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Director's Report to the National Advisory Council on Drug Abuse - September, 2005



Research Findings - Prevention Ressearch

Children in EIFC Had Fewer Failed Placements than Children in Regular Foster Care

From the early 1980s through the mid-1990s, children under age 6 were the fastest growing segment of the U.S. foster care population. These children are at exceptionally high risk for poor outcomes across many domains, including risk for substance use and abuse. The Early Intervention Foster Care (EIFC) program was designed to improve reunification and adoption outcomes for foster children in this age range. Children receive individual therapy, and birth parents or other permanent placement families receive intensive parent training. The program emphasizes concrete encouragement for prosocial behavior, consistent, nonabusive limit setting to address disruptive behavior, and close supervision of the child in order to create the optimal environmental conditions for developmental progress, including a responsive and consistent caregiver and a predictable daily routine. To test the efficacy of the EIFC, the Oregon Department of Human Services Child Welfare identified 3-6 year old foster care children in need of a new foster placement. Eligible participants were randomly assigned to the intervention (EIFC, n = 47) or regular foster care comparison (RFC, n = 43). Families were assessed at entry, 3 to 5 weeks after entering their new foster care placement and at 3-month intervals over 24 months. Of the 90 children, 54 were placed permanently. Although they entered permanent placement at equal rates, experiences varied greatly. Placements failed for 36% of RFC children compared to only 10% of EIFC children. The number of placements prior to the study was significantly related to failed placements for children in RFC but not for children in EIFC. Permanent placement success rate was 64% for RFC and 90% for EIFC. Fisher, P.A., Burraston, B. and Pears, K. The Early Intervention Foster Care Program: Permanent Placement Outcomes From a Randomized Trial. Child Maltreatment, 10, pp. 61-71, 2005.

Pre- and Post-HAART Risk Behaviors of Youth Living with HIV

This study examined transmission behaviors among youth living with HIV (YLH), pre- and post-HAART (Highly Active Antiretroviral Therapy). Two cohorts were recruited: (1) 349 YLH during 1994 to 1996 and (2) 175 YLH during 1999 to 2000, after the wide availability of HAART. The cross-sectional data were drawn from 2 different cohorts of YLH collected at 2 different points in time, 1 pre- and the other post- introduction of HAART. Differences in sexual and substance-use risk acts and quality of life were examined. The post-HAART YLH were more likely to engage in unprotected sex (odds ratio [OR] =1.96; p<.05) and substance use (marijuana OR=2.36; p<.01; hard drugs OR=2.80; p<.01), to be more emotionally distressed OR=1.64; p<.05), and to have lower self-reported quality of life than were pre-HAART YLH. Lightfoot, M., Swendeman, D., Rotheram-Borus, M.J., Comulada, W.S. and Weiss R. Risk Behaviors of Youth Living with HIV: Pre- and Post-HAART. American Journal of Health Behavior, 29(2), pp. 162-171, 2005.

HIV Predictors of Sexual Transmission Risk Behaviors among HIV-Positive Young Men

Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. This study examined the roles of current substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15 - 24 years. Demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, being White and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals. Stein, J.A., Rotheram-Borus, M.J., Swendeman, D. and Milburn, N.G. AIDS CARE-Psychological and Socio-Medical Aspects of AIDS/HIV, 17(4), pp. 433-442, 2005.

Schools and Homes In Partnership (SHIP): Long-Term Effects of a Preventive Intervention Focused on Social Behavior and Reading Skill in Early Elementary School

This paper reports a randomized controlled trial of the effects of behavioral parenting skills training, social skills training, and supplemental reading instruction on the social behavior of early elementary school children (K through 3). Children were selected on the basis of teacher-rated aggressive behavior or reading-skill deficits. The intervention was delivered over a 2-year period and follow-up data were collected for two additional years. There were 162 in the intervention group and 165 in the control group; 171 Hispanic children and 158 European-American; 153 female. The intervention affected only two of eight measures of child functioning: 1) parent daily reports of antisocial behavior (p=.04), and 2) parent ratings of coercive behavior (p=0.02). There was evidence that parents of boys in the intervention condition displayed significantly greater declines in their rated use of coercive discipline than did parents of boys in the control condition. Smolkowski, K., Biglan, A., Barrera, M., Taylor, T., Black, C. and Blair, J. Prevention Science, 6(2), pp. 113-125, 2005.

