Early adolescent alcohol use and sexual experience by emerging adulthood: a 10-year longitudinal investigation

Analyzing risky behaviors among different minority and majority race in teenagers in the USA using latent classes

Objective: This study is to ascertain any inconsistencies in the trend of co-occurrence by sex of teenage health risk behavior patterns such as smoking, behaviors contributing to deliberate and unintentional injuries, risky sexual behavior, and sedentary lifestyle. Methods: The study's purpose was accomplished using Youth Risk Behavior Surveillance System (YRBSS) 2013 data. A Latent Class Analysis (LCA) was conducted for the entire sample of teenagers as well as separately for each sex. Results: In this subset of youths, marijuana use was acknowledged by more than half of them, and smoking cigarettes was far more likely. More than half of the individuals in this subset engaged in risky sexual practices, like not using a condom during their most recent encounter. Males were split into three categories based on their involvement in risky behavior, while females were split into four subgroups. Conclusion: Regardless of gender, various risk behaviors among teenagers are connected. However, gender variations in the higher risk of particular trends, such as mood disorders and depression among females, underline the significance of creating treatments that take adolescent demographics into account.

Determinants and consequences of heavy episodic drinking among female sex workers in Ethiopia: A respondent-driven sampling study

Background

Female sex workers (FSW), due to their working conditions, have an increased likelihood of heavy episodic drinking (HED), which is associated with risky sexual behavior. Nevertheless the specific contribution of HED to risky sexual behavior among FSWs in Ethiopia is not well documented for prevention activities.

Objective

The purpose of this study was to explore the determinants and consequences of HED among FSWs in Ethiopia.

Methods

A cross-sectional study using respondent-driven sampling was conducted among 4886 FSWs in 11 major towns in Ethiopia in 2014. A structured interview was performed, and data were examined using descriptive statistics and multiple logistic regression analyses.

Results

Most (66%) FSWs consumed alcohol, and the prevalence of HED was 29.1%. Compared to street-based FSWs, those who worked in bars/hotels and local drinking houses had 2.19 and 1.29 times higher odds of HED, respectively. FSWs who started selling sex when younger than 18 years (compared to those who started when older than 25 years) and those who were forced into selling sex had 1.48 and 2.91 times higher odds of HED, respectively. FSWs with more income from selling sex and FSWs who chewed khat reported increased odds of HED. Moreover, FSWs with experience of HED reported 1.27 and 1.44 times higher odds of physical beating and condom breakage/slippage, respectively. Furthermore, the population attributable risk fraction of HED among FSWs showed that 6.2% of physical beating and 8.9% of condom breakage/slippage could be attributed to HED.

Conclusion

In general, several factors increase the experience of HED, and HED in turn increases the likelihood of violence and condom breakage. These factors could inform programs and intervention activities among FSWs populations.

Does Alcohol Initiation in Early-To-Middle Adolescence Predict Changes in Reward Motivation? Evidence of Sex Differences

BACKGROUND

Reward motivation has been cross-sectionally correlated with adolescent alcohol use, but the temporal nature of this relationship remains unclear. This project sought to determine whether adolescent alcohol initiation longitudinally predicted changes in reward motivation and behavioral inhibition from early to middle adolescence, and explored the role of adolescent sex in this prediction.

METHODS

A total of 180 11- to 14-year-olds were recruited and then followed for 3 years to age 14 to 17. Participants self-reported their alcohol use at all time points. We selected participants who were alcohol-naïve at Baseline (early adolescence) and then grouped them based on whether or not they reported alcohol initiation by Year 3 (Y3: middle adolescence). Adolescents completed self-report and experimental (delay discounting) measures of reward motivation and self-report measures of behavioral inhibition at Baseline and Y3.

RESULTS

Adolescents' alcohol initiation significantly predicted higher Y3 self-reported reward motivation on one measure. Additionally, a significant sex × alcohol initiation interaction was found predicting Y3 task-based reward motivation (delay discounting), with boys' alcohol initiation predicting increased bias toward immediate reward at Y3. There was also a sex × alcohol initiation interaction predicting behavioral inhibition, with girls' alcohol initiation predicting higher behavioral inhibition at Y3.

