Etiology, Prevention, and Epidemiology Research
Continued
The Effects of a Multicomponent Prevention Intervention Program:
The Adolescent Transitions Program (ATP) is a multicomponent intervention program for prevention of substance use and other behaviors. It consists of two coordinated prevention intervention packages aimed at parents (Parent Focus) and youths (Teen Focus). Dishion and colleagues evaluated the basic prevention program components with 158 families. Information collected to help judge program effectiveness included program engagement, skill acquisition, improvement in family interaction, and reductions in problem behavior. The study found that these basic components were effective in engaging students and their parents, teaching them skills and improving parent-child relations. In addition, the Parent Focus curriculum had a short term effect on the incidence of aggressive and delinquent behaviors of young teens. The Teen Focus curriculum, while enhancing parent-child relations, did not influence problem behavior in short term evaluations. Teens participating in the Teen Focus curriculum seem to escalate in their problem behavior after experiencing the intervention. Andrews, D.W., Soberman, L.H. & Dishion, T.J. The Adolescent Transitions Program for High-Risk Teens and Their Parents: Toward a School-Based Intervention. Education and Treatment of Children., in press.
Effects of Parent and Peer Factors on Refusal Skills to Prevent Early Adolescent Alcohol Use
Peer refusal techniques have been used with some success in drug abuse prevention intervention efforts. Spoth and colleagues have tested a model of protective parent and peer factors in peer refusal skills. Data from a sample of 209 families who were Caucasian and recruited from economically stressed rural midwestern school districts were used. Two versions of the model were tested, one version addressing attachment and skills training attendance specific to mothers and one specific to fathers. Strong fits with the data were achieved for both mother and father versions of the model; hypothesized protective factor effects and skill training effects were significant. The degree to which findings would generalize to a more diverse sample is unknown. Spoth, R., Yoo, S., Kahn, J., Redmond, C. A Model of the Effects of Protective Parent and Peer Factors on Early Adolescent Alcohol Refusal Skills, Journal of Primary Prevention, in press.
Evaluation of a Prevention Intervention Program in an Economically Stressed Rural Area:
Spoth and colleagues have completed the evaluation of a prevention intervention program, Preparing for the Drug (Free) Years, with a sample of 209 families residing in an economically stressed rural area. The study was an experimental test of intervention versus control differences on directly targeted protective parenting behavior and more general child management skills. The study showed significant intervention effects on both measures for both mothers and fathers. Results also indicated that both mothers' and fathers' level of intervention attendance and expressed readiness for parenting change were significant predictors of the targeted parenting outcome which in turn significantly affected the general child management outcome for both mothers and fathers. Spoth, R., Redmond, C., Haggerty, K., Ward, T. A Controlled Parenting Skills Outcome Study Examining Individual Difference and Attendance Effects, Journal of Marriage and the Family, 57:449, 1995,
Drug Use in the Workplace:
Etiological theories regarding drug use and intoxication on the job tend to emphasize either personal characteristics or job conditions. Using prospective data from a community sample (N=545) assessed in young adulthood (20-25 years) and again four years later (25-29 years), both cross-sectional and longitudinal analyses evaluated associations among multiple measures of intoxication in the workplace, job instability and satisfaction, and social conformity. Being high on the job was more prevalent, frequent, and stable over time for men than women, although rates decreased for both genders with age. Measures of social conformity were most related to drug use on the job within time, but had few unique effects over time. After controlling for prior intoxication on the job, only a few earlier work characteristics (but no personal traits) affected later intoxication on the job, providing little support for either etiological position. However, several significant interactions were found between personal and job variables that predicted increased intoxication in the workplace. On the other hand, earlier intoxication on the job increased later measures of job instability.
Newcomb, M.D. Prospective Dynamics of Drug Use in the Workplace: Personal and JobRelated Predictors and Consequences. Experimental and Clinical Psychopharmacology, 3:1995:56-74.
