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

Research Findings - Prevention Research

Intervention Effects on Foster Preschoolers' Attachment Behaviors

This study examined change in attachment-related behaviors among foster preschoolers participating in a randomized trial of the Multidimensional Treatment Foster Care Program for Preschoolers (MTFC-P). Measures of secure, resistant, and avoidant behaviors were collected using a caregiver-report diary at 3-month intervals during the 12 months following a new foster placement. Children randomly assigned to the MTFC-P intervention condition (n = 57) showed significant increases in secure behavior and significant decreases in avoidant behavior relative to children assigned to the regular foster care condition (n = 60). Both groups showed significant decreases in resistant behavior over time. Analyses also revealed a significant interaction between treatment condition and age at first foster placement on change in secure behavior, suggesting that foster preschoolers placed earlier tended to show greater increases in secure behavior over time. Results are discussed in terms of the importance of early intervention and prevention services for foster preschoolers. Fisher, P.A., and Kim, H.K. Intervention Effects on Foster Preschoolers' Attachment-Related Behaviors from a Randomized Trial. Prev Sci, 8(2), pp. 161-170, 2007.

Preventing Youth Violence and Delinquency

Violence is an important public health problem among adolescents in the United States. Substance use and violence tend to co-occur among adolescents and appear to have similar etiologies. The present study examined the extent to which a comprehensive prevention approach targeting an array of individual-level risk and protective factors and previously found effective in preventing tobacco, alcohol, and illicit drug use is capable of decreasing violence and delinquency. Schools (N=41) were randomly assigned to intervention and control conditions. Participants in the 20 intervention schools received the Life Skills Training prevention program including material focusing on violence and the media, anger management, and conflict resolution skills. Survey data were collected from 4,858 sixth grade students prior to the intervention and three months later after the intervention. Findings showed significant reductions in violence and delinquency for intervention participants relative to controls. Stronger prevention effects were found for students who received at least half of the preventive intervention. These effects include less verbal and physical aggression, fighting, and delinquency. The results of this study indicate that a school-based prevention approach previously found to prevent tobacco, alcohol, and illicit drug use can also prevent violence and delinquency. The authors suggest future research to determine whether these effects are durable, and whether they extend to more serious forms of violence. Botvin, G., Griffin, K., and Nichols, T. Preventing Youth Violence and Delinquency Through a Universal School-Based Prevention Approach. Prev Sci, 7(4), pp. 403-408, 2006.

Long-Term Effects of Brief Substance Use Interventions 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, the 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 postintervention. 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. The 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. 1-12, 2007.

Crystal Methamphetamine Use Among Young Adults in the USA

The aim of this study was to examine the prevalence and correlates of crystal methamphetamine use among young adults in the USA. The design consisted of cross-sectional analyses of nationally representative data of young adults from the National Longitudinal Study of Adolescent Health (Add Health); in-home interviews were conducted in 2001-02. Participants included 14,322 respondents aged 18-26 years. Measurements used were past year and 30-day crystal methamphetamine use, crime/violence (ever arrested, past year drug selling, past year violent behavior) and sexual risk behaviors (multiple partners, poor condom use, regretted sex, sex for money). Findings showed prevalence of past year crystal methamphetamine use was 2.8% and past month was 1.3%. White or Native American race, residence in the west or south, having an ever-incarcerated father, marijuana, cocaine, intravenous drug use and high novelty seeking were associated with greater likelihood of past year use in multivariate analyses. Compared to marijuana and cocaine users, crystal methamphetamine users were more likely to be male, unemployed, reside in the west or south, have an ever-incarcerated father and less likely to be black or Hispanic. Frequent users were no different from occasional users, except being more likely to have dropped out of school. Although crystal methamphetamine use was associated with crime and risky sex, controlling for covariates greatly diminished this relationship. It was concluded that most users are occasional users, but any past year use is associated with risky and antisocial behaviors, including other illicit drug use. Further research is needed to examine how other drug addiction is associated with methamphetamine use, and to identify longitudinal antecedents for prevention. Iritani, B., Hallfors, D., and Bauer, D. Crystal Methamphetamine Use Among Young Adults in the USA. Addiction, 102(7), pp. 1102-1113, 2007.

Patterns of Heavy Drinking from Ages 18 to 30

The purpose of this study was to illustrate the use of latent class analysis to examine change in behavior over time. Patterns of heavy drinking from ages 18 to 30 were explored in a national sample; the relationship between college enrollment and pathways of heavy drinking, particularly those leading to adult heavy drinking, was explored. Latent class analysis for repeated measures is used to estimate common pathways through a stage-sequential process. Common patterns of development in a categorical variable (presence or absence of heavy drinking) are estimated and college enrollment is a grouping variable. Data were from the National Longitudinal Survey of Youth (N = 1,265). Eight patterns of heavy drinking were identified: no heavy drinking (53.7%); young adulthood only (3.7%); young adulthood and adulthood (3.7%); college age only (2.6%); college age, young adulthood, and adulthood (8.7%); high school and college age (4.4%); high school, college age, and young adulthood (6.3%); and persistent heavy drinking (16.9%). The researchers found no evidence that prevalence of heavy drinking for those enrolled in college exceeds the prevalence for those not enrolled at any of the four developmental periods studied. In fact, there is some evidence that being enrolled in college appears to be a protective factor for young adult and adult heavy drinking. College-enrolled individuals more often show a pattern characterized by heavy drinking during college ages only, with no heavy drinking prior to and after the college years, whereas nonenrolled individuals not drinking heavily during high school or college ages are at increased risk for adult heavy drinking. Lanza, S.T., and Collins, L.M. A Mixture Model of Discontinuous Development in Heavy Drinking From Ages 18 to 30: The Role of College Enrollment. J Stud Alcohol, 67(4), pp. 552-561, 2006.

Marijuana Use and Education Level Predict Late Onset Cigarette Smoking in African American Males

This study examined adolescent risk factors for late-onset cigarette smoking among African American males. Data came from the Pittsburgh Youth Study, a longitudinal study of young men followed from age 13 to age 25. Individuals who began smoking at age 17 or older were compared with those who began smoking by age 16 and with those who never smoked in terms of risk factors measured in middle (at age 16) and late adolescence (from age 17 to 19). The study included 281 African American young men. A total of 18 psychological, behavioral and environmental risk factors were measured at age 16, and 19 risk factors were measured between ages 17 and 19. Several risk factors at age 16 differed between early-onset and late-onset smokers or nonsmokers; however, in multivariate analyses, only peer drug use and truancy were significant. Among the age 16 risk factors, only truancy differentiated late-onset smokers from nonsmokers. Late adolescence behavioral risk factors were significantly related to late-onset smoking. However, only smoking marijuana and highest grade completed differentiated late-onset smokers from nonsmokers in multivariate analyses. Well-established predictors of cigarette smoking assessed in middle adolescence could identify individuals who already smoked but could not distinguish between those who would and would not begin smoking later. Late adolescence life transitions were not related to late-onset smoking. More research is needed to examine contextual factors in late adolescence and early adulthood that protect against and precipitate late-onset of smoking for African Americans. White, H., Violette, N., Metzger, L., and Stouthamer-Loeber, M. Adolescent Risk Factors for Late-Onset Smoking Among African American Young Men. Nicotine Tob Res, 9(1), pp. 153-161, 2007.

