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Director's Report to the National Advisory Council on Drug Abuse - February, 2007



Research Findings - Prevention Research

Universal Drug Prevention Programs Reduce Methamphetamine Use

This study examined the long-term effects of universal preventive interventions on methamphetamine use by adolescents in the general population during their late high school years, using data from two randomized, controlled prevention trials were. Participants attended public middle schools in the Midwest from 1993 to 2004. Study 1 began with 667 sixth grade students from 33 rural public schools, who were followed up 6 _ years later (grade 12); the follow-up included 457 students. Study 2 began with 679 seventh grade students from 36 rural public schools who were followed up 4 _ (grade 11) and 5 _ (grade 12) years later; the follow-up assessment included 597 students. Three interventions were used across the two RCTs. In study 1, schools were assigned to the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years, or a control condition. In study 2, schools were assigned to a revised ISFP (SFP 10- 14) plus Life Skills Training (SPF 10-14_LST), LST alone, or a control condition. Self-reports of lifetime and past-year methamphetamine use were collected at 6_ years past baseline (study 1) and at 4_ and 5_ years past baseline (study 2). In study 1, the ISFP past-year rate was 0.0% compared with 3.2% in the control condition (P=.04). In study 2, SFP 10-14_LST showed significant effects on lifetime and past-year use at the 4_year follow-up (eg, 0.5% lifetime use in the intervention condition vs 5.2% in the control condition, P=.006); both SFP 10-14_LST and LST alone had significant lifetime use effects at the 5_ year follow-up. Findings demonstrate that brief universal interventions have potential for public health impact by reducing methamphetamine use among adolescents. Spoth, R.L., Clair, S., Shin, C., and Redmond, C. Long-term Effects of Universal Preventive Interventions on Methamphetamine Use Among Adolescents. Arch Pediatr Adolesc Med, 160 pp. 876-882, 2006.

Raising Healthy Children Promotes Alcohol-free Driving

This study evaluated the impact of two targeted family sessions focused on driving issues delivered within the context of the Raising Healthy Children project. The Raising Healthy Children project began in the fall of 1993, drawing students in the 1st or 2nd grades from 10 schools. Schools were assigned to an intervention or control condition, and the school-wide, family- and student-focused preventive intervention to address developmentally salient risk and protective factors was delivered during elementary and middle school. The family driving sessions were administered to families in the intervention condition prior to and after teenagers received their driver's license. The first session consisted of a home visit with families designed to help parents and their children improve decision-making skills concerning driving and to develop clear standards and expectations regarding driving-related behavior. A second session, at the time of licensure, was designed to help parents and teens develop a written contract that stated family expectations, a plan for monitoring compliance with these expectations, and consequences for compliance or non-compliance. Consistent with the study's group-randomized design, intervention effects were assessed with multi-level logistic regression models in which students were grouped by their original school assignment. These models assessed specific effects of the driving sessions by adjusting for control variables measured when students were in 8th grade, prior to the driving sessions. Results indicated that students in the intervention group were more likely than students in the control group to report that they had a written driving contract (p = .003, OR = 4.98) and had participated in making the driving rules in the family (p = .025, OR = 1.70). Further, students in the intervention group reported significantly fewer risky behaviors including driving under the influence of alcohol (p = .021, OR = .45) and driving with someone who had been drinking (p = .038, OR = .56). Haggerty, K.P., Fleming, C.B., Catalano, R.F., Harachi, T.W., and Abbott, R.D. Raising Healthy Children: Examining the Impact of Promoting Healthy Driving Behavior within a Social Development Intervention. Prev Sci, 7 pp. 257-267, 2006.

Predictors of Intervention Adherence Among Young People Living With HIV

This study examined adherence to a 23-session intervention for young people living with HIV. Two hundred eight HIV-positive youth were assigned by small cohort to a behavioral intervention. Results showed that youth with more personal strengths were more likely to attend the intervention; those with more competing environmental demands (eg, employment, school) were less likely to attend the intervention. Using a social support, spiritual hope, or self-destructive and escape coping style was associated with attendance. Youth who reported many sexual partners attended fewer sessions. Adherence varied by cohort assignment. It was concluded that high attendance should be considered as a goal when designing future interventions. Song, J., Lee, M., Rotheram-Borus, M., and Swendeman, D. Predictors of Intervention Adherence Among Young People Living With HIV. Am J Health Behav, 30(2), pp. 136-146, 2006.

Family Focused Intervention Provides Similar Benefits for High and Low Risk Youth

This study extends earlier investigation of family risk-related moderation of two brief, family-focused preventive interventions. It examines effects on the trajectories of substance initiation over a period of six years after a pretest assessment, evaluating whether effects were comparable across higher- and lower-risk subgroups. The two interventions, designed for general-population families of adolescents, were the seven-session Iowa Strengthening Families Program (ISFP) and the five-session Preparing for the Drug Free Years program (PDFY). Thirty-three rural public schools were randomly assigned to either the ISFP, the PDFY, or a minimal contact control condition. Curvilinear growth curve analyses were used to evaluate the universality of intervention effectiveness by testing for risk moderation of intervention effects on school-level substance use trajectories of initiation of alcohol and illicit substance use. Results were most consistent with the interpretation that both interventions provided comparable benefits for both outcome measures, regardless of family risk status. Findings are discussed in terms of their implications for implementing universal preventive interventions in general populations. Spoth, R., Shin, C., Guyll, M., Redmond, C., and Azevedo, K. Universality of Effects: An Examination of the Comparability of Long-term Family Intervention Effects on Substance use Across Risk-related Subgroups. Prev Sci, 7(2), pp. 209-224, 2006.

Internet-Based Intervention for Mental Health and Substance Use Problems in Disaster-Affected Populations: A Pilot Feasibility Study

Early interventions that reduce the societal burden of mental health problems in the aftermath of disasters and mass violence have the potential to be enormously valuable. Internet-based interventions can be delivered widely, efficiently, and at low cost and as such are of particular interest. The development and feasibility analysis of an Internet-delivered intervention designed to address mental health and substance-related reactions in disaster-affected populations is described. Participants (n = 285) were recruited from a cohort of New York City-area residents that had been followed longitudinally in epidemiological research initiated 6 months after the terrorist attacks of September 11, 2001. The intervention consisted of 7 modules: posttraumatic stress/panic, depression, generalized anxiety, alcohol use, marijuana use, drug use, and cigarette use. Feasibility data were promising and suggest the need for further evaluation. Ruggiero, K., Resnick, H., Acierno, R., Coffey, S., Carpenter, M., Ruscio, A., Stephens, R., Kilpatrick, D., Stasiewicz, P., Roffman, R., Bucuvalas, M., and Galea, S. Internet-Based Intervention for Mental Health and Substance Use Problems in Disaster-Affected Populations: A Pilot Feasibility Study. Behav Ther, 37(2), pp. 190-205, 2006.

Providing Prevention Services for Conduct Problems to High Risk Children and Their Families

This study examined whether the link between risk factors for conduct problems and low rates of participation in mental health treatment could be decoupled through the provision of integrated prevention services in multiple easily-accessible contexts. It included 445 families of first-grade children (55% minority), living in four diverse communities, and selected for early signs of conduct problems. Children and families were participants in a larger study of a multi-component, multi-year Program, Fast Track, designed to prevent conduct problems among young children already exhibiting behavior problems. Results indicated that, under the right circumstances, these children and families could be enticed to participate at high rates in school-based services, therapeutic groups, and home visits. For example, 49% of the sample received a majority of the intervention services that were provided: 92% of school-based services, 88% of therapeutic groups, and 92% of home visits. Only 6% of the sample participated in a greater proportion of services. Because different sets of risk factors were related to different profiles of participation across the components of the prevention program, findings highlight the need to offer services in multiple contexts to reach all children and families who might benefit from them. Nix, R., Pinderhughes, E., Bierman, K., Maples, J., and Maples, J.T. Decoupling the Relation Between Risk Factors for Conduct Problems and the Receipt of Intervention Services: Participation Across Multiple Components of a Prevention Program. Am J Community Psychol, 36(3-4), pp. 307-325, 2005.

Prevention Program Format May Impact Participant Initiation and Exposure Rates

The primary aim of this study was to compare participation rates in two different formats of "Parents Who Care" a universal, family-based preventive intervention. Participants in the study were blocked on race and gender and randomized to three conditions: 1) a self administered format (SA) involving a video and workbook to be completed within 10 weeks 2) a parent adolescent group format (PAG) involving seven weekly meetings and 3) a no intervention control group. In this study, predictors of participation and exposure were compared across the two intervention formats. Families of 225 8th-grade students were assigned to the (PAG) or the (SA) group. Logistic regression showed greater program initiation in SA than in PAG. Hierarchical regression showed only one variable (parent high-risk behavior) to be associated with lower program exposure in the self-administered format. In contrast, demographic variables (e.g., being African American) predicted lower exposure in PAG. Overall, the findings of this study were notable in that most of the variables that have been identified in past research as lowering participation rates were not related to program initiation or level of exposure to either format of "Parents Who Care". Further, the self-administered format may be particularly useful to increase program participation for families, even those who are traditionally difficult to reach. Haggerty, K., MacKenzie, E., Skinner, M., Harachi, T., and Catalano, R. Participation in "Parents Who Care": Predicting Program Initiation and Exposure in Two Different Program Formats. J Prim Prev, 27(1), pp. 47-65, 2006.

