Mechanisms linking high school graduation to health disparities in young adulthood: a longitudinal analysis of the role of health behaviours, psychosocial stressors, and health insurance

OBJECTIVES

This study examined three competing mechanisms in the link between educational attainment and health among young adults: (a) a health behaviour mechanism; (b) a psychosocial stressor mechanism; and (c) a health insurance mechanism. The central research question was the pervasiveness and specificity of these mechanisms in the link between low educational attainment and health outcomes during young adulthood.

STUDY DESIGN

A prospective longitudinal study was conducted with 808 men and women followed to age 33 years in the USA.

METHODS

Health outcomes included major depressive disorder, obesity, chronic health conditions, and self-rated health. The focal predictor was educational attainment at age 21. The roles of the health behaviour mechanism (heavy episodic drinking, cigarette smoking, and meeting physical activity guidelines), the psychosocial stressor mechanism (stressful life events, perceived financial stress, and lack of control at work), and having health insurance (either through their employer or union or via family members) in the link between education and varying health outcomes were assessed using path analyses.

RESULTS

Lack of health insurance emerged as a statistically significant explanatory factor underlying the association of education with depression and self-rated health. Health behaviours, specifically smoking and physical activity, were statistically significant intervening factors for obesity and self-rated health.

CONCLUSIONS

The processes linking educational attainment to health inequalities begin unfolding during young adulthood. The salience of different mechanisms is specific to a health outcome rather than pervasive across multiple health outcomes. Public health policies with a broad spectrum of components, particularly focussing on smoking, physical activity, and lack of health insurance, are recommended to promote educational equalities in multiple health outcomes among young adults.

General and substance-specific predictors of young adult nicotine dependence, alcohol use disorder, and problem behavior: replication in two samples

BACKGROUND

This paper presents two replications of a heuristic model for measuring environment in studies of gene-environment interplay in the etiology of young adult problem behaviors.

METHODS

Data were drawn from two longitudinal, U.S. studies of the etiology of substance use and related behaviors: the Raising Healthy Children study (RHC; N=1040, 47% female) and the Minnesota Twin Family Study (MTFS; N=1512, 50% female). RHC included a Pacific Northwest, school-based, community sample. MTFS included twins identified from state birth records in Minnesota. Both studies included commensurate measures of general family environment and family substance-specific environments in adolescence (RHC ages 10-18; MTFS age 18), as well as young adult nicotine dependence, alcohol and illicit drug use disorders, HIV sexual risk behavior, and antisocial behavior (RHC ages 24, 25; MTFS age 25).

RESULTS

Results from the two samples were highly consistent and largely supported the heuristic model proposed by Bailey et al. (2011). Adolescent general family environment, family smoking environment, and family drinking environment predicted shared variance in problem behaviors in young adulthood. Family smoking environment predicted unique variance in young adult nicotine dependence. Family drinking environment did not appear to predict unique variance in young adult alcohol use disorder.

CONCLUSIONS

Organizing environmental predictors and outcomes into general and substance-specific measures provides a useful way forward in modeling complex environments and phenotypes. Results suggest that programs aimed at preventing young adult problem behaviors should target general family environment and family smoking and drinking environments in adolescence.

Educational inequalities in the co-occurrence of mental health and substance use problems, and its adult socio-economic consequences: a longitudinal study of young adults in a community sample

OBJECTIVES

To examine the relationship between the co-occurrence of mental health and substance use problems and socio-economic status (SES).

STUDY DESIGN

A prospective longitudinal study of 808 males and females followed to age 30.

METHODS

Survey data were used to derive latent classes (profiles) of mental health (depression, anxiety) and substance use (alcohol, nicotine, and marijuana [cannabis]) problems at age 27. Analyses examined the associations of these profiles with earlier educational attainment (high school diploma) and indicators of SES at age 30.

RESULTS

Latent Class Analysis produced four profiles: a low disorder symptoms group, a licit substance use disorder symptoms group (alcohol and nicotine), a mental health disorder symptoms group, and a comorbid group. Earning a high school diploma by age 21 decreased the odds of belonging to the comorbid group or the licit substance use disorder symptoms group when compared to the low disorder symptoms group. These disorder profiles also were found to adversely impact subsequent adult SES. The adverse impact was more evident in income maintenance and wealth accumulation by age 30 than market or non-market labour force participation.

CONCLUSIONS

Earning a high school diploma lessens the risk of co-occurring mental health and substance use problems which contribute to economic instability in young adulthood. Findings underscore the importance of public health programmes to reduce the incidence of mental health and substance use problems and their associated high costs to individuals and to society.

