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Director's Report to the National Advisory Council on Drug Abuse - February, 2008

Research Findings - Prevention Research

Effects of a Nurse Visiting Program With African American Mothers and Infants On Age 9 Outcomes

This study examined the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2. A randomized, controlled trial in a public system of obstetric and pediatric care was conducted. A total of 743 primarily black women <29 weeks gestation, with previous live births and at least 2 socio-demographic risk characteristics (unmarried, <12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequealae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality. Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births/year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with control-group counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1-3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes. By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes. Olds, D., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K. et al. Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of a Randomized Trial. Pediatrics, 120(4), pp. e832-e845, 2007.

Long Term Follow up of Brief Intervention for Mandated College Students

It is known that brief interventions for mandated college students decrease alcohol use and/or related problems in the short term. However, none of the existing studies has followed students past 6 months. Therefore, this study compared the long-term efficacy of 2 brief substance use feedback interventions for mandated college students. The study followed up mandated students (n = 348) who were randomly assigned to either a brief motivational interview (BMI; n = 180) or a written feedback-only (WF; n = 168) intervention at 4 months and 15 months post intervention. Long-term follow-up data revealed that students, at the aggregate level, decreased their peak blood alcohol concentration (BAC) levels, number of drinks per week, and number of alcohol related problems at 15 months post intervention compared with their baseline levels. With the exception of peak BAC, the observed long-term reduction was mainly due to the positive change among students who received the BMI intervention. Students in the BMI intervention showed significantly lower levels of alcohol-related problems at 15 months than those in the WF intervention. The BMI intervention more effectively reduced within-individual alcohol-related problems during the initial 4 months, and more successfully curbed the subsequent increase in alcohol use frequency and number of drinks per week during the 11 months between the 2 follow-up assessments. These results suggest that brief substance use interventions reduce the riskiest type of alcohol use (e.g., peak BAC) among mandated college students over the long term, and that sleeper effects of in-person personal feedback interventions (PFIs) exist. In-person PFIs in the context of a motivational interview may be more efficacious in the long term than written feedback-only interventions for mandated students. Future studies comparing interventions for college students should extend follow-up for longer periods of time. White, H.R., Mun, E.Y., Pugh, L., and Morgan, T.J. Long-Term Effects of Brief Substance Use Interventions for Mandated College Students: Sleeper Effects of an In-Person Personal Feedback Intervention. Alcohol Clin. Exp. Res., 31(8), pp. 1380-1391, 2007.

Drug Testing Has Little Effect on Student Athletes' Drug Use

This study was designed to assess the effects of random drug and alcohol testing (DAT) among high school athletes. This was a 2-year prospective randomized controlled study of a single cohort among five intervention high schools with a DAT policy and six schools with a deferred policy, serially assessed by voluntary, confidential questionnaires. DAT school athletes were at risk for random testing during the full academic year. Positive test results were reported to parents or guardians, with mandatory counseling. Indices of illicit drug use, with and without alcohol use, were assessed at the beginning and end of each school year for the past month and prior year. Potential mediating variables were evaluated. Student-athletes from intervention and control schools did not differ in past 1-month use of illicit drug or a combination of drug and alcohol use at any of the four follow-up periods. At the end of the initial school year and after 2 full school years, student-athletes at DAT schools reported less drug use during the past year (p < .01) compared to athletes at the deferred policy schools. Combining past year drug and alcohol use together, student-athletes at DAT schools reported less use at the second and third follow-up assessments (p < .05). Paradoxically, DAT athletes across all assessments reported less athletic competence (p < .001), less belief authorities were opposed to drug use (p < .01), and indicated greater risk-taking (p < .05). At the final assessment, DAT athletes believed less in testing benefits (p < .05) and less that testing was a reason not to use drugs (p < .01). No DAT deterrent effects were evident for past month use during any of four follow-up periods. Prior-year drug use was reduced in two of four follow-up self-reports, and a combination of drug and alcohol use was reduced at two assessments as well. Overall, drug testing was accompanied by an increase in some risk factors for future substance use. More research is needed before DAT is considered an effective deterrent for school-based athletes. Goldberg, L., Elliot, D.L., MacKinnon, D.P., Moe, E.L., Kuehl, K.S., and Yoon, M. Outcomes of a Prospective Trial of Student-Athlete Drug Testing: The Student Athlete Testing Using Random Notification (SATURN) Study. J. Adolescent Health, 41 pp. 421-429, 2007.

Factors among Collaborative Community Teams that Influence Prevention Operations

This study examined the longitudinal predictors of quality of functioning of community prevention teams during the "operations" phase of team development. The 14 community teams were involved in a randomized-trial of a university-community partnership project, PROSPER, which implements evidence-based interventions intended to support positive youth development and reduce early substance use, as well as other problem behaviors. The study included a multi-informant approach to measurement of constructs, and included data from 137 team members, 59 human service agency directors and school administrators, 16 school principals, and 8 Prevention Coordinators (i.e. technical assistance providers). How community demographics and social capital, team level characteristics, and team member attributes and attitudes are related to local team functioning across an 18-month period was examined. Findings indicate that community demographics (poverty), social capital, team member attitudes towards prevention, and team members' views of the acceptability of teen alcohol use played a substantial role in predicting various indicators of the quality of team functioning 18 months later. Feinberg, M., Chilenski, S., Greenberg, M., Spoth, R., and Redmond, C. Community and Team Member Factors that Influence the Operations Phase of Local Prevention Teams: The PROSPER Project. Prev. Sci., 8(3), pp. 214-226, 2007.

