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

Research Findings - Prevention Research

National Youth Anti-Drug Media Campaign: No Effect on Youths

This study examined the cognitive and behavioral effects of the National Youth Anti-Drug Media Campaign on youths aged 12.5 to 18 years and reports core evaluation results. From September 1999 to June 2004, 3 nationally representative cohorts of US youths aged 9 to 18 years were surveyed at home 4 times. Sample size ranged from 8,117 in the first to 5,126 in the fourth round (65% first-round response rate, with 86%-93% of still eligible youths interviewed subsequently). Main outcomes were self-reported lifetime, past-year, and past-30-day marijuana use and related cognitions. Most analyses showed no effects from the campaign. From interview round three to interview round four, however, more ad exposure predicted less intention to avoid marijuana use, and weaker antidrug social norms at the subsequent round. Indeed, campaign ad exposure at round 3 predicted marijuana initiation at round 4. Through June 2004, the campaign is unlikely to have had favorable effects on youths and may have had delayed unfavorable effects. This evaluation challenges the usefulness of the campaign. Hornik, R., Jacobsohn, L., Orwin, R., Piesse, A., and Kalton, G. Effects of the National Youth Anti-Drug Media Campaign on Youths. Am. J. Public Health, 98(12), pp. 2229-2236, 2008.

Intervention Effects Foster Parent Stress and Child Cortisol Levels

Foster children exhibit high rates of atypical neuroendocrine functioning compared to children in the general population. In particular, alterations in the daytime diurnal activity of the hypothalamic-pituitary-adrenal (HPA) axis have been observed in foster children, often characterized by blunted salivary cortisol levels (i.e., low morning levels that remain low throughout the day). There is emerging evidence that therapeutic interventions for foster children can affect this pattern of HPA axis activity, but the specific intervention components responsible for change have not been fully explicated. Within a randomized trial to evaluate a therapeutic intervention for foster preschoolers (n = 57 intervention condition; n = 60 comparison condition; n = 60 community comparison condition), the present study examined whether diurnal cortisol activity was associated with caregiver self-reported stress in response to child problem behavior. Results showed immediate reductions in caregiver stress that were sustained through 12 months postbaseline in the intervention condition. In contrast, caregivers in the regular foster care condition showed higher rates of stress across time and increased stress sensitivity to child problem behaviors. In addition, among caregivers in regular foster care, higher self-reported stress was associated with lower morning cortisol levels and more blunted diurnal cortisol activity. These results provide evidence that interventions can simultaneously impact caregiver stress and buffer children from the negative impacts of caregiver stress on HPA axis regulation. Fisher, P., and Stoolmiller, M. Intervention Effects on Foster Parent Stress: Associations with Child Cortisol Levels. Dev. Psychopathol., 20(3), pp. 1003-1021, 2008.

Long-Term Effects of Universal Preventive Interventions on Youth Prescription Drug Use

This article reports on the long-term effects of universal preventive interventions conducted during middle school on 17-21-year-olds' prescription drug misuse. Two randomized controlled prevention trials were conducted in public schools in the rural Midwest of the United States. Study 1 began in 1993, with 667 6th-graders and follow-ups with 12th-graders and 21-year-olds included 457, and 483 participants, respectively. Study 2 began in 1998 with 7th-graders (total sample across waves 2127) and follow-ups with 11th- and 12th-graders included 1,443 and 1,212 participants, respectively. In study 1, schools were assigned to the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years, or a control condition. In study 2, schools were assigned to the school-based Life Skills Training (LST) plus a revised ISFP, called SFP 10-14 (LST + SFP 10-14), LST-only, or a control condition. Measures for this study included self reports of lifetime and past-year prescription drug misuse, collected starting in 10th grade in study 1 and 9th grade in study 2. The findings for study 1 indicated that 12th-grade ISFP intervention condition participants' past year narcotic misuse was significantly less than controls, as was life-time narcotic and barbiturate misuse rates for 21 year-old ISFP intervention participants. In study 2, LST + SFP 10-14 showed significant effects on life-time prescription drug misuse at the 11th-grade follow-up, while effects at the 12th-grade follow-up were marginally significant. The results suggest that universal interventions have potential for public health impact by reducing some types of prescription drug misuse among adolescents and young adults. Spoth, R., Trudeau, L., Shin, C., and Redmond, C. Long-Term Effects of Universal Preventive Interventions on Prescription Drug Misuse. Addiction, 103(7), pp. 1160-1168, 2008.

5.5 Year Follow-up Substance Use Outcomes for Universal Family and School Adolescent Preventive Interventions

This study examines adolescent substance use outcomes of universal family and school preventive interventions 5.5 years past baseline. Seventh grade students from 36 schools were randomly assigned to one of three conditions: (1) the school-based Life Skills Training (LST) plus the Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14), (2) LST-alone, or (3) a control condition. Self-reported measures, including substance initiation, frequency of substance use, and measures of problematic or serious substance use, were collected at baseline, 6 months after the interventions, and again yearly through the 12th grade. A composite substance initiation index measure (SII) was derived from the data. Both the LST + SFP 10-14 condition and the LST alone condition reduced the growth in substance initiation as measured by the SII index. Program effectiveness results for individual substance initiation measures varied by study condition and by analytic method used to assess effectiveness. While no program effects on the overall sample were detected for the more serious substance use outcomes, intervention conditions prevented escalation into more problematic behaviors among high-risk youth (those who reported use of at least two substances at pretest). Spoth, R., Randall, G., Trudeau, L., Shin, C., and Redmond, C. Substance Use Outcomes 5 1/2 Years Past Baseline for Partnership-Based, Family-School Preventive Interventions. Drug Alcohol Depend., 96(1-2), pp. 57-68, 2008.