The Role of Gender and Acculturation on Drug-related Outcomes for "Keepin' it REAL" Prevention Program

This study examined whether the efficacy of the Keepin' it REAL school-based prevention program was moderated by gender, ethnicity, and acculturation. Data came from a randomized trial in Phoenix AZ middle schools involving 4622 mostly Latino 7th graders. Youth participated in the prevention program that involved 10 classroom lessons and 5 videos developed based on extensive input from youth. Previous research on the program has demonstrated its efficacy with regard to slowing initiation of drug use. In the current study, using multi-level mixed models, results for the total sample showed no gender differences in program effects on recent substance use. However, the program was more effective in fostering anti-drug norms among boys than among girls. Subgroup analyses indicated that there were more beneficial program effects for less acculturated boys than less acculturated girls. Specifically, there was less alcohol and cigarette use and stronger anti-drug norms post intervention for less acculturated boys in the intervention group than their female counterparts. It is notable that less acculturated Latino boys had higher baseline substance use rates and stronger pro-drug norms than less acculturated Latino girls, and the lower risk of use for less acculturated girls may have attenuated the potential for program effects. The results of this study, while generally verifying the efficacy of gender-inclusive prevention strategies, suggest that efforts may be strengthened by attending to the special risks and resilience of certain subgroups of female and male youth. Kulis, S., Yabiku, S.T., Marsiglia, F.F., Nieri, T., and Crossman, A. Differences By Gender, Ethnicity, and Acculturation in the Efficacy of the Keepin' it REAL Model Prevention Program. J Drug Educ, 37(2), pp. 123-144, 2007.

Experimental Treatment Effects Compared to Care as Usual Depend on the Type of Care As Usual

In psychotherapy, effectiveness of an experimental treatment often is compared to care as usual. However, little if any attention has been paid to the heterogeneity of care as usual. The authors examined the effectiveness of manualized behavior therapy on school-aged disruptive behavior disordered (DBD) children in everyday clinical practice. A total of 77 DBD children (8-13 years) were randomly assigned to the Utrecht Coping Power Program (UCPP) condition or the care as usual condition. Care as usual consisted of family therapy (FT) or behavior therapy (BT). Decrease in parent-reported overt aggression was significantly larger in the UCPP condition than in the FT condition, but UCPP and BT did not differ significantly in this respect. The effect sizes of difference scores on other variables were more in favor of UCPP when compared to FT than to BT. The comparison of an experimental treatment to care as usual depends on the type of usual treatment. Van de Wiel, N., Matthys, W., Cohen-Kettenis, P., Maassen, G., Lochman, J., and van Engeland, H. The Effectiveness of an Experimental Treatment when Compared to Care as Usual Depends on the Type of Care as Usual. Behav Modif, 31(3), pp. 298-312, 2007.

Effects of Iowa Strengthening Families Program on Internalizing Symptoms and Polysubstance Use in Adolescence

This study evaluated effects of the Iowa Strengthening Families Program, a family-focused universal preventive intervention, on growth patterns of adolescent internalizing (anxiety and depressive symptoms) and monthly polysubstance use (alcohol, tobacco, marijuana, inhalants, and other illicit drugs), as well as the association between internalizing and polysubstance growth factors. The sample consisted of rural Midwestern adolescents (N=383), followed from sixth through twelfth grade. Compared to the control group, the intervention group adolescents showed a slower rate of increase in internalizing symptoms and polysubstance use. Intervention effects on internalizing symptoms were similar for boys and girls; however, girls demonstrated a higher overall level and a greater rate of increase across time. The intervention slowed the rate of increase in polysubstance use significantly more for girls than for boys, although overall levels of use were lower in the intervention group for both genders. Associations between internalizing and polysubstance use growth factors were found for girls, but not for boys, suggesting gender differences in psychosocial development. Trudeau, L., Spoth, R., Randall, G.K., and Azevedo, K. Longitudinal Effects of a Universal Family-Focused Intervention on Growth Patterns of Adolescent Internalizing Symptoms and Polysubstance Use: Gender Comparisons. Journal of Youth and Adolescence, 36(6), pp. 725-740, 2007.

HIV Prevention for Injection Drug Users in China and Vietnam

A pattern of serious injection drug user (IDU) driven HIV epidemics in Asia, with emerging evidence of generalization through heterosexual transmission, indicates the need for interventions focusing on both drug- and sex-related risk reduction. In a cross-border HIV prevention project for IDUs in northern Vietnam and southern China, peer educators disseminated risk reduction information to IDUs in the community and provided 20,000-25,000 sterile needles/syringes and 4,000-6,000 condoms per month. Since implementation of these interventions, the frequency of both injecting and sexual risk behaviors fell significantly, HIV prevalence among IDUs declined or stabilized, and HIV incidence dropped. There is official support for harm reduction interventions in both countries but this appears precarious in view of persistently powerful political and financial support for a law enforcement approach. Hammett, T.M., Des Jarlais, D., Johnston, P., Kling, R., Ngu, D., Liu, W., Chen, Y., Van, L. K., and Donghua, M. HIV Prevention for Injection Drug Users in China and Vietnam: Policy and Research Considerations. Global Public Health, 2 (2), pp. 125-139, 2007.

Community Coalition Structure Influences Adoption of Evidence-Based Drug Abuse Prevention Programs

This study examined the effect of community coalition network structure on the effectiveness of an intervention designed to accelerate the adoption of evidence-based substance abuse prevention programs. At baseline, 24 cities were matched and randomly assigned to 3 conditions (control, satellite TV training, and training plus technical assistance). 415 community leaders were surveyed at baseline and 406 at 18-month follow-up about their attitudes and practices toward substance abuse prevention programs. Network structure was measured by asking leaders whom in their coalition they turned to for advice about prevention programs. The outcome was a scale with 4 subscales: coalition function, planning, achievement of benchmarks, and progress in prevention activities. Multiple linear regression and path analysis were used to test hypotheses, and the two intervention conditions were combined for analyses. The intervention had a significant effect on decreasing the density of coalition networks. The change in density subsequently increased adoption of evidence-based practices. Optimal community network structures for the adoption of public health programs are unknown, but it should not be assumed that increasing network density or centralization are appropriate goals. Lower-density networks may be more efficient for organizing evidence-based prevention programs in communities. Valente, T.W., Chou, C.P., and Pentz, M.A. Community Coalitions as a System: Effects of Network Change on Adoption of Evidence-Based Substance Abuse Prevention. Research and Practice, 97(5), pp. 880-886, 2007.

