Initial experimentation with tobacco is associated with subsequent tobacco use patterns among youth in the United States

Understanding the association between initial experimentation with a tobacco product and subsequent patterns of tobacco use among youth is important to informing prevention activities for youth in the US. We conducted an online survey from August to October 2017 among youth aged 13-18 years. The current analysis focused on respondents reporting initial experimentation with any tobacco product (n = 2,022). Using multinomial logistic regression, we examined the association between first tobacco product tried (cigarettes; cigars including cigarillos, little cigars, and bidis; electronic nicotine delivery systems (ENDS); smokeless and chewing tobacco; or hookah) with subsequent patterns of tobacco use while adjusting for covariates. Of the youth who experimented, 56.8% were non-current tobacco users. Of current tobacco users (n = 934), 13% were exclusive ENDS users, 5.3% exclusive combustible mono-users, 13.4% ENDS plus combustible poly-users, 3.3% combustible product only poly-users, and 8.2% other tobacco poly-users. The most common type of first tobacco product tried was ENDS (44.7%), followed by cigarettes (35.0%) and cigars (8.6%). Those who experimented with combustible tobacco products were less likely to be exclusive ENDS users [Relative Risk Ratio (RRR) = 0.46; 95% CI = 0.28, 0.73 for cigarettes; RRR = 0.32; 95% CI = 0.13, 0.81 for cigars; and RRR = 0.33; 95% CI = 0.14, 0.79 for hookah] when compared to non-current tobacco users (reference group). Tobacco product choices for initial experimentation appear to play a role in subsequent tobacco use patterns among youth. Understanding the reasons behind initial product choice may inform our understanding regarding the reasons for subsequent current tobacco product use, thus informing youth prevention efforts.

Pod-based e-cigarette use among US college-aged adults: A survey on the perception of health effects, sociodemographic correlates, and interplay with other tobacco products

INTRODUCTION

E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the US. Using an online survey, we explored the socio-behavioral correlates, predisposing factors, and addictive behaviors, among young adult pod-mod users within a University in Maryland, USA.

METHODS

In total, 112 eligible college students aged 18-24 years, recruited from a University in Maryland, who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past-30-day use. Descriptive statistics were used to analyze participants' responses.

RESULTS

The mean age of the survey participants was 20.5 ± 1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8 ± 1.4 years, while the mean age of regular use was 18.5 ± 1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of the current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were aged <21 years. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio, AOR=4.52; 95% CI: 1.76-11.64), JUUL use (AOR=2.56; 95% CI: 1.08-6.03), and menthol flavor (AOR=6.52; 95% CI: 1.38-30.89) were associated with reduced nicotine autonomy, a measure of addiction.

CONCLUSIONS

Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

Share of Advertising Voice at the Point-of-Sale and Its Influence on At-Risk Students' Use of Alternative Tobacco Products

INTRODUCTION

As adolescent tobacco use shifts from traditional cigarettes to alternative products, it is important to understand the influence of point-of-sale (POS) advertising on product use. This research investigated whether the percentage of POS advertising for a particular product, known as the share of advertising voice (SAV), moderated the relationship between exposure to POS tobacco advertisements and tobacco use among at-risk youth.

METHODS

Longitudinal self-report data from 746 students attending 20 alternative high schools in southern California was merged with observational data cataloging 2101 advertisements for cigarettes, e-cigarettes, cigars, and smokeless tobacco from 87 tobacco retail outlets within a half mile of the schools. Four multilevel Poisson regression models examined whether SAV interacted with POS tobacco advertising exposure to influence the use of tobacco products 1 year later.

RESULTS

Adolescent exposure to POS tobacco advertisements was significantly associated with increased use of all four tobacco products (p < .02). When SAV was added to the model as a moderator, the results showed a significant interaction, such that increasing the SAV for e-cigarettes was associated with greater use of that product (β = 0.27, SE = 0.07, p < .001). The same moderating effect was found for smokeless tobacco (β = 0.56, SE = 0.19, p = .004) but no moderating effect was observed for cigarettes or cigars.

CONCLUSION

POS SAV has the potential to influence at-risk students' use of alternative tobacco products and may be a contributing factor to recent nationwide shifts in youth tobacco use.

