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Director's Report to the National Advisory Council on Drug Abuse - September, 2004

Research Findings - Prevention Research

Revised Project ALERT Modifies Risk Factors in Adolescents

The revised Project ALERT curriculum is designed to help young people resist pro-drug pressures and contains additional lessons on smoking cessation, and alcohol misuse, and a series of new home-learning activities that encourage parental involvement. To test the impact of the revised curriculum, fifty-five middle schools from South Dakota were randomly assigned to the revised ALERT or control condition. Treatment group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4,276 eighth graders were assessed 18 months after baseline. Results indicated that the revised ALERT had statistically significant effects on all targeted risk factors associated with cigarette and marijuana use and more modest gains with pro-alcohol risk factors. The program showed beneficial changes in adolescents at all risk levels (i.e., low, moderate and high) for future use, with the effect sizes typically stronger for the low and moderate risk groups. Gosh-Dastidar, B., Longshore, D., Ellickson, P. and McCaffrey, D. Modifying Pro-Drug Risk Factors in Adolescents: Results from Project ALERT. Health Education & Behavior, 31(3), pp. 318-334, 2004.

Classroom Environment Influences On Aggression, Peer Relations and Academic Focus

Peers provide models of behavior, and consequently classrooms containing high numbers of students with poor academic skills or behavioral problems are likely to promote bad behavior in individual students. This study examined the extent to which variations in social and academic classroom composition as well as the larger school context affected behavior in a normative sample of children over a 2-year period. Teachers provided ratings of individual students, which were then aggregated to form teacher-based measures of classroom environment. Concurrent and longitudinal effects of classroom and school environments on individual behaviors were examined for students in 65 classrooms in 17 schools. Poorer classroom environments were associated with higher levels of student aggression, poor peer relations, and lack of academic focus. Changes in student behavior over time can be explained by the classroom environment. Barth, J.M., Dunlap, S.I., Dane, H., Lochman, J.E. and Wells, K.C. Journal of School Psychology, 42(2), pp. 115-133, 2004.

Advocacy Interventions Reduce Smoking among Teenagers

The purpose of this study was to determine whether high school students' participation in advocacy activities related to the advertising, availability and use of tobacco in communities would prevent or reduce their own use. Eleventh and 12th grade students in 10 continuation high schools were randomly assigned to advocacy activities (treatment in 5 schools) or to learning about drug and alcohol abuse prevention during a semester-long program (5 control schools). Based on self-reports, students were classified as nonsmokers, light smokers (those who smoked less than a pack per week) or regular smokers (those that smoked one or more packs per week. Three additional measures were assessed: perceived self-efficacy, perceived incentive value, and outcome expectances. There was a significant net change from baseline to the end of the semester (after the intervention) between treatment and control schools for students who were regular smokers but not for students who were nonsmokers or light smokers. Regular smoking decreased 3.8% in treatment schools and increased 1.5% in control schools (P<.001). Regular smoking continued to decrease at 6-months post-intervention in treatment schools, with a total change in prevalence from 25.1% to 20.3%. Measures of community-advocacy involvement and the three social constructs also showed significant net changes between control and treatment schools. Winkelby, M.A., Feighery, E., Dunn, M., Kole, S., Ahn, D. and Killen, J.D. Effects of an Advocacy Intervention to Reduce Smoking Among Teenagers. Archives of Pediatric and Adolescent Medicine 158, pp. 269-275, 2004.

Brief Family Intervention Effects 6 Years Past Baseline

This study examines the effects of two brief family-focused interventions on the trajectories of substance initiation over a period of 6 years following a baseline assessment. The interventions, designed for general population families of adolescents, were the 7-session Iowa Strengthening Families Program (ISFP) and the 5-session Preparing for the Drug Free Years Program (PDFY). Thirty-three rural public schools were randomly assigned to the ISFP, the PDFY, or a minimal contact control condition. These interventions have been previously proven to reduce alcohol use at 2.5 years and 4 years past baseline. The curvilinear growth observed in school-level outcome measures of drug initiation was evaluated using a logistic growth curve analysis. Alcohol and tobacco composite use indices—as well as lifetime use of alcohol, cigarettes, and marijuana—and lifetime drunkenness, were examined in the current analysis, in which study participants are an average of 18.2 years old. Significant intervention-control differences were observed, indicating favorable delays in growth rates of initiation of alcohol use without parental permission, drunkenness, and cigarette use initiation in the intervention groups. Spoth, R.L., Redmond, C., Shin, C. and Azevedo, K. Brief Family Intervention Effects on Adolescent Substance Initiation: School-level Growth Curve Analyses 6 Years Following Baseline. Journal of Consulting and Clinical Psychology, 72(3), pp. 535-542, 2004.

