Long-term effects of drug prevention on risky sexual behavior among young adults

Effects of a School-Based Drug Prevention Program on Sexual Risk Behavior Among Adolescents in Brazilian Schools

Sexual risk behaviors are closely related to the use of alcohol, tobacco, and other illicit drugs as well as teen dating violence. School-based drug prevention programs that teach social and personal skills could potentially also reduce sexual risk behaviors. We examined the effects of the #Tamojunto program on youth sexual risk behaviors. A randomized controlled trial was conducted with 6391 7th and 8th grade students in 72 public schools in six Brazilian cities. Baseline data were collected prior to program implementation. Two waves of follow-up assessments occurred after 9 and 21 months. Analyses were performed taking into account the multilevel structure of the data. We used intention-to-treat to evaluate changes in the prevalence of sexual risk behaviors over time and between groups. Adolescent age ranged from 11 to 15 years, with a mean of 12.6 ± 0.8 years, and 51.0% were female. Among all participants, receipt of #Tamojunto was associated with higher risk of lifetime sex at 21 months follow-up (OR 1.27, 95% CI [1.03, 1.56]). Among girls, at 9 months follow-up, the program was associated with higher likelihood of having engaged in sex in the last month (OR 1.76, 95% CI [1.13, 2.74]). At 21 months follow-up, girls receiving the program were more likely to report engaging in condomless sex in the last month (OR 1.64, 95% CI [1.07, 2.50]). #Tamojunto may be ineffective and possibly harmful for preventing sexual risk behaviors, especially among girls. We suggest further investigation of the possible mediating role of life skills intervention components on girl's sexual behaviors.

Optimizing Assessment of Risk and Protection for Diverse Adolescent Outcomes: Do Risk and Protective Factors for Delinquency and Substance Use Also Predict Risky Sexual Behavior?

Assessments of youth risk and protective factors (RPFs) for substance use, delinquency, and violence have been used by communities to identify priorities and target them with prevention interventions. These same RPFs may also predict other youth problems. This study examined the strength and consistency of relationships of 41 ecological RPFs that predict antisocial behavior and substance use with sexual behavior outcomes in a sample of 2150 urban youth in 10th and 12th grade. After adjusting for controls, findings identify significant associations among the majority of community, school, family, peer, and individual risk factors, and family, peer, and individual protective factors, with sexual behavior outcomes, specifying unique associations among multiple factors with risky sex relative to both safe sex and not being sexually active. Prevention programming that targets common predictors for multiple problems may address a broad array of outcomes, including sexual health risk behaviors.

Exploring the Protective Effects of Judaism on Risky Behaviors in College Students: A Pilot Study

BACKGROUND

Common risky behaviors among college-aged young adults include risky sexual behaviors and substance use.

PURPOSE

This study examines the protective effects of Judaism on students' engagement in risky behaviors, building on a body of research on the protective effects of religious beliefs on risky health behaviors.

METHODS

Validated and reliable measures were used to assess religiosity and risky behaviors through anonymous surveys. Data was collected in Fall 2018 from a small cohort (N = 15) of Jewish day school students.

RESULTS

Females had overall higher rates of risky behaviors such as drinking or using drugs before sex (27% compared to 13% for males), not using condoms (62% to 0% for males), and higher rates of binge drinking (62% to 20% for males).

CONCLUSION

Higher religiosity was more associated with delayed sexual activity than substance use behaviors. Judaism and religiosity were more strongly associated with the male participants than the female.

PRACTICE IMPLICATIONS

Since the participants still had low rates of condom use and other high risk behaviors despite speaking with their healthcare providers, the health care community must better educate adolescents and young adults on the health and social consequences of such risky activities, both in formal education programs during middle and high school, and in office visits.

Cognitive-behavioural treatment for amphetamine-type stimulants (ATS)-use disorders

Background

Amphetamine-type stimulants (ATS) refer to a group of synthetic stimulants including amphetamine, methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA) and related substances. ATS are highly addictive and prolonged use may result in a series of mental and physical symptoms including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations and delusion.Currently there is no widely accepted treatment for ATS-use disorder. However, cognitive-behavioural treatment (CBT) is the first-choice treatment. The effectiveness of CBT for other substance-use disorders (e.g. alcohol-, opioid- and cocaine-use disorders) has been well documented and as such this basic treatment approach has been applied to the ATS-use disorder.

