The Impact of the Good Behavior Game on Risk for Drug Use Disorder in an Agent-Based Model of Southern Sweden

OBJECTIVE

Drug use disorder (DUD) is a worldwide problem, and strategies to reduce its incidence are central to decreasing its burden. This investigation seeks to provide a proof of concept for the ability of agent-based modeling to predict the impact of the introduction of an effective school-based intervention, the Good Behavior Game (GBG), on reducing DUD in Scania, Sweden, primarily through increasing school achievement.

METHOD

We modified an existing agent-based simulation model of opioid use disorder to represent DUD in Scania County, southern Sweden. The model represents every individual in the population and is calibrated with the linked individual data from multiple sources including demographics, education, medical care, and criminal history. Risks for developing DUD were estimated from the population in Scania. Scenarios estimated the impact of introducing the GBG in schools located in disadvantaged areas.

RESULTS

The model accurately reflected the growth of DUD in Scania over a multiyear period and reproduced the levels of affected individuals in various socioeconomic strata over time. The GBG was estimated to improve school achievement and lower DUD registrations over time in males residing in disadvantaged areas by 10%, reflecting a decrease of 540 cases of DUD. Effects were considerably smaller in females.

CONCLUSIONS

This work provides support for the impact of improving school achievement on long-term risks of developing DUD. It also demonstrated the value of using simulation modeling calibrated with data from a real population to estimate the impact of an intervention applied at a population level.

The conditioning effects of positive experiences on the ACEs-offending relationship in adolescence

BACKGROUND

Research shows that adverse childhood experiences (ACEs) are problematic and may impact delinquency and arrest in adolescence. However, resiliency theories suggest the association between ACEs and delinquency/arrest may be mitigated by positive childhood experiences (PCEs).

OBJECTIVE

This study tests the hypothesis that an accumulation of PCEs ameliorates the relationship between ACEs and delinquency and arrest during adolescence.

PARTICIPANTS AND SETTING

Prospective data were collected from approximately 800 participants in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN).

METHODS

Self-report data from 16-year-old participants were used to measure the two dependent variables: the number of delinquent acts committed and having at least one arrest in the past year. Count measures reflected the number of ACEs and PCEs, with the former based on reports from child protective services, caregivers, and youth collected from ages 4-12, and the latter based on self-reports at age 12. Negative binomial models analyzed delinquency outcomes, logistic regression models examined arrest, and interaction terms assessed moderating effects.

RESULTS

ACEs were associated with significantly more delinquent acts but not arrest, and PCEs were associated with significantly fewer delinquent acts but not arrest. PCEs significantly reduced the relationship between ACEs and delinquency but only for youth with moderate levels of ACEs.

CONCLUSIONS

Findings indicate a need for additional research measuring the moderating effects of a variety of PCEs and to the need to enhance positive experiences for youth to prevent delinquency.

Adverse Childhood Experiences and Adolescent Exposure to Violence

Adverse childhood experiences (ACEs) are relatively common and can lead to harmful outcomes in adolescence and adulthood. The current study investigates the relationship between ACEs and exposure to violence in adolescence, an important area of research given the high rates of victimization in adolescence and the need for evidence-based strategies to prevent and reduce the negative consequences of victimization. The study also examines sex differences in the effects of ACEs, given that some research finds that the prevalence and impact of ACEs vary for females and males. Research questions were analyzed using prospective data from 766 to 773 high-risk youth and caregivers participating in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). A total of 10 ACEs were assessed, including five types of child maltreatment measured using official data from child protective services agencies and five types of household dysfunction reported primarily by caregivers. Exposure to three types of violence (verbal intimidation, physical victimization, and witnessing violence) were measured using youth self-reports. Logistic regression analyses examined the relationship between the number of ACEs experienced before age 12 and the likelihood of violence exposure from ages 15 to 18. Youth experiencing more ACEs had a significantly greater likelihood of physical victimization (with an adjusted odds ratio of 1.15), but not intimidation (Adjusted Odds Ratio [AOR] = 1.10) or witnessing violence (AOR = 1.11). Sex did not significantly moderate these relationships, but in sex-specific analyses, ACEs significantly increased intimidation and victimization for girls and witnessing violence for boys. Although the findings showed inconsistent evidence of a relationship between ACEs and exposure to violence, they support the need for interventions to reduce ACEs and their impact on exposure to violence during adolescence.

Evidence for a Causal Relationship Between Academic Achievement and Cigarette Smoking

INTRODUCTION

Academic achievement (AA) is associated with smoking rates. Can we determine the degree to which this relationship is likely a causal one?

METHODS

We predict smoking in male conscripts (mean age 18.2) assessed from 1984 to 1991 (N = 233 248) and pregnant females (mean age 27.7) receiving prenatal care 1972-1990 (N = 494 995) from AA assessed in all students at 16. Instrumental variable (IV) analyses used the instrument month-of-birth as in each school year, older children have high AA. Co-relative analyses used AA-smoking associations in the population, cousins and siblings to predict the AA-smoking relationship in MZ twins, thereby controlling for familial confounding.

RESULTS

In males, higher AA was associated with a substantial decrease in risk for smoking (odds ratio [OR] [95% confidence intervals [CIs]] per standard deviation [SD] = 0.41 [0.40-0.41]) while the parallel figures obtain from our IV and co-relative analyses were 0.47 (0.39-0.57) and 0.51 (0.43-0.60), respectively. In females, these figures for pre-pregnancy smoking were, respectively, 0.39 (0.39-0.39), 0.50 (0.46-0.54) and 0.54 (0.51-0.58). Results for heavy versus light smoking suggested a causal effect but were inconsistent across methods. However, among females smoking prior to pregnancy, AA predicted a reduced risk for continued smoking with ORs for uncontrolled, IV, and co-relative analyses equaling, respectively, were 0.54 (0.53-0.55) 0.68 (0.56-0.82) and 0.78 (0.66-0.91), respectively.

CONCLUSIONS

Two different methods produced consistent evidence that higher AA has a causal effect on reducing smoking rates and increasing cessation rates in smoking pregnant females. Improving AA may result in meaningful gains in population health through reduced smoking.

IMPLICATIONS

This study provides consistent evidence across two different methods that high AA is causally related to reduced rates of smoking and increasing rates of smoking cessation among pregnant women. Our results suggest that interventions that improve educational achievement in adolescence would reduce tobacco consumption, thereby improving public health.

The causal effect of resilience on risk for drug abuse: a Swedish national instrumental variable, co-relative and propensity-score analysis

BACKGROUND

We sought to quantify and investigate the causal nature of the association between resilience at age 18 and future drug abuse (DA).

