.e., synthetic cathi- nones), which was low for most years (<0.1% of total queries from 2007 to 2011), increased in 2013 to 2.7% of questions. Topics Youth Asked About in Chat Day Questions Table 2 shows the percentage of questions that fell into each of the main domains for all years combined as well as each domain’s definition and examples of questions submitted. In the presentation of results, quotes from the Chat Day transcripts are presented verbatim. Questions most frequently concerned the short- and long-term effects of drug use (33.5%). Examples include “Does ecstasy really put a pencil sized whole in your brain every time you do it?” “How long does it take you to have lung cancer if you do smoke?” These were followed by questions about general drug information (30.2%), which was something of a catchall category that include topics like the addictiveness of drugs, the experience of being high, the pharmacology of drugs, where to buy drugs. Questions included the following: “Is heroin the most dangerous drug out their?,” “What are typical hallucinations when you take meth?” Youth asked the Figure 1.Top 5 drugs mentioned in Chat Day questions by year. Morton et al.201 Table 2.Topics Youth Asked About During Chat Day. 1 Topic Domain (definition) % Examples of Domain Questions Effects (short- and long-term effects of drug use, how drugs affect the brain, body, and physical health, how drugs affect mental health, the behavioral and social effects of drugs, drugs use and pregnancy, drug use and sex, drug use and academic or sports performance)33.5 What are the long-term effects of marijuana use? Do shrooms make your brain bleed and lose memory? How fast would it take to get gums dis- ease if you chewed tobacco? Is it true that ecstasy pills can kill a pregnant woman’s child? Does taking drugs make sex more enjoyable? Does marijuana affect your ability to drive a car? General Drug Information (concerns about drug use, the experience of being high, what causes addiction, how drugs are administered, pharmacology, drug sales and acquisition)30.2 How do you know if somebody is high? What is worse shooting up or snort- ing? Since people smoke bath salts, can they smoke chlorine from pools too? What is the difference between cocaine and crack? Environment (epidemiological data on drug use and drug-related harms, his- torical background of drugs)8.1 How many people die by drunk driving aday? What is the most popular drug? Reasons for using (motivations for initi- ating drug use, biological causes of drug use, curiosity about experiment- ing with drugs)5.5 What makes people turn to drug? Is it more likely for kids with alcoholic parents to become alcoholics when they get older? Legal issues (criminal justice issues related to drug use or possession, legality of drugs, medical marijuana)5.6 What is the jail sentence if you are caught with possession? Why are some drugs illegal while others are not? Is there a difference between medical marijuana and illegal marijuana? Quitting (how to quit personal drug use, how to help friend or relative quit drug use, recovery process, treatment options for drug abuse)3.9 I love pot, what can I do to stop? My friend is addicted to meth how can I help him get off? What are the side effects after an addict quits heroin? What kind of medications are out there that can help you stop abusing drugs? Are there any types of drugs that are impossible to quit? Prevention (how to avoid drug use, information on formal school- or com- munity-based prevention programs)0.7 I[t] seems like everyone around me does some type of drugs. How do I get away from it? Do you think if you stop telling people about drugs they won’t use them? 202Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) least number of questions about how to avoid drug use (less than 1% of ques- tions were about prevention). Cross-tabulating each type of drug by the various domains produced fairly similar results. For the five most frequently asked about drugs as well as the any drug category, students inquired mainly about drug effects (ranging from 30.9% to 43.5% of questions for the various drug types) and general drug information (ranging from 23.5% to 31.8%). The differences between these two domains for most of these questions were small (ranging from 0.8% to 4.2%), except for the alcohol and tobacco questions where 41.7% and 43.5% of students asked about effects, respectively, but only 30.9% and 23.5% asked for general drug informa- tion. For cocaine and pharmaceuticals, the percentage of questions about effects and general drug information combined (about 83% for each drug) was consid- erably higher than for the other drug categories (which ranged from 59.3% to 72.6%) where students’ questions were spread out proportionately more over the other domains. For example, when it came to marijuana, more students were concerned (17.3%) about legal issues (e.g., “What made marijuana become an illegal drug in so many states?”) than was the case for other drugs. Discussion The quantitative analysis of Chat Day questions produced several key findings about the questions teenagers have about drugs. While the top five drugs asked about were marijuana (16.4%), alcohol (8.5%), tobacco (6%), cocaine (5.7), and pharmaceutical drugs (4.5%), students mainly asked about drugs in general (44.3%). Although about twice as many students asked questions about mari- juana than alcohol, alcohol ranked higher in terms of lifetime and annual use among 8th, 10th, and 12th grade students during each year Chat Day was con- ducted (Johnston et al., 2014). Some questions reflected the emergence of new drugs or changing trends in drug use, such as those about salvia, synthetic marijuana, bath salts, and caffeinated beverages. While teenagers were con- cerned mainly about the effects of drugs (33.5%) and general drug information (30.5%), few were concerned about prevention or avoiding drug use. In the realm of “drug effects,” students tended to ask many questions about the effects of drugs on the body and physical health (e.g., “what happens when u take drugs?” or “where do drugs affect the most in the human body?”). Furthermore, students wanted to know about both positive effects and negative drug effects (e.g., “how do drugs help you relax?” and “does marijuana cure arthritis”). Moreover, many effects questions were worded neutrally (e.g., How does smoking pot effect sex?). This presented a methodological coding challenge for the research team whereby questions about “drug effects” were originally categorized into negative effects versus neutral or positive effects. After begin- ning the analysis, however, the “neutral” designation proved problematic across coding pairs for some of the broader or more ambiguous questions. Morton et al.203 For example, the question “what are the long-term effects of drug use?” is osten- sibly neutral, whereas concerns over long-term drug effects were generally con- sidered more negative than positive. Such ambiguity led to concerns about the internal validity of the two different effects codes, which were thus combined into one category to eliminate the possibility of misclassification. Although the combined category makes sense intuitively (all of the questions are still about effects), the research team lamented the loss of this useful granularity concerning questions about positive effects and felt it important to note that the effects category includes positive and unspecified effects as well as negative ones. Another common theme that cut across multiple domains was the concern students had about drug use among their family and friends. Common issues included having a friend who used alcohol or drugs and concerns over how to approach him or her, whereas other concerns involved how to prevent drug use initiation among peers. For example, one student asked: “What would you say to someone you know that is addicted to drugs without hurting the relationship you have with them?” Another asked: “What do you suggest as the best pre- vention strategy for kids born into families who abuse substances?” which per- tained to prevention. And lastly: “How can I get my father to stop smoking, chewing, drinking?” pertained to quitting. These questions were assigned to three domains, respectively: drug use, prevention, and quitting. The nature of these questions, however, points to an intervention need that goes beyond tech- nical coding issues or the ability of a remote NDIA expert to provide informa- tion, and the concern expressed by many students for the well-being of others was especially heartening. Another important issue involved problem severity. From a quantitative per- spective, drug prevention appears to be a relatively infrequent concern; however, those questions may reflect serious problems qualitatively. For example, one student asked, “I love pot, what can I do?” and another asked, “I think I might be addicted to heroin. How can I no longer be addicted?” While the relative infrequency of questions about avoiding or quitting drugs may not be surprising given the relatively low prevalence of students who abuse certain drugs (Johnston et al., 2014)—it may represent a very serious problem for those who are actually using drugs or feel pressure to start using them. In most of the questions about drug effects, it could not be determined whether the students were using drugs or not (e.g., “Why do drugs give you face acne?”), and some of these questions reflected an interest in other bodily issues (e.g., “i heard if u smoke rock your penis increases in size??????”). Thus, the results across drug categories accurately quantify levels of drug interest and drug curi- osity among youth but do not act as an accurate proxy of use. Students seemed to ask questions for a variety of reasons. While some ques- tions seemed to be motivated by a real, immediate concern (e.g., worrying that they may be hooked on drugs, or wanting to help a family member quit smok- ing) more often than not students seemed to be asking questions out of a general 204Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) interest in drugs. Many questions seemed to indicate a future interest to experi- ment with drugs. For example, a fairly common concern was about the addic- tiveness of drugs, as reflected in questions like “If you start off on weed is there a 100% chance you will do other drugs or is it possible to just stay on weed?” Sometimes students seemed to be questioning the veracity of urban legends or rumors, as with questions like “Why do they (the man) put rocketfule in ciggerates?” and “Does ecstasy really put a pencil sized whole in your brain every time you do it?” It is likely that many students asked questions because they were required to for classroom purposes. Perhaps in defiance, or because they felt it would be fun in an anonymous, unrestricted chat forum, some stu- dents asked questions that were coded as “frivolous” (5.3%), such as “can you inhale a turtle?” or “what are the long term effects of YOUR MOM?” Other questions reflected legitimate concerns about Chat Day, such as having to wait for a response (e.g., “when are you going to start answering [our school’s] ques- tions?”), or curiosity about the expert on the other end (e.g., “have you ever smoked weed? did you like it?”). Some questions appear to be a response to media reports about drugs. For, example, one interpretation for the precipitous rise in questions about marijuana in 2009 may be that NIDA Drug Facts Week—conducted in January each year—followed an election year in which three states (California, Michigan, and Massachusetts) had marijuana ballot initiatives (Marijuana Policy Project, 2014). The political context of changing marijuana legislation seemed evident in questions such as “What made marijuana become an illegal drug in so many states?” Such findings support previous research related to youth curiosity sur- rounding marijuana policy and marijuana use initiation (D’Amico et al., 2015). Similarly reflecting contemporary drug issues, bath salts were a relatively new drug category in 2013, and their emergence, along with prominent news reports of alleged bath salt-related attacks in 2012, may account for the sudden appear- ance of questions about bath salts (“Face-eating cannibal attack may be latest in string of ‘bath salts’ incidents,” 2012; National Institute on Drug Abuse, 2012). In 2013, for example, one student asked, “do bath salts make you eat people?” There are three main limitations to this study. First, although the percentages for the various drug types were based on all Chat Day questions and the various domains were estimated from a random sample of questions, the results cannot be generalized to the total population of U.S. middle and high school students. In 2007, schools participated based purely on self-selection; because of the over- whelming number of questions, NIDA limited the number of schools that could participate in subsequent years. The basis upon which schools volunteered or NIDA approved them to participate is not known, but their selection was non-random (and was in some cases based on personal communication or rec- ommendation from a NIDA program officer). Furthermore, in some schools, students were required to participate in Chat Day—sometimes their grades depended on it—and in others, participation was voluntary. It is not known Morton et al.205 whether or how this type of coercion may have biased the kinds of questions students asked. Thus, it cannot be known how accurately the content analysis results reflect the concerns of students nationwide. Second, these results are highly sensitive to the coding scheme and the coders’ interpretation of questions. In developing a classification scheme such as the one used in this study, the researchers carefully considered an important tradeoff. On the one hand, having a larger number of categories makes data interpretation more meaningful. For example, while it is useful to know that 30.2% of students asked for information about drugs (which we classified as “general drug infor- mation”), subcategories could have provided added research utility, such as the experience of being high versus the causes of addiction or the pharmacology of drugs. The research team involved in this study chose to omit such subcategories in order to preserve interrater reliability and make the many complex or ambigu- ous questions possible to code. This choice operated at the expense of capturing this added level of data granularity but was necessary given certain challenges with interpreting the data. For example, students often wrote in a vernacular that could be difficult to interpret, spelling was often in shorthand or contained multiple errors, and some questions were vague or unclear. A final limitation concerns the sample size of questions; about 9% of the total questions were used in the content analysis. It is important to note that over half of the 67,051 questions came from 2007 alone, and while the overall sample was 9%, every other year under review had a roughly 20% random sample taken. The authors are confident that saturation was reached in terms of the codes developed for drug type and question theme. However, future studies could employ different methods to analyze a larger sample of questions, creating more generalizable results. In the future, analyses of Chat Day questions could be improved to provide students with more useful information about drugs. Other potential improve- ments to the NIDA Chat Day forum itself would be to reduce selection biases and use data more effectively. For example, NIDA could select schools ran- domly from across the country or require students to provide demographic data prior to asking questions. Gender and grade-level are commonly reported on in studies of adolescent drug use (e.g., Johnston et al., 2014), and if captured, could be analyzed across drug type or question theme domains in order to identify the kinds of information sought by specific subpopulations of students. Other measures at the analytical stage could improve upon coding schemes, such as separating negative from positive and neutral drug effects. It is not known whether the information that students received during Chat Day was useful or educational. Many questions, such as those about deleterious drug effects, may indicate a desire for information in order to weigh the pros and cons of using drugs themselves. It might be worthwhile, particularly given NIDA’s mandate to prevent drug use, to perform an analysis of responses from NIDA experts, or subsequently assess the utility and perceived helpfulness 206Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) of responses. Results from this study show the types and frequencies of drug information sought using Chat Day question-data, but evaluative Chat Day response-data from teens themselves could be used to improve the quality of information used for educational programs aimed at adolescents. The ultimate public-health aims of such efforts would be to help more effectively curb harms associated with problem drug use. In addition to providing a contemporary picture of adolescent drug use concerns both by substance type and drug use theme or concern, this study shows the potential for NIDA Chat Day data to be used as a research tool in the promotion of public health. Acknowledgments The authors would like to thank the pre- and postdoctoral fellows in the Behavioral Sciences Training in Drug Abuse Research Program at Public Health Solutions who participated in the development and coding of the Chat Day data. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, author- ship, and/or publication of this article: Authors were supported as pre- and postdoctoral fellows and as principal investigator (Falkin) in the Behavioral Sciences Training Program in Drug Abuse Research sponsored by Public Health Solutions and Public Health Solutions with funding from the National Institute on Drug Abuse [grant number T32 DA007233]. Points of view, opinions, and conclusions in this article do not necessarily represent the official position of the U.S. Government or Public Health Solutions. Note 1. All quotes are verbatim from transcripts. References Face-eating cannibal attack may be latest in string of ‘bath salts’ incidents. (2012, June). ABC News. Retrieved from http://abcnews.go.com/Blotter/face-eating-cannibal- attack-latest-bath-salts-incident/story?id¼16470389 Ahern, N. R., & Mechling, B. (2014). 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Youth curiosity about cigarettes, smokeless tobacco, and cigars: Prevalence and associations with advertising.American Journal of Preventative Medicine,47(2), S76–S86. Stoelben, S., Krappweis, J., Rossler, G., & Kirch, W. (2000). Adolescents’ drug use and drug knowledge.European Journal of Pediatrics,159(8), 608–614. Strasburger, V. C. (1990). Television and adolescents: Sex, drugs, rock ‘n’ roll. In V. C. Strasburger & D. E. Greydanus (Eds.),Adolescent medicine: The at-risk adolescent (pp. 161–194). Philadelphia, PA: Hanley and Belfus. Thomas, D. R. (2006). A general inductive approach for analyzing qualitative evaluation data.American Journal of Evaluation,27, 237–246. WordStat (Version 6) [computer software]. (2005). Montreal, Quebec: Provalis Research. Author Biographies Cory M. Morton, MSW, PhD, is an Assistant Professor in the Department of Social Work at the University of New Hampshire. His research interests include population-based analyses of substance abuse and child maltreatment, focused on identifying aspects of the built environment that may be leveraged for pre- vention efforts. Heidi Hoefinger, PhD, is a Professor of Science at Berkeley College in New York City. She received her training in Social Sciences at Goldsmiths, University of London, followed by a postdoctoral fellowship in the Behavioral Science Training in Drug Abuse Research at the National Development and Research Institutes in New York. She conducts ethnographic research on sexually and socially marginalized populations of drug users, sex workers and LGBT communities. Rebecca Linn-Walton, PhD, LCSW, is the Director of Planning, Research, and Evaluation at the Center for Alternative Sentencing and Employment Services in New York City. She is also on the adjunct faculty at the Fordham Graduate School of Social Service. Her research focuses on engagement and the therapeu- tic relationship with populations typically stigmatized and labeled difficult, such as justice-involved youth, and adults with severe mental illness who are also justice involved. She uses her background as a clinical social worker to inform her research questions and design. Ross D. Aikins, PhD, is a Lecturer and Program Manager of the Higher Education Division in the University of Pennsylvania Graduate School of Education. He previously served as an NIH Postdoctoral Fellow at the National Development and Research Institutes, Inc., specializing in collegiate Morton et al.209 nonmedical prescription stimulant use and student veteran health. His ongoing research interests include mental health in postsecondary student populations, “enhancement” drug use, athletic doping, and sexual assault in higher education among other college student health issues. Gregory P. Falkin, Ph.D., directs the Behavioral Sciences Training in Drug Abuse program, which is the National Institute on Drug Abuse’s largest and longest-standing institutional training program for behavioral scientists. The BST program is administered by Public Health Solutions and fellows attend weekly training sessions at National Development and Research Institutes, Inc., a leader in the field of drug abuse research. At NIDA’s request Dr. Falkin worked with all 16 research fellows to analyze the Chat Day questions as part of their training, which culminated in this publication. 210Journal of Drug Education: Substance Abuse Research and Prevention 45(3-4) Copyright ofJournal ofDrug Education isthe property ofSage Publications Inc.andits content maynotbecopied oremailed tomultiple sitesorposted toalistserv without the copyright holder'sexpresswrittenpermission. However,usersmayprint, download, oremail articles forindividual use. I need you to write a 6 page paper ( the first page need to be 200 word abstract and then there needs to be a 5 page literature review, which you have to compare and contrast all the dataand sources Community Mental Health Journal (2020) 56:568–580 https://doi.org/10.1007/s10597-019-00514-5 ORIGINAL PAPER Mental Health Recovery: The Eectiveness of Peer Services in the Community Melissa A. Kowalski 1 Received: 9 April 2018 / Accepted: 2 December 2019 / Published online: 5 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Peer recovery services are a community-based treatment option for people suering from mental illness and/or substance use problems. Peer services provide an alternative to inpatient care and can help decrease costs associated with hospitaliza- tion or incarceration of the mentally ill. Yet, scant research has explored the eect of these services, particularly in rural communities. The current study assesses the impact of peer services on peer mentees’ and mentors’ recovery capital, quality of life, and general wellness. Consumers of peer services completed three surveys every three months for approximately 18months. Quantitative analyses demonstrated that subjects had a marginal change in their recovery capital, but quality of life and general wellness were unaected. Peer providers’ experiences were also explored through interviews. Qualitative analyses revealed that providers have a positive outlook regarding peer services but would benet from greater resources and additional training. Policy and community implications are also discussed. Keywords Peer services· Recovery· Community treatment· Mental illness· Substance abuse Introduction Peer recovery services are one option in treating individuals with mental health issues. These services may serve as an alternative to inpatient institutional care and have implica- tions for health policies, as the number of inpatient programs and psychiatric beds in the United States has decreased (Chaimowitz 2011). Unfortunately, these decreases have occurred without a structured transition to community-based treatment. One solution to improve outcomes for people with mental health problems (MHPs), and to help reduce state costs, involves recovery centers and their associated peer support services. This option has been acknowledged at the national level. In 2003, the President’s New Freedom Commission on Mental Health recommended a transition to recovery ser - vices for people with MHPs (Sledge et al. 2011 ). Many peer programs have been created in recent decades (Gold- strom etal. 2006; Moran and Russo-Netzer 2016); however, research supporting the eectiveness of peer services has not kept up with the development of such services (David- son etal. 2006). Accordingly, more research on the e cacy of peer recovery services is required (Nestor and Galletly 2008). The purpose of the current study is to address the eectiveness of peer services in a recovery center in a rural area in a Western state, referred to as the “Center” from here on. Changes in recovery capital, quality of life, general well- ness, as well as the perceptions of peer mentors regarding the services they provide, are examined. The recovery process for mental health involves helping individuals feel like they belong in their communities and assisting them in establishing an identity distinct from their mental illness (Davidson etal. 2007). Recovery centers are premised o this model, and they present as a low-cost alter - native to conventional outpatient and inpatient mental health treatment as they are, in part, operated by consumers of men- tal health services (Brown and Townley 2015). As such, vol- unteers are, themselves, in later stages of their recovery and can assist others. Additionally, these programs are eective in promoting feelings of community and empowerment, and using peer providers helps better engage others seeking recovery (Brown and Townley 2015). Many recovery cent- ers oer peer support, which Yanos, Primavera, and Knight ( 2001) found helps protect against mental health relapse. * Melissa A. Kowalski [email protected] 1 Department ofCriminal Justice, The College At Brockport, State University ofNew York, 350 New Campus Drive, Brockport, NY14420, USA Vol:.