Communities That Care, Core Elements and Context: Research of Implementation in Two Countries

This paper describes the degree to which implementation of the Communities That Care (CTC) prevention operating system was reached in 22 communities in 2 countries: the US (12 communities) and the Netherlands (10 communities). Core elements of CTC and results from two implementation measures conducted in both countries are reported here. Similarities and differences of the implementation process are discussed.

Youth alcohol and other drug use in the United States and Australia: a cross-national comparison of three state-wide samples

Although youth drug and alcohol harm minimization policies in Australia are often contrasted with the abstinence and zero tolerance policies adopted in the United States, there has been little research directly comparing youth substance use behaviour in the two countries. Three state representative samples in Victoria, Australia (n = 7898) and in the US states of Oregon (n = 15,224) and Maine (n = 16,245) completed a common cross-sectional student survey. Rates of alcohol use (lifetime alcohol use, recent use in the past 30 days), alcohol use exceeding recommended consumption limits (binge drinking: five or more drinks in a session), other licit drug use (tobacco use), and norm-violating substance use (substance use at school, use in the past 30 days of marijuana or other illicit drug use) were compared for males and females at ages 12-17. Rates were lower (odds ratios 0.5-0.8) for youth in Maine and Oregon compared to Victoria for lifetime and recent alcohol use, binge drinking and daily cigarette smoking. However, rates of recent marijuana use and recent use of other illicit drugs were higher in Maine and Oregon, as were reports of being drunk or high at school. In contradiction of harm minimization objectives, Victoria, relative to the US states of Oregon and Maine, demonstrated higher rates of alcohol use exceeding recommended consumption limits and daily tobacco use. However, findings suggested that aspects of norm-violating substance use (substance use at school, marijuana use and other illicit drug use) were higher in the US states compared to Victoria.

Childhood risk factors for persistence of violence in the transition to adulthood: a social development perspective

This study examined violent behavior from ages 13 to 21 and identified predictors at age 10. Logistic regression was used to assess predictors of developmental patterns of violence. The sample is from a study of 808 youth interviewed annually from age 10 to 16 years, and again at ages 18 and 21. Over 28% of the youth in the sample reported nonviolence throughout adolescence and into early adulthood. Most youth (55%) engaged in violence in adolescence but desisted from violence in early adulthood, while 16% persisted in violent behavior at age 21. Violence in adolescence was best predicted by male gender, Asian American ethnicity (a protective factor), childhood fighting, early individual characteristics, and early antisocial influences. Adult persistence of violence was best predicted by male gender, early school achievement (which was protective), and early antisocial influences. Early prosocial development was also protective against violence persistence for females. Implications for prevention are discussed.

Correlates contributing to involvement in violent behaviors among young adults

The study examines the extent to which gender, personality attributes, household, community, and environmental factors are associated with violent behaviors in young adulthood. The authors present findings from a sample of 765 21-year-old individuals participating in a drug and delinquency prevention study. Personality attributes, opportunities, and social acceptability of antisocial behaviors were identified as accounting for gender differences and having more influence on violent behavior than environmental correlates. Implications for preventive intervention are discussed.

The social predictors of adolescent alcohol misuse: a test of the social development model

OBJECTIVE

This study was conducted to investigate the ability of the social development model (SDM) to predict alcohol misuse at age 16 and to investigate the ability of the SDM to mediate the effects of alcohol use at age 14 on alcohol misuse at age 16.

METHOD

The sample of 807 (411 males) is from the longitudinal panel of the Seattle Social Development Project which, in 1985, surveyed all consenting fifth-grade students from 18 elementary schools serving high-crime neighborhoods in Seattle, Washington. Alcohol use was measured at age 14, predictors of alcohol misuse were measured at age 15 and alcohol misuse was measured at age 16. Structural equation modeling was used to examine the fit of the model to the data.

RESULTS

All factor loadings were highly significant and the measurement model achieved a good fit with the data (Comparative Fit Index [CFI] = 0.93). A second-order structural model fit the data well (CFI = 0.91) and also explained 45% of the variance in alcohol misuse at age 16. The SDM partially and significantly mediated the direct effect of age-14 alcohol use on age-16 alcohol misuse.

CONCLUSIONS

The risk and protective processes specified by the SDM serve as potential targets for the prevention or reduction of adolescent alcohol misuse.