Community Readiness for Drug Abuse Prevention:
Eugene Oetting and colleagues have published an article which for the first time has defined stages in community readiness for drug abuse prevention and other intervention efforts. One cannot simply impose a prevention program. The community has to grow through a series of stages prior to initiating a prevention program. In addition, there are stages that mark the quality of a community's readiness. The article also provides a set of anchored rating scales for assessing community readiness. The article has become the basis for many workshops and programs for minority communities. Oetting, E.R., Donnermeyer, J.J., Plested, B.A., Edwards, R.W., Kelly, K., and Beauvais, F. Assessing Community Readiness for Prevention, The International Journal of the Addictions, 30(6), 659, 1995.
Adaptive Behaviors Among Psychiatrically Hospitalized Children: The Role of Intelligence and Related Attributes:
Intelligence has previously been found to serve protective functions for the maintenance of socially competent behaviors. As a part of a larger study of children of substance abusers, this study of 126 psychiatrically hospitalized children studied intelligence and two constructs possibly associated with the protective effects of intelligence: level of academic achievement and the distinction between internalizing and externalizing symptomatology. Of the variables examined, achievement showed the strongest associations with different types of adaptive behaviors. Further, achievement levels appeared to mediate even the modest associations that were found for intelligence. Type of symptomatology had significant associations with adaptive behaviors chiefly in the socialization domain, and these effects seemed largely independent of both IQ and achievement. Luthar, S.S., Woolston, J.W., Sparrow, S.S., Zimmerman, L.D., & Riddle, M.A. Adaptive Behaviors Among Psychiatrically Hospitalized Children: The Role of Intelligence and Related Attributes. Journal of Clinical Child Psychology, 24:1995:98-108.
"Unselling" Drugs: The Marketing of Prevention
Kathleen Kelly has published an article that provides a valuable foundation for understanding the use of media in prevention intervention efforts. It reviews the literature on "social marketing" and relates social marketing to traditional marketing, pointing out crucial differences. For example, traditional marketing urges immediate gratification of immediate wants and needs through purchase or use of a product. Drug prevention requires delay of gratification of immediate needs in exchange for long term gain. Nevertheless, basic principles of marketing are often ignored by drug prevention programs. The paper gives practical advice noting that marketing methods can be used to improve our ability to convince the public to support drug prevention efforts and to improve the efficacy of our prevention programs. Kelly, K. "Unselling" Drugs: The Marketing of Prevention, The International Journal of the Addictions, 30(8), 1043, 1995.
Immediate Impact of Social Influence-Oriented Substance Abuse Prevention Curricula in High Schools:
A study examining the immediate impact of social influence-oriented activities on drug related knowledge and beliefs for students at traditional versus continuation high schools has been completed by Sussman and colleagues. The relative effectiveness of two intervention program delivery methods (active versus passive) was also examined. Continuation high school students reported much higher levels of overall drug use. Across school type, the activities showed the most impact on knowledge change. Overall, the comparison evaluation study of the social influence lessons suggests that most of the components of a social influence curriculum can have an immediate effect on knowledge regardless of school type or delivery method. Taken together, the immediate impact findings suggest that (1) it is more difficult to achieve an immediate impact on beliefs than knowledge, (2) students in continuation high schools are less likely to experience immediate changes in beliefs from single social influences lessons, and (3) actively participating in a curriculum is more likely to lead to a significant change in beliefs than is passive participation. Sussman, S., Dent, C., Simon, T., Stacy, A., Galaif, E., Moss, M., Craig, S., Johnson, C. Immediate Impact of Social Influence-Oriented Substance Abuse Prevention Curricula in Traditional and Continuation High Schools. Co-published simultaneously in Drugs & Society, 8, 65, 1994. and Drug Prevention Research and Practice, Leukefeld, C., (ed.), The Haworth Press, Inc., 1994,
Parental Influences on Early Adolescent Deviant Behavior:
Having fewer than two supportive parents generally increases the risk of deviant behavior, but more so for boys than for girls. This is the conclusion of a longitudinal study of 601 families examining the separate and combined effects of parental psychiatric disorders, supportive parent-child communications, and household income on the development of deviant behavior in boys and girls 11 to 14 years of age. Deviance in this study was defined on the basis of 15 specific behavior patterns, including three related to substance use (began drinking or using drugs, smoked cigarettes during the past 30 days, and drank alcohol in the past 30 days). The relationships between having fewer than two supportive parents and deviant behavior was more pronounced when one or more parents had a chronic mental disorder (principally depression and substance abuse), but the combination of fewer than two supportive parents and one psychiatrically impaired parent had a particularly marked effect on girls. Moreover, older children's behavior is affected more dramatically by parental mental disorders, especially among girls; 13-to-14-year-old girls with both parental risk factors were virtually as deviant as male agemates with both risks. Each of these effects is present regardless of family income level, but without these risks, household income is negatively related to deviant behavior. Johnson, R.A., Su, S.S., Gerstein, D.R., Shin, H.C. & Hoffmann, J.P. Parental Influences on Deviant Behavior in Early Adolescence: A Logistic Response Analysis of Age- and Gender-Differentiated Effects. Journal of Quantitative Criminology, 11:1995:167-193.