Evaluation of a High School Peer Group Intervention for At-Risk Youth

The purpose of this paper is to examine the effectiveness of Reconnecting Youth, a prevention program for at-risk high school youth. Data are from a large, independently evaluated effectiveness trial in two diverse urban school districts. A total of 1,218 students participated; 50% were male; average age was 15. They tested whether positive efficacy trial effects could be replicated, and whether any negative behavioral effects occur when clustering high-risk youth. Although mixed program effects were observed at immediate post-intervention, only negative effects were found at 6-month follow-up. These effects included less optimal scores on measures of Grade Point Average (GPA), anger, school connectedness, conventional peer bonding, and peer high-risk behaviors. Overall, they found little support for the use of this social-influence model intervention aimed at increasing school connectedness for high-risk youth. Further, this study provides evidence that clustering high-risk youth in preventive interventions has the potential for iatrogenic effects. Cho, H.S., Hallfors, D.D. and Sanchez, V. Journal of Abnormal Child Psychology, 33(3), pp. 363-374, 2005.

Peer Influence is an Important Mediator for Smoking

Mediation analyses were conducted on a middle school student population (2,554 treatment and 1,723 control) data where students were exposed to Project ALERT (a social influence-based school prevention program), to examine the mechanisms by which program effects on past month cigarette use and alcohol misuse were achieved. Results for cigarettes showed that all hypothesized mediating variables were significant mediators of ALERT's effect on intentions to smoke and past month cigarette use, with peer influence being the strongest. Results for alcohol point to positive beliefs about the consequences of drinking as an important mediator for alcohol misuse. Taken together, the findings highlight an avenue for program improvement through increased impact on peer influence to use alcohol and drugs. Orlando, M., Ellickson, P.L., McCaffrey, D.F., and Longshore, D.L. Mediation Analyses of a School-based Drug Prevention Program: Effects of Project ALERT. Prevention Science, 6(1), pp. 35-46, 2005.

Adolescents' Beliefs About Harm of Substance Use on Future Aspirations

One consistently reported protective factor in terms of adolescent drug use risk is bonding to school. This study examined the dynamic relationship between school bonding, beliefs about the deleterious effects of substance use on future aspirations, and subsequent substance use (cigarettes, alcohol, marijuana) among a sample of 1065 middle school students. The students participated in a larger prevention study, but represented the control condition, which received no intervention. The students were in 6th or 7th grade at the initial survey and they provided data on three additional occasions over a 2-year period. Mediation models showed that beliefs about the risks of substance use on future aspirations were a significant mediator of the relationship between school bonding and subsequent substance use. That is, adolescent's perceptions about the risks associated with substance use on future aspirations explained part of the reason why poor school bonding predicts subsequent substance use. Further analyses suggested that students who were characterized by a consistently poor bond to school were less likely to perceive that substance use would have deleterious effects on the attainment of future goals. In addition, a strong intra-individual effect of school bonding indicated that as a student became more or less bonded to his/her school, the belief that substance use may harm his/her future also changed in a similar fashion. By implementing on-going school-based programs that foster strong school bonds, adolescents may be more likely to perceive that substance use will impact the attainment of future goals, and as a result, they may be less likely to use substances. Henry, K.L., Swaim, R.C., and Slater, M.D. Intraindividual Variability of School Bonding and Adolescents' Beliefs About the Effect of Substance Use on Future Aspirations. Prevention Science, 6, pp. 101-112, 2005.

