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Director's Report to the National Advisory Council on Drug Abuse - September, 2006

Research Findings - Prevention Ressearch

Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection. Griffin, K., Botvin, G., and Nichols, T. Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood. Prev Sci, 7(1), pp. 103-112, 2006.

Neurocognitive Skills Moderate Responses to Preventive Intervention

The present experiment was designed to determine whether individual variation in neurobiological mechanisms associated with substance abuse risk moderated effects of a brief preventive intervention on social competency skills. This study was conducted in collaboration with the ongoing preventive intervention study at Johns Hopkins University Prevention Intervention Research Center (JHU PIRC) within the Baltimore City Public Schools. A sub-sample (N = 120) of male 9th grade students was recruited from the larger JHU study population. Approximately half of the participants had a current or lifetime diagnosis of CD while the other half had no diagnosis of CD or other reported problem behaviors. Measures of executive cognitive function (ECF), emotional perception and intelligence were administered. In a later session, participants were randomly assigned to either an experimental or control group. The experimental group underwent a facilitated session using excerpted materials from a model preventive intervention, Positive Adolescent Choices Training (PACT), and controls received no intervention. Outcomes (i.e., social competency skills) were assessed using virtual reality vignettes involving behavioral choices as well as three social cognition questionnaires. Poor cognitive and emotional performance and a diagnosis of CD predicted less favorable change in social competency skills in response to the prevention curriculum. This study provides evidence for the moderating effects of neurocognitive and emotional regulatory functions on ability of urban male youth to respond to preventive intervention materials. Fishbein, D.H., Hyde, C., Eldreth, D., Paschall, M.J., Hubal, R., Das, A., Tarter, R., Ialongo, N., Hubbard, S., and Yung, B. Neurocognitive Skills Moderate Urban Male Adolescents' Responses to Preventive Intervention Materials. Drug Alcohol Depend, 82(1), pp. 47-60, 2006.

Project TND Demonstrated Long-term Effects on Drug Use of High Risk Youth

Project Towards No Drug Abuse is a 9-session health motivation--social skills--decision-making curriculum, which was implemented in South Carolina during years 1994-1999. Twenty-one schools recruited were randomly assigned to standard care (control), classroom only, or a classroom plus semester-long school-as-community component. Last 30-day use of cigarettes, alcohol, marijuana, and hard drugs were assessed at three time intervals: short-term (year 1), middle-term (years 2 or 3), and long-term (years 4 or 5). Multilevel random coefficients modeling were employed to estimate the adjusted levels of substance use. Among 1578 baseline subjects, follow-up data were available for 68% (year 1), 66% (years 2 or 3), and 46% (years 4 or 5) of subjects, respectively. Results revealed significant positive long-term program effects for hard drug use at year 4 or 5 for the two program interventions (P = 0.02). Project TND reduced hard drug use in the 46% who were successfully followed. It is the first program to demonstrate long-term self-reported behavioral effects on hard drug use among high-risk youth by using a school-based, limited-session model. Sun, W., Skara, S., Sun, P., Dent, C., and Sussman, S. Project Towards No Drug Abuse: Long-term Substance Use Outcomes Evaluation. Prev Med, 42(3), pp. 188-192, 2006.

Group Chat About Anti-drug Ads Produced Pro-Marijuana Attitudes

One route to influence in mass communication campaigns to reduce risky behavior is through interpersonal discussion of the content of the campaign and other behaviors pertinent to those targeted by the campaign. The goal of this study was to test the effects of online group interaction among adolescents about anti-marijuana advertisements on relevant attitudes and behaviors. A between-subjects post-only experimental design was used to test two crossed factors, online chat and strength of arguments in anti-drug ads. A sample of 535 students (46% male; mean age 15.5 years) was randomly assigned to one of four conditions: chat and strong-argument ads, chat and weak-argument ads, no chat and strong-argument ads, and no chat and weak-argument ads. The group interactions about anti-drug ads led to negative effects such that those who chatted reported more pro-marijuana attitudes and subjective normative beliefs than those who just viewed the ads. No support was found for the hypothesis that strong-argument ads would result in more anti-drug beliefs relative to weak-argument ads in either the chat or the no-chat conditions. Overall, these findings suggest that viewing anti-drug ads and discussing them with peers may result in deleterious effects in adolescents. David, C., Cappell, J.N., and Martin, F. The Social Diffusion of Influence Among Adolescents: Group Interaction in a Chat Room Environment About Anti-drug Advertisements. Communication Theory, 16(1), pp. 118-140, 2006.