Natural History of Crack Cocaine Users:
Bruce Johnson and colleagues reported recent findings from their analysis of data from an eight year (1989-1997) natural history cohort study of crack cocaine dealers and users in New York City. They found that crack cocaine use has been on a steady decline since peaking in the mid to late 1980s and that crack dealing has shifted from conspicuous sales in open, outdoor drug markets to clandestine sales in private settings in apartments buildings. The decline in use of crack cocaine appears to reflect both changing attitudes and norms among youth as well as general shifts among drug users to powdered cocaine and smokable heroin. The authors report there has been a notable increase in the number of female crack cocaine sellers; they speculate that this may be because of the high incarceration rates of male crack cocaine dealers as well as the declining profitability from selling the drug. Golub, A., Johnson, B., and Fagan, J. Careers in Crack Use, Drug Distribution, and Nondrug Criminality. Crime and Delinquency; 41; 3; 1995; 275-295.
Biological Mechanisms Related to Prevention of Drug Abuse:
Bardo et al. have published a review article that examines biological mechanisms that have potential implications for prevention intervention of drug abuse. In this article, scientific evidence is provided to support the contention that drug seeking behavior is rewarding because it activates a brain system similar to that normally activated by novelty seeking (i.e., the mesolimbic dopamine system). The hypothesis is that individual differences in the need for novelty make individuals differentially susceptible to drug use. There are a number of indications that novelty or sensation seeking in humans in biologically based as well as evidence of high heritability of the trait. Despite the role of genetics, however, evidence from animals indicates that early developmental experiences alter many both novelty- and drug-seeking behaviors. Within the context of this biological formation, implications for the prevention of drug abuse are discussed. Bardo, M.T., Donohew, R.L, and Harrington, N.G., Psychobiology of Novelty-Seeking and Drug-Seeking Behavior. Behavioral Brain Research, In press, 1995.
Group Self-Identification and Adolescent Cigarette Smoking: A One Year Prospective Study:
As an extension of previous work on prevention interventions, this study by Sussman,
et al. analyzed the longitudinal relations and predictive precedence of group self-identification and adolescent cigarette smoking. Results indicated that 7th-grade group self-identification predicted 8th-grade cigarette smoking, whereas 7th-grade cigarette smoking did not predict 8th-grade group self-identification. Group self-identification was also compared with 7 other psychosocial variables as predictors of smoking 1 year later. The pattern of results suggests that group selfidentification is about as good a predictor of smoking as other psychosocial variables, and that group self-identification is more than a mere proxy of other psychosocial variables. Sussman, S., et al. Group Self-Identification and Adolescent Cigarette Smoking: A 1-Year Prospective Study. Journal of Abnormal Psychology, 103, 1994.
Five Methods of Assessing Use of Cigarettes and Alcohol at High Schools to Better Target Prevention Intervention Efforts:
Sussman and Stacy explored five methods of estimating school-level daily use of cigarettes and alcohol by adolescents at 20 continuation high schools in southern California. Campbell and Fiske's criteria were used to estimate convergent and discriminant validity of a correlation matrix consisting of two "traits" (daily use of cigarettes or alcohol) and five "methods" (aggregated student self-report, school personnel prevalence estimate, student prevalence estimate, naturalistic observation of use, and school refuse evidence). The different methods varied dramatically in convergent and discriminant validity. The findings, as well as assessment cost considerations, suggest that refuse analysis is the most economic proxy measure for estimating school-level daily student cigarette smoking and other drug use.
Sussman, S., Stacy, A. Five Methods of Assessing School-Level Daily Use of Cigarettes and Alcohol by Adolescents at Continuation High Schools. Evaluation Review, 18, 741, 1994.