(1234567890) 1 3 569 Community Mental Health Journal (2020) 56:568–580 The evidence on recovery centers is mostly positive (Ahmed etal. 2015; Brown etal. 2003; Davidson etal. 2006; Felton et al. 1995; Gidugu et al. 2015; Hutchinson et al. 2006; Kemp and Henderson 2012; Kennedy 1990; Lewis etal. 2012; McDiarmid etal. 2005; Mowbray etal. 1998; Nestor and Galletly 2008; Resnick and Rosenheck 2008; Rivera etal. 2007; Roberts etal. 1999; Sledge etal. 2011; Solomon 2004). These centers may become increasingly important as states continue to encounter healthcare reform and budget crises (Whitley etal. 2012). However, the path to reform is not unobstructed. Many centers lack standardized services, clear goals, and/or quality assurance. Moreover, recovery centers may result in harm to some individuals, who may be further isolated from the community and who may become service-dependent (Whitley etal. 2012). Thus, more research is needed to ascertain whether peer recovery services have more benets than they do costs. Recovery peer mentors are individuals recovering or who have recovered from a mental illness and who provide services to others currently suering from a mental illness (Moran and Russo-Netzer 2016). The use of peer mentors is supported by social learning theory, as mentors act as positive role models for mentees (Solomon 2004). Social comparison is also relevant, in the sense that mentees may interact better with peer mentors than they do with mental health professionals because of the shared experience men- tors and mentees have regarding mental illness. Peer mentors are not completely without professional skills. It is typical for peer mentors to undergo training about the recovery model (Ahmed etal. 2015). Yet, the best advan- tage peer mentors have is their own experiential knowledge of mental illness (Nestor and Galletly 2008). Moreover, mentees’ ability to self-identify with their mentors is criti- cal, as this identication cannot be created by other mental health providers (Sells et al. 2008). Additionally, Rivera etal. (2007) found that peer mentors are about as equally eective as professional mental health providers. Davidson etal. (2006) came to a similar conclusion after reviewing four studies that used randomized controlled trials. Across the studies, there were scarce dierences between care pro- vided by peers and non-peers. In short, peer services may oer a good complement to traditional professional services but may not be e cacious enough to completely replace professional services (Gidugu etal. 2015). As such, there is no clear evidence to suggest that peer mentors are more eective than professional mental health providers (Solomon 2004). Nonetheless, peer recovery ser - vices are attractive to many individuals with mental illness because they are dissatised with the conventional mental health system (Whitley etal. 2012). Positive outcomes asso- ciated with peer services for mentees include improved psy - chological and social adjustment (Rivera etal. 2007; Rob- erts etal. 1999), recovery (Felton etal. 1995), self-esteem (Kennedy 1990), condence, social interaction, lifestyle, motivation, and attitude (Kemp and Henderson 2012). Peer services are also associated with fewer psychiatric symptoms (Rivera etal. 2007) and a decreased likelihood of re-hospi- talization (Sledge etal. 2011). However, Brown etal. (2003) found that recovery services may detrimentally impact mentees because they may experience lowered self-esteem. Taken together, these results indicate that peer recovery ser - vices are mostly benecial for mentees, but certain concerns remain to be addressed. Peer mentors may also benet from peer services by way of improved self-esteem (Brown etal. 2003), personal rela- tionships (Mowbray etal. 1998), well-being (Resnick and Rosenheck 2008), job satisfaction (Hutchinson etal. 2006; Nestor and Galletly 2008), condence (McDiarmid etal. 2005), hope, empowerment, and social engagement (Ahmed etal. 2015). More tangible outcomes include lowered risk of hospitalization (Hutchinson etal. 2006; McDiarmid etal. 2005 ), maintenance of psychiatric health (Ahmed et al. 2015), and stable employment (Hutchinson et al. 2006). Yet, peer mentors may be detrimentally aected by their interactions with mentees. For example, Ahmed etal. (2015) discovered that peer mentors experienced emotional stress from aiding others, di culty maintaining personal wellness, and work stress. Peer services have also been devalued by professional mental health providers (Chinman etal. 2002). More explicitly, mental health professionals may not view experiential knowledge as particularly useful (Hodges and Hardiman 2006). Con icting research on the e cacy of peer recovery services indicates a need for more research. This need is particularly relevant considering the lack of evidence-based status for peer services (Davidson etal. 2006) despite grow - ing utilization of such services. This study contributes to the recovery research by assessing the eectiveness of services as well as interviewing peer mentors to understand their experiences and the process of providing services. Methodology This study assesses the eect of peer recovery services in the Center via a mixed-methods design, and the results may help better elucidate the impact of peer services on mentees, in addition to the process behind services, as described by mentors. Although extant research has considered the eec- tiveness of peer recovery services, the current study expands upon such research in several ways. First, the Center diers from others in its state, as it has taken steps to assess the eect of its services, and it is in the process of becoming more integrated in its community through a plethora of out- reach programs. Moreover, unlike many other recovery cent- ers, it is not a liated with any organization and is centrally 1 3 570 Community Mental Health Journal (2020) 56:568–580 located in a downtown business district. The Center has implemented three surveys to analyze peers’ recovery, qual- ity of life, and wellness. The surveys are administered every three months as well as when a person enters and leaves the program. Peer mentors’ perceptions of the services they pro- vide and whether they feel they are accepted in their roles as a pseudo mental health provider are also assessed. Mentors’ perceptions of their role in addition to the eectiveness of the Center build upon observed outcomes in the quantitative analyses to better gauge the overall eectiveness, perceived or documented, of the Center. Research questions include: 1. Do peer services improve recovery capital, quality of life, and/or general wellness? 2. What are recovery peer volunteers’ perceived goals of peer services? 3. What are sources of satisfaction and stress for recovery peer volunteers? 4. How do recovery peer volunteers perceive their work environment? 5. How do recovery peer volunteers perceive the eective- ness of peer services? Sampling Procedure and Measurement As of the Center’s most recent report at the time of the study, 108 people had undergone peer recovery services. Only subjects with responses to all items on a survey are included in this study. Three peer mentors were additionally recruited for interviews. Surveys are analyzed to look at peer mentors’ recovery capital, quality of life, and wellness. The Center routinely administers the Assessment of Recovery Capital (ARC), the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF), and a Wellness Self-Assessment. Scores on the three surveys are compared across time, as measured by the number of times the surveys have been administered. Cloud and Graneld (2008) dene recovery capital as the resources, internal and external, an individual utilizes to initiate and maintain recovery. The ARC quanties recovery capital, which can then be used to examine progression in recovery (Groshkova etal. 2013 ). The ARC has 50 items representing ten sub-scales that measure recovery strength. A higher score indicates greater recovery capital. Groshkova etal. (2013) conducted a conrmatory factor analysis on the ARC and found concurrent validity, acceptable test–retest reliability, and that the ARC discriminates amongst respond- ents who are in later stages of recovery compared to those in earlier stages. Quality of life is relevant to this study, as such factors may result in vulnerability to substance use (Foster etal. 2000) and recovery eort (Laudet 2011). The WHOQOL- BREF has 26 items that assist in creating a quality of life prole (World Health Organization [WHO] 1996). The scale has four domains, including physical, environment, social, and psychological. A higher score signies a better quality of life. Skevington etal. (2004) investigated the psychomet- ric properties of this scale and discovered it has good to excellent reliability. This scale is valid across cultures and has good internal consistency and discriminant validity. The third survey is a Wellness Self-Assessment, which examines general physical well-being and includes items measuring environment, employment, and stress. The assessment has 39 items, and the psychometric properties have not yet been investigated. However, it is anticipated that respondents’ general well-being may in uence their recovery process. Data for the present study was granted on the condition of anonymity; accordingly, it was not pos- sible to access o cial records regarding mental health or substance abuse/dependence histories. Neither identifying information nor contact details for survey respondents or interviewees was collected either. Although this lack of measurement limits the generalizability of the study, I felt it was important to ensure anonymity to avoid deterring indi- viduals from seeking out the Center’s services. Such caution is warranted in light of stigma and shame surrounding MHPs and service-seeking, an issue the interviewees commented on (see below). This study also includes semi-structured interviews with peer mentors to learn more about the processes and mecha- nisms underlying peer services, as there is a lack of research regarding how mentors use their experiences to help men- tees recover (Davidson etal. 2006). These interviews may also help reveal whether providing services are more ben- ecial than they are not for mentors. The research has been mixed on this issue (Ahmed etal. 2015; Brown etal. 2003; McDiarmid et al. 2005; Resnick and Rosenheck 2008). The interview guide was formed by deductively compiling themes found in the recovery literature. Open-ended ques- tions during the interviews also allowed for other themes to emerge. Interviewees were recruited via the Center’s Pro - gram Director, who asked all peer mentors if they would volunteer for an interview with the researcher. At the time of the study, there were six peer mentors. Three peer mentors volunteered, representing 50% of the mentor population for the Center. Analysis Plan Three repeated measures analyses were conducted to exam- ine how subjects’ responses to the ARC, the WHOQOL- BREF, and the Wellness Self-Assessment change over time, as substantial level two clustering (peer level) was evident following the calculation of an intraclass correlation. Linear regressions were also performed to assess how the overall scores from the surveys relate to each other. I hypothesized 1 3 571 Community Mental Health Journal (2020) 56:568–580 that peers would have improved recovery, quality of life, and wellness over time. For the qualitative analyses, I enlist a thematic analysis to examine transcribed interviews (see Braun and Clarke 2006) and look for themes discovered deductively through examin- ing the literature in addition to themes that emerge induc- tively from the data. I analyzed the interviews until I reached saturation, and no further themes emerged. The study was approved by the Washington State University’s Institutional Review Board. The author has no known con ict of interest in performing this study and certies responsibility for the study. Below, qualitative results are integrated with quantita- tive ndings to detail the perceived and observed eective- ness of the Center. Results Repeated measures analyses for the three surveys revealed marginally signicant results for the ARC but statistically nonsignicant results for the WHOQOL-BREF and Well- ness Assessment. For these latter two surveys, change in scores were in the anticipated direction. The repeated meas- ures model is shown only for the ARC. Furthermore, analy - sis of the interviews identied several themes, in line with previous research, including goals of peer support services, qualities of peer providers, peer services as an alternative to professional services (Solomon 2004), a lack of value and support for peer services, personal growth for peer providers (Brown etal. 2003), relapse in recovery, peer provider sat- isfaction (Hutchinson etal. 2006; Nestor and Galletly 2008) and stress (Ahmed etal. 2015), the need for these services, and eectiveness of peer services (Brown and Townley 2015 ). Themes not deduced from the literature emerged, including dening recovery, volunteer identication and duties, a lack of resources, and training and education as a pathway to employment. Interviewee demographics are not included, as such descriptions could result in interviewee identication. How - ever, all interviewees had either self-reported substance abuse and/or mental health diagnoses. As Fig. 1 shows, there were six overarching themes and 15 sub-themes. Several of these themes relate to the surveys and are discussed in the context of the relevant survey. However, rst context regard- ing the services provided by the peers and Center, as they were discussed in the interviews, is provided. Context of Services De ning Recovery Identifying recovery is an overarching theme that subsumes all other themes. Recovery is an ongoing process, and inter - viewees agreed that recovery is ambiguous. Interviewees dened recovery spontaneously, and they all emphasized how personalizing support was essential. One interviewee described recovery as a “personal journey” (Interviewee #1), while another stated, “If you believe you are in recovery, you’re in recovery” (Interviewee #2). The third interviewee discussed how recovery involves control over his/her men- tal health and substance abuse issues while engaging with the community. Consequently, there are several paths to recovery. De ning Peer Support Services Interviewees were asked about the goals of their work, as well as qualities peer mentors should have. Two other Fig. 1 Deduced and emerged themes in peer support services 1 3 572 Community Mental Health Journal (2020) 56:568–580 sub-themes emerged during this line of questioning: vol- unteer identication and volunteer duties. Taken together, these sub-themes provide a scene for what happens at the recovery center. Goals of Peer Support Services Overall, the recovery center has a mission statement that peer mentors are meant to adhere to. The mission statement was brought up by two of the interviewees generally, but neither of them mentioned specic wording. The statement is as follows: …The Center is a private, non-prot organization serv - ing people who are in recovery from alcohol and other drug use or mental health disorders. It is a partnership between people in recovery, family members, allies and local organizations who respect the dignity and equality of all people and who are dedicated to pro- moting healthy communities. Interviewees discussed dierent components of the mission statement, except for family and local organizational involve- ment in the recovery process. One interviewee