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Limited research has examined the effectiveness of brief interventions in this subpopulation. This study aimed to examine whether psychological diagnoses were associated with screening positive for problematic substance use, and whether psychological diagnoses impacted effectiveness of a brief intervention for substance use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal observational study of adolescents (ages 10\u201320\u2009years) seen for mandated health examinations in a foster care clinic. Youth who endorsed substance use and received a brief intervention were invited to complete baseline surveys and follow\u2010ups at 30\u2009days, 60\u2009days and 6\u00a0months. Logistic regressions evaluated associations of mental health disorders with endorsing problematic substance use. Generalized linear mixed models examined associations of mental health disorders with trajectories of post\u2010intervention change in substance use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Midwest, United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Adolescents seen for mandated health examinations in a foster care clinic who completed a substance use screening measure [CRAFFT2.1\u2009+\u2009N;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091656; mean age (SD)\u2009=\u200914.4 (2.6); 53.4% female; 58.4% Black, 31.6% white]. A second subsample included only those adolescents who received a brief intervention for substance use during their clinic visit [\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009287; mean age (SD)\u2009=\u200915.9 (2.1); 59.9% female; 53.7% Black, 35.5% white].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Mental health diagnoses and CRAFFT2.1\u2009+\u2009N were extracted from the electronic health record. Youth\u2010reported count of past 30\u2010day use of alcohol, cannabis and nicotine\/tobacco at each wave.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      A minority (12%) of youth in foster care endorsed problematic substance use. Youth with a mental health diagnosis had 58% to 161% higher odds of reporting problematic substance use [odds ratios (\n                      <jats:italic>OR<\/jats:italic>\n                      s)\u2009=\u20091.58\u20132.61; 95% confidence intervals (CIs) = (1.16\u20132.13) \u2013 (1.93\u20133.56)]. Following the intervention, youth who had been diagnosed with internalizing disorders (i.e. anxiety, depressive and trauma disorders), and those with co\u2010occurring internalizing and externalizing disorders, reported smaller decreases or no decreases in their cannabis [\n                      <jats:italic>OR<\/jats:italic>\n                      s\u2009=\u20092.09, 7.03; 95%\u00a0CIs = (1.17\u20133.71), (3.43\u201314.42)] and nicotine use [\n                      <jats:italic>ORs<\/jats:italic>\n                      \u2009=\u20091.95\u20137.68; 95%\u00a0CIs = (1.08\u20133.53) \u2013 (4.12\u201314.32)]. Alcohol use did not vary as a function of mental health diagnoses [\n                      <jats:italic>ORs<\/jats:italic>\n                      \u2009=\u20090.31\u201313.10; 95%\u00a0CIs = (0.00\u201319.37) \u2013 (0.19\u2013915.80).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Foster youth in the United States, particularly those with mental health concerns, appear to be at high risk for problematic substance use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70546","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:40:08Z","timestamp":1785411608000},"page":"3106-3120","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of mental health disorders on problematic substance use and effectiveness of brief intervention among young people in foster care"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9388-7269","authenticated-orcid":false,"given":"Courtney B.","family":"Dunn","sequence":"first","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1955-6864","authenticated-orcid":false,"given":"Austin","family":"Blake","sequence":"additional","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"Department of Psychiatry University of Colorado Anschutz  Aurora CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7027-9017","authenticated-orcid":false,"given":"Katie","family":"Fox","sequence":"additional","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2295-6789","authenticated-orcid":false,"given":"Mary V.","family":"Greiner","sequence":"additional","affiliation":[{"name":"Division of General and Community Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7223-0070","authenticated-orcid":false,"given":"Sarah J.","family":"Beal","sequence":"additional","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"Division of General and Community Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"Department of Pediatrics University of Cincinnati  Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2023.106473"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2012.10.269"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1524838020941197"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cppeds.2015.08.002"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2016.06.001"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2006.12.012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-017-0800-6"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0014215"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077559516669443"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-023-02265-x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2018.01.005"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/DBP.0000000000001191"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijchp.2024.100502"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0024519"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2012.01.015"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2012.08.011"},{"key":"e_1_2_9_18_1","unstructured":"Center for Health Care Strategies.Health screening and assessment for children and youth entering foster care: State requirements and opportunities. 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