Peer-led Prevention Programs Can Accelerate Positive or Negative Peer Influences

This study tested whether a social network tailored substance abuse prevention program can reduce substance use among high-risk adolescents without creating deviancy training (iatrogenic effects). A classroom randomized controlled trial comparing control classes with those receiving an evidence-based substance use prevention program [Towards No Drug Abuse (TND)] and TND Network, a peer-led interactive version of TND. Students (n = 541, mean age 16.3 years) in 75 classes from 14 alternative high schools completed surveys before and approximately 1 year after curriculum delivery. Past-month use of tobacco, alcohol, marijuana and cocaine were assessed. Overall, TND Network was effective in reducing substance use. However, the program effect interacted with peer influence and was effective mainly for students who had peer networks that did not use substances. Students with classroom friends who use substances were more likely to increase their use. These results demonstrate that a peer-led interactive substance abuse prevention program can accelerate peer influences. For students with a peer environment that supports non-use, the program was effective and reduced substance use. For students with a peer environment that supports substance use, an interactive program may have deleterious effects. Valente, T., Ritt-Olson, A., Stacy, A., Unger, J., Okamoto, J., and Sussman, S. Peer Acceleration: Effects of a Social Network Tailored Substance Abuse Prevention Program among High-Risk Adolescents. Addiction, 102(11), pp. 1804-1815, 2007.

An Acute Post-Sexual Assault Intervention to Prevent Drug Abuse

Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1) less than 3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault. Resnick, H.S., Acierno, R., Amstadter, A. B., Self-Brown, S., and Kilpatrick, D.G. An Acute Post-Sexual Assault Intervention to Prevent Drug Abuse: Updated Findings. Addictive Behaviors, 32, pp. 2032-2045, 2007.

Randomized Controlled Evaluation of an Early Intervention to Prevent Post-Rape Psychopathology

A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 non video) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a video X prior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms. Resnick, H., Acierno, R., Waldrop, A., King, L., King, D., Danielson, C., Ruggiero, K., and Kilpatrick, D. Randomized Controlled Evaluation of an Early Intervention to Prevent Post-Rape Psychopathology. Behav. Res. Ther., 45(10), pp. 2432-2447, 2007.

Clinical Trial of Bupropion for Smoking Prevention among Adolescents with ADHD

Since attention-deficit/hyperactivity disorder (ADHD) is a well-documented risk factor for smoking and bupropion has been shown to be effective for smoking cessation, the efficacy of bupropion was tested as a prophylactic agent for the prevention of smoking in children and adolescents with ADHD. A longitudinal, randomized, double-blind, placebo-controlled, parallel-group study was conducted of bupropion at a large, urban, outpatient medical center. Recruitment began in April 1999, and the last subject was followed until September 2004. Patients were nonsmoking youth, of both sexes, between 9 and 18 years of age, with DSM-IV ADHD. After random assignment to either bupropion or placebo, subjects were assessed weekly for 8 weeks, biweekly for 4 weeks, and monthly thereafter for up to 6.5 years (mean 12 months). Also, patients received treatment with psychostimulants for ADHD symptoms as needed. To assess smoking, an assay of cotinine in urine was used. Fifty-seven subjects (28 receiving bupropion and 29 receiving placebo) were randomly assigned and included in the analysis. No differences were found between the bupropion and placebo groups on demographic factors. About half of each group was treated with stimulants for ADHD. Statistical separation between bupropion and placebo in the rate of smoking initiation or continued smoking was not demonstrated. However, secondary post hoc analyses revealed that concurrent stimulant treatment was significantly associated with a lower rate of smoking onset (hazard ratio [HR] = 0.2, 95% CI = 0.08 to 0.89; z = -2.2, p = .03) and a lower rate of continued smoking (HR = 0.3, 95% CI = 0.11 to 0.85; z = -2.3, p = .02). While bupropion was not associated with a lower rate of smoking in youth with ADHD, post hoc analyses suggest that stimulant treatment was. Future controlled studies should investigate the role of stimulants in the prevention of smoking in children and adolescents with ADHD. Monuteaux, M., Spencer, T., Faraone, S., Wilson, A., and Biederman, J. A Randomized, Placebo-Controlled Clinical Trial of Bupropion for the Prevention of Smoking in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J. Clin. Psychiatry, 68(7), pp. 1094-1101, 2007.