Two-year Effects of the Family Checkup Program on the Prevention of Early Conduct Problems

This randomized trial examined the two-year outcomes of an initial study implementing an early childhood version of the Family Check-Up (FCU) program with 120 high risk families participating in the Women, Infants and Children (WIC) Nutritional Supplement Program for low-income families. Families with two-year old boys, and one or more risk factors for child problem behaviors were recruited and randomized to either intervention or control, and followed up when the children were ages 3 and 4. The FCU intervention was associated with reductions in disruptive behavior and greater maternal involvement and was particularly effective for children at greater risk for a persistent trajectory of conduct problems. The results are discussed in relation to other preventive interventions for young children. Very few family-based preventive interventions for child problem behaviors are available for this age group. These initial results support the early identification of risk factors for conduct problems, which increase risk for drug abuse, and support the development of prevention strategies for early childhood. Shaw, D., Dishion, T., Supplee, L., Gardner, F., and Arnds, K. Randomized Trial of a Family-centered Approach to the Prevention of Early Conduct Problems: 2-year Effects of the Family Check-up in Early Childhood. J Consult Clin Psychol, 74(1), pp. 1-9, 2006.

Multi-component Drug Abuse Prevention Programs: Effects of a Parent Component on Adolescent Outcomes

The current study estimates the effects of the parent program component of an evidence-based multi-component drug abuse prevention program for adolescents, Project STAR, among 351 parents of middle school students, who had been assigned by school to a program or comparison condition (n = 8 schools). The study was originally conducted in 1986, and the other program components were at the level of teachers, community leaders, and policy makers. Parents completed self-report surveys at baseline and two years later. Analyses estimated effects of the overall parent program as well as its three key constituent activities (parent-school committee participation, parent skills training, and parent-child homework activities) on perceptions of parental influence over their children's substance use. Parents who participated in the overall parent program demonstrated greater perceptions of influence over their children's substance use at two-year follow-up. Furthermore, parents who participated in parent-school committees and homework sessions demonstrated greater perceptions of influence over their children's substance use than those who did not. Parent skills training did not have an effect on perceptions of youth substance use. This study supports the use of components analysis to examine the impact of different program components on prevention outcomes. Also, the findings suggest that parent interventions may increase self-efficacy in parent-child management and communication skills. Riggs, N., Elfenbaum, P., and Pentz, M. Parent Program Component Analysis in a Drug Abuse Prevention Trial. J Adolesc Health, 39(1), pp. 66-72, 2006.

Prevention Curriculum Video Exposure Predicts Changes in Drug Use

This study sought to determine if exposure to two communication-oriented activities, videotapes and public service announcements, account for changes in substance use among adolescents participating in the Drug Resistance Strategies Project's "keepin' it REAL" adolescent substance use prevention curriculum. Students from 35 middle-schools (n=4,734, 72% Latino) responded to questionnaires related to these analyses. An analysis of covariance (ANCOVA) model was fit separately to six substance use outcomes. The results suggested that intervention students who saw four or five videos reported smaller increases in alcohol and marijuana use in the past month than did students who saw fewer videos. Having seen the PSAs one or more times did not predict the reported change in substance use. Warren, J.R., Hecht, M.L., Wagstaff, D.A., Elek, E., Ndiaye, K., Dustman, P., and Marsiglia, F.F. Communicating Prevention… Journal of Applied Communication Research, 34(2), pp. 209-227, 2006.

Exposure to Classroom Aggression Predicts Development of Aggression in Children

Prior research suggests that exposure to elementary classrooms characterized by high levels of student aggression may contribute to the development of child aggressive behavior problems. To explore this process in more detail, this study followed a longitudinal sample of 4,907 children. The children were participants in the control arm of the universal level of Fast Track, a multi-site study of the prevention of conduct problems. Demographic factors associated with exposure to high-aggression classrooms, including school context factors (school size, student poverty levels, and rural vs. urban location) and child ethnicity (African American, European American) were examined. The developmental impact of different temporal patterns of exposure (e.g., primacy, recency, chronicity) to high-aggression classrooms was evaluated on child aggression. Analyses revealed that African American children attending large, urban schools that served socio-economically disadvantaged students were more likely than other students to be exposed to high-aggressive classroom contexts. Hierarchical regressions demonstrated cumulative effects for temporal exposure, whereby children with multiple years of exposure showed higher levels of aggressive behavior after 3 years than children with primacy, less recent, and less chronic exposure, controlling for initial levels of aggression. The findings of this study have implications for developmental research and preventive interventions. Specifically, transactional models that account for individual, classroom, school contextual and socio-cultural factors on the development of aggression, and the development of ecological interventions are discussed. Dishion, T., and Bierman, K. The Impact of Classroom Aggression on the Development of Aggressive Behavior Problems in Children. Dev Psychopathol, 18(2), pp. 471-487, 2006.