Risk and Protective Factors During Adolescence that Predict Future Smoking and Other Problem Behaviors

This study identifies risk and protective factors during early and later adolescence that predict future regular smoking and multiple problem behavior among at-risk youth, defined as those who tried smoking by grade 7. At grades 7, 10, and 12, data were collected from 2,000 early smokers drawn from California and Oregon. Multivariate regression analyses tested predictors of the two grade 12 outcomes in separate models using data from grades 7 and 10. Gender interactions and buffering of risk factors by protective factors were assessed. The results indicate that for at-risk youth, consistent protective factors against future smoking and problem behavior included living in an intact nuclear family, getting good grades, and parental disapproval of smoking/drug use. Consistent risk factors included exposure to substance-using peers and problems in school. Adult substance use was a predictor during early, but not later, adolescence. Pro-smoking/drug use beliefs were significant predictors during later adolescence. There were few differences across gender and no significant buffers against risk. The authors suggest that at-risk youth would benefit from peer resistance training, parental involvement in prevention efforts, and efforts to improve educational performance during both middle school and high school. Changing pro-drug beliefs may be more effective among older adolescents. Ellickson, P., Tucker, J., and Klein, D. Reducing Early Smokers ' Risk for Future Smoking and Other Problem Behavior: Insights from a Five-Year Longitudinal Study. J. Adolesc. Health, 43(4), pp. 394-400, 2008.

Temporal Associations of Cigarette Smoking with Social Influences, Academic Performance, and Delinquency

This study examined the temporal associations of cigarette smoking in youth with prosmoking social influences, academic performance, and delinquency in order to strengthen existing data that informs the development of anti-smoking prevention efforts. The investigators examined data from a cohort of 6,527 adolescents surveyed at ages 13, 16, 18, and 23 years as a part of trial to test the Project Alert prevention program. Results suggest that prosmoking peer and family influences were risk factors for future smoking throughout adolescence, with family influences perhaps also operating indirectly through the adolescents' exposure to prosmoking peers. There were reciprocal associations of youth smoking with parental approval, peer smoking, and poor grades (but not delinquency), with youth smoking emerging as a stronger antecedent than consequence of these psychosocial factors. Few gender differences in these associations were observed. These results suggest that adolescent smoking is associated with increased risk for future problems including delinquent behavior, academic difficulties, involvement with prosmoking peers, and perceiving greater parental approval of smoking. Tucker, J., Martinez, J., Ellickson, P., and Edelen, M. Temporal Associations of Cigarette Smoking with Social Influences, Academic Performance, and Delinquency: A Four-Wave Longitudinal Study from Ages 13-23. Psychol. Addict. Behav., 22(1), pp. 1-11, 2008.

Early Steps to Drug Abuse Prevention

This study presents the age 4 outcomes of children enrolled in the Early Steps Multi-site Project targeting the prevention of drug use risk. Seven hundred thirty-one families with a 2 year old child, in 3 geographical regions, who were enrolled in the Women Infants and Children (WIC) national food supplement program were screened for high risk behaviors related to a developmental trajectory leading to early-onset substance use and abuse were recruited and randomized to a brief family intervention or usual WIC services. At child ages 2 and 3, the intervention group caregivers were offered the Family Check-Up and linked parenting support services. Assessments were completed at baseline when the children were age 2, and again when the children were age 3 and age 4. Latent growth models on caregiver reports at child ages 2, 3, and 4 revealed decreased behavior problems when compared with the control group. Intervention effects occurred predominantly among families reporting high levels of problem behavior at child age 2. Families in the intervention condition improved on direct observation measures of caregivers' positive behavior support at child ages 2 and 3. Improvements in positive behavior support mediated improvements in children's early problem behavior. These findings support the potential long-term benefits of brief, family-based interventions in early childhood. Dishion, T., Shaw, D., Connell, A., Gardner, F., Weaver, C., and Wilson, M. The Family Check-Up with High-Risk Indigent Families: Preventing Problem Behavior by Increasing Parents' Positive Behavior Support in Early Childhood. Child. Dev., 79(5), pp. 1395-1414, 2008.

Messages About Social Harms of Inhalants More Effective than Physical Harm Messages