The Role of Parental Risk in the Moderation of Child Intervention Outcomes

Four years of longitudinal data from 373 families participating in a randomized intervention trial were used to examine whether intervention effects on adolescent alcohol and tobacco use trajectories were moderated by family risk, as defined by parental social emotional adjustment. A single parental social emotional maladjustment score was calculated by summing average scores from subscales tapping anxiety, depression, and hostility based on parent report. Consistent with previous studies based on a different analytic technique, the current analyses confirmed that both the Preparing for the Drug Free Years program and the Iowa Strengthening Families Program favorably influenced youth alcohol use index trajectories across the time frame of the study while only the latter program evidenced positive effects on a tobacco use index. With regard to the role of parental risk in moderating these program outcomes, analyses provided no support for family risk moderation of any intervention effect. Guyll, M., Spoth, R.L., Chao, W., Wickrama, K.A.S. and Russell, D. Family-focused Preventive Interventions: Evaluating Parental Risk Moderation of Substance Use Trajectories. Journal of Family Psychology, 18(2), pp. 293-301, 2004.

Violence Prevention among African American Adolescent Males

This study tests whether the efficacious, multi-year Aban Aya intervention has significant effects on the proposed mediating variables and whether the significant preventive effects in reducing violence found in previous analyses are mediated by changes in proposed mediators. Five hundred seventy-one African American adolescent males participated in this randomized trial. Multi-level modeling techniques were used to ascertain both intervention and mediated effects. The intervention significantly reduced the rate of growth of violence and five social and psychological factors in the treatment group relative to the control group. Four of these social and psychological factors, behavioral intentions, attitudes toward violence, estimates of peers' behaviors, and estimates of best friends' behaviors, were found to be complete mediators between the intervention and its preventive effects. Ngwe, J.E., Liu, L.C., Flay, B.R., Segawa, E. and the Aban Aya coinvestigators. Violence Prevention among African American Adolescent Males. American Journal of Health Behavior, 28(Suppl 1), pp. S24-S37, 2004.

Social Assertiveness, Internalizing, and Gender Moderation Effects Of A Preventive Intervention

The current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency and the initiation of substance use as well as the effects of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment. A latent growth curve comparison analysis found that internalizing was inversely related to initial levels of social assertiveness skill among girls. Internalizing was positively related to substance use initiation growth trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance use initiation and a faster increase in social assertiveness. Lillehoj, C.J., Trudeau, L., Spoth, R.and Wickrama, K.A.S. Internalizing, Social Competence, and Substance Initiation: Influence of Gender Moderation and a Preventive Intervention. Substance Use and Misuse, 39(6), pp. 963-991, 2004.

Educational Resilience among Youth at Risk

Educational experts and others recognize the importance of early school experiences on later educational outcomes. Following a sample of youth based on 692 files from low-income, single parent families from one urban school district from 1898-90 to 1996-97, the authors apply event history analytic techniques to examine the relationship between first grade retention and high school completion. The findings indicate that being retained in first grade increases the risk of dropping out of high school years later. However, there is a link between retention, extracurricular activity participation and high school completion such that those students who were retained but were involved in extracurricular activities had drop out rates that were lower than the retained uninvolved students. Thus educational trajectories can be redirected such that positive educational outcomes can occur. Randoph, K.A., Fraser, M.W. and Orthner, D.K. Educational Resilience among Youth at Risk: Substance Use and Misuse 39, pp. 747-767, 2004.