It Matters Who Leads School-based Prevention Programs

Studies have shown that the effectiveness of programs or curricula may depend in part on who delivers the material. In adolescent health education programs, peer leaders are often recruited to implement programs because they are more persuasive to other adolescents than adults. Teachers also systematically vary how groups are constructed in school-based health education programs. This study compared the effects of three leader and group selection methods within the context of two tobacco prevention programs delivered in middle schools. Eight schools received a social influences program (Chips) and eight received a program with a multicultural emphasis (Flavor). Within these 16 schools 84 classrooms consisting of 1486 students were randomly assigned to one of three leader and group creation conditions: (i) leaders defined as those who received the most nominations by students and groups created randomly (random group), (ii) same as (i) but groups created by assigning students to the leaders they nominated (network), and (iii) leaders and groups created by teachers (teacher). One year follow-up data showed that main effects of the curriculum and network assignments were non-significant on smoking initiation when entered alone. Interaction terms of curriculum and assignment methods, however, were significant such that the network and teacher conditions were less effective than the random group condition with Chips, and more effective than random group condition with Flavor. These data show that school-based prevention programs should be evaluated in light of who implements the program. Even a peer-led program will be differentially effective based on how leaders are selected and how groups are formed, and this effect may be curriculum dependent. Valente, T.W., Unger, J.B., Anamara, R., Cen, S.Y., and Johnson, C.A. The Interaction of Curriculum Type and Implementation Method on 1-year Smoking Outcomes in a School-based Prevention Program. Health Education Research, 21(3), pp. 315-324, 2006.

Ways to Say No to Smoking and Other High Risk Behaviors

This study examined associations among adolescents' generated verbal strategies (i.e., Simple No, Declarative Statements, Excuse, Alternatives) and underlying nonverbal assertiveness (e.g., having a firm, authoritative voice; using direct eye contact; having a serious and confident facial expression) in 2 refusal situations: smoking and shoplifting. It is the first study to examine refusal skills strategies with a non-drug use and delinquent behavior situation. 454 sixth-grade urban minority students participated in videotaped role-play assessments of peer refusal skills. Differences were found by situation with students demonstrating greater use of Simple No in the smoking refusal and Alternatives in the shoplifting refusal. Nonverbal assertiveness was similar across situations and was associated with Declarative Statements, but only in the smoking refusal. The findings from this study suggest that, in addition to general refusal skills, prevention programs should tailor refusal skills practice to cover specific peer pressure situations. Nichols, T., Graber, J., Brooks-Gunn, J., and Botvin, G. Ways to Say No: Refusal Skill Strategies Among Urban Adolescents. Am J Health Behav, 30(3), pp. 227-236, 2006.

Results of Two Methods of Delivery of Life Skills Training

The study reported here assessed two methods of delivery of a prevention program called Life Skills Training (LST), implemented in nine rural disadvantaged school districts. This study tested the effectiveness of both standard LST curriculum, which is usually taught by one or two teachers in classes dedicated to substance abuse prevention), and the infused LST (I-LST) condition, which integrates LST and alcohol, tobacco and other drug information into the existing grade-level subject curricula, taught by the regular teachers for these subject areas. The results indicate that neither standard LST nor an infused LST delivery methods were effective for the entire sample, although some encouraging results were found for the females in the study. This study, conducted by researchers independent of the original LST program, is useful for school decision makers in determining what programs are most effective with which groups. It included all students with parental permission, controlling for prior use levels, unlike some previous LST studies. The results of the program, as implemented by regular classroom teachers, reflect many issues relevant to recruitment, training, implementation, adaptation, and institutionalization of prevention programming. Vicary, J., Smith, E., Swisher, J., Hopkins, A., Elek, E., Bechtel, L., and Henry, K. Results of a 3-year Study of Two Methods of Delivery of Life Skills Training. Health Educ Behav, 33(3), pp. 325-339, 2006.