This study investigates an approach for reducing inhalant initiation among younger adolescents. The approach seeks to alter Socio-Personal Expectations (SPEs), a term referring to perceived linkages between behavior and personally relevant social outcomes. The study focuses specifically on expectations regarding outcomes associated with increased social status and popularity. An anti-inhalant message was embedded within a short anti-bullying education video. Young adolescents (N = 893) were assigned randomly to receive a message focused on the physical or the social harms of inhalant use. The objectives of this study were to test: (1) the malleability of socio-personal expectations, (2) the predictive validity of socio-personal expectations for future inhalant use, and (3) whether being exposed to a socio-personal threat, rather than a physical threat, leads to different decision-making processes. Analysis of variance suggested the malleability of socio-personal expectations, and multiple regression analysis revealed that these expectations were predictive of future inhalant use. Socio-personal expectations accounted for a significant portion of variance in future intentions over and above demographic variables, prior use, psychosocial variables, and perceived physical harm. Moreover, being exposed to a social, rather than a physical threat, message resulted in different variables being predictive of future intentions to use inhalants. The findings of the current study lend support to broaden the focus of media intervention efforts to include expectations regarding social acceptance or popularity along with discussion of physical harms. Based on current knowledge, there appears little to be gained by focusing solely on physical harms. A more intensive focus on social expectations could prove effective in persuading adolescents to refrain from use of a class of drugs that represents a serious threat to the well-being of all who use them. Siegel, J., Alvaro, E., Crano, W., Skenderian, J., Lac, A., and Patel, N. Influencing Inhalant Intentions by Changing Socio-Personal Expectations. Prev. Sci., 9(3), pp. 153-165, 2008.

One Year Outcome Study of 4th Replication of Project Towards No Drug Abuse

This study examined the one-year outcomes of the fourth experimental trial of Project Towards No Drug Abuse. Two theoretical content components of the program (i.e., cognitive perception information and cognitive perception information plus behavioral skills) were examined to increase understanding of the relative contribution of each to the effectiveness of the program. High schools in Southern California (n=18) were randomly assigned to one of three conditions: the two comparative program conditions and a standard care condition. The curricula were delivered to high school students (n=2734) by project health educators and regular classroom teachers. Program effectiveness was assessed with both dichotomous and continuous measures of 30-day substance use at baseline and one-year follow-up. Across all program schools, the two different curricula failed to significantly reduce dichotomous measures of substance use (cigarette, alcohol, marijuana, and hard drugs) at one-year follow-up. Both curricula exerted an effect only on the continuous measure of hard drug use, indicating a 42% (p=0.02) reduction in the number of times hard drugs were used in the last 30 days in the program groups relative to the control. In summary, the one-year effects of Project TND on hard drug use that have been shown in previous trials were replicated in the present study. The lack of main effects on the use of cigarettes, alcohol, and marijuana is contrary to previous findings. Sun, P., Sussman, S., Dent, C., and Rohrbach, L. One-Year Follow-Up Evaluation of Project Towards No Drug Abuse (TND-4). Prev. Med., 47, pp. 438-442, 2008.

Early Findings from the Community Youth Development Study

This study reports findings from Communities That Care (CTC), a prevention system designed to reduce levels of adolescent delinquency and substance use through the selection and use of effective preventive interventions tailored to a community's specific profile of risk and protection. This article describes early findings from the first group-randomized trial of CTC. A panel of 4,407 fifth-grade students was surveyed annually through seventh grade. Analyses were conducted to assess the effects of CTC on reducing levels of targeted risk factors and reducing initiation of delinquent behavior and substance use in seventh grade, 1.67 years after implementing preventive interventions selected through the CTC process. Results indicate that mean levels of targeted risks for students in seventh grade were significantly lower in CTC communities compared with controls. Specifically, significantly fewer students in CTC communities than in control communities initiated delinquent behavior between grades 5 and 7. No significant intervention effect on substance use initiation by spring of seventh grade was observed. CTC's theory of change hypothesizes that it takes from 2 to 5 years to observe community-level effects on risk factors and 5 or more years to observe effects on adolescent delinquency or substance use. These early findings indicating hypothesized effects of CTC on targeted risk factors and initiation of delinquent behavior are promising. Hawkins, J., Brown, E., Oesterle, S., Arthur, M., Abbott, R., and Catalano, R. Early Effects of Communities That Care on Targeted Risks and Initiation of Delinquent Behavior and Substance Use. J. Adolesc. Health, 43(1), pp. 15-22, 2008.

Improving Implementation Through the Communities That Care Operating System

This paper describes the development, application, and results of an implementation monitoring component of the Communities That Care (CTC) prevention framework used in the Community Youth Development Study (CYDS) to ensure high-fidelity prevention program implementation. CYDS is a randomized controlled trial of 24 communities (12 CYDS, 12 usual services), designed to test the effects of the CTC operating system on community prevention services and on levels and trends in drug abuse risk and protective factors among youth aged 9 through 18. The implementation monitoring system was created based on research that community-based implementation of evidence-based prevention programs often includes adaptations in program design, content, or manner of delivery. A lack of fidelity to the implementation standards delineated by program designers is one indicator of a gap between prevention science and practice which can lessen the likelihood that communities will realize the positive participant effects demonstrated in research trials. By using the CTC model to select and monitor the quality of prevention activities, the 12 CYDS communities replicated 13 prevention programs with high rates of adherence to the programs' core components and in accordance with dosage requirements regarding the number, length, and frequency of sessions. This success indicates the potential of the CTC program implementation monitoring system to enhance community Prevention Delivery Systems and to improve the likelihood of desired participant changes. Fagan, A., Hanson, K., Hawkins, J., and Arthur, M. Bridging Science to Practice: Achieving Prevention Program Implementation Fidelity in the Community Youth Development Study. Am. J. Community Psychol., 41(3-4), pp. 235-249, 2008.