Preparing for the drug free years: session-specific effects of a universal parent-training intervention with rural families

Like their urban counterparts, adolescents from rural areas are at risk for health and behavior problems, including alcohol and other drug use. This study tested the effects on parenting practices of specific sessions of a parent-training intervention, Preparing for the Drug Free Years, designed to prevent adolescent substance abuse and other problem behaviors. Two hundred and nine rural families were randomly assigned to an intervention or a wait-list control condition. Analyses of covariance comparing adjusted posttest scores revealed that parents in the intervention condition reported significant improvements in parenting behaviors targeted by specific intervention sessions when compared with controls. Effects were most pronounced among mothers. No significant effects were found for nontargeted parenting behaviors, and targeted behaviors were most improved among parents attending relevant program sessions. These results strengthen the internal validity of the study and increase the plausibility that reported improvements were due to the intervention.

An evaluation of the social recreation component of a community mental health program

The paper describes the results of an evaluation designed to determine the effectiveness of the social recreation component of a community-based mental health program. The program is for individuals with serious mental health problems, with a particular focus on those who perceive deficiencies in their social relationships. Findings showed that the individuals who participated in the program, in varying frequency, reported significant improvements in their self-ratings of loneliness, self-esteem, social functioning, satisfaction with social relations and leisure activities, as well as general life satisfaction. The association between particular program- or client-related factors and the outcome variables were examined to provide insights into why people changed. The merits and limitations of the evaluation methodology are discussed.

Effects of the "Preparing for the Drug Free Years" curriculum on growth in alcohol use and risk for alcohol use in early adolescence

Preparing for the Drug-Free Years (PDFY) is a curriculum designed to help parents learn skills to consistently communicate clear norms against adolescent substance use, effectively and proactively manage their families, reduce family conflict, and help their children learn skills to resist antisocial peer influences. This study examined the effects of PDFY on the trajectories of these factors, as well as on the trajectory of alcohol use from early to mid adolescence. The sample consisted of 424 rural families of sixth graders from schools randomly assigned to an intervention or a control condition. Data were collected from both parents and students at pretest, posttest, and 1-, 2- and 3 1/2-year follow-ups. Latent growth models were examined. PDFY significantly reduced the growth of alcohol use and improved parent norms regarding adolescent alcohol use over time. Implications for prevention and evaluation are discussed.

Early adult outcomes of adolescent binge drinking: person- and variable-centered analyses of binge drinking trajectories

BACKGROUND

Many studies of the consequences of binge drinking take a variable-centered approach that may mask developmentally different trajectories. Recent studies have reported qualitatively different binge drinking trajectories in young adulthood. However, analyses of developmental trajectories of binge drinking have not been examined for an important period of drinking development: adolescence. The purpose of this study was to examine young adult outcomes of adolescent binge drinking using an approach that combines person-centered and variable-centered methods.

METHODS

Data were from the Seattle Social Development Project, an ethnically diverse, gender balanced sample (n = 808) followed prospectively from age 10 to age 21. Semiparametric group-based modeling was used to determine groups of binge drinking trajectories in adolescence. Logistic regression was used to examine how well the trajectory groups predicted young adult outcomes after demographics, childhood measures, and adolescent drug use were considered.

RESULTS

Four distinct trajectories of binge drinking during adolescence were identified: Early Highs, Increasers, Late Onsetters, and Nonbingers. These trajectories significantly predicted positive and negative outcomes in adulthood after controlling for demographic characteristics, early proxy measures of the outcome, and adolescent drug use.

CONCLUSIONS

This integrated person- and variable-centered approach provides more information about the effects of specific patterns of binge drinking than studies that employ variable-centered methods alone.

The dynamics of alcohol and marijuana initiation: patterns and predictors of first use in adolescence

OBJECTIVES

This study, guided by the social development model, examined the dynamic patterns and predictors of alcohol and marijuana use onset.

METHODS

Survival analysis and complementary log-log regression were used to model hazard rates and etiology of initiation with time-varying covariates. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age.

RESULTS

Alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years.

CONCLUSIONS

This study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother.

Developmental risk factors for youth violence

PURPOSE

To replicate earlier research findings on risk factors for youth violence and to explore the effects on violent behavior of constructs shown to increase risk for other problem behaviors, within a developmental frame.

METHODS

Data were from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985. Potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Bivariate relationships involving risk factor constructs in the individual, family, school, peer and community domains and violence were examined at each age to assess changes in their strength of prediction over time. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years. A final set of analyses explored the extent to which youths were correctly classified as having committed a violent act (or not) at age 18 years on the basis of their overall level of risk at ages 10, 14, and 16 years.