Real-World Universal Prevention Reduces Drug Use

This study examined the effects of "real-world," community-based implementation of universal preventive interventions selected from a menu, including effects specific to higher- and lower-risk subsamples delivered via the PROSPER community-university partnership model. School districts were selected based on size and location, and then randomly assigned to a control condition or to an experimental condition in a cohort sequential design. The study included 28 public school districts in Iowa and Pennsylvania that were located in rural towns and small cities, ranging in size from 6,975 to 44,510. Sixth and seventh graders in these school districts participated in the study (n=12,022). Community teams were mobilized, with each team implementing one of three evidence-based, family-focused interventions (5 to 12 sessions) and one of three evidence-based school interventions (11 to 15 sessions), for 6th and 7th graders, respectively. Observations showed that interventions were implemented with fidelity. Outcomes included student reports of past month, past year, and lifetime use of alcohol, cigarettes, marijuana, methamphetamines, ecstasy, and inhalants, as well as indices of gateway and illicit substance initiation, at pretest and at a follow-up assessment 18 months later. Intent-to-treat analyses demonstrated significant effects on substance initiation (marijuana, inhalants, methamphetamines, ecstasy, gateway index, illicit-use index), as well as past-year use of marijuana and inhalants, with positive trends for all substances measured. For three outcomes, intervention effects were stronger for higher-risk students than lower-risk students. Community-based implementation of brief universal interventions designed for general populations has potential for public health impact by reducing substance use among adolescents. Spoth, R., Redmond, C., Shin, C., Greenberg, M., Clair, S., and Feinberg, M. Substance-Use Outcomes at 18 Months Past Baseline: The PROSPER Community-University Partnership Trial. Am J Prev Med, 32(5), pp. 395-402, 2007.

The Cost of ADHD in Childhood and Adolescence

Using a cost of illness (COI) framework, this article examined the economic impact of attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence. A review of published literature identified 13 studies, most conducted on existing databases by using diagnostic and medical procedure codes and focused on health care costs. Two were longitudinal studies of identified children with ADHD followed into adolescence. Costs were examined for ADHD treatment-related and other health care costs (all but 1 study addressed some aspect of health care), education (special education, 2 studies; disciplinary costs: 1 study), parental work loss (2 studies), and juvenile justice (2 studies). Based on this small and as yet incomplete evidence base, the researchers estimated annual COI of ADHD in children and adolescents at $14,576 per individual (2005 dollars). Given the variability of estimates across studies on which that number is based, a reasonable range is between $12,005 and $17,458 per individual. Using a prevalence rate of 5%, a conservative estimate of the annual societal COI for ADHD in childhood and adolescence is $42.5 billion, with a range between $36 billion and $52.4 billion. Estimates are preliminary because the literature is incomplete; many potential costs have not been assessed in extant studies. Limitations of the review and suggestions for future research on COI of ADHD are provided. Pelham, W.E., Foster, E.M., and Robb, J.A. The Economic Impact of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. J Pediatr Psychol, 32(6), pp. 711-727, 2007.

Strengths-Based Case Management: Implementation with High Risk Youth

Few effective methods of intervention exist for youth at risk for negative life outcomes. One method used successfully with both adults with chronic mental illness and adults with substance abuse problems is strengths-based case management (SBCM). Based on the principles of strengths theory, SBCM aims to assist individuals in identifying and achieving personal goals, with an emphasis on the case manager-client relationship and client self-determination. In the current study, the authors report findings from a feasibility study that implemented SBCM with adolescent runaways. Challenges to implementation, such as financial status, the role of families, abuse and neglect, developmental issues, education, peer relationships, and transportation, were examined. The current findings suggest that it is feasible to successfully implement SBCM with adolescents, but the challenges to application are different with this group compared with adults, given the developmental differences between adolescents and adults. Arnold, E.M., Walsh, A.K., Oldham, M.S., and Rapp, C.A. Strengths-Based Case Management: Implementation with High-Risk Youth. Families in Society-The Journal of Contemporary Social Services, 88(1), pp. 86-94, 2007.

Differences in Perceived Implementation: Standard Versus Peer-Led Prevention Program

The objective of this study was to assess perceived implementation of 2 substance-abuse prevention programs: a standard one and a peer-led interactive one. Data from 16 health educators were collected after 504 classroom sessions, 63 of which were observed by 24 monitors. In the interactive program, health educators (HEs) followed the curriculum less closely, reported less favorable classroom processes and less off-task talking than in the standard one. These data indicate that an interactive substance-abuse prevention program does not necessarily entail more off-task discussion but also does not necessarily guarantee more favorable program implementation. Valente, T., Okamoto, J., Pumpuang, P., Okamoto, P., and Sussman, S. Differences in Perceived Implementation of a Standard Versus Peer-Led Interactive Substance Abuse Prevention Program. Am J Health Behav, 31(3), pp. 297-311, 2007.

School-Level Influences on Discipline Referrals in First Grade

School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at risk for developing disruptive behavior problems (n = 186) and a universal sample (n = 531) from 20 schools. Most SDRs were given for physical aggression and the predominant consequence was time out. As expected, boys and at-risk students were more likely to receive an SDR and to have more SDRs than were girls and the universal sample. A large difference between schools regarding the delivery of SDRs was found. A zero-inflated Poisson model clustered by school tested the prediction of school-level variables. Students in schools that had a systematic way of tracking SDRs were more likely to receive one. Also, schools with more low-income students and larger class sizes gave fewer SDRs. SDRs predicted teacher ratings, and to a lesser extent, parent ratings of disruptive behavior at the end of first grade. Thus, practitioners and researchers should examine school-level influences whenever first grade discipline referrals are used to measure problem behavior for the purpose of planning and evaluating interventions. Rusby, J.C., Taylor, T.K., and Foster, E.M. A Descriptive Study of School Discipline Referrals in First Grade. Psychol Sch, 44(4), pp. 333-350, 2007.

Stigma Affects Drug Users Readiness to Change Behavior

The U.S. public health community is in its 3rd decade of seeking to prevent and treat HIV/AIDS. Injection drug users (IDUs) are central to targeted HIV prevention interventions as approximately one third of new U.S. infections are attributable to injection drug use (Santibanez et al., Journal of Urban Health, 83[1], 86-100, 2006). Targeted behavior change efforts are often explicitly built upon the risk perception of targeted individuals. In this article, the researchers consider the efficacy of behavior change based on IDUs' perceptions of elevated risk. This qualitative analysis of 28 interviews with HIV negative IDUs in inner city Baltimore suggests that participants did not see themselves as personally affected by HIV. Rather, respondents constructed accounts in which they differentiated themselves from the type of people who are so affected, thereby creating a less stigmatizing identity. The researchers argue that effective HIV prevention should explicitly acknowledge and address the stigmatized IDU identity, rather than assuming readiness for behavior change. Smith, K.C., Tle, L.L., and Latkin, C.A. Injection Drug Users' Strategies to Manage Perceptions of Personal Risk: How Do IDUs See HIV as Having Affected Them? AIDS Educ Prev, 19(3), pp. 245-257, 2007.