The Impact of Tailored Intervention on Child Outcomes

Although clinical judgment is often used in assessment and treatment planning, rarely has research examined its reliability, validity, or impact in practice settings. This study tailored the frequency of home visits in a prevention program for aggressive- disruptive children (n = 410; 56% minority) on the basis of 2 kinds of clinical judgment: ratings of parental functioning using a standardized multi-item scale and global assessments of family need for services. Parents and children were participants in Fast Track, a multi-component, longitudinal intervention to prevent conduct problems and serious antisocial behavior. Stronger reliability and better concurrent and predictive validity emerged for ratings of parental functioning than for global assessments. Exploratory analyses suggested that using ratings of parental functioning to tailor treatment recommendations improved the impact of the intervention by the end of 3rd grade but using more global assessments of family need did not, and may lead to delivery of optimal intervention doses. Bierman, K., Nix, R., Maples, J., and Murphy, S. Examining Clinical Judgment in an Adaptive Intervention Design: The Fast Track Program. J Consult Clin Psychol, 74(3), pp. 468-481, 2006.

Fidelity of Implementation of a School-based Drug Abuse Prevention Program: Project Toward No Drug Abuse (TND)

This article provides an implementation fidelity evaluation of the fourth experimental trial of Project toward No Drug Abuse (TND). Two theoretical content components of TND were examined to increase our understanding of the active ingredients of successful drug abuse prevention programs. A total of 18 senior high schools were randomly assigned by block to receive one of three conditions: 1) cognitive perception information curriculum; 2) cognitive perception information + behavioral skills curriculum; or 3) standard care (control). These curricula were delivered to both regular and continuation high school students (n=2331) by trained health educators and regular classroom teachers. Across all program schools, the two different curricula were implemented as intended, were received favorably by students, and showed significant improvement in knowledge specific to the theoretical content being delivered. This pattern of results suggests that the experimental manipulations worked as intended, and thus, permitted the attribution of future behavioral outcome differences between conditions to differences in content of Project TND material provided rather than to differences in the fidelity of delivery. Further, findings indicate that Project TND can be implemented effectively with low and high-risk youth in a general environment as well as with high-risk youth in a more specialized environment. Skara, S., Rohrbach, L. A., Sun, P., and Sussman, S. An Evaluation of the Fidelity of Implementation of a School-based Drug Abuse Prevention Program: Project Toward No Drug Abuse (TND). J Drug Educ, 35(4), pp. 305-329, 2005.

Prenatal Care Providers' Role in Reducing Risk for Smoking, Alcohol Use, Illicit Drug Use and Domestic Violence During Pregnancy

This qualitative study explored prenatal care providers' methods for identifying and counseling pregnant women to reduce or stop 4 high risk behaviors: smoking, alcohol use, illicit drug use, and the risk of domestic violence. Six focus groups were conducted (five with OB/Gyn physicians, one with nurse practitioners and certified nurse midwives), with 49 care providers, using open-ended questions that assessed: providers' specific issues or interests in preventing the risk behaviors; providers'' reactions and opinions to ACOG recommendations for handling the risk behaviors and whether providers feel they can have a positive impact on the risk behaviors; providers' challenges with assessing and counseling patients; providers' opinions about whether pregnancy is an opportune time to effect behavior change; whether providers should counsel patients about risk behaviors; best ways for providers to ask about the risky behaviors; and specific strategies providers have found effective for the risky behaviors. Three major themes emerged: (1) specific risk-prevention tactics or strategies exist that are useful during pregnancy; (2) some providers address patients' isolation or depression; and (3) providers can adopt a policy of "just chipping away" at risks. Specific tactics included normalizing risk prevention, using specific assessment techniques and counseling strategies, employing a patient-centered style of smoking reduction, and involving the family. Providers generally agreed that addressing behavioral risks in pregnant patients is challenging, and that patient-centered techniques and awareness of patients' social contexts help patients disclose and discuss risks. Herzig, K., Danley, D., Jackson, R., Petersen, R., Chamberlain, L., and Gerbert, B. Seizing the 9-month Moment: Addressing Behavioral Risks in Prenatal Patients. Patient Educ Couns, 61(2), pp. 228-235, 2006.

HIV Risk is Common Among Older (Age 49-60) Substance Users, Particularly Men

Gender differences and other factors associated with current heroin and cocaine use were assessed among middle-aged drug users in New York City . Baseline data were merged from 2 studies of men and women with or at risk for HIV infection, and those age 49-60 years who had ever used heroin or cocaine were selected for analysis. HIV-antibody status, drug-use history, and psychosocial and sociodemographic data were examined. Logistic regression models were used to assess factors independently associated with current heroin and cocaine use. Of 627 persons who ever had used heroin and/or cocaine, 250 (39.9%) reported using these drugs within 6 months of the study interview. Men were more likely to be using drugs currently, compared with women (42.3% vs. 28.2%; p = .007). In multivariate analysis, men, unemployed persons, and HIV-seronegative persons were more likely to be using heroin or cocaine at the time of the interview. In addition, current marijuana users, persons drinking alcohol on a daily basis, and persons who had been homeless in the 6 months before the interview were also more likely to be using these drugs. It appears that a relatively high proportion of middle-aged substance users with or at risk for HIV infection, especially men, may continue to use illicit drugs into the sixth decade of life. Special attention needs to be given to aging and gender issues in framing HIV-prevention and drug-treatment programs. Hartel, D.M., Schoenbaum, E.E., Lo, Y., and Klein, R.S. Gender Differences in Illicit Substance Use Among Middle-Aged Drug Users with or at Risk for HIV Infection. Clin Infect Dis, 43(4), pp. 525-531, 2006.

Saturated in Beer: Awareness of Beer Advertising in Late Childhood and Adolescence

The purpose of this study was to examine exposure, response to, and awareness of beer advertising in 2 age groups, including awareness of a Budweiser advertisement (ad) that portrayed lizards and an animated ferret. In the spring of 2000, 1,996 fourth graders and 1,525 ninth graders attending 1 of 60 South Dakota schools participated in an in-school survey. Several indicators of advertising awareness, exposure, and response were assessed: recognition, product naming, brand naming, and liking in response to stills drawn from 4 masked television beer ads, listing of beer brands, exposure, attention to, and skepticism toward television beer ads. Fourteen percent of 4th graders and 20% of 9th graders recognized at least 3 of 4 sample beer ads. Seventy-five percent of 4th graders and 87% of 9th graders recognized the Budweiser ferret ad; about one in three 4th graders could name the brand it advertised, whereas more than three in four 9th graders could do so. When asked to list as many beer brands as they could, almost 29% of 4th graders listed 3 or more beer brands and 82% of 9th graders did so. Ninth graders liked beer advertisements more and paid greater attention to them, but 4th graders were exposed to them more often. Television beer ads result in high levels of beer advertising awareness in children as young as age 9, and even higher awareness among 14-year-olds. Practices that expose or appeal to youth, including use of animated characters, should be avoided by beer advertisers. Collins, R., Ellickson, P., McCaffrey, D., and Hambarsoomians, K. Saturated in Beer: Awareness of Beer Advertising in Late Childhood and Adolescence. J Adolesc Health, 37(1), pp. 29-36, 2005.

Effects of Differential Family Acculturation on Latino Adolescent Substance Use

This study examined links between parent-youth differential acculturation and youth substance-use likelihood in a sample of 73 recently immigrated Latino families with middle-school-aged youth. Multiple agents were utilized to assess family functioning and youth outcomes. Findings suggested that a greater level of differential acculturation between parents and youth was associated with greater likelihood of future youth substance use. However, the relationship between differential acculturation and youth substance use was mediated by family stress processes and effective parenting practices. Differential acculturation was related to increases in family stress and decreases in effective parenting practices, and each of these, in turn, was related to increases in future substance-use likelihood among Latino youth. Findings implicate the need for advancing policies and practices that address acculturation as a family process, rather than as merely an individual psychological phenomenon. Martinez, C.R. Effects of Differential Family Acculturation on Latino Adolescent Substance Use. Family Relations, 55, pp. 306-317, 2006.

Social Competence Among Urban Minority Youth Entering Middle School: Relationship with Alcohol Use and Antisocial Behaviors