Peer Health Advocates are Trusted as Sources for HIV Prevention Material by Drug Using Peers

This article presents results from a process evaluation of a peer-led HIV prevention intervention. The Risk Avoidance Partnership, conducted from 2001 to 2005, trained active drug users to be peer health advocates (PHAs) to provide harm reduction materials and information to their peers. Results indicate that PHAs actively conducted harm reduction outreach both when partnered with staff and on their own time. Although PHAs conducted most of their outreach in public locations, they also provided drug users with harm reduction materials at critical moments in places where HIV risky behaviors were likely to occur. PHAs were credible and trusted sources of information to their drug-using peers who sought PHAs out for HIV prevention materials. Process evaluations of successful HIV prevention interventions are necessary to understand how and why such interventions work for further intervention refinement. Dickson-Gomez, J., Weeks, M., Martinez, M., and Convey, M. Times and Places: Process Evaluation of a Peer-led HIV Prevention Intervention. Subst Use Misuse, 41(5), pp. 669-690, 2006.

Tailoring Tobacco Counteradvertisements for Bicultural Mexican American Youth

The growing population of Mexican American youth and the increasing smoking rates in this population present a considerable public health challenge and little is known about the most effective ways to adapt messages aimed at this audience. To explore key variables that can affect success, a study was conducted with 249 Mexican American middle-school youth from a U.S./Mexico border community to examine the effectiveness of language (English, Spanish, or a combination of English and Spanish) and theme (secondhand smoke, anti-tobacco social norms, and tobacco industry manipulation) in print tobacco counteradvertisements. Measures included ad preferences, acculturation, and tobacco-related attitudes and behavior. Results showed that although a large percentage identified with the Mexican American rather than the Anglo American culture and spoke Spanish in selected contexts, readability was greater for ads in English, and participants rated the English ads as most effective. The social norms counteradvertisement was preferred overall. Kelly, K., Stanley, L., Comello, M., and Gonzalez, G. Tobacco Counteradvertisements Aimed at Bicultural Mexican American Youth: The Impact of Language and Theme. J Health Commun, 11(5), pp. 455-476, 2006.

Group Interventions May be Able to Minimize Peer Contagion

This study involving novel methodology applies a multi-player arms race model to peer contagion in the aggressive and delinquent behaviors of inner-city elementary school students. Because this model of peer contagion differs from the usual model based on positive reinforcement of delinquent behavior, it raises the possibility that the persistent finding of iatrogenic effects of group treatment might not apply to group treatment of elementary school children if aggressive behavior in the group is limited. One way of limiting aggressive behavior is to include parents in the groups. To test this hypothesis, this study applies the model to groups of elementary school students assigned to Families and Schools Together (FAST), a group treatment that includes parental participation, or to an intervention focused on individual families. Data came from a longitudinal study of 403 children, their parents, and their teachers who participated in an evaluation of the FAST program. The model effectively describes the relationship between group averages of aggressive behavior in the classroom and aggressive and delinquent behavior outside the classroom for those students assigned to the individual intervention. The model fits those children assigned to FAST less well, suggesting that FAST may make it less likely that aggressive and delinquent behavior is generalized outside of aggressive classroom settings. Warren, K., Moberg, D., and McDonald, L. FAST and the Arms Race: The Interaction of Group Aggression and the Families and Schools Together Program in the Aggressive and Delinquent Behaviors of Inner-city Elementary School Students. J Prim Prev, 27(1), pp. 27-45, 2006.

Recommendations for the Prevention of HIV Transmission in Hispanic Adolescents

This article reviews the state of the science in HIV prevention for Hispanic adolescents. Literature is reviewed in three broad areas: (1) the prevalence rates of drug and alcohol misuse, sexual practices, and HIV infection; (2) risk and protective factors for drug and alcohol misuse and unprotected sex (in general and specifically for Hispanics); and (3) the state of HIV prevention intervention development and evaluation targeting Hispanic youth. Little basic and intervention research has been conducted on HIV prevention in Hispanic adolescents, with even less attention given to Hispanic young men who have sex with men (YMSM). There are a number of areas in which further knowledge development and scientific advancement are needed. The seven areas identified in this review were (a) the need for analyses of nationwide epidemiological data examining risk and protective factors for substance use and unsafe sexual behavior for heterosexual and homosexual youth; (b) explaining variations in drug/alcohol use, unsafe sexual behavior, and HIV infection among Hispanic subgroups; (c) need for adaptive preventive interventions for Hispanic subgroups with varying risk and protection profiles; (d) incorporation of ethnic, cultural, and sexual identity into prevention programs for Hispanic adolescents; (e) examination of the role of gender in preventive interventions for Hispanic adolescents; (f) research on the effects of psychiatric comorbidity on drug/alcohol use and unsafe sex and on the efficacy of prevention programs; and (g) increased focus on intravenous drug use as a mode of HIV infection among Hispanics, particularly Puerto Ricans. Research addressing these research needs has the potential to facilitate progress toward achieving the two primary objectives of Healthy People 2010--improving the quality of life for all Americans and reducing health disparities between and among segments of the U.S. population. Prado, G., Schwartz, S.J., Pattatucci-Aragon, A., Clatts, M., Pantin, H., Fernandez, M., Lopez, B., Briones, E., Amarof, H., and Szapocznik, J. The Prevention of HIV Transmission in Hispanic Adolescents. Drug Alcohol Depend, 84S pp. S43-S53, 2006.

Unprotected Sex Among Youth Living With HIV Before and After the Advent of Highly Active Antiretroviral Therapy

Since the advent of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV-especially among young men who have sex with men-and the prevalence of unprotected sex among HIV-positive persons have increased. The characteristics associated with unprotected sex among youth living with HIV since the advent of HAART have not been explored. Samples of HIV-positive youth aged 13-24 were taken from two intervention studies that targeted the sexual behaviors of HIV-positive youth-one from 1994 to 1996 (pre-HAART) and the other from 1999 to 2000 (post-HAART). Generalized estimating equations were used to identify characteristics associated with unprotected sex in each sample. The prevalence of unprotected sex in the post-HAART sample was more than twice that in the pre-HAART sample (62% vs. 25%). Among the pre-HAART sample, being a man who has sex with men and having sex with a casual partner were negatively associated with the odds of unprotected intercourse (odds ratios, 0.5 and 0.2, respectively). Among the post-HAART sample, unprotected sex was negatively associated with knowing that a partner was HIV-negative (0.2) and positively associated with poorer mental health (1.02). In analyses among the post-HAART sample, poorer mental health was associated with increased odds of unprotected sex among youth living with HIV who were not receiving the treatment (1.02). It was concluded that interventions for HIV-positive youth must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health. Rice, E., Batterham, P., and Rotheram-Borus, M. Unprotected Sex Among Youth Living With HIV Before and After the Advent of Highly Active Antiretroviral Therapy. Perspect Sex Reprod Health, 38(3), pp. 162-167, 2006.

Predictors of HIV-Related Stigma Among Young People Living with HIV

Enacted and perceived HIV stigma was examined among 147 substance-using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City. Almost all YPLH (89%) reported perceived stigma, 31% reported enacted experiences in the past 3 months; and 64% reported experiences during their lifetime. The HIV stigma questions were characterized by factors of avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay or bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV stigma than their heterosexual peers. Swendeman, D., Rotheram-Borus, M., Comulada, S., Weiss, R., and Ramos, M. Predictors of HIV-Related Stigma Among Young People Living with HIV. Health Psychol, 25(4), pp. 501-509, 2006.

Prevalence and Correlates of Exchanging Sex for Drugs or Money Among Adolescents in the United States

This study examined the prevalence and correlates of exchanging sex for drugs or money among a nationally representative sample of 13,294 adolescents in the United States. Data are from the National Longitudinal Study of Adolescent Health, waves I and II. The lifetime prevalence of exchanging sex was estimated and a cross sectional analysis of sociodemographic and behavioral correlates was conducted. Unadjusted odds ratios were obtained. Results showed that 3.5% of adolescents had ever exchanged sex for drugs or money; two-thirds of these youths were boys. The odds of having exchanged sex were higher for youths who had used drugs, had run away from home, were depressed, and had engaged in various sexual risk behaviors. 15% of boys and 20% of girls who had exchanged sex reported they had ever been told they have HIV or another sexually transmitted infection (STI). It was concluded that adolescents with a history of exchanging sex have engaged in other high risk behaviors and may experience poor health outcomes, including depression and HIV/STIs. These findings should help inform strategies to prevent this high risk sexual behavior and its potential consequences. Edwards, J., Iritani, B., and Hallfors, D. Prevalence and Correlates of Exchanging Sex for Drugs or Money Among Adolescents in the United States. Sex Transm Infect, 82(5), pp. 354-358, 2006.