Objectives

To investigate the efficacy of cognitive-behavioural treatment for people with ATS-use disorder for reducing ATS use compared to other types of psychotherapy, pharmacotherapy, 12-step facilitation, no intervention or treatment as usual.

Search methods

We identified randomised controlled trials (RCT) and quasi-RCTs comparing CBT for ATS-use disorders with other types of psychotherapy, pharmacotherapy, 12 step facilitation or no intervention. We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase and five other databases up to July 2018. In addition, we examined reference lists of eligible studies and other systematic reviews. We contacted experts in the field.

Selection criteria

Eligibility criteria consisted of RCTs and quasi-RCTs comparing CBT versus other types of interventions with adult ATS users (aged 18 years or older) diagnosed by any explicit diagnostic system. Primary outcomes included abstinence rate and other indicators of drug-using behaviours.

Data collection and analysis

We used standard methodological procedures expected by Cochrane.

Main results

Only two studies met the eligibility criteria. Both studies were at low risk of selection bias and reporting bias. In one study, almost half of participants in the intervention group dropped out and this study was at high risk of attrition bias. The studies compared a single session of brief CBT or a web-based CBT to a waiting-list control (total sample size across studies of 129). Results were mixed across the studies. For the single-session brief CBT study, two out of five measures of drug use produced significant results, percentage of abstinent days in 90 days (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.11) and dependence symptoms (standardised mean difference (SMD) -0.59, 95% CI-1.16 to-0.02). Little confidence could be placed in the results from this study give the small sample size (25 participants per group) and corresponding large CIs around the observed effects. For the web-based CBT, there was no significant difference across different outcomes. Neither study reported adverse effects. The meta-analytic mean across these two trials for drug use was not significant (SMD -0.28, 95% CI-0.69 to 0.14). In summary, overall quality of evidence was low and there was insufficient evidence to conclude that CBT is effective, or ineffective, at treating ATS use.

Authors' conclusions

Currently, there is not enough evidence to establish the efficacy of CBT for ATS-use disorders because of a paucity of high-quality research in this area.

Cognitive-behavioural treatment for amphetamine-type stimulants (ATS)-use disorders

BACKGROUND

Amphetamine-type stimulants (ATS) refer to a group of synthetic stimulants including amphetamine, methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA) and related substances. ATS are highly addictive and prolonged use may result in a series of mental and physical symptoms including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations and delusion.Currently there is no widely accepted treatment for ATS-use disorder. However, cognitive-behavioural treatment (CBT) is the first-choice treatment. The effectiveness of CBT for other substance-use disorders (e.g. alcohol-, opioid- and cocaine-use disorders) has been well documented and as such this basic treatment approach has been applied to the ATS-use disorder.

OBJECTIVES

To investigate the efficacy of cognitive-behavioural treatment for people with ATS-use disorder for reducing ATS use compared to other types of psychotherapy, pharmacotherapy, 12-step facilitation, no intervention or treatment as usual.

SEARCH METHODS

We identified randomised controlled trials (RCT) and quasi-RCTs comparing CBT for ATS-use disorders with other types of psychotherapy, pharmacotherapy, 12 step facilitation or no intervention. We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase and five other databases up to July 2018. In addition, we examined reference lists of eligible studies and other systematic reviews. We contacted experts in the field.

SELECTION CRITERIA

Eligibility criteria consisted of RCTs and quasi-RCTs comparing CBT versus other types of interventions with adult ATS users (aged 18 years or older) diagnosed by any explicit diagnostic system. Primary outcomes included abstinence rate and other indicators of drug-using behaviours.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

Only two studies met the eligibility criteria. Both studies were at low risk of selection bias and reporting bias. In one study, almost half of participants in the intervention group dropped out and this study was at high risk of attrition bias. The studies compared a single session of brief CBT or a web-based CBT to a waiting-list control (total sample size across studies of 129). Results were mixed across the studies. For the single-session brief CBT study, two out of five measures of drug use produced significant results, percentage of abstinent days in 90 days (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.11) and dependence symptoms (standardised mean difference (SMD) -0.59, 95% CI -1.16 to -0.02). Little confidence could be placed in the results from this study give the small sample size (25 participants per group) and corresponding large CIs around the observed effects. For the web-based CBT, there was no significant difference across different outcomes. Neither study reported adverse effects. The meta-analytic mean across these two trials for drug use was not significant (SMD -0.28, 95% CI -0.69 to 0.14). In summary, overall quality of evidence was low and there was insufficient evidence to conclude that CBT is effective, or ineffective, at treating ATS use.

