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Director's Report to the National Advisory Council on Drug Abuse - September, 2009



Research Findings - Prevention Research

Intensity of Prevention Training for Practitioners Related to Child Outcomes

This study examined an important but rarely investigated aspect of the dissemination process: the intensity of training provided to practitioners. Counselors in 57 schools were randomly assigned to 1 of 3 conditions: Coping Power-training plus feedback (CP-TF), Coping Power-basic training (CP-BT), or a comparison condition. CP-TF counselors produced reductions in children's externalizing behavior problems and improvements in children's social and academic skills in comparison to results for target children in both the comparison and the CP-BT conditions. Children were screened for participation in the study; children at high risk for aggressive behaviors were invited into the study. In the final sample, 168 children were in the CP-TF school, 183 were in the CP-BT school and 180 were in the comparison condition. Three sets of measures were used to generate data for this study: (1) program implementation, which was assessed through eight variables evaluating concrete aspects of program delivery and counselor engagement in delivering the program; (2) The National Youth Survey (NYS) questionnaire and the Behavior Assessment System for Children were used to assess child delinquency, substance use, and behavioral outcomes; and (3) the Outcome Expectations Questionnaire and the Alabama Parenting Questionnaire were used to assess child and parent mediating processes. Hierarchical Linear Modeling (HLM) was used for the analyses. Results showed that in comparison to children who worked with CP-BT counselors, children who worked with CP-TF counselors had relatively lower levels of teacher-rated and parent-rated externalizing behavior problems, lower rates of child-reported assaultive behaviors, and reductions in their expectations that aggressive behaviors would lead to good outcomes for them. In addition, it was found that training intensity was critical for successful dissemination, although the implementation mechanism underlying this effect remains unclear, as condition effects were not significant for completion of session objectives but were significant for the quality of counselors' engagement with children. Lochman J, Boxmeyer C, Powell N, Qu L, Wells K, Windle M. Dissemination of the coping power program: importance of intensity of counselor training. J Consult Clin Psychol. 2009;77(3):397-409.

Promising Prevention Program to Reduce Tobacco Use Rates among Indian Youth

Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) is a group-randomized trial designed to assess a multi-component intervention aimed at preventing tobacco use among Indian adolescents. Thirty-two schools in Delhi and Channai, India, were recruited and randomly assigned to an intervention or delayed intervention control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th and 8th grade students in 2004; 14,063 students took part in the study and completed a survey in 2004, 2005, or 2006. The two-year intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (small hand-rolled, often flavored cigarettes), chewing tobacco and future intentions to smoke or use chewing tobacco. Findings showed that students in the intervention group were significantly less likely than were students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future. Perry C, Stigler M, Arora M, Reddy S. Preventing tobacco use among young people in India: Project MYTRI. Am J Public Health. 2009;99(5):899-906.

Brief Family Intervention Improves Maternal Depression Which Mediates Effects on Problem Behaviors in Early Childhood

Maternal depression has been consistently linked to the development of child problem behavior, particularly in early childhood, but few studies have examined whether reductions in maternal depression serve as a mediator in relation to changes associated with a family-based intervention. The current study addressed this issue with a sample of 731 families receiving services from a national food supplement and nutrition program – The Women Infants and Children's (WIC) program. Families were recruited from 3 WIC sites in Urban, Suburban and Semi-Urban/Rural communities. Families with toddlers between ages 2 and 3 were screened and then randomized to a brief family intervention, the Family Check-Up, which included linked interventions that were tailored and adapted to the families needs. Follow-up intervention services were provided at age 3 and follow-up of child outcomes occurred at ages 3 and 4. Between ages 2 and 4, families received an average of 2.8 to 3 intervention sessions. Latent growth models revealed intervention effects for early externalizing and internalizing problems from 2 to 4, and reductions in maternal depression from ages 2 to 3. In addition, reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior after accounting for the potential mediating effects of improvements in positive parenting. The results are discussed with respect to targeting maternal depression in future intervention studies aimed at improving early child problem behavior. In summary, this study of a brief, family-based prevention intervention, tailored to family needs, demonstrated benefits on maternal mental health, which mediated intervention effects on child behavior problems. Shaw D, Connell A, Dishion T, Wilson M, Gardner F. Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior. Dev Psychopathol. 2009;21(2):417-439.

Child's Genetic Risk for Negative Affect and Poor Self-Control Moderates the Impact of a Parenting Intervention on Parental Depressive Symptoms

A previous report in the Journal of Family Psychology described the results of a randomized prevention trial contrasting families who participated in the Strong African American Families Program (SAAF, a preventive intervention for rural African American parents and their 11-year-olds) with control families. The current report examines a novel contextual variable, child's genetic risk status for negative affect and poor self-control, as a moderator of treatment effects on caregiver's depression. Genetic data were obtained from youth saliva samples (n=109). The primary study hypothesis of differential program impact on caregiver depression as a function of youth genetic risk was confirmed. Among caregivers with initially elevated scores on the Center for Epidemiological Studies-Depression scale, an indicator of depressive symptomology, SAAF participation was associated with greater impact on depressive symptoms among those whose children were at genetic risk. This finding suggests that effect size estimates based on full samples may underestimate the impact of prevention programs on at-risk subgroups, such as parents with depressive symptoms. Beach S, Brody G, Kogan S, Philibert R, Chen Y, Lei M. Change in caregiver depression in response to parent training: genetic moderation of intervention effects. J Fam Psychol. 2009;23(1):112-117.

Multidimensional Treatment Foster Care Program for Preschoolers Effects Electrophysio-logical Measures

The current study was designed to assess the impact of a family-based preventive intervention for preschool-aged, maltreated children in foster care by using behavioral measures (i.e., accuracy and reaction times) and electrophysiological measures (i.e., event-related potentials). These measures were recorded during a computerized flanker task designed to assess cognitive control and response monitoring. The sample was recruited from a larger randomized efficacy trial of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) which included foster children assigned to the intervention condition (n = 10), foster children assigned to a services-as-usual comparison condition (n = 13), and low-income, non-maltreated community children (n = 11). Overall the sample included 46 children (age range=4.87–6.99 years, M=5.94 years; 25 males and 21 females). Children's behavioral and electrophysiological performance on the task was generally consistent with previous research with adults and older children. There were no group differences on the behavioral measures of cognitive control or response monitoring. Notably, however, group differences were observed on the electrophysiological measures of response monitoring. Specifically, the foster children who received services as usual were significantly less responsive to performance feedback about errors than the foster children who received the intervention and the non-maltreated children. This methodology provides an important new approach for assessing the effects of psychosocial preventive interventions for foster care children at both the behavioral and the physiological levels of analysis. Bruce J, McDermott J, Fisher P, Fox N. Using behavioral and electrophysiological measures to assess the effects of a preventive intervention: a preliminary study with preschool-aged foster children. Prev Sci. 2009;10(2):129-140.

Involved-Supportive Parenting Moderates Impact of Genetic Vulnerability on Substance Use

The authors used a longitudinal, prospective design to investigate a moderation effect of parenting style in the association between a genetic vulnerability factor, a variable nucleotide repeat polymorphism in the promoter region of 5HTT (5-HTTLPR), and increases in youths' substance use. The primary study hypothesis predicted that involved-supportive parenting would attenuate the link between the 5-HTTLPR polymorphism and longitudinal increases in substance use. African American youths residing in rural Georgia (N = 253, mean age = 11.5 years) provided 4 waves of data on their substance use and the mothers of the youths provided data on their parenting practices. Genetic data were obtained from youths via saliva samples. Latent growth curve modeling indicated that 5-HTTLPR status (presence of 1 or 2 copies of the s allele) was linked with increases in substance use over time; however, this association was greatly reduced when youths received high levels of involved-supportive parenting. This study demonstrates that parenting processes have the potential to ameliorate genetic risk. Brody G, Beach S, Philibert R, Chen Y, Lei M, Murry V, Brown A. Parenting moderates a genetic vulnerability factor in longitudinal increases in youths' substance use. J Consult Clin Psychol. 2009;77(1):1-11.

Neural Correlates of Emotional Reactivity in Sensation Seeking

High sensation seeking has been linked to increased risk for drug abuse and other negative behavioral outcomes. This study explored the neurobiological basis of this personality trait using functional magnetic resonance imaging (FMRI). High sensation seekers (HSSs) and low sensation seekers (LSSs) viewed high- and low-arousal pictures. Participants were healthy adults, ages 18 through 25, whose scores on the Brief Sensation-Seeking Scale placed them in the top (HSSs; n=20; 10 males, 10 females) and bottom (LSSs; n=20; 10 males, 10 females) quartiles of population-based norms. Exclusion criteria included the presence of metal in or on the body, pregnancy, a prior neurological or psychiatric diagnosis, learning disability, a history of substance abuse or smoking, current use of central nervous system medications, left-handedness, and poor vision that could not be corrected. Comparison of the groups revealed that HSSs showed stronger FMRI responses to high-arousal stimuli in brain regions associated with arousal and reinforcement (right insula, posterior medial orbit frontal cortex), whereas LSSs showed greater activation and earlier onset of FMRI responses to high-arousal stimuli in regions involved in emotional regulation (anterior medial orbit frontal cortex, anterior cingulate). Furthermore, FMRI response in anterior medial orbit frontal cortex and anterior cingulate was negatively correlated with urgency. Finally, LSSs showed greater sensitivity to the valence of the stimuli than did HSSs. These distinct neurobiological profiles suggest that HSSs exhibit neural responses consistent with an overactive approach system, whereas LSSs exhibit responses consistent with a stronger inhibitory system. Joseph JE, Liu X, Jiang Y, Lynam D, Kelly TH. Neural correlates of emotional reactivity in sensation seeking. Psychol Sci. 2009;20(2):215-223.

Cigarette Smoking Following Rape

Although prior research has identified increases in cigarette smoking following trauma exposure, no studies have examined smoking following rape. The present study identified and characterized longitudinal trajectories (< 3 months, 3-6 months, and >6 months post assault) of smoking following a rape (N=152) in a sample of 268 female sexual assault victims participating in a forensic medical exam. Of participants endorsing smoking post rape, two trajectories were identified, with the majority of participants (74.6%) evidencing smoking with a slight decrease over time and remaining participants showing heavy smoking with a slight increase over time (25.4%). Heavy smokers consumed more than twice as many cigarettes as moderate smokers at 3-month post-rape, evidencing increased smoking over time. Additionally, having sustained an injury during rape increased the likelihood of being in the heavy smoking group. The association between injury and smoking may be related to attempts at pain management, or due to restricted activity levels. Early identification and efforts at reducing smoking with these subsets of rape victims are warranted. Ananda AB, Resnick HS, Nugent NR, Acierno R, Rheingold AA, Minhinnett R, Kilpatrick DG. Longitudinal trajectories of cigarette smoking following rape. J Trauma Stress. 2009;22(2):113-121.

Sexual Risk-Taking among African American College Men

This study investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs). Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease. Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors. Results suggest that services designed to prevent sexually transmitted diseases should be provided to all male college students and that prevention should address drug and alcohol use before sexual activity. Browne D, Clubb P, Wang Y, Wagner F. Drug use and high-risk sexual behaviors among African American men who have sex with men and men who have sex with women. Am J Public Health. 2009;99(6):1062-1066.

Stakeholder Perceptions of Prevention Modalities in Tijuana, Mexico

Injection drug use is a growing public health crisis along the U.S.-Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. In-depth qualitative interviews were conducted with 40 stakeholders (i.e., pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel) to explore the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped, transcribed verbatim, and translated. Content analysis indicated varying levels of support regarding the acceptance and feasibility of needle exchange programs (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding. Results from this study may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana. Philbin MM, Mantsios A, Lozada R, Case P, Pollini RA, Alvelais J, Latkin C, Magis-Rodriguez C, Strathdee SA. Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico. Int J Drug Policy. 2009;20(4):329-335.

School-Based Tobacco Prevention Program in India Has Impact on Psychosocial Risk Factors for Intentions To Use Tobacco

The current study used mediation analysis to investigate whether Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) altered the psychosocial risk factors as intended by the intervention, and whether the changes in psychosocial risk factors were responsible for altering students' tobacco use intentions. Multi-level mediation models were estimated using student data from baseline and 1-year follow-up surveys. Results indicated that the psychosocial risk factors Knowledge of Health Effects, Normative Beliefs, and Reasons to Use Tobacco were significant mediators between the intervention activities and students' tobacco use intentions. These findings are consistent with the broad goal of the first year curriculum—to fortify students' knowledge and beliefs about tobacco use—toward the aim of reducing intentions to use tobacco. Bate SL, Stigler MH, Thompson MS, Arora M, Perry CL, Reddy KS. Psychosocial mediators of a school-based tobacco prevention program in india: results from the first year of Project MYRTI. Prev Sci. 2009;10:116-128.

Moderators of Outcome of a Brief Intervention for High Risk Toddlers and their Families

This study investigated moderators of change in an empirically supported family-centered intervention (the Family Check-Up) for problem behavior in early childhood. Participants were 731 2- to 3-year-olds (49% girls; 28% African American, 50% European American, 13% biracial) from low-income families and had been screened for risk of family stress and early-onset problem behavior. They were randomized to the Family Check-Up intervention or to a no-intervention control group. Latent growth models examined sociodemographic and parent psychological risk factors as potential moderators of change in problem behavior between ages 2, 3, and 4. Results revealed 2 moderators of intervention effectiveness. Caregivers with the lowest educational levels were more responsive to the family-centered intervention, and 2-parent families were more responsive to the intervention. Other risk factors showed no predictive effects. Overall, findings suggest that this brief family-centered intervention can be effective in reaching the most distressed and most disadvantaged families, compared to those who are more advantaged. However, results suggest that more attention may be needed to address the intervention needs of single parent families in reducing problem behavior in early childhood. Gardner F, Connell A, Trentacosta C, Shaw D, Dishion T, Wilson M. Moderators of outcome in a brief family-centered intervention for preventing early problem behavior. J Consult Clin Psychol. 2009;77(3):543-553.

Preventing Multiple Negative Adolescent Outcomes Following Divorce

This paper presents experimental tests of the Oregon delinquency model applied within a randomized design of an at-risk sample of divorced, single mothers and their elementary school-aged sons. In the theoretical model, ineffective parenting practices and deviant peer association serve as the primary mechanisms for growth in adolescent delinquent behavior and early arrests. Participants included 238 mothers and sons who were initially recruited after the divorce, and when the child was in first, second or third grade. Multiple-method assessments of mothers and sons included delinquency as measured by teacher reports and official arrest records, parenting skills measured by observations of parent-child interactions, and deviant peer association as reported by focal boys. The intervention consisted of 14 sessions of parent group meetings held weekly. The intervention focused on five parenting practices: skill encouragement, limit setting, monitoring, problem solving, and positive involvement. To meet the needs of divorced families, the intervention included content to address issues related to divorce, including emotion regulation, managing inter-parental conflict, and addressing children's divorce related concerns. Intention-to-treat analyses were conducted using Latent Growth Models. Analyses of the 9-year follow-up data indicated that the Oregon model of parent management training significantly reduced teacher-reported delinquency and police arrests for focal boys. As hypothesized, the experiments demonstrated that improving parenting practices and reducing contacts with deviant peers served as mediating mechanisms for reducing rates of adolescent delinquency. As predicted, there was also a significant delay in the timing of police arrests for youth in the experimental as compared to the control group. Forgatch M, Patterson G, Degarmo D, Beldavs Z. Testing the Oregon Delinquency Model with 9-Year follow-up of the Oregon Divorce Study. Dev. Psychopathol. 2009;21(2):637-660.

Predictors of Response to Parent Management Training

This study examined whether attendance and quality of participation in parent management training predicted treatment response. Data were from 445 parents enrolled in the intervention condition of the Fast Track study (55% minority; 62% single; almost all of low socioeconomic status) who had 1st-grade children with severe conduct problems (445 children; 72% boys; 45% European American, 53% African American, and 2% Asian American, Latino, or American Indian). Children were about 6 years old (M = 6.47 years, SD = 0.48) when the intervention began. Quality of participation in weekly parent groups was based on group leader ratings. Parent outcomes were based on interviewer ratings, behavioral observations, parent reports, and teacher ratings. Results of hierarchical linear models suggested that few family characteristics predicted attendance and that attendance was not related to changes in parenting over the year. However, several family characteristics predicted quality of participation in parent management training, and this in turn predicted changes in parenting – parental perceptions, warmth, physical punishment, and school involvement. Nix R, Bierman K, McMahon R, McMahon RT. How attendance and quality of participation affect treatment response to parent management training. J Consult Clin Psychol. 2009;77(3):429-438.

Delaying First Time Cigarette Use among Urban Youth

Two first-grade, universal preventive interventions were investigated to determine the influence of depressed mood, the interventions, and their interaction on delaying first time cigarette use through age 19. Both interventions were designed to improve student behavior and learning. One intervention focused on improving teacher behavior management and instructional skills (Classroom-Centered, CC); the other focused on the family-school partnership (FSP). Self-reports of smoking behavior and depressed mood were collected on an annual basis from grade 6 through age 19. The present analyses were restricted to the 563 youth who had never smoked by grade 6, or 83% of the original sample of first grade participants. Discrete-time survival analysis was used to examine the effects of depressed mood and the interventions on first tobacco cigarette smoked. Analyses revealed that depressed mood was associated with reduced time to the first cigarette smoked (adjusted hazard ratio, aHR: 1.4; 95% CI: 1.1-1.9), whereas the CC intervention prolonged the time before first cigarette smoked (aHR: 0.8; 95% CI: 0.7-0.9). No significant variation in the effect of depressed mood on first cigarette used was found by gender or grade, nor was the effect of the CC intervention moderated by depressed mood. FSP did not play a significant role in delaying participants first time smoking in middle or late adolescence. Authors proposed that strategies to prevent tobacco cigarette smoking should include both a focus on early success in elementary school as well as on depressed mood in adolescence. Wang Y, Browne D, Petras H, Stuart E, Wagner F, Lambert S, Kellam S, Ialongo N. Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth. Drug Alc Depend. 2009;100(3):194-203.

Adolescent Belief that Using Inhalants May Increase Social Acceptance and Gain Parental Attention

With an eye toward future prevention efforts, this study explored perceptions of inhalant utility among young adolescents in the United States. The study makes use of data gathered via nine focus groups conducted in Tucson, Arizona in 2004. A focus group approach was selected as the method of data collection in order to generate new insights and hypotheses regarding the nature of inhalant use among middle school students. Of the nine focus groups conducted, one consisted of only males and one of exclusively females (of the same grade). The remaining seven groups consisted of males and females of the same grade. Participants ranged from 11 to 16 years of age (M = 13.2). The race/ethnicity composition of the groups was as follows: American Indian/Alaska Native n=3 (6.4%); Black/African-American n=4 (8.5%); Hispanic or Latino/Latina n=15 (31.9%); White or Caucasian (non-Hispanic) n=19 (40.4%); Other n=6 (13.7%). Thirteen participants (27.7%) indicated some degree of past inhalant use. Three main themes emerged concerning the perceived utility of inhalant use: (1) inhalant use as a means of mental escape, (2) inhalant use as a social tool, and (3) inhalant use as a parental relations tool (as a means to deal with lack of parental attention). Additionally, participants discussed an interaction hypothesis regarding inhalant use and popularity. Surprisingly, participants less frequently spoke of situations in which they were pressured to use inhalants, compared to situations in which young adolescents, believing that inhalants will increase social acceptance. This study represents the first step toward understanding the outcomes young adolescents associate with inhalant use. Siegel J, Alvaro E, Patel N, Crano W. "You would probably want to do it. Cause that's what made them popular": Exploring perceptions of inhalant utility among young adolescent nonusers and occasional users. Subst Use Misuse. 2009;44(5):597-615.

Parental Knowledge about Children's Whereabouts and Parental Warmth Inversely Relate to Youth Marijuana Use

Despite research indicating that effective parenting plays an important protective role in adolescent risk behaviors, few studies have applied theory to examine this link with marijuana use. In the current study, secondary analysis were obtained from the restricted version of the National Survey of Parents and Youth, which was conducted to evaluate the National Youth Anti-Drug Media Campaign (N = 2,141 adolescents aged 12-18, 51.1% male). As posited by the Theory of Planned Behavior (TPB), this study hypothesized that parental knowledge (of adolescent activities and whereabouts) and parental warmth are antecedents of adolescents' marijuana beliefs-attitudes, subjective norms, and perceived behavioral control. These three types of beliefs were hypothesized to predict marijuana intention, which in turn was hypothesized to predict marijuana consumption. Results of confirmatory factor analysis corroborated the psychometric properties of the two-factor parenting structure as well as the five-factor structure of the TPB. Further, the proposed integrative predictive framework, estimated with a latent structural equation model, was largely supported. Parental knowledge of adolescent activities and whereabouts inversely predicted pro-marijuana attitudes, subjective norms, and perceived behavioral control; parental warmth inversely predicted pro-marijuana attitudes and subjective norms. Marijuana intention, but not perceived behavioral control, predicted marijuana use 1 year later. In households with high parental knowledge, parental warmth also was perceived to be high (r = .54, p < .001). Owing to the analysis of nationally representative data, results are generalizable to the United States population of adolescents 12-18 years of age. Lac A, Alvaro E, Crano W, Siegel J. Pathways from parental knowledge and warmth to adolescent marijuana use: An extension to the theory of planned behavior. Prev Sci. 2009;10(1):22-32.

Predicting Substance Use and Sexual Behavior in Subgroups of Hispanic Adolescents

Hispanic adolescents are a rapidly growing population and are highly vulnerable to substance abuse and HIV infection. Many interventions implemented thus far have been "one size fits all" models that deliver the same dosage and sequence of modules to all participants. To more effectively prevent substance use and HIV in Hispanic adolescents, different risk profiles and subgroups should be considered. This used intrapersonal risks (e.g., attitudes toward risk taking), and eco-develop-mental risks (e.g., negative parenting), to identify Hispanic adolescent subgroups and to compare substance use rates and sexual behavior by risk subgroup. The study participants were 254 Hispanic adolescents enrolled in a substance abuse and HIV prevention study. The results indicate that a larger proportion with high eco-developmental risk (irrespective of the intrapersonal risk for sub-stance use) report lifetime and past 90-day cigarette and illicit drug use. In contrast, a larger propor-tion with high intrapersonal risk for unsafe sex (irrespective of eco-developmental risk) report early sex initiation and sexually transmitted disease incidence. Prado G, Schwartz S, Maldonado-Molina M, Huang S, Pantin H, Lopez B, Szapocznik J. Eco-developmental x intrapersonal risk: substance use and sexual behavior in Hispanic adolescents. Health Educ Behav. 2009;36(1):45-61.

Predictors of Functional Resilience in Children of Individuals in Methadone Treatment

This study describes the adversities experienced by a sample of children of opiate-dependent parents, examines criteria for young adulthood functional resilience, and tests parent, child, and school predictors of resilience. The Focus on Families (FOF) project was a randomized trial of a family-focused intervention with opiate-dependent individuals in methadone treatment and their children. Analyses were conducted on data from the children in treatment and control families during the original study (1991-1995) and a long-term follow-up interview (2005-2006). Although all participants had an opiate-dependent parent, 70% experienced two or more additional types of childhood adversity and 20% experienced four or more types. A total of 24% met the following three criteria for functional resilience at the time of their young-adult interview: (1) working or being enrolled in school, (2) no history of substance abuse or dependence, and (3) no adult criminal charges in the prior 5 years. The FOF intervention did not significantly predict functional resilience. Girls were approximately four times more likely to exhibit resilience than boys. Experiencing a wider range of adversities in addition to having an opiate-dependent parent did not reduce the likelihood of functional resilience. Of the five child, family, and school predictors tested, only lower externalizing or internalizing problems in childhood were significantly associated with the likelihood of functional resilience (odds ratio=.30, p=.04) as a young adult. These findings suggest that early intervention with families with opiate-dependent parents to prevent and reduce internal-izeing and externalizing problems in their children holds the most promise of supporting resilient adaptation in early adulthood. Skinner M, Haggerty K, Fleming C, Catalano R. Predicting function-al resilience among young-adult children of opiate-dependent parents. J Adol. Health. 2009;44(3): 283-290.

Black-White Similarities in Parental Influences on Teen Smoking

The health risks associated with smoking disproportionately burden Blacks, and Black adults are more likely to smoke than are White adults. Most adult smokers have their first smoking experience as teenagers; however, rates of smoking initiation during adolescence remain lower among Black compared with White youth. The level and impact of family and peer risk and protective factors on adolescent smoking across both groups were modeled prospectively from 8th to 10th grade in a sample of 331 (Black n = 162, White n = 168) families using data from self-administered computer-assisted questionnaires. Predictors included parent smoking, guidelines against substance use, monitoring, consistent discipline, attachment to parents, and association with deviant peers. Mean-level differences indicated greater risk for Black teens in some cases and higher protection in others. Multiple-group structural equation modeling indicated no race differences. Several factors affected both groups: (a) parenting factors reduced association with deviant peers, (b) association with deviant peers increased the risk of smoking in the 10th grade, and (c) teens were more likely to smoke if their parents smoked. The authors propose that reduced smoking among Black teens compared with White teens may be due to the protection provided by clear parental guidelines about substance use and clearly stated consequences for failure to observe those guidelines. Skinner M, Haggerty K, Catalano R. Parental and peer influences on teen smoking: are white and black families different? Nicotine Tob Res. 2009;11(5):558-563.