CONCLUSIONS

Results suggest that alcohol initiation among adolescents might precede changes in reward motivation, and the effects of alcohol on reward and behavioral inhibition may differ by adolescent sex.

Interaction Between Smoking Cigarettes and Alcohol Consumption on Sexual Experience in High School Students

Objectives

This study aimed to analyze nationwide representative data from the 11^th Korean Youth Health Risk Behavior Web-Based Survey to determine whether factors including socio-demographics, smoking and alcohol consumption, were factors related to high school students that had experienced sexual intercourse.

Methods

A total of 33,744 students (17,346 boys and 16,398 girls) in 1^st, 2^nd, and 3^rd grade at high school were analyzed. SPSS complex samples methods were used for analyses. Socio-demographic and health risk behaviors (type of region of residence, family structure, and economic status, student academic achievement, gender, high school grade, pocket money, student smoking, alcohol consumption, and having engaged in sexual intercourse) were considered as independent variables.

Results

There were 3.6% of girls and 9.9% of boys in high school that were sexually active. This behavior and the average number of cigarettes smoked daily, and alcohol consumed weekly, represented a dose-response relationship, after considering confounding factors. Compared with students that did not smoke or consume alcohol, smoking 1–9 cigarettes per day and consuming 1–6 cups of alcohol and group “smoking more than 10 cigarettes per day and consuming more than 7 cups of alcohol, had a 5.94 and 22.25 higher risk of having had sexual intercourse, respectively.

Conclusion

Cigarette smoking and alcohol consumption were associated with an increased likelihood of high school students engaging in sexual intercourse.

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions.

Attachment orientation and sexual risk behaviour among young Black gay and bisexual men

This mixed methods study used an explanatory sequential design to examine the relationship between attachment and sexual behavior among young Black gay and bisexual men (YBGBM). Cross sectional online surveys and sex diaries were completed by a sample of YBGBM in New York City (n = 153) to assess the association between adult attachment insecurity and sexual risk behavior. The Experiences in Close Relationships Scale-Revised (ECR-R) was used to assess three types of adult attachment (i.e., secure, anxious, and avoidant). Participants reported condomless sex encounters, as well as serodiscordant condomless anal sex encounters, as measures of sexual risk. Quantitative findings suggested that there were few associations between attachment type and sexual risk behavior; only men with attachment avoidance were likely to engage in condomless sex. However, qualitative findings illuminated some of the social complexities of the association between attachment in childhood, attachment in young adulthood and intimate partnerships, which could be linked to young adult sexual risk behavior. The study findings highlight the need for researchers to further examine the process by which individual differences in attachment orientation are related to YBGBM's sexual behavior.

Psychometric Properties of the Persian Version of Self-Transcendence Scale: Adolescent Version

BACKGROUND

Given the greater tendency during adolescence toward risk-taking, identifying and measuring the factors affecting the adolescents' health is highly important to ensure the efficacy of health promoting interventions. One of these factors is self-transcendence. The aim of this study was to assess the psychometric features of the Self-Transcendence Scale (adolescents' version) in students in Tehran, the capital city of Iran.

METHODS

This research was conducted in 2015. For this purpose, 1210 high school students were selected through the multistage cluster sampling method. After the backward-forward translation, the psychometric properties of the scale were examined through the assessment of the (face and construct) validity and reliability (internal consistency and stability) of the scale. The construct validity was assessed using two methods, factor analysis, and convergence of the scale with the Hopefulness Scale for Adolescents.

RESULTS

The result of face validity was minor modifications in some words. The exploratory factor analysis resulted in the extraction of two dimensions, with explaining 52.79% of the variance collectively. In determining the convergent validity, the correlation between hopefulness score and self-transcendence score was r=0.47 (P<0.001). The internal consistency of the scale was determined using Cronbach's alpha of 0.82 for the whole scale and 0.75 and 0.70 for each of the sub-scales. The stability reliability was found to have an ICC of 0.86 and a confidence interval of 95%.