AUTHORS' CONCLUSIONS

Currently, there is not enough evidence to establish the efficacy of CBT for ATS-use disorders because of a paucity of high-quality research in this area.

Impact of Brief Intervention Services on Drug-Using Truant Youths' Self-Reported Delinquency and Arrest Charges: A Longitudinal Study

The issue of delinquency among truant youth is insufficiently documented in the literature. There is a need to elucidate this issue, and assess the efficacy of interventions to reduce this problem behavior. The present, NIDA-funded study addressed this gap by examining the impact of a Brief Intervention (BI), originally designed to address youth substance use, on their delinquent behavior over an 18-month follow-up period (for self-reported delinquency) and a 24-month follow-up period (for official record delinquency). A number of significant BI intervention effects with sizable effect sizes were found, as well as a number of marginally significant BI effects. In particular, significant reductions in arrest charges at 24-month follow-up for youth receiving BI services compared to controls were among the key findings of this study. Service delivery implications and directions for future analyses are discussed.

Impact of Brief Intervention Services on Drug Using Truant Youth Arrest Charges over Time

School truancy is a serious concern in the U.S., with far-reaching negative consequences. Truancy has been positively associated with substance use and delinquent behavior; however, research is limited. Consequently, the Truancy Brief Intervention Project was established to treat and prevent substance use and other risky behaviors among truants. This article examines whether the Brief Intervention program is more effective in preventing future delinquency over a 12-month follow-up period, than the standard truancy program. Results indicate the Brief Intervention was marginally significant in effecting future delinquency among truants, compared to the standard truancy program. Future implications of this study are discussed.

Brief Intervention for Truant Youth Sexual Risk Behavior and Alcohol Use: A Parallel Process Growth Model Analysis

Truant youths represent a challenging, yet very promising group of at-risk youth to study. In addition to problems in school, they frequently experience troubled family situations, emotional/ psychological problems, involvement in substance use, and delinquency. Given the problems often experienced by truant youth, it is likely they are engaging in alcohol use and sexual risk behavior at a higher rate, than the general youth population. Identification of these youths' problems and early placement into effective intervention services would benefit them, their families, and society. The current study presents interim findings from an ongoing, NIDA-funded experimental, Brief Intervention (BI) study involving truant youths and their parent/guardians. Baseline, 3-month, 6-month, and 12-month follow up data were analyzed to determine whether alcohol use and sexual risk behaviors were longitudinally related, examine the effects of the intervention on longitudinal alcohol use and sexual risk behaviors, identify latent subgroups of youths in the data for alcohol use and sexual risk behaviors, and determine whether the intervention influenced these subgroups. Results indicated alcohol use and sexual risk were longitudinally related. Subgroups of youth were also identified based on alcohol use and sexual risk behavior levels and trends. Further, limited treatment effects were observed for alcohol use. Implications of the results for future research and service delivery are considered.

Maternal drinking and risky sexual behavior in offspring

Teenage mothers are more likely to use drugs, and their children are more likely to use substances and become pregnant during adolescence. Teenage mothers' substance use may play a role in the intergenerational risk for adolescent pregnancy. Pregnant adolescents (12-18 years) were seen during pregnancy and postnatal years 6, 10, 14, and 16 (n = 332). Teenage mothers reported on substance use and family characteristics. The offspring reported substance use (starting at age 10) and sexual behavior (ages 14 and 16). Prenatal alcohol exposure was associated with offspring (a) having a risky first sex partner and (b) multiple sex partners in the past year. Heavy maternal drinking during childhood was associated with offspring reports of a risky first sex partner and early teenage pregnancy. Findings from this unique birth cohort have implications for alcohol prevention efforts with girls during and after a teenage pregnancy and interventions to prevent risky sex in high-risk youth.