Risky Products Elicit More Arousal and Memory than Non-risky Products

This article reports on two studies designed to measure whether the mere presence of a risky product in a message elicits greater attention and arousal in young adults. Participants for both studies (n = 42) were recruited from undergraduate communication courses at a large Midwestern university. The average age of the participants was 20 and 42.9% of them were male. In the first study, participants viewed and rated 30 pictures of risky (alcohol, tobacco, drugs, condoms) and nonrisky (soda, juice, food) products while heart rate and skin conductance were measured. In the second study, participants viewed and rated 30 risky and nonrisky product words. Results indicated that the risky pictures and words elicited more emotional and physiological arousal than nonrisky pictures and words. Both risky pictures and words were remembered better than nonrisky pictures and words. However, there was little evidence to suggest that risky products elicited more attention than nonrisky products. Instead, the results showed that risky products might be identified more quickly than nonrisky products. Overall these two studies suggest that the mere presence of a risky product either pictorial or verbal elicits more arousal and more memory, but not more attention. These findings could have practical application for designing effective health campaign messages. The arousal elicited by risky products results in the automatic allocation of resources to storage, and as a result, the risky products are remembered better than the nonrisky products. However, because messages that contain representations of risky products may require more resources to process they may be more likely to result in cognitive overload. Lang, A., Chung, Y., Lee, S., and Zhao, X. It's the Product: Do Risky Products Compel Attention and Elicit Arousal in Media Users? Health Communications, 17, pp. 283-300, 2005.

School Prevention Coordinators Influence Selection of Evidence-based Curricula

In 1999 a written survey of substance abuse prevention coordinators (N=1593) in public schools that served students in grades 5-8 indicated that 47.5% of districts used at least one evidence-based curriculum (EBC) in their middle schools. Coordinators reported they had the greatest input in decisions about curricula. In a multivariate analysis of factors positively associated with district-level decisions to adopt EBC programs, significant factors included input from a state prevention group, use of information disseminated by NIDA or CSAP, use of local needs assessment data, consideration of research showing which curricula are effective, and allocation of a greater proportion of the coordinator's time to substance use prevention activities. The conclusion is that state and federal agencies should increase their efforts in disseminating information about EBC programs, targeting in particular the district substance use prevention coordinator. Rohrbach, L.A., Ringwalt, C.R., Ennett, S.T. and Vincus, A.A. Factors Associated With Adoption of Evidence-based Substance Use Prevention Curricula in US School Districts. Health Education Research, 2, pp. 1-13, 2005.

School-based Prevention Implemented Via School-Extension Collaboration

Despite availability of empirically supported school-based prevention programs, adoption and implementation fidelity of such programs appear to be low. To investigate school adoption and implementation processes, Project ALERT a program identified as evidence-based, was replicated by using Cooperative Extension Specialists as implementers. Interviews with school personnel revealed: 1) schools were not aware of evidence-based programs until Extension approached them; 2) schools afraid to eliminate DARE; 3) teachers were unlikely to implement with fidelity; 4) implementation of theory-based prevention was not consistent with school views of curriculum delivery; and 5) schools believed Project ALERT via Cooperative Extension personnel was an advantage over teacher delivery, but only 3 of the 8 schools sustained the model. Their article discusses potential for Extension as a national implementation system, the value of qualitative inquiry to study processes of adoption, and issues related to the selection and implementation of evidence-based programs. St. Pierre, T.L. and Kaltreider, L. Tales of Refusal, Adoption, and Maintenance: Evidence-based Substance Abuse Prevention Via School-Extension Collaboration. American Journal of Evaluation, 25(4), pp. 479-491, 2005.

Community Organizing to Prevent Youth Drug Use and Violence

Multiple studies have demonstrated that community organizing is an effective method to influence public health problems. Understanding and documenting the community organizing process is critical for dissemination. The DARE Plus Project is a multi-component, community-wide intervention to reduce drug use and violent behaviors among adolescents, using classroom, family, and community organizing strategies. This paper describes the community organizing methods and process results of 8 adult and youth action teams, and suggests that community organizing is an effective method for engaging community members in prevention efforts around youth drug use and violence. Bosma, L.M., Komro, K.A., Perry, C.L., Veblen-Mortenson, and Farbakhsh, K. Community Organizing to Prevent Youth Drug Use and Violence: The DARE Plus Project. Journal of Community Practice, 13(2), pp. 5-19, 2005.