METHOD

In a national sample of Swedish men (n = 1 392 800), followed for a mean of 30.3 years, resilience was assessed during military conscription and DA defined from medical, criminal and pharmacy registers. For causal inference, we utilized three methods: (i) instrumental variable analyses with the month of birth as the instrument; (ii) co-relative analyses using the general population, cousins, siblings and monozygotic twins; and (iii) propensity scoring on a subsample (n = 48 548) with strong resilience predictors. Cox proportional hazards models were utilized to examine survival time till DA diagnosis.

RESULTS

Low resilience was most robustly predicted from internalizing symptoms. Lower levels of standardized resilience strongly predicted the risk for DA (HR = 2.31, 95% CIs 2.28-2.33). In instrumental, co-relative, and propensity score analyses, the association between resilience and DA was estimated at HR = 3.06 (2.44-3.85), 1.34 (1.28-1.39), and 1.40 (1.28-1.53), respectively. Sensitivity analyses suggested that our instrument was weak and, despite our large sample, likely under-estimated confounding.

CONCLUSIONS

Low resilience strongly predicts DA risk. Three different causal analysis methods, with divergent assumptions, concurred in estimating that an appreciable proportion of this association was causal, probably around 40%, with the remainder arising from confounding variables many of which are likely familial. Consistent with prior interventions focused on substance use prevention, our results suggest that prevention programs that increase resilience in adolescence should meaningfully reduce the long-term risk for DA.

Perceptions of danger, tolerance of delinquency, and economic disadvantage: Examining neighborhood influences on child physical abuse

BACKGROUND

Social disorganization theory posits that both structural and social features of a particular geographic unit are associated with criminal behavior. Despite many tests of social disorganization theory, few studies have assessed its relevance to child abuse.

OBJECTIVE

This study seeks to explain neighborhood variation in child maltreatment. The goal of the current study is to fill this gap by investigating whether or not child physical abuse is related to neighborhood economic disadvantage, perceptions of the dangerousness of the neighborhood, and norms regarding delinquency.

PARTICIPANTS AND SETTING

Data were drawn from the Project on Human Development in Chicago Neighborhoods (PHDCN) and included 2364 respondents from 79 neighborhoods. The dependent variable, the variety or number of acts of severe child physical abuse, was reported by caregivers, while neighborhood characteristics were based on information from the U.S. Census Data and adult respondents living in Chicago neighborhoods.

METHODS

A multilevel, over-dispersed, Poisson regression models were utilized to predict the variety of acts of severe physical abuse that a child living within a given neighborhood would experience.

RESULTS

Neighborhood economic disadvantage was not significantly associated with greater variety of physical abuse. However, neighborhoods perceived as dangerous had greater variety of physical abuse (b = .25, p < .05), while those with a greater tolerance for deviance had somewhat lower variety of physical abuse (b= -.69, p ≤ .10).

CONCLUSIONS

These results suggest that some contextual factors may help explain child maltreatment and should be subject to additional research.

Child Maltreatment and Aggressive Behaviors in Early Adolescence: Evidence of Moderation by Parent/Child Relationship Quality

The cycle of violence suggests that maltreatment increases children's aggression, but research shows that many children are resilient to the harms caused by maltreatment. This study examines whether or not parent/child relationship quality accounts for variation in the impact of maltreatment on aggression and hypothesizes that the effect will be weaker for children who have better relationships with their caregivers. Race differences in these effects are also examined. Based on prospective data from a high-risk sample of 620 (207 White and 413 Black) families in the Longitudinal Studies of Child Abuse and Neglect, ordinary least squares regression analyses indicated that youth with at least one official allegation of maltreatment before age 10 had significantly more frequent aggressive behaviors at age 12. The direct effect of maltreatment on aggression did not vary for Black and White youth. However, a significant three-way interaction indicated that parent/child relationship quality buffered the relationship between maltreatment and aggressive behaviors for White but not Black children. Although additional research is required to identify factors that ameliorate the impact of maltreatment for Black youth, the findings support the need for interventions to help children cope with maltreatment and to strengthen parent/child relationships.

Making Evidence-Based Interventions Relevant for Users: A Comparison of Requirements for Dissemination Readiness Across Program Registries

This study compares prevention program registries in current use on their level of support for users seeking to implement evidence-based programs. Despite the importance of registries as intermediaries between researchers and the public, and although previous studies have examined how registries define their standards for methodological soundness and evidence of efficacy, little research has focused on the degree to which registries consider programs' dissemination readiness. The result is that registry users are uncertain whether listed programs and their necessary support materials are even available for implementation. This study evaluates 11 publicly and privately funded prevention registries that review the evidence base of programs seeking to improve child health and prosocial outcomes on the degree to which they use dissemination readiness as an evidentiary criterion for rating programs, and the extent and type of information they provide about dissemination readiness to support real-world implementation. The results show wide variability, with few having standards about dissemination readiness or making evidence-based information about interventions easily accessible to users. Findings indicate the need for registries to (1) do more to assess dissemination readiness before including programs on their website and (2) offer more complete information on dissemination readiness and implementation support to users.

Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

Academic Achievement and Drug Abuse Risk Assessed Using Instrumental Variable Analysis and Co-relative Designs

Importance

Low academic achievement (AA) in childhood and adolescence is associated with increased substance use. Empirical evidence, using longitudinal epidemiologic data, may provide support for interventions to improve AA as a means to reduce risk of drug abuse (DA).

Objective

To clarify the nature of the association between adolescent AA and risk of DA by using instrumental variable and co-relative analysis designs.

Design, Setting, and Participants

This study, assessing nationwide data from individuals born in Sweden between 1971 and 1982, used instrumental variable and co-relative analyses of the association between AA and DA. The instrument was month of birth. Co-relative analyses were conducted in pairs of cousins (263 222 pairs), full siblings (154 295), and monozygotic twins (1623) discordant for AA, with raw results fitted to a genetic model. The AA-DA association was modeled using Cox regression. Data analysis was conducted from October 2017 to January 2018.

Exposures

Academic achievement assessed at 16 years of age (for instrumental variable analyses), and estimated discordance in AA in pairs of monozygotic twins (for co-relative analyses).

Main Outcomes and Measures

Drug abuse registration in national medical, criminal, or pharmacy registries.