CONCLUSION

The Persian version of the Adolescents' Self-Transcendence Scale showed an acceptable validity and reliability and can be used in the assessment of self-transcendence in Iranian adolescents.

Prevalence and sociodemographic correlates of lifetime substance use among a rural and diverse sample of adolescents

BACKGROUND

Data are limited regarding the prevalence of substance use among adolescents in rural and ethnically diverse communities. This study examined rates and sociodemographic correlates of lifetime substance use among adolescents in Mississippi, a rural state that is the poorest in the country (21.3% poverty rate) and has the largest proportion of African Americans per capita (36.3%).

METHODS

Participants in this cross-sectional study were 6349 adolescents (6th through 12th grade) who reported on lifetime tobacco, alcohol, marijuana, cocaine, inhalant, hallucinogen, and methamphetamine use.

RESULTS

Lifetime smoking (10.2% to 44.5%), alcohol (23.2% to 72.0%), and marijuana use (7.9% to 39.2%) increased steadily when comparing students in 6th to 12th grade. Substances with more serious abuse potential (cocaine [6.7% to 11.1%], inhalants [12.2% to 17.9%], hallucinogens [4.4% to 12.1%], and methamphetamine [3.0% to 6.7%]) displayed more modest increases across grade. Adolescents who classified their race/ethnicity as "Other" (i.e., not white, black/African American, Asian, or Hispanic/Latino/Latina) demonstrated more than 2-fold increased likelihood of methamphetamine use (odds ratio [OR] = 2.42), and increased risk for use of any illicit substance (OR = 1.49). In general, males demonstrated an increased risk for use across substances (OR = 1.15-1.94), and higher income was associated with a decreased likelihood of illicit substance use (OR = 0.51-0.67). Living in a more populated area was associated with an increased likelihood of alcohol (OR = 1.43), marijuana (OR = 2.11), and cocaine use (OR = 2.06), and use of any illicit substance (OR = 1.54).

CONCLUSIONS

Mississippi adolescents reported higher rates of lifetime cocaine, inhalant, hallucinogen, and methamphetamine use across all grade levels compared with national surveys. Male gender, low income, and residence in more populated areas were associated with increased use of several substances. Findings demonstrate the need for prevention and intervention programs targeting impoverished rural and ethnically diverse communities.

Risk Reduction Therapy for Adolescents: Targeting Substance Use and HIV/STI-Risk Behaviors

This paper describes a family-based intervention for addressing both substance use and unprotected sexual behavior in adolescents presenting for outpatient substance use treatment. The intervention combines contingency management (CM) for adolescent substance use, which is a behavioral intervention modeled on the Community Reinforcement Approach, with a sexual risk reduction protocol that mirrors aspects of the CM model. As a family-based intervention, caregivers attend every session and actively collaborate with the therapist to address their youth's behavior problems. The treatment is criterion-based with treatment duration determined by the youth's achievement of reduced substance use and unprotected sexual behavior goals. A case study describes the implementation of this treatment with an adolescent presenting a history of polysubstance use and unprotected sexual intercourse. Following the adolescent and caregiver's participation in weekly sessions, the adolescent demonstrated improvements in substance use, unprotected sexual behavior, and other behavior problems. Clinical summary data from two outpatient clinics reveal similar positive outcomes for youth receiving the intervention. This paper illustrates the potential utility of an integrated treatment approach targeting substance use and unprotected sexual behavior in an adolescent population.

Cost-effectiveness of the strong African American families-teen program: 1-year follow-up

INTRODUCTION

Alcohol use poses a major threat to the health and well being of rural African American adolescents by negatively impacting academic performance, health, and safety. However, rigorous economic evaluations of prevention programs targeting this population are scarce.

METHODS

Cost-effectiveness analyses were conducted of SAAF-T relative to an attention-control intervention (ACI), as part of a randomized prevention trial. Outcomes of interest were the number of alcohol use and binge drinking episodes prevented, one year following the intervention. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were used to determine the cost-effectiveness of SAAF-T compared to the ACI intervention.