Gender Differences in Associations Between Depressive Symptoms and Patterns of Substance Use and Risky Sexual Behavior Among a Nationally Representative Sample of U.S. Adolescents

This study uses a cluster analysis of adolescents, based on their substance use and sexual risk behaviors, to 1) examine associations between risk behavior patterns and depressive symptoms, stratified by gender, and 2) examine gender differences in risk for depression. Data are from a nationally representative survey of over 20,000 U.S. adolescents. Logistic regression was used to examine the associations between 16 risk behavior patterns and current depressive symptoms by gender. Compared to abstention, involvement in common adolescent risk behaviors (drinking, smoking, and sexual intercourse) was associated with increased odds of depressive symptoms in both sexes. However, sex differences in depressive symptoms vary by risk behavior pattern. There were no differences in odds for depressive symptoms between abstaining male and female adolescents (OR = 1.07, 95% CI 0.70-1.62). There were also few sex differences in odds of depressive symptoms within the highest-risk behavior profiles. Among adolescents showing light and moderate risk behavior patterns, females experienced significantly more depressive symptoms than males. It was concluded that adolescents who engage in risk behaviors are at increased risk for depressive symptoms. Girls engaging in low and moderate substance use and sexual activity experience more depressive symptoms than boys with similar behavior. Screening for depression is indicated for female adolescents engaging in even experimental risk behaviors. Waller, M., Hallfors, D., Halpern, C., Iritani, B., Ford, C., and Guo, G. Gender Differences in Associations Between Depressive Symptoms and Patterns of Substance use and Risky Sexual Behavior Among A Nationally Representative Sample of U.S. Adolescents. Arch Womens Ment Health, 9(3), pp. 139-150, 2006.

Genetic Contribution to Suicidal Behaviors and Associated Risk Factors Among Adolescents in the U.S.

This paper examines genetic contribution to suicidal behaviors and other risk factors associated with suicidal behavior among adolescents in the U.S. Using adolescent twin data in the National Longitudinal Study of Adolescent Health (N=1448), authors compared concordance in suicidal ideation and attempt among monozygotic (MZ) and dizygotic (DZ) twins. Heritability of risk factors for suicidal behaviors also was examined using Pearson correlation and mixed-model analyses. A trend of higher concordance in suicidal ideation and attempt was found among MZ than DZ twins but the difference was not statistically significant by the stringent test of bootstrapping analysis. Evidence of heritability was found for several suicide risk factors. The percentage of variance explained by heritability was larger among female twins for depression, aggression, and quantity of cigarettes smoked in comparison to heritability estimates for male twins. However, estimated heritability was larger among male than female twins for alcohol use and binge drinking. Heritability influence was negligible among both sexes for other drug use. Risk factors for suicidal behaviors among adolescents may be heritable. Gender differences found in the heritability of some suicide risk factors suggest these genetic contributions are gender specific. Future research examining potential interactions between expression of genetic influence and particular environmental contexts may enhance prevention and intervention efforts. Cho, H., Guo, G., Iritani, B.J., and Hallfors, D.D. Genetic Contribution to Suicidal Behaviors and Associated Risk Factors Among Adolescents in the U.S. Prev Sci, 7(3), pp. 303-311, 2006.

In School Alcohol and Marijuana Use Among High School Students

The problem of adolescent substance use has been examined extensively. Beyond simple prevalence estimates, however, little research has been conducted on substance use in the school context. The present investigation was an in-depth study of students' attitudes and behaviors regarding alcohol and marijuana use during the school day. Based on a representative sample of 1123 high school students, 48% male, in grades 9-12 in western New York state, this study assessed the frequency of alcohol and marijuana use at school among demographic subgroups, the accessibility of drugs in school, and students' perceived consequences of being caught using drugs in school. Twelve percent of the sample reported using alcohol during school hours in the past 6 months while 16% reported using marijuana at school. Among students who used alcohol outside of school, 18% also used alcohol at school. For marijuana users, 47% used marijuana at school. There was evidence of some demographic differences in school drug use. Specifically, male and Hispanic students had slightly higher levels of drug use at school compared to female and white students, respectively, and in school drug use was more prevalent among older students. In terms of accessibility, students reported that alcohol and marijuana were easily obtained and used on school grounds. Many students (40%) were not aware of the specific actions taken in their schools to punish drug use. The need for additional research on school-related drug use is emphasized. Finn, K. V. Patterns of Alcohol and Marijuana Use at School. Journal of Research on Adolescence, 16(1), pp. 69-77, 2006.

Methodological Considerations for Testing Causal Effects in Drug Abuse Prevention Research

Observational data are often used to address prevention questions such as, "If alcohol initiation could be delayed, would that in turn cause a delay in marijuana initiation?" This question is concerned with the total causal effect of the timing of alcohol initiation on the timing of marijuana initiation. Unfortunately, when observational data are used to address a question such as the above, alternative explanations for the observed relationship between the predictor, here timing of alcohol initiation, and the response abound. These alternative explanations are due to the presence of confounders. Adjusting for confounders when using observational data is a particularly challenging problem when the predictor and confounders are time-varying. When time-varying confounders are present, the standard method of adjusting for confounders may fail to reduce bias and indeed can increase bias. In this paper, an intuitive and accessible graphical approach was used to illustrate how the standard method of controlling for confounders may result in biased total causal effect estimates. Based on the graphical approach, an alternative method proposed by James Robins was used to examine causal effect estimates. Implications for prevention researchers who wish to estimate total causal effects using longitudinal observational data are discussed. Bray, B., Almirall, D., Zimmerman, R., Lynam, D., and Murphy, S. Assessing the Total Effect of Time-varying Predictors in Prevention Research. Prev Sci, 7(1), pp. 1-17, 2006.

Rasch Analysis of Data From Prevention Study in South Africa Supports Jessors' Problem Behavior Theory

The goal of the study was to determine the presence of a syndrome of health risk behaviors in South African teenagers from Rasch modeling of items from self-report measures covering six conceptually distinct health risk domains selected because they are among the most assessed health risk outcomes in prevention research and practice. A total of 2186 in-school adolescents participated in the study (males = 1077; females = 1119; age range = 12-16 years; median = 13 years). The data are baseline from a longitudinal study of a leisure-based drug abuse and HIV/AIDS prevention program at Mitchell's Plain in Cape Town, South Africa. The adolescents completed a self-report measure on various health risk vulnerabilities, including use of alcohol, tobacco and other drugs (ATOD), co-occurrence of penetrative sex with use of ATOD, health related self-efficacy, personal beliefs about health, peer perceptions, and use of contraceptives. The Rasch analysis calibrated data on 50 items from the conceptually distinct health risk domains. Infit and Outfit mean square statistics and principal components analysis of the standardized residuals suggested a fit of the data to the unidimensional Rasch measurement model. The findings support a syndrome view of health risk in teenagers as proposed by problem behavior theory. Mpofu, E., Caldwell, L., Smith, E., Flisher, A., Mathews, C., Wegner, L., and Vergnani, T. Rasch Modeling of the Structure of Health Risk Behavior in South African Adolescents. J Appl Meas, 7(3), pp. 323-334, 2006.

Parent Daily Report Checklist Can Be Used to Predict Foster Care Disruptions

The objective of this study was to identify reliable, inexpensive predictors of foster care placement disruption that could be used to assess risk of placement failure. Using the Parent Daily Report Checklist (PDR), foster or kinship parents of 246 children (5-12 years old; 131 boys, 115 girls) in California were interviewed three times about whether or not their foster child engaged in any of the 30 problem behaviors during the previous 24 hours. The PDR was conducted during telephone contacts (5-10 min each) that occurred from 1 to 3 days apart at baseline. Disruptions were tracked for the subsequent 12 months. Other potential predictors of disruption were examined, including the child's age, gender, and ethnicity, the foster parent's ethnicity, the number of other children in the foster home, and the type of placement (kin or non-kin). Foster/kin parents reported an average of 5.77 child problems per day on the PDR checklist. The number of problem behaviors was linearly related to the child's risk of placement disruption during the subsequent year. The threshold for the number of problem behaviors per day that foster and kinship parents tolerated without increased risk of placement disruption for these latency-aged children was 6 or fewer. Children in non-kin placements were more likely to disrupt than those in kinship placements. There was a trend for increased risk of disruption as the number of children in the home increased. The PDR Checklist may be useful in predicting which placements are at most risk of future disruption, allowing for targeted services and supports. Chamberlain, P., Price, J.M., Reid, J.B., Landsverk, J., Fisher, P.A., and Stoolmiller, M. Who Disrupts from Placement in Foster and Kinship Care? Child Abuse & Neglect, 30, pp. 409-424, 2006.

Predicting Reunification Failures in Foster Care

Previous studies have suggested that roughly 30% of all reunified foster children reenter foster care. Because reunification is one of the primary objectives of the child welfare system, it is imperative that correlates of reunification failure across parent, child, service, home and neighborhood domains be better understood. This study examined post-reunification variables regarding parent characteristics, child characteristics, parent service utilization, child service utilization, family environment, and neighborhood environment as they relate to reunification failure. The sample for the study included 16 foster children who, at reunification with their birth parents, ranged in age from 4-7 years. All participants were reunified with at least one parent. Among the variables found to significantly differentiate between failed and successful reunifications were parental utilization of substance abuse treatment, child utilization of special educational services, child utilization of individual, family, or group therapy, overall parenting skill level, appropriate use of discipline, and quality of neighborhood. The article discusses the implications of these results for policies aimed at increasing the success rate of reunifications following foster care. Miller, K.A., Fisher, P.A., Fetrow, B., and Jordan, K. Trouble on the Journey Home: Reunification Failures in Foster Care. Children and Youth Services Review, 28, pp. 260-274, 2006.