Results

This instrumental variable analysis included 934 462 participants (478 341 males and 456 121 females) with a mean (SD) age of 34.7 (4.3) years at a mean follow-up of 19 years. Earlier month of birth was associated with a linear effect on AA, with the regression coefficient per month equaling -0.0225 SDs (95% CI, -0.0231 to -0.0219). Controlling for AA, month of birth had no association with risk of DA (hazard ratio [HR], 1.000; 95% CI, 0.997-1.004). Lower AA had a significant association with risk of subsequent DA registration (HR per SD, 2.33; 95% CI, 2.30-2.35). Instrumental variable analysis produced a substantial but modestly attenuated association (HR, 2.04; 95% CI, 1.75-2.33). Controlling for modest associations between month of birth and parental educational status and DA risk reduced the association to a HR of 1.92 (95% CI, 1.67-2.22). The genetic model applied to the results of co-relative analyses fitted the observed data well and estimated the AA-DA association in monozygotic twins discordant for AA to equal a HR of 1.79 (95% CI, 1.64-1.92).

Conclusions and Relevance

Two different methodological approaches with divergent assumptions both produced results consistent with the hypothesis that the significant association observed between AA at 16 years of age and risk of DA into middle adulthood may be causal. These results provide empirical support for efforts to improve AA as a means to reduce risk of DA.

Neighborhood Parks and Playgrounds: Risky or Protective Contexts for Youth Substance Use?

Neighborhood parks and playgrounds are thought to reduce the stressors of disorganized urban environments by adding greenspace and fostering community cohesion, and, in doing so, may reduce crime and delinquency. Yet, they may also foster criminal behaviors, including substance use, as they can provide areas for would-be offenders to gather without surveillance or fear of being caught. This study provides one of the first examinations of the relationship between the number of parks and playgrounds in a neighborhood and adolescent substance use. To do so, we analyze data from 1,584 youth living in 76 neighborhoods in Chicago. Using multivariate, multilevel Rasch models that control for many other factors that may affect adolescent substance use, we find that youth living in areas with more parks and playgrounds have a greater odds of engaging in substance use compared with those living in areas with fewer parks and centers.

Gender Differences in the Relationship Between Offending, Self-harm and Depression in Adolescence and Young Adulthood

Criminal offending and poor mental health are both recognised as important social problems warranting prevention and intervention efforts. Although there is some evidence for comorbidity between these problems, little research has examined the causal relationship between offending and mental health, particularly for young people. The present investigation addresses these issues by using data from the Sibling Study, a longitudinal investigation of delinquency as self-reported by 731 adolescents and young adults in south-east Queensland, Australia. The results suggest that for young women, but not men, offending behaviours (including the use of illicit drugs) lead to increases in self-harm and depression. Conversely, poor mental health, as indicated by having low self-esteem, a poor future outlook, and a belief that life is very confusing, does not influence subsequent levels of offending for either sex. The implications for prevention and intervention are discussed, with emphasis on the need for the criminal justice system to provide mental health services to young female offenders.

The cycle of victimization: The relationship between childhood maltreatment and adolescent peer victimization

Child maltreatment has been demonstrated to have many short- and long-term harmful consequences for victims, but whether or not child abuse is associated with an increased risk of peer victimization during adolescence is unclear. This study analyzed prospective data from 831 children and parents participating in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) to investigate the relationships between child physical and sexual abuse and adolescent victimization by peers, as well as the potential for gender to moderate these relationships. Results from ordinal logit regression models indicated that children who were physically abused prior to age 12, based on official reports, parent reports, and child reports, had a greater risk of experiencing more intimidation and physical assault by peers at age 16. Having a history of sexual abuse predicted more physical assault but not intimidation. There was no evidence that gender moderated these relationships; in all cases, the relationship between abuse and revictimization was similar for boys and girls. The findings emphasize the need to provide victims of abuse with assistance to help prevent a cycle of victimization.

The Relative Contributions of Parental and Sibling Substance Use to Adolescent Tobacco, Alcohol, and other Drug Use

While research demonstrates that parental tobacco and alcohol use increases the likelihood of children's substance use, it is unclear whether or not sibling use has a greater, weaker, or similar effect. Based upon self-reported information from Australian adolescents, their siblings and parents, this investigation examines the association between siblings' tobacco and alcohol use. The relationship is consistent, moderately strong, and remains significant when controlling for a number of family-related factors, indicating that the shared environment cannot fully explain the extent of similarity in siblings' behaviors. In addition, sibling substance use has a greater effect on adolescent substance use than does smoking or drinking by parents. These findings indicate the need to include siblings and information regarding sibling relationships in prevention and intervention programs.

Effects of Communities That Care on Males' and Females' Drug Use and Delinquency 9 Years After Baseline in a Community-Randomized Trial

This study tested sustained effects of the Communities That Care (CTC) prevention system on health-risking behaviors 9 years after baseline in a community-randomized trial involving 24 towns in seven states. Earlier analyses found sustained effects on abstinence from drug use and delinquency through Grade 12 in a panel of fifth graders. At age 19, 91 % (n = 3986) of the living panel completed the survey. Data were analyzed using generalized linear mixed models. The prevalence of lifetime and current substance use and delinquency were the primary outcomes. Secondary outcomes included substance use disorders, major depression, suicidality, educational attainment, and sexual risk behaviors. CTC had a significant overall effect across lifetime measures of the primary outcomes for males, but not for females or the full sample, although lifetime abstinence from delinquency in the full sample was significantly higher in CTC communities (ARR = 1.16). Males in CTC communities also continued to show greater lifetime abstinence from cigarette smoking (ARR = 1.22). CTC did not have a sustained effect on current substance use and delinquency nor did it improve the secondary outcomes at age 19 for either gender. Communities using CTC may need to extend their prevention planning to include the high school years to sustain effects on drug use and delinquency beyond high school for both genders.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01088542.

Variation in the sustained effects of the communities that care prevention system on adolescent smoking, delinquency, and violence

Communities That Care (CTC) is a universal, science-based community prevention system designed to reduce risk, enhance protection, and prevent adolescent health and behavior problems community wide. CTC has been found to have sustained effects on cigarette use and delinquent and violent behaviors in grade 10 in a panel of 4,407 students followed from fifth grade in a community randomized trial. It is important to test variation in the effects of this prevention system designed to be universal to understand for whom it is most effective and whether it fails to produce change or leads to iatrogenic effects for certain categories of individuals. The present study examined variation in the sustained effects of CTC on tenth-grade cigarette use and delinquent and violent behaviors. Interaction analyses suggest that the effect of CTC did not differ between those who had high levels of community-targeted risk factors at baseline or had already engaged in substance use, delinquency, or violence at baseline versus those who had not. Although CTC reduced the prevalence of both girls' and boys' problem behaviors, the effect on delinquency was marginally (p = 0.08) larger for boys than for girls.