ALERT Plus Drug Prevention Curriculum Curbs Drinking and Drug Use Among At-Risk Ninth Grade Girls

In a recently published paper, Ellickson and colleagues found that the Project ALERT school-based drug prevention curriculum administered to youth in seventh and eight grade curbed alcohol misuse and tobacco and marijuana use among youth at the end of the eighth grade. The current research examined the effects among ninth-grade at-risk adolescents who participated in the trial. The current trial involved randomization of school clusters to three groups: the ALERT condition (intervened upon in 7th and 8th grade), the ALERT Plus conduction (received the ALERT condition intervention plus ninth-grade boosters), and the control group. Comparisons between at-risk girls in ALERT Plus schools and at-risk girls in control schools showed the program curbed weekly alcohol and marijuana use, at-risk drinking, alcohol use resulting in negative consequences, and attitudinal and perceptual factors conducive to drug use. Perceived social influences, ability to resist social influences, and beliefs about the consequences of drug use mediated the effects of the ALERT Plus program on drug use. No significant effects emerged for at-risk boys or at-risk adolescents in schools where the basic ALERT curriculum was delivered. Longshore, D., Ellickson, P., McCaffrey, D., and St. Clair, P. School-Based Drug Prevention among At-Risk Adolescents: Effects of ALERT Plus. Health Educ. Behav., 34(4), pp. 651-668, 2007.

Effects of Brief Family Intervention on Parenting Behavior and Mediation of Disruptive Behaviors in Preschoolers

Despite knowledge of early pathways to conduct problems, few preventive interventions are specifically designed to modify disruptive behavior in toddler hood. One potential prevention target is proactive and positive parenting, which is associated with reduced risk of conduct problems in preschoolers. This randomized trial with 120 low-income 2-year-old boys examined whether a brief family-centered intervention that reduces disruptive behavior also leads to increases in proactive and positive parenting. It also explored whether change in parenting predicts change in disruptive behavior. In the intervention group, proactive and positive parenting skills increased among parents of 3-year-olds. Change in proactive and positive parenting of 2- to 3-year-old toddlers correlated with change in child disruptive behavior, although the mediation effect of positive parenting was of only borderline significance. Findings suggest that even within a brief and multifaceted preventive intervention, change in proactive parenting skills contributes modestly but significantly to change in child problem behavior. Gardner, F., Shaw, D., Dishion, T., Burton, J., and Supplee, L. Randomized Prevention Trial for Early Conduct Problems: Effects on Proactive Parenting and Links to Toddler Disruptive Behavior. J. Fam. Psychol., 21(3), pp. 398-406, 2007.

Classroom Teachers Can Implement Evidence-based Prevention Programs with Fidelity

This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which the investigators compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students' posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects. Rohrbach, L.A., Dent, C.W., Skara, S., Sun, P., and Sussman, S. Fidelity of Implementation in Project Towards No Drug Abuse (TND): A Comparison of Classroom Teachers and Program Specialists. Prev. Sci., 8, pp. 125-132, 2007.

Positive Impact on Tobacco Use for Project MYTRI in India

The purpose of this study was to determine the intermediate results for Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India). Project MYTRI is a school-based, multiple component intervention designed to prevent and reduce many forms of tobacco use (chewing tobacco, cigarettes, and bidis) among youth in India. The intervention is based on effective models in the United States "translated" for use in this context. The intervention targets two cohorts of students who were in the 6th and 8th grade when the study started. Thirty-two schools in Delhi (north India) and Chennai (south India) were randomized to receive the intervention (n = 16) or serve as a delayed intervention control (n = 16). Students in these schools were surveyed before the intervention began and at an intermediate point, 1 year into this 2-year intervention (n = 8,369). A test of the changes in risk factors for tobacco use between the baseline and intermediate surveys revealed that, compared with the control, students in the intervention condition (a) had better knowledge about the health effects of tobacco; (b) believed that there were more negative social consequences to using tobacco; (c) had fewer reasons to use tobacco; (d) had more reasons not to use tobacco; (e) were less socially susceptible to chewing and smoking tobacco; (f) perceived fewer peers and adults around them smoked or chewed tobacco; (g) felt that tobacco use was not acceptable, especially among their peers; (h) were more confident in their ability to advocate for tobacco control; (i) were more knowledgeable about tobacco control policies; and (j) supported these policies, too. Fewer students in the intervention condition reported having intentions to smoke tobacco in the next year or chew tobacco when they reached college. Although no changes in actual tobacco use were observed at this stage of the study, the fact that a significant impact was made on important risk factors is promising and supports the theoretical model of change. Stigler, M., Perry, C., Arora, M., Shrivastav, R., Mathur, C., and Reddy, K. Intermediate Outcomes from Project MYTRI: Mobilizing Youth for Tobacco-Related Initiatives in India. Cancer Epidemiol. Biomarkers Prev., 16(6), pp. 1050-1056, 2007.

Risk Patterns of Tobacco Initiation in Indian Youth

Previous data from urban Indian students indicated that 6th graders reported more tobacco use than 8th graders. The current study examined underlying factors to understand this unexpected difference. Students in the 6th and 8th grade (n = 11,642) from 32 private (high socioeconomic status) and government (low-mid SES) schools in two large cities in India (Delhi and Chennai) completed a cross sectional survey as the baseline evaluation tool for a group-randomized tobacco prevention intervention trial (Project MYTRI). Mixed-effects regression models were used to (1) examine the relationship between 15 psychosocial risk factors and current use of any tobacco, by grade; and (2) examine differences in psychosocial risk factors by grade. For students in both grades, almost all psychosocial factors were significantly related to tobacco use. Some of the strongest correlates included social susceptibility to and social norms about use. Exposure to tobacco advertising was a strong correlate of tobacco use for 6th graders, but not for 8th graders. Sixth graders scored lower than 8th graders on almost all factors, indicating higher risk. The data indicate that the 'risk profile' of these 6th graders makes them more vulnerable to begin using tobacco, as well as to outside influences that may encourage use. Stigler, M., Perry, C., Arora, M., and Reddy, K. Why Are Urban Indian 6th Graders Using More Tobacco Than 8th Graders? Findings from Project MYTRI. Tob. Control, 15 Suppl 1, pp. 54-60, 2006.