Classroom Contextual Effects of Race on Children's Peer Nominations

Black children generally receive poorer sociometric nominations compared with Whites. This effect is not fully understood because Black children rarely hold a classroom majority and teachers' race is rarely investigated. Research from a person-environment perspective suggests that the effects of children's race depend on the racial composition of the classroom and society's racial attitudes. Sociometric nominations were obtained from 1,268 5th graders, between 9 and 11 years old (53% Black), across 57 classrooms (3-95% Black students). Half of the teachers were Black. The results indicated that ratings of Black children were more influenced by the racial context of classrooms than were ratings of White children. The implications of this study are discussed in relation to group dynamics and racial discrimination. Jackson, M., Barth, J., Powell, N., and Lochman, J. Classroom Contextual Effects of Race on Children's Peer Nominations. Child Dev, 77(5), pp. 1325-1337, 2006.

Improving Consent Return Rates Among Urban Elementary Students

This paper reports on consent form return rates for 3rd grade students attending schools in low-income, urban areas, where the researchers developed procedures to maximize their active parent consent efforts. The schools and participants were part of a larger study of a school-based prevention program. Research staff used a class incentive and class visits to retrieve consent forms from students. Of the 811 third-grade students, 98% returned a form and 79% (n = 627) of those students' parents provided an affirmative response. Return rates did not vary by students' ethnicity or by the schools' demographic variables. The authors conclude that incentives and class visits can yield a high return rate of active parent consent forms for third-grade minority, urban, low-income students. Ji, P., Flay, B., Dubois, D., Brechling, V., Day, J., and Cantillon, D. Consent Form Return Rates for Third-grade Urban Elementary Students. Am J Health Behav, 30(5), pp. 467-474, 2006.

The Relationship of Family Instability to Child Maladjustment

This study examines the relation between family instability and child maladjustment over a 6-year period in 369 children from four communities. The children and families were part of a larger study examining the impact of the multi-level, multi-year Fast Track preventive intervention on child conduct problems. Measures were collected annually from kindergarten through fifth grade. In associative growth curve models, family instability trajectories predicted children's externalizing and internalizing behavior trajectories during this time period. High levels of family instability also incrementally predicted the likelihood of meeting criteria for a DSM IV diagnosis during elementary school, above and beyond prediction from earlier measures of maladjustment. However, the timing of family instability had a different effect on externalizing versus internalizing disorders. In general, stronger relations were found between family instability and externalizing behaviors relative to internalizing behaviors, although children with comorbid disorders experienced the highest levels of family instability. Future research that examines the underlying mechanisms that account for the influence of family instability on child maladjustment is discussed. Milan, S., Pinderhughes, E., and Pinderhughes, E.T. Family Instability and Child Maladjustment Trajectories During Elementary School. J Abnorm Child Psychol, 34(1), pp. 43-56, 2006.

Time Varying Family and Peer Influences on Adolescent Daily Mood

The time-varying influences of peer and family support on adolescent daily mood were explored among 268 youth transitioning from middle school to high school (8th to 9th grade) as compared to 240 youth transitioning from 10th to 11th grade. The participants were part of a larger study examining the natural history of smoking. Real-time ecological momentary assessments measures of daily positive and negative affect were collected via palmtop computers at baseline, 6 months, and 12 months. Participants rated 12 mood adjectives in response to 5 to 7 random prompts per day for 7 consecutive days. Perceived peer and family support were assessed via self-report. Mixed-effects regression analyses revealed significant grade by time by peer support interactions for positive and negative mood, with the younger cohort showing greater increases in the relation between peer support and affect over time than the older cohort. Family support did not interact with cohort or time. The authors summarize that peer influences may increase as adolescents develop, thus developmental influences should be included in examinations of dynamic relations between peers and adolescent mood. Also, these results may help elucidate transitions that may be optimal times for preventive interventions targeting emotional well-being of adolescents, specifically transition to high school. This transition point also coincides with a growth in mood disorders in adolescents, in particular girls. Girls were found to exhibit higher levels of negative moods at lower levels of peer support, relative to boys. The authors call for future research that captures the bidirectional nature of support--mood relations across adolescence. Weinstein, S., Mermelstein, R., Hedeker, D., Hankin, B., and Flay, B. The Time-varying Influences of Peer and Family Support on Adolescent Daily Positive and Negative Affect. J Clin Child Adolesc Psychol, 35(3), pp. 420-430, 2006.

Trajectories of Depression in Male and Female Children of Depressed Mothers

This study reports on relationships among gender, maternal depressed mood, and children's trajectories of depressive phenomena across middle childhood and early adolescence. It tested the hypothesis that, compared to boys, girls become increasingly vulnerable to maternal depression as they enter adolescence. The study sample consisted of 834 families from 10 Pacific Northwest schools that participated in the Raising Healthy Children project, a longitudinal study of the etiology of problem behaviors and test of a multicomponent, multiyear intervention targeting risk and protective factors within key child socializing domains of family, school, peer, group, and individual. Maternal depressed mood and children's depressive phenomena were assessed annually during an 8-year period that spanned Grade 3 through Grade 10 for the children. Mean scores for girls' depressive phenomena increased relative to those for boys as children matured. Maternal depressed mood was significantly and positively associated with children's level of depressive phenomena. An interaction effect of gender and maternal depressed mood on acceleration in children's depressive phenomena indicated that girls' trajectories of depressive phenomena were sustained in the presence of maternal depression while those of boys declined in the presence of maternal depression. Implications for the prevention and treatment of adolescent depression are discussed. Cortes, R.C., Fleming, C.B., Catalano, R.F., and Brown, E.C. Gender Differences in the Association Between Maternal Depressed Mood and Child Depressive Phenomena from Grade 3 Through Grade 10. J Youth Adolescence, 35, pp. 815-826, 2006.

Tobacco Litigation In Argentina

This project evaluated the processes and outcomes of tobacco litigation in Argentina by analyzing the strategies and documents which the tobacco industry used to oppose litigation. A systematic search of tobacco industry documents on the internet dating from 1978 to 2002, and law library searches for Argentinean official and unofficial reports were combined with other online searches. This search pointed out that there have been at least 15 failed litigation cases in Argentina where the tobacco industry has been able to present a concerted defense in every claim regardless of cost. Industry strategies included hiring legal consultants from prestigious international and Argentinean law firms, monitoring of legal and academic meetings, controlling the development of new product liability legislation, obtaining favorable opinions from experts, and closely observing the development of litigation in Argentina. These strategies used by the industry have been successful in preventing recovery for tobacco injuries through litigation. The conclusion of this study is that Argentinean health advocates and lawyers need to be aware of the roles and strategies of the tobacco industry in order to develop effective litigation in Argentina. Flores, M., Barnoya, J., Mejia, R., Alderete, E., and Perez-Stable, E. Litigation in Argentina: Challenging the Tobacco Industry. Tob Control, 15(2), pp. 90-96, 2006.

Translation of Prevention Interventions From Research to Practice

This article summarizes research on Type II translation of prevention interventions aimed at enhancing the adoption of effective programs and practices in communities. The primary goal of Type II translation is to institutionalize evidence-based programs, products, and services. First, the authors describe theoretical frameworks that are useful to guide Type II translation research. Second, research on prevention program implementation, including fidelity of implementation and factors that are associated with successful program implementation, is summarized. The authors describe interventions designed to enhance the dissemination of preventive interventions in community and public health settings. Third, they describe strategies used by prevention program developers who have taken programs to scale. Fourth, they present a case example of Project Towards No Drug Abuse (TND), an empirically validated high school-based substance abuse prevention program. They describe ongoing research on the dissemination of Project TND. Finally, they provide suggestions for future Type II translation research. Rohrbach, L., Grana, R., Sussman, S., and Valente, T. Type II Translation: Transporting Prevention Interventions From Research to Real-world Settings. Eval Health Prof, 29(3), pp. 302-333, 2006.

Translation in the Health Professions: Converting Science into Action

The systematic translation of evidence-based research findings, tools, and information into practice is critical to improving the quality of our nation's health. However, despite several decades of advances in developing medical knowledge based on high-quality empirical evidence, widespread implementation of these findings into practice in diverse applied settings has not been achieved. This article reviews definitions and conceptual models that describe the translation of research from basic discovery to real-world applications, summarizes the various issues involved in the process of translation, discusses multiple barriers, and provides recommendations to surmount these hurdles. Areas of further research in this arena are suggested. Finally, the article concludes that translational research is an important area to continue to pursue requiring long-term collaborative commitment among researchers and practitioners. Sussman, S., Valente, T., Rohrbach, L., Skara, S., and Pentz, M. Translation in the Health Professions: Converting Science into Action. Eval Health Prof, 29(1), pp. 7-32, 2006.

