Substance abuse and other adverse outcomes for military-connected youth in California: Results from a large-scale normative population survey

Importance Military families and military-connected youth exhibit significant strengths; however, a sizeable proportion of these families appear to be struggling in the face of war-related stressors. Understanding the consequences of war is critical as a public health concern and because additional resourcesmay be needed to support military families. Objective To determine whether rates of adverse outcomes are higher for military-connected adolescents during war compared with nonmilitary peers. Design, Setting, and Participants This study is a secondary data analysis of a large, normative, and geographically comprehensive administrative data set (2013 California Healthy Kids Survey) to determine whether military-connected youth are at risk for adverse outcomes, including substance use, experiencing violence and harassment, and weapon carrying, during wartime. These outcomes are of particular concern because they affect socioemotional adjustment and academic success. Data were collected in March and April 2013 and participants included 54 679 military-connected and 634 034 nonmilitaryconnected secondary school students from public civilian schools in every county and almost all school districts in California. Main Outcomes and Measures Outcomes included lifetime and recent use of alcohol, tobacco, marijuana, prescription medications, and other drugs, as well as experiences of physical and nonphysical violence and harassment and weapon carrying during the last year. Results Multivariable logistic regression models indicated that military-connected youth had greater odds of substance use, experience of physical violence and nonphysical harassment, and weapon carrying. For example, military-connected youth had 73%greater odds of recent other drug use (eg, cocaine and lysergic acid diethylamide; odds ratio [OR], 1.73; 95%CI, 1.66-1.80) and twice the odds of bringing a gun to school (OR, 2.20; 95%CI, 2.10-2.30) compared with nonmilitary-connected peers. Their odds of being threatened with a weapon or being in a fight were also significantly higher than their civilian counterparts (OR, 1.87; 95%CI, 1.80-1.95 and OR, 1.67; 95%CI, 1.62-1.71, respectively). Conclusions and Relevance Most military-connected youth demonstrate resilience. however, results suggest that during wartime, military-connected youth are at increased risk for adverse outcomes. Further, when compared with data from 2011, the rates of these negative outcomes appear to be increasing. These findings suggest a need to identify and intervene with military-connected adolescents and reflect a larger concern regarding the well-being of military families during wartime.