D.A.R.E Plus Is More Effective in Preventing Violence Among Boys Than Girls

Twenty-four middle schools were randomly assigned to: 1) DARE curriculum; 2) DARE Plus multi-component curriculum; or 3) control condition. Outcomes of the three conditions on violence-related behaviors were compared, and mediational analyses were conducted to examine how interventions reduced physical and verbal violence. Generally, boys demonstrated higher rates of violence and victimization than girls. Boys in the DARE Plus condition had a marginally significant lower number of verbally violent acts than boys in the control condition. Boys in the DARE Plus condition had a marginally lower number of physically violent acts than boys in the DARE condition. There were no significant differences between the DARE only and control groups. There were no significant differences between the three groups in victimization. The small behavioral effect that DARE Plus demonstrated on physical and verbal violence among boys was mediated by a decrease of norms that support violence, an increase in outcome expectancies about being violence-free, and an increase in parental consequences for fighting. DARE Plus was not as effective in preventing violence among girls, however, girls in the DARE Plus condition had significantly lower scores on the Victimization Scale than girls in the DARE only condition. Komro, K.A., Perry, C.L., Veblen-Mortenson, S., Stigler, M.H., Bosma, L.M., Munson, K.A. and Farbakhsh, K. Violence-related Outcomes of the DARE Plus Project. Health Education & Behavior, 31(3), pp. 335-354, 2004. Perceptions of Rural Parents Regarding Family-Focused Programs Data collected in the Promoting School-Community-University Partnership to Enhance Resilience (PROSPER) project during telephone interviews with 1,156 parents of sixth graders from 36 rural schools were used in multilevel structural equation modeling. Results of analyses show that: 1) parents considered their children to be at low risk for substance use; 2) parents perceived themselves to be effective in helping their children avoid maladaptive behaviors; 3) mothers perceived themselves to be more efficacious than did fathers; 4) parental efficacy perceptions inversely affected perceptions of child susceptibility; 5) parents' perceptions of child susceptibility positively affected perceived program benefits; and 6) higher perceived program benefits and higher perceived child susceptibility were associated with mothers, male children, single parents, lower household income, and lower parent education. Redmond, C., Spoth, R, Shin, C. and Hill, G. Engaging Rural Parents in Family-Focused Programs to Prevent Youth Substance Abuse. Journal of Primary Prevention, 24(3), Spring, 2004.

Alcohol and Marijuana Use in Early and Late Adolescence

This study examined alcohol and marijuana use over a 9-year period between ages 11-12 and ages 19-21 using a community based dataset collected prospectively as part of the evaluation of Project DARE. Because the DARE intervention was found to have no effects on any program targets, this dataset provides an appropriate community sample for investigating developmental changes in drug use over time. 481 participants (50.17% male, 79.2% Caucasian) were interviewed once a year in the sixth through tenth grades and again at age 20. A growth mixture model approach was used to analyze interview data from 6 time points in an attempt to empirically identify subgroups of alcohol and marijuana users over time. Three subgroups were identified for both alcohol use and marijuana use: a group that initiated substance use in early adolescence (age 11-12), a group that initiated use in late adolescence/early adulthood (age 15-16), and an abstainer group. Several variables measured in early adolescence including school and church involvement, self-esteem, peer pressure resistance, sensation seeking, expectancies, and conduct problems significantly differentiated the alcohol and marijuana subgroups. The subgroups also differed significantly on young adult outcomes, including alcohol and marijuana dependence, antisocial personality disorder symptoms, and number of arrests. For alcohol use, the early-onset group was more dysfunctional in terms of early psychosocial risk factors and later deleterious outcomes whereas the late-onset and nonuser groups were better adjusted. In contrast, for marijuana, the early- and late-onset groups were both more dysfunctional than the nonuser group. Flory, K., Lynam, D., Milich, R., Leukefeld, C. and Clayton, R. Early Adolescent through Young Adult Alcohol and Marijuana Use Trajectories: Early Predictors, Young Adult Outcomes, and Predictive Utility. Development and Psychopathology, 16, pp. 93-213, 2004.

Children's Intuitive Theories of Drug Action

In an effort to develop a method for characterizing children's intuitive theories of drug action, 217 children (53.7% girls) in grades 1 through 6 were interviewed about how alcohol and cocaine cause behavioral changes in users. Using Piagetian and intuitive theories perspectives children's responses to interview questions were classified in terms of both structure and content. With respect to structure, responses were coded for their complexity of causal reasoning, coherence, and level of construction of a casual explanatory framework with nodes, links, and causal mechanisms. In terms of content, responses were coded for relevant biological ontology, mastery of propositions in a scientifically correct theory of drug action, and reliance on alternative theoretical models. Scores on all measures of structure and content increased with age, especially between first and second grade and third and fourth grade. Growth between third/fourth and fifth/sixth grades was more evident for cocaine than for alcohol. Overall, elementary school age children appear capable of framing causal explanations of drug action and they possess relevant biological knowledge, particularly about the central role of the brain in mediating the effects of drugs on behavior. Davies, E.P., Sigelman, C.K., Bridges, L.J., Rinehart, C.S. and Sorongon, A.G. A Characterization of Children's Intuitive Theories of Drug Action. Applied Developmental Science, 8, pp. 58-74, 2004.

