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Director's Report to the National Advisory Council on Drug Abuse - May, 2008

Research Findings - Prevention Research

The Negative Impacts of Starting Middle School in Sixth Grade

This study examined administrative data on public school students in North Carolina. The sample included data from 99 public school districts, 243 schools with 44,709 sixth graders. Just 11 percent of the students in the sample were in elementary schools. Analyses revealed that sixth grade students attending middle schools were much more likely to be cited for discipline problems than those attending elementary school. That difference remained after adjusting for the socioeconomic and demographic characteristics of the students and their schools. Furthermore, the higher infraction rates recorded by sixth graders who were placed in middle school persisted at least through ninth grade. An analysis of end-of-grade test scores provides complementary findings. A plausible explanation is that sixth graders are at an especially impressionable age; in middle school, the exposure to older peers and the relative freedom from supervision have deleterious consequences. These findings are relevant to the current debate over the best school configuration for incorporating the middle grades. Based on their results, the authors suggest that there is a strong argument for separating sixth graders from older adolescents. Cook, P.J., MacCoun, R., Muschkin, C., and Vigdor, J. The Negative Impacts of Starting Middle School in Sixth Grade. Journal of Policy Analysis and Management, 27(1), pp. 104-121, 2008.

Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings From Grades 3 to 9

This study tests the efficacy of the Fast Track Program in preventing antisocial behavior and psychiatric disorders among groups varying in initial risk. Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk institutions based on neighborhood crime and poverty levels. After screening 9,594 kindergarteners in these schools, 891 highest risk and moderate-risk children (69% male and 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention (begun in 1991 with three yearly cohorts) included parent behavior-management training, child social-cognitive skills training, reading tutoring, home visiting, mentoring, and a universal classroom curriculum. Outcomes included criterion counts and psychiatric diagnoses after grades 3, 6, and 9 for conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, any externalizing disorder, and self-reported antisocial behavior. Grade 9 outcomes were assessed between 2000 and 2003, depending upon cohort. Significant interaction effects between intervention and initial risk level were found at each age but most strongly after grade 9. Assignment to intervention had a significant positive effect in lowering criterion count scores and diagnoses for conduct disorder, attention-deficit/hyperactivity disorder, and any externalizing disorder, and lowering antisocial behavior scores, but only among those at highest risk initially. Prevention of serious antisocial behavior can be efficacious across sex, ethnicity, and urban/rural residence, but screening is essential. Bierman, K.L., Coie, J.D., Dodge, K.A., Foster, E.M., Greenberg, M.T., Lochman, J.E., McMahon, R.J., and Pinderhughes, E.E. Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings from Grades 3 to 9. J. Am. Acad. Child Adolesc. Psychiatry, 46(10), pp. 1250-1262, 2007.

Overcoming Adolescents' Resistance to Anti-Inhalant Appeals

This research was concerned with factors that affect adolescents' evaluations of persuasive anti-inhalant messages and the association of these evaluations with usage intentions. Sixth and 7th graders (N=894) received anti-inhalant messages that varied as a result of the factorial combination of message source (doctor or peer), suggested harm (social or physical), and target (message was addressed directly or indirectly to receivers). Manipulated variables were crossed with inhalant-user status (resolute nonuser, vulnerable nonuser, and user). Significant target and status effects on message evaluation were found. Significant interactions of status with each of the manipulated variables also emerged. Results indicated that indirectly targeted messages were significantly more effective than targeted ones. However, this result was evident only among users and vulnerable nonusers. These groups, which would be expected to be the most resistant to anti-inhalant appeals, were significantly more influenced by indirect messaging than when messages were addressed directly to them. This result suggests that indirectly targeted messages have a greater chance of success when the messages' audiences are resistant to the topic under consideration. The simple effects analyses showed that resolute nonusers almost invariably responded more favorably to the messages than either users or vulnerable nonusers. Their lack of discrimination in response to the experimental condition indicates their willingness to accept anti-inhalant messages delivered directly or indirectly, by peer or adult, threatening social or physical harms. The ad appeals were not counter-attitudinal for this group, but rather reinforcing, and possibly helped bolster a pre-established position. Implications for the application of these findings are clear. In health communication appeals, it is imperative to identify the audience we wish to influence. The consistent interaction of user status with every manipulated variable indicates that a one-size-fits-all approach will not succeed. This study provides guidance on the particular form of appeal most likely to succeed and points to topics that might improve future prevention efforts. Crano, W., Siegel, J., Alvaro, E., and Patel, N. Overcoming Adolescents' Resistance to Anti-Inhalant Appeals. Psychol. Addict. Behav., 21(4), pp. 516-524, 2007.