mentioned the importance of the community and how peer mentors work with mentees so mentees can be reintegrated into the community (Interviewee #3). Again, the goals for working with mentees are not delineated clearly because recovery varies across people. Accordingly, the level of guidance peer mentors oer depends on the mentee’s needs. With this indi- vidualization in mind, it is di cult for the Center to develop set guidelines for how mentors should support all people seeking help. Qualities of Peer Providers I elicited responses regard- ing interviewees’ perceptions of what qualities mentors should have. The responses were diverse, from empathy and patience (Interviewee #1) to being a good listener (Inter - viewee #2). Yet, all interviewees agreed that having life experience is vital. In fact, having this experience is one requirement for becoming a volunteer (Interviewee #3). Interviewees also accentuated how this life experience dif- ferentiated peer mentors from mental health professionals. Volunteer Identity Another theme that emerged includes how mentors viewed themselves. One interviewee saw him- self/herself as a friend to mentees (Interviewee #2) while another made it clear that he/she was not a friend (Inter - viewee #1). This construction of self in working with men- tees related to how peer mentors do their work and how their identity connects to their perceptions of professionalism. Volunteer Duties The interviewees also discussed the duties they perform; they agreed that part of what they do is external guidance for mentees. Recovery as an individu- alized process was again emphasized, as well as mentees’ willingness to be proactive about their own recovery process (Interviewee #1). One interviewee discussed his/her work in more detail than the others: We don’t have a step-by-step rulebook or something that’s like, ‘Here, dothis’. But, it’s kind of where your mentee is and trying to nd something, you know, that matches … Ah, you know, we don’t diagnose… We don’t … We refer people if we think that’s where the person is, just like you need to know what your issue is. Okay, let’s refer you to someone that can diag- nose. Ah … We can try to help keep people motivated to work on their recovery. We can provide external accountability. We can, you know, provide some struc- ture. Ah … But, it’s vastly dependent on the person’s desire to, you know, work on their own recovery (Inter - viewee #1). This interviewee alluded to a couple of points regarding peer mentors’ duties. First, peer mentors need to match services to mentees’ needs. Second, a mentor’s role is dierent from that of a mental health professional. For instance, mentors do not diagnose mentees but will refer them to mental health professionals as needed. Third, mentors are an external sup- port and help make mentees accountable to themselves in achieving recovery. Two interviewees (#2 and #3) further discussed how mentors help bridge a gap between the com- munity and mentees by addressing stigmatization of mental illness and drug abuse, where mentors help mentees under - stand how to live their lives without being stigmatized (Interviewee #3). Overall, these ndings provide a setting in which services are provided and which may improve recovery, quality of life, and general wellness for mentors and mentees. Assessment of Recovery Capital Forty-two subjects completed the ARC at least once, 17 nished it twice, 11 a third time, and 2 a fourth time (see Table 1). The fourth wave was not included since few sub- jects completed it. The model had a marginally good t ( x 2 = 3.50, p = 0.06), and the average starting score was about 177 points out of 250. Subjects experienced a marginal Table 1 Repeated measures of survey administration eect on ARC scores (N = 70) † p < .1, *p < .05, **p < .01, ***p < .001 ARC total score Coe cientSEz 95% condence interval Constant 177.225.3633.07*** 166.72187.72 Survey administration 5.913.160.06 † − 0.28 12.11 1 3 573 Community Mental Health Journal (2020) 56:568–580 change in their scores, with an increase of about six points for each successive administration (p = 0.06). As displayed in Fig. 2, subjects’ xed eects ARC scores were around 172 points for the rst administration of the ARC. Over time, subjects’ ARC scores increased by the third administration of the ARC to an average score of about 187 points. The overall model was statistically signicant (p < 0.001), and the predictors explained 77% of the variance in subjects’ ARC scores (see Table 2). Subjects’ scores on the QOL sur - vey were statistically and positively related to their ARC scores. Accordingly, higher scores on the QOL are associ- ated with higher scores on the ARC (p < 0.001). Interview results also suggested that mentors and mentees experience recovery, as indicated in themes regarding outcomes of ser - vices and justication for services. Outcome for Peer Providers There were positive and negative eects associated with providing services. Interviewees discussed personal growth, relapse, stress, and satisfaction with the work they do. For stress and satisfaction, the relationship between peer mentors and mentees was a source of both frustration and enjoyment. The direction these interactions took often depended on the mentee, where mentee success in overcoming barriers resulted in satisfaction (Interviewee #1), while other mentees intentionally tried to provoke mentors (Interviewee #2). Nev - ertheless, the interviewees appeared to have more positive outcomes than they did negative ones. Personal Growth I sought information about peer mentors’ personal growth in providing services, as the literature sug- gested that this is one of the positive eects for peer mentors (Brown et al. 2003). The interviewees conrmed that they have grown and changed as a result of working with men- tees. All interviewees emphasized a sense of greater self- understanding and how it has been an important benet of providing services. Relapse Relapse was one concern emphasized in the lit- erature (Ahmed et al. 2015). Not all interviewees relapsed while providing services; however, the interviewees agreed that the Center was a good place to relapse if they did since they had a support system there. One interviewee who has relapsed also described how the supportive environment at the Center helped him/her to regain and maintain recovery (Interviewee #2). Peer Provider Stress Stress associated with providing sup- port is a concern reported by past researchers (Ahmed etal. 2015); therefore, I asked interviewees about what was stress- ful when providing services. Again, two of them (Interview - ees #1 and #2) discussed how the mentees may be a source of stress. However, not having enough training and a lack of resources was also a substantial concern. Peer Provider Satisfaction I inquired about sources of satis- faction for mentors as peer support can be personally reward- ing (Hutchinson etal. 2006; Nestor and Galletly 2008). The interviewees conrmed this nding and discussed how it can be satisfying to see mentees overcome specic obsta- cles (Interviewee #1) and/or to help people take control of their lives again (Interviewee #3). Another rewarding aspect involves interaction with others (Interviewee #2). Volunteer - ing, itself, was a source of satisfaction, as one interviewee described it: Give me a scale of 1 to 10, 100 … I love my job. I get to help people get through the same things I went through. I learn things every day. Every day is almost like a challenge. But I meet almost all of those chal- lenges, and in that process, I grow. I grow so much and help other people grow (Interviewee #3). As this interviewee demonstrated, peer mentors may gain a sense of satisfaction by helping others, which can also help them grow. 17 0 175 180 185 190 AR C Fixe d Ef fects Scores 0 .5 1 1. 5 2 Time Fig. 2 ARC scores across time Table 2 Regression of QOL and wellness assessment predicting ARC (N = 37) † p < .1, *p < .05, **p < .01, ***p < .001 F = 37.21***, R 2 = 0.77 Covariates b (SE)t Constant − 10.08 (19.7)– Survey administration 5.04 (4.60)1.10 QOL total score 1.78 (0.23)7.61*** Wellness assessment total score 0.21 (0.17)1.24 1 3 574 Community Mental Health Journal (2020) 56:568–580 Justi cation of Peer Support Services The main purpose of this study was to determine the eec- tiveness of peer services. As such, I sought interviewees’ perceptions regarding recovery services. The interviewees agreed that peer services are needed and eective. Yet, they believed implementation issues hindered provision of services. Lack of Resources All interviewees acknowledged a chal- lenge the Center faces: a lack of resources, which was viewed as interfering with provision of eective services. Insu cient resources included: too few peer mentors, too little shared experience with mentees, not enough training, too few male peer mentors (Interviewee #1), and insu - cient funding to support more peer services (Interviewees #1 and #3). One interviewee was concerned about this lack of resources because an insu cient number of peer mentors impeded successful collaborations with the community and other agencies (Interviewee #1). This interviewee empha- sized how mentors’ work predominately benets only indi- viduals, not the community generally, due to having too few mentors. Yet, the interviewees also discussed programs that the Center plans to implement that may be more benecial to the community. Need for Services Overall, interviewees believed peer sup- port services were necessary to help people who have been devalued or disregarded by the community. For example, So, having peer providers who have been there a little bit and can possibly say, ‘Hey, you know, you’re still valuable as our community member or as a person, and if I can, I’ll help you navigate some of this that now you’re a part of because you did something dumb or were diagnosed with an issue …’ So, I think they often come to us as a community member … And, I think we can help navigate (Interviewee #1). In other words, peer mentors humanize people who have fallen out of favor with society and gives them back the status of being worthwhile. Eectiveness of Peer Support Services The interviewees were in consensus about the eectiveness of peer services. In describing the e cacy of services, interviewees again emphasized how peer services are dierent from profes- sional services. One interviewee described more in-depth why peer support services are eective: For all of us … we’ve done it. And now we are helping somebody else do it … I’ve seen somebody go from coming in here like this to talk to me for the rst time to a year later and sometimes it’s longer than that, to seeing the person on the street, and they’ve got a smile on their face (Interviewee #2). Furthermore, the voluntary nature of peer services may con- tribute to their eectiveness because mentees are not forced to seek treatment (Interviewees #1 and #3). Consequently, peer services may be a viable alternative for people who cannot or will not turn elsewhere for help. These services are also eective for mentors because they experience per - sonal growth and satisfaction that outweighs the negative eects of their work. The results from the ARC and the interviews suggest that peers, overall, experience improve- ment in recovery. World Health Organization Quality of Life Assessment‑BREF Forty-seven subjects took the WHOQOL-BREF at least once, 19 completed it twice, 10 three times, 3 four times, 2 ve times, and 1 six times. Subjects who were administered the survey four, ve, or six times were collapsed into one wave. The average starting score was about 85 points for the rst administration of the survey. The covariates oered a good t (p < 0.001) and explained 78% of the variance in subjects’ QOL scores (see Table 3). Survey administrations were marginally signicant, where subjects tended to have lower QOL scores across time when controlling for Wellness Assessment and ARC total scores ( p = 0.07). Higher ARC scores were also related to higher QOL scores (p < 0.001). Although the repeated measures analysis was not statistically signicant, interviewees dis- cussed how quality of life has been improved by way of professionalism. Professionalism I sought themes involving professionalism, as the lit- erature demonstrated potential contention between peer support and professional services (Chinman etal. 2002; Solomon 2004). All interviewees commented on peer sup- port as a supplement to professional services. Training and Table 3 Regression of ARC and wellness assessment predicting QOL (N = 37) † p < .1, *p < .05, **p < .01, ***p < .001 F = 38.52***, R 2 = 0.78 Covariates b (SE)t Constant 14.26 (8.58)– Survey administration − 3.73 (1.99)− 1.87 † ARC total score 0.36 (0.05)7.61*** Wellness assessment total score 0.08 (0.08)1.09 1 3 575 Community Mental Health Journal (2020) 56:568–580 education, as well as volunteering as a path to an occupa- tion, were mentioned spontaneously. Peer Support Services as an Alternative to Professional Services The literature suggested that peer support ser - vices may be a feasible alternative to professional services (Solomon 2004). However, the interviewees viewed peer services as a complement to professional services, which is in line with Gidugu et al.’s (2015) ndings. Still, the interviewees perceived peer services as being benecial for some people seeking help because those people either had prior bad experiences with a professional provider or because they felt stigmatized by seeking professional ser - vices. I also inquired about how lived experiences com- pares to the work of mental health professionals, who are not required to have such experience. The interviewees thought lived experience was important, but they also acknowledged the limitations of having no formal edu - cation in mental health or substance abuse treatment. Accordingly, there are limits to both peer and professional mental health services. Training and Education Training and education emerged as a theme and was viewed by interviewees