HIV Risk Reduction is Affected by Beliefs about HIV Treatment Efficacy

This study describes the sexual behavior of HIV-positive women within new versus more established relationships and determines whether beliefs about HIV antiretroviral therapy (ART) impact these behaviors. The Women's Interagency HIV Study is a longitudinal cohort study of HIV among women in the United States. Sexually active HIV-positive women (N = 1,090) completed interviews on beliefs and behaviors at 6-month intervals. Data were analyzed for the period between April 2002 and March 2003. Of 1,517 sexual partners reported, 32% were newly acquired within the previous 6 months. As compared with more established sexual relationships, newer partnerships were characterized by greater condom use consistency (odds ratio = 1.8, 95% confidence interval = 1.4-2.3). Holding beliefs that ART is protective for HIV transmission impacted the relationship between partner type and condom use. In established relationships, 63% reported consistent condom use if they believed that ART is not protective, whereas 54% reported consistent condom use if they believed that ART is protective. These findings highlight the importance of ongoing support for sexual risk reduction among women with HIV-infection and for strategies that reduce the strength of relationships between ART beliefs and sexual risk behavior. Wilson, T.E., Feldman, J., Vega, M.Y., Ghandi, M., Richardson, J., Cohen, M.H., McKaig, R., Ostrow, D., Robison, E., and Gange, S.J. Acquisition of New Sexual Partners Among Women With HIV Infection: Patterns of Disclosure and Sexual Behavior within New Partnerships. AIDS Educ Prev, 19(2), pp. 151-159, 2007.

Racial and Gender Differences in Adolescent Sexual Attitudes and Associations with Coital Debut

Delay of sexual debut is an important strategy in reducing the risk of negative adolescent health outcomes. Race and gender are known to be related to sexual behavior and outcomes, but little is known about how these characteristics affect sexual attitudes. This article examines differences in coital and pregnancy attitudes by gender and race, the influence of attitudes on transition to first coitus for each subgroup, and implications for prevention. Data are from Waves I and II of the National Longitudinal Study of Adolescent Health, limited to Non-Hispanic White and African American adolescents (n = 6652). The authors' factor analyzed attitude items, and examined effects of race, gender, and their interaction, controlling for sexual debut at Wave I. Next, sexual debut over time was predicted by attitudes for virgins (n = 3281) separately for each subgroup, controlling for covariates. Results showed that compared with boys, girls perceived less positive benefits from sex and more shame and guilt with sex, but had fewer negative perceptions about pregnancy. Compared with White boys, African American boys perceived less shame and guilt about sex; girls did not differ by race. Higher perceived benefits of sex increased the likelihood of sexual debut among African American girls. Perceived shame and guilt lowered the likelihood for White boys and girls. It was concluded that reinforcing protective attitudes through gender and race-specific programs may delay sexual intercourse, but more research is needed. Specifically, it will be important to examine whether there is an optimal coital age after which negative health outcomes are attenuated, and whether this differs by gender and race. Cuffee, J., Hallfors, D., and Waller, M. Racial and Gender Differences in Adolescent Sexual Attitudes and Longitudinal Associations with Coital Debut. J Adolesc Health, 41(1), pp. 19-26, 2007.

Mothers' Relational Schemas Predict Adolescent Antisocial Behavior

Relational schemas, as described and measured in this study, refer to automatic, unconscious response tendencies that reflect the nature of one's relationship to another person. In this research, these are measured through interpreting speech samples where a mother (biological, step, or adoptive) is describing her relationship with a target adolescent. These samples were assessed using the Family Affective Attitude Rating Scale for coding 5-minute speech samples. The internal consistency and validity of positive relational schema and negative relational schema scales were also evaluated. Data were collected from a multiethnic subsample of early-starting antisocial (n = 20) and successful (n = 20) urban adolescents and their families, using direct observations of parent-adolescent interactions, 5-minute speech samples, and questionnaires. The negative relational schema and positive relational schema scales were internally consistent, correlated reliably with critical and positive dimensions of 5-minute speech samples expressed emotion and with observed parent-adolescent interactions, and discriminated between antisocial and successful adolescents. The negative relational schema scale accounted for unique variance in adolescent antisocial behavior when controlling for previous problem behavior and observed coercion. A significant interaction was also found between negative relational schema rating and observed parent-adolescent dynamics when escalations in adolescent problem behavior were added to the model. Relational schema narratives provided unique information in the prediction of adolescent antisocial behavior and should be considered in the assessment of family dynamics and the design of interventions to prevent and treat adolescent behavior problems. Bullock, B., and Dishion, T. Family Processes and Adolescent Problem Behavior: Integrating Relationship Narratives Into Understanding Development and Change. J Am Acad Child Adolesc Psychiatry, 46(3), pp. 396-407, 2007.

Substance Use and Risk for Suicide

This study examined the association between onset of substance use and risk factors related to suicide. 1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt. Results from multivariate models controlling for current substance use and demographic characteristics indicated that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some suicide risk factors. The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences. Cho, H., Hallfors, D., and Iritani, B. Early Initiation of Substance Use and Subsequent Risk Factors Related to Suicide Among Urban High School Students. Addict Behav, 32(8), pp. 1628-1639, 2007.

Effects of Prenatal and Postnatal Parental Substance Use on Child Maltreatment

Parental substance use is a well-documented risk for children. However, little is known about specific effects of prenatal and postnatal substance use on child maltreatment and foster care placement transitions. In this study, the authors' unpacked unique effects of (a) prenatal and postnatal parental alcohol and drug use and (b) maternal and paternal substance use as predictors of child maltreatment and foster care placement transitions in a sample of 117 maltreated foster care children. Models were tested with structural equation path modeling. Results indicated that prenatal maternal alcohol use predicted child maltreatment and that combined prenatal maternal alcohol and drug use predicted foster care placement transitions. Prenatal maternal alcohol and drug use also predicted postnatal paternal alcohol and drug use, which in turn predicted foster care placement transitions. Findings highlight the potential integrative role that maternal and paternal substance use has on the risk for child maltreatment and foster care placement transitions. Smith, D., Johnson, A., Pears, K., Fisher, P., and DeGarmo, D. Child Maltreatment and Foster Care: Unpacking the Effects of Prenatal and Postnatal Parental Substance Use. Child Maltreat, 12(2), pp. 150-160, 2007.