School Readiness Intervention for Foster Children Increases Social Competence and Self-Regulation

Foster children are at great risk for poor school outcomes. Given that school readiness is a powerful predictor of later school success, the promotion of school readiness skills in foster children is an opportunity for preventive intervention. Results are presented from a preliminary evaluation of a program designed to improve school readiness in foster children. Twenty-four foster children were randomly assigned to the intervention group (IG; n = 11) or the foster care services as usual comparison group (CG; n = 13). There were 6 intervention group males and 5 control group males. The mean age was 6.49 years (SD = 0.86) for IG children and 6.61 years (SD = 1.16) for CG children. The intervention consisted of therapeutic playgroups (twice weekly for 7 weeks during the summer) focusing on social competence and self-regulation skills. Attendance rates for the playgroups are reported. In addition, group differences on data collected before and after the intervention are reported. Intervention group children exhibited increased social competence and self-regulation. Comparison group children exhibited poorer performance in these domains over time. Results are discussed in terms of how the study has informed a current randomized efficacy trial of a school-readiness intervention. Pears, K.C., Fisher, P.A., and Bronz, K.D. An Intervention to Promote Social Emotional School Readiness in Foster Children: Preliminary Outcomes From a Pilot Study. School Psychology Review, 36(4), pp. 665-673, 2007.

Family-based Therapeutic Intervention May Reverse Disruptions in HPA Axis Functioning

Atypical diurnal patterns of hypothalamic-pituitary-adrenal (HPA) axis activity have been observed in samples of individuals following early life adversity. A characteristic pattern arising from disrupted care giving is a low early-morning cortisol level that changes little from morning to evening. Less well understood is the plasticity of the HPA axis in response to subsequent supportive care giving environments. Monthly early-morning and evening cortisol levels were assessed over 12 months in a sample of 3-6-year-old foster children enrolled in a randomized trial of a family-based therapeutic intervention (N=117; intervention condition, n=57; regular foster care condition, n=60), and a community comparison group of same-aged, non-maltreated children from low-income families (n=60). Latent growth analyses revealed stable and typical diurnal (morning-to-evening) cortisol activity among non-maltreated children. Foster children in the intervention condition exhibited cortisol activity that became comparable to the non-maltreated children over the course of the study. In contrast, children in regular foster care condition exhibited increasingly flattened morning-to-evening cortisol activity over the course of the study. In sum, improvements in care giving following early adversity appear to have the potential to reverse or prevent disruptions in HPA axis functioning. Fisher, P., Stoolmiller, M., Gunnar, M., and Burraston, B. Effects of a Therapeutic Intervention for Foster Preschoolers on Diurnal Cortisol Activity. Psychoneuroendocrinology, 32(8-10), pp. 892-905, 2007.

Cueing Prenatal Providers to Counsel Pregnant Women with Behavioral Health Risks

This study examined the impact of the Health in Pregnancy (HIP) computer program on prenatal providers' counseling about behavioral risks with patients, in particular risk for intimate partner violence (IPV) during pregnancy. English-speaking women 18 years or older, less than 26-weeks pregnant, and receiving prenatal care at one of five participating clinics in the San Francisco area, were randomized in parallel groups in a controlled trial. Participants reporting one or more risks were randomized to intervention or control in stratified blocks. Providers received summary "cueing sheets" alerting them to their patient's risk(s) and suggesting counseling statements. Thirteen percent (37/286) of the sample reported current IPV. Provider cueing resulted in 85% of the IPV-intervention group reporting discussions with their provider, compared to 23.5% of the control group (p<0.001). Thus IPV discussions were influenced strongly by cueing providers. Provider cueing may be an effective and appropriate adjunct to routine risk counseling in prenatal care. Calderon, S., Gilbert, P., Jackson, R., Kohn, M., and Gerbert, B. Cueing Prenatal Providers Effects on Discussions of Intimate Partner Violence. Am. J. Prev. Med., 34(2), pp. 134-137, 2008.

Efficacy of a Culturally Adapted Intervention for Youth Living with HIV in Uganda

This study examined whether a culturally adapted version of a previously evaluated efficacious HIV prevention program reduced sexual risk behaviors of youth living with HIV (YLH) in Uganda. YLH, 14 to 21 years, were randomized to intervention (N=50) or control (N=50) conditions. Significantly more YLH in the intervention used condoms consistently and decreased their number of sexual partners in comparison to the control condition. Western interventions can be culturally adapted to retain efficacy in reducing the sexual risk behavior of YLH. Lightfoot, M. A., Kasirye, R., Comulada, W.S., and Rotheram-Borus, M.J. Efficacy of a Culturally Adapted Intervention for Youth Living with HIV in Uganda. Prev. Sci., 8(4), pp. 271-273, 2007.