as an impor - tant part of providing services. All interviewees were condent in providing services, despite having no formal education in treatment provision. Lived experiences con- tinued to be a crucial part of providing services. When asked whether lived experience or training was more help- ful, one interviewee described how both were resources to draw on when the interviewee (#1) found himself/herself decient in one or the other. The balance between training and life experiences is similar to how peer mentors viewed peer services and professional services: the lived experi- ences of mentors can be an adjunct to training they have received; both were viewed as necessary to be an eective mentor. Volunteer work wasalso perceived as a path to employ - ment (Interviewee #1). The possibility of turning training into a career was expressed by one mentor: … I know for some people, too, the certications you can get for certied peer coach or certied peer spe- cialist … place them in a professional position. Take something with some negative in their life, the whole time, and spin it into a career prospect (Interviewee #1). In short, peer services can improve traditional mental health treatment peers already receive, or mentors can improve their own career prospects by volunteering. In both cases, peers were able to improve their care and quality of life by participating at the Center. Wellness Self‑Assessment Thirty subjects completed the assessment at least once, while 14 subjects nished the assessment twice, and ve subjects three times. The model was statistically signicant (p = 0.001), but none of the individual predictors were (see Table 4). Across time, subjects’ scores on the ARC and QOL were not related to their scores on the Wellness Assessment. Although the Wellness Assessment does not have items related to support specically, it does include questions about relationships with others and participation in groups. These items speak to interpersonal interactions; as such, I include interviewee responses about support here because greater support may improve wellness. Support for Services According to Chinman etal. (2002), mentors’ work is not valued due to the lack of their professional status, and men - tors may not feel supported in their work. I asked about interviewees’ perceptions regarding whether their work is valued and whether they feel supported. Value of Peer Providers’ Work All interviewees described how their work was valued, both by the mentees they worked with and the community at large. Despite the work being di cult at times, the appreciation shown by others outweighed peer mentors’ frustration and made their work worth it. Support Peer Providers Receive Not only was interviewees’ work valued, but they also felt supported when they needed it. This support was essential for one interviewee, who reported needing it when he/she was feeling down (Inter - viewee #2). The interviewees also reported that the com- munity was supportive of their work. Yet, despite this sup- port, one interviewee felt that the community was ignorant of peer support services: Table 4 Regression of QOL and ARC predicting wellness assessment (N = 37) † p < .1, *p < .05, **p < .01, ***p < .001 F = 7.0**, R 2 = 0.40 Covariates b (SE)t Constant 62.45 (17.45)– Survey administration 3.40 (4.75)0.72 QOL total score 0.41 (0.40)1.04 ARC total score 0.22 (0.17)1.29 1 3 576 Community Mental Health Journal (2020) 56:568–580 I think the community is supportive … I don’t think they really know much about us … The community supports those in disadvantaged positions ... We think something should be done about that, and if you’re doing something, that’s great, but I don’t know what you do ... I think many of them don’t understand how complicated the process of recovery can be for some people (Interviewee #1). It appears more education is needed for the community regarding the Center and the services it provides. Working with the community is part of the recovery center’s mission statement, but the Center may be limited in this endeavor due to a lack of resources (Interviewee #1). The amount of support provided by the community may change as it realizes the role the Center plays. One interviewee men- tioned how he/she has already seen support grow because of the community learning more about peer support services (Interviewee #2). Greater integration between the commu- nity and the Center may also serve to improve outcomes for peers. Discussion The purpose of this study was to examine the eectiveness of peer services in a recovery center, as past research on the e cacy of such services is ambiguous (Davidson etal. 2006). Overall, the results demonstrate that subjects experi - ence statistically signicant improvement in recovery over time. Although not statistically signicant, scores for the WHOQOL-BREF and the Wellness Self-Assessment also increased over time, indicating improved quality of life and general wellness. Furthermore, higher scores on the ARC were associated with higher scores on the WHOQOL- BREF. This nding supports past research on the concurrent validity of the ARC (Groshkova etal. 2013). Interestingly, when controlling for total scores on the ARC and Wellness Self-Assessment, subjects had a marginal decrease in their WHOQOL-BREF scores over time. Scores on the Wellness Self-Assessment were not statistically or signicantly asso- ciated with scores on either the ARC or WHOQOL-BREF. The ndings further suggest there are several themes related to peer support services in the Center. Several of the themes found in the literature, including lived experi- ence as acharacteristic of mentors (Moran and Russo-Netzer 2016); stress (Ahmed etal. 2015) and satisfaction experi- enced by peer mentors (Hutchinson etal. 2006; Nestor and Galletly 2008); personal growth (Brown etal. 2003); and the eectiveness of peer support services (Brown and Townley 2015), were conrmed. In contrast, other themes in the literature were not sup- ported by interviewees’ reports. These latter themes included peer services as a viable alternative to professional mental health services (Solomon 2004), unequal or unsupportive treatment (Chinman etal. 2002), and a lack of value in men- tors’ work. Interviewees felt supported and valued but also believed the community did not understand the Center’s ser - vices. Accordingly, community ignorance may need to be rectied for the Center to maximize its services and improve its eectiveness. Contrary to Yanos etal.’s (2001) ndings, providing peer services was not a protective factor for all mentors. One mentor (Interviewee #2) discussed how he/ she has relapsed several times since becoming a volunteer. Yet, like Yanos etal.’s (2001) ndings, this same interviewee found coping strategies to be an important part of regaining recovery. Past research has been contradictory regarding whether peer or professional services are more eective. Gidugu et al. (2015) suggested peer services are not a feasible replacement to professional services. In contrast, other researchers have found that peer services are either equally eective (Rivera etal. 2007; Davidson etal. 2006) or more eective (Solomon 2004). The interviewees agreed that peer services are best as a supplement to professional services but can be more benecial if people do not want to seek profes- sional services. Findings for peer mentors’ relapse while providing peer services were mixed. Moreover, the idea of “recovery” did not match past research. Interviewees could not pinpoint an exact denition because recovery varies for each person seeking it. Nebulous descriptions of recovery t the nature of the services (i.e. individualized) they provide. Again, as one interviewee (#2) described it, “if you believe you are in recovery, you’re in recovery”. Recovery is subjective and relies heavily on each person’s perception of his or her own change. Also, inter - viewees’ reported goals varied, again due to the ambiguous nature of the recovery process. This vagueness may be a contributing factor in why recovery centers often lack clear goals or standardized services (Whitely etal. 2012). How - ever, uniform practices and goals may be too restrictive for the recovery process. Additionally, in discussing the qualities of peer provid - ers, two more themes emerged in the form of identication and volunteer duties. One mentor (Interviewee #1) was clear in dierentiating himself/herself from mental health professionals and clarifying that he/she is not a friend to mentees but a motivator and source of accountability for mentees. This nding supports the literature since recipro- cal accountability is an aspect of peer-run organizations (Lewis etal. 2012). In terms of duties, mentors provide guidance to mentees (Interviewees #1 and #2), but this support is dierent from the help mental health profession- als provide because mentors rely much more on their lived experiences (Interviewee #1). This last point resonates with Solomon’s (2004) description of social comparison 1 3 577 Community Mental Health Journal (2020) 56:568–580 and how mentees may do better with peers than with pro- fessionals because of shared experience. Furthermore, peer mentors are typically trained in recovery and helping others (Ahmed et al. 2015). The sub-theme of training emerged but was a key factor in how mentors viewed themselves as competent. When asked whether training or life experience was more use- ful, one mentor (Interviewee #1) responded that both are necessary and can be used to complement one another if a mentor is decient in either. This result is akin to Nestor and Galletly’s (2008) claim that experiential knowl- edge is the key advantage peer mentors have over mental health professionals. Moreover, this training could result in employment for mentors. However, peer mentors may face a barrier in the way of unequal treatment in the work - place. Mental health professionals do not view experiential knowledge as valuable (Hodges and Hardiman 2006). Yet, the interviewees reported that they were treated equitably at the Center, suggesting that these mentors’ experiences are appreciated. A sub-theme emerging from the interviews is that men- tor–mentee interactions may result in stress or satisfac- tion for peer mentors. This theme is not in the recovery research; nonetheless, mentors appeared to value these interactions much more than they did not. Moreover, mentors may better understand recovery and themselves because of these interactions (Interviewee #1). The inter - viewees described a lack of resources, including concerns about continued funding for the Center, not having enough time, having too few male mentors, and not having enough training. Despite insu cient resources, the interviewees expressed a positive outlook about peer services. As discussed by mentors, peer services help people regain their connections to the community without the stigma of a diagnosis or professional help-seeking. These results are similar to Brown and Townley’s (2015) ndings that peer programs help promote a sense of community and that mentors are successful in engaging others who seek recovery. Overall, the eectiveness of peer services partly derives from how they are dierent from professional mental health services (Interviewees #1 and #3) because mentors have the lived experience and can relate to mentees (Solomon 2004; Nestor and Galletly 2008; Sells etal. 2008). Apart from benetting mentees, peer services may also be eec- tive for mentors because they learn more about recovery (Interviewee #1), may develop a new support system if they relapse (Interviewee #2), and/or may gain employment fol- lowing their volunteer work. Additionally, satisfaction men- tors gain from their work outweighs stress or other negative outcomes they experience. It remains to be seen how the community will benet from these services because the Center is still in its infancy. Future Research This study contributes to the recovery research by lling a gap about recovery services in a rural area. Yet, there is more work to be done to determine the overall eective - ness of these services and their impact on the community and other systems (e.g., the medical and criminal justice systems). Further research could examine why mentees choose peer support services either in addition to or in place of professional services. It would also be benecial to learn more about how the community perceives peer support services. Exploring these views could eventu- ally help bridge the gap between the Center and the com- munity. The same could be done with policymakers who decide whether the Center should receive funding. It is essential to know what these decision-makers expect so the Center can either inform them about the limitations of what they are expected to do or so the Center can work towards fullling these expectations. This research could also be repeated with more recovery centers to determine whether the same themes emerge. Additionally, a longer follow-up period could be assessed. As part of this follow- up, research could look at whether mentors become sta or nd work somewhere else in the helping eld to conrm whether volunteering is a pathway to employment and to examine whether mentors and/or mentees relapse. Limitations This study was exploratory in nature and is not intended to make any causal inferences regarding the e cacy of peer recovery services. I conducted the study under certain constraints, and limitations must be addressed by future research to further support evidence for the ndings dis- covered here. First, I was not able to interview every peer mentor in the Center, resulting in a convenience sample of peer mentor volunteers. Consequently, participants may not be representative of all peer mentors at the Center. However, random sampling was not feasible. Of more concern, respondents knew the nature of the study and that I was seeking to learn about the eectiveness of peer services, so their responses may have been biased in that they may have overemphasized the positive outcomes