Quality of Implementation: Developing Measures Crucial to Understanding the Diffusion of Preventive Interventions

As prevention programs become disseminated, the most serious threat to effectiveness is maintaining the quality of implementation intended by the developers. This paper presents a methodology for measuring quality of implementation in school settings and presents data from a pilot study designed to test several of the proposed components. These methods included assessments of adherence, quality of process, the positive or negative valence of adaptations, teachers' attitudes and teachers' understanding of program content. This study was conducted with 11 teachers who had varying degrees of experience with teaching Life Skills Training (LST). Observation and interview data were collected during visits to schools. Results suggest that quality of implementation can be measured through observation and interview. Teachers varied in adherence and quality of program delivery. All teachers made adaptations to the program. Experienced teachers were more likely to adhere to the curriculum, deliver it in a way that was more interactive and engaging to students, communicate the goals and objectives better, and make positive adaptations. The field can use these findings as the basis for exploring strategies for measuring and improving quality of implementation. Dusenbury, L., Brannigan, R., Hansen, W.B., Walsh, J. and Falco, M. Quality of Implementation: Developing Measures Crucial to Understanding the Diffusion of Preventive Interventions. Health Education Research, 20(3), pp. 308-313, 2005.

Key Informant Assessments of Community Readiness Benefits Prevention Trial

Researchers and practitioners have found that communities vary greatly in their interest and willingness to try new prevention strategies. In this study key informant readiness was assessed via interviews conducted with community members in 16 U.S. communities (8 treatment, 8 control), in a group-randomized trial of a community and school media intervention, prior to and following the intervention. Project staff asked community members to identify people in their community who were the most knowledgeable or influential relative to the issue of substance use. Recruitment was stratified to represent a broad spectrum of society, with at least one person in each community representing the perspectives of schools, law enforcement, human services, and the general community. Results indicated that the intervention itself influenced community knowledge of effort and improved prevention leadership quality and community climate supportive of prevention efforts. The authors suggest that key informant community readiness assessments have a valuable role to play in evaluating randomized community trials. Key informant readiness assessments provide formative insights into community dynamics, offer a basis for matching community assignment to condition, and they offer a tool that can be used directly with community activists in coalition-building in a workshop setting. Finally, key informant assessments can be used as a means of assessing outcomes at the community level to supplement individual-level behavioral and attitudinal outcomes. Slater, M.D., Edwards, R.W., Plested, B.A., Thurman, P.J., Kelly, K.J., Comello, M.L.G., and Keefe, T.J. Using Community Readiness Key Informant Assessments in a Randomized Group Prevention Trial: Impact of a Participatory Community-Media Intervention. Journal of Community Health, 30, pp. 39-53, 2005.

Opinion of Indian Youth Used as Basis for Prevention Program

This article discusses the findings of Focus Group Discussions (FGD) that were conducted as a formative assessment for a project titled "Mobilizing Youth for Tobacco Related Initiatives in India", a randomized, multi-component, school-based trial to prevent and control tobacco use among youth in India. Forty-eight FGDs were conducted with students (N=435) in 6th and 8th grades in 6 schools in Delhi, India. Key findings include: 1) students in government schools self-reported as "consumers" of tobacco, whereas students in private schools reported as "commentators"; 2) parents and peers have a strong influence on youth tobacco use; 3) chewing gutkha is considered less harmful and more accessible than smoking cigarettes; 4) schools are not promoting tobacco control activities; and 5) students were enthusiastic about the role government should play in tobacco control. Mishra, A., Arora, M., Stigler, M.H., Komro, L.A., Srinath Reddy, K., and Perry, C.L. Indian Youth Speak About Tobacco: Results of Focus Group discussions with School Students. Health Education & Behavior, 32(3), pp. 363-379, 2005.