Reducing HIV Infection Among New Injecting Drug Users in the China-Vietnam Cross Border Project

The objective of this study was to assess an HIV prevention program for injecting drug users (IDU) in the cross border area between China and Vietnam. Serial cross-sectional surveys (0, 6, 12, 18, 24 and 36 months) of community-recruited current IDUs. The project included peer educator outreach and the large-scale distribution of sterile injection equipment. Serial cross-sectional surveys with HIV testing of community recruited IDUs were conducted at baseline (before implementation) and 6, 12, 18, 24 and 36 months post-baseline. HIV prevalence and estimated HIV incidence among new injectors (individuals injecting drugs for < 3 years) in each survey wave were the primary outcome measures. Results showed that the percentages of new injectors among all subjects declined across each survey wave in both Ning Ming and Lang Son. HIV prevalence and estimated incidence fell by approximately half at the 24-month survey and by approximately three quarters at the 36-month survey in both areas (all p<0.01). It was concluded that the implementation of large-scale outreach and syringe access programmes was followed by substantial reductions in HIV infection among new injectors, with no evidence of any increase in individuals beginning to inject drugs. This project may serve as a model for large-scale HIV prevention programming for IDUs in China, Vietnam, and other developing/transitional countries. Des Jarlais, D., Kling, R., Hammett, T., Ngu, D., Liu, W., Chen, Y., Binh, K., and Friedmann, P. Reducing HIV Infection among New Injecting Drug Users in the China-Vietnam Cross Border Project. AIDS, 21 Suppl 8, pp. S109-S114, 2007.

Brief Interventions for College Students Can Influence Multiple Health Behaviors

This study examined the effects of brief image-based interventions, including a multiple behavior health contract, a one-on-one tailored consultation, and a combined consultation plus contract intervention, for impacting multiple health behaviors of students in a university health clinic. A total of 155 college students attending a major southern university were recruited to participate in a study evaluating a health promotion program titled Project Fitness during the fall 2005 and spring 2006. The majority of the participating students were female (66%), with a mean age of 19 years. The sample was diverse, with a slight majority being Caucasian (52%), followed by Hispanic (14%), African American (11%), and Asian youth (7%). Participants were randomly assigned to one of three treatments as they presented at the clinic: 1) a multiple behavior health contract, 2) a one-on-one tailored consultation, or 3) a combined consultation plus contract intervention. Baseline and 1-month post-intervention data were collected using computer-assisted questionnaires in a quiet office within the student health clinic. Omnibus repeated-measures analyses of variance were significant for drinking driving behaviors, F(2,136) = 4.43, p = .01, exercise behaviors, F(5,140) = 6.12, p = .00, nutrition habits, F(3,143) = 5.37, p = .00, sleep habits, F(2,144) = 5.03, p = .01, and health quality of life, F(5,140) = 3.09, p = .01, with improvements on each behavior across time. Analysis of group-by-time interaction effects showed an increase in the use of techniques to manage stress, F (2,144) = 5.48, p = .01, and the number of health behavior goals set in the last 30 days, F (2,143) = 5.35, p = .01, but only among adolescents receiving the consultation, or consultation plus contract. Effect sizes were consistently larger across health behaviors, and medium in size, when both consult and contract were used together. Brief interventions using a positive goal image of fitness, and addressing a number of health habits using a contract and consultation strategy alone, or in combination, have the potential to influence positive changes in multiple health behaviors of college students attending a university primary health care clinic. Werch, C., Bian, H., Moore, M., Ames, S., DiClemente, C., and Weiler, R. Brief Multiple Behavior Interventions in a College Student Health Care Clinic. J. Adolesc. Health, 41(6), pp. 577-585, 2007.

Stability of Psychopathic Characteristics in Childhood: The Influence of Social Relationships

The current study is a preliminary longitudinal investigation of the stability of psychopathic characteristics, including social relationships as a moderator, within a group of aggressive children (N = 80). Data were collected from the children, their parents, teachers, and peers. Results indicated that the psychopathic characteristics (callous-unemotional traits, impulsive conduct problems, and narcissism) were relatively stable across three time points. Social relationship variables (child self-report of social competence, teacher-rated social competence, and peer-rated social preference) were generally correlated with psychopathic characteristics. Self-report of social competence moderated change from Time 1 to Time 2 narcissism based on parent report. Both peer-rated social preference and teacher-rated social competence moderated change from Time 1 to Time 3 impulsive conduct problems. These results provide preliminary support that psychopathic characteristics are generally stable in aggressive children and that social relationships are a potentially valuable point of intervention when children present with these characteristics. Barry, T.D., Barry, C.T., Deming, A.M., and Lochman, J.E. Stability of Psychopathic Characteristics in Childhood: The Influence of Social Relationships. Criminal Justice and Behavior, 35(2), pp. 244-262, 2008.