of peer services. However, I attempted to learn about both negatives and positives of services during the interviews, and the surveys were utilized to produce more information about the potential eectiveness of the Center. Although the survey data oered much information regarding peers’ outcomes, the in-depth interviews with mentors resulted in more meaningful data that helped to clarify how the 1 3 578 Community Mental Health Journal (2020) 56:568–580 Center could facilitate successful recovery in peers who utilized services. Furthermore, the sample sizes for the quantitative anal - yses were relatively small. Another concern is the attrition rate; mentees are not required to nish peer services. As of the Center’s latest reportwhen the study was conducted, 24 peers either left the program, entered an inpatient pro- gram, or were in jail. Additionally, characteristics of sub- jects and amount of service utilization were not measured, as that information was not released in order to protect peers’ condentiality and respect the anonymity of the Center’s environment. Moreover, service utilization is not measured by the Center, as peers are encouraged to visit the Center whenever they feel they need the support of other peers. Services utilized may also not be easily meas- urable, as “utilization” could involve a call with a mentor, meeting for coee, playing chess, doing yoga, or other activities not traditionally dened as treatment. Informa- tion regarding demographics and service utilization could help better explain what specic peer characteristics as well as what dosages of services most impact the outcomes examined above. However, the overarching intent of the current study was not to examine how individual charac- teristics or how amount of service contributed to changes in recovery capital, quality of life, and general well-being. Rather, trends in change for these outcomes were evalu- ated with the goal to assess whether the recovery center is having an impact on peers’ outcomes across time in a rural area. Additionally, the reliability, validity, and credibility of the results may present as a concern. I took several steps to address these issues. To establish reliability for the qualita- tive aspects of this study, I focused on consistency in the interviews by utilizing an interview guide to ensure all inter - viewees were asked the same questions regarding deduced themes. Brink (1991) has proposed consistency as a test of reliability for qualitative work. Although considered a weak form of validity (Long and Johnson 2000), the interview guide also demonstrates face validity, as it was developed following deduced themes from the literature regarding the eectiveness of peer recovery services. Moreover, each interview transcript was rated the same way to reduce measurement error, and I transcribed both notes taken during the interview and recorded the inter - views as an alternative option of data recording to improve reliability and validity for the single interviews conducted with mentees (Brink 1991). I also attempted to falsify the data by looking for discrepant evidence (Maxwell 1996 ) for deductively deduced themes. Throughout this rereading and revalidating process, it became clear that some of the themes I originally identied as separate issues overlapped with others. I was able to better construct themes following continued review of the literature to verify whether what peer mentors reported aligned with past research. Furthermore, I attempted to ensure credibility in the results via establishing trust with respondents andinter - viewing them in a setting familiar to them (e.g., the Center) as well as being sensitive to their life-styles and histo- ries. These decisions were intended not only to develop a rapport with respondents but also to better understand a fuller narrative regarding the Center (views of mentees), attempting to improve content validity (Halls and Stevens 1991). I further attempted to improve credibility pertain- ing to the Center’s eectiveness via triangulation (Halls and Stevens 1991), wherein I examined quantitative sur - veys regarding peer mentees’ outcomes and qualitative interviews involving peer mentors’ perceived eectiveness of the Center within a very specic context: a centrally located peer recovery center in a rural community. For instance, the surveys had close-ended questions, which may mask information about why someone responded the way he or she did. The surveys limit researcher bias, but the context for answers could be critical to understanding how peer recovery services benet or are detrimental to respondents. For this issue, the interviews helped to reveal these processes. Other attempts made to improve the rigor and valid- ity of the study included engaging in both personal and interpersonal re exivity (Hesse-Biber and Leavy 2006) throughout the data collection and analysis process to bet- ter understand any biases I may have had and any situ- ational dynamics between myself and interviewees that may have aected knowledge creation regarding the eec- tiveness of the Center. Additionally, the results were pre- sented to the Program Director of the Center as a member check (Lincoln and Guba 1985) to gain additional insight regarding the Center and the ndings. I also performed peer debrieng (Robson and McCartan 2016) by discuss- ing my analysis, themes, and conclusions throughout data analysis with a colleague familiar with the Center and its operations. This process, along with the re exivity I engaged in, resulted in dropping or merging themes found to be irrelevant. Another limitation of this study is that it is based solely on peers from one peer recovery center in a rural area. This is an understudied population requiring more research in order to better comprehendthe peer recovery process for individuals with MHPs or substance use issues in a rural community. The very nature of the Center—its location in a central area within a rural community—makes the present study unique but also limits any ability to generalize these ndings outside of the Center. Although ndings here can- not be generalized elsewhere, they may serve as a compari- son for other peer recovery centers that may be established in rural communities in the future. These areas certainly 1 3 579 Community Mental Health Journal (2020) 56:568–580 warrant further study and would benet from inclusion of more respondent information. Conclusion This study is one of the rst to examine the eect of peer support services in a rural area. There is preliminary evi- dence that subjects’ recovery improved over time. The ndings also re ect some of the di culties peer mentors face but also the benets they derive from their work. The ndings provide insight for policymakers, who may make funding decisions for recovery centers. It is imperative we heed the stories of these ndings and not rely solely on the numbers of those who have relapsed or fail to attain recov - ery because, as the ndings show, peer mentors provide a service that is utilized and contributes to the well-being of the community. References Ahmed, A. O., Hunter, K. M., Mabe, A. P., Tucker, S. J., & Buckley, P. F. (2015). 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Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional a liations. 1 3 I need you to write a 6 page paper ( the first page need to be 200 word abstract and then there needs to be a 5 page literature review, which you have to compare and contrast all the dataand sources Int J Ment Health Addiction (2017) 15:1023–1036 Parenting and Adolescent Substance Use: Moderation Effects of Community Engagement Beth S. Russell1 & Mellissa Gordon2 Published online: 10 January 2017 # Springer Science+Business Media New York 2017 Abstract Supportive parenting practices including autonomy granting and non-parental factors including adolescents’ connections to their communities are significantly associated with adolescent substance use outcomes; however, few longitudinal studies have considered both factors concurrently in nationally representative samples. Using longitudinal data from a nationally representative sample of adolescents in grades 7–12 (n = 12,139; 51% male), results indicated that community engagement significantly moderated the association between parental autonomy granting and substance use into emerging adulthood. Results also suggested that community disadvantage was a significant risk factor for adolescents’ substance use. These results further indicated that substance use among emerging adults was also high when accounting for prior levels of community engagement and parental-autonomy, and while controlling for substance use during adolescence. Keywords Adolescentsubstanceuse.Parenting.Autonomygranting.Communityengagement Parental involvement in adolescents’ daily lives is a consistent predictor of risk behavior; parental processes – including autonomy granting practices that encourage teens to develop a sense of competence in their decision making skills - are significantly associated with risk outcomes including substance use initiation and ongoing patterns of use (Abar et al. 2015; Chan and Chan 2013). Similarly, indicators of relationship dynamics that describe the bond or connection teens experience with their parents – like attachment security and perceived familial support – are protective factors against maladaptive outcomes across adolescence and through the transition to adulthood (Bell et al. 2000; Dixon et al. 2008). Recent research suggests that parenting practices that shape the socioemotional tenor of the home may act * Beth S. Russell [email protected] 1 Department of Human Development & Family Studies, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT 06269-1058, USA 2 Human Development & Family Studies Department, University of Delaware, 111 Alison Hall West, Newark, DE 19716, USA independently from the influence of broader family functioning predictors of adolescent outcomes. For example, in a study of over 300 families, Everri et al. (2015) found that indicators of parental involvement intensified the beneficial influence of adaptive family functioning while also exerting a protective influence against the negative impact of dysfunctional family dynamics. Additionally, non-parental factors including adolescents’ connections to their communities are an important consideration in the study of substance use (Brooks et al. 2012); however, few longitudinal studies have considered both factors concurrently. This scarcity in the literature, as well as a lack of nationally representative samples, presents an opportunity to strengthen developmentally appropriate studies of adolescent risk behavior. Parenting Practices During Adolescence Studies of parental influence on adolescent risk behavior suggest that there are specific features of parenting that are associated with substance use in adolescence. A careful examination of these features – or parenting practices – is warranted as results from the most recent National Survey on Drug Use and Health indicate over 2 million adolescents aged 12–17 were illicit drug users in 2013 (SAMHSA, Center for Behavioral Health Statistics and Quality 2014). Further, there are deeply concerning consequences from adolescent drug and alcohol use, such as impaired cognition associated with accidents, homicide, and suicide – the leading causes of morbidity and mortality for this age group (CDC 2015; Miniño 2010). The supportive tenor of the parent–child relationship serves as a crucial influence on parent–child communication about appropriate and risky behavior throughout adolescence. Parents’ involvement in adolescents’ social lives via monitoring, or parents’ active pursuit of knowledge about child behaviors to identify and intervene against perceived inappropriate or risky behaviors, decreases over time (Abar et al. 2015). In contrast, practices that encourage independent decision making – or autonomy granting practices – increase. Parents may scale-down their monitoring practices reactively as children become more competent problem-solvers or when teens respond to their bids for information as increasingly unwanted; conversely, parents may proactively encourage more autonomous development. Developmental theories describe this as the normative process of an adolescents’ individuation from their families (parents in particular), and note a shift to an increased reliance on peers, as teens strive to build a sense of self from broader connections to their communities (Cox et al. 1999; Steinberg 2001; Steinberg and Morris 2001). In doing so, adolescents encounter an increasingly nuanced social landscape that expands to include a greater number of sources of socialization over time. These sources provide information about culturally accepted behavior and attitudes that shape individuals’ choices as they seek a sense of belonging; including whether and to what extent youth engage in risk behavior (Oetting and Donnermeyer 1998). Reports of parents’ efforts to grant their adolescents greater autonomy and the resulting insights they may have about their child’s activities and relationships vary by source (Lippold et al. 2011; Reynolds et al. 2011). For instance, Abar and colleagues’ (2015) study of a large, longitudinal sample of 6th–8th graders indicated that while adolescents’ reports of parental monitoring were better predictors of substance use outcomes than parents’ reports, the largest discrepancies between the reports were often uniquely associated with a higher probability of alcohol use. This discordance reflects reporters’ subjective perceptions - of what and how the parent asks, and what the child is comfortable sharing - and may be influenced by reporter bias reflecting parents’ desires to appear attentive and adolescents’ desires tobeautonomous (Latendresseetal. 