IMPLICATIONS

Future studies should monitor changes in SAV to gain insight into POS marketing trends that may be impacting youth tobacco use. In addition, state and local governments should consider implementing policies that limit the volume and proportion of POS tobacco advertising for all nicotine and tobacco products available in retail environments near schools. Restrictions placed on a single product may cause unintended shifts in product selection rather than a reduction in youth tobacco use.

Poly-substance use and sexual risk behaviours: a cross-sectional comparison of adolescents in mainstream and alternative education settings

BACKGROUND

Surveys of young people under-represent those in alternative education settings (AES), potentially disguising health inequalities. We present the first quantitative UK evidence of health inequalities between AES and mainstream education school (MES) pupils, assessing whether observed inequalities are attributable to socioeconomic, familial, educational and peer factors.

METHODS

Cross-sectional, self-reported data on individual- and poly-substance use (PSU: combined tobacco, alcohol and cannabis use) and sexual risk-taking from 219 pupils in AES (mean age 15.9 years) were compared with data from 4024 pupils in MES (mean age 15.5 years). Data were collected from 2008 to 2009 as part of the quasi-experimental evaluation of Healthy Respect 2 (HR2).

RESULTS

AES pupils reported higher levels of substance use, including tobacco use, weekly drunkenness, using cannabis at least once a week and engaging in PSU at least once a week. AES pupils also reported higher levels of sexual health risk behaviours than their MES counterparts, including: earlier sexual activity; less protection against sexually transmitted infections (STIs); and having 3+ lifetime sexual partners. In multivariate analyses, inequalities in sexual risk-taking were fully explained after adjusting for higher deprivation, lower parental monitoring, lower parent-child connectedness, school disengagement and heightened intentions towards early parenthood among AES vs MES pupils. However, an increased risk (OR = 1.73, 95% CI 1.15, 2.60) of weekly PSU was found for AES vs MES pupils after adjusting for these factors and the influence of peer behaviours.

CONCLUSION

AES pupils are more likely to engage in health risk behaviours, including PSU and sexual risk-taking, compared with MES pupils. AES pupils are a vulnerable group who may not be easily targeted by conventional population-level public health programmes. Health promotion interventions need to be tailored and contextualised for AES pupils, in particular for sexual health and PSU. These could be included within interventions designed to promote broader outcomes such as mental wellbeing, educational engagement, raise future aspirations and promote resilience.

Racial and Ethnic Differences in Problem Gambling among College Students

The college years are a formative period where the risk for development of problematic gambling is high. Research examining racial and ethnic differences in gambling behaviors has been limited and inconsistent. The aims of this study were to examine racial and ethnic differences in problem gambling among a large sample of college students. Undergraduates (N = 3058) from a large southern university completed an online screening questionnaire which included demographics, gambling frequency, gambling expenditure (i.e. money lost) in the previous 6 months, and the South Oaks Gambling Screen (SOGS). Negative binomial regression results indicated that Asian participants gambled less frequently than participants who were Caucasian or Hispanic/Latino(a), but spent more money than participants who were African-American (AA)/Black or Hispanic/Latino(a). A significantly larger proportion of Asian students met probable pathological gambling criteria (SOGS 5+; 7.8 %) and at-risk gambling criteria (SOGS 3+; 16.3 %)) than Caucasian (5.2; 10.1 %), AA/Black (3.9; 10.2 %), or Hispanic/Latino(a) (3.6; 9.4 %) students. Additionally, a significantly larger proportion of Asian students endorsed problematic gambling indicators such as lying about losses, feeling guilty about gambling, feeling like they had a gambling problem, being criticized for their gambling, feeling like they couldn't stop gambling, losing time from school or work due to gambling, having a family history of problem gambling, and arguing with close others about their gambling than Caucasian, AA/Black or Hispanic/Latino(a) students. Results suggest that Asian students may be a high-risk sub-group of college gamblers, and that there is a critical need for targeted interventions for this population.