Universal Drug Prevention Programs Reduce Methamphetamine Use

This study examined the long-term effects of universal preventive interventions on methamphetamine use by adolescents in the general population during their late high school years, using data from two randomized, controlled prevention trials were. Participants attended public middle schools in the Midwest from 1993 to 2004. Study 1 began with 667 sixth grade students from 33 rural public schools, who were followed up 6 _ years later (grade 12); the follow-up included 457 students. Study 2 began with 679 seventh grade students from 36 rural public schools who were followed up 4 _ (grade 11) and 5 _ (grade 12) years later; the follow-up assessment included 597 students. Three interventions were used across the two RCTs. In study 1, schools were assigned to the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years, or a control condition. In study 2, schools were assigned to a revised ISFP (SFP 10- 14) plus Life Skills Training (SPF 10-14_LST), LST alone, or a control condition. Self-reports of lifetime and past-year methamphetamine use were collected at 6_ years past baseline (study 1) and at 4_ and 5_ years past baseline (study 2). In study 1, the ISFP past-year rate was 0.0% compared with 3.2% in the control condition (P=.04). In study 2, SFP 10-14_LST showed significant effects on lifetime and past-year use at the 4_year follow-up (eg, 0.5% lifetime use in the intervention condition vs 5.2% in the control condition, P=.006); both SFP 10-14_LST and LST alone had significant lifetime use effects at the 5_ year follow-up. Findings demonstrate that brief universal interventions have potential for public health impact by reducing methamphetamine use among adolescents. Spoth, R.L., Clair, S., Shin, C., and Redmond, C. Long-term Effects of Universal Preventive Interventions on Methamphetamine Use Among Adolescents. Arch Pediatr Adolesc Med, 160 pp. 876-882, 2006.

Raising Healthy Children Promotes Alcohol-free Driving

This study evaluated the impact of two targeted family sessions focused on driving issues delivered within the context of the Raising Healthy Children project. The Raising Healthy Children project began in the fall of 1993, drawing students in the 1st or 2nd grades from 10 schools. Schools were assigned to an intervention or control condition, and the school-wide, family- and student-focused preventive intervention to address developmentally salient risk and protective factors was delivered during elementary and middle school. The family driving sessions were administered to families in the intervention condition prior to and after teenagers received their driver's license. The first session consisted of a home visit with families designed to help parents and their children improve decision-making skills concerning driving and to develop clear standards and expectations regarding driving-related behavior. A second session, at the time of licensure, was designed to help parents and teens develop a written contract that stated family expectations, a plan for monitoring compliance with these expectations, and consequences for compliance or non-compliance. Consistent with the study's group-randomized design, intervention effects were assessed with multi-level logistic regression models in which students were grouped by their original school assignment. These models assessed specific effects of the driving sessions by adjusting for control variables measured when students were in 8th grade, prior to the driving sessions. Results indicated that students in the intervention group were more likely than students in the control group to report that they had a written driving contract (p = .003, OR = 4.98) and had participated in making the driving rules in the family (p = .025, OR = 1.70). Further, students in the intervention group reported significantly fewer risky behaviors including driving under the influence of alcohol (p = .021, OR = .45) and driving with someone who had been drinking (p = .038, OR = .56). Haggerty, K.P., Fleming, C.B., Catalano, R.F., Harachi, T.W., and Abbott, R.D. Raising Healthy Children: Examining the Impact of Promoting Healthy Driving Behavior within a Social Development Intervention. Prev Sci, 7 pp. 257-267, 2006.

Predictors of Intervention Adherence Among Young People Living With HIV

This study examined adherence to a 23-session intervention for young people living with HIV. Two hundred eight HIV-positive youth were assigned by small cohort to a behavioral intervention. Results showed that youth with more personal strengths were more likely to attend the intervention; those with more competing environmental demands (eg, employment, school) were less likely to attend the intervention. Using a social support, spiritual hope, or self-destructive and escape coping style was associated with attendance. Youth who reported many sexual partners attended fewer sessions. Adherence varied by cohort assignment. It was concluded that high attendance should be considered as a goal when designing future interventions. Song, J., Lee, M., Rotheram-Borus, M., and Swendeman, D. Predictors of Intervention Adherence Among Young People Living With HIV. Am J Health Behav, 30(2), pp. 136-146, 2006.

Family Focused Intervention Provides Similar Benefits for High and Low Risk Youth

This study extends earlier investigation of family risk-related moderation of two brief, family-focused preventive interventions. It examines effects on the trajectories of substance initiation over a period of six years after a pretest assessment, evaluating whether effects were comparable across higher- and lower-risk subgroups. The two interventions, designed for general-population families of adolescents, were the seven-session Iowa Strengthening Families Program (ISFP) and the five-session Preparing for the Drug Free Years program (PDFY). Thirty-three rural public schools were randomly assigned to either the ISFP, the PDFY, or a minimal contact control condition. Curvilinear growth curve analyses were used to evaluate the universality of intervention effectiveness by testing for risk moderation of intervention effects on school-level substance use trajectories of initiation of alcohol and illicit substance use. Results were most consistent with the interpretation that both interventions provided comparable benefits for both outcome measures, regardless of family risk status. Findings are discussed in terms of their implications for implementing universal preventive interventions in general populations. Spoth, R., Shin, C., Guyll, M., Redmond, C., and Azevedo, K. Universality of Effects: An Examination of the Comparability of Long-term Family Intervention Effects on Substance use Across Risk-related Subgroups. Prev Sci, 7(2), pp. 209-224, 2006.

Internet-Based Intervention for Mental Health and Substance Use Problems in Disaster-Affected Populations: A Pilot Feasibility Study

Early interventions that reduce the societal burden of mental health problems in the aftermath of disasters and mass violence have the potential to be enormously valuable. Internet-based interventions can be delivered widely, efficiently, and at low cost and as such are of particular interest. The development and feasibility analysis of an Internet-delivered intervention designed to address mental health and substance-related reactions in disaster-affected populations is described. Participants (n = 285) were recruited from a cohort of New York City-area residents that had been followed longitudinally in epidemiological research initiated 6 months after the terrorist attacks of September 11, 2001. The intervention consisted of 7 modules: posttraumatic stress/panic, depression, generalized anxiety, alcohol use, marijuana use, drug use, and cigarette use. Feasibility data were promising and suggest the need for further evaluation. Ruggiero, K., Resnick, H., Acierno, R., Coffey, S., Carpenter, M., Ruscio, A., Stephens, R., Kilpatrick, D., Stasiewicz, P., Roffman, R., Bucuvalas, M., and Galea, S. Internet-Based Intervention for Mental Health and Substance Use Problems in Disaster-Affected Populations: A Pilot Feasibility Study. Behav Ther, 37(2), pp. 190-205, 2006.

Providing Prevention Services for Conduct Problems to High Risk Children and Their Families

This study examined whether the link between risk factors for conduct problems and low rates of participation in mental health treatment could be decoupled through the provision of integrated prevention services in multiple easily-accessible contexts. It included 445 families of first-grade children (55% minority), living in four diverse communities, and selected for early signs of conduct problems. Children and families were participants in a larger study of a multi-component, multi-year Program, Fast Track, designed to prevent conduct problems among young children already exhibiting behavior problems. Results indicated that, under the right circumstances, these children and families could be enticed to participate at high rates in school-based services, therapeutic groups, and home visits. For example, 49% of the sample received a majority of the intervention services that were provided: 92% of school-based services, 88% of therapeutic groups, and 92% of home visits. Only 6% of the sample participated in a greater proportion of services. Because different sets of risk factors were related to different profiles of participation across the components of the prevention program, findings highlight the need to offer services in multiple contexts to reach all children and families who might benefit from them. Nix, R., Pinderhughes, E., Bierman, K., Maples, J., and Maples, J.T. Decoupling the Relation Between Risk Factors for Conduct Problems and the Receipt of Intervention Services: Participation Across Multiple Components of a Prevention Program. Am J Community Psychol, 36(3-4), pp. 307-325, 2005.

Prevention Program Format May Impact Participant Initiation and Exposure Rates

The primary aim of this study was to compare participation rates in two different formats of "Parents Who Care" a universal, family-based preventive intervention. Participants in the study were blocked on race and gender and randomized to three conditions: 1) a self administered format (SA) involving a video and workbook to be completed within 10 weeks 2) a parent adolescent group format (PAG) involving seven weekly meetings and 3) a no intervention control group. In this study, predictors of participation and exposure were compared across the two intervention formats. Families of 225 8th-grade students were assigned to the (PAG) or the (SA) group. Logistic regression showed greater program initiation in SA than in PAG. Hierarchical regression showed only one variable (parent high-risk behavior) to be associated with lower program exposure in the self-administered format. In contrast, demographic variables (e.g., being African American) predicted lower exposure in PAG. Overall, the findings of this study were notable in that most of the variables that have been identified in past research as lowering participation rates were not related to program initiation or level of exposure to either format of "Parents Who Care". Further, the self-administered format may be particularly useful to increase program participation for families, even those who are traditionally difficult to reach. Haggerty, K., MacKenzie, E., Skinner, M., Harachi, T., and Catalano, R. Participation in "Parents Who Care": Predicting Program Initiation and Exposure in Two Different Program Formats. J Prim Prev, 27(1), pp. 47-65, 2006.