Peer Standing and Substance Use in Early-Adolescence

Two competing hypotheses were tested concerning the associations between current alcohol and cigarette use and measures of individual, group, and network peer standing in an ethnically-diverse sample of 156 male and female adolescents sampled at two time points in the seventh grade. Findings lent greater support to the person hypothesis, with early regular substance users enjoying elevated standing amongst their peers and maintaining this standing regardless of their maintenance of or desistance from current use later in the school year. In the fall semester, users (n=20, 13%) had greater social impact, were described by their peers as more popular, and were more central to the peer network than abstainers (i.e., those who did not report current use). Conversely, in the spring semester, there were no differences between users (n=22, 13%) and abstainers in peer ratings of popularity or social impact. Notably, the spring semester users group retained fewer than half of the users from the fall semester. Further, students who had reported current use in the fall, as a group, retained their positions of elevated peer standing in the spring, compared to all other students, and continued to be rated by their peers as more popular and as having greater social impact. The authors discuss the findings in terms of the benefit of employing simultaneous systemic and individual measures of peer standing or group prominence, which in the case of peer-based prevention programs, can help clarify the truly influential from the "pretenders" in the case of diffusion of risk-related behaviors. Killeya-Jones, L.A., Nakajima, R., and Costanzo, P.R. Peer Standing and Substance Use in Early-Adolescent Grade-Level Networks: A Short-Term Longitudinal Study. Prev Sci, 8(1), pp. 11-23, 2007.

Trajectories of Physical Violence and Theft are Related to Neurocognitive Performance

Neurocognitive mechanisms have long been hypothesized to influence developmental trajectories of antisocial behavior. However, studies examining this association tend to aggregate a variety of problem behaviors that may be differentially affected by neurocognitive deficits. This study sought to describe the developmental trajectories of physical violence and theft from adolescence to adulthood, their associations, and the neurocognitive characteristics of individuals following different patterns of trajectory association. An accelerated cohort-sequential, longitudinal design was used to examine these issues in the Rutgers Health and Human Development Project. Participants were six hundred ninety-eight men. Self-reports of physical violence (ages 12-24 years) and theft (ages 12-31 years) were collected across 5 waves. Neurocognitive performance was assessed with executive function and verbal IQ tests between late adolescence and early adulthood. The majority (55%) of subjects showed an increased frequency of theft during the study period, while only a minority (13%) evinced an increasing frequency of physical violence. Executive function and verbal IQ performance were negatively related to high frequency of physical violence but positively related to high frequency of theft. Developmental trajectories of physical violence and theft during adolescence and early adulthood are different and differently related to neurocognitive functioning. Global indexes of antisocial behavior mask the development of antisocial behavior subtypes and putative causal mechanisms. Barker, E., Seguin, J., White, H., Bates, M., Lacourse, E., Carbonneau, R., and Tremblay, R. Developmental Trajectories of Male Physical Violence and Theft: Relations to Neurocognitive Performance. Arch Gen Psychiatry, 64 (5), pp. 592-599, 2007.

Relationship of Perceived Prevalence of Drug Use to Subsequent Drug Use

The investigators examined the effects of perceived prevalence of drug use among same-age peers on adolescents' subsequent drug use. This study involved 1,723 youth participating in a prevention trial who were administered a survey in the fall of 7th grade then 18 months later in the spring of 8th grade. On the first survey, students reported on their own use of alcohol and marijuana, receipt of offers to use these drugs, and frequency of contact with peers who use these drugs. Students also estimated the percentage of 7th grade students in their school who used alcohol or marijuana at least once per month. These estimates were compared with the actual percentage of 7th graders who reported using these substances. On the follow up survey, students reported on their alcohol and marijuana use. Overall, students overestimated alcohol use in the sample by 9.5% and students overestimated marijuana use by 8.0%. Although perceived prevalence of drug use predicted subsequent alcohol and marijuana use when controlling for actual prevalence, these effects did not remain when participants' prior drug use and proximal peer contacts were considered. Juvonen, J., Martino, S.C., Ellickson, P. L., and Longshore, D. "But Others Do It!: Do Misperceptions of Schoolmate Alcohol and Marijuana Use Predict Subsequent Drug Use Among Young Adolescents?" Journal of Applied Social Psychology, 37(4), pp. 740-758, 2007.

Physical Environmental Influences on Early Externalizing Behaviors

Research on the development of externalizing behaviors during early childhood has focused on child and parenting factors. Fewer studies have investigated effects of aversive features of the micro-level physical environment, such as overcrowding and chaos in the home, and the macro-level environment, such as neighborhood quality. This study extends research on physical environmental factors by examining their association with children's early externalizing behaviors, and exploring how maternal monitoring may serve as a protective factor in such contexts. One hundred twenty male toddlers at high risk for developing early externalizing behaviors, participating in an ecologically-based family preventive intervention were followed from ages 2 to 5 years. Direct longitudinal associations were found for micro-level environmental factors beginning at age 2 and for neighborhood risk beginning at age 3. Maternal monitoring served as a protective factor for child externalizing behaviors in the context of neighborhood risk. Implications for prevention research and the development of early externalizing behaviors are discussed. Supplee, L.H., Unikel, E., and Shaw, D.S. Physical Environmental Adversity and the Protective Role of Maternal Monitoring in Relation to Early Child Conduct Problems. Journal of Applied Developmental Psychology, 28(2), pp. 166-183, 2007.

Parental Substance Use and Foster Care Placements

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examined demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption. Implications for specialized services and prevention are discussed. Vanderploeg, J., Connell, C., Caron, C., Saunders, L., Katz, K., and Tebes, J. The Impact of Parental Alcohol or Drug Removals on Foster Care Placement Experiences: A Matched Comparison Group Study. Child Maltreat, 12(2), pp. 125-136, 2007.

Adolescent Peer Group Identification: A Review of the Literature

This study provides an exhaustive review of 44 peer-reviewed quantitative or qualitative data-based peer-reviewed studies completed on adolescent peer group identification. Adolescent peer group identification is one's self-perceived or other-perceived membership in discrete teenage peer groups. The studies reviewed suggest that adolescent peer groups consist of five general categories differentiable by lifestyle characteristics: Elites, Athletes, Academics, Deviants, and Others. The researchers found that the Deviant adolescent group category reported relatively greater participation in drug use and other problem behaviors across studies, whereas Academics and Athletes exhibited the least participation in these problem behaviors. Additional research is needed in this arena to better understand the operation of adolescent group labels. Sussman, S., Pokhrel, P., Ashmore, R.D., Brown, B.B., and Brown, B.B. Adolescent Peer Group Identification and Characteristics: A Review of the Literature. Addict Behav, 32(8), pp. 1602-1627, 2007.

Ethnic Identity as a Predictor of Substance Use Norms and Behaviors

This paper explores whether ethnicity and three ethnic identity instruments are useful in predicting substance use outcomes among three samples of ethnically diverse middle school youth. Participants were 7th and 8th grade youth attending a multiethnic school in an urban low-income community who were subsampled from participants in a larger prevention research study. More than half of the participants in the research were of Hispanic origin. Results suggest that age, gender, and/or racial/ethnic group membership influenced the strength of ethnic identity. In addition, age, sex, and strength of ethnic identity influenced substance use norms and behaviors. In each case where effects were significant, a stronger sense of ethnic identity as measured by two of the instruments predicted more negative attitudes toward and less use of alcohol, cigarettes, and marijuana. Holley, L.C., Kulis, S., Marsiglia, F.F., and Keith, V.M. Ethnicity Versus Ethnic Identity: What Predicts Substance Use Norms and Behaviors. Journal of Social Work Practice in the Addictions, 6(3), pp. 53-79, 2006.

Quality of Parent-Child Interaction Predicts Child Problem Behaviors

This article reports on two exploratory studies where the hypothesis is tested that there will be an inverse relationship between the quality of parent-child interactions and adolescent problem behaviors. Study 1 involves survey data from Midwestern parents of boys (n=377) and girls (335) between the ages of 11 and 13 years. Study 2, conducted to replicate the findings of Study 1, was similarly constructed with parents of boys (n=279) and girls (n=269). The quality of parent child interactions latent construct was formed from indicators of effective child management and parent-child affective quality, both self-reported by parents. Child problem behaviors were assessed with indicator measures of aggressive and oppositional behavior, school-related problems, and problematic peer relations. Multisample latent variable structural equation modeling confirms that a higher level of parent-child interaction quality was associated with a lower level of problem behaviors. This relationship was significant for parent-reported behavior, for both boys and girls, in both Study 1 and Study 2. The amount of variance explained indicated a moderate relationship between these variables and is consistent with earlier studies indicating that parent-child interaction quality is associated with problem behaviors among rural dwelling early adolescents. Spoth, R., Neppl, T., Goldberg-Lillehoj, C., Jung, T., and Ramisetty-Mikler, S. Gender-Related Quality of Parent-Child Interactions and Early Adolescent Problem Behaviors: Exploratory Study with Midwestern Samples. Journal of Family Issues, 27(6), pp. 826-849, 2006.

Cross-sectional Study of Female Students Reporting Anabolic Steroid Use

The objective of this article was to determine the characteristics of female US high school students reporting anabolic steroid use. This paper reports findings from cross-sectional assessments collected as part of the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. The data come from a nationally representative sample of US high schools, and the focus was on Female students in grades 9 through 12 (n = 7544). Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation. Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics. Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors. Elliot, D.L., Cheong, J., Moe, E.L., and Goldberg, L. Cross-Sectional Study of Female Students Reporting Anabolic Steroid Use. Arch Pediatr Adolesc Med, 161(6), pp. 572-577, 2007.

An HIV-Preventive Intervention for Youth Living with HIV

As the number of youth infected with HIV rises, secondary prevention programs are needed to help youth living with HIV meet three goals: (a) increase self-care behaviors, medical adherence, and health-related interactions; (b) reduce transmission acts; and (c) enhance their quality of life. This article describes an intervention program for youth living with HIV. Youth engage in small-group activities with other infected peers to modify their behavioral patterns. The intervention aims to (a) reduce substance use and sexual behaviors that may transmit or enhance transmission of the HIV virus; (b) reduce negative impacts of substance use on seeking and utilizing health care, assertiveness, and adherence to health regimens; and (c) enhance the quality of life to maintain behavior changes over time. Interventions that target youth living with HIV are warranted. A variety of delivery strategies are discussed for secondary interventions. Lightfoot, M., Rotheram-Borus, M., and Tevendale, H. An HIV-Preventive Intervention for Youth Living With HIV. Behav Modif, 31(3), pp. 345-363, 2007.

Narcissism and Self-Esteem Predicts Proactive and Reactive Child Aggression

The present study examined the importance of psychopathy-linked narcissism in predicting proactive and reactive aggression and conduct problems in a group of 160 moderately to highly aggressive children (mean age of 10 years, 9 months). Children's self-report of self-esteem and parent and teacher report of dimensions of psychopathy [narcissism, callous-unemotional (CU) traits, and impulsivity], proactive and reactive aggression, and conduct problems were collected. Composites of parent and teacher ratings of children's behavior were used. Consistent with the study's hypotheses, narcissism predicted unique variance in both proactive and reactive aggression, even when controlling for other dimensions of psychopathy, demographic variables associated with narcissism, and the alternative subtype of aggression. As hypothesized, impulsivity was significantly associated with only reactive aggression. CU traits were not related to proactive or reactive aggression once the control variables were entered. All dimensions of psychopathy predicted unique variance in conduct problems. Consistent with prediction, narcissism was not significantly related to general self-esteem, providing support that narcissism and self-esteem are different constructs. Furthermore, narcissism and self-esteem related differentially to proactive aggression, reactive aggression, and conduct problems. Furthermore, narcissism but not self-esteem accounted for unique variance in aggression and conduct problems. Barry, T., Thompson, A., Barry, C., Lochman, J., Adler, K., and Hill, K. The Importance of Narcissism in Predicting Proactive and Reactive Aggression in Moderately to Highly Aggressive Children. Aggress Behav, 33(3), pp. 185-197, 2007.

Engagement in Daily Activities and Adolescent Mood

This study explored the combined influences of daily activities and autonomy in activity engagement on adolescent daily positive and negative moods. Ecological momentary assessments (EMA) were used to obtain information about 8th- and 10th-grade students' (N = 517) mood, activities, and situation throughout the day. Participants responded to random prompts on the EMA device and, when prompted, rated mood adjectives and reported on their current activity and perceived autonomy in activity engagement. Mixed-effects regression models examined changes in mood across specific activity categories. Positive mood significantly improved when engaging in numerous activities; negative mood improved during social activities as well as "arty" and "hanging out" events but was fairly consistent across other activities. Stronger mood-activity relations were found after controlling for autonomy in activity engagement. Weinstein, S., and Mermelstein, R. Relations Between Daily Activities and Adolescent Mood: The Role of Autonomy. J Clin Child Adolesc Psychol, 36(2), pp. 182-194, 2007.

A Review of Research on Caretaking of Children of Incarcerated Parents

This paper reviews the literature for research findings on caretaking-related problems associated with the absence of parents from the home following incarceration. It focuses on the impact of incarceration on the welfare and adjustment of urban African American children and on the assumption of caretaking responsibilities by other caretakers, principally maternal grandmothers. Noting the complex situational difficulties involved and the potential burdens associated with surrogate parenting in general, and with this population in particular, the service-provider implications of this parenting arrangement are considered in this review. Findings indicate that problems associated with incarceration of parents tend to be intergenerational and vary considerably in complexity and severity. To the extent that they impact the children involved, these issues should be addressed in coordinated service delivery focusing on prevention. Hanlon, T.E., Carswell, S.B., and Rose, M. Research on the Caretaking of Children of Incarcerated Parents: Findings and Their Service Delivery Implications. Children and Youth Services Review, 29(3), pp. 348-362, 2007.

Young Adults' Reasons for Using Marijuana

Previous research has evaluated marijuana motives among adolescents and emerging adults using a predetermined set of motives, largely adapted from the alcohol literature. This research was designed to identify marijuana motives from the perspective of the user. Recent high school graduates who reported using marijuana (N=634) provided self-generated reasons for using. They also provided information on how many times they used marijuana in the past three months and negative consequences of marijuana use. The study authors independently reviewed all 2258 open ended reasons for using marijuana and developed a list of definitions for 19 distinct marijuana motives that emerged from the list. These definitions were provided to five raters who classified each of the statements. The most frequently reported reasons for using marijuana included enjoyment/fun, conformity, experimentation, social enhancement, boredom, and relaxation. Regression analyses revealed that experimentation was consistently associated with less use and fewer problems whereas enjoyment, habit, activity enhancement, and altered perception or perspectives were associated with heavier use and more problems. Current strategies for intervention may be enhanced by highlighting and understanding the individual reasons a person may choose to use marijuana. Lee, C., Neighbors, C., and Woods, B. Marijuana Motives: Young Adults'Reasons for Using Marijuana. Addict Behav, 32(7), pp. 1384-1394, 2007.

The Role of Delinquency and Depressed Mood in Late Adolescent Substance Use

This study examines the extent to which delinquency and depressed mood, measured at ages 11, 12, 13, 14, and 16, predict problem substance use at age 18. This study also examines mediation of these effects through alcohol use at age 16 across gender. Participants were 429 rural youths (222 girls and 207 boys) and their families who participated in Project Family, a prevention research study. Problem substance use was defined through both youth and parent responses to survey items reflecting problems with alcohol and drug use. Both delinquency and depressed mood appeared to play a role in the development of problem substance use, but their effects may be moderated by gender and may vary throughout adolescence. Indirect positive effects of delinquency on problem substance use were observed for boys, while direct positive effects of depressed mood were observed for girls. These findings have potential implications for specific targets of early prevention and how these may differ for boys and girls. Mason, W., Hitchings, J., and Spoth, R. Emergence of Delinquency and Depressed Mood Throughout Adolescence as Predictors of Late Adolescent Problem Substance Use. Psychol Addict Behav, 21(1), pp. 13-24, 2007.

Neighborhood Effects on Youth Substance Abuse

This study examines neighborhood influences on alcohol, cigarette, and marijuana use among a predominantly Latino middle school sample. Drawing on theories of immigrant adaptation and segmented assimilation, the authors test whether neighborhood immigrant, ethnic, and socioeconomic composition, violent crime, residential instability, and family structure have differential effects on substance use among youth from different ethnic and acculturation backgrounds. Data are drawn from self-reports from 3,721 seventh-grade students attending thirty-five middle schools in the Southwest. Analysis was restricted to the two largest ethnic groups: Latino students of Mexican heritage and non-Hispanic Whites. After adjusting for individual-level characteristics and school-level random effects, the only neighborhood effect found for the sample overall was that neighborhood instability predicted recent cigarette use. Subgroup analyses by individual ethnicity and acculturation was more revealing. Living in neighborhoods with high proportions of recent immigrants was protective against alcohol, cigarette, and marijuana use for Latino students at different acculturation levels. However, living in predominantly Mexican heritage neighborhoods with mostly non-immigrants was a risk factor for alcohol and marijuana use for less acculturated Latinos. Neighborhood poverty and crime had effects on cigarette and alcohol use respectively, but only for more acculturated Latinos. No neighborhood effects emerged for non-Hispanic White students. Results suggest that disadvantaged neighborhoods increase substance use among some ethnic minority youth, and immigrant enclaves appear to provide some protection against these effects. Kulis, S., Marsiglia, F.F., Sicotte, D., and Nieri, T. Neighborhood Effects on Youth Substance Use in a Southwest City. Sociological Perspectives, 50(2), pp. 273-301, 2007.

Family Process Influences Competence in Rural African American Youth

This paper investigates the effects of a family process on social and cognitive competence and on aggressive and deviant behavior among rural African American adolescents. The data were collected as a part of a study of 465 families who were randomly assigned to either a 6-week family process group or a control group and assessed at pretest, posttest, and follow-up. There were no significant differences between the experimental and control groups who participated in the research. However, families with a more routine environment and more parent-child interaction had adolescents with higher levels of competence and fewer behavioral problems. Pre-existing family characteristics better predicted adolescent success factors than participation in the family process group. Toldson, I. A., Harrison, M. G., Perine, R., Carreiro, P., and Caldwell, L. D. Assessing the Impact of Family Process on Rural African American Adolescents' Competence and Behavior Using Latent Growth Curve Analysis. Journal of Negro Education, 75(3), pp. 430-442, 2007.

Development and Validation of the Communities that Care Survey

The Communities That Care Youth Survey measures risk and protective factors shown in prior studies to predict adolescent problem behaviors such as drug use, delinquency, and violence. This paper describes the development and validation of cut points for the risk and protective factor scales in the Communities That Care Youth Survey that distinguish youths at higher risk for involvement in problem behaviors from those at lower risk. Using these cut points, populations surveyed with this instrument can be described in terms of the proportions of youths experiencing risk and the proportions experiencing protection on each predictor. This facilitates communities' prioritization of specific factors for attention. This paper compares different cut points, and evaluates the discriminant validity of selected cut points. Results indicate that cut points with sufficient sensitivity and selectivity can be established for each of the scales, and that risk and protective factors can be profiled as prevalence rates. Implications of these findings for prevention planning are discussed. Arthur, M.W., Briney, J.S., Hawkins, J.D., Abbott, R.D., Brooke-Weiss, B.L., and Catalano, R.F. Measuring Risk and Protection in Communities Using the Communities that Care Youth Survey. Evaluation and Program Planning, 30(2), pp. 197-211, 2007.