RESULTS

At each age, risk factors strongly related to later violence were distributed among the five domains. Ten of 15 risk factors constructs measured at age 10 years were significantly predictive of violence at age 18 years. Twenty of 25 constructs measured at age 14 years and 19 of 21 constructs measured at age 16 years were significantly predictive of later violence. Many constructs predicted violence from more than one developmental point. Hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence from ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were notably more likely than others to engage in later violence. The odds for violence of youths exposed to more than five risk factors compared to the odds for violence of youths exposed to fewer than two risk factors at each age were seven times greater at age 10 years, 10 times greater at age 14 years, and nearly 11 times greater at age 16 years. However, despite information gained from all significant risk factors, the overall accuracy in predicting youths who would go on to commit violent acts was limited.

CONCLUSIONS

Findings from the study have important implications for preventive intervention programs. Prevention efforts must be comprehensive and developmentally sensitive, responding to large groups or populations exposed to multiple risks.

LD and delinquency: rethinking the "link"

Longitudinal data from a 7-year prospective study was examined to investigate whether the presence of learning disabilities (LD) increases a youth's risk of becoming a juvenile delinquent. The sample included 515 students enrolled in the fifth grade in the fall of 1985, 51 (9.9%) of whom were youth with LD. Self-report data on delinquent activity were collected in the spring of 1993. Official court records were obtained for the years 1985 through 1992. Hierarchical multiple regression analyses were performed using a block of three demographic variables (gender, ethnicity, and socioeconomic status) as predictors in the first step and including LD status in a second step. Seven separate analyses were performed, using different measures of delinquency as criterion variables. In no case did LD status account for a significant portion of unique variance in the delinquency variables when the demographic variables were controlled for. The results of this study did not confirm the presence of a direct relationship between LD and delinquency and suggest that the finding of a direct relationship in other studies may have been due to confounding of the LD status with age, ethnicity, or socioeconomic status.

Preventing adolescent health-risk behaviors by strengthening protection during childhood

OBJECTIVE

To examine the long-term effects of an intervention combining teacher training, parent education, and social competence training for children during the elementary grades on adolescent health-risk behaviors at age 18 years.

DESIGN

Nonrandomized controlled trial with follow-up 6 years after intervention.

SETTING

Public elementary schools serving high-crime areas in Seattle, Wash.

PARTICIPANTS

Of the fifth-grade students enrolled in participating schools, 643 (76%) were given written parental consent for the longitudinal study and 598 (93%) were followed up and interviewed at age 18 years.

INTERVENTIONS

A full intervention provided in grades 1 through 6 of 5 days of in-service training for teachers each intervention year, developmentally appropriate parenting classes offered to parents when children were in grades 1 through 3 and 5 through 6, and developmentally adjusted social competence training for children in grades 1 and 6. A late intervention, provided in grades 5 and 6 only, paralleled the full intervention at these grades.

MAIN OUTCOME MEASURES

Self-reported violent and nonviolent crime, substance use, sexual activity, pregnancy, bonding to school, school achievement, grade repetition and school dropout, suspension and/or expulsion, and school misbehavior; delinquency charges from court records; grade point average; California Achievement Test scores: and disciplinary action reports from school records.

RESULTS

Fewer students receiving full intervention than control students reported violent delinquent acts (48.3% vs 59.7%; P=.04), heavy drinking (15.4% vs 25.6%; P=.04), sexual intercourse (72.1% vs 83.0%; P=.02), having multiple sex partners (49.7% vs 61.5%; P=.04), and pregnancy or causing pregnancy (17.1% vs 26.4%; P=.06) by age 18 years. The full intervention student group reported more commitment (P=.03) and attachment (P=.006) to school, better academic achievement (P=.01), and less school misbehavior (P=.02) than control students. Late intervention in grades 5 and 6 only did not significantly affect health-risk behaviors in adolescence.

CONCLUSIONS

A package of interventions with teachers, parents, and children provided throughout the elementary grades can have enduring effects in reducing violent behavior, heavy drinking, and sexual intercourse by age 18 years among multiethnic urban children. Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods.

Changing teaching practices to promote achievement and bonding to school

An intervention to modify teaching practices in grades five and six was evaluated. Results showed that higher levels of teacher implementation of the modified practices favorably influenced students' levels of classroom opportunity, involvement, reinforcement, and bonding to school. Levels of academic achievement were also increased. The importance of assessing implementation in theory-guided experimental studies is discussed.

Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse

OBJECTIVE

This study examines whether the age of initiation of alcohol use mediates the effects of other variables that predict alcohol misuse among adolescents and also whether the age of initiation of alcohol use accounts for known gender differences in the severity of alcohol misuse.

METHOD

Data were taken from an ethnically diverse sample of 808 (412 male) students who were recruited in grade 5 at age 10-11 and followed prospectively on an annual basis for the next 7 years to age 17-18. State-of-the-art missing data methodology was used to address nonresponse due to noninitiation of alcohol use. Structural equation modeling was used to examine hypotheses for the prediction of alcohol misuse.