Substance Use is a Robust Predictor of Adolescent Recidivism

How well does substance use predict adolescent recidivism? When the Cox proportional hazards model was applied to officially recorded first re-arrest of 505 juvenile offenders, a best-fitting complex multivariate model indicated that: (a) parent reports that youth "often" uses substances more than doubles first re-arrest risk, (b) averaged youth/parent substance use reports predict recidivism better than a single source, (c) parent or youth denial of youth's substance use predicts recidivism, (d) age at first arrest does not predict recidivism, (e) non-White/non-Asians have a 79% a higher recidivism risk than other adjudicated youth, (f) parent-reported delinquency predicts recidivism with declining accuracy over time, and (g) substance use robustly predicts recidivism despite prior reported delinquency, gender, ethnicity, age, follow-up time, or data source. Stoolmiller, M. and Blechman, E.A. Criminal Justice and Behavior, 32(3), pp. 302-328, 2005.

Spirituality Is Not Protective against Violence Perpetration and Drug Use Among Youth at Continuation High Schools

This paper presents the results of a 1-year prospective study of violence perpetration, drug use, and spirituality among continuation high school youth. Data are reported on a sample of 501 adolescents from 19 continuation high schools located in a five-county region of Southern California. Age of participants at baseline was 14 to 19 years (M=16.8, SD=0.9). Participants were 57% male, with an ethnic distribution of 34% White, 49% Latino, 5% African American, 7% Asian). Analyses were undertaken to identify independent variables that predicted violence perpetration, drug use, or spirituality at 1-year follow-up. Spirituality was found to predict later violence perpetration and drug use as a single predictor. However, it failed to predict violence or drug use in models that also included six other variables. It is possible that current measures of spirituality predict later violence perpetration and drug use as a result of tapping attitudes about morality. Controlling for baseline spirituality, male gender, low morality of drug use, violence perpetration, and drug use predicted later spirituality. Spirituality appears to be affected by drug use and violence, but not the converse. The protective influence of spirituality is not supported, at least as currently measured. Sussman, S., Skara, S., De Calice, P., Hoffman, B. and Dent, C.W. Spirituality as a 1-Year Prospective Predictor of Violence Perpetration and Drug Use Among Youth at Continuation High Schools. Journal of Applied Social Psychology, 35(1), pp. 80-99, 2005.

Parents' Beliefs Synergistically Affect Children's Drinking

This research examined whether mother's and father's beliefs about their children's alcohol use had cumulative self-fulfilling effects on their children's future drinking behavior. Researchers analyzed longitudinal data from 115 seventh-grade children and their mothers and fathers. Questionnaire data were collected at two points in time 12 months apart. At the first time point, researchers measured parents' beliefs about their child's alcohol use, the child's alcohol use and intentions to use and other risk and protective factors for substance use. At the second time point, child's recent alcohol use was measured. Findings suggest that the inaccurate portion (e.g., overestimation or underestimation) of parent's beliefs about their children's behavior at time 1 uniquely accounted for variance in a model predicting alcohol use at time 2. Mothers' beliefs that overestimated children's alcohol use more strongly predicted time 2 alcohol use when father's beliefs also overestimated time 2 use, a process the authors call synergistic accumulation. However, synergistic accumulation did not occur when parents' beliefs underestimated children's alcohol use. Madon, S., Guyll, M., Spoth, R. and Willard, J. Self-Fulfilling Prophecies: The Synergistic Accumulative Effect of Parents' Beliefs on Children's Drinking Behavior. Psychological Science, 15(12), pp. 837-845, 2004.

The Role of Neglect and Harsh Parenting in the Development of Childhood Aggression

Multimethod and multisource indices were used to measure social disadvantage, denial of care neglect, supervisory neglect, and punitive discipline in a sample of 218 disadvantaged families with children ages 4 to 8 years. The goal was to understand the effects of neglectful parenting, poor supervision, and punitive parenting on the development of children's aggression. A replication of the hypothesized theoretical model from prior research was tested. The results established the role of care neglect, supervisory neglect, and punitive parenting as mediators of the role of social disadvantage in the development of children's aggression. That is, the direct path from social status to aggression was rendered nonsignificant after entering the intervening mechanisms. Findings further highlight the importance of distinguishing between the two subtypes of neglect (care neglect and supervisory neglect) and the need to consider the role of harsh discipline when attempting to understand the effects of parenting in the development of aggression. Knutson, J.K., DeGarmo, D., Koeppl, G. and Reid, J.B. Care Neglect, Supervisory Neglect, and Harsh Parenting in the Development of Children's Aggression: A Replication and Extension. Child Maltreatment, 10, pp. 92-107, 2005.