RESULTS

For the 473 participating youth completing baseline and follow-up assessments, the incremental per participant costs were $168, while the incremental per participant effects were 3.39 episodes of alcohol use prevented and 1.36 episodes of binge drinking prevented. Compared to the ACI intervention, the SAAF-T program cost $50 per reduction in an alcohol use episode and $123 per reduced episode of binge drinking. For the CEACs, at thresholds of $100 and $440, SAAF-T has at least a 90% probability of being cost-effective, relative to the ACI, for reductions in alcohol use and binge drinking episodes, respectively.

CONCLUSIONS

The SAAF-T intervention provides a potentially cost-effective means for reducing the African American youths' alcohol use and binge drinking episodes.

Contributions of family environment and parenting processes to sexual risk and substance use of rural African American males: a 4-year longitudinal analysis

This study sought to identify factors that forecast sexual risk and alcohol or other substance use patterns among 411 rural African American males as they transitioned from middle childhood to late adolescence. In addition, an exploration was undertaken to examine the contribution of both risk and protective factors in distinguishing rural African American males at highest risk for engaging in risky sexual behavior and elevated substance use from those with relatively low risk of engaging in these behaviors. Findings revealed that exposure to negative life events during middle childhood has prognostic significance for rural African American males' susceptibility to engaging in HIV-related risk behaviors as they transition into adolescence and young adulthood. High-risk engaging males had significantly higher means on susceptibility to risk and marginally significantly higher means on substance-using peer affiliation. High-risk rural African American males also reported lower means on involved-vigilant parent than the normative group (low-risk group). However, economic hardship, family stress, parental psychological functioning, and harsh and inconsistent parenting did not emerge as significant predictors of high- or low-risk group membership. The implication for future research and preventive interventions is discussed.

Age at first alcoholic drink as predictor of current HIV sexual risk behaviors among a sample of injection drug users (IDUs) and non-IDUs who are sexual partners of IDUs, in St. Petersburg, Russia

This study investigates whether age at first alcoholic drink is associated with sexual risk behaviors among injection drug users (IDUs) and non-IDUs who are sexual partners of IDUs in St. Petersburg, Russia. A path analysis was used to test a model of age at first drink, age at sexual debut, age at first drug use, current substance use patterns and current sexual risk behaviors among 558 participants. Results revealed that age at first drink had an effect on multiple sex partners through age at sexual debut and injection drug use, but no effect on unprotected sex. Age at first drug use was not related to sexual risk behaviors. Investigation of age of drinking onset may provide useful information for programs to reduce sexual risk behaviors and injection drug use. Different paths leading to unprotected sex and multiple sexual partners call for different approaches to reduce sexual risk behaviors among this population.

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.

The role of academic motivation in high school students' current and lifetime alcohol consumption: adopting a self-determination theory perspective

OBJECTIVE

The current study investigated the relationship between different types of academic motives-specifically, intrinsic motivation, introjected regulation, and external regulation-and high school students' current and lifetime alcohol consumption.

METHOD

One thousand sixty-seven high school students completed measures of academic motivation, other school-related factors, and lifetime and current alcohol consumption.

RESULTS

Using structural equation modeling, different types of motivation and school-related factors were differentially related to student drinking. Specifically, intrinsic motivation was negatively related to lifetime and current alcohol consumption. External regulation, on the other hand, was positively associated with current drinking. Grade point average was the only school-related factor related to student alcohol use.

CONCLUSIONS

These findings suggest that motivation is an important construct to consider in predicting students' alcohol use, even when other more commonly studied educational variables are considered. In addition, it supports the adoption of a motivation framework that considers different types of motivation in understanding the relationship between academic motivation and alcohol use. Suggestions for incorporating the self-determination model of motivation into studies of alcohol and substance use, as well as potential impacts on intervention efforts, are discussed. In particular, it may be important to foster only certain types of motivation, rather than all types of academically-focused motives, in efforts to deter alcohol use.