Peer Health Advocates are Trusted as Sources for HIV Prevention Material by Drug Using Peers

This article presents results from a process evaluation of a peer-led HIV prevention intervention. The Risk Avoidance Partnership, conducted from 2001 to 2005, trained active drug users to be peer health advocates (PHAs) to provide harm reduction materials and information to their peers. Results indicate that PHAs actively conducted harm reduction outreach both when partnered with staff and on their own time. Although PHAs conducted most of their outreach in public locations, they also provided drug users with harm reduction materials at critical moments in places where HIV risky behaviors were likely to occur. PHAs were credible and trusted sources of information to their drug-using peers who sought PHAs out for HIV prevention materials. Process evaluations of successful HIV prevention interventions are necessary to understand how and why such interventions work for further intervention refinement. Dickson-Gomez, J., Weeks, M., Martinez, M., and Convey, M. Times and Places: Process Evaluation of a Peer-led HIV Prevention Intervention. Subst Use Misuse, 41(5), pp. 669-690, 2006.

Tailoring Tobacco Counteradvertisements for Bicultural Mexican American Youth

The growing population of Mexican American youth and the increasing smoking rates in this population present a considerable public health challenge and little is known about the most effective ways to adapt messages aimed at this audience. To explore key variables that can affect success, a study was conducted with 249 Mexican American middle-school youth from a U.S./Mexico border community to examine the effectiveness of language (English, Spanish, or a combination of English and Spanish) and theme (secondhand smoke, anti-tobacco social norms, and tobacco industry manipulation) in print tobacco counteradvertisements. Measures included ad preferences, acculturation, and tobacco-related attitudes and behavior. Results showed that although a large percentage identified with the Mexican American rather than the Anglo American culture and spoke Spanish in selected contexts, readability was greater for ads in English, and participants rated the English ads as most effective. The social norms counteradvertisement was preferred overall. Kelly, K., Stanley, L., Comello, M., and Gonzalez, G. Tobacco Counteradvertisements Aimed at Bicultural Mexican American Youth: The Impact of Language and Theme. J Health Commun, 11(5), pp. 455-476, 2006.

Group Interventions May be Able to Minimize Peer Contagion

This study involving novel methodology applies a multi-player arms race model to peer contagion in the aggressive and delinquent behaviors of inner-city elementary school students. Because this model of peer contagion differs from the usual model based on positive reinforcement of delinquent behavior, it raises the possibility that the persistent finding of iatrogenic effects of group treatment might not apply to group treatment of elementary school children if aggressive behavior in the group is limited. One way of limiting aggressive behavior is to include parents in the groups. To test this hypothesis, this study applies the model to groups of elementary school students assigned to Families and Schools Together (FAST), a group treatment that includes parental participation, or to an intervention focused on individual families. Data came from a longitudinal study of 403 children, their parents, and their teachers who participated in an evaluation of the FAST program. The model effectively describes the relationship between group averages of aggressive behavior in the classroom and aggressive and delinquent behavior outside the classroom for those students assigned to the individual intervention. The model fits those children assigned to FAST less well, suggesting that FAST may make it less likely that aggressive and delinquent behavior is generalized outside of aggressive classroom settings. Warren, K., Moberg, D., and McDonald, L. FAST and the Arms Race: The Interaction of Group Aggression and the Families and Schools Together Program in the Aggressive and Delinquent Behaviors of Inner-city Elementary School Students. J Prim Prev, 27(1), pp. 27-45, 2006.

Recommendations for the Prevention of HIV Transmission in Hispanic Adolescents

This article reviews the state of the science in HIV prevention for Hispanic adolescents. Literature is reviewed in three broad areas: (1) the prevalence rates of drug and alcohol misuse, sexual practices, and HIV infection; (2) risk and protective factors for drug and alcohol misuse and unprotected sex (in general and specifically for Hispanics); and (3) the state of HIV prevention intervention development and evaluation targeting Hispanic youth. Little basic and intervention research has been conducted on HIV prevention in Hispanic adolescents, with even less attention given to Hispanic young men who have sex with men (YMSM). There are a number of areas in which further knowledge development and scientific advancement are needed. The seven areas identified in this review were (a) the need for analyses of nationwide epidemiological data examining risk and protective factors for substance use and unsafe sexual behavior for heterosexual and homosexual youth; (b) explaining variations in drug/alcohol use, unsafe sexual behavior, and HIV infection among Hispanic subgroups; (c) need for adaptive preventive interventions for Hispanic subgroups with varying risk and protection profiles; (d) incorporation of ethnic, cultural, and sexual identity into prevention programs for Hispanic adolescents; (e) examination of the role of gender in preventive interventions for Hispanic adolescents; (f) research on the effects of psychiatric comorbidity on drug/alcohol use and unsafe sex and on the efficacy of prevention programs; and (g) increased focus on intravenous drug use as a mode of HIV infection among Hispanics, particularly Puerto Ricans. Research addressing these research needs has the potential to facilitate progress toward achieving the two primary objectives of Healthy People 2010--improving the quality of life for all Americans and reducing health disparities between and among segments of the U.S. population. Prado, G., Schwartz, S.J., Pattatucci-Aragon, A., Clatts, M., Pantin, H., Fernandez, M., Lopez, B., Briones, E., Amarof, H., and Szapocznik, J. The Prevention of HIV Transmission in Hispanic Adolescents. Drug Alcohol Depend, 84S pp. S43-S53, 2006.

Unprotected Sex Among Youth Living With HIV Before and After the Advent of Highly Active Antiretroviral Therapy

Since the advent of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV-especially among young men who have sex with men-and the prevalence of unprotected sex among HIV-positive persons have increased. The characteristics associated with unprotected sex among youth living with HIV since the advent of HAART have not been explored. Samples of HIV-positive youth aged 13-24 were taken from two intervention studies that targeted the sexual behaviors of HIV-positive youth-one from 1994 to 1996 (pre-HAART) and the other from 1999 to 2000 (post-HAART). Generalized estimating equations were used to identify characteristics associated with unprotected sex in each sample. The prevalence of unprotected sex in the post-HAART sample was more than twice that in the pre-HAART sample (62% vs. 25%). Among the pre-HAART sample, being a man who has sex with men and having sex with a casual partner were negatively associated with the odds of unprotected intercourse (odds ratios, 0.5 and 0.2, respectively). Among the post-HAART sample, unprotected sex was negatively associated with knowing that a partner was HIV-negative (0.2) and positively associated with poorer mental health (1.02). In analyses among the post-HAART sample, poorer mental health was associated with increased odds of unprotected sex among youth living with HIV who were not receiving the treatment (1.02). It was concluded that interventions for HIV-positive youth must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health. Rice, E., Batterham, P., and Rotheram-Borus, M. Unprotected Sex Among Youth Living With HIV Before and After the Advent of Highly Active Antiretroviral Therapy. Perspect Sex Reprod Health, 38(3), pp. 162-167, 2006.

Predictors of HIV-Related Stigma Among Young People Living with HIV

Enacted and perceived HIV stigma was examined among 147 substance-using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City. Almost all YPLH (89%) reported perceived stigma, 31% reported enacted experiences in the past 3 months; and 64% reported experiences during their lifetime. The HIV stigma questions were characterized by factors of avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay or bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV stigma than their heterosexual peers. Swendeman, D., Rotheram-Borus, M., Comulada, S., Weiss, R., and Ramos, M. Predictors of HIV-Related Stigma Among Young People Living with HIV. Health Psychol, 25(4), pp. 501-509, 2006.

Prevalence and Correlates of Exchanging Sex for Drugs or Money Among Adolescents in the United States

This study examined the prevalence and correlates of exchanging sex for drugs or money among a nationally representative sample of 13,294 adolescents in the United States. Data are from the National Longitudinal Study of Adolescent Health, waves I and II. The lifetime prevalence of exchanging sex was estimated and a cross sectional analysis of sociodemographic and behavioral correlates was conducted. Unadjusted odds ratios were obtained. Results showed that 3.5% of adolescents had ever exchanged sex for drugs or money; two-thirds of these youths were boys. The odds of having exchanged sex were higher for youths who had used drugs, had run away from home, were depressed, and had engaged in various sexual risk behaviors. 15% of boys and 20% of girls who had exchanged sex reported they had ever been told they have HIV or another sexually transmitted infection (STI). It was concluded that adolescents with a history of exchanging sex have engaged in other high risk behaviors and may experience poor health outcomes, including depression and HIV/STIs. These findings should help inform strategies to prevent this high risk sexual behavior and its potential consequences. Edwards, J., Iritani, B., and Hallfors, D. Prevalence and Correlates of Exchanging Sex for Drugs or Money Among Adolescents in the United States. Sex Transm Infect, 82(5), pp. 354-358, 2006.