Brief Intervention for Truant Youth Sexual Risk Behavior and Marijuana Use

Substance use and sexual risk behaviors are common among adolescents. Although attention has focused primarily on alcohol use, less is known about the relationship between marijuana use and sexual risk behavior among high-risk youth. Since truant youth often experience problems in school, troubled family situations, and other psychosocial problems, they represent an important group of high-risk youth to study. Previous research suggests that truant youth are at considerable risk of continuing their troubled behavior in school and entering the juvenile justice system. It is also likely that truant youth are involved in marijuana use and sexual risk behavior at a higher rate, than the general youth population. Involving them in effective intervention services could reduce these risk behaviors. The current study presents interim findings from a NIDA-funded experimental, brief intervention (BI) study involving truant youths and their parents/guardians. Longitudinal data were analyzed to study: (1) the relationships between the youths' marijuana use and engaging in sexual risk behavior over time, and (2) the effects of a substance use BI on their marijuana use and sexual risk behavior. Analyses examined a growth model for parallel processes in marijuana use and sexual risk behavior, and an assessment of the effect of the intervention on linear and quadratic trends, and on subgroups of youth differing in their sexual risk behavior and marijuana use. Implications of the results for future research and service delivery are considered.

The Relation Between Risk and Protective Factors for Problem Behaviors and Depressive Symptoms, Antisocial Behavior, and Alcohol Use in Adolescence

Both externalizing and internalizing psychopathology increase throughout adolescence and a similar set of risk and protective factors may underlie depressive symptoms, antisocial behavior, and alcohol use. Analyses test how risk and protective factors for externalizing behavior in community, school, family, peer and individual domains are related to depressive symptoms, antisocial behavior, and alcohol use concurrently and longitudinally in a sample of 2002 students assessed in 8th and 10th grades (52% male; 58% Caucasian). Findings indicate that risk and protective factors for antisocial behavior and alcohol use are also associated with depressive symptoms, both concurrently and longitudinally. Prevention approaches that target risk and protective factors for externalizing problems may have crossover effects on depressive symptoms during adolescence.

A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence

We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up. Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies.

Sex risk behavior among adolescent and young adult children of opiate addicts: outcomes from the focus on families prevention trial and an examination of childhood and concurrent predictors of sex risk behavior

This study reports on rates and predictors of sex risk behavior among a sample of adolescent and young adult children of parents enrolled in methadone treatment for opiate addiction. Data are from 151 participants (80 males, 71 females) in the Focus on Families (FOF) project, a randomized trial of a family intervention and a study of the development of at-risk children. The study participants are children of parents enrolled in methadone treatment between 1990 and 1993. Participants were interviewed in 2005 when they ranged in age from 15 to 29 years. In the year prior to the follow-up, 79% of the males and 83% of females were sexually active, 26% of males and 10% of females had more than one partner in the prior year, and 34% of males and 24% of females reported having sex outside of a committed relationship. Twenty-four percent of males and 17% of females met criteria for high-risk sexual behavior, reporting casual or multiple partners in the prior year and inconsistent condom use. Participants in the intervention and control conditions did not differ significantly in terms of any measure of sex risk behavior examined. None of the measures of parent behavior and family processes derived from data at baseline of the FOF study predicted whether participants engaged in high-risk sex. Among measures derived from data collected at long-term follow-up, however, having ever met criteria for substance abuse or dependence predicted greater likelihood of high-risk sexual behavior, and being married or being in a romantic relationship was associated with lower likelihood of high-risk sexual behavior. The findings point to the important role of committed relationships in regulating sex risk behavior among this population, as well as heightened levels of sex risk behavior associated with substance abuse or dependence.

Did we get our money's worth? Bridging economic and behavioral measures of program success in adolescent drug prevention

The recent U.S. Congressional mandate for creating drug-free learning environments in elementary and secondary schools stipulates that education reform rely on accountability, parental and community involvement, local decision making, and use of evidence-based drug prevention programs. By necessity, this charge has been paralleled by increased interest in demonstrating that drug prevention programs net tangible benefits to society. One pressing concern is precisely how to integrate traditional scientific methods of program evaluation with economic measures of “cost efficiency”. The languages and methods of each respective discipline don’t necessarily converge on how to establish the true benefits of drug prevention. This article serves as a primer for conducting economic analyses of school-based drug prevention programs. The article provides the reader with a foundation in the relevant principles, methodologies, and benefits related to conducting economic analysis. Discussion revolves around how economists value the potential costs and benefits, both financial and personal, from implementing school-based drug prevention programs targeting youth. Application of heterogeneous costing methods coupled with widely divergent program evaluation findings influences the feasibility of these techniques and may hinder utilization of these practices. Determination of cost-efficiency should undoubtedly become one of several markers of program success and contribute to the ongoing debate over health policy.