Drug Treatment is Associated with Better HIV Treatment Adherence

Using longitudinal data from the Women's Interagency HIV Study, this paper evaluated the relationship between drug abuse treatment modality and adherence to antiretroviral therapies. In prospective analyses, individuals who reported accessing any drug abuse treatment program were significantly more likely to report adherence to antiretroviral regimens. Involvement in either a medication-based or medication-free program was similarly associated with improved adherence. Drug abuse treatment programs, irrespective of modality, were associated with improved adherence to antiretroviral therapies among drug users. Concerted efforts to enroll individuals with drug use histories in treatment programs are warranted to improve HIV disease outcomes. Kapadia, F., Vlahov, D., Wu, Y., Cohen, M., Greenblatt, R., Howard, A., Cook, J., Goparaju, L., Golub, E., Richardson, J., and Wilson, T. Impact of Drug Abuse Treatment Modalities on Adherence to ART/HAART Among a Cohort of HIV Seropositive Women. Am. J. Drug Alcohol Abuse, 34(2), pp. 161-170, 2008.

Early Intervention for Externalizing Behavior Problems Can Also Impact Comorbid Internalizing Problems

This study used latent transition analysis (LTA) to examine changes in early emotional and behavioral problems in children age 2 to 4 years resulting from participation in a family-centered intervention. A sample of 731 economically disadvantaged families was recruited from among participants in the Women Infants and Children (WIC) program, a national food supplement and nutrition program--from three geographic locations. Families with toddlers between age 2 and 3 were randomized to receive either the Family Check-Up (FCU) or a no intervention (control). The FCU's linked interventions were tailored to each family's needs. Assessments occurred at age 2, 3, and 4. The FCU followed age 2 and age 3 assessments. Latent class analyses were conducted on mother reports of behavior and emotional problems from age 2 to 4 to study transitions among the following four groups: (a) externalizing only, (b) internalizing only, (c) comorbid internalizing and externalizing, and (d) normative. Results revealed that participation in the FCU increased the likelihood of transitioning from either the comorbid or the internalizing class into the normative class by age 4. These results suggest the potential for family interventions in early childhood to disrupt the early emergence of both emotional and behavioral problems. Connell, A., Bullock, B., Dishion, T., Shaw, D., Wilson, M., and Gardner, F. Family Intervention Effects on Co-occurring Early Childhood Behavioral and Emotional Problems: A Latent Transition Analysis Approach. J. Abnorm. Child Psychol., 36(8), pp. 1211-1225, 2008.

Bidirectional Relations Between Child Behavior and Parental Well-Being

Although much has been written about transactional models in the study of parenting practices, relatively few researchers have used this approach to examine how child behavior might be related to parental well-being. This study used latent growth curve modeling to test transactional models of age 2 child noncompliance, parental depressive symptoms, and age 4 internalizing and externalizing behaviors using a subsample of families in the Early Steps Multisite Study, a randomized controlled trial of the Family Check-up Intervention with 731 families with a toddler at high risk for early onset child behavior problems. In unconditional models, maternal depressive symptoms showed a linear decrease from child ages 2 to 4, whereas paternal depression did not show significant change. Observed child noncompliance at age 2 showed significant associations with concurrent reports of maternal depressive symptoms and trend-level associations with paternal depressive symptoms. For both parents, higher levels of initial depressive symptoms were related to increased age 4 child internalizing behaviors. The findings provide support for reciprocal process models of parental depression and child behavior, and this study is one of the first to present empirical evidence that fathers' depressive symptoms have bidirectional associations with their children's behavior in early childhood. Gross, H., Shaw, D., Moilanen, K., Dishion, T., and Wilson, M. Reciprocal Models of Child Behavior and Depressive Symptoms in Mothers and Fathers in a Sample of Children at Risk for Early Conduct Problems. J. Fam. Psychol., 22(5), pp. 742-751, 2008.

Increasing School Success through Partnership-Based Family Competency Training

This research tests a model examining the mediational pathways of effects of a universal partnership-based family competency training program on academic success in youth. Twenty-two rural schools were randomized to receive the Iowa Strengthening Families Program (ISFP) or a minimal contact control condition. Data on academic success, school engagement, substance related risk, and parent competency were collected from 445 families. Structural equation modeling was conducted to test the hypothesized relationships. The intervention increased parenting competencies and reduced students' substance-related risk in the sixth grade, thereby positively affecting school engagement and positively impacting upon twelfth grade academic performance. This research, conducted through a school-community-university partnership underscores the benefits of such collaborative efforts on academic outcomes and complements previous work on the impact of this intervention on substance use. Spoth, R., Randall, G.K., and Shin, C. Increasing School Success through Partnership-Based Family Competency Training: Experimental Study of Long-Term Outcomes. School Psychology Quarterly, 23(1), pp. 70-89, 2008.

Positive Effects of Media, Community, and School-Based Anti-Violence Intervention

In a community randomized controlled trial, intervention middle school students from small towns were exposed to a community and school-based anti-violence intervention ("Resolve It, Solve It"). The primary intervention was a media campaign in which local high school students served as models in print, radio, and television PSAs and spearheaded local school and community activities. The media campaign was supported with school and community events that reinforced campaign messages. Six middle schools across five different communities participated: two schools from one community in Kentucky and one school each from Louisiana, Illinois, Indiana, and California. All classrooms with seventh and eighth grade students were invited to participate. A total of 1,492 middle school students were surveyed with 404 male and 376 female students in the control condition, and 307 male and 405 female students in the intervention condition. Tests of recognition and recall indicated widespread exposure to the media intervention. Multiple group latent growth models indicated that relative to control students, intervention students reported significant differences in rates of growth for intent for violence, physical assault against people, verbal victimization, and perceived safety at school. No differences were found for verbal assault, physical assault against objects, physical victimization, or self-efficacy for avoiding violence. When examined by sex, it was determined that results for physical assault against people were obtained only among female students, and changes in verbal victimization and perceived school safety were observed only among male students. These results suggest that a media and reinforcing community intervention led by older peers can alter rates of growth for some measures of violence and associated factors among small-town youth. Further research is indicated to determine how different campaign messages influence students by sex. Swaim, R., and Kelly, K. Efficacy of a Randomized Trial of a Community and School-based Anti-violence Media Intervention Among Small-Town Middle School Youth. Prev. Sci., 9(3), pp. 202-214, 2008.