RESULTS

A younger age of alcohol initiation was strongly related to a higher level of alcohol misuse at age 17-18 and fully mediated the effects of parent drinking, proactive parenting, school bonding, peer alcohol initiation and ethnicity, all measured at age 10-11, and perceived harmfulness of alcohol use, measured at age 10-11 and age 11-12. However, age of alcohol initiation did not fully account for gender differences in the level of alcohol misuse at age 17-18. To further examine the role of gender, interactions between gender and school bonding, and gender and friend's alcohol initiation, were evaluated. However, neither of the interaction terms had direct effects on either age of initiation or level of alcohol-related problems.

CONCLUSIONS

Most measured risk factors for alcohol misuse were mediated through age of alcohol initiation. Only gender differences in alcohol misuse at age 17-18 were not mediated by age of alcohol initiation. Variables associated with these differences require further study. The results of this study indicate the importance of prevention strategies to delay the age of initiation of alcohol use.

Predicting serious delinquency and substance use among aggressive boys

Early aggressive behavior puts boys at increased risk for involvement in a variety of later problem behaviors, including delinquency and drug abuse. However, not all boys who evidence aggressive behavior in childhood continue to engage in problem behaviors in adolescence. This 3.5-year prospective study examined the role of factors hypothesized by the social development model to inhibit or increase the likelihood of subsequent involvement in serious delinquency and substance use within a sample of boys identified as aggressive by teacher report at ages 10 and 11. At ages 12 and 13, a combination of the constructs of skills for prosocial involvement, school bonding and achievement, family bonding and management practices, norms against substance use, and interaction with peers and adults involved in antisocial behavior significantly discriminated between boys who were and were not involved in serious delinquent behavior and substance use at ages 13 and 14, although family bonding and management practices appeared to contribute little to the discriminant function. Implications of the results for preventive interventions with aggressive boys are discussed.

Predicting serious delinquency and substance use among aggressive boys

Early aggressive behavior puts boys at increased risk for involvement in a variety of later problem behaviors, including delinquency and drug abuse. However, not all boys who evidence aggressive behavior in childhood continue to engage in problem behaviors in adolescence. This 3.5-year prospective study examined the role of factors hypothesized by the social development model to inhibit or increase the likelihood of subsequent involvement in serious delinquency and substance use within a sample of boys identified as aggressive by teacher report at ages 10 and 11. At ages 12 and 13, a combination of the constructs of skills for prosocial involvement, school bonding and achievement, family bonding and management practices, norms against substance use, and interaction with peers and adults involved in antisocial behavior significantly discriminated between boys who were and were not involved in serious delinquent behavior and substance use at ages 13 and 14, although family bonding and management practices appeared to contribute little to the discriminant function. Implications of the results for preventive interventions with aggressive boys are discussed.

Preventing school failure, drug use, and delinquency among low-income children: long-term intervention in elementary schools

A six-year, school-based prevention program, which modified classroom teacher practices, offered parent training, and provided child social skills training, was evaluated for its effects on school failure, drug abuse, and delinquency among low-income urban children. Compared to a low-income control group, children in the intervention group showed enhanced school commitment and class participation. The girls in the group also evidenced lower rates of substance use initiation, while the boys exhibited increased social and school work skills.

The science of prevention. A conceptual framework and some directions for a national research program

A conceptual framework for studying the prevention of human dysfunction is offered. On the basis of recent advances in research on the development of psychological disorders and methods of preventive intervention, generalizations about the relation of risk and protective factors to disorder are put forward, along with a set of principles for what may be identified as the science of prevention. Emerging themes from the study of human development, in general, need to be incorporated in the models for explaining and preventing serious problems of human adaptation. The article concludes with a set of recommendations for a national prevention research agenda.

Using research to guide culturally appropriate drug abuse prevention

Several ways in which research can be an important tool in creating culturally appropriate prevention programs are suggested. To illustrate cultural variability, we present data from a study of 5th-grade African-American and European-American students. These data describe rates of early initiation, levels of exposure to identified risk factors, and degree to which identified risk factors predict substances initiated. Results indicate that European-American Ss have higher rates of tobacco and alcohol initiation, that the same risk factors predict the variety of substances initiated for African-American and European-American Ss, and that several differences exist in the level of exposure to risk factors between the 2 groups. Implications of the findings for developing culturally appropriate drug abuse prevention are discussed.