Components of an Anabolic Steroid Prevention Intervention Program
Anabolic androgenic steroids (AAS) prevention efforts have involved alternatives to athletic enhancing drugs, including strength training instruction; however, this component of an AAS intervention has never been studied among a group of adolescent athletes. Forty-eight high school varsity football players completed an 8 week AAS education program which was composed of 8 didactic sessions and 8 weekly strength training periods. The overall satisfaction with the program was 95%. Students reported positive benefits concerning physical changes after the intervention. Those who participated in the intervention were less willing to try ASS after the intervention. Results suggest that as part of an AAS prevention program, 8 sessions of strength training can enhance adolescent self-efficacy in the weight room and enhance a successful school-based anabolic steroid drug prevention program. Green, C.P., Goldberg, L., Elliot D., Moe, E. Adolescent Attitudes Toward a Strength Training Program: A Component of an Anabolic Steroid Program Intervention. Medicine and Science in Sports and Exercise, (Supplement), 1995, 27:S173.
Defining Steroid Users' Characteristics to Allow Rational Structuring of Prevention Intervention Programs
Goldberg et al. studied the characteristics of the users of anabolic steroids (AS) comparing high intent athletes to players having less predisposition toward AS use. High intent athletes had more access to AS, reported greater belief in AS's beneficial effects, felt greater influence to use AS by teammates' and friends' AS use, experienced less parental influence not to use, had less comfort refusing AS, and were more impulsive and stronger believers in "winning at all costs." Understanding of specific AS risks and benefits did not differ between groups. Elliot, D., Goldberg, L., Clarke, G., Zoref, L., Moe, E., MacKinnon, D., Green, C., Wolf, S., Miller, D., Greffrath, E. Characterization of Adolescent Athletes with High Behavioral Intent to Use Anabolic Steroids. Paper presented at the Third IOC World Congress on Sports Sciences, Atlanta, Georgia, September, 1995.
Examination of Development Risk Factors Leading to Steroid Use:
To determine the need for differential prevention interventions for anabolic steroid (AS) use, Goldberg et al. conducted a study to determine the developmental sequence of factors relating to AS. High school football players age 14, 15, 16, 17 and 18 from 31 schools in the Portland, Oregon metropolitan area were given a 168 item confidential questionnaire. Significant differences were present among the ages. Older students were more likely to use protein and carbohydrate supplements and less curious to try AS. Older athletes had less belief that parents would disapprove of drug use, believed more in "winning at all costs" and reported more understanding of alternatives to AS (e.g., strength training and nutrition to gain muscle). Factors which did not differ by age included peer influences, perceived coach disapproval and concern about drug side effects. Younger high school athletes' knowledge gaps in nutrition and strength training suggest intervention programs correcting these gaps may enhance athletic development and deter future AS use. Interventions for older athletes may be enhanced more by impacting on attitudes about winning and peer/non-peer influences. Goldberg, L., Elliott, D., Clarke, G., Zoref, L. Moe, E. MacKinnon, D., Green, C., Wolf, S., Miller, E., Greffrath, E. Does Age Affect Factors that Relate to Ergogenic Drug Use? Differences Among Athletes Aged 14 to 18. Paper presented at the Third IOC World Congress on Sports Sciences, Atlanta, Georgia, September, 1995.
The ATLAS Prevention Program
Researchers at the Oregon Health Sciences University have developed and are testing a school-based intervention to prevent anabolic steroid (AAS) use among high risk adolescent athletes. Eight weekly, one hour classroom sessions delivered by the coach and adolescent team leaders and eight weightroom sessions delivered by research staff were part of the intervention. Other components were sports nutrition and strength training as alternatives to AAS use, drug refusal role play and anti-AAS media campaigns. Comparison of the experimental group with controls indicates that the intervention was successful based on a variety of indices. Significant beneficial effects were found despite a small sample size, suggesting that the effect of the intervention was large. Goldberg, L., Elliot, D., Clarke, G., Zoref, L., MacKinnon, D., Moe, E., Green, C., Wolf, S., Schoenherr, D. The Adolescent Training and Learning to Avoid Steroids (A.T.L.A.S.) Prevention Program: Background and Results of a Model Intervention. Archives of Pediatrics & Adolescent Medicine, in press; and Adolescents Training and Learning to Avoid Steroids (ATLAS): Initial Results of a Prevention Program. Medicine and Science in Sports and Exercise, (Supplement), 1995, 27:S173.