Stressful Life Events and Predictors of Post-traumatic Growth among High-Risk Early Emerging Adults

Stressful life events (SLEs) may elicit positive psychosocial change among youth, referred to as Post-traumatic Growth (PTG). We assessed types of SLEs experienced, degree to which participants reported PTG, and variables predicting PTG across 24 months among a sample of high risk, ethnically diverse early emerging adults. Participants were recruited from alternative high schools (n = 564; mean age=16.8; 65% Hispanic). Multi-level regression models were constructed to examine the impact of environmental (SLE quantity, severity) and personal factors (hedonic ability, perceived stress, developmental stage, future time orientation) on a composite score of PTG. The majority of participants reported positive changes resulted from their most life-altering SLE of the past two years. Predictors of PTG included fewer SLEs, less general stress, having a future time perspective, and greater identification with the developmental stage of Emerging Adulthood. Findings suggest intervention targets to foster positive adaptation among early emerging adults who experience frequent SLEs.

Post-traumatic growth, stressful life events, and relationships with substance use behaviors among alternative high school students: a prospective study

A highly stressful life event (SLE) can elicit positive psychosocial growth, referred to as post-traumatic growth (PTG) among youth. We examined PTG and the number of SLEs for their influence on substance use behaviours among a sample of older, diverse alternative high school students participating in a drug prevention programme (n=564; mean age=16.8; 49% female; 65% Hispanic). Surveys assessed PTG, SLEs and substance use behaviours at the two-year follow-up. Multilevel regression models were run to examine the effect of PTG and the number of SLEs on frequency of substance use at the two-year follow-up, controlling for baseline substance use, sociodemographic variables, peer substance use, attrition propensity and treatment group. Greater PTG scores were associated with lower frequencies of alcohol use, getting drunk on alcohol, binge drinking, marijuana use and less substance abuse at the two-year follow-up, but not associated with cigarette or hard drug use. Also, PTG did not moderate the relationship between cumulative number of SLEs and substance use behaviours, rather PTG appears to be protective against negative effects of a single, life-altering SLE. Fostering PTG from a particularly poignant SLE may be useful for prevention programmes targeting alcohol, marijuana and substance abuse behaviours among high-risk youth.

Test implementation of a school-oriented drug prevention program "Study without Drugs": pre- and post-testing for effectiveness

Background

In this article, the test implementation of a school-oriented drug prevention program “Study without Drugs” is discussed. The aims of this study were to determine the results of the process evaluation and to determine whether the proposed school-oriented drug prevention program during a pilot project was effective for the participating pupils.

Methods

Sixty second-grade pupils at a junior high school in Paramaribo, Suriname participated in the test implementation. They were divided into two classes. For the process evaluation the students completed a structured questionnaire focusing on content and teaching method after every lesson. Lessons were qualified with a score from 0–10. The process was also evaluated by the teachers through structured interviews. Attention was paid to reach, dose delivered, dose received, fidelity, connection, achieved effects/observed behaviors, areas for improvement, and lesson strengths. The effect evaluation was conducted by using the General Liniair Model (repeated measure). The research (-design) was a pre-experimental design with pre-and post-test.

Results

No class or sex differences were detected among the pupils with regard to the assessment of content, methodology, and qualification of the lessons. Post-testing showed that participating pupils obtained an increased knowledge of drugs, their drug-resisting skills were enhanced, and behavior determinants (attitude, subjective norm, self-efficacy, and intention) became more negative towards drugs.

Conclusions

From the results of the test implementation can be cautiously concluded that the program “Study without Drugs” may yield positive results when applied in schools). Thus, this pilot program can be considered a step towards the development and implementation of an evidence-based school-oriented program for pupils in Suriname.

Emerging Adulthood

Following adolescence and prior to young adulthood is a life developmental period that has been referred to as “emerging adulthood.” This period of life involves an extended duration of learning and experimentation before settling into a career and stable relationship. Risky behaviors may be most tolerated or even promoted during emerging adulthood. Various substance and behavioral addictions are most likely to be realized during this period. Understanding what differentiates emerging adults that develop or do not develop full-blown addictions will assist in the creation of more efficacious prevention and cessation programs.