Outpatient treatment for cocaine abuse: a controlled comparison of relapse prevention and twelve-step approaches

This study sought to assess the efficacy of treatment for cocaine abuse and to compare the relative effectiveness of a cognitive-behavioral relapse prevention treatment with that of a Twelve-Step recovery support group in an outpatient group treatment setting. One hundred ten subjects seeking treatment were alternately assigned to relapse prevention or Twelve-Step treatment. Self-report data were collected at baseline, posttreatment, and 6-month follow-up. There were no differential effects of treatment type on cocaine or marijuana use over time. However, subjects in both treatment conditions reduced cocaine and marijuana use at posttreatment. Subjects in both groups reduced their alcohol use from pretreatment to posttreatment. Subjects receiving Twelve-Step treatment showed greater increases from posttreatment to 6-month follow-up in alcohol use than did relapse prevention participants. Treatment attendance was negatively related to cocaine use at posttreatment and cocaine and marijuana use at 6-month follow-up. Difficulties in conducting cocaine treatment outcome research are discussed as are treatment and research implications of the findings.

Using research to guide culturally appropriate drug abuse prevention

Several ways in which research can be an important tool in creating culturally appropriate prevention programs are suggested. To illustrate cultural variability, we present data from a study of 5th-grade African-American and European-American students. These data describe rates of early initiation, levels of exposure to identified risk factors, and degree to which identified risk factors predict substances initiated. Results indicate that European-American Ss have higher rates of tobacco and alcohol initiation, that the same risk factors predict the variety of substances initiated for African-American and European-American Ss, and that several differences exist in the level of exposure to risk factors between the 2 groups. Implications of the findings for developing culturally appropriate drug abuse prevention are discussed.

The science of prevention. A conceptual framework and some directions for a national research program

A conceptual framework for studying the prevention of human dysfunction is offered. On the basis of recent advances in research on the development of psychological disorders and methods of preventive intervention, generalizations about the relation of risk and protective factors to disorder are put forward, along with a set of principles for what may be identified as the science of prevention. Emerging themes from the study of human development, in general, need to be incorporated in the models for explaining and preventing serious problems of human adaptation. The article concludes with a set of recommendations for a national prevention research agenda.

Predicting treatment retention among cocaine users

Few studies have addressed treatment retention among cocaine-using samples. The current study develops and tests a model of treatment retention at the individual level, employing data from 110 cocaine users who initiated outpatient treatment. The model includes measures of extent of drug involvement, social isolation and support, motivation, and demographic characteristics. Logistic regression is used to fit a final model, which includes measures of the following: living alone, use of multiple substances prior to treatment, length of cocaine use, and external motivation. Treatment implications and directions for further research are discussed.

The effects of skills and intentions to use drugs on posttreatment drug use of adolescents

The present study examines the relationship between (a) social, cognitive, and behavioral skills; (b) self-reported intentions to use drugs and alcohol following treatment; and (c) later drug and alcohol use for a sample of 130 adolescents. Social, problem solving, self-control, and drug and alcohol avoidance skills were significantly related to marijuana use, variety and severity of drug use, and to the number of drug-free months for female subjects at 12-month follow-up. These skills did not have a statistically significant direct effect on any measured drug outcomes for males. However, skills did lower male subjects' intentions to use drugs or alcohol. Decreased intentions to use, in turn, were associated with less drug and alcohol use, suggesting an indirect relationship between skills and reductions in drug and alcohol use among males at 12-month follow-up. Implications for the treatment of adolescents who engage in drug and alcohol use are discussed.

Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention

The authors suggest that the most promising route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies. The authors review risk and protective factors for drug abuse, assess a number of approaches for drug abuse prevention potential with high-risk groups, and make recommendations for research and practice.

Ethnic differences in family factors related to early drug initiation

The literature on family predictors of substance use for the general population is reviewed and compared to findings for three specific ethnic groups: black, white and Asian Americans. Rates of substance use initiation are examined in a sample of 919 urban 5th-grade students. Ethnic differences on measures of family predictors are examined and significant ethnic differences are found on several of these factors. Finally, separate regressions for black, white and Asian American youths of family factors on the variety of substances initiated examine ethnic similarities and differences in predictors. The results demonstrate significant differences by ethnicity in family management practices, involvement in family activity, sibling deviance, parental disapproval of children's drinking and family structure. The regression equations identified unique as well as common predictors of the variety of substances initiated by the end of 5th grade. Implications of the results are discussed.