Social competence is increasingly multidimensional during adolescence as young people encounter a variety of new social situations and can respond with a broad range of appropriate behaviors. However, research on social competence has focused more on children than adolescents. The present study examined the relationships between components of social competence (e.g., assertiveness and social confidence) and adolescent problem behaviors including alcohol use and antisocial behaviors (e.g., aggression and delinquency). A survey was administered to 6th grade students (N=2411) entering 20 New York City public and parochial middle schools and again a year later in the 7th grade. Findings indicated that verbal aggression was reported most frequently among students (93%), followed by physical aggression (69%), delinquent behaviors (53%), and alcohol use (16%). Structural equation modeling indicated that while assertiveness was protective in terms of adolescent problem behaviors, social confidence--the level of confidence that students had in initiating social interactions including dating--was associated with greater alcohol use and antisocial behavior both cross-sectionally and longitudinally. Additional analyses revealed that social confidence related to the initiation of dating (e.g., asking someone out for a date or having a conversation with a member of the opposite sex) was most strongly correlated with each problem behavior outcome. These findings suggest that social confidence, particularly as it relates to precocious dating behavior during early adolescence, is a risk factor for the early initiation of alcohol use and antisocial behavior. Griffin, K., Nichols, T., Birnbaum, A., and Botvin, G. Social Competence Among Urban Minority Youth Entering Middle School: Relationships with Alcohol Use and Antisocial Behaviors. Int J Adolesc Med Health, 18(1), pp. 97-106, 2006.

In India Sixth Graders Use More Tobacco Than Eight Graders

The epidemic of tobacco use is shifting from developed to developing countries, including India, where increased use is expected to result in a large disease burden in the future. Changes in prevalence of tobacco use in adolescents are important to monitor, since increased use by young people might be a precursor to increased rates in the population. A survey of 11,642 students in the sixth and eighth grades in 32 schools in Delhi and Chennai, India about their tobacco use and psychosocial factors related to onset of tobacco use was conducted. Schools were representative of the range of types of school in these cities. Students who were in government schools, male, older, and in sixth grade were more likely to use tobacco than students who were in private schools, female, younger, and in eighth grade. Students in sixth grade were, overall, two to four times more likely to use tobacco than those in eighth grade. 24.8% (1529 of 6165) of sixth-grade students and 9.3% (509 of 5477) of eighth-grade students had ever used tobacco; 6.7% (413 of 6165) and 2.9% (159 of 5477), respectively, were current users. Psychosocial risk factors were greater in sixth-grade than in eighth-grade students. The increase in tobacco use by age within each grade was larger in sixth grade than in eighth grade in government schools, with older sixth-grade students at especially high risk. The finding that sixth-grade students use significantly more tobacco than eighth-grade students is unusual, and might indicate a new wave of increased tobacco use in urban India that warrants confirmation and early intervention. Reddy, K., Perry, C., Stigler, M., and Arora, M. Differences in Tobacco use Among Young People in Urban India by Sex, Socioeconomic Status, Age, and School Grade: Assessment of Baseline Survey Data. Lancet, 367(9510), pp. 589-594, 2006.

Direct and Mediated Effects of Aggressive Marital Conflict on Child Aggressive-Disruptive Behavior

Direct associations between aggressive marital conflict and child aggressive-disruptive behavior at home and school were explored in this cross-sectional study of 360 kindergarten children. In addition, mediated pathways linking aggressive marital conflict to maternal harsh punishment to child aggressive-disruptive behavior were examined. Moderation analyses explored how the overall frequency of marital disagreement might buffer or exacerbate the impact of aggressive marital conflict on maternal harsh punishment and child aggressive-disruptive behavior. Participants were a sub-sample of the normative and high risk groups in the Fast Track Project, and were included in this analysis if the biological mother of the study child was married and living with a spouse, and if the mother completed the measure of aggressive marital conflict during the child's kindergarten year. The Hierarchical regressions revealed direct pathways linking aggressive marital conflict to child aggressive-disruptive behavior at home and school, and maternal harsh punishment partially mediated the pathway linking aggressive marital conflict to child aggressive-disruptive behavior at home. Further analyses revealed that rates of marital disagreement moderated the association between aggressive marital conflict and child aggressive-disruptive behavior at home, with an attenuated association at high rates of marital disagreement as compared with low rates of marital disagreement. These preliminary findings suggest that marital conflict may be another important target for the prevention of child conduct problems and related high-risk trajectories. Erath, S., Bierman, K., and Bierman, K.C. Aggressive Marital Conflict, Maternal Harsh Punishment, and Child Aggressive-disruptive Behavior: Evidence for Direct and Mediated Relations. J Fam Psychol, 20(2), pp. 217-226, 2006.