Evaluating Retailer Behavior through Measurement of Youth Purchase Attempts

This study evaluated the potential of youth purchase attempts to detect actual changes in retail availability of harmful legal products to get high. These results were triangulated with self-reports from retailers about their own policies and practices. Before the intervention, less than half of retailers reported using any of six possible strategies identified as ways to reduce youth access to harmful products, and less than 8% of baseline youth attempts to purchase potentially harmful legal products were refused or questioned. After the low-dosage intervention, retailers reported increased use of three strategies and a statistically significant increase in the percentage of purchase attempts that were either questioned or refused by retail clerks. These findings demonstrate the potential feasibility of retailer-focused environmental strategies and support continued use of youth purchase attempts as a measure of actual retailer behavior. Courser, M., Holder, H., Collins, D., Johnson, K., and Ogilvie, K. Evaluating Retailer Behavior in Preventing Youth Access to Harmful Legal Products: A Feasibility Test. Eval. Rev., 31(4), pp. 343-363, 2008.

Effects of Mexican Origin Family Structure on Parental Monitoring and Pre-Adolescent Substance Use and Expectancies

This study examines the relationship between the structure of Mexican origin families (i.e., nuclear, single-parent, blended or extended), and the parental monitoring, substance use expectancies, and substance use reported by pre-adolescents. The findings indicate that family structure did not differentiate the substance use prevalence, expectancies or parental monitoring among the 1224 low-income, Mexican-origin fifth grade participants. Parents from all family types demonstrated similar levels of parental monitoring. Most importantly, family composition was not related to pre-adolescents' substance use. In addition, findings indicated that the relationship between substance use and certain demographic variables (e.g., gender, country of birth, language use) did not differ across family structures. Warren, J.R., Wagstaff, D.A., Hecht, M.L., and Elek, E. The Effects of Mexican Origin Family Structure on Parental Monitoring and Pre-Adolescent Substance Use Expectancies and Substance Use. Journal of Substance Use, 13(4), pp. 283-292, 2008.

Innovative Technologies for Monitoring Intervention Fidelity in Rural School Sites

The present study examined the feasibility of an innovative technology designed to assess implementation fidelity of the Early Risers conduct problems prevention program across 27 geographically dispersed school sites. Previous randomized trials of the Early Risers program established the efficacy and effectiveness of the intervention. The current study is assessing the associations between fidelity and participants' psychosocial outcomes. In this article on feasibility of the fidelity monitoring system, a multidimensional construct of fidelity was used to assess the quantity of services provided (exposure), the degree to which program strategies conformed to the manual (adherence), and how well implementers delivered the program (quality of delivery). The measurement technology featured a fidelity monitoring system that required (a) weekly reporting on a web-based documentation system to assess program exposure and adherence, and (b) five annually administered telephone interviews with a technical assistant to assess quality of program implementation. The results showed that the fidelity monitoring system was feasible, with all sites achieving 100% compliance in completion of their required on-line reporting and on average over 80% of the required teleconference interviews. User feedback indicated satisfaction with the web-based program. The system was successful in measuring multiple indices of fidelity. The strengths and limitations of measuring fidelity at a distance with web-based and teleconferencing technologies are discussed. Lee, C., August, G., Realmuto, G., Horowitz, J., Bloomquist, M., and Klimes-Dougan, B. Fidelity at a Distance: Assessing Implementation Fidelity of the Early Risers Prevention Program in a Going-to-Scale Intervention Trial. Prev. Sci., 9(3), pp. 215-229, 2008.

Higher Behavioral Problems Associated with Reentry into Foster Care

A recognized goal of family reunification programs is preventing the reentry of children into foster care. Although rates of reentry vary widely, the available evidence has demonstrated that reentry to foster care after a failed reunification attempt is not a rare event. Using data from the National Survey of Child and Adolescent Well-Being, this study examined reentry for 273 children between the ages of 5 and 12 years. In multivariate models, reentry into foster care was associated with higher Child Behavior Checklist (CBCL) scores and higher numbers of children in the household when the child is living at home. Although these are not the only risk factors that should be considered in deciding whether to reunify a child, these characteristics appear to be high valence problems for families and their children who are reunified. Future research on reentry and on placement disruptions from foster care should routinely include information about the number of children in the family and behavior problems when endeavoring to explain caseload dynamics. Barth, R.P., Weigensberg, E.C., Fisher, P.A., Fetrow, B., and Green, R.L. Reentry of Elementary Aged Children Following Reunification from Foster Care. Children and Youth Services Review, 30 pp. 353-364, 2008.