2009;Stattin andKerr2000). While literature on social influences on adolescent risk behavior might place parent/family influence in opposition to that of peers and the broader community (Werner-Wilson and Arbel 2000), there is evidence that these two domains are not orthogonal, but instead are related: An adolescents’ sense of connection to the broader community context outside the home is in part dependent on the extent to which their parents support their autonomy and exploration in society (Darling and Steinberg 1993). Supportive parenting that scaffolds adolescents’ independence during the transition to adulthood reflects a degree of sensitivity and developmental awareness characteristic of a nurturing parenting style (Baumrind 1991, 2013; Darling and Steinberg 1993). While findings regarding the association between adolescent outcomes and an authoritative parenting style that balances controlling or demanding qualities against warm and nurturing ones are mixed (Koning et al. 2012; Kosterman et al. 2000), there is evidence that particular practices common to this overarching style may be more consistent predictors of risk behavior (Minaie et al. 2015). Parental autonomy granting provides youth with significant opportunities to develop decision-making skills that promote adaptive outcomes over time and is associated with reduced risk taking behavior (Bell et al. 2000; Brenning et al. 2015; Fletcher and Jefferies 1999; Luk et al. 2015; Patock-Peckham and Morgan-Lopez 2009; Steinberg 1990). The extant literature on the possible protective influence of autonomy granting during adolescence is nuanced however, as some studies report that the greatest benefit to youth risk outcomes is only seen when autonomy granting parenting practices are coupled with parental responsivity and other features of authoritative parenting (Steinberg and Morris 2001). For example, Lanza et al. (2013) used latent class analysis with a sample of over 4,700 12–14 year olds to examine associations between parental autonomy granting and risk behavior. They reported that teens with parents who granted a high degree of autonomy but provided low levels of responsivity were more likely to take greater risks compared to all other groups. Indeed, a careful discussion about the extent to which adolescents should be granted freedom to make their own choices with regards to friends, leisure time, and risk behavior should not be uncoupled from other supportive parenting behaviors that scaffold decision making skills needed for teens’ ability to assess risk (Best and Miller 2010; Huizinga et al. 2006). The parenting of adolescents often involves a balance between the need to support their exploration as a means of individuation, against the need to know their whereabouts and behavior. Parental monitoring is widely suggested as a protective factor against delinquency and substance use, specifically, but as Stattin and Kerr (2000) pointed out, parental monitoring is only one parenting practice for use in keeping track of youth’s behavior and associations. They posit that open communication is more beneficial than surveillance and control. In particular, their review of several studies indicated that supportive parent-adolescent relationship qualities are associated with more positive outcomes and lower risks, and that interventions to boost parents’ surveillance and control over their adolescents had no effect. Their interpretation of these findings is that parents who know more about their adolescent’s friends and how they spend their time together are likely to come by an important level of detail gained through teens’ self-disclosure; and that self-disclosure is most likely to occur in relationships characterized by open, supportive communication. In short, adolescents were more likely to share details of their lives with parents with whom they shared a supportive bond characterized by open communication. Community Connections in Adolescence How adolescents encounter and navigate the tension between connections to family and connections to communities outside the home is a crucial consideration in predictions of adolescents’ risk behavior (Allen, and Loeb 2015; Chan and Chan 2013). Salient to the study of adolescence and emerging adulthood is an adolescent’s sense of supportive connection to their community – or lack there of – which is significantly associated with subsequent risk behavior (Brooks, et al. 2012). For example, feelings of marginalization and underrepresentation in one’s community are predictive of socioemotional struggles and increased risk behaviors, including substance use (Brenner and Wang 2015), whereas a sense of connection to positive nonfamily role models, or of belonging in one’s neighborhood community, is associated with decreased risk behavior (Scales et al. 2006). Community disorganization – physical deterioration, neighborhood crime, vagrancy, loitering, public intoxication and other forms of social disorder - is associated with negative child and adolescent health and wellbeing outcomes (Latkin and Curry 2003), whereas and community cohesion – including a sense of trust and safety in the community paired with perceived support from community members- is noted as a protective factor against substance use (Brooks et al. 2012). Questions remain however, concerning the duration of the effect parents’ autonomy granting practices can have. For example, Fletcher and Jefferies (1999) found significant associations between autonomy granting as a feature of authoritative parenting and substance use outcomes in a sample of 8th graders, and Luk et al. (2015) found similar associations in a sample of college students. It is reasonable to ask whether this relation remains significant in longitudinal examinations of substance use over time. If so, would any longitudinal effects of parental autonomy granting on substance use be dependent on either the adolescents’ sense of connection to community or on supportive qualities of the parent–child relationship? The present study sought to fill this gap in the extant literature. We considered whether the longitudinal association between autonomy granting and substance use might be moderated by qualities of the parent-teen relationship (i.e., parental support) or by adolescents’ sense of community engagement. We hypothesized that there would be a significant association between parental autonomy granting and substance use during adolescence and emerging adulthood (H1). Further, we hypothesized that parental support and community engagement would moderate the association between parental autonomy granting and substance use during adolescence (H2), as well as during emerging adulthood (H3). Methods This study relies on longitudinal data collected through The National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of adolescents in grades 7–12 in the United States during the 1994–95 school year. The Add Health used a multistage, stratified, school-based cluster design and the inclusion of contextual data from the U.S. census tracts (Merten 2010; Stewart and Simons 2010). Students in the selected schools responded to an in-school survey from which a nationally representative sample was selected for in-home interviews when the students were 13–17 years old (Wave 1), with a subsequent follow-up 1 year later (Wave 2). At Wave I, data collection efforts included interview questions regarding the social and demographic characteristics of the respondents, the education and occupation of their parents, household structure, risk behaviors, expectations for the future, and school-year extracurricular activities. At Wave II, data collection efforts extended to include questions relating to the adolescents’ daily activities, academics and education, their access to health care services, relations with peers, among other things (Mo and Singh 2008). Participants Of the 20,745 Add Health respondents who completed in-home interviews at Wave 1, 17,165 (51% male) respondents from Wave 1, and 12,139 from Wave 2 were included in the current study. Of these, the majority were Caucasian (67%) and lived with both their biological parents (53%; see Table 1 for further demographic details). Measures Substance Use (Wave 2) was measured using the same 5 items at both Waves. Items assessed the total frequency of adolescents’ use of inhalants, cocaine, marijuana, cigarettes, and alcohol in the last 30 days (e.g., BDuring the past 30 days, how many times did you use marijuana?^). Parental Autonomy Granting (Wave 1) was measured using a composite of 7 items assessing the degree to which adolescents’ reported their parents encourage autonomous decision making (including how to spend leisure time, peer selection, and daily schedule choices like bed and mealtimes, for example BDo your parents let you make your own decisions about the time you must be home on weekend nights?^). Parental Support (Wave 1) was measured by using a composite of participants’ responses to items on their perceptions of parents’ supportive and affectionate behaviors toward their adolescent (2 items for each parent, 4 total). Community Engagement (Wave 1) included 6- items assessing the level of engagement and satisfaction adolescents experienced with members of their community. Items included Bexample here^, for example. Based on the literature, a number of covariates were included in the present study, such as, gender, race, parental education, and community disadvantage. The coding for race and ethnicity used three dummy variables, including White (reference category), African-American, and Hispanic-American. Other Race/Ethnicities represented in the Add Health dataset were not included in this study due to small group sizes and subsequent limited power to detect significant differences. The family income variable was created from the Add Health household roster and family income-toneeds ratios suggested by the federal poverty guideline for that year. Lastly, family structure was coded using three dummy variables: dual parent parent families (reference category), father-headed households, and mother-headed households. As with the Race/Ethnicity variable, other Family structures were not considered in the analyses due to small samples, and limited support for their inclusion in the extant literature. Community-Level Disadvantage The community disadvantage variable was constructed fromAdd Health’s Wave1 contextual datafile using fivecensus-level items with stronginternal consistency (Cronbach’s alpha = 0.91). These included: (1) proportion of female headed households with children 18 years of age or younger, (2) proportion of households with public assistance income, (3) proportion of individuals with service-level or clerical jobs, (4) proportion of persons or households with income below poverty, and (5) proportion of individual’s unemployed. Scores ranged from 0 (least advantage) to 5 (highest advantage), where higher values on this scale indicated greater levels of community disadvantage. Analysis Using the statistical software STATA, interaction terms were created for parental support and community engagement using the predictor term parental autonomy granting. Next, we tested the main effect of parental autonomy granting in adolescence and the moderating effects of parenting and community factors on later substance. In order to test our first hypothesis that parental support would moderate associations between parental autonomy granting at Wave 1 and adolescent substance use at Wave 2, we employed structural equation modeling techniques, controlling for substance use at Wave 1, gender, race, parental education, and community disadvantage. In this model, we included parental autonomy granting X parental-support as our moderating variable. A similar analytic approach was used to test our second hypothesis that community engagement wouldsignificantlymoderatethesesameassociations –againcontrollingforgender,race, parental education, community disadvantage, and substance use at Wave 1. In this model, we included parental autonomy granting X community engagement as our moderating variable. Missing data were handled using FIML procedures which assume that values are missing at random and are Table 1 Descriptive statistics Variable Mean/% SD Min Max Dependent variable Substance use (Time II) 1.00 1.08 0 4 Substance use (Time I)a 0.03 1.44 −2.63 28.13 Parental autonomy granting 5.12 1.59 0 7 Parental support 4.62 0.57 1 5 Community engagementa 0.11 2.80 −11.81 5.32 Race White (reference) 67.2% Hispanic 12% Black 16% Asian 3.5% Other race 1.3% Gender Male 51% Female 49% Community disadvantage 0.70 0.44 0.95 3.52 Parental education Less than high school 12.4% High school (reference) 32.0% Some college 21.6% College 34.0% Family structure Two-biological parents (reference) 53.3% Single mother 20.4% Single father 3.1% Step-family 17.2% Other family structure 6.0% All data collected at Wave I, with the exception of Substance at Wave II a Standardized to accommodate differences in Add Health scales appropriate for large data sets. Unlike typical Missing At-Random (MAR) procedures, however, FIML estimates a likelihood function for each individual based on the variables that are present so that all the available data are used (Graham et al. 2003). Results Descriptive Statistics Table 1 provides the descriptive statistics for the present study. Slightly more than half the participants were male (51.0%), with just over two-thirds self-identifying as White. Most adolescents reported residing in a two-biological parent household, and over one-third of the participants’ parents had earned at least a college degree. Substance use among adolescents (Wave I) and emerging adults (Wave II) within the sample was fairly low. Scores for community disadvantage were standardized and ranged from 0.11 to 2.80. Compared with Census data in 1990 regarding population demographics, income and poverty, and community (e.g., U.S. Census Bureau, Current Population Reports, 1994; 2015), these demographics were fairly comparable to the general adolescent population (e.g., 72.5% of children living with two-biological parents in Census as compared to 74.7% in two-biological parent families and stepfamilies in the sample). Hypothesis