The Mutual Influence of Parenting and Boys' Externalizing Behavior Problems

The current study examined the mutual influence of parenting and boys' externalizing behavior from 4th to 8th grade, how these relationships change as children develop, and the stability of parenting and child behavior in a sample of 122 boys. Child behavior predicted poor parental monitoring at 6th and 7th grade and inconsistent discipline at all grade levels examined. Parenting behavior was not related to child behavior above and beyond the stability of child behavior. Stability of child behavior decreased from 5th to 6th grade and stability of parental monitoring decreased from 5th-6th and 6th-7th grade, suggesting that 6th grade was an important transition point for both parenting and child behavior. Fite, P.J., Colder, C.R., Lochman, J.E., and Wells, K.C. The Mutual Influence of Parenting and Boys' Externalizing Behavior Problems. Journal of Applied Developmental Psychology, 27(2), pp. 151-164, 2006.

Influences of Social Norms on Early Adolescent Substance Use

Social norms play an important role in adolescent substance use. Norm focus theory (Cialdini et al., 1990) distinguishes three types of norms: injunctive, descriptive, and personal. This study examines the relative influence of these three norms, as well as the moderating effects of gender and ethnicity, on the concurrent substance use of 2,245 Mexican or Mexican-American students, 676 other Latino students, 756 non-Hispanic White students, and 353 African-American students. Personal norms appear to be the strongest significant predictor of substance use. Descriptive, parental injunctive, and friend injunctive norms also demonstrate significant, though weaker influences. Controlling for intentions reduces the predictive ability of each type of norm, especially personal norms. Gender moderates the relationship between norms and substance use with the relationships generally stronger for males. Personal norms act as stronger predictors of some types of substance use for Mexican/Mexican Americans. Elek, E., Miller-Day, M., and Hecht, M.L. Influences of Personal, Injunctive, and Descriptive Norms on Early Adolescent Substance Use. Journal of Drug Issues, 36(1), pp. 147-171, 2006.

Brief Motivational Interviewing for Drug Using Adolescents

This article reviews studies of brief motivational interviewing (MI) interventions applied to adolescents (ages 13 to 18 years) and young adults (ages 19 to 25 years) using alcohol or other psychoactive substances. An overview of the principles of MI is provided followed by a review of 17 clinical studies reported in the literature. This review revealed mixed findings for the efficacy of brief MI among these populations. However, in 29% of the studies (5 of 17), there was a clear advantage of the brief MI demonstrated compared to standard care or other programming. Components common to successful brief MI interventions included one-on-one sessions and feedback on substance use compared to norms. Interviewer empathy has been shown to be a key component in studies with adults, but this was not measured in a standardized manner across the current studies. The studies reviewed here indicate that brief MI might be effective among these populations, but the key components necessary for successful MI interventions have not been fully identified. Grenard, J., Ames, S., Pentz, M., and Sussman, S. Motivational Interviewing with Adolescents and Young Adults for Drug-related Problems. Int J Adolesc Med Health, 18(1), pp. 53-67, 2006.

Victimization and Health Among Indigent Young Women in the Transition to Adulthood: A Portrait of Need

To understand victimization by physical and sexual violence and its association with physical and behavioral health in a probability sample of sheltered homeless and low-income-housed young women in the transition to adulthood (ages 18 through 25). Participants were 224 women ages 18 through 25 who were selected by means of a stratified random sample from 51 temporary shelter facilities (N = 94) and 66 Section 8 private project-based Housing and Urban Development (HUD)-subsidized apartment buildings (N = 130) in Los Angeles County, California. Women completed structured interviews. Forty-one percent of the sample had been physically or sexually victimized as children and 51% had been victimized since turning 18. Young women who experienced victimization were significantly (p < .05) more likely than non-victimized women to have a sexually-transmitted disease (STD) other than HIV/AIDS or Hepatitis B or C, vaginal discharge or bleeding and pelvic pain in the past 6 months, and past-12 month screening diagnoses of drug abuse/dependence and depression. Victimized women were also significantly more likely to use alcohol to intoxication and drugs, including crack and amphetamines, during the past 6 months, and to have experienced psychological distress and poor self-esteem. This study highlights striking rates of victimization and its association with physical and behavioral health problems among indigent young women during the period of emerging adulthood. This portrait of need communicates an urgency to develop multifaceted programs for such women to help them successfully navigate the transition to adulthood and realize their full potential as adults. Wenzel, S., Hambarsoomian, K., D 'Amico, E., Ellison, M., and Tucker, J. Victimization and Health Among Indigent Young Women in the Transition to Adulthood: A Portrait of Need. J Adolesc Health, 38(5), pp. 536-543, 2006.