Evidence-Based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior. Embry, D., and Biglan, A. Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clin. Child Fam. Psychol. Rev., 11(3), pp. 75-113, 2008.

Diffusion of Evidence-Based Drug Abuse Prevention: The Communities That Care System

Recent advances in prevention science provide evidence that adolescent health and behavior problems can be prevented by high-quality prevention services. However, many communities continue to use prevention strategies that have not been shown to be effective. This paper describes the rationale, aims, intervention, and design of the Community Youth Development Study, a randomized controlled community trial of the Communities That Care (CTC) system, and investigates the baseline comparability of the 12 intervention and 12 control communities in the study. Studying processes for promoting the dissemination and high-quality implementation of prevention strategies found to be effective in controlled research trials has become an important focus for prevention science. The CTC prevention operating system provides manuals, tools, training, and technical assistance to activate communities to use advances in prevention science to plan and implement community prevention services to reduce adolescent substance use, delinquency, and related health and behavior problems. Results indicate baseline similarity of the intervention and control communities in levels of adolescent drug use and antisocial behavior prior to CTC intervention. Hawkins, J., Catalano, R., Arthur, M., Egan, E., Brown, E., Abbott, R., and Murray, D. Testing Communities That Care: The Rationale, Design and Behavioral Baseline Equivalence of The Community Youth Development Study. Prev. Sci., 9(3), pp. 178-190, 2008.

Differences in Substance Use Among Bisexual and Heterosexual Young Women

This study examined similarities, and differences between bisexual, and heterosexual women in their substance use at ages 14 and 18, compared these groups at ages 14 and 18 on key psychosocial factors known to predict young adult substance use, and determined whether these psychosocial factors at age 18 could account for sexual orientation differences in substance use at age 23. Longitudinal survey data from a West Coast cohort were used to compare heterosexual (n = 1,479) and bisexual (n = 141) women on their substance use and psychosocial characteristics. Results indicated that during adolescence, bisexual women were more likely to have been current and solitary substance users, to have reported stronger pro-drug beliefs and lower resistance self-efficacy, to have reported greater perceived parental approval of their substance use, to have had more exposure to substance-using peers, and to have reported poorer mental health. By age 23, bisexual women had higher rates of current substance use, greater quantity and frequency of use, and more problematic alcohol and drug use. Differences in problematic use at age 23 could be partially explained by risk factors assessed five years earlier at age 18, particularly pro-drug social influences and beliefs. Notwithstanding the lack of longitudinal data on sexual orientation, these results provide important insights regarding the drug prevention needs of bisexual women. Tucker, J., Ellickson, P., and Klein, D. Understanding Differences in Substance Use Among Bisexual and Heterosexual Young Women. Womens Health Issues, 18(5), pp. 387-398, 2008.

Gender Differences in Physical and Relational Aggression as Predictors of Drug Use in High School Students

The present study investigated the longitudinal relationships between physical and relational aggression and later drug use, as moderated by gender. Self-reported data were gathered from 2,064 high school students at pretest and 1-year post-test to test the hypotheses that (1) males would engage in more physical aggression than females, whereas females would engage in more relational aggression than males; and (2) physical aggression would be a stronger drug use predictor for males and relational aggression a stronger predictor for females. Results indicated that males reported engaging in more physical aggression than females at baseline; however, females and males reported engaging in similar rates of relational aggression. After controlling for relational aggression, baseline drug use, and demographic variables, physical aggression at baseline was found to predict alcohol use 1-year later for males but not for females. After controlling for physical aggression, baseline drug use, and demographic variables, relational aggression was found to predict cigarette use and marijuana use for females but not for males. However, relational aggression was found to predict later alcohol and hard drug equally across gender. These findings suggest that both physical and relational aggression are predictive of subsequent drug use and have important implications for violence and drug use prevention intervention efforts. Skara, S., Pokhrel, P., Weiner, M., Sun, P., Dent, C., and Sussman, S. Physical and Relational Aggression as Predictors of Drug Use: Gender Differences Among High School Students. Addict. Behav., 33(12), pp. 1507-1515, 2008.

Cross-National Study of Substance Use Rates among Preadolescents in Spain and Arizona

This study aims to comparatively examine drug use in Arizona and Spain, in order to know if similarities and differences in drug use patterns justify the administration in Spain of U.S. prevention intervention programs. Data were obtained from independent samples of seventh-grade students recruited from urban public schools and surveyed in 1998. The samples included 4,035 ethnically diverse Arizona students (Latinos and non-Hispanic Whites), and 2,243 Spanish-White students. Odds ratios and Chi-square tests were used to assess and compare differences in drug use rates between preadolescents in Arizona and Spain taking into account gender. Ethnicity differences in preadolescent drug use and in psychosocial risk factors were examined using multivariate analysis. The results revealed similar trends in drug use between Arizona and Spain students, with gateway drugs already in use by early adolescents, and with higher rates of drug use among males than among females. However, cross-national differences in marijuana/cannabis use were noteworthy: Arizona preadolescents were over 25 times more likely to report marijuana/cannabis use than preadolescents from Spain. Moreover, when ethnic differences were considered, Latinos in Arizona reported higher marijuana/cannabis use compared with non-Latino students. Drug use patterns among Latino preadolescents, as well as the relevance of some risk factors among the diverse groups, were strongly influenced by their level of acculturation. Luengo, M., Kulis, S., Marsiglia, F., Romero, E., Gomez-Fraguela, J., Villar, P., and Nieri, T. A Cross-National Study of Preadolescent Substance Use: Exploring Differences Between Youth in Spain and Arizona. Subst. Use Misuse, 43(11), pp. 1571-1593, 2008.