Gender Differences in Associations Between Depressive Symptoms and Patterns of Substance Use and Risky Sexual Behavior Among a Nationally Representative Sample of U.S. Adolescents

This study uses a cluster analysis of adolescents, based on their substance use and sexual risk behaviors, to 1) examine associations between risk behavior patterns and depressive symptoms, stratified by gender, and 2) examine gender differences in risk for depression. Data are from a nationally representative survey of over 20,000 U.S. adolescents. Logistic regression was used to examine the associations between 16 risk behavior patterns and current depressive symptoms by gender. Compared to abstention, involvement in common adolescent risk behaviors (drinking, smoking, and sexual intercourse) was associated with increased odds of depressive symptoms in both sexes. However, sex differences in depressive symptoms vary by risk behavior pattern. There were no differences in odds for depressive symptoms between abstaining male and female adolescents (OR = 1.07, 95% CI 0.70-1.62). There were also few sex differences in odds of depressive symptoms within the highest-risk behavior profiles. Among adolescents showing light and moderate risk behavior patterns, females experienced significantly more depressive symptoms than males. It was concluded that adolescents who engage in risk behaviors are at increased risk for depressive symptoms. Girls engaging in low and moderate substance use and sexual activity experience more depressive symptoms than boys with similar behavior. Screening for depression is indicated for female adolescents engaging in even experimental risk behaviors. Waller, M., Hallfors, D., Halpern, C., Iritani, B., Ford, C., and Guo, G. Gender Differences in Associations Between Depressive Symptoms and Patterns of Substance use and Risky Sexual Behavior Among A Nationally Representative Sample of U.S. Adolescents. Arch Womens Ment Health, 9(3), pp. 139-150, 2006.

Genetic Contribution to Suicidal Behaviors and Associated Risk Factors Among Adolescents in the U.S.

This paper examines genetic contribution to suicidal behaviors and other risk factors associated with suicidal behavior among adolescents in the U.S. Using adolescent twin data in the National Longitudinal Study of Adolescent Health (N=1448), authors compared concordance in suicidal ideation and attempt among monozygotic (MZ) and dizygotic (DZ) twins. Heritability of risk factors for suicidal behaviors also was examined using Pearson correlation and mixed-model analyses. A trend of higher concordance in suicidal ideation and attempt was found among MZ than DZ twins but the difference was not statistically significant by the stringent test of bootstrapping analysis. Evidence of heritability was found for several suicide risk factors. The percentage of variance explained by heritability was larger among female twins for depression, aggression, and quantity of cigarettes smoked in comparison to heritability estimates for male twins. However, estimated heritability was larger among male than female twins for alcohol use and binge drinking. Heritability influence was negligible among both sexes for other drug use. Risk factors for suicidal behaviors among adolescents may be heritable. Gender differences found in the heritability of some suicide risk factors suggest these genetic contributions are gender specific. Future research examining potential interactions between expression of genetic influence and particular environmental contexts may enhance prevention and intervention efforts. Cho, H., Guo, G., Iritani, B.J., and Hallfors, D.D. Genetic Contribution to Suicidal Behaviors and Associated Risk Factors Among Adolescents in the U.S. Prev Sci, 7(3), pp. 303-311, 2006.

In School Alcohol and Marijuana Use Among High School Students

The problem of adolescent substance use has been examined extensively. Beyond simple prevalence estimates, however, little research has been conducted on substance use in the school context. The present investigation was an in-depth study of students' attitudes and behaviors regarding alcohol and marijuana use during the school day. Based on a representative sample of 1123 high school students, 48% male, in grades 9-12 in western New York state, this study assessed the frequency of alcohol and marijuana use at school among demographic subgroups, the accessibility of drugs in school, and students' perceived consequences of being caught using drugs in school. Twelve percent of the sample reported using alcohol during school hours in the past 6 months while 16% reported using marijuana at school. Among students who used alcohol outside of school, 18% also used alcohol at school. For marijuana users, 47% used marijuana at school. There was evidence of some demographic differences in school drug use. Specifically, male and Hispanic students had slightly higher levels of drug use at school compared to female and white students, respectively, and in school drug use was more prevalent among older students. In terms of accessibility, students reported that alcohol and marijuana were easily obtained and used on school grounds. Many students (40%) were not aware of the specific actions taken in their schools to punish drug use. The need for additional research on school-related drug use is emphasized. Finn, K. V. Patterns of Alcohol and Marijuana Use at School. Journal of Research on Adolescence, 16(1), pp. 69-77, 2006.

Methodological Considerations for Testing Causal Effects in Drug Abuse Prevention Research

Observational data are often used to address prevention questions such as, "If alcohol initiation could be delayed, would that in turn cause a delay in marijuana initiation?" This question is concerned with the total causal effect of the timing of alcohol initiation on the timing of marijuana initiation. Unfortunately, when observational data are used to address a question such as the above, alternative explanations for the observed relationship between the predictor, here timing of alcohol initiation, and the response abound. These alternative explanations are due to the presence of confounders. Adjusting for confounders when using observational data is a particularly challenging problem when the predictor and confounders are time-varying. When time-varying confounders are present, the standard method of adjusting for confounders may fail to reduce bias and indeed can increase bias. In this paper, an intuitive and accessible graphical approach was used to illustrate how the standard method of controlling for confounders may result in biased total causal effect estimates. Based on the graphical approach, an alternative method proposed by James Robins was used to examine causal effect estimates. Implications for prevention researchers who wish to estimate total causal effects using longitudinal observational data are discussed. Bray, B., Almirall, D., Zimmerman, R., Lynam, D., and Murphy, S. Assessing the Total Effect of Time-varying Predictors in Prevention Research. Prev Sci, 7(1), pp. 1-17, 2006.

Rasch Analysis of Data From Prevention Study in South Africa Supports Jessors' Problem Behavior Theory

The goal of the study was to determine the presence of a syndrome of health risk behaviors in South African teenagers from Rasch modeling of items from self-report measures covering six conceptually distinct health risk domains selected because they are among the most assessed health risk outcomes in prevention research and practice. A total of 2186 in-school adolescents participated in the study (males = 1077; females = 1119; age range = 12-16 years; median = 13 years). The data are baseline from a longitudinal study of a leisure-based drug abuse and HIV/AIDS prevention program at Mitchell's Plain in Cape Town, South Africa. The adolescents completed a self-report measure on various health risk vulnerabilities, including use of alcohol, tobacco and other drugs (ATOD), co-occurrence of penetrative sex with use of ATOD, health related self-efficacy, personal beliefs about health, peer perceptions, and use of contraceptives. The Rasch analysis calibrated data on 50 items from the conceptually distinct health risk domains. Infit and Outfit mean square statistics and principal components analysis of the standardized residuals suggested a fit of the data to the unidimensional Rasch measurement model. The findings support a syndrome view of health risk in teenagers as proposed by problem behavior theory. Mpofu, E., Caldwell, L., Smith, E., Flisher, A., Mathews, C., Wegner, L., and Vergnani, T. Rasch Modeling of the Structure of Health Risk Behavior in South African Adolescents. J Appl Meas, 7(3), pp. 323-334, 2006.

Parent Daily Report Checklist Can Be Used to Predict Foster Care Disruptions

The objective of this study was to identify reliable, inexpensive predictors of foster care placement disruption that could be used to assess risk of placement failure. Using the Parent Daily Report Checklist (PDR), foster or kinship parents of 246 children (5-12 years old; 131 boys, 115 girls) in California were interviewed three times about whether or not their foster child engaged in any of the 30 problem behaviors during the previous 24 hours. The PDR was conducted during telephone contacts (5-10 min each) that occurred from 1 to 3 days apart at baseline. Disruptions were tracked for the subsequent 12 months. Other potential predictors of disruption were examined, including the child's age, gender, and ethnicity, the foster parent's ethnicity, the number of other children in the foster home, and the type of placement (kin or non-kin). Foster/kin parents reported an average of 5.77 child problems per day on the PDR checklist. The number of problem behaviors was linearly related to the child's risk of placement disruption during the subsequent year. The threshold for the number of problem behaviors per day that foster and kinship parents tolerated without increased risk of placement disruption for these latency-aged children was 6 or fewer. Children in non-kin placements were more likely to disrupt than those in kinship placements. There was a trend for increased risk of disruption as the number of children in the home increased. The PDR Checklist may be useful in predicting which placements are at most risk of future disruption, allowing for targeted services and supports. Chamberlain, P., Price, J.M., Reid, J.B., Landsverk, J., Fisher, P.A., and Stoolmiller, M. Who Disrupts from Placement in Foster and Kinship Care? Child Abuse & Neglect, 30, pp. 409-424, 2006.

Predicting Reunification Failures in Foster Care

Previous studies have suggested that roughly 30% of all reunified foster children reenter foster care. Because reunification is one of the primary objectives of the child welfare system, it is imperative that correlates of reunification failure across parent, child, service, home and neighborhood domains be better understood. This study examined post-reunification variables regarding parent characteristics, child characteristics, parent service utilization, child service utilization, family environment, and neighborhood environment as they relate to reunification failure. The sample for the study included 16 foster children who, at reunification with their birth parents, ranged in age from 4-7 years. All participants were reunified with at least one parent. Among the variables found to significantly differentiate between failed and successful reunifications were parental utilization of substance abuse treatment, child utilization of special educational services, child utilization of individual, family, or group therapy, overall parenting skill level, appropriate use of discipline, and quality of neighborhood. The article discusses the implications of these results for policies aimed at increasing the success rate of reunifications following foster care. Miller, K.A., Fisher, P.A., Fetrow, B., and Jordan, K. Trouble on the Journey Home: Reunification Failures in Foster Care. Children and Youth Services Review, 28, pp. 260-274, 2006.