Elementary school children's cheating behavior and its cognitive correlates

Elementary school children's cheating behavior and its cognitive correlates were investigated using a guessing game. Children (n=95) between 8 and 12 years of age were asked to guess which side of the screen a coin would appear on and received rewards based on their self-reported accuracy. Children's cheating behavior was measured by examining whether children failed to adhere to the game rules by falsely reporting their accuracy. Children's theory-of-mind understanding and executive functioning skills were also assessed. The majority of children cheated during the guessing game, and cheating behavior decreased with age. Children with better working memory and inhibitory control were less likely to cheat. However, among the cheaters, those with greater cognitive flexibility use more tactics while cheating. Results revealed the unique role that executive functioning plays in children's cheating behavior: Like a double-edged sword, executive functioning can inhibit children's cheating behavior, on the one hand, while it can promote the sophistication of children's cheating tactics, on the other.

An Exploratory Multilevel Analysis of Nonprescription Stimulant Use in a Sample of College Students

Nonprescription stimulant use is a high-risk behavior prevalent in the college population. To date, research on this substance use behavior lacks a comprehensive theoretical lens as well as geographical diversity. Guided by the Theory of Triadic Influence (TTI), multilevel (i.e., students within schools) modeling was used to analyze survey data from the Spring 2009 American College Health Association–National College Health Assessment II. We hypothesized that the behavior would be associated with ultimate underlying causes, distal predisposing influences, proximal immediate predictors, and immediate precursors found in the TTI’s three streams of influence (i.e., intrapersonal, social situation/context, and sociocultural environment). In our sample ( N = 10,220 students; 18 schools), the mean prevalence of past-year use of prescription stimulants without a prescription was 10.70% (range across schools, 0.33%-20.04%). Our hypothesis regarding the multifaceted nature of the predictors of the behavior was supported. Implications for prevention efforts, limitations, and future research directions are discussed.

Changes in developmental contexts as predictors of transitions in HIV-risk behaviors among young men who have sex with men (YMSM)

Emerging adulthood is a transitional time often marked by instability in many areas of life, including residential status, work, school, and romantic relationships. The purpose of this study is to examine transitions in HIV-risk related behaviors among a cohort of ethnically-diverse young men who have sex with men (YMSM) and to reveal how changes in developmental contexts during emerging adulthood might be associated with these behavioral changes. Hidden Markov models were used to examine movement across different stages of behavioral risk-taking over time. Semi-annual surveys were administered across 2 years; analyses included those with at least three of the five waves of data. Results indicated substantial movement at the individual-level transitions. Additionally, high variability in sexual risk, alcohol misuse, and illicit drug-risk behaviors was predicted by age, ethnicity, and correlates of emerging adulthood, such as residential status, work, post-secondary school enrollment, and primary-relationship status. Findings provide evidence of great change in risky behaviors among YMSM during this pivotal time, particularly among those who actively experiment in varying levels of risk-taking. In order to prevent experimental behaviors from evolving into more serious risk, interventions must consider ways to assist YMSM to adjust to life changes brought on by emerging adulthood.

The sustained impact of adolescent violence histories on early adulthood outcomes

A history of victimization and violence perpetration are well-established risk factors that hamper positive development in early adulthood, yet their separate and overlapping effects are rarely examined simultaneously, confounding understanding of their relative impacts. This study follows a diverse sample of at-risk adolescents (N=570) into early adulthood, comparing roles and resources, stress and distress, and maladaptive behaviors for those with a history of no violence, victimization only, perpetration only, and both perpetration and victimization. Results demonstrate four distinctive profiles, although all violence-exposed youth report more problems in the three assessed domains relative to those with no violence histories. Implications for intervention are discussed.

Trends in Video Game Play through Childhood, Adolescence, and Emerging Adulthood

This study explored the relationship between video gaming and age during childhood, adolescence, and emerging adulthood. It also examined whether "role incompatibility," the theory that normative levels of substance use decrease through young adulthood as newly acquired adult roles create competing demands, generalizes to video gaming. Emerging adult video gamers (n = 702) recruited from video gaming contexts in New York City completed a computer-assisted personal interview and life-history calendar. All four video gaming indicators-days/week played, school/work day play, nonschool/work day play, and problem play-had significant curvilinear relationships with age. The "shape" of video gaming's relationship with age is, therefore, similar to that of substance use, but video gaming appears to peak earlier in life than substance use, that is, in late adolescence rather than emerging adulthood. Of the four video gaming indicators, role incompatibility only significantly affected school/work day play, the dimension with the clearest potential to interfere with life obligations.