Parents Influence Teen's Peer Relations and Drinking in College

This study examined the possible indirect influence that parents may have on their teen's alcohol use. Friends' alcohol use served as a mediator of the relationship between parenting characteristics and teen alcohol use in a longitudinal college sample. As part of a larger study of college student drinking, 392 incoming college freshmen were assessed for their perceptions of their parent's parenting practices, and their peer alcohol use. Results from SEM indicated that friend alcohol use (gathered in first semester freshman year) mediated the relationship between parental knowledge about what their teen was doing in his/her free time (gathered at baseline pre-matriculation to college) and individual use in college (gathered at second semester freshman year). Findings suggest that during college parents continue to exhibit influence on the choices their teens make as far as friends, which in turn influences their teens' drinking in college. Abar, C., and Turrisi, R. How Important are Parents During The College Years? A Longitudinal Perspective of Indirect Influences Parents Yield on Their College Teens' Alcohol Use. Addict. Behav., 33(10), pp. 1360-1368, 2008.

Gambling Among African-American Adolescents

This study explores gender differences in lifetime and recent substance use/internalizing behavior, childhood externalizing behavior, and gambling preferences among African-American youth gamblers. Data are from a prospective study conducted within the context of a group randomized prevention trial targeting academic achievement and aggression in 27 first grade classrooms in nine urban primary schools primarily located in western Baltimore (N = 678). The study sample for this study focuses on the 452 African-American adolescents (54% male, mean age 17.1 years). The participants were enrolled in the study at entry into first grade and were followed for ten years. The overall estimated past-year gambling prevalence was 47.4%; 56.6% of males (n = 138), and 36.5% of females (n = 76) had gambled in the year preceding the interview. There were no differences in neighborhood disadvantage, parents' level of education, or first grade intervention status between gamblers and non-gamblers. Gambling was associated with high teacher ratings of childhood externalizing behaviors among males and with high parent ratings of childhood impulsivity and hyperactivity among both genders. Internalizing behavior was associated with female gambling. No male-female differences in substance use/lifetime or conduct disorder among gamblers were noted, however, overall, male gamblers had higher levels of externalizing behaviors as compared to female gamblers. Martins, S., Storr, C., Ialongo, N., and Chilcoat, H. Gender Differences in Mental Health Characteristics and Gambling Among African-American Adolescent Gamblers. Am. J. Addict., 17(2), pp. 126-134, 2008.

Adolescent Alcohol Involvement Predicts Major Depression in Young Adults

This study examined the extent to which four different adolescent alcohol dimensions (i.e., frequency of alcohol use, quantity of consumption, frequency of heavy episodic drinking, and frequency of problem use) were predictive of young-adult major depressive disorder (MDD). Participants in this prospective longitudinal study were 429 rural teens and their families. Self-reports of each dimension of adolescent alcohol involvement were obtained at ages 16 and 18. Depression diagnoses were obtained at age 22, using a structured interview. Analyses included adolescent depressed mood, measured via self-report at ages 16 and 18. Data were analyzed using confirmatory factor analysis and structural equation modeling. Results indicated that the multidimensional nature of adolescent alcohol involvement was best represented by a first-order problem-use factor and a second-order alcohol-intake factor comprised of quantity, frequency, and heavy drinking. After controlling for gender and depressed mood, adolescent problem use, but not alcohol intake, was a significant positive predictor of young-adult MDD. The findings help clarify the link between alcohol involvement and depression and suggest that harm-reduction strategies may help prevent later mood disorders. Mason, W., Kosterman, R., Haggerty, K., Hawkins, J., Redmond, C., Spoth, R., Shin, C., and Shin, C. Dimensions of Adolescent Alcohol Involvement as Predictors of Young-Adult Major Depression. J. Stud. Alcohol Drugs, 69(2), pp. 275-285, 2008.

Predictors of Heavy Drinking Among Youth Living in Permissive Households

This study identified psychosocial factors that may deter adolescents living in permissive households from heavy drinking in Grades 9 and 11. Longitudinal data were obtained from 710 youth who participated in a study of the efficacy of the Alert Plus curriculum. Study participants completed surveys in grades 7 through 11. Permissive household was defined based on adolescent reports of whether the parents (1) would be upset if the adolescent drank or used marijuana, (2) knew their child's whereabouts when the adolescent was away from home, and (3) set curfews. The outcome of interest was frequency of heavy drinking in the last 30 days, defined as the number of days the adolescent had at least three alcoholic drinks. Three quarters of adolescents from permissive households reported heavy drinking at Grade 9, with less frequent heavy drinking among those who concurrently reported less exposure to peer and adult drinking, less peer approval of drinking, weaker positive beliefs about drinking, a stronger academic orientation, higher resistance self-efficacy, and less delinquency. Further, social influences and alcohol beliefs predicted the frequency of heavy drinking 2 years later among adolescents from permissive households. Although most of these factors were also predictive for adolescents from nonpermissive households, social influences, alcohol beliefs and resistance self-efficacy were stronger predictors of heavy drinking at Grade 9 among youth from permissive households. The authors conclude that alcohol prevention programs that target pro-drinking peer and adult influences, positive attitudes toward drinking, and resistance self-efficacy may be particularly important in deterring heavy drinking among adolescents living in permissive households. Tucker, J., Ellickson, P., and Klein, D. Growing Up in a Permissive Household: What Deters At-Risk Adolescents From Heavy Drinking? J. Stud. Alcohol Drugs, 69(4), pp. 528-534, 2008.

