Risk taking and refusal assertiveness in a longitudinal model of alcohol use among inner-city adolescents.

Risk taking and refusal assertiveness have been shown to be important determinants of adolescent alcohol use. However, it remains unclear whether youth predisposed to risk taking would be less likely to assertively refuse. This study examined the relationships among risk taking, refusal assertiveness, and alcohol use in a sample of inner-city minority students (N = 1,459), using a cross-lagged longitudinal structural equation model. Data collectors administered the questionnaire to students following a standardized protocol during a 40-min class period. Based on the tested model, risk taking was more stable over time than refusal assertiveness. Furthermore, high risk takers reported less frequent subsequent refusal assertiveness, and less frequent refusal assertiveness predicted greater drinking. A predisposition toward risk taking appears to be an enduring characteristic that is associated with low refusal assertiveness and increased alcohol use. These findings suggest that alcohol prevention programs that emphasize refusal skills training may be less effective for high risk takers. But programs that focus on enhancing competence or reducing normative expectations for peer alcohol use might be more effective for high risk-taking youth.

Protective role of personal competence skills in adolescent substance use: psychological well-being as a mediating factor.

Adolescents who use a variety of cognitive and behavioral self-management strategies have been shown to report reduced rates of early-stage substance use, but little is known about how these personal competence skills may be protective. In a series of structural equation models, this study examined the association between competence skills and substance use over a 3-year period among 849 suburban junior high school students, and whether psychological distress, well-being, or both mediated this relation. Findings indicated that well-being fully mediated the relation between early competence and later substance use, but distress did not. Youth with good competence skills reported greater subsequent well-being, which in turn predicted less later substance use. Findings suggest that competence skills protect youth by enhancing well-being and that prevention programs should aim to enhance competence in order to promote resilience.

Preventive intervention effects on developmental progression in drug use: structural equation modeling analyses using longitudinal data.

This study examined the plausibility of the gateway hypothesis to account for drug involvement in a sample of middle school students participating in a drug abuse, prevention trial. Analyses focused on a single prevention approach to exemplify intervention effects on drug progression. Improvements to social competence reduced multiple drug use at 1- and 2-year follow-ups. Specific program effects disrupted drug progression by decreasing alcohol and cigarette use over 1 year and reducing cigarette use over a 2-year period. Controlling for previous drug use, alcohol was integrally involved in the progression to multiple drug use. Subgroup analyses based on distinctions of pretest use/nonuse of alcohol and cigarettes provided partial support for the gateway hypothesis. However, evidence also supported alternate pathways including cigarette use as a starting point for later alcohol and multiple drug use. Findings underscore the utility of targeting more than one gateway substance to prevent escalation of drug involvement and reinforce the importance of social competence enhancement as an effective deterrent to early-stage drug use.

Drug abuse prevention among minority adolescents: posttest and one-year follow-up of a school-based preventive intervention.

Most drug abuse prevention research has been conducted with predominantly White middle-class adolescent populations. The present study tested a school-based drug abuse preventive intervention in a sample of predominantly minority students (N = 3,621) in 29 New York City schools. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills in an effort to provide students with skills and information for resisting drug offers, to decrease motivations to use drugs, and decrease vulnerability to drug use social influences. Results indicated that those who received the program (n = 2,144) reported less smoking, drinking, drunkenness, inhalant use, and polydrug use relative to controls (n = 1,477). The program also had a direct positive effect on several cognitive, attitudinal, and personality variables believed to play a role in adolescent substance use. Mediational analyses showed that prevention effects on some drug use outcomes were mediated in part by risk-taking, behavioral intentions, and peer normative expectations regarding drug use. The findings from this study show that a drug abuse prevention program originally designed for White middle-class adolescent populations is effective in a sample of minority, economically disadvantaged, inner-city adolescents.

Linguistic acculturation associated with higher marijuana and polydrug use among Hispanic adolescents.

Hispanic sixth and seventh graders in 22 New York City middle schools (mean age: 12.66 years) completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana) use and linguistic acculturation at two assessments (N = 1299 at baseline; N = 1038 at 1-year follow-up). Adolescents who spoke English with their parents smoked marijuana more frequently than those who spoke Spanish with their parents at both surveys. By the 1-year follow-up, students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents.

Alcohol use among Dominican and Puerto Rican adolescents residing in New York City: role of Hispanic group and gender.

Hispanic groups are often aggregated when examining adolescent drinking. The objective of this study was to determine the roles of Hispanic group (Puerto Rican versus Dominican) and gender in alcohol use among inner-city youth. Sixth and seventh graders in 22 New York City schools who identified themselves as Puerto Rican or Dominican completed self-report questionnaires at two assessments (N = 849 at baseline; N = 678 at 1-year follow-up). Dominican adolescents generally engaged in more alcohol use than Puerto Rican adolescents. In a number of cases, gender moderated the effect of Hispanic group on drinking. Specifically, Dominican boys reported greater use than Dominican girls, but use was similar across gender for Puerto Rican adolescents. These findings highlight the importance of considering Hispanic group and gender when examining adolescent drinking.