Self-Initiated Quitting of Cigarette Smoking Among High-Risk Youth

This paper provides a 5-year replication-extension of a previous 1-year follow-up study of the same sample of southern California alternative high school youth. Demographic, behavioral, psychosocial, and emerging adult function predictors of adolescent self-initiated smoking cessation were investigated. The baseline smokers varied from 14 to 19 years of age (mean age = 16.8 years, S.D. = 0.9). The sample was 59% male; 50% white, 37% Latino, 4% African American, 5% Asian, 2% Native American, and 2% other ethnicity. The retained sample size for analysis was 303 baseline cigarette smokers that were followed-up 5 years later. This analysis consisted of 51% of those 593 baseline cigarette smokers that previously had been examined at baseline and again at a 1-year follow-up (Sussman et al., 1998). The study compared the analysis sub sample on baseline measures to those of the full measured baseline sample, using a series of single sample t-tests or calculation of an approximate confidence interval for proportions with large samples. Quitters were more likely to be Latino (49% versus 34%), were less likely to be White (38% versus 52%), were slightly older (means=17.00 and 16.72 years, S.D. =0.89 and 0.93), were less acculturated, and were more likely to be holding down jobs. Regarding drug use related measures; quitters reported a lower level of cigarette smoking at baseline and intention to smoke cigarettes in the future at baseline. None of the perceived social variables discriminated between quitters and non-quitters. Based on these findings one may speculate that smoking cessation programs for adolescents should include counteraction of problem-prone attitudes, assistance with job aspirations and information about drug-free workplaces, motivation to quit strategies, and assistance with overcoming withdrawal symptoms. Sussman, S., and Dent, C.W. Five-Year Prospective Prediction of Self-Initiated Quitting of Cigarette Smoking of High-Risk Youth. Addict. Behav., 32, pp. 1094-1098, 2007.

Tests of Implicit Memory and Cognition Predict Marijuana Use Among High-Risk Adolescents

In this study, the authors compared indirect measures that attempt to quantify the level of marijuana associations among adolescents. They also evaluated whether these various methods overlap or tap different aspects of associative processes that may act in concert to influence marijuana use. Automatic drug-relevant associations were assessed in 121 at-risk youth in continuation high schools in California with the use of a word association index and computer-based, reaction time measures (i.e., Implicit Association Test [IAT] and Extrinsic Affective Simon Task [EAST]). Measures of working memory capacity, sensation seeking, and explicit cognitions also were included in analyses as potential confounders. The word association index and the marijuana IAT excited D measure were significant predictors of marijuana use. The word association index accounted for more variance in marijuana use than did the IAT or EAST measures. Further, confirmatory factor analytic models of the indirect measures of marijuana use revealed a significant moderate correlation between the EAST Excitement and Word Association factors but no significant correlations between the Word Association and IAT factors. These findings suggest that there is some convergence among the different indirect measures, but these assessments also appear to tap different aspects of associative processes. The types of indirect measures evaluated in this work provide information about spontaneous cognitions related to substance use, capturing influences on behavior that are not evaluated with traditional explicit assessments of behavior. Findings from this work add to a growing body of research that implicates the importance of implicit associative processes in risk and health behaviors. Ames, S., Grenard, J., Thush, C., Sussman, S., Wiers, R., and Stacy, A. Comparison of Indirect Assessments of Association as Predictors of Marijuana use Among At-Risk Adolescents. Exp. Clin. Psychopharmacol., 15(2), pp. 204-218, 2007.

Effects of ONDCP Marijuana Initiative on High-Sensation-Seeking Adolescents

This study evaluated the effects of the Marijuana Initiative portion of the Office of National Drug Control Policy's National Youth Anti-Drug Media Campaign on high-sensation-seeking and low-sensation-seeking adolescents. Personal interviews were conducted via laptop computers with independent monthly random samples of 100 youths (ages 9 to 13) from the same age cohort in each of 2 moderate-sized communities (Fayette County Kentucky, and Knox County Tennessee) over 48 months (April 1999-March 2003) of the campaign, including the critical first 6 months of the 9-month initiative. The start of the initiative was treated as an "interruption" in time-series analyses of the combined community sample. The Marijuana Initiative reversed upward developmental trends in 30-day marijuana use among high-sensation-seeking adolescents (P<.001) and significantly reduced positive marijuana attitudes and beliefs in this at-risk population. Use of control substances was not affected. As expected, low-sensation-seeking adolescents had low marijuana-use levels, and the campaign had no detectable effects on them. Other analyses indicated that the initiative's dramatic depiction of negative consequences of marijuana use was principally responsible for its effects on high-sensation-seeking youths. Substance use prevention campaigns can be effective within an approach using dramatic negative-consequence messages targeted to high-sensation seekers. Palmgreen, P., Lorch, E.P., Stephenson, M.T., Hoyle, R.H., and Donohew, L. Effects of the Office of National Drug Control Policys' Marijuana Initiative Campaign on High-Sensation-Seeking Adolescents. Am. J. Public Health, 97(9), pp. 1644-1649, 2007.