The Mental Health, Substance Use, and Delinquency among Truant Youths in a Brief Intervention Project: A Longitudinal Study

The relationship between substance use, mental health disorders, and delinquency among youth is well documented. What has received far less attention from researchers is the relationship between these issues among truant youth, in spite of studies that document truants are a population at-risk for negative outcomes. The present study bridges this gap by (1) examining psychosocial functioning and delinquency among truants, and (2) assessing the efficacy of a Brief Intervention (BI) in reducing delinquent behavior over time. To meet these objectives, data were collected from 183 truant youth enrolled in an ongoing NIDA-funded BI project. Informed by a developmental damage perspective, a structural equation model was formulated and estimated. Interim results provide overall support for the model, and suggest the BI may be a promising, innovative intervention for truant youth. Service delivery implications and directions for future analyses are discussed.

The association of perceived provider-patient communication and relationship quality with colorectal cancer screening

BACKGROUND

Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior.

METHODS

The association of provider communication quality, relationship, and colorectal cancer screening was examined within data from the 2007 Health Information National Trends Survey.

RESULTS

Perceived provider communication and relationship quality were associated with both adherence to colonoscopy and with ever having been screened. Predictive margins analyses indicated that increasing perceptions from lowest to highest levels of communication and relationship quality would be associated with increases in screening rates approaching 16 percentage points.

CONCLUSION

Improving provider-patient communication and relationship quality could potentially improve colorectal cancer screening behaviors among adults aged 50 years and older. Future research and clinical practice should focus on understanding the role of these factors in screening behavior and enhance the provider-patient interaction.

Co-occurrence of sexual risk behaviors and substance use across emerging adulthood: evidence for state- and trait-level associations

AIMS

  Prior research has suggested that problematic alcohol and drug use are related to risky sexual behaviors, either due to trait-level associations driven by shared risk factors such as sensation seeking or by state-specific effects, such as the direct effects of substance use on sexual behaviors. Although the prevalence of both high-risk sexual activity and alcohol problems decline with age, little is known about how the associations between substance use disorder symptoms and high-risk sexual behaviors change across young adulthood.

DESIGN, SETTING AND PARTICIPANTS

  Using a community sample (n = 790) interviewed every 3 years from age 21 to age 30 years, we tested trait- and state-level associations among symptoms of alcohol and drug abuse and dependence and high-risk sexual behaviors across young adulthood using latent growth curve models.

MEASUREMENTS

  We utilized diagnostic interviews to obtain self-report of past-year drug and alcohol abuse and dependence symptoms. High-risk sexual behaviors were assessed with a composite of four self-reported behaviors.

FINDINGS

  Results showed time-specific associations between alcohol disorder symptoms and risky sexual behaviors (r = 0.195, P < 0.001), but not associations between their trajectories of change. Conversely, risky sexual behaviors and drug disorder symptoms were associated only at the trait level, not the state level, such that the levels and rate of change over time of both were correlated (r = 0.35, P < 0.001).

CONCLUSIONS

  High-risk sexual behaviors during young adulthood seem to be driven both by trait and state factors, and intervention efforts may be successful if they are either aimed at high-risk individuals or if they work to disaggregate alcohol use from risky sexual activities.

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review

AIMS

To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people.

METHODS

A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour.

CONCLUSIONS

There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.