Evaluation of the Psychometric Properties of the Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) in a Sample of Continuation High School Students

It is now presumed that youth do not move directly from adolescence to adulthood, but rather pass through a transitional period, "emerging adulthood." The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) is a self-report instrument developed to examine the attributes of this period. "At-risk" youth appear to enter emerging adulthood developmental tasks at a slightly earlier age than general population youth. In the present study, a 21-item version of the IDEA was administered to a sample of 1676 "at-risk" continuation (alternative) high school students in Southern California. Principal component factor analysis with orthogonal rotation revealed three factors the authors labeled "Identity Exploration," "Experimentation/Possibilities," and "Independence." Overall, the measure demonstrated high internal consistency. Construct validity analyses indicated that the measure was correlated with demographics, risk behaviors, and psychological measures. The authors conclude that the IDEA-R is a useful instrument for measuring emerging adulthood in at-risk populations.

Social integration in friendship networks: the synergy of network structure and peer influence in relation to cigarette smoking among high risk adolescents

Using data from a study of high risk adolescents in Southern California, U.S.A. (N=851), this study examined synergy between social network measures of social integration and peer influence in relation to past month cigarette smoking. Using Hierarchical Linear Modeling, results indicated that being central in networks was significantly and positively related to past month cigarette smoking, across all study models. In addition, there is modest evidence that the number of reciprocated friendship ties was positively related to past month cigarette smoking. There is also some modest evidence that the relationship between having reciprocated friendships and past month cigarette smoking was moderated by a network peer influence process, smoking with those in youths' best friend networks. Findings indicate that being integrated within a social network context of peer influences favoring drug use relates to more smoking among these high risk youth.

Health behaviors and mental health of students attending alternative high schools: a review of the research literature

PURPOSE

The purpose of this review is to describe current knowledge about health-risk behaviors and mental health among alternative high school students.

CONCLUSIONS

Substance use, diet and/or physical activity, sexual-risk behaviors, mental health, and violence were reviewed. Students were described as marginalized youth facing significant social environmental challenges. Findings from 43 studies published from 1997-2010 suggested a high prevalence of health-risk behaviors among alternative high school students. Very few studies were conducted by nurse researchers. Suggestions for future research include addressing social environmental factors, resiliency, and emotional/mental health outcomes.

PRACTICE IMPLICATIONS

Alternative high schools offer a venue to conduct research and implement nursing interventions with high-risk, yet resilient, youth.

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.

Exploring Race Based Differences in Patterns of Life-Course Criminality

A persistent issue facing criminologists is the challenge of developing theoretical models that provide comprehensive explanations of the onset and persistence of criminality. One promising theory to develop over the last 30 years has been life-course theory. Using multivariate analysis of variance the main question posed in this research, do elements of social development shape the trajectory of persistent offending in a race-neutral fashion, or are the dynamics shaping life-course criminality unique for people of color, was examined. The results provide a number of useful insights into the relationship between race, life-course transition factors, and longitudinal patterns of criminality.

Dissonance-Based Interventions for Substance Using Alternative High-School Youth

This article describes an innovative new intervention tailored to older youth who are already abusing drugs, but who are not diagnostically ready for treatment. The basic tenet of this intervention is to utilize adolescents engaged in drug use as "experts" in the prevention curriculum adaptation activity. This activity then serves as a mechanism for their dissonance-based change. This process is designed to intervene with drug abusing youth prior to their development of substance dependence. The community-based design grew from a United States federally funded NIDA project (National Institute of Drug Abuse Mentored Research Scientist Award) which found that the youth who conduct program adaptations were effectively engaged, animatedly discussing the payoffs and downsides of drug and alcohol abuse. It is maintained through this research that dissonance between their role of "Preventionist" and their own substance abuse behaviors lead to shifts in attitudes and behaviors. Dissonance-based interventions (DBIs) have been successfully utilized for positive behavioral change with a variety of disorders, but have not yet been implemented with substance abusing youth. Findings of pilot research are shared along with implications for future research and interventions.