Prevention Program Leader Characteristics Predict Program Outcomes

A previously published effectiveness study of Project ALERT delivered in schools by outside providers from Cooperative Extension found no positive effects for the adult or teen-assisted delivery of the curriculum despite high-quality implementation. Those findings and the likelihood that more outside providers will deliver evidence-based drug prevention programs in the future, led to this investigation of possible influences of leaders' personal characteristics on ALERT's program effects. Modeling techniques were utilized to determine the influence of leader characteristics on students' drug use. Students in classrooms with adult leaders who were more conscientious, sociable, or individuated were more likely to experience beneficial program effects. Students in teen-assisted classrooms with teen leaders who were more sociable or, to a lesser extent, highly individuated, showed more positive effects. These findings suggest that significant program effects of ALERT implemented with outside providers may be achieved when utilizing providers with characteristics conducive to effective program delivery. St. Pierre, T., Osgood, D., Siennick, S., Kauh, T., and Burden, F. Project ALERT with Outside Leaders: What Leader Characteristics are Important for Success? Prev. Sci., 8(1), pp. 51-64, 2007.

Prospective Associations of Social Self-Control with Drug Use Among Youth from Regular and Alternative High Schools

This study examined the one year prospective associations between adolescent social self-control and drug outcomes (cigarette use, alcohol use, marijuana use, hard drug use, and problem drug use) among adolescents from regular and continuation high schools. In the authors' previous cross-sectional study, poor social self-control was found to be associated with higher drug use, controlling for 12 personality disorder categories. The aims of this study were to determine (a) whether lack of social self-control predicted drug use one year later, and (b) whether drug use at baseline predicted social self-control one year later. Subjects were 2081 older adolescents from 9 regular (N = 1529) and 9 continuation (alternative) (N = 552) high schools in the Los Angeles area. Data were collected at two time points in an interval of approximately 1 year. Past 30-day cigarette smoking, marijuana use, hard drug use, and problem drug use at baseline were found to predict lower social self-control at follow-up, controlling for baseline social self-control and demographic variables. The effect of problem drug use as a one-year predictor of social self-control was found to be moderated by school type (regular or continuation high school), such that the relationship was significant for continuation high school students only. Conversely, social self-control was found to predict past 30-day alcohol use, marijuana use, and problem drug use, controlling for baseline drug use and demographic variables. For alcohol use, marijuana use, and problem drug use outcomes, school type was not found to moderate the effects of social self-control, though an interaction effect was found regarding cigarette smoking. Social self-control was a significant predictor of cigarette use only at regular high school. The results indicate that social self-control and drug use share a reciprocal relationship. Lack of social self-control in adolescents seems to result in increased drug use, which in turn is likely to further decrease social self-control. Thus, it seems that social self-control is an alterable cognitive-behavioral attribute which can be improved through skill-based interventions in order to prevent drug use among adolescents. Policies aimed at preventing drug abuse among adolescents may benefit from institutionalizing social self-control skills training. Pokhrel, P., Sussman, S., Rohrbach, L., and Sun, P. Prospective Associations of Social Self-Control with Drug use Among Youth from Regular and Alternative High Schools. Subst. Abuse Treat. Prev. Policy, 2(1), pp. 22-29, 2007.

Development of Callous-Unemotional Traits and Antisocial Behavior in Children

Callous and unemotional (CU) traits have been linked to severe antisocial behavior in youth, but studies examining the etiology of CU traits are lacking. Based on prior research, it was hypothesized that childhood anxiety and parenting practices would interact to predict changes in CU traits over time. Hypotheses were tested using a sample of 120 moderate to highly aggressive fifth graders followed over a 1-year period. Although CU traits displayed moderate temporal stability and predicted increases in antisocial behavior, evidence suggested that these features were not immutable. Children exposed to lower levels of physical punishment showed decreases in CU traits over time, whereas higher levels of child-reported parental warmth and involvement predicted decreases in both CU traits and antisocial behavior over time. Lower levels of anxiety were uniquely related to increased CU traits for children who described their primary caregiver as exhibiting low warmth and involvement. Pardini, D., Lochman, J., and Powell, N. The Development of Callous-Unemotional Traits and Antisocial Behavior in Children: Are There Shared and/or Unique Predictors? J. Clin. Child Adolesc. Psychol., 36(3), pp. 319-333, 2007.

Measuring and Valuing Time Costs in Prevention Interventions

The economic evaluation of psychosocial interventions is a growing area of research. Though time costs are central to the economist's understanding of social costs, these costs generally have been ignored by prevention scientists. This article highlights the need to measure such costs and then reviews the principles economists use in valuing time. It then considers the specific time costs that often arise in interventions designed to reduce behavior problems among children and youth. These include classroom time devoted to program activities, the time of parents or other caregivers, the time of teachers (outside of the classroom), and the time of volunteers. Consideration is give to the economic principles that govern how economists value these inputs and then apply these principles to data from an evaluation of a widely used intervention, the Incredible Years Program. Implications for public policy are discussed. Foster, E., Johnson-Shelton, D., and Taylor, T. Measuring Time Costs in Interventions Designed to Reduce Behavior Problems Among Children and Youth. Am. J. Community Psychol., 40(1-2), pp. 64-81, 2007.