A multi-level analysis of the impact of neighborhood structural and social factors on adolescent substance use

BACKGROUND

This paper examined the effects of neighborhood structural (i.e., economic disadvantage, immigrant concentration, residential stability) and social (e.g., collective efficacy, social network interactions, intolerance of drug use, legal cynicism) factors on the likelihood of any adolescent tobacco, alcohol, and marijuana use.

METHODS

Analyses drew upon information from the Project on Human Development in Chicago Neighborhoods (PHDCN). Data were obtained from a survey of adult residents of 79 Chicago neighborhoods, two waves of interviews with 1657 to 1664 care-givers and youth aged 8 to 16 years, and information from the 1990 U.S. Census Bureau. Hierarchical Bernoulli regression models estimated the impact of neighborhood factors on substance use controlling for individual-level demographic characteristics and psycho-social risk factors.

RESULTS

Few neighborhood factors had statistically significant direct effects on adolescent tobacco, alcohol or marijuana use, although youth living in neighborhoods with greater levels of immigrant concentration were less likely to report any drinking.

CONCLUSION

Additional theorizing and more empirical research are needed to better understand the ways in which contextual influences affect adolescent substance use and delinquency.

Benefit-Cost Analysis of a Randomized Evaluation of Communities That Care: Monetizing Intervention Effects on the Initiation of Delinquency and Substance Use Through Grade 12

OBJECTIVE

To determine whether the Communities That Care (CTC) prevention system is a cost-beneficial intervention.

METHODS

Data were from a longitudinal panel of 4,407 youth participating in a randomized controlled trial including 24 towns in 7 states, matched in pairs within state and randomly assigned to condition. Significant differences favoring intervention youth in sustained abstinence from delinquency, alcohol use, and tobacco use through Grade 12 were monetized and compared to economic investment in CTC.

RESULTS

CTC was estimated to produce $4,477 in benefits per youth (discounted 2011 dollars). It cost $556 per youth to implement CTC for 5 years. The net present benefit was $3,920. The benefit-cost ratio was $8.22 per dollar invested. The internal rate of return was 21%. Risk that investment would exceed benefits was minimal. Investment was expected to be recouped within 9 years. Sensitivity analyses in which effects were halved yielded positive cost-beneficial results.

CONCLUSIONS

CTC is a cost-beneficial, community-based approach to preventing initiation of delinquency, alcohol use, and tobacco use. CTC is estimated to generate economic benefits that exceed implementation costs when disseminated with fidelity in communities.

Exposure to violence, substance use, and neighborhood context

Adolescent exposure to violence and substance use are both public health problems, but how neighborhood context contributes to these outcomes is unclear. This study uses prospective data from 1416 adolescents to examine the direct and interacting influences of victimization and neighborhood factors on adolescent substance use. Based on hierarchical Bernoulli regression models that controlled for prior substance use and multiple individual-level factors, exposure to violence significantly increased the likelihood of marijuana use but not alcohol use or binge drinking. There was little evidence that community norms regarding adolescent substance use influenced rates of substance use or moderated the impact of victimization. Community disadvantage did not directly impact substance use, but the relationship between victimization and marijuana use was stronger for those in neighborhoods with greater disadvantage. The results suggest that victimization is particularly likely to affect adolescents' marijuana use, and that this relationship may be contingent upon neighborhood economic conditions.

Effects of the Communities That Care system on cross-sectional profiles of adolescent substance use and delinquency

INTRODUCTION

Adolescent substance use and delinquency are major public health problems. Although community-based prevention strategies have been recommended to produce population-level reductions in rates of substance use and delinquency, few models show evidence of effectiveness.

PURPOSE

To test the efficacy of a community-based prevention system, Communities That Care (CTC), in reducing community rates of problem behaviors, particularly effects on specific profiles of adolescent substance use and delinquency in eighth- and tenth-graders.

METHODS

Twenty-four communities were randomized to CTC intervention or control groups. Data were collected from 14,099 8th- and 10th-grade students in these communities using anonymous cross-sectional surveys in 2004 and 2010 and analyzed in 2012. Outcomes were four different profiles of self-reported substance use and delinquency in 8th grade and five profiles in 10th grade.

RESULTS

In the cross-sectional 2010 data, there was no intervention effect on the probability of experimenting with substances or of substance use coupled with delinquent activities for either grade. However, tenth-graders in intervention communities were significantly less likely to be alcohol users than those in control communities (OR=0.69, CI=0.48, 1.00).

CONCLUSIONS

Cross-sectional population surveys showed evidence of CTC effects in reducing tenth-grade alcohol users but not experimenters. A community-wide reduction in adolescent alcohol use is important because alcohol is the most commonly used illicit substance during adolescence, and early initiation of alcohol use has been associated with alcohol-related disorders in adulthood. Failure to find hypothesized effects on experimenters qualifies these results.

The Moderating Effects of Peer and Parental Support on the Relationship Between Vicarious Victimization and Substance Use

General strain theory (GST) hypothesizes that youth are more likely to engage in delinquency when they experience vicarious victimization, defined as knowing about or witnessing violence perpetrated against others, but that this relationship may be attenuated for those who receive social support from significant others. Based on prospective data from youth aged 8 to 17 participating in the Project on Human Development in Chicago Neighborhoods (PHDCN), this article found mixed support for these hypotheses. Controlling for prior involvement in delinquency, as well as other risk and protective factors, adolescents who reported more vicarious victimization had an increased likelihood of alcohol use in the short term, but not the long term, and victimization was not related to tobacco or marijuana use. Peer support did not moderate the relationship between vicarious victimization and substance use, but family support did. In contrast to strain theory's predictions, the relationship between vicarious victimization and substance use was stronger for those who had higher compared with lower levels of family support. Implications of these findings for strain theory and future research are discussed.

Victimization experiences and adolescent substance use: does the type and degree of victimization matter?

Evidence indicates an association between victimization and adolescent substance use, but the exact nature of this relationship remains unclear. Some research focuses solely on the consequences of experiencing indirect victimization (e.g., witnessing violence), others examine direct victimization (e.g., being personally victimized), and still others combine both forms of victimization without assessing the relative impact of each on substance use. Furthermore, many of these studies only assess these relationships in the short-term using cross-sectional data. This study uses data from the Project on Human Development in Chicago Neighborhoods (PHDCN) to explore the impact of experiencing only indirect victimization, only direct victimization, both forms of victimization, and no victimization on substance use at two time points during adolescence. We find that of those adolescents who are victimized, the majority experience indirect victimization only, followed by experiencing both forms of victimization, and experiencing direct victimization only. Each of the victimization experiences were associated with increased contemporaneous substance use, with the strongest effects for those experiencing multiple forms of violence. For all victims, however, the impact on substance use declined over time.

Avoiding violent victimization among youths in urban neighborhoods: the importance of street efficacy

OBJECTIVES

We investigated how street efficacy--the perceived ability to avoid dangerous and unsafe situations--is related to violent victimization across different levels of neighborhood disadvantage.

METHODS

We used 2 waves of self-report data collected between 1995 and 1999 from 1865 youths in the 9-, 12-, and 15-year-old cohorts of the Project on Human Development in Chicago Neighborhoods to measure violent victimization, street efficacy, and risk factors for violent victimization. We also analyzed data from the 1990 US Census to measure categories of neighborhood concentrated disadvantage for which the cohorts of youths reside. We used logistic regression models to examine the association between street efficacy and violent victimization while we controlled for demographic, family and parenting, self-control, and behavioral and lifestyle variables.

RESULTS

Logistic regression results showed that street efficacy had its strongest association with violent victimization in the most disadvantaged neighborhoods (odds ratio = 0.700; 95% confidence interval = 0.55, 0.89).

CONCLUSIONS

Our findings support the need to teach youths ways to successfully navigate potentially violent situations in environments that pose moderate to high risks for exposure to violence.

The effects of exposure to violence and victimization across life domains on adolescent substance use

This study uses longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN) to examine the effects of exposure to school violence, community violence, child abuse, and parental intimate partner violence (IPV) on youths' subsequent alcohol and marijuana use. We also examine the cumulative effects of being exposed to violence across these domains. Longitudinal data were obtained from 1,655 adolescents and their primary caregivers participating in the PHDCN. The effects of adolescents' exposure to various forms of violence across different life domains were examined relative to adolescents' frequency of alcohol and marijuana use three years later. Multivariate statistical models were employed to control for a range of child, parent, and family risk factors. Exposure to violence in a one-year period increased the frequency of substance use three years later, though the specific relationships between victimization and use varied for alcohol and marijuana use. Community violence and child abuse, but not school violence or exposure to IPV, were predictive of future marijuana use. None of the independent measures of exposure to violence significantly predicted future alcohol use. Finally, the accumulation of exposure to violence across life domains was detrimental to both future alcohol and marijuana use. The findings support prior research indicating that exposure to multiple forms of violence, across multiple domains of life, negatively impacts adolescent outcomes, including substance use. The findings also suggest that the context in which exposure to violence occurs should be considered in future research, since the more domains in which youth are exposed to violence, the fewer "safe havens" they have available. Finally, a better understanding of the types of violence youth encounter and the contexts in which these experiences occur can help inform intervention efforts aimed at reducing victimization and its negative consequences.

Differential Effects of Parental Controls on Adolescent Substance Use: For Whom Is the Family Most Important?

OBJECTIVE

Social control theory assumes that the ability of social constraints to deter juvenile delinquency will be invariant across individuals. This paper tests this hypothesis and examines the degree to which there are differential effects of parental controls on adolescent substance use.

METHODS

Analyses are based on self-reported data from 7,349 10th-grade students and rely on regression mixture models to identify latent classes of individuals who may vary in the effects of parental controls on drug use.

RESULTS

All parental controls were significantly related to adolescent drug use, with higher levels of control associated with less drug use. The effects of instrumental parental controls (e.g., parental management strategies) on drug use were shown to vary across individuals, while expressive controls (e.g., parent/child attachment) had uniform effects in reducing drug use. Specifically, poor family management and more favorable parental attitudes regarding children's drug use and delinquency had stronger effects on drug use for students who reported greater attachment to their neighborhoods, less acceptance of adolescent drug use by neighborhood residents, and fewer delinquent peers, compared to those with greater community and peer risk exposure. Parental influences were also stronger for Caucasian students versus those from other racial/ethnic groups, but no differences in effects were found based on students' gender or commitment to school.

CONCLUSIONS

The findings demonstrate support for social control theory, and also help to refine and add precision to this perspective by identifying groups of individuals for whom parental controls are most influential. Further, they offer an innovative methodology that can be applied to any criminological theory to examine the complex forces that result in illegal behavior.

THE CYCLE OF VIOLENCE IN CONTEXT: EXPLORING THE MODERATING ROLES OF NEIGHBORHOOD DISADVANTAGE AND CULTURAL NORMS

Although the cycle of violence theory has received empirical support (Widom, 1989a, 1989b), in reality, not all victims of child physical abuse become involved in violence. Therefore, little is known regarding factors that may moderate the relationship between abuse and subsequent violence, particularly contextual circumstances. The current investigation used longitudinal data from 1,372 youth living in 79 neighborhoods who participated in the Project on Human Development in Chicago Neighborhoods (PHDCN), and it employed a multivariate, multilevel Rasch model to explore the degree to which neighborhood disadvantage and cultural norms attenuate or strengthen the abuse-violence relationship. The results indicate that the effect of child physical abuse on violence was weaker in more disadvantaged communities. Neighborhood cultural norms regarding tolerance for youth delinquency and fighting among family and friends did not moderate the child abuse-violence relationship, but each had a direct effect on violence, such that residence in neighborhoods more tolerant of delinquency and fighting increased the propensity for violence. These results suggest that the cycle of violence may be contextualized by neighborhood structural and cultural conditions.

Gender differences in the effects of exposure to violence on adolescent substance use

To date, research exploring gender differences in the relationship between exposure to community violence and substance use has been limited. This study employs longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN) to assess the exposure to violence-substance use relationship and explore whether this relationship varies by gender. We find that the two forms of exposure to violence-direct (primary) and indirect (secondary)-independently increase the frequency of subsequent alcohol use, binge drinking, and marijuana use among males and females. One gender difference emerged, as females who had been directly victimized engaged in more frequent binge drinking than males who had been directly victimized. Across both sexes, the effect of each form of violence weakened when other predictors of substance use were included in the models. Future directions for this research are discussed, including policy recommendations to help adolescents cope with victimization experiences.

Racial/Ethnic Differences in the Relationship Between Neighborhood Disadvantage and Adolescent Substance Use

Although social disorganization theory hypothesizes that neighborhood characteristics influence youth delinquency, the impact of neighborhood disadvantage on adolescent substance use and racial/ethnic differences in this relationship have not been widely investigated. The present study examines these issues using longitudinal data from 1,856 African American, Hispanic, and Caucasian adolescents participating in the Project on Human Development in Chicago Neighborhoods (PHDCN). The results indicated that neighborhood disadvantage did not significantly increase the likelihood of substance use for the full sample. When relationships were analyzed by race/ethnicity, one significant (p ≤ .10) effect was found; disadvantage increased alcohol use among African Americans only. The size of this effect differed significantly between African American and Hispanic youth. In no other cases did race/ethnicity moderate the impact of disadvantage on substance use. These results suggest that disadvantage is not a strong predictor of adolescent substance use, although other features of the neighborhood may affect such behaviors.

Sustaining the utilization and high quality implementation of tested and effective prevention programs using the communities that care prevention system

This paper describes the extent to which communities implementing the Communities That Care (CTC) prevention system adopt, replicate with fidelity, and sustain programs shown to be effective in reducing adolescent drug use, delinquency, and other problem behaviors. Data were collected from directors of community-based agencies and coalitions, school principals, service providers, and teachers, all of whom participated in a randomized, controlled evaluation of CTC in 24 communities. The results indicated significantly increased use and sustainability of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, during the active phase of the research project when training, technical assistance, and funding were provided to intervention sites, and 2 years following provision of such resources. At both time points, intervention communities also delivered prevention services to a significantly greater number of children and parents. The quality of implementation was high in both conditions, with only one significant difference: CTC sites were significantly more likely than control sites to monitor the quality of implementation during the sustainability phase of the project.

Worldwide application of prevention science in adolescent health

The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable. In the past 30 years new discoveries have led to prevention science being established as a discipline designed to mitigate these problem behaviours. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviours. Risks cluster across development to produce early accumulation of risk in childhood and more pervasive risk in adolescence. This understanding has led to the construction of developmentally appropriate prevention policies and programmes that have shown short-term and long-term reductions in these adolescent problem behaviours. We describe the principles of prevention science, provide examples of efficacious preventive interventions, describe challenges and potential solutions to take efficacious prevention policies and programmes to scale, and conclude with recommendations to reduce the burden of adolescent mortality and morbidity worldwide through preventive intervention.

Not quite normal: Consequences of violating the assumption of normality in regression mixture models

Regression mixture models are a new approach for finding differential effects which have only recently begun to be used in applied research. This approach comes at the cost of the assumption that error terms are normally distributed within classes. The current study uses Monte Carlo simulations to explore the effects of relatively minor violations of this assumption, the use of an ordered polytomous outcome is then examined as an alternative which makes somewhat weaker assumptions, and finally both approaches are demonstrated with an applied example looking at differences in the effects of family management on the highly skewed outcome of drug use. Results show that violating the assumption of normal errors results in systematic bias in both latent class enumeration and parameter estimates. Additional classes which reflect violations of distributional assumptions are found. Under some conditions it is possible to come to conclusions that are consistent with the effects in the population, but when errors are skewed in both classes the results typically no longer reflect even the pattern of effects in the population. The polytomous regression model performs better under all scenarios examined and comes to reasonable results with the highly skewed outcome in the applied example. We recommend that careful evaluation of model sensitivity to distributional assumptions be the norm when conducting regression mixture models.

Effects of Communities That Care on the adoption and implementation fidelity of evidence-based prevention programs in communities: results from a randomized controlled trial

This paper describes findings from the Community Youth Development Study (CYDS), a randomized controlled trial of the Communities That Care (CTC) prevention system, on the adoption and implementation fidelity of science-based prevention programming in 24 communities. Data were collected using the Community Resource Documentation (CRD), which entailed a multi-tiered sampling process and phone and web-based surveys with directors of community-based agencies and coalitions, school principals, service providers, and teachers. Four years after the initiation of the CTC prevention system, the results indicated increased use of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, and significant differences favoring the intervention communities in the numbers of children and families participating in these programs. Few significant differences were found regarding implementation quality; respondents from both intervention and control communities reported high rates of implementation fidelity across the services provided.

Effects of Communities That Care on the adoption and implementation fidelity of evidence-based prevention programs in communities: results from a randomized controlled trial

This paper describes findings from the Community Youth Development Study (CYDS), a randomized controlled trial of the Communities That Care (CTC) prevention system, on the adoption and implementation fidelity of science-based prevention programming in 24 communities. Data were collected using the Community Resource Documentation (CRD), which entailed a multi-tiered sampling process and phone and web-based surveys with directors of community-based agencies and coalitions, school principals, service providers, and teachers. Four years after the initiation of the CTC prevention system, the results indicated increased use of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, and significant differences favoring the intervention communities in the numbers of children and families participating in these programs. Few significant differences were found regarding implementation quality; respondents from both intervention and control communities reported high rates of implementation fidelity across the services provided.

Gender differences in the effects of exposure to intimate partner violence on adolescent violence and drug use

OBJECTIVE

This study investigated the long-term effects of exposure to intimate partner violence in the home on adolescent violence and drug use and gender differences in these relationships. Although the general relationship between exposure to IPV and negative outcomes for youth has been demonstrated in past research, gender differences in the effects of IPV on adolescents have been rarely assessed using longitudinal data.

METHODS

Longitudinal data was obtained from 1,315 adolescents and their primary caregivers participating in the Project on Human Development in Chicago Neighborhoods (PHDCN). The sample was 51% female and ethnically diverse (45% Hispanic, 37% African-American, and 14% Caucasian). Two waves of data were assessed to examine the effects of exposure to IPV, reported by caregivers when their children were aged 12 and 15, on violence and drug use, reported by adolescents 3 years later. Multivariate statistical models were employed to control for a range of child, parent, family, and neighborhood risk factors.

RESULTS

Exposure to IPV did not significantly predict subsequent violence among males or females in multivariate analyses. IPV exposure was significantly related to the frequency of drug use for females but did not predict drug use among males. This gender difference was not statistically significant, however, which suggests more similarities than differences in the relationship between exposure to IPV and subsequent violence and drug use.

CONCLUSIONS

This study supports prior research indicating that exposure to IPV can negatively impact adolescent development, but it suggests that these effects may be more likely to influence some outcomes (e.g., drug use) than others (e.g., interpersonal violence). The findings also emphasize the need for additional research examining the overall impact of IPV on adolescent problem behaviors and gender differences in these relationships, including longitudinal studies and investigations that control for a range of other important predictors. A better understanding of these relationships can help inform intervention efforts aimed at ensuring that adolescents living in violent households receive timely and appropriate services to help prevent the occurrence of future problem behaviors.

How Do Families Matter? Age and Gender Differences in Family Influences on Delinquency and Drug Use

Parenting practices, age, and gender all influence adolescent delinquency and drug use, but few studies have examined how these factors interact to affect offending. Using data from 18,512 students in Grades 6, 8, 10 and 12, this study found that across grades, parents treated girls and boys differently, but neither sex received preferential treatment for all practices assessed, and younger children reported more positive parenting than older students. Family factors were significantly related to delinquency and drug use for both sexes and for all grades. However, particular parenting practices showed gender and age differences in the degree to which they were related to outcomes, which indicates complexities in parent/child interactions that must be taken into account when investigating the causes of adolescent offending and when planning strategies to prevent the development of problem behaviors.

Prevention Service System Transformation Using Communities That Care

This study examines prevention system transformation as part of a community-randomized controlled trial of Communities That Care (CTC). Using data from surveys of community leaders, we examine differences between CTC and control communities 4.5 years after CTC implementation. Significantly higher levels of adopting a science-based approach to prevention observed in CTC communities compared to controls in 2004 were maintained in 2007. Leaders in CTC communities expressed a willingness to contribute significantly more funds to prevention than did leaders in control communities in 2007. Significant differences in levels of community collaboration observed in 2004 were not maintained in 2007. Leaders in CTC communities with high poverty rates and large minority student populations reported higher levels of community norms against drug use and greater use of the social development strategy, respectively, than did leaders in control communities with similar characteristics.

Engaging communities to prevent underage drinking

Community-based efforts offer broad potential for achieving population-level reductions in alcohol misuse among youth and young adults. A common feature of successful community strategies is reliance on local coalitions to select and fully implement preventive interventions that have been shown to be effective in changing factors that influence risk of youth engaging in alcohol use, including both proximal influences and structural and/or environmental factors related to alcohol use. Inclusion of a universal, school-based prevention curriculum in the larger community-based effort is associated with the reduction of alcohol use by youth younger than 18 years of age and can help reach large numbers of youth with effective alcohol misuse prevention.

Disseminating Effective Community Prevention Practices: Opportunities for Social Work Education

In the United States about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect 1 in 5 families and cost $247 million annually (O'Connell, Boat, & Warner, 2009). Some strategies for preventing mental, emotional, and behavioral disorders in young people have been developed, tested, and found to be effective in preventing the onset, persistence, and severity of psychological disorders, drug abuse, and delinquency. Unfortunately, tested and effective prevention policies, programs, and practices are not widely used (O'Connell, Boat, & Warner, 2009). This paper highlights recent advances in prevention science and describes some opportunities and challenges in advancing the use of science-based prevention in communities. The chapter concludes by exploring the potential role of social work education in developing a workforce ready to increase community access to effective prevention strategies.

If At First You Don't Succeed…Keep Trying: Strategies to Enhance Coalition/School Partnerships to Implement School-Based Prevention Programming

Community-based coalitions have been advocated as a promising mechanism to reduce youth involvement in violence, delinquency, and substance use, but coalitions have not always been successful in ensuring widespread adoption of evidence-based prevention strategies. This paper describes the strategies used by 12 community coalitions to collaborate with schools to select and implement school-based prevention programs, including the barriers to establishing coalition/school partnerships and methods for overcoming these challenges.In this five-year research project, all communities adopted school-based prevention programs. Coalitions helped achieve this outcome by building relationships with school personnel, fostering champions within the school, creating win/win situations in which schools' needs were addressed, and initiating school-based prevention programs as pilot efforts that were later expanded. While success was achieved in all cases, persistent messaging about the importance of youth problem behaviours was needed to overcome schools' concerns about using academic time to teach prevention messages and replacing current practices with unfamiliar programs.Findings from this study can be used by coalitions and prevention scientists that want to partner with schools to reach a large population of students with effective prevention programming. The results are also of value to researchers and practitioners interested in fostering widespread dissemination of other types of evidence-based programs.

Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: a test of Communities That Care

OBJECTIVE

To test whether the Communities That Care (CTC) prevention system reduces adolescent alcohol, tobacco, and other drug use and delinquent behavior communitywide.

DESIGN

The Community Youth Development Study is the first randomized trial of CTC.

SETTING

In 2003, 24 small towns in 7 states, matched within state, were randomly assigned to control or CTC conditions.

PARTICIPANTS

A panel of 4407 fifth-grade students was surveyed annually through eighth grade. Intervention A coalition of community stakeholders received training and technical assistance to install the CTC prevention system. They used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their community's specific profile from a menu of effective programs for families, schools, and youths aged 10 to 14 years.

MAIN OUTCOME MEASURES

Incidence and prevalence of alcohol, tobacco, and other drug use and delinquent behavior by spring of grade 8.

RESULTS

The incidences of alcohol, cigarette and smokeless tobacco initiation, and delinquent behavior were significantly lower in CTC than in control communities for students in grades 5 through 8. In grade 8, the prevalences of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last 2 weeks, and the number of different delinquent behaviors committed in the last year were significantly lower for students in CTC communities.

CONCLUSION

Using the CTC system to reduce health-risking behaviors in adolescents can significantly reduce these behaviors communitywide.

Translational Research in Action: Implementation of the Communities That Care Prevention System in 12 Communities

Translational research (Pentz, Jasuja, Rohrbach, Sussman, & Bardo, 2006; Woolf, 2008) is concerned with moving advances in prevention science into everyday practice in communities, yet there are few models for ensuring this transfer of knowledge. Communities That Care (CTC) provides a planned, structured, and data-driven system that trains community prevention coalitions to select evidence-based programs and replicate them with strong implementation fidelity. This paper describes the implementation of the CTC prevention system in 12 communities participating in the Community Youth Development Study.The results indicated that intervention communities enacted, on average, 90% of the core components of the CTC system, and achieved high rates of implementation fidelity when replicating school, afterschool, and parent training programs. These results held over time; communities successfully launched their prevention coalitions and programs and maintained the quality of their prevention services over five years. These results indicate that the CTC system can be used to foster translational research.

Bridging science to practice: achieving prevention program implementation fidelity in the community youth development study

This paper describes the development, application, and results of an implementation monitoring component of the Communities That Care (CTC) prevention framework used in the Community Youth Development Study (CYDS) to ensure high-fidelity prevention program implementation. This system was created based on research that community-based implementation of evidence-based prevention programs often includes adaptations in program design, content, or manner of delivery (Gottfredson and Gottfredson, Journal of research in crime and delinquency, 39, 3-35, 2002; Hallfors and Godette, Health Education Research, 17, 461-470, 2002; Wandersman and Florin, American Psychologist, 58, 441-448, 2003). A lack of fidelity to the implementation standards delineated by program designers is one indicator of a gap between prevention science and practice which can lessen the likelihood that communities will realize the positive participant effects demonstrated in research trials. By using the CTC model to select and monitor the quality of prevention activities, the 12 CYDS communities replicated 13 prevention programs with high rates of adherence to the programs' core components and in accordance with dosage requirements regarding the number, length, and frequency of sessions. This success indicates the potential of the CTC program implementation monitoring system to enhance community Prevention Delivery Systems (Wandersman et al. American Journal of Community Psychology, this issue) and improve the likelihood of desired participant changes.

Using Multilevel Mixtures to Evaluate Intervention Effects in Group Randomized Trials

There is evidence to suggest that the effects of behavioral interventions may be limited to specific types of individuals, but methods for evaluating such outcomes have not been fully developed. This study proposes the use of finite mixture models to evaluate whether interventions, and, specifically, group randomized trials, impact participants with certain characteristics or levels of problem behaviors. This study uses latent classes defined by clustering of individuals based on the targeted behaviors and illustrates the model by testing whether a preventive intervention aimed at reducing problem behaviors affects experimental users of illicit substances differently than problematic substance users or those individuals engaged in more serious problem behaviors. An illustrative example is used to demonstrate the identification of latent classes, specification of random effects in a multilevel mixture model, independent validation of latent classes, and the estimation of power for the proposed models to detect intervention effects. This study proposes specific steps for the estimation of multilevel mixture models and their power and suggests that this model can be applied more broadly to understand the effectiveness of interventions.

Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity

Background

Widespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured.

Methods

This paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST) drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness.

Results

Although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers), ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence). Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage). Student behavior and use of interactive teaching techniques (quality of delivery) were positively related. No variables were related to student participation (student responsiveness).

Conclusion

Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that organizations should consider to ensure fidelity, such as selecting programs with features that minimize complexity while maximizing flexibility. Time constraints in the classroom should be considered when choosing a program. Student behavior also influences program delivery, so schools should train teachers in the use of classroom management skills. This project involved comprehensive program monitoring and technical assistance that likely facilitated the identification and resolution of problems and contributed to the overall high quality of implementation. Schools should recognize the importance of training and technical assistance to ensure quality program delivery.

Gender similarities and differences in the association between risk and protective factors and self-reported serious delinquency

Boys consistently report higher rates of serious offending during late adolescence than do girls, yet research is mixed regarding the ways in which males and females may differentially experience risk and protection in their families, schools, peer groups, and as individuals. This article examines gender differences in 22 psychosocial risk and protective factors associated with serious delinquency. Based on self-reported information from 7,829 10th-grade students completing the Communities That Care Youth Survey, all psychosocial factors were significantly related to serious delinquency for both sexes. For 12 of the 22 factors, the strength of the association was significantly greater for males, and, for 18 factors, boys reported higher levels of risk exposure and lower levels of protection than did girls. Together, these findings suggest that boys' greater involvement in serious delinquency is due to the combination of experiencing more risk and less protection than girls and the greater association of these predictors with serious delinquency for boys compared to girls. Implications for prevention programming are discussed.

Early risk factors for adolescent antisocial behaviour: an Australian longitudinal study

OBJECTIVE

This investigation utilizes data from an Australian longitudinal study to identify early risk factors for adolescent antisocial behaviour.

METHOD

Analyses are based on data from the Mater University Study of Pregnancy, an on-going longitudinal investigation of women's and children's health and development involving over 8000 participants. Five types of risk factors (child characteristics, perinatal factors, maternal/familial characteristics, maternal pre- and post-natal substance use and parenting practices) were included in analyses and were based on maternal reports, child assessments and medical records. Adolescent antisocial behaviour was measured when children were 14 years old, using the delinquency subscale of the Child Behaviour Checklist.

RESULTS

Based on a series of logistic regression models, significant risk factors for adolescent antisocial behaviour included children's prior problem behaviour (i.e. aggression and attention/restlessness problems at age 5 years) and marital instability, which doubled or tripled the odds of antisocial behaviour. Perinatal factors, maternal substance use, and parenting practices were relatively poor predictors of antisocial behaviour.

CONCLUSIONS

Few studies have assessed early predictors of antisocial behaviour in Australia and the current results can be used to inform prevention programs that target risk factors likely to lead to problem outcomes for Australian youth.

Sibling influences on adolescent delinquent behaviour: an Australian longitudinal study

This article examines sibling influences on adolescent delinquency at age 14, using data from an Australian longitudinal study of 374 same- and mixed-sex sibling pairs. Based on maternal and self-reports, a moderately strong association between siblings' delinquency is found. The relationship remains significant controlling for childhood aggression and family environment factors measured during childhood (age 5) and adolescence (age 14), using both standardized instruments and new scales. This effect varies according to the sex composition of the sibling pair and is stronger for males and those whose parents have been arrested. The need for increased attention to sibling influences by researchers and prevention practitioners is discussed.

The short- and long-term effects of adolescent violent victimization experienced within the family and community

Adolescents face high rates of victimization, yet little is known regarding the criminal consequences of these experiences. Using data from the National Youth Survey, this investigation compared the relative and combined effects of adolescent violent victimization perpetrated by family and nonfamily members on self-reported criminal offending from adolescence to early adulthood. The results demonstrate that both types of violence have an immediate and sustained impact on criminal involvement, although the effect is somewhat stronger for nonfamily victimization, and for both types, the relationship tends to weaken over time. In addition, those experiencing both types of victimization report a higher frequency of offending compared to those experiencing only one type. The findings indicate the need for prevention programs aimed at decreasing the prevalence of adolescent victimization, as well as intervention efforts to help victims from becoming offenders.

The gender cycle of violence: comparing the effects of child abuse and neglect on criminal offending for males and females

Despite ample evidence of the relationship between childhood maltreatment and offending, the ways in which the cycle of violence operates remain unclear. For example, feminist researchers contend that female victims are more likely to become offenders, compared to male victims, but more research is needed to substantiate this claim. Moreover, the contradictions in research findings-with retrospective research demonstrating that most offenders have histories of abuse, and prospective work indicating that the majority of victims do not become involved in crime-highlight the importance of identifying the intermediating variables that lead from maltreatment to criminality. This review summarizes investigations related to the cycle of violence, discusses the intermediating circumstances that may affect the cycle, and identifies whether or not these processes are similar for women and men.