Noncollege Students May Be More Important Targets for Prevention Programs than College Students

Youth who transition from high school to college face a set of challenges that can impact their drug use behaviors. Noncollege-bound youth who move out of their parents' homes also experience several of the same changes and risk factors following high school, although much less research has focused on them. This study examined transitions in alcohol, cigarette, and marijuana use and alcohol- and marijuana-related problems from late adolescence through young adulthood. Men and women who attended college were compared to their peers who did not in order to determine if the situational/socialization effects of college are unique during this developmental period. Prospective data from a community sample were collected at ages 18, 21, and 30 years from a college group (n = 326, 172 females, 154 males) and a noncollege group (n = 221, 109 females, 112 males). Analyses revealed that 18 year olds who transitioned out of high school, regardless of college status, reported higher levels of substance use than their peers who were still in high school. In addition, noncollege students compared to college students reported higher levels of cigarette and marijuana use in adolescence, emerging adulthood, and young adulthood and higher levels of alcohol- and marijuana-related problems in adolescence and young adulthood. Latent growth curve analyses revealed that college status was related to lower levels of alcohol and marijuana problems at age 18, greater increases from ages 18 to 21, and greater decreases from ages 21 to 30 even after controlling for level and growth in use. Overall the findings suggest that noncollege students may be a more important target group than college students from drug use prevention efforts during emerging adulthood. White, H.R., Labouvie, E.W. and Papadratsakis, V. Changes in Substance Use During the Transition to Adulthood: A Comparison of College Students and their Noncollege Age Peers. Journal of Drug Issues, 35, pp. 281-306, 2005.

Higher Impulsivity Related to Fewer Negative Expectancies and More Marijuana Use

The current study evaluated a model of marijuana use by examining the relationship between a distal risk factor (impulsivity) and a proximal risk factor (marijuana use expectancies) and marijuana use. An impulsive personality style has been identified as both a risk factor and a predictor of substance use and abuse. Marijuana expectancies, or evaluations of marijuana's expected effects (positive, negative, or neutral) have emerged as a strong predictor of marijuana use. Estimated probabilities and subjective evaluations of personally expected marijuana effects, along with impulsivity and frequency of marijuana use, were assessed in a sample of 337 college undergraduates (248 females, 89 males, average age of 20.84 years). Tests of mediation indicated that negative expectancies were a significant mediator for both males and females. That is, participants who were higher on impulsivity had fewer negative expectancies and in turn used more marijuana. Vangsness, L., Bry, B.H. and LaBouvie, E.W. Impulsivity, Negative Expectancies, and Marijuana Use: A Test of the Acquired Preparedness Model. Addictive Behaviors, 30, pp. 1071-1076, 2005.

Effective Community Collaboration

This article discusses one solution to a significant challenge in prevention research: bridging the divide between scientists and communities in the implementation and study of prevention programs. The tribal participatory research approach was developed to facilitate culturally centered prevention research in American Indian and Alaska Native communities. To produce meaningful and lasting results at the level of the community, prevention research frequently requires investigators to reevaluate the boundaries that have traditionally separated them from the subjects of their investigations. This paradigm describes new tools and techniques to facilitate collaboration between researchers and communities while maintaining scientific rigor. This approach is discussed within the broader context of community-based participatory research, and increasingly prevalent paradigm in the prevention field. Fisher, P.A. and Ball, T.J. Balancing Empiricism and Local Cultural Knowledge in the Design of Prevention Research. Journal of Urban Health, 82(2) supplement 3, pp. 44-55, 2005.


Index

Research Findings

Program Activities

Extramural Policy and Review Activities

Congressional Affairs

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Meetings and Conferences

Media and Education Activities

Planned Meetings

Publications

Staff Highlights

Grantee Honors

In Memoriam



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