Classroom Contextual Effects of Race on Children's Peer Nominations

Black children generally receive poorer sociometric nominations compared with Whites. This effect is not fully understood because Black children rarely hold a classroom majority and teachers' race is rarely investigated. Research from a person-environment perspective suggests that the effects of children's race depend on the racial composition of the classroom and society's racial attitudes. Sociometric nominations were obtained from 1,268 5th graders, between 9 and 11 years old (53% Black), across 57 classrooms (3-95% Black students). Half of the teachers were Black. The results indicated that ratings of Black children were more influenced by the racial context of classrooms than were ratings of White children. The implications of this study are discussed in relation to group dynamics and racial discrimination. Jackson, M., Barth, J., Powell, N., and Lochman, J. Classroom Contextual Effects of Race on Children's Peer Nominations. Child Dev, 77(5), pp. 1325-1337, 2006.

Improving Consent Return Rates Among Urban Elementary Students

This paper reports on consent form return rates for 3rd grade students attending schools in low-income, urban areas, where the researchers developed procedures to maximize their active parent consent efforts. The schools and participants were part of a larger study of a school-based prevention program. Research staff used a class incentive and class visits to retrieve consent forms from students. Of the 811 third-grade students, 98% returned a form and 79% (n = 627) of those students' parents provided an affirmative response. Return rates did not vary by students' ethnicity or by the schools' demographic variables. The authors conclude that incentives and class visits can yield a high return rate of active parent consent forms for third-grade minority, urban, low-income students. Ji, P., Flay, B., Dubois, D., Brechling, V., Day, J., and Cantillon, D. Consent Form Return Rates for Third-grade Urban Elementary Students. Am J Health Behav, 30(5), pp. 467-474, 2006.

The Relationship of Family Instability to Child Maladjustment

This study examines the relation between family instability and child maladjustment over a 6-year period in 369 children from four communities. The children and families were part of a larger study examining the impact of the multi-level, multi-year Fast Track preventive intervention on child conduct problems. Measures were collected annually from kindergarten through fifth grade. In associative growth curve models, family instability trajectories predicted children's externalizing and internalizing behavior trajectories during this time period. High levels of family instability also incrementally predicted the likelihood of meeting criteria for a DSM IV diagnosis during elementary school, above and beyond prediction from earlier measures of maladjustment. However, the timing of family instability had a different effect on externalizing versus internalizing disorders. In general, stronger relations were found between family instability and externalizing behaviors relative to internalizing behaviors, although children with comorbid disorders experienced the highest levels of family instability. Future research that examines the underlying mechanisms that account for the influence of family instability on child maladjustment is discussed. Milan, S., Pinderhughes, E., and Pinderhughes, E.T. Family Instability and Child Maladjustment Trajectories During Elementary School. J Abnorm Child Psychol, 34(1), pp. 43-56, 2006.

Time Varying Family and Peer Influences on Adolescent Daily Mood

The time-varying influences of peer and family support on adolescent daily mood were explored among 268 youth transitioning from middle school to high school (8th to 9th grade) as compared to 240 youth transitioning from 10th to 11th grade. The participants were part of a larger study examining the natural history of smoking. Real-time ecological momentary assessments measures of daily positive and negative affect were collected via palmtop computers at baseline, 6 months, and 12 months. Participants rated 12 mood adjectives in response to 5 to 7 random prompts per day for 7 consecutive days. Perceived peer and family support were assessed via self-report. Mixed-effects regression analyses revealed significant grade by time by peer support interactions for positive and negative mood, with the younger cohort showing greater increases in the relation between peer support and affect over time than the older cohort. Family support did not interact with cohort or time. The authors summarize that peer influences may increase as adolescents develop, thus developmental influences should be included in examinations of dynamic relations between peers and adolescent mood. Also, these results may help elucidate transitions that may be optimal times for preventive interventions targeting emotional well-being of adolescents, specifically transition to high school. This transition point also coincides with a growth in mood disorders in adolescents, in particular girls. Girls were found to exhibit higher levels of negative moods at lower levels of peer support, relative to boys. The authors call for future research that captures the bidirectional nature of support--mood relations across adolescence. Weinstein, S., Mermelstein, R., Hedeker, D., Hankin, B., and Flay, B. The Time-varying Influences of Peer and Family Support on Adolescent Daily Positive and Negative Affect. J Clin Child Adolesc Psychol, 35(3), pp. 420-430, 2006.

Trajectories of Depression in Male and Female Children of Depressed Mothers

This study reports on relationships among gender, maternal depressed mood, and children's trajectories of depressive phenomena across middle childhood and early adolescence. It tested the hypothesis that, compared to boys, girls become increasingly vulnerable to maternal depression as they enter adolescence. The study sample consisted of 834 families from 10 Pacific Northwest schools that participated in the Raising Healthy Children project, a longitudinal study of the etiology of problem behaviors and test of a multicomponent, multiyear intervention targeting risk and protective factors within key child socializing domains of family, school, peer, group, and individual. Maternal depressed mood and children's depressive phenomena were assessed annually during an 8-year period that spanned Grade 3 through Grade 10 for the children. Mean scores for girls' depressive phenomena increased relative to those for boys as children matured. Maternal depressed mood was significantly and positively associated with children's level of depressive phenomena. An interaction effect of gender and maternal depressed mood on acceleration in children's depressive phenomena indicated that girls' trajectories of depressive phenomena were sustained in the presence of maternal depression while those of boys declined in the presence of maternal depression. Implications for the prevention and treatment of adolescent depression are discussed. Cortes, R.C., Fleming, C.B., Catalano, R.F., and Brown, E.C. Gender Differences in the Association Between Maternal Depressed Mood and Child Depressive Phenomena from Grade 3 Through Grade 10. J Youth Adolescence, 35, pp. 815-826, 2006.

Tobacco Litigation In Argentina

This project evaluated the processes and outcomes of tobacco litigation in Argentina by analyzing the strategies and documents which the tobacco industry used to oppose litigation. A systematic search of tobacco industry documents on the internet dating from 1978 to 2002, and law library searches for Argentinean official and unofficial reports were combined with other online searches. This search pointed out that there have been at least 15 failed litigation cases in Argentina where the tobacco industry has been able to present a concerted defense in every claim regardless of cost. Industry strategies included hiring legal consultants from prestigious international and Argentinean law firms, monitoring of legal and academic meetings, controlling the development of new product liability legislation, obtaining favorable opinions from experts, and closely observing the development of litigation in Argentina. These strategies used by the industry have been successful in preventing recovery for tobacco injuries through litigation. The conclusion of this study is that Argentinean health advocates and lawyers need to be aware of the roles and strategies of the tobacco industry in order to develop effective litigation in Argentina. Flores, M., Barnoya, J., Mejia, R., Alderete, E., and Perez-Stable, E. Litigation in Argentina: Challenging the Tobacco Industry. Tob Control, 15(2), pp. 90-96, 2006.

Translation of Prevention Interventions From Research to Practice

This article summarizes research on Type II translation of prevention interventions aimed at enhancing the adoption of effective programs and practices in communities. The primary goal of Type II translation is to institutionalize evidence-based programs, products, and services. First, the authors describe theoretical frameworks that are useful to guide Type II translation research. Second, research on prevention program implementation, including fidelity of implementation and factors that are associated with successful program implementation, is summarized. The authors describe interventions designed to enhance the dissemination of preventive interventions in community and public health settings. Third, they describe strategies used by prevention program developers who have taken programs to scale. Fourth, they present a case example of Project Towards No Drug Abuse (TND), an empirically validated high school-based substance abuse prevention program. They describe ongoing research on the dissemination of Project TND. Finally, they provide suggestions for future Type II translation research. Rohrbach, L., Grana, R., Sussman, S., and Valente, T. Type II Translation: Transporting Prevention Interventions From Research to Real-world Settings. Eval Health Prof, 29(3), pp. 302-333, 2006.

Translation in the Health Professions: Converting Science into Action

The systematic translation of evidence-based research findings, tools, and information into practice is critical to improving the quality of our nation's health. However, despite several decades of advances in developing medical knowledge based on high-quality empirical evidence, widespread implementation of these findings into practice in diverse applied settings has not been achieved. This article reviews definitions and conceptual models that describe the translation of research from basic discovery to real-world applications, summarizes the various issues involved in the process of translation, discusses multiple barriers, and provides recommendations to surmount these hurdles. Areas of further research in this arena are suggested. Finally, the article concludes that translational research is an important area to continue to pursue requiring long-term collaborative commitment among researchers and practitioners. Sussman, S., Valente, T., Rohrbach, L., Skara, S., and Pentz, M. Translation in the Health Professions: Converting Science into Action. Eval Health Prof, 29(1), pp. 7-32, 2006.


Index

Research Findings

Program Activities

Extramural Policy and Review Activities

Congressional Affairs

International Activities

Meetings and Conferences

Media and Education Activities

Planned Meetings

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Staff Highlights

Grantee Honors



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