HIV Infection is a Significant Risk Factor for Human Papillomavirus (HPV) Among Drug Using Women

A total of 230 female former and current drug users in New York City were prospectively studied at 6 month intervals. Each assessment included interviews, HIV testing, and cervicovaginal lavage sampling for human papillomavirus (HPV). Incidence rates of and factors associated with HPV infections of all types and high-risk types were analyzed. Baseline median age was 40 years (range 24-65); 62% of women were Hispanic, 20% black, and 16% white; 54 (24%) were HIV seropositive; 172 (75%) were without detectable HPV; 58 (25%) had only low-risk or untypeable HPV. The incidence rate for any HPV 9.5/100 person-years type and for high-risk types was 4.8/100 person-years. HIV-seropositive women had a significantly increased hazard rate for any HPV (HRadj: 3.4; 95% CI: 1.4 to 8.0) and for high-risk HPV (HRadj 3.0; 95% CI: 1.4 to 6.6), adjusted for race, sexual behaviors, condom use, and history of other sexually transmitted infections. HIV infection was independently associated with a substantial and significantly increased risk for any and for high-risk genital HPV infection and was the most important risk factor found. Dev, D., Lo, Y., Ho, G.Y., Burk, R.D., and Klein, R.S. Incidence of and Risk Factors for Genital Human Papillomavirus Infection in Women Drug Users. J Acquir Immune Defic Syndr, 41(4), pp. 527-529, 2006.

HIV Prevalence and Risk Behaviors Among Injection Drug Users Following Implementation of Cross-border HIV Prevention Interventions in Northern Vietnam and Southern China

In 2002, the researchers implemented a 4-year HIV prevention intervention for injection drug users (IDUs) in Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China, a cross-border region seriously affected by inter-twined epidemics of heroin injection and HIV infection. The interventions involve peer education on HIV risk reduction and provision of new needles/syringes through direct distribution and pharmacy vouchers. The researchers consider this to be a structural intervention in which risk reduction information and sterile injection equipment are diffused through the IDU populations and not limited to those who actually interact with peer educators. The evaluation of structural interventions poses complex methodological challenges. The evaluation of our interventions relies primarily on cross-sectional surveys (interviews and HIV testing) of samples of IDUs selected using a combination of targeted cluster and snowball methods. The researchers consider this to be an appropriate, albeit imperfect, design given the study context. This paper presents analyses of data from the IDU surveys conducted just prior to implementation of the interventions and 24 months thereafter. The cross-border interventions have reached large proportions of the IDUs in the project sites, drug-related HIV risk behaviors have declined in frequency, and HIV prevalence among IDUs has been stable in China and declined in Vietnam over the 24 months since the interventions were implemented. Attribution of these positive trends to the interventions must be qualified in light of possible sampling biases and the absence of control groups. However, the researchers believe that the structural interventions implemented by the cross-border project have played a role in stabilizing HIV prevalence among IDUs two years after they were initiated. Evidence of further diffusion of the interventions among IDUs and continued stability or decline of HIV prevalence would strengthen this case. Hammett, T., Kling, R., Johnston, P., Liu, W., Ngu, D., Friedmann, P., Binh, K., Dong, H., Van, L., Donghua, M., Chen, Y., Jarlais, D., and Jarlais, D. Patterns of HIV Prevalence and HIV Risk Behaviors Among Injection Drug Users Prior to and 24 Months Following Implementation of Cross-border HIV Prevention Interventions in Northern Vietnam and Southern China. AIDS Educ Prev, 18(2), pp. 97-115, 2006.

Condom Use Among Mexican Migrants

This study analyzed the association between condom use and migration to the United States (US) in two Mexican municipalities. A cross-sectional, non-probabilistic study of egocentric social networks was conducted in Cuauhtémoc, Colima and Tonalá, Jalisco during the months of December 2003 and January 2004, in 354 male migrants (mean age 32.8 years old). Migration, sexual network, history and risk for sexually transmitted infections (STIs) characteristics were surveyed. Statistical analyses were conducted using logistic regression. Results indicated that increased migration travel to the US was significantly associated with consistent condom use for Cuauhtémoc (OR: 3.87; p< 0.05) and Tonalá (OR: 4.12; p< 0.05) municipalities. Other significant predictors included: age, type of sex partner, and perceived monogamy. These data support the hypothesis that migration to the US is associated with condom use. Fosados, R., Caballero-Hoyos, R., Torres-López, T., and Valente, T. Condom Use and Migration in a Sample of Mexican Migrants: Potential for HIV/STI Transmission. Salud Publica Mex, 48(1), pp. 57-61, 2006.


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