Preventing binge drinking during early adolescence: one- and two-year follow-up of a school-based preventive intervention.

The authors examined the effectiveness of a school-based prevention program on reducing binge drinking in a sample of minority, inner-city, middle-school students. Rates of binge drinking were compared among youth who received the program beginning in the 7th grade (n = 1,713) and a control group (n = 1,328) that did not. The prevention program had protective effects in terms of binge drinking at the 1-year (8th grade) and 2-year (9th grade) follow-up assessments. The proportion of binge drinkers was over 50% lower in the intervention group relative to the control group at the follow-up assessments. There were also several significant program effects on proximal drinking variables, including drinking knowledge, pro-drinking attitudes, and peer drinking norms. These findings indicate that a school-based drug abuse prevention approach previously found to be effective among White youth significantly reduced binge drinking among urban minority youth.

Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors.

Drug abuse continues to be an important public health problem throughout the world. Although considerable progress has been made in identifying effective prevention approaches, there is a large gap between what research has shown to be effective and the methods generally used in most schools. The most promising prevention approaches target individuals during the beginning of adolescence and teach drug resistance skills and norm setting either alone or in combination with general personal and social skills. Evaluation studies testing these approaches show that they can significantly reduce adolescent tobacco, alcohol, and marijuana use. While some studies show that these effects may decrease over time, booster interventions have been found to maintain and in some instances even enhance prevention effects. The results of one large-scale evaluation study shows that it is possible to produce reductions in drug use that last until the end of high school. Available evidence suggests that these approaches may be effective when taught by different kinds of teachers and with different populations. The current paper provides a brief review of school-based prevention approaches targeting individual-level etiologic factors, evidence supporting their effectiveness, and a discussion of potential mediating mechanisms.

Methods to decrease attrition in longitudinal studies with adolescents.

A summary of methods to decrease attrition in longitudinal school-based studies conducted with adolescents beginning junior high schools or middle schools is presented. These include collection of contact information about students, additional days to collect data from absentee students, data collection in new high schools once students graduate from junior high schools or middle schools, sending questionnaires by mail, and conducting telephone or home interviews.

Preventing illicit drug use in adolescents: long-term follow-up data from a randomized control trial of a school population.

National survey data indicate that illicit drug use has steadily increased among American adolescents since 1992. This upward trend underscores the need for identifying effective prevention approaches capable of reducing the use of both licit and illicit drugs. The present study examined long-term follow-up data from a large-scale randomized prevention trial to determine the extent to which participation in a cognitive-behavioral skills-training prevention program led to less illicit drug use than for untreated controls. Data were collected by mail from 447 individuals who were contacted after the end of the 12th grade, 6.5 years after the initial pretest. Results indicated that students who received the prevention program (Life Skills Training) during junior high school reported less use of illicit drugs than controls. These results also support the hypothesis that illicit drug use can be prevented by targeting the use of gateway drugs such as tobacco and alcohol.

Psychosocial and behavioral factors in early adolescence as predictors of heavy drinking among high school seniors.

OBJECTIVE: Most adolescents experiment with alcohol, and the use of alcohol typically escalates during the teenage years. The present study examined how several risk and protective factors measured during early adolescence were associated with heavy drinking in a sample of high school seniors. METHOD: As part of a school-based survey, seventh-grade students (N = 1,132) reported degrees of experimentation with alcohol and cigarettes. Several psychosocial factors deemed to be important in the etiology of drinking were also assessed. Students were followed-up in the twelfth grade, when 16% were categorized as heavy drinkers based on drinking and drunkenness frequency and quantity typically consumed. RESULTS: Logistic regression analyses revealed that heavy drinking was predicted by having had experimented with alcohol or cigarettes, having had a majority of one's friends drink and having had poor behavioral self-control in early adolescence. In addition, several effects were limited to either boys or girls. For example, positive alcohol expectancies predicted greater later heavy drinking in boys, while friends' smoking predicted later heavy drinking in girls. CONCLUSIONS: The findings suggest that early intervention programs aimed at preventing alcohol use by addressing the social and psychological determinants of alcohol use may have important preventive effects in terms of later heavy drinking.

A model of smoking among inner-city adolescents: the role of personal competence and perceived social benefits of smoking.

BACKGROUND: Based on current trends, smoking will remain a major public health problem in the 21st century. Effective smoking prevention approaches offer the best hope for decreasing the rise in adolescent smoking rates. Competence enhancement approaches to smoking prevention are among the most successful. Yet, there is not a full understanding of how effective prevention approaches work. This study tests whether a deficiency in competence (poor decision-making skills and low personal efficacy) is linked to acquiring beliefs in the perceived benefits of smoking and whether these perceived benefits are then related to subsequent smoking. METHODS: A sample of 1459 students attending 22 middle and junior high schools in New York City participated. Students completed surveys at baseline, 1-year follow-up and 2-year follow-up during a regular class period. They self-reported smoking, decision-making skills, personal efficacy and beliefs in the perceived benefits of smoking. RESULTS: The tested structural equation model had a good fit and was parsimonious and consistent with the theory underlying the competence approach to smoking prevention. CONCLUSIONS: This research highlights the importance of addressing decision-making skills, personal efficacy, and beliefs in the social benefits of smoking within adolescent smoking prevention programs.