Mediation of Effects of a Universal Prevention Program on Violent Behavior in Youth

The purpose of this investigation was to determine if the Aban Aya Youth Project, a culturally grounded intervention designed for low income African American youth, produced changes over time in core intervening variables and whether these variables mediated intervention effects on the development of youth violent behavior. The intervening variables of interest include communal value orientation (e.g., cooperating with others, keeping the neighborhood clean), empathy (items reflecting concern for others), and violence avoidance efficacy beliefs (certainty that one can keep from fighting). Fifth grade cohorts at 12 schools were randomly assigned to a classroom social development intervention, a school, family, and community intervention, or an attention control condition. Study participants were followed through eighth grade. Six hundred sixty-eight students (49% male) participated in the study. Mediation analyses suggested that compared to the control condition, both program conditions led to steeper increases over time in empathy which, in turn were related to reductions in the likelihood of violent behavior over time. There were no program effects on communal value orientation and violence avoidance efficacy beliefs. However, the investigators found that changes over time in violence avoidance efficacy were associated with reduced likelihood of violent behavior. Jagers, R., Morgan-Lopez, A., Howard, T., Browne, D., and Flay, B. Mediators of the Development and Prevention of Violent Behavior. Prev.Sci., 8, pp. 171-179, 2007.

Feasibility of Youth Purchase Attempts of Harmful Legal Products

Communities across the nation have become increasingly concerned about inhalant use and use of harmful legal products among youth because of increasing prevalence rates and deleterious health consequences from abusing these products. The increasing concern of communities about inhaling and ingesting legal products has been coupled with increasing awareness and concern about ability of youth to access and abuse a variety of other legal retail products. There are few examples of scientifically designed community prevention projects that seek to reduce youth abuse of such legal products. This article describes a community prevention trial that is designed to reduce sales of inhalants and other harmful legal products to youth and demonstrates how the retailer component of the trial can be rigorously evaluated. Data on retailer surveys and youth purchase attempts confirm the feasibility of such data collection tools for component evaluation. Courser, M., Holder, H., Collins, D., Johnson, K., and Ogilvie, K. An Evaluation of Retail Outlets as Part of a Community Prevention Trial to Reduce Sales of Harmful Legal Products to Youth. Eval. Rev., 31(4), pp. 343-363, 2007.

Perceived Risks of Marijuana Use in Marijuana Users and Non-Users

The present study evaluates differences in risk perception related to marijuana use as a function of past use and, among those who report marijuana use, as a function of frequency of use and having experienced negative consequences of marijuana use. Participants were 725 incoming first year college students in a longitudinal study examining the efficacy of a marijuana prevention program and data used for this analysis were from the baseline survey. Participants were 57% female and 62% Caucasian, and 48% reported ever using marijuana. Analyses indicated that risk perception was greater among non-users of marijuana than for those who reported marijuana use (and, in turn, who were more likely to have actually experienced a drug-related consequence). Among marijuana users, risk perception was not influenced by the frequency of marijuana use nor was it influenced by the actual experience of a drug-related consequence. The findings suggest that for abstainers, perceived risk and the potential consequences of marijuana use may serve a protective role against the initiation of marijuana use. For those who use marijuana, intervention efforts utilizing motivation enhancement approaches could explore the discrepancy between perceived risks and actual experienced consequences. Kilmer, J., Hunt, S., Lee, C., and Neighbors, C. Marijuana Use, Risk Perception, and Consequences: Is Perceived Risk Congruent with Reality? Addict. Behav., 32, pp. 3026-3033, 2007.

Adolescent Friendship Interactions and Deviant vs. Normative Developmental Pathways

Interpersonal dynamics within friendships were observed in a sample of 120 (60 male, 60 female) ethnically diverse 16- and 17-year-old adolescents characterized as "persistently antisocial", "adolescent-onset", and normative. Group definitions were based on antisocial behavior scores from a survey of antisocial behavior and substance use developed by Dishion and Kavanagh and administered at four points in time to adolescents starting at age 11-12. Persistently antisocial adolescents were defined as those who had above average scores compared to those within their gender group and had greater than the median antisocial score at all assessment points. "Adolescent-onset" youth comprised participants whose antisocial behaviors increased from below the median in earlier waves of the survey to above the median in later waves. The normative group included participants with the lowest sum antisocial behavior scores of the group who also had below median antisocial behavior scores during all waves. Dyadic mutuality, i.e., talk that is mutually responsive, reciprocal, and harmonious, and deviant talk, i.e., inappropriate talk and talk about violating community or societal rules, were coded from videotaped friendship interactions. Persistently antisocial adolescents demonstrated lower levels of dyadic mutuality compared with adolescent-onset and normative adolescents. Persistently antisocial and adolescent-onset adolescents spent more time in deviant talk than did normative adolescents. Across groups, girls were rated as more mutual and coded less in deviant talk than boys. Furthermore, friendship dyads that engaged in high levels of deviant talk and were mutual in their interactions reported the highest rates of antisocial behavior, Piehler, T., and Dishion, T. Interpersonal Dynamics within Adolescent Friendships: Dyadic Mutuality, Deviant Talk, and Patterns of Antisocial Behavior. Child Dev., 78(5), pp. 1611-1624, 2007.