Strategies to Prevent Drug Abuse in Ethnic Minorities
Dr. Trimble has written a book chapter which reviews and comments on research on the prevention of drug problems in America's ethnic minority populations. The chapter examines the inaccurate stereotype of drug use as a minority problem and examines the gaps that exist in knowledge about drug use and risk factors for drug use among ethnic minorities. Trimble, J.E. (1995) Ethnic Minorities. in R.H. Coombs & D. Ziedonis (Eds.), Handbook on Drug Abuse Prevention: A Comprehensive Strategy to Prevent the Abuse of Alcohol and Other Drugs. (pp. 379-409). Boston: Allyn & Bacon.
Reaching Parents of At-Risk Populations for Prevention Intervention Program Participation
To understand the motivation behind parents' decisions to involve themselves in prevention intervention programs, Spoth and Redmond studied a heuristic model of health belief and family context factors associated with parent inclination to enroll in parenting skills programs. They collected data from 1,192 rural midwestern parents of 5th graders. Perceived program benefits, program barriers, and past parenting resource use showed the strongest influence on the parents' inclination to enroll. Parents' predisposition toward parenting skills enhancement efforts in general and parenting skills programs in particular may be operative in addition to rational choice factors such as costs and benefits. Spoth, R., Redmond C., Parent Motivation to Enroll in Parenting Skills Programs: A Model of Family Context and Health Belief Predictors, Journal of Family Psychology, 9(3), in press.
Likelihood Ratio Test for the Correlation Coefficient:
Many studies of drug abuse causes and consequences by necessity must rely on correlational designs. One of the most commonly used analytic tools in drug abuse research is the correlation coefficient. Therefore, improving methods of estimation and model based hypothesis testing using correlations is of considerable importance. To replace the approximate methods, the exact likelihood ratio test for the correlation coefficient was developed, along with other technical features such as its power curve. The new procedure is available to researchers in the form of a personal computer program. Liu, W.C., Woodward, J.A. & Bonett, D.G. The Generalized Likelihood Ratio Test for the Pearson Correlation. Communications in Statistics, 1995.
Parameter Estimation in Structural Equation Modeling
A general review of parameter estimation in structural modeling, and procedures for evaluating model fit under nominal conditions and under conditions of nonnormal distributions such as are typically found in drug abuse research was undertaken. It was found that researchers cannot simply use a program default to analyze their data under nonstandard conditions, because the standard methods could lead to very misleading results. While normal theory maximum likelihood estimates were good even under violation of normality, the associated standard errors and test statistics could not be trusted. The Satorra-Bentler scaled chi-square statistic, and the robust standard errors, were found to work better under various conditions than any alternative (these methods are available in EQS). A new empirical computer study was undertaken to provide a solid foundation for these recommendations. (Chou, C.P. & Bentler, P.M. Estimates and Tests in Structural Equation Modeling. In R.H. Hoyle, (ed.), Structural Equation Modeling: Concepts, Issues and Applications, Thousand Oaks, CA: Sage, 1995, 37-55.
Evaluation of Chi-Square Tests:
When the sample size is large, or when nonstandard conditions exist, the chi-square test for model evaluation often leads to misleading results. For example, even trivial discrepancies between model and data may yield a test statistic that implies an unacceptable model with large samples. As a result, a wide variety of fit indices have been developed to supplement the chi-square test. A new classification of these fit indices in terms of the amount of information they utilize is provided. The various pitfalls associated with chi-square tests and fit indices, and reports on a new computer sampling study that evaluated the various indices was reviewed. In general, it was found that indices that incorporate more correct information, such as the expected values of the chi-square under the correct model, and especially the expected values of the chi-square under misspecification (noncentral chi-square), work best. (Hu, L.T. & Bentler, P. M. Evaluating model fit. In RH Hoyle (Ed), Structural Equation Modeling: Concepts, Issues and Applications Thousand Oaks, CA: Sage, 1995, 76-99).
[