Structure of problem behaviors in preadolescence

Earlier research suggests that diverse adolescent problem behaviors, such as substance use, school problems, early sexual intercourse, and delinquency, reflect a single underlying dimension of behavior. Data from an ongoing longitudinal study were used to examine this issue in a previously unexamined sample (N = 426) of preadolescent sixth-grade youth. Ss included boys and girls from diverse socioeconomic and racial/ethnic backgrounds, whose average ages were 11 and 12. By using confirmatory factor analyses to test competing models, multiple factor structures were detected, suggesting that earlier findings supporting a single factor conceptualization may not be generalizable to this age group. Implications of the finding that problem behaviors may be more differentiated in late childhood than in adolescence are discussed.

Reducing early childhood aggression: results of a primary prevention program

Teacher-rated antisocial behavior in early elementary grades has been shown to be a precursor of adolescent delinquency and drug use. The combined effects of parent and teacher training on the teacher-rated antisocial behavior of a panel of subjects assigned to experimental and control classrooms at entry into the first grade was assessed at the end of the second grade. Lower rates of aggressiveness were found for white boys in the experimental classrooms and lower rates of self-destructive behavior were found for white girls in the experimental classrooms when compared with controls on the Teacher Form of the Child Behavior Checklist. No significant condition differences were found for black subjects. The interventions are described and limits and implications of the study are discussed.

Structure of problem behaviors in preadolescence

Earlier research suggests that diverse adolescent problem behaviors, such as substance use, school problems, early sexual intercourse, and delinquency, reflect a single underlying dimension of behavior. Data from an ongoing longitudinal study were used to examine this issue in a previously unexamined sample (N = 426) of preadolescent sixth-grade youth. Ss included boys and girls from diverse socioeconomic and racial/ethnic backgrounds, whose average ages were 11 and 12. By using confirmatory factor analyses to test competing models, multiple factor structures were detected, suggesting that earlier findings supporting a single factor conceptualization may not be generalizable to this age group. Implications of the finding that problem behaviors may be more differentiated in late childhood than in adolescence are discussed.

Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse, and promising approaches for relapse prevention

A review of controlled evaluations of adolescent and other drug abuse treatment programs concludes that some treatment is better than no treatment, that few comparisons of treatment method have consistently demonstrated the superiority of one method over another, that posttreatment relapse rates are high, and that more controlled studies of adolescent treatment which allow evaluation of the elements of treatment are needed. In the absence of the clear superiority of specific treatment techniques, it is suggested that examination of factors related to relapse can provide an empirical base for identifying effective treatment approaches. Pretreatment, during-treatment, and posttreatment factors related to relapse are reviewed from existing studies of adolescent treatment. Program components are suggested which have been associated with or hold promise for reducing factors associated with higher relapse rates and increasing factors associated with lower relapse rates.

Racial differences in acceptability and availability of drugs and early initiation of substance use

This paper examines differences among three racial groups in exposure to three risk factors for drug use (availability of drugs, acceptability of drug use, and peer alcohol use), and the relationship of these factors to drug use initiation in a sample of preadolescent urban youths. Tobacco and alcohol initiation rates were highest among Whites, lower among Blacks, and lowest among Asian-Americans. Paralleling these differences, White youths reported the greatest access to marijuana, greatest parental tolerance of substance use, and greatest intentions to use drugs as adults. Blacks somewhat less, and Asian-Americans the least. No racial differences appear in the proportion who reported that their peers used alcohol. Marijuana availability and peer use predicted substance initiation for all three racial groups. However, intentions to use substances as an adult and perceived parental tolerance of substance use predicted drug use only for White and Asian-American youths, while the expectation of punishment for drug use predicted lower drug use only among Black youths. Implications for prevention are discussed.

Skills training for drug abusers: generalization, maintenance, and effects on drug use

This study reports on the follow-up data for the treatment of drug abuse (Hawkins, Catalano, & Wells, 1986). In the original study, 130 clients in the reentry phase of residential drug treatment programs were randomly assigned to a control group (n = 60) or to a 10-week supplemental behavioral skills training course (n = 70). Eight-two percent of the sample was male, and 75% was White. Subjects' ages ranged from 15 to 55 years, though the majority (71%) were in their twenties. A role-play test assessing skill levels was administered as a pretest, following the 10-week skill training course, and again at 6 and 12 months as follow-ups. Although skills decayed slightly over time, the skill levels of experimental subjects were higher than the control group 12 months after training. Generalization of skills to role-play situations for which no training had been received was also found. However, with the exceptions of marijuana and amphetamine use, skill training did not affect drug use after treatment.