Longitudinal associations between adolescent alcohol use and adulthood sexual risk behavior and sexually transmitted infection in the United States: assessment of differences by race

OBJECTIVES

We examined race differences in the longitudinal associations between adolescent alcohol use and adulthood sexually transmitted infection (STI) risk in the United States.

METHODS

We estimated multivariable logistic regression models using Waves I (1994-1995: adolescence) and III (2001-2002: young adulthood) of the National Longitudinal Study of Adolescent Health (n = 10 783) to estimate associations and assess differences between Whites and African Americans.

RESULTS

In adjusted analyses, adolescent alcohol indicators predicted adulthood inconsistent condom use for both races but were significantly stronger, more consistent predictors of elevated partnership levels for African Americans than Whites. Among African Americans but not Whites, self-reported STI was predicted by adolescent report of any prior use (adjusted odds ratio [AOR] = 1.47; 95% confidence interval [CI] = 1.00, 2.17) and past-year history of getting drunk (AOR = 1.53; 95% CI = 1.01, 2.32). Among Whites but not African Americans, biologically confirmed STI was predicted by adolescent report of past-year history of getting drunk (AOR = 1.68; 95% CI = 1.07, 2.63) and consistent drinking (AOR = 1.65; 95% CI = 1.03, 2.65).

CONCLUSIONS

African American and White adolescent drinkers are priority populations for STI prevention. Prevention of adolescent alcohol use may contribute to reductions in adulthood STI risk.

Growth in adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders, and risky sex: a comparison of youth from low- versus middle-income backgrounds

BACKGROUND

This study examined adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders (AUDs), and risky sex. Analyses further examined the influences of late childhood involvement in these problem behavior outcomes, with mediation through teen delinquency and alcohol use, and examined differences in the pathways for youth from low- compared to middle-income backgrounds.

METHOD

Multiple-group latent growth curve modeling was conducted using data collected from a sample of 808 youth followed from age 10 to age 24. Self-report assessments included delinquent involvement, alcohol use, and sexual activity in late childhood; delinquency and alcohol use in adolescence; and crime, AUDs, and risky sex in early adulthood.

RESULTS

Late childhood delinquent involvement was associated with young adult crime, AUDs, and risky sex indirectly through adolescent delinquency, and had a persistent direct effect on crime. Adolescent delinquency also mediated the relation between early sex onset and crime. Early alcohol use predicted a higher level of, and a faster rate of increase in, adolescent drinking, which predicted, in turn, young adult AUDs and risky sex. Significant group differences indicated stronger associations between adolescent delinquency and each young adult outcome for youth from low- compared to those from middle-income backgrounds.

CONCLUSIONS

Early intervention may help prevent the development of crime, AUDs, and risky sex behaviors, especially among disadvantaged youth.

Spirituality within the family and the prevention of health risk behavior among adolescents in Bangkok, Thailand

This study investigates the influences of a family's spiritual beliefs and practices on substance use and sexual risk behaviors among young adolescents 13-14 years old in Bangkok, Thailand. Independent predictor variables are the parents' and teens' spiritual beliefs and practices in Buddhism and parental monitoring behaviors. The study uses data from the 2007 Baseline Survey of the Thai Family Matters Project, which adapted a U.S. based family prevention program for Thai culture. A representative sample of 420 pairs of parents and teens from the Bangkok metropolitan area was recruited to participate in the study. Structural equation models indicate that positive direct and indirect associations of the spirituality of parents and teens within a family and the prevention of adolescent risk behaviors are significant and consistent.

Risk behaviors among adolescent girls in an HIV prevention trial

Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.

Longitudinal outcomes of an alcohol abuse prevention program for urban adolescents

PURPOSE

This randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths.

METHODS

Study participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CD(P)), and control. Once all youths completed baseline measures, those in CD and CD(P) arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CD(P) arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD- and CD(P)-arm participants received annual booster intervention sessions.

RESULTS

Seven years following postintervention testing and relative to control-arm youths, youths in CD and CD(P) arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CD(P) arms.

CONCLUSIONS

Study findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking.