Elementary school age children's future intentions and use of substances

How Dangerous? Substance Use Risk Perceptions in Chilean Preadolescents

Early substance use initiation among children represents a significant risk to public health. Research suggests that early positive perceptions and cognitions of elementary students toward substance use may predict later use during adolescence. Studies among adolescent populations have shown an inverse relationship between substance use and risk perceptions. To gain insight into alcohol, tobacco, and marijuana risk perceptions prior to adolescence, we analyzed data from the Chilean Early Childhood Longitudinal Survey (ELPI). In a sample of 5,278 families (mean age of preadolescents 10.63 years, SD = .64; 50.5% males), our findings showed that an important proportion of Chilean 10 years old did not perceive occasional tobacco, alcohol, or marijuana use to be high-risk activities. However, the majority of respondents did consider daily substance use to be a high-risk activity, with some variation across substances. Overall, older preadolescents were more likely to consider substance use to be less risky compared to their slightly younger counterparts. Our analysis also demonstrated that past month substances use by caregivers were all found to be predictive of low-medium risk perceptions among preadolescents surveyed, while conversely, caregivers' negative reactions to finding out their child had used a substance decreased the likelihood of holding low-medium risk perceptions. Individuals from single-parent households were less likely to consider substance use as being high-risk compared to their peers. Preadolescents with caregivers reporting higher average incomes were also more likely to hold lower risk perceptions of occasional substance use. Implications for public policies to prevent substance use in the pre-adolescent population are discussed.

Assessing the Pragmatic Effectiveness and Implementation of Click City: Tobacco: A School-Based Prevention Program Targeting Youth Cigarette and E-cigarette Use

INTRODUCTION

Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use.

METHODS

To evaluate the effectiveness of the updated 5th-grade program within a "real world" setting, we conducted a pragmatic randomized trial with 5th-grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n = 1327) received the updated version of Click City: Tobacco; students in control schools (n = 1346) received their usual tobacco prevention curriculum.

RESULTS

Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (before COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention condition completed the entire program, supporting fidelity of implementation, and teachers reported satisfaction with the program.

CONCLUSIONS

Findings suggest that Click City: Tobacco is effective for all 5th-grade students and can be delivered with fidelity across school settings.

IMPLICATIONS

The results of a randomized pragmatic effectiveness trial showed that the updated Click City: Tobacco program decreased intentions and willingness to both vape e-cigarettes and smoke cigarettes among 5th-grade students, particularly for those at high risk. Program effectiveness and lack of differences because of factors such as state, gender, ethnicity, and historical timing have universal implications, suggesting that all students can benefit from this program. Click City: Tobacco received high ratings of program satisfaction from teachers and was implemented with fidelity. Findings suggest that Click City: Tobacco is effective and can be easily implemented in schools.

The moderating effects of alcohol use with and without parent permission on alcohol risk communication in early adolescence

The frequency of parental alcohol risk communication (ARC) is considered an integral component of socializing youth about alcohol, but the literature offers mixed findings on whether such communication is protective. Early adolescents' prior drinking experiences may moderate the effectiveness of ARC, but evidence for such an interaction is inconsistent. One limitation of this work considering prior drinking experience is that it has not distinguished drinking with versus without parental permission. Parents are one of the earliest sources of information about alcohol use and many parents view allowing adolescents to drink alcohol with permission as a harm reduction strategy, despite some work suggesting the opposite effect. Using a random effects multilevel regression, we tested the unique moderating effects of drinking with and without parental permission on the prospective association between alcohol risk communication and later drinking without parental permission. Adolescent and parent dyads completed 3 annual assessments (first assessment mean age = 12.6, 52% girls, 76% White/non-Hispanic). Results supported a three-way interaction. There was a modest protective effect of parental ARC on later adolescent drinking, but only for adolescents who had prior experience drinking both with and without parental permission. For all other combinations of prior drinking experience, parental communication was not prospectively related to later drinking. These results help clarify the mixed literature on alcohol communication and suggests that ARC may help reduce some of the risk associated with allowing youth to drink alcohol but only for youth who also have experience with alcohol outside of parental supervision.

Associations between pre-adolescents' cognitive responses to alcohol-related cues, maternal drinking, and direct exposure to alcohol

The current study investigated pre-adolescent children's (N = 140, M_age = 10.11 years, SD = 1.48, 59.5% girls) implicit evaluations of and explicit expectancies about alcohol-related cues as a function of their mothers' drinking behaviors and their exposure to alcohol. Children's implicit evaluative responses were measured using the Affect Misattribution Procedure (AMP), which consisted of trials that depicted pictures of either alcoholic or non-alcoholic beverages, half of which were presented alone (inactive) and half of which were presented with a human interacting with the beverage (active). In addition, children's explicit expectancies, whether they had ever tasted alcohol, and their mothers' alcohol dependency and escape drinking motivations were measured. Results indicated that overall children's implicit evaluations were less positive for alcohol- than for non-alcohol-related cues, and those whose mothers reported higher alcohol dependency evaluated inactive alcohol-related cues more negatively. Moreover, those who had previously tasted alcohol endorsed positive expectancies more than negative expectancies. These findings contribute to our understanding of the processes through which implicit associations are learned in the context of addiction. Understanding cognitive as well as other potential biological and environmental factors that may predict drinking behaviors in youth will aid in the development of more effective evidence-based strategies for the prevention of alcoholism.

Short-Term Secondary Effects of a School-Based Drug Prevention Program: Cluster-Randomized Controlled Trial of the Brazilian Version of DARE's Keepin' it REAL

This study aimed to evaluate the effectiveness of the drug and violence resistance educational program (PROERD) on short-term secondary outcomes, such as intentions to use drugs, attitudes toward drugs, school experience, and life skills (refusal, decision-making, and communication). Two cluster-randomized controlled trials were conducted in 30 public schools in the city of São Paulo (Brazil) with 4030 students (1727 fifth and 2303 seventh graders). The intervention group attended 10 PROERD classes conducted by trained police officers, whereas the control group received no intervention. PROERD is a Brazilian adaptation of the North American Drug Abuse Resistance Education (DARE) program Keepin' it REAL. Data were collected at two time points: pre-intervention and at 9-month follow-up. Two different paradigms were used in the multilevel analysis, complete case (CC), and intention-to-treat (ITT) analyses, using full information maximum likelihood (FIML). We found mixed results. Although the seventh-year curriculum seems to have positive effects on school experience (coef = 0.093; 95% CI: 0.001, -0.185), it also increases the intention to use cigarettes in the future (OR = 1.93, 95% CI: 1.109, 3.379) and the chances of accepting marijuana (OR = 1.62, 95% CI: 1.03, 2.53), and it appears to slightly reduce decision-making skills among fifth graders (coef = -0.078; 95% CI: -0.131, -0.025). Our results suggest that PROERD implementation and cultural adaptation should be reevaluated to understand why the program does not achieve the expected preventive goals and produces potential iatrogenic effects.

Parental drinking according to parental composition and adolescent binge drinking: findings from a nationwide high school survey in Japan

Background

Alcohol problems in parents have been revealed to affect adolescent alcohol misuse. However, few studies examine the effects of parental drinking on adolescent risky drinking (including binge drinking) in the general population. In particular, previous study findings are inconsistent regarding the influence of parental drinking according to parental composition. In this study, we aimed to examine the relationship between parental drinking, according to parental composition, and binge drinking among high school students in Japan.

Methods

We performed a secondary analysis of the Nationwide High School Survey on Drug Use and Lifestyle 2018, Japan. A total of 46,848 valid surveys from high school students of 78 schools were included for analysis. Logistic regression analysis with a generalized linear mixed model was conducted with binge drinking as the dependent variable and “parental drinking according to parental composition” (e.g., father’s drinking, mother’s drinking, father’s absence, mother’s absence, both parents drinking, and neither parent at home) as the independent variable, after adjusting with covariates. Binge drinking was defined as five or more alcoholic drinks for male adolescents or four or more alcoholic drinks for females on the same occasion within two hours.

Results

In the fully adjusted models, adolescents whose mothers drink (adjusted odds ratio (AOR): 1.50, 95% confidence interval (CI): 1.06–2.12) were significantly associated with adolescent binge drinking. This risk was significantly higher among students with neither parent living at home (AOR: 4.35, 95% CI: 2.10–9.02).

Conclusion

Parental drinking and absence do affect adolescent binge drinking; our findings show that adolescents are more likely to engage in binge drinking if their mothers drink or if they are not living with either parent. Therefore, it is important to engage parents and non-parental family members in future programs and interventions to prevent adolescent binge drinking.

Behavioral and brain signatures of substance use vulnerability in childhood

The prevalence of risky behavior such as substance use increases during adolescence; however, the neurobiological precursors to adolescent substance use remain unclear. Predictive modeling may complement previous work observing associations with known risk factors or substance use outcomes by developing generalizable models that predict early susceptibility. The aims of the current study were to identify and characterize behavioral and brain models of vulnerability to future substance use. Principal components analysis (PCA) of behavioral risk factors were used together with connectome-based predictive modeling (CPM) during rest and task-based functional imaging to generate predictive models in a large cohort of nine- and ten-year-olds enrolled in the Adolescent Brain & Cognitive Development (ABCD) study (NDA release 2.0.1). Dimensionality reduction (n = 9,437) of behavioral measures associated with substance use identified two latent dimensions that explained the largest amount of variance: risk-seeking (PC1; e.g., curiosity to try substances) and familial factors (PC2; e.g., family history of substance use disorder). Using cross-validated regularized regression in a subset of data (Year 1 Fast Track data; n>1,500), functional connectivity during rest and task conditions (resting-state; monetary incentive delay task; stop signal task; emotional n-back task) significantly predicted individual differences in risk-seeking (PC1) in held-out participants (partial correlations between predicted and observed scores controlling for motion and number of frames [r_p]: 0.07-0.21). By contrast, functional connectivity was a weak predictor of familial risk factors associated with substance use (PC2) (r_p: 0.03-0.06). These results demonstrate a novel approach to understanding substance use vulnerability, which—together with mechanistic perspectives—may inform strategies aimed at early identification of risk for addiction.

Evaluating the Effects of a Brief Tobacco Intervention in the US Air Force

INTRODUCTION

Military personnel have among the highest rates of tobacco use in the United States. Unfortunately, there are few interventions aimed at reducing tobacco use among this vulnerable population. The current study addresses this need by evaluating the short-term effectiveness of a Brief Tobacco Intervention (BTI), a 40-min group-based intervention designed to reduce contemporary patterns of tobacco use among a sample of US military enlistees during an 11-week period of involuntary tobacco abstinence.

AIMS AND METHODS

Participants were 2999 US Air Force Technical Trainees at Joint Base San Antonio-Lackland Air Force Base in San Antonio, Texas from April 2017 through January 2018. Participants were cluster randomized to three conditions: (1) BTI + Airman's Guide to Remaining Tobacco Free (AG), (2) AG intervention, or (3) standard smoking cessation intervention. The primary analysis was a comparison of the interventions' efficacies in preventing tobacco use during Technical Training, conducted using a generalized estimating equations logistic regression model controlling for covariates. Multiple imputation was used to account for loss to follow-up.

RESULTS

There was not a significant difference by condition in the use of tobacco products at follow-up (p = .454). The BTI + AG condition did produce short-term changes in perceived harm, intentions to use tobacco, knowledge about tobacco products, and normative beliefs.

CONCLUSIONS

These findings suggest that while the intervention was effective in the short term, it was not potent enough over a 12-week period to prevent Airmen from initiating tobacco use. Future studies should examine whether adding a booster session or media campaign enhances the effectiveness of the intervention.

IMPLICATIONS

Despite the fact that most Airmen believe they will remain tobacco free following the ban in Technical Training, a large percentage of these Airmen resume and initiate tobacco use during this high-risk period. As a result, there is a need for interventions targeting the range of tobacco available to military trainees during a teachable moment when they report intentions to remain tobacco free. The current study shows that a BTI has promise in reducing long-term tobacco use, when coupled with additional interventions, such as a booster session or a media campaign.

Welsh Primary Schoolchildren's Perceptions of Electronic Cigarettes: A Mixed Methods Study

There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren’s (aged 7–11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation.

The comparative effectiveness of two brief tobacco interventions in the U.S. Air Force: Perceived harm and intentions-to-use of tobacco products

INTRODUCTION

Brief health prevention programs have been shown efficacious in prevention of tobacco use initiation and re-initiation in the US Air Force. In this manuscript we apply a comparative effectiveness assessment of two published studies, based on testing the equality of effect sizes for perceived harm and intentions-to-use for five tobacco products.

METHODS

We calculate and compare the effect sizes from the brief tobacco intervention (BTI) study (N=1055) with those of the anti-tobacco media campaign (MEDIA) study (N=665), for perceived harm and intentions-to-use of cigarettes, smokeless tobacco, cigarillos, e-cigarettes and hookah, among Airmen in the US Air Force Technical Training. Univariate and multivariate parametric and non-parametric methods and models were applied to compare the outcomes between the interventions. In addition, we calculate and report the cost of each intervention per Airman.

RESULTS

Effect sizes for perceived harm were 0.24–0.99 for BTI and 0.17–0.33 for MEDIA, while intentions-to-use effect sizes were 0.14–0.34 for BTI and 0.01– 0.07 for MEDIA, depending on the product. BTI intervention effects sizes were significantly greater than MEDIA intervention for all products, mainly among past users, and for both perceived harm (all p<0.0001) and intentions-to-use (all p<0.01). Cost per Airmen was comparable between the two interventions, $14.90 for BTI and $16.52 for MEDIA.

CONCLUSIONS

Direct comparison suggests that BTI produced effect sizes of significantly higher magnitude in the desired direction for perceived harm and intentions-to-use, for five tobacco products most commonly used by the Airmen, and mainly among past users.

The Efficacy of an American Indian Culturally-Based Risk Prevention Program for Upper Elementary School Youth Residing on the Northern Plains Reservations

Culturally-based risk behavior prevention programs for American Indian elementary school children are sparse. Thus a group of American Indian educators collaborated in the creation of a program that helps children make healthy decisions based on their cultural and traditional value system. In this paper the effectiveness of Lakota Circles of Hope (LCH), an elementary school culturally-based prevention program was studied and evaluated. Three cohorts of fourth and fifth graders participated in a mixed methods quasi-experimental evaluative research design that included focus groups and surveys prior to and following the intervention. Five research questions regarding the program's impact on students' self-esteem and self-efficacy, Lakota identity, communication, conflict resolution and risk behaviors were addressed in this study. Participants were compared to non-participants in three American Indian reservation school sites. Educators completed a survey to record their observations and feedback regarding the implementation of the program within their respective school sites. The study provides preliminary evidence that, when delivered with fidelity, LCH contributes to statistically significant changes in risk behaviors, Lakota identity, respect for others, and adult and parent communication. A two-way multivariate analysis of variance with post hoc analysis of data collected from the LCH participants (N = 1392) were used to substantiate a significant increase in respect for others and a decrease in risk behaviors which included alcohol, tobacco, and substance use at the 0.10 alpha level. Significant positive improvements in parent and adult communication and an increased Lakota identity at the 0.01 alpha level were obtained. There were no significant differences in self-esteem and conflict resolution from pre to post intervention and in comparison with non LCH participating students.

Early alcohol use with parental permission: Psychosocial characteristics and drinking in late adolescence

The earliest experiences with alcohol for many children occur in the family context with parental supervision. The current study examined individual and sociocultural characteristics associated with early (prior to age 13years) sipping and tasting alcohol with parental permission in two longitudinal community samples. Early sipping/tasting was also tested as a predictor of frequency and quantity of alcohol use, and alcohol-related problems seven years later in late adolescence. Early sipping/tasting with parental permission was associated with a sociocultural context supportive of alcohol use (e.g., parental alcohol use, permissive rules about alcohol use in the home, parental attitudes about underage drinking, perceived peer norms), adolescent sensation seeking and disinhibition (e.g., surgency, externalizing behavior) and appraisals of alcohol (negative outcome expectancies and negative implicit alcohol associations). Early sipping/tasting predicted increased frequency and quantity of alcohol consumption, and increased alcohol-related problems in late adolescence, even after controlling sociocultural and individual difference variables. Findings suggest that early sipping/tasting with parental permission is not benign and is a viable target for preventive interventions.

A systematic review of children's alcohol-related knowledge, attitudes and expectancies

Understanding the nature of, and transitions in, young children's alcohol-related knowledge and attitudes is important to determining the age at which we should start educating children about alcohol and informing our understanding of the focus of such education. This paper aimed to explore current literature on the alcohol-related knowledge, beliefs, attitudes and expectancies of children aged 12years and under. Electronic databases were searched for papers published from January 2000-August 2016. Further papers were identified by a manual review of reference lists, and contacting corresponding authors of included papers. Papers that reported on children's knowledge or beliefs about alcohol, attitudes towards alcohol and/or expectancies regarding alcohol consumption were included. Seventeen cross-sectional, experimental or observational studies and seven longitudinal studies met the inclusion criteria. Data on key measures was tabulated. From a very young age children are aware of and able to identify alcohol, and have some knowledge of its effects; their attitudes become more positive with increasing age and these shifts appear to precede drinking initiation by some years. The small number of available studies, with different measures of knowledge, attitudes and expectancies, made assessment of bias unfeasible. Only three studies were published in the last five years. Children's knowledge of, and attitudes towards, alcohol form before they initiate alcohol use, and are likely acquired through observation. Alcohol-related education should commence before children begin drinking, and should encourage the delay of alcohol initiation, address social norms, and reduce positive expectancies.

Types of Dual and Poly-Tobacco Users in the US Military

The present investigation was designed to determine the prevalence and types of dual and poly-use of tobacco products in the US Air Force, as well as characteristics and factors associated with these types. We conducted a cross-sectional assessment of tobacco-product use among 13,873 Air Force trainees from 2013 to 2014. The assessment included prevalence of the use of 10 different tobacco products and demographic and environmental factors, such as risk perceptions of tobacco use, peer use, and tobacco-company influences. Latent class analysis was carried out to determine types of poly-tobacco users. Tobacco-product use was reported by 27.1% of participants, and of those, over half reported using more than 1 tobacco product. Latent class analysis indicated 5 classes of poly-tobacco use. Factors associated with poly-tobacco (vs. mono-tobacco) use included lower confidence to remain tobacco-free, low harm perceptions, and receiving tobacco products free at bars or social events. Rates of dual and poly-tobacco use are high among trainees, and while these groups are similar to mono users in some ways, there are a number of differences that need to be considered when developing targeted interventions to address use of multiple tobacco products.

Effect of a sport-for-health intervention (SmokeFree Sports) on smoking-related intentions and cognitions among 9-10 year old primary school children: a controlled trial

BACKGROUND

Preventing children from smoking is a public health priority. This study evaluated the effects of a sport-for-health smoking prevention programme (SmokeFree Sports) on smoking-related intentions and cognitions among primary school children from deprived communities.

METHODS

A non-randomised-controlled trial targeted 9-10 year old children from Merseyside, North-West England. 32 primary schools received a programme of sport-for-health activities over 7 months; 11 comparison schools followed usual routines. Data were collected pre-intervention (T0), and at 8 months (T1) and one year post-intervention (T2). Smoking-related intentions and cognitions were assessed using an online questionnaire. Intervention effects were analysed using multi-level modelling (school, student), adjusted for baseline values and potential confounders. Mixed-sex focus groups (n = 18) were conducted at T1.

RESULTS

961 children completed all assessments and were included in the final analyses. There were no significant differences between the two study groups for non-smoking intentions (T1: β = 0.02, 95 % CI = -0.08-0.12; T2: β = 0.08, 95 % CI = -0.02-0.17) or for cigarette refusal self-efficacy (T1: β = 0.28, 95 % CI = -0.11-0.67; T2: β = 0.23, 95 % CI = -0.07-0.52). At T1 there was a positive intervention effect for cigarette refusal self-efficacy in girls (β = 0.72, 95 % CI = 0.21-1.23). Intervention participants were more likely to 'definitely' believe that: 'it is not safe to smoke for a year or two as long as you quit after that' (RR = 1.19, 95 % CI = 1.07-1.33), 'it is difficult to quit smoking once started' (RR = 1.56, 95 % CI = 1.38-1.76), 'smoke from other peoples' cigarettes is harmful' (RR = 1.19, 95 % CI = 1.20-2.08), 'smoking affects sports performance' (RR = 1.73, 95 % CI = 1.59-1.88) and 'smoking makes 'no difference' to weight' (RR = 2.13, 95 % CI = 1.86-2.44). At T2, significant between-group differences remained just for 'smoking affects sports performance' (RR = 1.57, 95 % CI = 1.43-1.72). Focus groups showed that SFS made children determined to remain smoke free and that the interactive activities aided children's understanding of smoking harms.

CONCLUSION

SFS demonstrated short-term positive effects on smoking attitudes among children, and cigarette refusal self-efficacy among girls. Although no effects were observed for non-smoking intentions, children said that SFS made them more determined not to smoke. Most children had strong intentions not to smoke; therefore, smoking prevention programmes should perhaps target early adolescents, who are closer to the age of smoking onset.

Decreasing Risk Factors for Later Alcohol Use and Antisocial Behaviors in Children in Foster Care by Increasing Early Promotive Factors

Children in foster care are at high risk for poor psychosocial outcomes, including school failure, alcohol and other substance abuse, and criminal behaviors. Promoting healthy development by increasing broad-impact positive skills may help reduce some of the risk factors for longer-term negative outcomes. School readiness has been linked to a number of positive outcomes across childhood, adolescence, and adulthood, and may also boost intermediary positive skills such as self-competence. This paper presents findings from a longitudinal study involving 192 children in foster care who were 5 years old at the start of the study. They participated in a randomized controlled trial of a school readiness program to prepare them for kindergarten. Outcomes were assessed at third grade (9 years old) on variables associated with risk for later involvement in substance use and delinquency. These included positive attitudes towards alcohol use, positive attitudes towards antisocial behaviors, and involvement with deviant peers. Results showed that the intervention decreased positive attitudes towards alcohol use and antisocial behaviors. Further, the mediating role of children's self-competence was tested. The intervention positively influenced children's third-grade self-competence, which in turn, decreased their involvement with deviant peers. Findings suggest that promoting school readiness in children in foster care can have far-reaching, positive effects and that increased self-competence may be a mechanism for reducing risk.

The prospective association between sipping alcohol by the sixth grade and later substance use

OBJECTIVE

Although there is a clear association between early use of alcohol and short- and long-term adverse outcomes, it is unclear whether consumption of minor amounts of alcohol (less than a full drink) at a young age is prognostic of risk behaviors in later adolescence.

METHOD

Data were taken from 561 students enrolled in an ongoing prospective web-based study on alcohol initiation and progression (55% female; 25% White non-Hispanic). Based on a combination of monthly and semiannual surveys, we coded whether participants sipped alcohol before sixth grade and examined associations between early sipping and alcohol consumption by fall of ninth grade, as well as other indices of problem behavior. Participants also reported on the context of the first sipping event.

RESULTS

The prevalence of sipping alcohol by fall of sixth grade was 29.5%. Most participants indicated that their first sip took place at their own home, and the primary source of alcohol was an adult, usually a parent. Youth who sipped alcohol by sixth grade had significantly greater odds of consuming a full drink, getting drunk, and drinking heavily by ninth grade than nonsippers. These associations held even when we controlled for temperamental, behavioral, and environmental factors that contribute to proneness for problem behavior, which suggests that sipping is not simply a marker of underlying risk.

CONCLUSIONS

Our findings that early sipping is associated with elevated odds of risky behaviors at high school entry dispute the idea of sipping as a protective factor. Offering even just a sip of alcohol may undermine messages about the unacceptability of alcohol consumption for youth.

What predicts early smoking milestones?

OBJECTIVE

As many cigarette smokers begin experimenting before age 16, prevention efforts require a comprehensive understanding of smoking predictors during adolescence. Research has made many advances in understanding the predictors of smoking initiation, yet more precision is still needed to determine whether the patterns of prediction differ across early smoking milestones. The purpose of this study was to use a sample of young adolescents to examine the predictors of two key milestones in smoking initiation: first puff and first cigarette.

METHOD

Data came from an ongoing, prospective project examining psychosocial factors related to adolescent substance use. At Time 1 (T1), the sample was 1,023 Rhode Island middle school students (ages 10-15 years; M = 12.2). T1 measures included empirically supported risk and protective factors, as well as current smoking. Follow-up surveys assessed smoking behavior over the ensuing year (T2 smoking).

RESULTS

Cigarette availability was the most robust predictor of smoking milestones, increasing the likelihood of both first puff and first cigarette in cross-sectional and prospective analyses. Multivariable analyses also showed specificity, where some factors were only associated with one time point (e.g., age and T1 puff and cigarette), whereas others were only associated with one milestone (e.g., parental monitoring and whole cigarette at both time points).

CONCLUSIONS

This study found different patterns of predictors for two early smoking milestones. Such findings are the first to suggest that puff and whole cigarette are distinct smoking milestones and reaffirm arguments that researchers should distinguish the various stages of smoking initiation when examining the broader period of onset/initiation.

Prevalence and Correlates of Tobacco and Nicotine Containing Product Use in a Sample of United States Air Force Trainees

INTRODUCTION

Although there is increasing attention to the prevalence of new and emerging tobacco products in the civilian population, remarkably little is known about the current prevalence of these products in a military population.

METHODS

The current investigation was designed to determine the prevalence of tobacco and nicotine containing products (TNCP) and correlates of use across multiple cohorts of trainees undergoing Technical Training in the US Air Force between April 2013 and December 2014. Chi-square test, Cochran-Armitage test for linear trend, and logistic regression models were applied to test differences and linear trends across time for TNCP use as well as correlates of use in a cross-sectional sample of 13 685 Airmen (final analytic sample).

RESULTS

Over a quarter (26.9%) of Airmen reported regular use of a TNCP. The two most prevalent products were cigarettes (11.2%) and hookah (10.5%). Among correlates of use, Airmen that regularly use TNCPs were more likely to be male, younger, non-Hispanic white, and single with a high school degree or General Education Development. Hookah was the most endorsed for intentions to use, and along with e-cigarettes, had the lowest perception of harm. While prevalence of most products remained constant across entering cohorts, the prevalence of e-cigarettes showed significant linear increase.

CONCLUSIONS

The prevalence of TNCP use is high across cohorts of Airmen. Remarkably high estimates of future intentions to use and low perceptions of harm for emerging products suggest that intervention efforts should be directed at multiple forms of TNCP use to address this important public health issue.

A Parenting Program to Promote an Alcohol-Free Childhood: Influence on Parents' Readiness to Prevent Child Sipping

OBJECTIVE

This study reports effects of a parenting program to increase parents' readiness to socialize their children against early alcohol use.

METHOD

A two-group randomized controlled trial was conducted with a nonprobability sample of 816 mothers. Participants were recruited from school districts located primarily in North Carolina and completed telephone interviews at baseline and 6 and 18 months after delivery of a parenting program to the treatment group mothers. Mothers reported on psychological indicators of readiness to prevent child alcohol use (e.g., attitude toward child sipping) and on parenting behaviors with potential to prevent such use (e.g., setting rules about child sipping). Multivariate analysis of variance models tested program effects on composite sets of psychological and behavioral outcomes; step-down analysis identified the individual outcomes driving overall program effects. Moderation of program effects by mother's alcohol use, established beliefs about the consequences of child sipping, educational attainment, and race/ethnicity was tested.

RESULTS

The program had significant overall effects on each composite set of psychological and behavioral outcomes. Effects on psychological outcomes were moderated by mother's alcohol use, beliefs about the consequences of child sipping, and educational attainment; effects on the behavioral outcomes were moderated by mother's race/ethnicity.

CONCLUSIONS

The parenting program had favorable, sustained effects on targeted outcomes intended to increase parental readiness to socialize children against early alcohol use. Mothers expected to be least receptive to the program-those who, at baseline, believed that allowing children to sip alcohol can have beneficial consequences-were most changed by it.

Association of the OPRM1 Variant rs1799971 (A118G) with Non-Specific Liability to Substance Dependence in a Collaborative de novo Meta-Analysis of European-Ancestry Cohorts

The mu1 opioid receptor gene, OPRM1, has long been a high-priority candidate for human genetic studies of addiction. Because of its potential functional significance, the non-synonymous variant rs1799971 (A118G, Asn40Asp) in OPRM1 has been extensively studied, yet its role in addiction has remained unclear, with conflicting association findings. To resolve the question of what effect, if any, rs1799971 has on substance dependence risk, we conducted collaborative meta-analyses of 25 datasets with over 28,000 European-ancestry subjects. We investigated non-specific risk for "general" substance dependence, comparing cases dependent on any substance to controls who were non-dependent on all assessed substances. We also examined five specific substance dependence diagnoses: DSM-IV alcohol, opioid, cannabis, and cocaine dependence, and nicotine dependence defined by the proxy of heavy/light smoking (cigarettes-per-day >20 vs. ≤ 10). The G allele showed a modest protective effect on general substance dependence (OR = 0.90, 95% C.I. [0.83-0.97], p value = 0.0095, N = 16,908). We observed similar effects for each individual substance, although these were not statistically significant, likely because of reduced sample sizes. We conclude that rs1799971 contributes to mechanisms of addiction liability that are shared across different addictive substances. This project highlights the benefits of examining addictive behaviors collectively and the power of collaborative data sharing and meta-analyses.

A cross-validation trial of an Internet-based prevention program for alcohol and cannabis: Preliminary results from a cluster randomised controlled trial

OBJECTIVE

Replication is an important step in evaluating evidence-based preventive interventions and is crucial for establishing the generalizability and wider impact of a program. Despite this, few replications have occurred in the prevention science field. This study aims to fill this gap by conducting a cross-validation trial of the Climate Schools: Alcohol and Cannabis course, an Internet-based prevention program, among a new cohort of Australian students.

METHOD

A cluster randomized controlled trial was conducted among 1103 students (Mage: 13.25 years) from 13 schools in Australia in 2012. Six schools received the Climate Schools course and 7 schools were randomized to a control group (health education as usual). All students completed a self-report survey at baseline and immediately post-intervention. Mixed-effects regressions were conducted for all outcome variables. Outcomes assessed included alcohol and cannabis use, knowledge and intentions to use these substances.

RESULTS

Compared to the control group, immediately post-intervention the intervention group reported significantly greater alcohol (d = 0.67) and cannabis knowledge (d = 0.72), were less likely to have consumed any alcohol (even a sip or taste) in the past 6 months (odds ratio = 0.69) and were less likely to intend on using alcohol in the future (odds ratio = 0.62). However, there were no effects for binge drinking, cannabis use or intentions to use cannabis.

CONCLUSION

These preliminary results provide some support for the Internet-based Climate Schools: Alcohol and Cannabis course as a feasible way of delivering alcohol and cannabis prevention. Intervention effects for alcohol and cannabis knowledge were consistent with results from the original trial; however, analyses of longer-term follow-up data are needed to provide a clearer indication of the efficacy of the intervention, particularly in relation to behavioral changes.

Harsh Environments, Life History Strategies, and Adjustment: A Longitudinal Study of Oregon Youth

We modeled the effects of harsh environments in childhood on adjustment in early emerging adulthood, through parenting style and the development of fast Life History Strategies (LHS; risky beliefs and behaviors) in adolescence. Participants were from the Oregon Youth Substance Use Project (N = 988; 85.7% White). Five cohorts of children in Grades 1-5 at recruitment were assessed through one-year post high school. Greater environmental harshness (neighborhood quality and family poverty) in Grades 1-6 predicted less parental investment at Grade 8. This parenting style was related to the development of fast LHS (favorable beliefs about substance users and willingness to use substances at Grade 9, and engagement in substance use and risky sexual behavior assessed across Grades 10-12). The indirect path from harsh environment through parenting and LHS to (less) psychological adjustment (indicated by lower life satisfaction, self-rated health, trait sociability, and higher depression) was significant (indirect effect -.024, p = .011, 95% CI = -.043, -.006.). This chain of development was comparable to that found by Gibbons et al. (2012) for an African-American sample that, unlike the present study, included perceived racial discrimination in the assessment of harsh environment.

Prospective Predictors of Novel Tobacco and Nicotine Product Use in Emerging Adulthood

PURPOSE

The purpose of this study was to investigate whether risk factors for cigarette smoking assessed in adolescence predict the use of novel tobacco and nicotine products (hookah, little cigars, and e-cigarettes) in early emerging adulthood.

METHODS

In a longitudinal study (N = 862), risk factors were measured in middle and high school, and novel product use was measured in emerging adulthood (mean age 22.4 years). Structural equation modeling was used to test a model predicting lifetime use of any of hookah, little cigars, and e-cigarettes in early emerging adulthood from distal predictors (gender, maternal smoking through Grade 8; already tried alcohol, cigarettes, or marijuana by Grade 8; and sensation seeking at Grade 8) and potential mediators (intentions to smoke cigarettes, drink alcohol or smoke marijuana at Grade 9, and smoking trajectory across high school).

RESULTS

The most prevalent novel tobacco product was hookah (21.7%), followed by little cigars (16.8%) and e-cigarettes (6.6%). Maternal smoking, having already tried substances, and sensation seeking each predicted the use of at least one of these products via an indirect path through intentions to use substances and membership in a high-school smoking trajectory.

CONCLUSIONS

Risk factors for cigarette smoking were found to predict novel tobacco use, suggesting that interventions to prevent cigarette smoking could be extended to include common novel tobacco products.

Purpose in Life in Emerging Adulthood: Development and Validation of a New Brief Measure

Accruing evidence points to the value of studying purpose in life across adolescence and emerging adulthood. Research though is needed to understand the unique role of purpose in life in predicting well-being and developmentally relevant outcomes during emerging adulthood. The current studies (total n = 669) found support for the development of a new brief measure of purpose in life using data from American and Canadian samples, while demonstrating evidence for two important findings. First, purpose in life predicted well-being during emerging adulthood, even when controlling for the Big Five personality traits. Second, purpose in life was positively associated with self-image and negatively associated with delinquency, again controlling for personality traits. Findings are discussed with respect to how studying purpose in life can help understand which individuals are more likely to experience positive transitions into adulthood.

Alcohol use at the cusp of adolescence: a prospective national birth cohort study of prevalence and risk factors

PURPOSE

To estimate the prevalence of alcohol use at the age of 10-11 years and document variation by early sociodemographic and concurrent alcohol-specific risk factors.

METHODS

The Millennium Cohort Study is a prospective, nationally representative study of live births in the United Kingdom across 12 months. A random sample of electoral wards was stratified to adequately represent U.K. countries, economically deprived areas, and areas with high concentrations of Asian and Black British families. A total of 12,305 child-mother pairs provided self-report data at 9 months (mother's marital status, age, education, occupational level; child gender, ethnicity, country) and age 10-11 years (adolescent alcohol use and attitudes).

RESULTS

After adjusting for attrition and sampling design, 13.4% of 10- to 11-year-olds had had an alcoholic drink (more than few sips), 1.2% had felt drunk, and .6% had five or more drinks at a time. Odds of ever drinking were higher among boys (1.47, 95% confidence interval, 1.29-1.68) and lower among early adolescents who were Asian British (vs. white; .09, .05-.17) or Black British (.42, .29-.62). Beyond sociodemographic differences, more positive attitudes about alcohol were associated with greater odds of drinking (1.70, 1.51-1.91), feeling drunk (2.96, 2.07-4.24), and having five or more drinks (4.20, 2.66-6.61).

CONCLUSIONS

Alcohol use in the last year of primary school was identified but not common. Its use varied by sociodemographic groups; early adolescents with more positive alcohol attitudes had especially high risks of early alcohol initiation. Results support calls for increased surveillance and screening for very early drinking.

Detecting initiation or risk for initiation of substance use before high school during pediatric well-child check-ups

BACKGROUND

Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index(©) (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups.

DESIGN

A high-risk longitudinal design with two cross-sectional replication samples, ages 9-13 was used. Analyses included receiver operating characteristics and regression analyses.

PARTICIPANTS

A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool.

RESULTS

YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratios=7.44, CI=4.3-13.0) and conduct problems (odds ratios=7.33, CI=3.9-13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service.

CONCLUSIONS

Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI's association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders.

The Relationship Between Peer, Parent, and Grandparent Norms and Intentions to Use Substances for Urban American Indian Youth

Peer, parent, and grandparent norms may be a protective factor for American Indian (AI) youth intentions to use substances, but little research has explored these influences on urban AI youth. Using OLS regression, a secondary data analysis examined the relationship between peer, parent and grandparent substance use norms, and intentions to use substances (N = 148). Findings indicated that grandparent and peer norms were the strongest predictors of intentions to use substances. Implications of these results include the need for concerted, culturally focused efforts that address AI youth substance use by targeting AI peer and family networks.

Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9-10 year old children from deprived neighbourhoods: a cross-sectional study

Background

Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods.

Methods

Cross-sectional data was collected from 9–10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level.

Results

Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is ‘definitely’ bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to ‘definitely’ believe that the smoke from other people’s cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to ‘definitely’ believe that smoking is bad for health.

Conclusion

This study indicates that sibling and friend smoking may represent important influences on 9–10 year old children’s cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.

Differences in Substance Use and Substance Use Risk Factors by Asian Subgroups

The present study examined differences in lifetime use and initiation of substance use and associated risk factors for alcohol, cigarettes, and marijuana among seven subgroups of Asian American (AA) adolescents: Chinese, Filipino, Indian, Japanese, Korean, Vietnamese, and Mixed heritage Asian. Sixth and 7th grade AA adolescents in Southern California were surveyed five times over three academic years. We examined subgroup differences in (1) lifetime alcohol, cigarette, and marijuana use assessed at baseline, (2) initiation of each substance over three years, and (3) baseline individual (positive and negative expectancies about substances, resistance self-efficacy, and intentions to use), family (closest adult and older sibling substance use), and school factors (perceived peer use). Although there was considerable heterogeneity in lifetime substance use and initiation rates, subgroup differences were not statistically significant (ps > .20). Significant subgroup differences existed for negative expectancies about use, perceived peer use, and close adult alcohol and cigarette use (ps < .05). Specifically, Vietnamese and Japanese adolescents had the lowest negative expectancies about cigarettes and marijuana, respectively. Vietnamese adolescents reported the highest levels of perceived peer cigarette use. Mixed-heritage adolescents reported the highest frequency of alcohol and cigarette use by their closest adult. Although no differences in substance use rates were observed, these findings are an important first step in understanding heterogeneity in AA adolescents' risk for substance use and initiation.

Antecedent predictors of children's initiation of sipping/tasting alcohol

BACKGROUND

Sipping or tasting alcohol is one of the earliest alcohol-use behaviors in which young children engage, yet there is relatively little research on this behavior. Previous cross-sectional analyses determined that child sipping or tasting is associated with the child's attitude toward sipping and with a family environment supportive of alcohol use, but not with variables reflecting psychosocial proneness for problem behavior as formulated in Problem Behavior Theory (Jessor and Jessor, Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth, 1977, Academic Press, New York). This study extended these analyses longitudinally to identify antecedent predictors of the childhood initiation of sipping or tasting alcohol in a multiwave study.

METHODS

A sample of 452 children (238 girls) aged 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random digit dialing procedures. Children were interviewed using computer-assisted interviews. Antecedent variables collected at baseline (Wave 1) were examined as predictors of the initiation of sipping/tasting alcohol in childhood (before age 12) among Wave 1 abstainers (n = 286).

RESULTS

Ninety-four children initiated sipping/tasting alcohol in a nonreligious context between baseline and turning age 12. Initiation of sipping/tasting did not generally relate to baseline variables reflecting psychosocial proneness for problem behavior. Instead, as found in the previous cross-sectional analyses, the variables most predictive of initiating sipping/tasting were perceived parents' approval for child sipping, parents' reported approval for child sipping, parents' current drinking status, and children's attitudes toward sipping/tasting alcohol.

CONCLUSIONS

These longitudinal analyses replicate the earlier cross-sectional results. Young children's sipping/tasting of alcohol reflects parental modeling of drinking and parental approval of child sipping and does not represent a precocious manifestation of a psychosocial proneness to engage in problem behavior.

Do child's psychosocial functioning, and parent and family characteristics predict early alcohol use? The TRAILS Study

BACKGROUND

Given the negative consequences of early alcohol use for health and social functioning, it is essential to detect children at risk of early drinking. The aim of this study is to determine predictors of early alcohol use that can easily be detected in Preventive Child Healthcare (PCH).

METHODS

We obtained data from the first two waves on 1261 Dutch adolescents who participated in TRAILS (TRacking Adolescents' Individual Lives Survey) at ages 10-14 years and from the PCH records regarding ages 4-10 years. Early adolescence alcohol use (age 10-14 years) was defined as alcohol use at least once at ages 10-12 years (wave 1) and at least once in the previous 4 weeks at ages 12-14 years (wave 2). Predictors of early alcohol use concerned parent and teacher reports at wave 1 and PCH registrations, regarding the child's psychosocial functioning, and parental and socio-demographic characteristics.

RESULTS

A total of 17.2% of the adolescents reported early alcohol use. Predictors of early alcohol use were teacher-reported aggressive behaviour [odds ratios (OR); 95% confidence interval (CI): 1.86; 1.11-3.11], being a boy (OR 1.80, 95%-CI 1.31-2.56), being a non-immigrant (OR 2.31, 95%CI 1.05-5.09), and low and middle educational level of the father (OR 1.71, 95%CI 1.12-2.62 and OR 1.77, 95%CI 1.16-2.70, respectively), mutually adjusted.

CONCLUSION

A limited set of factors was predictive for early alcohol use. Use of this set may improve the detection of early adolescence alcohol use in PCH.

The acceptability of incorporating a youth smoking prevention intervention in the pediatric emergency department

The pediatric emergency department (PED) is under-utilized as a setting in which to provide tobacco prevention interventions for at-risk children. We sought to determine the acceptability and feasibility of incorporating a brief, parental tobacco prevention intervention to 520 parents during the PED visit. Mean age (SD) of parents and children was 38.6 (7.1) and 11.5 (1.1), respectively; 47% of children were female; 45% were African American; 36% of parents had an annual income less than $25,000; 28.8% of parents were current smokers. Over 90% of parents said the intervention provided "useful" and "easy to understand" information and 97% of practitioners said it did not "interfere with clinical care." Given the high prevalence of parental smoking in the PED, there is a high likelihood that their children will initiate smoking in the future. Thus, the use of the PED as a venue to providing tobacco prevention interventions warrants further evaluation.

The impact of mindfulness education on elementary school students: Evaluation of the Master Mind Program

Children need to be equipped with the skills to respond effectively to stress and prevent poor decision-making surrounding alcohol and tobacco use. Training and practice in mindfulness is one possible avenue for building children's skills. Recent research has revealed that mindfulness education in the classroom may play a role in enhancing children's self-regulatory abilities. Thus, the goal of the current study was to extend existing research in mindfulness education in classrooms and conduct an assessment of the feasibility and effectiveness of a new mindfulness education, substance abuse prevention program for 4^th and 5^th grade children (Master Mind). Two elementary schools were randomly assigned to be an intervention group (N = 71) or waitlist control group (N = 40). Students in the intervention group were taught the four-week Master Mind program by their regular classroom teachers. At pre- and post-intervention time points, students completed self-reports of their intentions to use substances and an executive functioning performance task. Teachers rated students on their behavior in the classroom. Findings revealed that students who participated in the Master Mind program, as compared to those in the wait-list control condition, showed significant improvements in executive functioning skills (girls and boys), as well as a marginally significant increase in self-control abilities (boys only). In addition, significant reductions were found in aggression and social problems (girls and boys), as well as anxiety (girls only). No significant differences across groups were found for intentions to use alcohol or tobacco. Teachers implemented the program with fidelity; both teachers and students positively rated the structure and content of the Master Mind program, providing evidence of program satisfaction and feasibility. Although generalization may be limited by the small sample size, the findings suggest that mindfulness education may be beneficial in increasing self-regulatory abilities, which is important for substance abuse prevention.

Parental socialization and children's susceptibility to alcohol use initiation

OBJECTIVE

This study examined relations between children's susceptibility to alcohol use initiation and parents' alcohol-specific beliefs, attitudes, and practices and whether these relations vary by parental alcohol use.

METHOD

The sample comprised 1,050 pairs of mothers or mother surrogates and their third-grade children (51.8% female) recruited for a 4-year intervention trial. Families were recruited from school districts located primarily in North Carolina; the school districts provided permission for study recruitment materials to be distributed to families but were not otherwise involved in the research. Data are from the baseline cross-sectional telephone interviews conducted with the mothers and children. Children's susceptibility to alcohol use initiation is based on child reports, and parental alcohol-specific beliefs, attitudes, and practices are based on maternal reports.

RESULTS

All parental alcohol socialization attributes were statistically significantly associated as hypothesized with child susceptibility to alcohol use initiation. In the final full model, the mother's disapproving attitude about child sipping and the interaction between mother-child communication and parental alcohol use frequency were uniquely significantly associated with child susceptibility. Talking with the child about harmful consequences of alcohol use was associated with reduced child susceptibility in families where parents drank alcohol more frequently but had no relationship with child susceptibility in families where parents drank infrequently.

CONCLUSIONS

The normative interactions that parents have with their elementary school children may inhibit or facilitate children's susceptibility to alcohol use. To the extent that child susceptibility leads to early onset of use, prevention programs directed at parents to reduce child susceptibility are indicated.

Long-term efficacy of click city(r): tobacco: a school-based tobacco prevention program

INTRODUCTION

Click City (®) : Tobacco is an innovative, computer-based tobacco prevention program designed to be implemented in 5th-grade classrooms with a booster in 6th grade. The program targets etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was empirically evaluated to assure that it changed its targeted mechanism. This paper describes long-term outcomes for students who participated in a randomized controlled efficacy trial of the program.

METHODS

A total of 26 middle schools were stratified and randomly assigned to the Click City (®) : Tobacco program or Usual Curriculum. The 47 elementary schools that fed into each middle school were assigned to the same condition as their respective middle school. In Click City (®) : Tobacco schools, 1,168 students from 24 elementary schools and 13 middle schools participated. In Usual Curriculum schools, 1,154 students from 23 elementary schools and 13 middle schools participated. All participating students completed baseline, post-6th grade program, and 7th grade assessments.

RESULTS

As compared to students in schools that continued with their usual curriculum, intentions and willingness to smoke increased less from baseline to 6th grade and from baseline to 7th grade, among students in schools that used the Click City (®) : Tobacco curriculum. Changes in mechanisms were also in the expected direction. The program was particularly efficacious for at-risk students.

CONCLUSIONS

Results provide evidence to support the long-term efficacy of Click City (®) : Tobacco. Program development, based on an empirical evaluation of each component, most likely played a role in the success of the program.

Attributes that differentiate children who sip alcohol from abstinent peers

Sipping alcohol during childhood may be a marker of differentiation as regards children's future risk of underage drinking; yet very little is known about alcohol use when it occurs among elementary school-aged children. The purpose of the present study is to examine alcohol sipping behavior in a sample of third-grade school children to learn whether sipping is associated with attributes that could increase children's likelihood of further underage drinking. We collected telephone interview data from 1,050 mothers and their third grade children (mean age 9.2 years; 48.2% male) residing in the Southeastern United States. The majority of mothers were White non-Hispanic (69.02%) or Black non-Hispanic (21.3%); most (85%) lived in households shared with fathers or other adult caretakers. We hypothesized that children who sip alcohol would score lower than abstinent peers on indicators of competence and score higher on indicators of exposure to alcohol-specific socialization by parents and peers. A multivariate model controlling for frequency of parent alcohol use and demographic covariates showed that children who had sipped alcohol were significantly less likely than abstinent peers to affirm indicators of competence and significantly more likely to affirm indicators of exposure to alcohol specific socialization by parents and by same age peers. These preliminary findings suggest that developmental attributes associated with risk of underage drinking begin to differentiate at least as young as middle childhood. Research is needed to test prospectively for continuity between alcohol risk attributes present in middle childhood and future alcohol use.

Inhalant use among schoolchildren in northeast India: a preliminary study

Inhalant use by children leads to poor performance in school and has been observed to precede substance use later in life. There is paucity of data on inhalant use among school children in India, particularly in the Northeast region of the country. We determined the prevalence and documented inhalant use characteristics among schoolchildren in the Northeast region of India. This cross sectional study was conducted in six states in the Northeast region of India. Schoolchildren between eighth and eleventh standards from the capital areas of the states were included in the study. Data were collected using a questionnaire. Analysis was done using descriptive statistics and Chi-square test. Of the 4074 enrolled students, data from 3943 students who responded to the inhalant use question were analyzed. Mean age was 14.8 ± 1.2 years and 51.2% of participants were male. The proportion of students who had ever used inhalants (ever user) was 18.8% and adhesive/glue was the inhalant misused by most of the students. A higher proportion of males than females were ever users (P ≤ 0.001) and the most common place of use was at home (33.1%). Being in the presence of an older person using an inhalant or tobacco was found to be associated with use of inhalants among students. Nearly one-fifth of the students had used inhalants and nearly half used inhalants in the past month. Sensitization of the parents and school authorities to the problem, as well as preventive and curative services, should be considered.

Longitudinal relationships of executive cognitive function and parent influence to child substance use and physical activity

Considered a set of neuro-cognitive skills, executive cognitive function (ECF) may serve to protect children from initiating substance use, although its role relative to other protective influences that parents and physical activity might provide is not known. As part of a large multiple health risk behavior trial for prevention of substance use and obesity, Pathways, the present study evaluated the relative impact of ECF on lifetime substance use (tobacco and alcohol) and physical activity in a panel of fourth grade children over a 6-month period (N = 1005; 51 % female; 25 % on free/reduced lunch; 60 % Hispanic/Latino or multi-racial; 28 elementary schools). A self-report survey included measures of ECF, lifetime tobacco and alcohol use, out-of-school physical activity, exercising with parents, and parent rules about food/sedentary behavior, monitoring, and arguing, was adapted for use with children. A path analysis demonstrated that ECF was the major predictor of lower substance use and higher physical activity and exercising with parents. Physical activity and exercising with parents showed reciprocal positive relationships. Findings suggest that promoting ECF skills should be a major focus of child health promotion and substance use prevention programs, although the potential protective effects of physical activity and exercise with parents on substance use in this young age group are not yet clear.

Types of alcohol use experience from childhood through adolescence

PURPOSE

There have been few reports of the development of alcohol involvement from childhood through adolescence. We examined the ages at which children first sipped or tasted alcohol, drank, had three or more drinks in a row, had five or more drinks in a row, were drunk, or had alcohol problems, to describe the types of drinking experience exhibited at each age from 8.5 through 18.0 years. Sipping and three or more drinks per occasion have been understudied to date.

METHODS

We collected 14 waves of longitudinal data from 452 children aged 8 or 10 years, randomly sampled from Allegheny County, Pennsylvania. Ages of initiating each alcohol use behavior were determined, and the data were coded to reflect the child's status on each behavior at each age. We determined types of alcohol use experience using latent class analyses.

RESULTS

From age 8.5 to 12.5 years, there were two latent classes: abstainers and sippers. The percentage of sippers increased to 67% by age 12.5 years. From ages 13.0 to 18.0, we identified three latent classes: abstainers, sippers/light drinkers, and drinkers with drunkenness. At ages 13.5-15.5 years, drinkers in the latter class reported drunkenness with just three to four drinks per occasion. By age 18 years, sippers/light drinkers comprised 55% of the sample and drinkers with drunkenness comprised 38%.

CONCLUSIONS

Childhood experience with alcohol was surprisingly widespread. Sipping or tasting alcohol was common by age 12 years. A quarter of the sample drank before age 15 years. Experience of intoxication increased throughout adolescence, even among those who had ever consumed just three to four drinks on an occasion.

Underage drinking: prevalence and risk factors associated with drinking experiences among Argentinean children

The aim of this study was to describe the prevalence and predictors of alcohol drinking behavior in children. Data were obtained from 367 children, aged 8-12 years (M = 10.44 years, SD = 1.21 years; 61.9% female) from the city of Córdoba, Argentina. Several scales were used to assess risk factors, including personality traits, alcohol expectancy (i.e., beliefs about the consequences of using alcohol), and perceived peer alcohol use, for alcohol drinking and alcohol drinking experiences. Hierarchical regression analysis was used to determine the contribution of multiple risk factors to the quantity of alcohol consumed. The results showed that 58% of the children had tasted alcohol, and approximately one-third drank alcohol again after the first drinking experience. Twelve-year-old children had a significantly higher prevalence of tasting and drinking alcohol and a significantly greater frequency and quantity of alcohol consumed than younger children. Eighty percent of the children who liked alcohol during their first drinking experience reported that they drank alcohol again. Among the children who did not like alcohol during their first drinking experience, only 31% drank alcohol again. Underage drinking usually occurred under adult supervision in family settings when parents or other relatives allowed them to drink or were aware of their children's drinking. The hierarchical regression analysis showed that being older and male, having more peers that drink alcohol, having higher levels of extroversion, and having alcohol expectancy for social facilitation increased the risk for greater alcohol use. The final model explained 33% of the total variance.

Using Peer Injunctive Norms to Predict Early Adolescent Cigarette Smoking Intentions

The present study investigated the importance of the perceived injunctive norm to predict early adolescent cigarette smoking intentions. A total of 271 6^th graders completed a survey that included perceived prevalence of friend smoking (descriptive norm), perceptions of friends' disapproval of smoking (injunctive norm), and future smoking intentions. Participants also listed their five best friends, in which the actual injunctive norm was calculated. Results showed that smoking intentions were significantly correlated with the perceived injunctive norm but not with the actual injunctive norm. Secondly, the perceived injunctive norm predicted an additional 3.4% of variance in smoking intentions above and beyond the perceived descriptive norm. These results demonstrate the importance of the perceived injunctive norm in predicting early adolescent smoking intentions.

Letting children sip: understanding why parents allow alcohol use by elementary school-aged children

OBJECTIVES

To investigate prosipping beliefs about alcohol among parents and the relations among these beliefs, parents' alcohol-specific attitudes and practices, and children's reports of initiation of alcohol use.

DESIGN

Telephone interview study of parent-child dyads. Data for the present study are from the baseline interviews of a 4-year intervention trial.

SETTING

Southeastern United States.

PARTICIPANTS

One thousand fifty pairs of mothers or mother surrogates and their third-grade children who were recruited for the 4-year intervention trial.

MAIN OUTCOME MEASURES

Key measures from parents included prosipping beliefs (ie, beliefs that sipping alcohol has protective consequences for children), attitudes about children's sipping, and parenting practices that affect children's opportunity to try alcohol. The key measure from children was experience sipping beer, wine, or other types of alcohol.

RESULTS

The belief among mothers that allowing children to sip alcohol can have protective consequences for children, including making children less likely to drink as adolescents and making them better at resisting peer influence to drink, ranged from approximately 15% to almost 40%. Alcohol use was reported by 32.8% of children. A strong, significant association was found between parental prosipping beliefs and children's reported alcohol use.

CONCLUSIONS

The notion that early exposure to alcohol can be beneficial has a strong foothold among some parents of elementary school-aged children. More research is needed to understand how parents acquire prosipping beliefs and to test messages that effectively modify such beliefs and associated prosipping attitudes and practices among parents.

Smoking trajectories across high school: sensation seeking and Hookah use

INTRODUCTION

This study investigated the associations of trajectories of cigarette smoking over the high school years with the prior development of childhood sensation seeking and the subsequent use of cigarettes and hookah at age 20/21.

METHODS

Participants (N = 963) were members of a cohort-sequential longitudinal study, the Oregon Youth Substance Use Project. Sensation seeking was assessed across 4th-8th grades and cigarette smoking was assessed across 9th-12th grades. Cigarette and hookah use was assessed at age 20/21 for 684 of the 963 participants.

RESULTS

Four trajectory classes were identified: Stable High Smokers (6%), Rapid Escalators (8%), Experimenters (15%), and Stable Nonsmokers or very occasional smokers (71%). Membership in any smoker class versus nonsmokers was predicted by initial level and growth of sensation seeking. At age 20/21, there was a positive association between smoking and hookah use for Nonsmokers and Experimenters in high school, whereas this association was not significant for Stable High Smokers or Rapid Escalators.

CONCLUSIONS

Level and rate of growth of sensation seeking are risk factors for adolescent smoking during high school (Stable High Smokers, Rapid Escalators, and Experimenters), suggesting the need for interventions to reduce the rate of increase in childhood sensation seeking. For those who were not already established smokers by the end of high school, hookah use may have served as a gateway to smoking.

The burden of alcohol use: focus on children and preadolescents

The study of alcohol use by children ages 12 and younger has been very limited. This article summarizes information from U.S. national and statewide surveys on the prevalence of alcohol use among children in grades 6 and lower, data on health conditions wholly attributable to alcohol, the prevalence of children's treatment admissions for alcohol abuse, and their rates of presentation at emergency departments for acute alcohol intoxication. Factors hampering the estimation of alcohol burden in this population include the lack of ongoing national surveys of alcohol use and problems in children, the hand-me-down nature of alcohol assessments in this population, and the lack of studies to establish whether there is a causal relationship between childhood-onset drinking and morbidity and mortality in adolescence and later in life that would permit determination of alcohol-attributable fractions. This article concludes that although the alcohol burden in childhood is low, it may be augmented by both referred alcohol burden through parental drinking and alcohol abuse and by deferred alcohol burden from longer-term consequences of early use.

Chronic psychosocial stressors and salivary biomarkers in emerging adults

We investigated whole saliva as a source of biomarkers to distinguish individuals who have, and who have not, been chronically exposed to severe and threatening life difficulties. We evaluated RNA and DNA metrics, expression of 37 candidate genes, and cortisol release in response to the Trier Social Stress Test, as well as clinical characteristics, from 48 individuals stratified on chronic exposure to psychosocial stressors within the last year as measured by the Life Events and Difficulties Schedule. Candidate genes were selected based on their differential gene expression ratio in circulating monocytes from a published genome-wide analysis of adults experiencing different levels of exposure to a chronic stressor. In univariate analyses, we observed significantly decreased RNA integrity (RIN) score (P = 0.04), and reduced expression of glucocorticoid receptor-regulated genes (Ps < 0.05) in whole saliva RNA from individuals exposed to chronic stressors, as compared to those with no exposure. In those exposed, we observed significantly decreased BMI (P < 0.001), increased ever-smoking and increased lifetime alcohol abuse or dependence (P ≤ 0.03), and a reduction of cortisol release. In post hoc multivariate analyses including clinical and biospecimen-derived variables, we consistently observed significantly decreased expression of IL8 (Ps<0.05) in individuals exposed, with no significant association to RIN score. Alcohol use disorders, tobacco use, a reduced acute stress response and decreased salivary IL8 gene expression characterize emerging adults chronically exposed to severe and threatening psychosocial stressors.