The use of the Risky Sex Scale among adolescents receiving treatment services for substance use problems: factor structure and predictive validity

This study evaluated the use of the Risky Sex Scale (RSS; T. O'Hare, 2001) among youth in outpatient treatment for substance use problems. An ethnically diverse sample of 394 adolescents (280 males; M(age) = 16.33 years, SD(age) = 1.15) was recruited from 2 treatment sites. The study was guided by two aims. First, a confirmatory factor analysis was conducted on RSS item responses. Findings replicated the factor structure identified in previous studies of undergraduate students cited for campus alcohol violations. Second, structural equation modeling was used to document associations between RSS subscales and self-reported substance use and sexual risk behaviors. The risky sex expectancies subscale was significantly associated with co-occurring alcohol use and sex, alcohol use at last intercourse, and alcohol use during the prior 30 days. The risky sexual behaviors subscale was significantly associated with co-occurring drug use and sex, condom use at last intercourse, and unprotected intercourse during the prior 30 days. The factor structure of the RSS was consistent across age group (12-16 and 16-18 years) and across gender, and the links between the RSS subscales and health risk behaviors varied somewhat by gender but not by age group. These findings suggest that the RSS is an appropriate brief screening tool for predicting health risk behaviors among adolescents in substance abuse treatment.

An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: project towards no drug abuse (TND)

The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n=1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended.

Strategies for characterizing complex phenotypes and environments: general and specific family environmental predictors of young adult tobacco dependence, alcohol use disorder, and co-occurring problems

BACKGROUND

Defining phenotypes in studies of tobacco and alcohol misuse is difficult because of the complexity of these behaviors and their strong association with each other and with other problem behaviors. The present paper suggests a strategy for addressing this issue by conceptualizing and partitioning variance in phenotypes into either general or substance/behavior-specific. The paper also applies the general or substance/behavior-specific conceptualization to environmental predictors of tobacco and alcohol misuse and other problem behaviors.

METHODS

Data were drawn from the Seattle Social Development Project, a contemporary, ethnically diverse and gender-balanced longitudinal panel including 808 participants. Latent variable modeling was used to partition variance in young adult (age 24) nicotine dependence, alcohol abuse and dependence, illicit drug abuse and dependence, involvement in crime, and engagement in HIV sexual risk behavior into general problem behavior and behavior-specific variance. Similarly, measures of general, drinking-specific, and smoking-specific adolescent family environment were constructed.

RESULTS

Consistent with expectations, more positive general family environment during adolescence was associated with lower levels of shared variance in problem behaviors at age 24, but not with unique variance in tobacco or alcohol use disorder. Higher levels of family smoking and drinking environments during adolescence, however, were positively associated with unique variance in tobacco and alcohol use disorder, respectively, but did not predict shared variance in problem behaviors.

CONCLUSIONS

Results support the utility of the proposed approach. Ways in which this approach might contribute to future molecular genetic studies are discussed.

Project success' effects on substance use-related attitudes and behaviors: a randomized controlled trial in alternative high schools

Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets high-risk students. We recruited two groups of alternative high schools in successive academic years, and randomly assigned schools in each group to either receive the intervention (n = 7) or serve as a control (n = 7). Students completed surveys prior to and following the administration of the program, and again 1 year later. Although participation in Project SUCCESS significantly increased students' perceptions of harm resulting from alcohol and marijuana use, students in the control group reported greater increases in peer support. We also found conflicting evidence in two opposing trends related to students' perceptions of the prevalence and acceptability of substance use. Therefore, the effects of Project SUCCESS on substance use-related beliefs and behaviors must be considered mixed.

Psychological distress, substance use, and HIV/STI risk behaviors among youth

Psychological distress has been inconsistently associated with sexual risk behavior in youth, suggesting additional factors, such as substance use, may explain this relationship. The mediating or moderating role of substance use on the relationship between psychological distress and sexual risk behaviors was prospectively examined over the four high school years in a sample of urban youth (N = 850; 80% African American; 50% female). Growth curve modeling was used to estimate changes in sexual risk across adolescence and to test its association to psychological distress symptoms and frequency of substance use. Substance use was associated with psychological distress. Greater psychological distress was associated with increased sexual intercourse frequency, decreased condom use, and increased number of partners. Substance use fully mediated the relationship between psychological distress and intercourse frequency and condom use, and partially mediated the relationship between psychological distress and number of partners. We found no differences in mediation by sex or race/ethnicity and no evidence to support moderation of psychological distress and substance use on sexual risk. Findings suggest that psychological distress is associated with sexual risk because youth with greater psychological distress are also more likely to use substances. Practical implications for adolescent HIV/STI prevention are discussed.