Diet Initiation Predicts Smoking Initiation Among Adolescent Females

This study was aimed at examining the relation between dieting and smoking initiation among adolescents. Prospective data from a nationally representative study were used. Specifically, the study used two waves (1994 to 1996) of the National Longitudinal Study of Adolescent Health. The sample included 7795 non-Latino Caucasian and non-Latino African-American adolescents. Dieting status was the independent variable and trying smoking and initiation of regular smoking were the dependent variables. Covariates included age, ethnicity, overweight status, false self-perception about being overweight, and availability of cigarettes at home. Logistic regression and latent transition analyses were used. Females had a higher prevalence of dieting (55%) when compared with males (25%). Dieting initiation was a significant predictor for initiation of regular smoking among females (OR = 1.94, p = .010), but not among males. Inactive dieting was a significant predictor among males (OR = 1.74, p = .031), but not among females. Compared to nondieters, initiating and consistent female dieters reported a higher probability of transitioning to having tried regular smoking, although results from logistic regression suggested that the association between consistent dieting and initiation of regular smoking was not significant. This analysis suggests that there is a positive relation between initiating dieting and initiating regular smoking among females, but among males it is the inactive dieters who show a positive relationship. Results illustrate the importance of examining the association between dieting and the initiation of regular smoking. Maldonado-Molina, M., Komro, K., and Prado, G. Prospective Association Between Dieting and Smoking Initiation among Adolescents. Am. J. Health Promot., 22(1), pp. 25-32, 2007.

Effects of a Foster Parent Training Intervention on Placement Changes of Children in Foster Care

Placement disruptions undermine efforts of child welfare agencies to promote safety, permanency, and child well-being. Child behavior problems significantly contribute to placement changes. The aims of this investigation were to examine the impact of a foster parent training and support intervention (KEEP) on placement changes and to determine whether the intervention mitigates placement disruption risks associated with children's placement histories. The sample included 700 families with children between ages 5 and 12 years, from a variety of ethnic backgrounds. Families were randomly assigned to the intervention or control condition. The number of prior placements was predictive of negative exits from current foster placements. The intervention increased chances of a positive exit (e.g., parent/child reunification) and mitigated the risk-enhancing effect of a history of multiple placements. Incorporating intervention approaches based on a parent management training model into child welfare services may improve placement outcomes for children in foster care. Price, J., Chamberlain, P., Landsverk, J., Reid, J., Leve, L., and Laurent, H. Effects of a Foster Parent Training Intervention on Placement Changes of Children in Foster Care. Child Maltreat., 13(1), pp. 64-75, 2008.

Adapting Evidence-Based Curricula to Unique Adolescent Cultures

It is recommended that community settings adapt curricula to meet their youths' unique needs to be effective, particularly with diverse cultures. The cultural adaptation process employed for the keepin' it REAL program is offered as an example. The original keepin' it REAL curriculum targeted middle-school youth. This project utilized youth as experts in the process of adapting the keepin' it REAL curriculum's student workbook and videos, extending the age target to 14- to 19-year olds in high-risk, unique community settings: alternative schools, public high schools, a homeless shelter, a juvenile justice day program, a YMCA-run program for youth at low-income housing centers, a drop-in center for GLBTQ youth, and a youth advocacy group on the US-Mexico border in Texas. In Phase I the researchers engaged adolescents in the adaptation of the curriculum to make it culturally appropriate for their own setting. In Phase II the team evaluated the effectiveness of the adapted curriculum in comparison with the original curriculum. The goal was to assess whether adaptations improved the curriculum as well as providing opportunities for adolescents to take an active role in making prevention curricula relevant. Overall, preliminary data suggest that participating in adaptation processes may genuinely change attitudes about drug use, suggesting that more research needs to be done on consideration of the adaptation process as an intervention in and of itself. Steiker, L. Making Drug and Alcohol Prevention Relevant: Adapting Evidence-Based Curricula to Unique Adolescent Cultures. Fam. Community Health, 31 Suppl 1 pp. S52-S60, 2008.

Increasing Adoption of Evidence-Based Practices Through Community Coalition Networks