Psychosocial Factors Related to Drinking Among Rural Adolescents

This study examined the relationship of psychosocial factors to alcohol use for adolescent boys and girls residing in rural Iowa. Seventh graders (n=1673) self-reported alcohol use, peer drinking norms, adult drinking norms, drug refusal assertiveness, drug refusal techniques, life skills, pro-drinking attitudes, risk-taking tendency, and perceived family management practices. Multiple regressions indicated that peers' drinking norms, drug refusal assertiveness, drug refusal techniques, life skills, pro-drinking attitudes, and risk taking tendency were related to drinking measures. Perceived family management skills and drug refusal techniques were associated with drinking for girls but not boys. Risk-taking tendency was related to drinking for boys but not girls. Epstein, J.A., Botvin, G.J. and Spoth, R. Which Psychosocial Factors are Related to Drinking Among Rural Adolescents? Journal of Child and Adolescent Substance Abuse, 13(1), pp. 19-35, 2003.

Spirituality and "Health-As-A-Value" Are Protective Against Teen Substance Use

This study investigated the influence of two potentially protective factors, Health-as-a-Value (HAV) and spirituality, on monthly alcohol, cigarette, and marijuana use in two multiethnic groups of adolescents varying in risk. Survey respondents included 382 students from continuation/alternative high school, a population considered at risk for drug use, and 260 students drawn from a medical magnet high school, and considered to be at lower risk. The data indicated that spirituality was protective against monthly alcohol use and marijuana use in the lower risk sample. In the higher risk sample, spirituality was protective against all monthly use. HAV was protective against monthly alcohol use in the low risk sample, and protective against all monthly use in the higher risk sample. When both constructs were entered into the same model, spirituality and HAV were independently protective of all monthly use for the higher risk sample and of monthly alcohol use in the lower risk sample, supporting the earlier finding that both are independently protective values. Thus, HAV and spirituality may be protective in various environments, independent of the level of use in the environment. Ritt-Olson, A., Milam, J., Unger, J.B., Trinidad, D., Teran, L., Dent, C.W., and Sussman, S. The Protective Influence Of Spirituality And "Health-As-A-Value" Against Monthly Substance Use Among Adolescents Varying In Risk. Journal Of Adolescent Health, 34 (3), pp. 192-199, 2004.

Gender Identity, Ethnicity, Acculturation and Drug Use

This article presents the findings of a survey completed by 1351 predominantly Mexican American middle school students residing in a large urban center in the U.S. Southwest. The study explores possible associations between drug use attitudes and behaviors and biological sex, gender identity, ethnicity, and acculturation status. Based on the concepts of "machismo" and "marianismo" that have been used to describe Mexican populations, four dimensions of gender identity were measured: aggressive masculinity, assertive masculinity, affective femininity, and submissive femininity. In explaining a variety of indicators of drug use behaviors and anti-drug norms, gender alone had limited explanatory power, while gender identity—often regardless of gender—was a better predictor. Aggressive masculinity was generally associated with higher risk of drug use, while the other three gender identity measures had selected protective effects. The impact of gender identity was strongly mediated by acculturation: less acculturated Mexican American students reported lower aggressive masculinity scores than non-Latinos; less acculturated Mexican American girls reported both the lowest aggressive masculinity scores and the highest submissive femininity scores; more acculturated Mexican American students, along with the less acculturated Mexican American boys, did not appear to be polarized by gender identity. The findings suggest that some aspects of culturally prescribed gender roles can have a protective effect against drug use behaviors and attitudes, possibly for both girls and boys. Kulis, S., Marsiglia, F.F. and Hurdle, D. Gender Identity, Ethnicity, Acculturation, and Drug Use: Exploring Differences Among Adolescents in the Southwest. Journal of Community Psychology, 31(2), pp.167-188, 2003.

Promoting Academic Success among Latino Youths

The Oregon Latino Youth Survey samples included a total of 564 Latino and non-Latino middle school and high school students and their parents. Analyses showed that Latino students reported a high frequency of discriminatory experiences and institutional barriers at school and that both Latino students and their parents were more likely to experience institutional barriers compared to non-Latinos. Further, Latino students and parents reported that they and/or their youngsters were more likely to drop out of school compared to non-Latinos. Path models showed that lower acculturation and more institutional barriers were related to less academic success for Latino students. More parent academic encouragement and staff extracurricular encouragement were associated with better academic outcomes for Latino students. Finally family socioeconomic disadvantage had an indirect effect on Latino youngster academic success through effects on parent monitoring and school involvement. Martinez, C.R., DeGarmo, D.S. and Eddy, J.M. Promoting Academic Success among Latino Youths. Hispanic Journal of Behavioral Sciences, 26(2), pp. 128-151, 2004.