Skills training for drug abusers: Generalization, maintenance, and effects on drug use

This study reports on the follow-up data for the treatment of drug abuse (Hawkins, Catalano, & Wells, 1986). In the original study, 130 clients in the reentry phase of residential drug treatment programs were randomly assigned to a control group (n = 60) or to a 10-week supplemental behavioral skills training course (n = 70). Eight-two percent of the sample was male, and 75% was White. Subjects' ages ranged from 15 to 55 years, though the majority (71%) were in their twenties. A role-play test assessing skill levels was administered as a pretest, following the 10-week skill training course, and again at 6 and 12 months as follow-ups. Although skills decayed slightly over time, the skill levels of experimental subjects were higher than the control group 12 months after training. Generalization of skills to role-play situations for which no training had been received was also found. However, with the exceptions of marijuana and amphetamine use, skill training did not affect drug use after treatment.

A survey on intron and exon lengths

The lengths of introns and exons in various parts of genes of vertebrates, insects, plants and fungi are tabulated. Differences between the various groups of organisms are apparent. The results are discussed and support the idea that, generally speaking, introns were present in primitive genomes, though in some cases they may have been inserted into pre-existing genes.

Choosing drug use measures for treatment outcome studies. I. The influence of measurement approach on treatment results

Drug use is measured in a number of different ways in drug treatment outcome studies. Different measures of outcome may yield different results, making comparison across studies difficult. The utility, sensitivity, and level of measurement of five categories of measures are reviewed. It is suggested that research focus on examining the properties of existing drug use measures, on developing methods of evaluating timing and sequence in the relapse process, and on standardizing measurement approaches across studies.

Choosing drug use measures for treatment outcome studies. II. Timing baseline and follow-up measurement

The use of different approaches to measurement in drug abuse treatment outcome studies has resulted in a lack of comparability across studies. This paper reviews different approaches to timing of baseline and follow-up periods and to dealing with time periods during which follow-up subjects are not "at risk" for drug use. Length and timing of baseline and follow-up periods are considered as well as periods of time within which specific drug use outcomes are measured. It is suggested that research focus on describing the natural course of drug use both prior to and following treatment, in order to determine the most appropriate length and timing of follow-up periods. It is recommended that investigators report drug use data from both "at risk" and "not at risk" periods, and that they choose methods of controlling for time "at risk" which do not eliminate important drug use data from analyses.

Risk factors for adolescent substance abuse. Implications for pediatric practice

This article describes the range of indicators to observe when considering which teenagers may be at risk for development of substance abuse. Currently, the notion of what constitutes a problem among teenagers is a controversy--thus the subject is approached from several major viewpoints. First, one may look at longitudinal studies and then make an attempt to construct some sort of substance abuser profile. Also, genetic predisposition may be considered.

The social networks of drug abusers before and after treatment

Changes in the social networks of a sample of 38 drug abusers are studied from pretreatment to 1 and 3 months following treatment. Overall network composition changed to include fewer drug users and fewer long-term acquaintances. While the pretreatment networks of those who used opiates and those who did not use opiates in the follow-up period were virtually the same, the posttreatment networks of opiate abusers contained greater social influence toward drug use following treatment. Implications for treatment are discussed.

The social development model: An integrated approach to delinquency prevention

This paper describes a comprehensive developmental approach to preventing youth crime based on the social development model, an integration of social control theory and social learning theory. The model asserts that the most important units of socialization, family, schools, peers, and community, influence behavior sequentially. Positive socialization is achieved when youths have the opportunity within each unit to be involved in conforming activities, when they develop skills necessary to be successfully involved, and when those with whom they interact consistently reward desired behaviors. These conditions should increase attachment to others, commitment to conforming behavior, and belief in the conventional order. These social bonds to conventional society inhibit association with delinquent pers and, in turn, prevent delinquent behavior. The paper describes prevention approaches consistent with the model. Rigorous evaluation of the delinquency prevention effects of these interventions is needed.

Aftercare in drug abuse treatment

Preventing relapse among treated drug abusers is the primary goal of aftercare. This paper identifies posttreatment factors associated with relapse and links these findings to known aftercare approaches. The literature on the effectiveness of these approaches is summarized and limitations in this literature are noted. Promising directions for policy, program development, and research (R&D) in aftercare are described.

The social networks of opioid abusers

Using social network analysis, the pretreatment social networks of 106 street drug abusers are examined. While no significant sociodemographic differences are found between opioid and nonopioid abusers, eight significant univariate differences in the characteristics of their social networks are reported. Four of these differences account for 32% of the variation between the two groups of abusers. The social networks of opioid abusers appear significantly less conventional than those of nonopioid abusers; however, opioid abusers appear less committed to the values and behaviors displayed by their network members. Network reconstruction is discussed as an explicit, empirically supportable rehabilitation strategy.