This study examined the effect of community coalition network structure on the effectiveness of an intervention designed to accelerate the adoption of evidence-based substance abuse prevention programs. At baseline, 24 cities were matched and randomly assigned to 3 conditions (control, satellite TV training, and training plus technical assistance). The intervention programs consisted of 6 interactive televised training segments on evidence-based prevention programs administered approximately every 6 months; 3 of these training segments occurred during the period of this study. Television broadcasts were complemented with planning meetings, where skills learned in training were shared with other members who did not participate in the live broadcast training. Training moved from large introductory sessions to smaller audience sessions that targeted those who would actively implement prevention programs; 343 leaders participated in the first session, 196 participated in the second session and 130 participated in the third session. The topics of the first 3 sessions were (1) identifying risk factors and protective factors of drug abuse, (2) organizing the community, and (3) understanding how to interact with local media using established community approaches for communicating public health issues and information. The study surveyed 415 community leaders at baseline and 406 at 18-month follow-up about their attitudes and practices toward substance abuse prevention programs. Network structure was measured by asking leaders whom in their coalition they turned to for advice about prevention programs. The outcome was a scale with 4 subscales: coalition function, planning, achievement of benchmarks, and progress in prevention activities. Multiple linear regression and path analysis were used to test the hypotheses. The intervention had a significant effect on decreasing the density of coalition networks. The change in density subsequently increased adoption of evidence-based practices. Optimal community network structures for the adoption of public health programs are unknown, but it should not be assumed that increasing network density or centralization are appropriate goals. Lower-density networks may be more efficient for organizing evidence-based prevention programs in communities. Valente, T.W., Chou, C.P., and Pentz, M. Community Coalitions as a System: Effects of Network Change on Adoption of Evidence-Based Substance Abuse Prevention. Am. J. Public Health, 97(5), pp. 880-886, 2007.

Systemic Factors that Influence Screening for Prenatal Behavioral Risks

This study examined how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks. Eight focus groups of 60 prenatal care providers were convened to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, a re-analysis of focus group transcripts to examine systemic factors was conducted. Results indicated that practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO. Thus, each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings. Gilbert, P., Herzig, K., Thakar, D., Viloria, J., Bogetz, A., Danley, D., Jackson, R., and Gerbert, B. How Health Care Setting Affects Prenatal Providers' Risk Reduction Practices: A Qualitative Comparison of Settings. Women Health, 45(2), pp. 41-57, 2007.

Effects of Communities that Care on Community Level Prevention Services Outcomes

The Community Youth Development Study (CYDS) is a community-randomized trial of the Communities That Care (CTC) prevention system. Using data from 2001 and 2004 administrations of the Community Key Informant Survey, this study reports changes in three community-level outcomes 1.5 years after implementing CTC in 12 communities. Respondents consisted of 534 community leaders in 24 communities representing multiple sectors within each community. Results of multilevel analyses controlling for respondent and community characteristics indicated that (a) CTC and control communities had comparable baseline levels of adopting a science-based approach to prevention, collaboration across community sectors, and collaboration regarding specific prevention activities; and (b) CTC communities exhibited significantly greater increases in these outcomes between 2001 and 2004 relative to control communities. These results suggest that CTC was successful in changing proximal system outcomes theorized to lead to more effective prevention services and, ultimately, reduced risk, enhanced protection, and improved adolescent health and behavior outcomes. Brown, E., Hawkins, J., Arthur, M., Briney, J., and Abbott, R. Effects of Communities That Care on Prevention Services Systems: Findings from The Community Youth Development Study At 1.5 Years. Prev. Sci., 8(3), pp. 180-191, 2007.

Community Coalitions to Prevent Drug Abuse: Influence of Community and Team Member Factors on Team Functioning

This research examines the early development of community teams participating in a university-community partnership project called PROSPER. PROSPER supports local community teams in rural areas and small towns to implement evidence-based programs intended to support positive youth development and reduce early substance use. The study evaluated 14 community teams and included longitudinal data from 108 team members, examining how community demographics and team member characteristics, perceptions, and attitudes at initial team formation were related to local team functioning 6 months later, when teams were planning for prevention program implementation. Community demographics (poverty), perceived community readiness, characteristics of local team members (previous collaborative experience) and attitudes toward prevention played a substantial role in predicting the quality of community team functioning 6 months later. Greenberg, M., Feinberg, M., Meyer-Chilenski, S., Spoth, R., and Redmond, C. Community and Team Member Factors that Influence the Early Phase Functioning of Community Prevention Teams: The PROSPER Project. J. Prim. Prev., 28(6), pp. 485-504, 2007.

Measuring Community-Wide Prevention Collaboration

This study assesses a measure of community-wide collaboration on prevention-specific activities (i.e., prevention collaboration) in context of the theory of community change used in the Communities That Care prevention system. Using data from a sample of 599 community leaders across 41 communities, the measure was examined with regard to its factor structure, associations with other concurrent community-level measures, and prediction by individual- and community-level characteristics. Results of multilevel confirmatory factor analysis provide evidence for the construct validity of the measure and indicate significant (p < .05) associations with concurrent validity criteria. Female community leaders reported significantly higher levels of prevention collaboration and community leaders sampled from religious organizations reported lower levels of prevention collaboration than did their respective counterparts. Although no community-level characteristics were associated significantly with prevention collaboration, community clustering accounted for 20-28% of the total variation in the measure. Findings support the use of this measure in assessing the importance of collaboration in community-based prevention initiatives. Brown, E., Hawkins, J., Arthur, M., Abbott, R., and Van Horn, M. Multilevel Analysis of a Measure of Community Prevention Collaboration. Am. J. Community Psychol., 41(1-2), pp. 115-126, 2008.