Structural, concurrent, and predictive validity of the Substance Use Risk Profile Scale in early adolescence

A brief personality risk profile (23 items), the Substance Use Risk Profile Scale was tested for concurrent and predictive validity for substance use in 1139 adolescents (grades 8-10) from a mid-sized city in western Canada. The SURPS was administered in two waves of a longitudinal study separated by 12 months (2003-04). As expected, four subscales were supported by confirmatory factor and metric invariance analysis. In regression analysis, three subscales, hopelessness, impulsivity, and sensation seeking, were positively related to current and future use; while one, anxiety sensitivity, was negatively related. Findings suggest clinical utility for screening adolescents at risk for substance use.

A motivational model of alcohol misuse in emerging adulthood

Many emerging adults who have dropped out of high school are known to misuse alcohol. Expectancies and motives for drinking are pivotal in shaping the drinking behavior of emerging adults, especially those related to social influences. We tested a motivational model of problematic alcohol use using drinking motives (enhancement, social, conformity, coping) as multiple mediators to explain the association between social alcohol expectancies and alcohol misuse. A community sample of 104 individuals between ages 16 and 21 attending a General Educational Development (GED) program completed self-report measures of alcohol expectancies, drinking motives, quantity and frequency of drinking, and a structured interview that assessed the symptoms of alcohol use disorders. Results of multiple regression analysis testing multiple mediators indicated that social alcohol expectancies were associated with alcohol misuse through the mediated pathways of enhancement drinking motives.

The Project Towards No Drug Abuse (TND) dissemination trial: implementation fidelity and immediate outcomes

One of the important research issues in the emerging area of research on dissemination of prevention programs relates to the type and extent of training needed by program providers to prepare them to implement effective programs with fidelity. The present paper describes the immediate outcomes of a dissemination and implementation trial of Project Toward No Drug Abuse, an evidence-based prevention program for high school students. A total of 65 high schools in 14 school districts across the USA were recruited and randomly assigned to one of three experimental conditions: comprehensive implementation support for teachers, regular workshop training only, or standard care control. The comprehensive intervention was comprised of on-site coaching, web-based support, and technical assistance, in addition to the regular workshop. Students (n = 2,983) completed self-report surveys before and immediately after program implementation. Fidelity of implementation was assessed with a classroom observation procedure that focused on program process. Results indicated that relative to the controls, both intervention conditions produced effects on hypothesized program mediators, including greater gains in program-related knowledge; greater reductions in cigarette, marijuana and hard drug use intentions; and more positive changes in drug-related beliefs. There were stronger effects on implementation fidelity in the comprehensive, relative to the regular, training condition. However, seven of the ten immediate student outcome measures showed no significant differences between the two training conditions. The implications of these findings for dissemination research and practice are discussed.

Assessing and quantifying high risk: comparing risky behaviors by youth in an urban, disadvantaged community with nationally representative youth

OBJECTIVE

This study examined whether youth who live in an urban, disadvantaged community are significantly more likely than youth representing the nation to engage in a range of health-compromising behaviors.

METHODS

Analyses were based on the Youth Violence Survey conducted in 2004 and administered to students (n=4131) in a high-risk school district. Students in ninth grade (n=1114) were compared with ninth-grade students in the 2003 national Youth Risk Behavior Survey (n=3674) and the National Longitudinal Study of Adolescent Health conducted in 1995/1996 (n=3523). Analyses assessed the differences in prevalence of risk and protective factors among ninth-grade students from the three studies using Chi-square tests.

RESULTS

The results showed that youth in this urban, disadvantaged community were significantly more likely than their peers across the country to report vandalism, theft, violence, and selling drugs. Youth in this community also reported significantly less support from their homes and schools, and less monitoring by their parents. Moreover, youth in this community were significantly less likely to binge drink or initiate alcohol use prior to age 13 than youth across the U.S.

CONCLUSIONS

Youth who live in this urban, disadvantaged community reported significantly higher prevalence of some, but not all, risky behaviors than nationally representative U.S. youth. These findings highlight that some caution is justified when defining what might constitute high risk and that demographic and other characteristics need to be carefully considered when targeting certain high-risk behaviors.