Relation Between Competence Skills and Substance Use

Only a few studies have found competence skills to be a protective factor against adolescent alcohol use; others did not find a direct effect on alcohol. A possible reason for this is that competence skills may moderate the effects of risk factors for alcohol use and that aspect has not been examined often or in a longitudinal design. This study tested whether several competence skills served either as direct protective factors against alcohol use or moderators of the impact of social risk factors on alcohol use. Participants (N = 1318) completed questionnaires that included measures of decision-making skills, refusal skill techniques, resisting media influences, friends' drinking and perceived social benefits of drinking, as well as current drinking amount and future drinking at baseline, one-year follow-up and two-year follow-up. Data analyses were conducted using multi-level mixed effects generalized linear models with random intercept. All the competence skills and the risk factors predicted current and future drinking. Several significant interactions were found between (1) perceived social benefits of drinking and decision-making skills, (2) perceived social benefits of drinking and refusal skill techniques and (3) friends' drinking and refusal skill techniques. Competence skills served as protective factors, as well as moderators. One possible reason that competence enhancement approaches to alcohol prevention are effective may be due to the inclusion of the competence skills component. Epstein, J., Zhou, X., Bang, H., and Botvin, G. Do Competence Skills Moderate the Impact of Social Influences to Drink and Perceived Social Benefits of Drinking on Alcohol use Among Inner-City Adolescents? Prev Sci, 8(1), pp. 65-73, 2007.

New Methods for More Potent Interventions

In this article two new methods for building and evaluating interventions are described. The first is the Multiphase Optimization Strategy (MOST). It consists of a screening phase, in which intervention components are efficiently identified for inclusion in an intervention or for rejection, based on their performance; a refining phase, in which the selected components are fine tuned and issues such as optimal levels of each component are investigated; and a confirming phase, in which the optimized intervention, consisting of the selected components delivered at optimal levels, is evaluated in a standard randomized controlled trial. The second is the Sequential Multiple Assignment Randomized Trial (SMART), which is an innovative research design especially suited for building time-varying adaptive interventions. A SMART trial can be used to identify the best tailoring variables and decision rules for an adaptive intervention empirically. Both the MOST and SMART approaches use randomized experimentation to enable valid inferences. When properly implemented, these approaches will lead to the development of more potent preventive interventions. Collins, L., Murphy, S., and Strecher, V. The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART) New Methods for More Potent eHealth Interventions. Am J Prev Med, 32(5 Suppl), pp. S112-S118, 2007.

Applying Engineering Principles to Inform Adaptive Interventions

The goal of this paper is to describe the role that control engineering principles can play in developing and improving the efficacy of adaptive, time-varying interventions. It is demonstrated that adaptive interventions constitute a form of feedback control system in the context of behavioral health. Consequently, drawing from ideas in control engineering has the potential to significantly inform the analysis, design, and implementation of adaptive interventions, leading to improved adherence, better management of limited resources, a reduction of negative effects, and overall more effective interventions. This article illustrates how to express an adaptive intervention in control engineering terms, and how to use this framework in a computer simulation to investigate the anticipated impact of intervention design choices on efficacy. The potential benefits of operationalizing decision rules based on control engineering principles are particularly significant for adaptive interventions that involve multiple components or address co-morbidities, situations that pose significant challenges to conventional clinical practice. Rivera, D., Pew, M., and Collins, L. Using Engineering Control Principles to Inform the Design of Adaptive Interventions: A Conceptual Introduction. Drug Alcohol Depend, 88 Suppl 2 pp. S31-S40, 2007.

Identifying Typologies of Alcohol Users in Emerging Adulthood

Longitudinal analyses identified unique multidimensional classes of alcohol use and examined individuals' movement among these classes during emerging adulthood. Latent transition analysis was used to identify a developmental model of alcohol use incorporating four aspects of use: use in the past year, frequency of use, quantity of use, and heavy episodic drinking. Participants were drawn from the Reducing Risk in Young Adult Transitions study (N = 1,143). Participants' alcohol use was assessed at mean ages of 18.5, 20.5, and 22.5 years. Through exploratory analysis, a five-class developmental model was identified as the best description of participants ' alcohol use between ages 18.5 and 22.5 years. This model consisted of five multidimensional alcohol-use latent variables: no use, occasional low use, occasional high use, frequent high use, and frequent high use with heavy episodic drinking. Analyses provided information regarding the proportion of participants in each latent class in the model at each measurement occasion and patterns of participants' movement among latent classes during the observed age period. Although alcohol use increased overall for study participants between ages 18.5 and 22.5, participants in lower-level alcohol-use latent classes were more likely to remain in low-level latent classes over time, and participants in moderate- and high-level latent classes were more likely to be in the frequent high use with heavy episodic drinking latent class over time. Implications for the prevention of heavy episodic drinking are discussed. Auerbach, K., and Collins, L. A Multidimensional Developmental Model of Alcohol Use During Emerging Adulthood. J Stud Alcohol, 67(6), pp. 917-925, 2006.

An Innovative, Effective and Cost Effective Survey Methodology

Maximizing the response rate to surveys involves thoughtful choices about survey design, sampling and collection methods. This paper describes an innovative survey method designed to provide immediate reinforcement for responding and to minimize response cost. This method involves using questionnaires printed as checks on security (anti-fraud) paper with questions and responses separated using a perforated tear off section. Once a participant completes the survey, the response area is detached from the questions, thus protecting the confidentiality of the subject, and the check is returned via the banking system. This report describes the survey-check methodology, the survey flow process, and the results from four research studies which have used this method. These studies include (1) a technology accessibility survey of parents with children enrolled in a low-income preschool program; (2) a parent report of their child's behavior used as screening criteria for inclusion in a computer-mediated parent education project; (3) a follow-up questionnaire as part of a longitudinal study of child behavior, covering home and classroom interventions, and service utilization, and; (4) a survey of dentists in support of efforts to recruit them to participate in a randomized control trial of tobacco cessation in dental offices. The results of using this method show great improvement in response rates over traditionally administered surveys for three of the four reported studies. Results are discussed in terms of future applications of this method, limitations, and potential cost savings. Feil, E., Severson, H., Taylor, T., Boles, S., Albert, D., and Blair, J. An Innovative, Effective and Cost Effective Survey Method Using a Survey-Check Response Format. Prev Sci, 8(2), pp. 133-140, 2007.

Methods for Improving Estimates of Alpha Coefficients

The point estimate of sample coefficient alpha may provide a misleading impression of the reliability of the test score. Because sample coefficient alpha is consistently biased downward, it is more likely to yield a misleading impression of poor reliability. The magnitude of the bias is greatest precisely when the variability of sample alpha is greatest (small population reliability and small sample size). Taking into account the variability of sample alpha with an interval estimator may lead to retaining reliable tests that would be otherwise rejected. In this article, the authors report on simulation studies conducted to investigate the behavior of asymptotically distribution-free (ADF) versus normal-theory interval estimators of coefficient alpha under varied conditions. Normal-theory intervals were found to be less accurate when item skewness >1 or excess kurtosis >1. For sample sizes over 100 observations, ADF intervals are preferable, regardless of item skewness and kurtosis. A formula for computing ADF confidence intervals for coefficient alpha for tests of any size is provided, along with its implementation as an SAS macro. Maydeu-Olivares, A., Coffman, D., and Hartmann, W. Asymptotically Distribution-Free (ADF) Interval Estimation of Coefficient Alpha. Psychol Methods, 12 (2), pp. 157-176, 2007.


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