Racial/Ethnic Differences in the Protective Effects of Self-Management Skills on Adolescent Substance Use

This study examined whether cognitive and behavioral self-management skills measured in the 7th grade served a protective function in 9th grade substance use across ethnically diverse samples of adolescents. Structural equation modeling indicated that a second order Self-Management Skills latent factor consisting of first order latent factors of Decision-Making, Self-Regulation, and Self-Reinforcement skills was protective for adolescent substance use across racial/ethnic subgroups. Self-Management Skills were more strongly protective for suburban White youth and less protective for urban minority youth. These findings are consistent with previous research showing that predictive power of risk and protective factors derived from psychosocial theories varies across racial/ethnic subgroups of youth and is weaker among racial/ethnic minority youth compared to White youth. Griffin, K., Botvin, G., and Scheier, L. Racial/Ethnic Differences in the Protective Effects of Self-Management Skills on Adolescent Substance Use. Subst. Abuse, 27(1-2), pp. 47-52, 2006.

Antisocial Psychopathy and HIV Risk Among Alcohol and Other Drug (AOD) Abusing Adolescent Offenders

While the consensus is that HIV prevalence has remained low among adolescent offenders, the prevalence of STDs and HIV transmission risk behaviors is alarming, particularly for those abusing alcohol and other drugs and those displaying antisocial or conduct disorder characteristics. In the current study, 269 male and 110 female inner city, culturally diverse alcohol and other drug (AOD) abusing adolescent offenders completed measures of (a) psychopathy, using the Millon Adolescent Clinical Inventory (MACI) (b) HIV transmission risk behavior, (c) prevention skills and attitudes and (d) social desirability. Results showed that those with high levels of psychopathy reported more AOD use, overall unprotected sex and more sexual activity when influenced by alcohol and/or marijuana. High psychopathy adolescent offenders also reported lower self-efficacy and sexual response-efficacy, less favorable safer sex and condom attitudes and less favorable intentions to engage in safer sex behaviors, when controlling for social desirability. Data suggest that adolescent offenders, who are either in court-ordered treatment or detention, should be assessed for psychopathy and provided with tailored risk reduction interventions, geared toward attitudinal and behavioral change. A discussion of integrating neurobiological measures to improve the next generation of tailored interventions for this risk group is offered in conclusion. Malow, R.M., Devieux, J., Rosenberg, R., Nair, M., McMahon, R., Brown, E.J., and Kalichman, S.C. Antisocial Psychopathy and HIV Risk Among Alcohol and Other Drug (AOD) Abusing Adolescent Offenders. American Journal of Infectious Diseases, 3(4), pp. 230-239, 2007.

Drinking By High School Seniors: Implications for Prevention

The transition from high school to college provides a potentially critical window to intervene and reduce risky behavior among adolescents. This study examined high school seniors' motivations (e.g., social, coping, enhancement) for alcohol use and patterns of use. Latent class analysis was used to examine the relationship between different patterns of drinking motivations and behaviors in a sample of 12th graders (N = 1,877) from the 2004 Monitoring the Future survey. A person-centered approach was used to identify types of motivations that cluster together within individuals and relates membership in these profiles to drinking behaviors. Results suggest four profiles of drinking motivations for both boys and girls, including Experimenters, Thrill-seekers, Multi-reasoners, and Relaxers. Early initiation of alcohol use, past year drunkenness, and drinking before 4 P.M. were associated with greater odds of membership in the Multi-reasoners class as compared to the Experimenters class. Although the strength of these relationships varied for boys and girls, findings were similar across gender suggesting that the riskiest drinking behavior was related to membership in the Multi-reasoners class. These findings can be used to inform prevention programming. Specifically, targeted interventions that tailor program content to the distinct drinking motivation profiles described above may prove to be effective in reducing risky drinking behavior among high school seniors. Coffman, D., Patrick, M., Palen, L., Rhoades, B., and Ventura, A. Why Do High School Seniors Drink? Implications for a Targeted Approach to Intervention. Prev. Sci., 8(4), pp. 241-248, 2007.