Concurrent predictors of cigarette and alcohol use among U.S. and Russian adolescents

In the present study, we describe correlates of 30-day cigarette and alcohol use among two samples of high school students, one in the Russian Federation (n = 365), and one in the United States (n = 965). The correlates used in the analyses are based on the theory of triadic influence, which organizes predictors of adolescent substance use into three distinct types of influence. Overall, correlates from each of the types of influence were significant predictors of substance use in both samples. The most consistent positive predictors of cigarette and alcohol use across countries were friends' substance use and sensation seeking behavior. Perceived harmfulness of drug use was negatively associated with cigarette and alcohol use in both samples. Having a substance abuser in one's family was negatively associated with alcohol use in the Russian sample, but positively associated with alcohol use in the U.S. sample. In general, similar patterns of relationships between predictors and substance use were seen across both countries.

Reducing early smokers' risk for future smoking and other problem behavior: insights from a five-year longitudinal study

PURPOSE

To identify risk and protective factors during early and later adolescence that predict future regular smoking and multiple problem behavior among at-risk youth, defined as those who tried smoking by grade 7.

METHODS

At grades 7, 10, and 12, data were collected from 2,000 early smokers drawn from California and Oregon. Multivariate regression analyses tested predictors of the two grade 12 outcomes in separate models using data from grades 7 and 10. Gender interactions and buffering of risk factors by protective factors were assessed.

RESULTS

For at-risk youth, consistent protective factors against future smoking and problem behavior included living in an intact nuclear family (all four models) plus getting good grades and parental disapproval of smoking/drug use (three of four models). Consistent risk factors included exposure to substance-using peers (four models) and problems in school (three of four models). Adult substance use was a predictor during early, but not later, adolescence; pro-smoking/drug use beliefs were significant predictors during later adolescence. There were few differences across gender and no significant buffers against risk.

CONCLUSIONS

At-risk youth would likely benefit from peer resistance training, parental involvement in prevention efforts, and efforts to improve educational performance during both middle school and high school. Changing pro-drug beliefs may be more effective among older adolescents.

Substance abuse among adolescents

Substance use and dependence are among the most prevalent causes of adolescent morbidity and mortality in the United States. This paper provides a review of differences between adolescent and adult substance abuse, prevention and treatment approaches, and future potential directions and needs for more effective programming in the treatment of adolescent substance abuse(1) and dependence on psychoactive substances.

Disordered gambling among college students: a meta-analytic synthesis

The purpose of this study was to use a meta-analytic procedure to synthesize the rates of disordered gambling for college students that have been reported in the research literature. In order to identify all possible studies that met stringent inclusion criteria, Medline, PsychINFO, and SocioIndex databases were searched with the terms "gambling," and "college student". This process resulted in 15 studies concerning gambling among college students that were published through July 2005. To synthesize the 15 studies, a random effects model for meta-analysis was applied. The estimated proportion of disordered gamblers among college students was 7.89%. This estimate is noteworthy because it is higher than that reported for adolescents, college students or adults in a previous study using meta-analytic procedures with studies conducted prior to 1997.

Fidelity of implementation in Project Towards No Drug Abuse (TND): a comparison of classroom teachers and program specialists

This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which we compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students' posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects.

Project Towards No Drug Abuse: long-term substance use outcomes evaluation

OBJECTIVES

This paper presents up to 5 years post-program outcomes of Project Towards No Drug Abuse (Project TND), a drug abuse prevention program conducted in South California alternative high school system during years 1994-1999.

METHODS

The effects of a 9-session health motivation--social skills--decision-making curriculum were evaluated. Twenty-one schools recruited were randomly assigned to standard care (control), classroom only, or a classroom plus semester-long school-as-community component. Last 30-day use of cigarettes, alcohol, marijuana, and hard drugs were assessed at three time intervals: short-term (year 1), middle-term (years 2 or 3), and long-term (years 4 or 5). Multilevel random coefficients modeling were employed to estimate the adjusted levels of substance use.

RESULTS

Among 1578 baseline subjects, follow-up data were available for 68% (year 1), 66% (years 2 or 3), and 46% (years 4 or 5) of subjects, respectively. Results revealed significant positive long-term program effects for hard drug use at year 4 or 5 for the two program interventions (P = 0.02).

CONCLUSIONS

Project TND reduced hard drug use in the 46% who were successfully followed. It is the first program to demonstrate long-term self-reported behavioral effects on hard drug use among high-risk youth by using a school-based, limited-session model.