Developing Teacher Proficiency in Culturally-Grounded Drug Use Prevention

The authors describe the training model used to develop proficiency in teaching "keepin it REAL," a culturally-grounded prevention curriculum. Training effects were evaluated using three datasets. Analyses suggested that training should emphasize teaching adult learners, it should encompass culture from many perspectives, it should address the teaching of prevention curricula, and it should emphasize fidelity as imperative. Trainers found the embedded focus on culture in the program essential to success. Teachers learned that a prevention curriculum can be instructionally engaging while theory-driven and academically rigorous. Harthun, M., Dustman, P., Reeves, L., Hecht, M., and Marsiglia, F. Culture in the Classroom: Developing Teacher Proficiency in Delivering a Culturally-grounded Prevention Curriculum. J. Prim. Prev., 29, pp. 435-454, 2008.

Self-Efficacy as a Moderator of Self-Fulfilling Prophecy Effects: Mothers' Beliefs and Children's Alcohol Use

This study examined two issues relevant to self-fulfilling prophecies: 1) it examined whether children's risk for alcohol use, as indicated by their self-efficacy to refuse alcohol from peers, moderated their susceptibility to negative and positive self-fulfilling prophecy effects created by their mothers; and 2) it explored behavioral mediators that could be involved in the self-fulfilling process between mothers and children. Longitudinal data were collected from 540 mother-child dyads. Participants were families of seventh graders enrolled in 36 rural schools in 22 counties in Iowa. The results indicated that: 1) low self-efficacy children were more susceptible to their mothers' positive than negative self-fulfilling effects, whereas high self-efficacy children's susceptibility did not vary, 2) mothers' global parenting and children's perception of their friends' alcohol use partially mediated mothers' self-fulfilling effects, and 3) these mediators contributed to low self-efficacy children's greater susceptibility to positive self-fulfilling prophecy effects. Willard, J., Madon, S., Guyll, M., Spoth, R., and Jussim, L. Self-Efficacy as a Moderator of Negative and Positive Self-Fulfilling Prophecy Effects: Mother's Beliefs and Children's Alcohol Use. European Journal of Social Psychology, 38, pp. 499-520, 2008.

Mediation of Mothers' Self-Fulfilling Effects on Children's Alcohol Use: Self-Verification, Informational Conformity, and Modeling Processes

This study examined whether self-fulfilling prophecy effects are mediated by self-verification, informational conformity, and modeling processes. These mediational processes were examined across multiple time frames using longitudinal data obtained from two samples of mother-child dyads (Sample 1 n=486; Sample 2 = n=287). Children's alcohol use was the outcome variable in these analyses. The results provided consistent support for self-verification as a mediator of mother's self-fulfilling effects. In both samples and across several years of adolescence, there was a significant indirect effect of mothers' beliefs on children's alcohol use through children's self-assessed likelihood of drinking alcohol in the future. Comparatively less support was found for informational conformity and modeling processes as mediators of mothers' self-fulfilling effects. Madon, S., Guyll, M., Buller, A., Scherr, K., Willard, J., and Spoth, R. The Mediation of Mothers' Self-Fulfilling Effects on Their Children's Alcohol Use: Self-Verification, Informational Conformity, and Modeling Processes. J. Pers. Soc. Psychol., 95(2), pp. 369-384, 2008.

Therapist Identification of Intimate Partner Violence

This study is a replication of research conducted more than a decade ago to examine mental health providers' ability to accurately perceive violence within couples presenting for therapy and to intervene in a manner that reduces risk. A decade ago, 40% of therapists sampled failed to identify the presence of intimate partner violence (IPV) and non predicted lethality. In the current study, a list of therapists, compiled from on-line websites maintained by 15 states within the United States consisting of independently licensed psychologists, clinical social workers, and marriage and family therapists was compiled. Twenty names and addresses from each of the states' licensing websites were randomly downloaded for the three different types of mental health providers, and a mail questionnaire was sent out for completion. The questionnaire included a case vignette and a series of open ended questions. One-hundred eleven of the 900 mailed surveys were returned. Two independent raters coded all of the vignette surveys. The expectation was that today's therapists are better prepared to identify IPV within a clinical vignette. Results show that therapists did have an improved ability to identify IPV. Thirteen percent of respondents from the present study failed to identify IPV within the relationship and about 80% suggested some sort of crisis intervention as a therapeutic approach. However, only one therapist accurately predicted lethality in the present study. Implications concerning IPV training for therapists are discussed. Dudley, D.R., McCloskey, K., and Kustron, D.A. Therapist Perceptions of Intimate Partner Violence: A Replication of Harway and Hansen's Study after More than a Decade. Journal of Aggression, Maltreatment and Trauma, 17(51), pp. 80-102, 2008.

Acceptance and Commitment: Implications for Prevention Science

Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions. Biglan, A., Hayes, S., and Pistorello, J. Acceptance and Commitment: Implications for Prevention Science. Prev. Sci., 9(3), pp. 139-152, 2008.


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