Sexual Behavior During Emerging Adulthood

Emerging adults (M = 18.99 years, SD = .50) completed cross-sectional questionnaires (N = 943) and targeted follow-up telephone surveys (N = 202) across the transition to college. Gender, personal goals (dating, friendship, academic), and past sexual behavior were examined as predictors of reasons to have and not to have sex. Men rated Self-focused reasons to have sex as more important; women rated Partner-focused reasons to have sex and Ethical reasons not to have sex as more important. Importance of Pregnancy/ STD reasons not to have sex did not differ by gender. Before college entrance, sexual history and personal goals predicted endorsement of reasons for/against sex. Personal goals predicted first intercourse during freshman year. Limitations of the study include the single university sample and use of closed-ended self-report measures. Personal goals and reasons for/against sex are associated with sexual behavior and should be addressed in programs designed to promote sexual health among emerging adult college students. Patrick, M., Maggs, J., and Abar, C. Reasons to Have Sex, Personal Goals, and Sexual Behavior During the Transition to College. J. Sex Res., 44(3), pp. 240-249, 2007.

Relation of Executive Function to Risk Behaviors in Female College Students

Relations among executive function, behavioral approach sensitivity, emotional decision making, and risk behaviors (alcohol use, drug use, and delinquent behavior) were examined in single female college students (N = 72). Hierarchical multiple regressions indicated a significant Approach Sensitivity x Working Memory interaction in which higher levels of alcohol use were associated with the combination of greater approach tendency and better working memory. This Approach Sensitivity x Working Memory interaction was also marginally significant for drug use and delinquency. Poor emotional decision making, as measured by a gambling task, was also associated with higher levels of alcohol use, but only for individuals low in inhibitory control. Findings point to the complexity of relations among aspects of self-regulation and personality and provide much needed data on neuropsychological correlates of risk behaviors in a nonclinical population. Patrick, M.E., Blair, C., and Maggs, J.L. Executive Function, Approach Sensitivity, and Emotional Decision Making as Influences on Risk Behaviors in Young Adults. J. Clin. Exp. Neuropsychol., 30(4), pp. 449-462, 2008.

Four Developmental Trajectories of Adolescent Physical Aggression

Latent growth mixture modeling was used to identify discrete patterns of physical aggression from Grades 7 to 11 among a sample of 1,877 youth (952 boys and 925 girls). These middle school students were participating in a field trial designed to test the effects of a drug prevention program. This study included only those students who were randomly assigned to the control condition schools. Students completed annual paper-and-pencil surveys in school at Grades 7 through 11. Four trajectory classes adequately explained the development of physical aggression in both boys and girls: Low/No Aggression; Persistent High Aggression; Desisting Aggression, characterized by decreasing risk throughout adolescence; and Adolescent Aggression, characterized by low early risk that increases until Grade 9, levels out, and then declines in late adolescence. Girls were less likely than boys were to be in any trajectory besides the Low/No Aggression trajectory. Parental supervision, deviant peer association, academic orientation, impulsivity, and emotional distress at Grade 7 were all strongly associated with trajectory class membership. These associations did not differ by gender. These findings strongly suggest that the processes involved in the development of physical aggression in adolescence operate similarly in boys and girls. Martino, S., Ellickson, P., Klein, D., McCaffrey, D., and Edelen, M. Multiple Trajectories of Physical Aggression among Adolescent Boys and Girls. Aggress. Behav., 34(1), pp. 61-75, 2008.

Psychosocial Factors That Moderate or Directly Affect Substance Use Among Inner-City Adolescents

The purpose of this longitudinal study was to predict main effects and interactions of psychosocial risk and protective factors on poly-drug use intensity and future smoking among inner-city adolescents. A panel sample of baseline, 1-year and 2-year follow-ups (N=1459) from the control group of a longitudinal smoking prevention trial participated. The analysis of the poly-drug use outcome indicated that refusal assertiveness undermined perceived friends' drug use and siblings' smoking, and that low risk-taking undermined perceived friends' drug use. There was a main effect for low psychological wellness. The significant interactions between perceived friends' drug use with refusal assertiveness and decision-making skills were observed for future smoking. Moreover, perceived peer smoking norms, siblings' smoking, and high risk-taking also showed significant main effects for increasing future smoking. Epstein, J., Bang, H., and Botvin, G. Which Psychosocial Factors Moderate or Directly Affect Substance Use among Inner-City Adolescents? Addict. Behav., 32(4), pp. 700-713, 2007.