Measuring Historical Trauma among American Indians

The developmental process and measurement characteristics observed in The American Indian Historical Loss Scale and the Historical Loss Associated Symptoms Scale are described. Measurement characteristics including frequencies, internal reliability, and confirmatory factor analysis were calculated based on responses from 143 American Indian adult parents of children aged 10-12 years who are a part of an ongoing longitudinal study of American Indian families in the Upper Midwest. Results indicate both scales have high internal reliability. Frequencies indicate that the current generation of American Indian adults have frequent thoughts pertaining to historical losses and that they associate these losses with negative feelings. Two factors of the Historical Loss Associated Symptoms Scale indicate one anxiety/depression component and one anger/avoidance component. The results are discussed in terms of future research and theory pertaining to historical trauma among American Indian people. Whitbeck, L.B., Adams, G.W., Hoyt, D.R. and Chen, Xiaojin. Conceptualizing and Measuring Historical Trauma Among American Indian People. American Journal of Community Psychology, 33(3/4), pp. 119-130, 2004.

Resolving Tensions Between Fidelity & Fit in Adapting Prevention Interventions

Debate over the need for strict fidelity of implementation versus the need for prevention that is responsive to the needs of specific populations from a community-based participatory research approach is the subject of this article. This approach to program adaptation emphasizes motivating community participation to enhance program outcomes. Both fidelity and adaptation are essential elements of prevention intervention program design and are best addressed through a planned, organized, and systematic approach. Castro, F.G., Barrera, M. and Martinez, C.R. The Cultural Adaptation of Prevention Interventions: Resolving Tensions between Fidelity and Fit. Prevention Science, 5(1), pp. 41-45, March 2004.

Agreement of Program Provider and Observer Ratings of School-Based Preventive Intervention Implementation & Relation to Youth Outcomes

Few prevention studies have examined the degree to which different measures of program implementation adherence predict youth outcomes. The current study was conducted with rural middle school youth participating in a longitudinal school-based preventive intervention program. Study participants' average age at the pretest assessment was 12.3 years. The association between program implementation ratings supplied by provider self-reports and trained independent observer reports were evaluated. In addition, the relationship between measures of implementation and youth outcomes were examined. Results indicated that although program providers tended to report higher implementation than independent observers, most ratings were correlated significantly across raters. Moreover, observer-reported implementation ratings significantly predicted several youth substance-related outcomes, while provider reported self-ratings did not. Findings suggest that there might be a social desirability bias in provider self-reported ratings of implementation and that caution must be used when interpreting self-reported ratings of implementation. Lillehoj, C.J., Griffin, K.W. and Spoth, R. Program Provider and Observer Ratings of School-based Preventive Intervention Implementation: Agreement and Relation to Youth Outcomes. Health Education and Behavior, 31(2), pp. 242-257, 2004.

Piecewise Growth Curve Modeling of Prevention Study Data

Longitudinal data from the Midwestern Prevention Project (MPP) was used as an example to illustrate an alternative growth curve model with multiple profiles to incorporate multiple developmental stages. The data contained a total of 50 junior high schools (23 control and 27 program schools) observed at 7 time points beginning at the seventh grade and crossing junior high school and high school stages. Baseline data were obtained in the fall of 1987 and 6 follow-ups were conducted, with the first being 6 months after baseline, and then 1 year apart for the other five follow-ups. The percentage of students reporting any cigarette use in the last 30 days in each school was used as the outcome measure. Several two-piece growth curve models were developed to examine longitudinal prevention effects. Each piecewise model included growth profiles at two separate developmental stages: the junior high school years and the high school years. Comparisons revealed that the piecewise growth curve models incorporating multiple stages demonstrated significant improvement of model fitting compared to the single-piece growth curve model. Results showed marginal prevention effects in the junior high school stage but not in the high school stage. Piecewise growth curve models offer both more substantively and analytically appropriate model specification and greater flexibility in incorporating transitional periods when studying changes across time. Chou, C.P., Yang, D., Pentz, M.A. and Hser, Y.I. Piecewise Growth Curve Modeling Approach for Longitudinal Prevention Study. Computational Statistics and Data Analysis, 46, pp. 213-225, 2004.


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