Protective Factors Associated with Preadolescent Violence

This study explores the influences of communal values, empathy, violence avoidance self-efficacy beliefs, and classmates' fighting on violent behaviors among urban African American preadolescent boys and girls. As part of a larger intervention study, 644 low-income 5th grade students from 12 schools completed a baseline assessment that included the target constructs. Boys reported more violent behaviors, and lower levels of empathy and violence avoidance self-efficacy beliefs than girls. Path analyses revealed that, after controlling for classmates' fighting, violence avoidance self-efficacy beliefs were negatively associated with violent behavior. Communal values had a direct negative relationship with violence for boys, but not girls. Both communal values and empathy were associated with less violent behavior through positive relationships with violence avoidance self-efficacy beliefs. For girls, classmates' fighting had an indirect positive association with violent behavior through its negative relationship with violence avoidance self-efficacy beliefs. This research identifies protective factors that can potentially be harnessed to delay the onset and/or slow the growth of violent behaviors in youth. Jagers, R., Sydnor, K., Mouttapa, M., and Flay, B. Protective Factors Associated with Preadolescent Violence: Preliminary Work on a Cultural Model. Am. J. Community Psychol., 40(1-2), pp. 138-145, 2007.

Pediatric Health Care Providers Report Low Levels of Screening for Maternal Depression

Screening for maternal depression with appropriate intervention has been emphasized through pediatric guidelines, but engaging providers to implement such procedures remains challenging. This study examined self-reported practice in recognizing and treating maternal depression in 98 pediatric health care providers. Over 85% agreed that recognizing maternal depression was their responsibility, yet only half reported confidence in their ability to do so. Fewer than 10% reported asking mothers about depression or using a screening tool. Clear differences in practice, treatment, and perceived barriers by confidence level were found. Implications for practice, research, and training are discussed. Connelly, C., Baker, M., Hazen, A., and Mueggenborg, M. Pediatric Health Care Providers' Self-Reported Practices in Recognizing and Treating Maternal Depression. Pediatr. Nurs., 33(2), pp. 165-172, 2007.

Low Levels of Intimate Partner Violence Assessment by Child Welfare Services

The purpose of this study was to describe policy and practice with respect to the assessment of intimate partner violence in a sample of child welfare agencies located throughout the United States and to examine the relationship of contextual characteristics and assessment practices. Telephone interviews were conducted with key informants from child welfare agencies. A snowball interviewing strategy was used to identify the best informant in each agency. Almost all of the participating agencies conducted some assessment of intimate partner violence, with most reporting that the majority of screening or assessment occurred during investigation of referrals. However, only 43.1% reported that all of the families referred to the child welfare system were assessed for intimate partner violence, and 52.8% indicated they had a written policy pertaining to screening and assessment of the problem. There was little relationship between county or agency characteristics and assessment practices. Additional research is needed to determine factors that influence assessment practices and to identify strategies to support and extend efforts to identify intimate partner violence and provide appropriate services for families in the child welfare system. Hazen, A.L., Connelly, C.D., Edleson, J., Kelleher, K., Landverk, J., Coben, J., Barth, R., McGeehan, J., Rolls, J., and Nuszukowski, M. Assessment of Intimate Partner Violence by Child Welfare Services. Children and Youth Services Review, 29 pp. 490-500, 2007.

Experience Seeking Correlates with Hippocampus Volume

Experience seekers continuously pursue novel environmental stimuli, a tendency linked to genetic variation in mesolimbic dopamine transmission. However, the neuroanatomical basis accompanying these genetic and neurochemical associations is unknown. Animal and human experimental results suggest a central role for the hippocampus in processing novel stimuli. This pilot study explored whether differences in human experience seeking are related to variations in hippocampal volume. High-resolution anatomic MR images were analyzed in 40 individuals who ranged from low through high on a validated experience seeking personality scale. Manual tracing analysis demonstrated positive correlation between right hippocampal volumes and scores on the experience seeking scale. A separate voxel-based morphometric analysis confirmed these results and localized the significant increase to the anterior portion of right hippocampal grey matter. The study tested and rejected the possibility that results were mediated by a personality trait related to, but distinct from, experience seeking. The present data provide the first direct evidence for a relationship between human experience seeking and brain structure. In addition, these results provide new ecologically relevant evidence for a link between right anterior hippocampus and novelty processing. Martin, S.B., Covell, D.J., Joseph, J.E., Chebrolu, H., Smith, C.D., Kelly, T.H., Jiang, Y., and Gold, B.T. Human Experience Seeking Correlates with Hippocampus Volume: Convergent Evidence from Manual Tracing and Voxel-Based Morphometry. Neuropsychologia, 45, pp. 2874-2881, 2007.