Considering Best Strategies for Recruiting Schools into Prevention Trials

Recruiting schools into a matched-pair randomized control trial (MP-RCT) to evaluate the efficacy of a school-level prevention program presents challenges for researchers. This study examined the effectiveness of 2 procedures for recruiting schools into a prevention study and assigning them to conditions. In 1 procedure (recruit and match/randomize), schools were recruited and matched prior to randomization, and in the other (match/randomize and recruitment), schools were matched and randomized prior to recruitment. The impact of each procedure on the randomization process was considered, as was the ability to recruit schools into the study. After implementing the selected procedure, the equivalence of both treatment and control group schools and the participating and nonparticipating schools on school demographic variables was evaluated. The recruit and match/randomize procedure was chosen because it would provide the opportunity to build rapport with the schools and prepare them for the randomization process, thereby increasing the likelihood that they would accept their randomly assigned conditions. Neither the treatment and control group schools nor the participating and nonparticipating schools exhibited statistically significant differences from each other on any of the school demographic variables. Recruitment of schools prior to matching and randomization in an MP-RCT may facilitate the recruitment of schools and thus enhance both the statistical power and the representativeness of study findings. Future research would benefit from the consideration of a broader range of variables (e.g., readiness to implement a comprehensive prevention program) both in matching schools and in evaluating their representativeness to nonparticipating schools. Ji, P., Dubois, D., Flay, B., and Brechling, V. "Congratulations, You Have Been Randomized Into the Control Group!(?)": Issues to Consider When Recruiting Schools for Matched-Pair Randomized Control Trials of Prevention Programs. J. Sch. Health, 78(3), pp. 131-139, 2008.

Methods for Interval Estimation

Confidence intervals for the intraclass correlation coefficient (ICC) have been proposed under the assumption of multivariate normality. This study proposes confidence intervals which do not require distributional assumptions. A simulation study was performed to assess the coverage rates of normal theory (NT) and asymptotically distribution free (ADF) intervals. ADF intervals performed better than the NT intervals when kurtosis was greater than 4. When violations of distributional assumptions were not too severe, both the intervals performed about the same. The point estimate of the ICC was robust to distributional violations. R code is for computing the ADF confidence intervals for the ICC is provided. Coffman, D.L., Maydeu-Olivares, A., and Arnau, J. Asymptotic Distribution Free Interval Estimation: For an Intraclass Correlation Coefficient with Applications to Longitudinal Data. Methodology: European Journal of Research Methods for the Behavioral and Social Sciences, 4(1), pp. 4-9, 2008.

Indirect Measures of Alcohol-related Cognitions Predict Use

Recently there has been increased interest in the role of implicit cognitive processes in the development of addictive behaviors. In this study, the authors compared 3 indirect measures of alcohol-related cognitions in the prospective prediction of alcohol use in at-risk adolescents. Implicit alcohol-related cognitions were assessed in 88 Dutch at-risk adolescents ranging in age from 14 to 20 years (51 males, 37 females) by means of varieties of word association tasks, Implicit Association Tests, and Extrinsic Affective Simon Tasks adapted for alcohol use. Alcohol use and alcohol-related problems were measured with self-report questionnaires at baseline and after 1 month. Results showed that the indirect measures predicted unique variance in prospective alcohol use after controlling for the direct measure of alcohol-related cognitions and background variables. The results indicate that the word association tasks were the best indirect measure of alcohol-related cognitions. These indirect measures appear to assess cognitive motivational processes that affect behavior in ways not reflected by direct measures of alcohol-related cognitions. Thush, C., Wiers, R., Ames, S., Grenard, J., Sussman, S., and Stacy, A. Apples and Oranges? Comparing Indirect Measures of Alcohol-Related Cognition Predicting Alcohol Use in At-Risk Adolescents. Psychol. Addict. Behav., 21(4), pp. 587-591, 2007.

Response Inconsistencies for Sex and Drug Use Behaviors Among South African High School Students

This study aims to describe patterns of inconsistent reports of sexual intercourse among a sample of South African adolescents. Consistency of reported lifetime sexual intercourse was assessed using five semiannual waves of data. Odds ratios related inconsistent reporting to demographic variables and potential indicators of general and risk-behavior-specific reliability problems. Participants were high school students from Mitchell's Plain, a low-income township near Cape Town, South Africa. Students (N = 2,414) were participating in a research trial of a classroom-based leisure, life skill, and sexuality education program. The sample for the present study was restricted to participants who reported lifetime sexual intercourse in at least one of the first four survey assessments (n = 713). This subsample was mostly male (69%) and "colored" (mix of African, Asian, and European ancestry) and had a mean age at baseline of 14 years. Of the sexually active participants in the sample, nearly 40% reported being virgins after sexual activity had been reported at an earlier assessment. Inconsistent reporting could not be predicted by gender or race or by general indicators of poor reliability (inconsistent reporting of gender and birth year). However individuals with inconsistent reports of sexual intercourse were more likely to be inconsistent reporters of substance use. These results suggest that researchers need to undertake efforts to deal specifically with inconsistent risk behavior data. These may include modification of data collection procedures and use of statistical methodologies that can account for response inconsistencies. Palen, L., Smith, E., Caldwell, L., Flisher, A., Wegner, L., and Vergnani, T. Inconsistent Reports of Sexual Intercourse among South African High School Students. J. Adolesc. Health, 42(3), pp. 221-227, 2008.


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