Testing In the present study, we investigated whether parental autonomy granting during adolescence would have an impact on adolescent substance use as well as on use over time during emerging adulthood. Further, we considered whether the aforementioned association would be moderated by qualities of the parent-teen relationship (i.e., parental support) or by adolescents’ sense of community engagement. To test our hypotheses that there were significant associations between parental autonomy granting and substance use during adolescence and emerging adulthood (H1), we employed structural equation modeling procedures using STATA. In our first model, we included substance use at Wave 1 as our dependent variable, and parental autonomy granting as the predictor variable. Race and ethnicity, gender, parental education, family structure, and community disadvantage were included in the model as controls. Results indicated a significant positive association between parental autonomy granting and substance use during adolescence (b = .12, p < .01), suggesting that the more autonomy parents granted to their adolescent, the more inclined the adolescent was to engage in substance use. A similar pattern was found in young adulthood, as results suggested a significant positive association between parental autonomy granting and substance use in emerging adulthood (b = .06, p < .01), even after controlling for substance use during adolescence. Next, to test the moderating effects of parental support and community engagement on the association between parental autonomy granting and substance use during adolescence (H2), we tested a model that included substance use at Wave 1 as the dependent variable, and parental autonomy granting as the predictor variable. Parental autonomy granting X parental support was included as an interaction term in one model, and parental autonomy granting X community engagement was included as an interaction term in an additional model. Race and ethnicity, gender, parental education, family structure, and community disadvantage were included as Fig. 1 The differential effect of parental autonomy granting on adolescents’ substance use by community engagement controls. Results suggested that neither parental support (b = .01, p < .35) or community engagement (b = .00, p < .44) moderated the association between parental autonomy granting and substance use during adolescence. Lastly, to test whether parental support and community engagement moderated the association between parental autonomy granting and substance use during emerging adulthood (H3), we tested a model in which substance use at Wave II was included as the dependent variable, and parental-autonomy granting as the predictor variable. Parental autonomy granting X parental support was included as an interaction term in one model, and parental autonomy granting X community engagement was included as an interaction term in a separate model. In addition to substance use at Wave I included as a control variable, race and ethnicity, gender, parental education, family structure, and community disadvantage were also included as covariates. Results suggested that although parental support (b = .01, p = .50) was not found to be a significant moderator, community engagement (b = −0.00, p = .94) significantly moderated the association between parental autonomy granting and substance use during emerging adulthood. As illustrated in Fig. 1, substance use among emerging adults is considerably greater when community engagement and parental-autonomy granting are both high, compared to when both community engagement and parental-autonomy granting are low. Results are shown in Tables 1 and 2. Additionally, several covariates were also significantly associated with adolescents’ substance use. First, results suggested that female adolescents reported significantly less substance use than theirmalecounterparts.Interestingly,regardingraceandethnicity,whiteadolescentsreportedgreater substance use than all other race and ethnicities. Furthermore, those adolescents whose parents earned a college degree reported significantly less substance use than those whose parents only held a high school diploma. Regarding family structure, adolescents from all other family structures reported significantly greater substance use than those from two-biological parent households. Table 2 The effects of parental support and community engagement on parental autonomy granting and adolescents’ substance use (Time I) Variable Model b SE Parental autonomy granting 0.12** 0.03 Parental support −0.33** 0.02 Community engagement −0.00 0.00 Race Hispanic −0.20** 0.04 Black −0.43** 0.04 Asian −0.31** 0.06 Other race −0.34** 1.00 Gender −0.13** 0.02 Community disadvantage −0.04 0.03 Parental education Less than high school 0.06 0.03 Some college −0.04 0.02 College 0.12** 0.02 Family structure Single mother 0.25** 0.03 Single father 0.46** 0.06 Step-family 0.27** 0.03 Other family 0.49** 0.06 Moderation Parental autonomy granting X parental support 0.01 0.01 Parental autonomy granting X community engagement 0.00 0.00 White is the reference category for race and ethnicity. Male is reference category for gender. High school is the reference category for parental education. Unstandardized coefficients **p < .01 Among emerging adults, Hispanic and black emerging adults reported significantly less substance use than Whites; similar to adolescents, emerging adults from two-biological parent households reported significantly less substance use than those from all other family structures. Also, community disadvantage was significantly associated with substance use among this sample, suggesting that those from communities experiencing greatest disadvantage were significantly more likely to engage in substance use than their peers residing in more affluent communities (Table 3). Discussion Our results are consistent with previous findings on the tensions between family and peer influence on risk behavior that indicate parental support is more meaningful at younger ages (Aalsma et al. 2011); also, our results build on prior literature as findings suggests that adolescents who report more parental autonomy granting were more likely to report substance use in emerging adulthood when they felt a higher degree of community engagement. This suggests that the influence of the parent-teen relationship and an adolescent’s sense of connection to their community may be developmentally sensitive - in accord with developmental theories for adolescence (Darling and Steinberg 1993) - such that adolescents raised in parenting environments that support exploration and autonomy may increase their substance Table 3 The effects of parental support and community engagement on parental autonomy granting and emerging adults’ substance use (Time 2) Variable Model b SE Substance use (Time I) 0.33** 0.01 Parental autonomy granting 0.06** 0.01 Parental support −0.20** 0.01 Community engagement −0.01* 0.00 Race Hispanic 0.02 0.03 Black −0.26** 0.03 Asian −0.26** 0.05 Other race 0.04 0.07 Gender (Reference) 0.03 0.02 Community disadvantage −0.08** 0.02 Parental education Less than high school −0.04 0.03 Some college 0.03 0.02 College −0.03 0.02 Family structure Single mother 0.16** 0.02 Single father 0.16** 0.05 Step-family 0.12** 0.02 Other family 0.14** 0.05 Moderation Parental autonomy granting X parental support 0.01 0.01 Parental autonomy granting X community engagement −0.00** 0.00 White is the reference category for race and ethnicity. Male is reference category for gender. High school is the reference category for parental education. Unstandardized coefficients *p < .05; **p < .01 use as they transition to adulthood, particularly when they feel a strong connection to their community. These results echo those published by Brooks et al. (2012) who report that peer community factors (at participants’ schools and neighborhoods) were a more powerful predictor of risk behavior than parental monitoring and regulation of adolescents’ autonomy. The finding that increases in risk behavior may be due to adolescents’ perceived connection to individuals within the community who accept and potentially promote a degree of substance use and a Bculture of drinking^ has clear intervention implications (Ahearn et al. 2008). Specifically, substance use prevention programs for older teens may benefit from promoting positive avenues to community engagement as adolescents leave their parents’ homes and become independent members of the community. Mentorship interventions that rely on positive relationships to establish young adults’ sense of connections through building an inclusive and constructive sense of belonging to their neighborhoods and larger communities may see powerful results (Brooks, et al. 2012). Scales and colleagues (2006) note that youth development programs that bolster community connection by fostering teens relationships with nonfamily mentors creates Bmore developmentally advantageous kind of adult engagement^ (p.411) that is associated with reduced risk behavior and improved indicators of thriving. Indeed, youth program practices that create positive connections to nonfamily mentors and opportunities for adolescents to make meaningful contributions to their communities are promising (Jennings et al. 2006. Our results suggest that racial/ethnic minority status was not a risk factor for adolescent or young adults’ substance use, but that community disadvantage was. This finding partially supports previous work on socioeconomic marginalization, which indicates the relationship between minority status and psychosocial problems is heightened among Latinos and African Americans (Galea et al. 2007; Brenner and Wang 2015). It may be the case that poverty and the marginalization families face by dint of the cumulative disadvantages associated with it (Bauman et al. 2006; Mulia et al. 2008) plays a stronger role in shaping parenting practices than those associated with race or ethnicity alone. Indeed, one may reasonably ask what aspects of social context and subsequent social capital (i.e., gender, race, ethnicity, singleparent family structure, income, education, etc.) hold sway in adolescent risk outcomes above and beyond the protective factors any particular parenting practice might afford? For this reason, reliance on race/ethnicity indicators alone is troublesome, as noted by Keyes and colleagues (2012). While race/ethnicity are subjective and dynamic concepts, and are powerfully predictive of health, they have little meaning beyond predicting social circumstances. As a result, examinations of risk behavior can avoid the concerning false dichotomies that may be introduced by relying on self-reports of discrete racial and ethnic categories alone by using a broader measure of disadvantage. The significant associations between higher rates of substance use in White adolescents also echo previous findings which demonstrate the established racial and ethnic disparity in substance use rates at younger ages diminishes over time (Keyes et al. 2012). Family background characteristics including the parenting practices that either promote or protect against behavioral risk outcomes, represent salient endowments adolescents carry with them as they enter high school. But according to Beck and Muschkin (2012), any family disadvantage should dwindle in importance once a student enters universal public education — Bwhen differences among students are the result of their efforts rather than their family endowments^ (p. 565). They posit that school-based interventions aimed at reducing academic and behavioral struggles have likely been crucial in reducing in this component of racial disadvantage. Moving to the gender differences, we observed a stronger association between gender and substance use for boys than girls. Although gender-differentiated associations between family dynamics and substance use may exist (i.e., a stronger association between substance use and family dynamics indicators like open communication among girls; Ohannessian et al. 2016), other studies have identified more similarities than differences between boys’ and girls’ substance use (e.g., Dornbusch et al. 2001). A strength of using nationally representative data from longitudinal studies like Add Health is the statistical power to ask rigorous analytic questions with the potential to generalize results to a broader population – in this case, to a range of young adults from a variety of family structures and communities. A limitation that must be noted, though, is the fixed set of measures available to answer these questions, and the potential strengths future studies can adopt by considering additional assessments going forward. For example, measures of problematic substance use (i.e., diagnosis with a substance use disorder, or reports on impaired function measures like the SMAST; Selzer et al. 1975) would provide helpful insights into the extent to which young adults’ substance use outcomes impair their daily lives. Given the differential reporting between parents and their adolescent children on parenting practices including autonomy granting– additional parent-report measures would also strengthen longitudinal examinations of the influence particular family dynamics in adolescence have over time. Lastly, although the Add Health sample was nationally representative of U.S. schools during 1994–95, the sample included lower representation of racial/ethnic minority youth than found in American secondary schools today which may have affected our power to detect some possible group differences. Compliance with Ethical Standards All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. Beth Russell and Melissa Gordon declare that they have no conflict of interest. Conflict of Interest/Funding The authors declare that they have no conflict of interest nor funding sources to disclose. References Abar, C. C., Jackson, K. M., Colby, S. M. & Barnett, N. P. (2015). 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