Gene-environment Contributions to Young Adult Sexual Partnering

There has been relatively little work completed to date on gene-environment contributions to human sexuality, especially molecular analyses examining the potential contributions of specific polymorphisms in conjunction with life experiences. Using Wave III data from 717 heterozygous young adult sibling pairs included in the National Longitudinal Study of Adolescent Health, this article examined the combined contributions of attendance at religious services and three genetic polymorphisms (in the dopamine D4 receptor [DRD4]), dopamine D2 receptor [DRD2]), and the serotonin transporter promoter [5HTT]) to sensation seeking, a personality construct related to sexual behavior, and the number of vaginal sex partners participants had in the year before interview. Data analyses used a mixed model approach to account for population stratification and correlated observations. DRD4 was unrelated to sensation seeking and to the number of sex partners in tests of both main effects and in interaction with religious attendance. Contrary to hypothesis, presence of the A1 DRD2 allele was associated with having had fewer sex partners in the past year. Associations between the 5HTT allele and sex partners varied by religious attendance, but again the patterns of associations were contrary to hypothesized relationships and were small in magnitude. These findings underscore the necessity of using more comprehensive multiple gene-multiple life experience approaches to investigations of complex behaviors such as sexual patterns. Halpern, C.T., Kaestle, C.E., Guo, G., Hallfors, D.D., and Hallfors, D.D. Gene-Environment Contributions to Young Adult Sexual Partnering. Arch. Sex Behav., 36(4), pp. 543-554, 2007.

Teens with Part-time Jobs More Likely to Smoke

This study investigated the links between working for pay and adolescent tobacco use to determine whether working for pay increases smoking risk. Analyses involved retrospective and prospective analyses using data from a representative cohort of 799 predominantly African American students in Baltimore, MD, who had been followed since the first grade. At the 10th year of follow-up, when the youths were aged 14 to 18 years, there was a positive relationship between the time they spent working for pay and current tobacco use. This relationship was attenuated somewhat after adjustment for potential selection effects. Adolescents who spent more than 10 hours per week working for pay also tended to initiate tobacco use earlier than did their peers. Among adolescents who had not yet used tobacco, those who started to work 1 year after assessment and those who worked over 2 consecutive assessments had an elevated risk of initiating use relative to adolescents who did not start working. In summary, there is a strong link between working for pay and adolescent tobacco use. Policymakers should monitor the conditions under which young people work to help minimize young workers' tobacco use and potential for initiating use. Ramchand, R., Ialongo, N.S., and Chilcoat, H.D. The Role of Working for Pay on Adolescent Tobacco Use. Am. J. Public Health, 97(11), pp. 1-7, 2007.

Rates of Substance Use Among Hispanic Youth in the US and Puerto Rico

This study examined patterns of progression in substance use among Hispanic youth 13 to 17 years of age from two longitudinally representative studies. Patterns of substance use among youth in Puerto Rico were examined using a longitudinal study (n=663) of adolescents living on the island. The National Longitudinal Study of Youth was used to examine patterns of substance use among Hispanics living in the United States (n=1445). Latent transition analysis was used to estimate the probability of membership in each stage of substance use and incidence of transitions between different substance use stages over time. Six stages best described the heterogeneity in substance use among youth in Puerto Rico. Five stages were sufficient to describe patterns of substance use among youth in the United States. Youth living in Puerto Rico reported lower rates of smoking and illicit drug use, but higher rates of alcohol use, when compared with rates among Hispanics in the United States. Similar patterns of substance use were identified for Hispanic youth living in the United States and youth living in Puerto Rico. Maldonado-Molina, M.M., Collins, L.M., Lanza, S.T., Prado, G., Ramirez, R., and Canino, G. Patterns of Substance use Onset among Hispanics in Puerto Rico and the United States. Addict. Behav., 32(10), pp. 2432-2437, 2007.

Water Pipe Smoking in Egypt: Misperceptions of Harm

This study investigated behavioral and sociodemographic factors associated with tobacco use among female university students patronizing water pipe cafes in Cairo, Egypt. Two groups of female university student smokers were interviewed (100 and 96 students from a public and a private university, respectively). The interviews took place in nine water pipe cafes near the two universities. A logistic regression model was developed to analyze the relationship between tobacco-related knowledge and beliefs and the choice between smoking water pipe or cigarettes. Among these smokers, 27% smoked cigarettes only, 37.8% smoked water pipe only, and 35.2% smoked both types of tobacco. Most of the water pipe smokers (74.1%) preferred this method because they believe it to be less harmful than smoking cigarettes. More than half of the subjects were encouraged to start smoking by other females (56.6%). Curiosity was a significant factor for initiation (OR = 2.8, 95% CI = 1.3-6.2, p<.01). The authors found no significant differences between water pipe and cigarette smokers regarding current age, age at initiation, quit attempts, knowledge about the hazards of smoking, wanting to be fashionable, or smoking with friends. About one in four (23.7%) attempted to quit, with health cited as a major reason. An urgent need exists for correction of the misperception among this study population that water pipe smoking is safe and less harmful than cigarette smoking. Labib, N., Radwan, G., Mikhail, N., Mohamed, M., Setouhy, M., Loffredo, C., and Israel, E. Comparison of Cigarette and Water Pipe Smoking among Female University Students in Egypt. Nicotine Tob. Res., 9(5), pp. 591-596, 2007.


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