Social Context and Identity are Related to Problem Behavior in High-Risk Hispanic Adolescents

The present study was designed to examine the extent to which (a) family and school functioning and (b) personal and ethnic identity are associated with conduct problems, drug use, and sexual risk taking in a sample of 227 high-risk Hispanic adolescents. Adolescents participated in the study with their primary parents, who were mostly mothers. Adolescents completed measures of family and school functioning, personal and ethnic identity, conduct problems, and drug use. Parents completed measures of family functioning and adolescent conduct problems. Results indicated that school functioning and personal identity confusion were related to alcohol use, illicit drug use, and sexual risk taking indirectly through adolescent reports of conduct problems. Adolescent reports of family functioning were related to alcohol use, illicit drug use, and sexual risk taking through school functioning and conduct problems. Results are discussed in terms of the problem behavior syndrome and in terms of the finding of relative independence of contextual and identity variables vis-ą-vis conduct problems, substance use, and sexual risk taking. Schwartz SJ, Mason CA, Pantin H, Wang W, Brown CH, Campo A, Szapocznik J. Relationships of social context and identity to problem behavior among high-risk Hispanic adolescents. Youth Soc. 2009;40(4):541-570.

Evidence of Memory Deficits and Hippocampal Dysfunction in HIV+ Women

Neurocognitive studies of HIV typically target executive functions dependent on frontostriatal circuitry. The integrity of medial temporal systems has received considerably less attention despite high hippocampal viral load. Studies also predominately involve HIV+ men, though HIV+ women may be at increased risk for cognitive dysfunction due to the high prevalence of psychosocial/mental health problems and lower educational attainment. This preliminary investigation of episodic memory and its neural correlates in HIV-infected and at-risk uninfected women was conducted with 54 HIV+ and 12 HIV- women (mean age = 43 years; 86% African American) recruited from the Chicago site of the Women's Interagency HIV Study. Participants completed standardized tests of verbal and visual episodic memory, working memory, and executive function. A subset of 11 women also underwent functional MRI during a delayed verbal episodic memory task. HIV serostatus predicted significantly lower immediate and delayed verbal episodic memory, working memory, and visual memory. Preliminary neuroimaging findings revealed group differences in bilateral hippocampal function, with HIV+ women showing decreased activation during encoding and increased activation during delayed recognition. These alterations correlated with worse episodic verbal memory. These results suggest that verbal episodic memory deficits are evident in HIV+ women and may be associated with hippocampal dysfunction at both encoding and retrieval. Maki P, Cohen M, Weber K, Little D, Fornelli D, Rubin L, Perschler P, Gould F, Martin E. Impairments in memory and hippocampal function in HIV-positive vs. HIV-negative women: A preliminary study. Neurology. 2009;72(19):1661-1668.

Disinhibited Social Behavior among Internationally Adopted Children

Post-institutionalized children frequently demonstrate persistent socioemotional difficulties. For example, some post-institutionalized children display an unusual lack of social reserve with unfamiliar adults. This behavior, which has been referred to as indiscriminate friendliness, disinhibited attachment behavior, and disinhibited social behavior, was examined by comparing children internationally adopted from institutional care to children internationally adopted from foster care and children raised by their biological families. Etiological factors and behavioral correlates were also investigated. The study sample included 120 6- to 7-year-old children. The children were equally distributed across the institutional care, foster care, and non-adopted groups. The adopted children had been internationally adopted into the United States after receiving institutional care or foster care for the majority of their lives. The children in the institutional care group had spent at least 70% of their lives in institutional care and no more than 6 months in family-based care prior to adoption, and the children in the foster care group had spent at least 70% of their lives in foster care and no more than 2 months in institutional care prior to adoption. The adopted children were required to have been adopted prior to the age of 36 months to ensure adequate time in their adoptive homes. The children in the non-adopted group were raised by their biological families in the United States. The groups did not differ in terms of age, and there were 30 girls and 10 boys in each group. Analyses showed that both groups of adopted children displayed more disinhibited social behavior than the non-adopted children. Of the etiological factors examined, only the length of time in institutional care was related to disinhibited social behavior. Disinhibited social behavior was not significantly correlated with general cognitive ability, attachment-related behaviors, or basic emotion abilities. However, this behavior was negatively associated with inhibitory control abilities even after controlling for the length of time in institutional care. These results suggest that disinhibited social behavior might reflect underlying deficits in inhibitory control. Bruce J, Tarullo A, Gunnar M. Disinhibited social behavior among internationally adopted children. Dev Psychopathol. 2009;21(1):157-171.

Development and Validation of a Questionnaire for Determining Marijuana Use Motives

Relatively little research has evaluated motives for using marijuana based on users' self-reported reasons. This article details the construction and psychometric validation of a new marijuana motives questionnaire. Participants included 346 marijuana-using college students who completed online assessments regarding their motives for, frequency of, and problems associated with their marijuana use. Exploratory and confirmatory factor analysis supported a 12-factor scale, including the following: (1) Enjoyment, (2) Conformity, (3) Coping, (4) Experimentation, (5) Boredom, (6) Alcohol, (7) Celebration, (8) Altered Perception, (9) Social Anxiety, (10) Relative Low Risk, (11) Sleep/Rest, and (12) Availability. Regression results indicated enjoyment, boredom, altered perception, relative low-risk, and sleep/rest were each uniquely associated with greater frequency of use. Experimentation and availability motives were associated with less use. After accounting for use, coping and sleep/rest were associated with significantly more consequences whereas enjoyment was associated with fewer consequences. Additional results comparing the scale to an existing marijuana motives measure indicated comparatively good convergent validity. Lee C, Neighbors C, Hendershot C, Grossbard J. Development and preliminary validation of a comprehensive marijuana motives questionnaire. J Stud Alcohol Drugs. 2009;70(2):279-287.

Efficiency and Quality of Mixed-mode Surveys to Assess Sexual Activity and Drug Use

This study examines whether it is possible to take advantage of the time and cost efficiencies of a Web mode of survey administration while minimizing coverage and non-response error by offering in-person interviews for participants who lack Internet access or are reluctant to use the Web mode. Furthermore the investigators examine whether responses to questions concerning sexual activity and drug use differ by mode of survey administration. This project is nested in the long-term follow up of a prevention study, and participants in the study (n=386) were on average 18 years old at the time of the survey. Participants in the study were randomly assigned to two conditions of mixed-mode approaches to data collection. One condition started with a Web survey and followed with an in-person interview for non-completers after a specified period of time while the other condition began with an in-person interview and followed with a Web survey for non-completers. The two conditions are compared with regard to cost, time, and error. Overall completion rates are compared for the two conditions. The Web-first condition resulted in cost savings although the overall completion rates for the 2 conditions were similar. On average, in-person-first condition participants completed surveys earlier in the field period than Web-first condition participants. Based on intent-to-treat analyses, little evidence was found of condition effects on response bias, with respect to rates or levels of reported behavior. McMorris B, Petrie R, Catalano R, Fleming C, Haggerty K, Abbott R. Use of web and in-person survey modes to gather data from young adults on sex and drug use: an evaluation of cost, time, and survey error based on a randomized mixed-mode design. Eval Rev. 2009;33(2):138-158.

Pilot Prevention Program for Homeless Women in the Transition to Adulthood

Among young women who are impoverished and homeless, the transition to adulthood (ages 18-25) is associated with alcohol and drug use, risky sexual activity, and increased risk of being victimized by intimate partner violence. "The Power of YOU," a program using motivational interviewing, was designed to address these problems. This program was piloted with 31 homeless women (ages 18-25) in 7 focus groups. Women completed questionnaires assessing background characteristics and satisfaction at the end of each group. Each group was followed by a feedback session that was audio-recorded and transcribed. Women expressed satisfaction and provided consistently positive feedback on the intervention, reporting that it was 'helpful to know how to put a condom on' and that they appreciated the attention paid to safety planning. Results from this pilot suggest this program may hold promise in helping homeless young women in the transition to adulthood and that the approach of motivational interviewing appeared appropriate for this population. Wenzel SL, D'Amico EJ, Barnes D, Gilbert ML. A pilot of a tripartite prevention program for homeless young women in the transition to adulthood. Women's Health Issues. 2009;19(3):193-201.


Index

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Program Activities

Extramural Policy and Review Activities

Congressional Affairs

International Activities

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Media and Education Activities

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Staff Highlights

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