Parenting practices as predictors of substance use, delinquency, and aggression among urban minority youth: moderating effects of family structure and gender.

This study examined how parenting factors were associated with adolescent problem behaviors among urban minority youth and to what extent these relationships were moderated by family structure and gender. Sixth-grade students (N = 228) reported how often they use alcohol, smoke cigarettes, or engage in aggressive or delinquent behaviors; a parent or guardian reported their monitoring and other parenting practices. Findings indicated that boys and those from single-parent families engaged in the highest rates of problem behavior. More parental monitoring was associated with less delinquency overall, as well as less drinking in boys only. Eating family dinners together was associated with less aggression overall, as well as less delinquency in youth from single-parent families and in girls. Unsupervised time at home alone was associated with more smoking for girls only. Implications for prevention interventions are discussed.

Role of general and specific competence skills in protecting inner-city adolescents from alcohol use.

OBJECTIVE: The purpose of this longitudinal investigation was to test whether higher levels of general competence are linked to greater refusal assertiveness that is, in turn, related to less subsequent alcohol use among inner-city adolescents. METHOD: A large sample of students attending 22 middle and junior high schools in New York City participated. Students completed surveys at baseline, at 1-year follow-up and at 2-year follow-up (N = 1,459; 54% female). The students self-reported alcohol use. decision-making skills, self-efficacy and refusal assertiveness. Teams of three to five data collectors administered the questionnaire following a standardized protocol. The data were collected in school during a regular 40-minute class period. RESULTS: According to the tested structural equation model, Decision Making (beta = .07, p < .05) and Self-Efficacy (beta = .24, p < .001) predicted higher Refusal Assertiveness and this greater assertiveness predicted less drinking at the 2-year follow-up (beta = -.21, p < .001). Earlier drinking predicted 2-year follow-up drinking (beta = .40, p < .001). Goodness-of-fit indices were excellent (chi2 = 1107.9, 238 df, N = 1,438, p < .001; NFI = .93, NNFI = .94, CFI = .95). CONCLUSIONS: The tested model had a good fit and was parsimonious and consistent with theory. This research highlights the importance of addressing decision-making skills, self-efficacy and refusal assertiveness within adolescent alcohol prevention programs.

Competence skills help deter smoking among inner city adolescents.

OBJECTIVE: To test whether higher levels of general competence are linked to more frequent use of refusal assertiveness that is in turn related to less subsequent smoking among inner city adolescents. METHODS: Longitudinal study conducted during three year middle school or junior high school period. A sample of 1459 students attending 22 middle (ages 11-14 years) and junior high (ages 12-15 years) schools in New York City participated. Students completed surveys at baseline, one year follow up, and two year follow up. The students self reported smoking, decision making skills, personal efficacy, and refusal assertiveness. Teams of three to five data collectors administered the questionnaire following a standardised protocol. These data were collected in school during a regular 40 minute class period. RESULTS: Based on the tested structural equation model, decision making and personal efficacy (that is, general competence) predicted higher refusal assertiveness and this greater assertiveness predicted less smoking at the two year follow up. The tested model had a good fit and was parsimonious and consistent with theory. CONCLUSIONS: Adolescent smoking prevention programmes often teach refusal skills in order to help youth resist peer pressure to smoke. The present findings suggest that teaching general competence skills as well may help to reduce smoking because youth with better personal efficacy and decision making skills are better able to implement smoking refusal strategies.

Preventing alcohol and tobacco use through life skills training.

Rates of drinking and smoking increase among high school students as they age. Therefore, prevention programs that target youth either before or during junior high school may help prevent alcohol, tobacco, and other drug (ATOD) use during high school. Life skills training (LST) is a school-based approach designed to prevent ATOD use among youth by influencing their knowledge and attitudes about ATODs, by teaching skills for resisting social pressures to use ATODs, and by helping students develop personal self-management and social skills. Researchers have studied this program's effectiveness in preventing use of various substances among varied populations.

Ethnic and gender differences in psychosocial risk, protection, and adolescent alcohol use.

Theoretical models suggest that many diverse psychosocial factors contribute to the etiology of substance use among youth. It has been suggested that substance use is a function of the total number of etiologic factors, rather than a specific type or set of factors. This study examined whether cumulative psychosocial risk and protection measured in the 7th grade predicted alcohol use in the 9th grade across ethnically diverse samples of adolescents. Participants consisted of black (n = 775) and Hispanic (n = 467) inner-city youth and white suburban youth (n = 708). Prevalence rates for alcohol use and risk/protection varied more widely based on ethnic group compared to gender. Black youth reported the fewest risk factors and lowest levels of alcohol use, white youth reported the most risk factors and highest levels of alcohol use, and Hispanic youth reported the fewest protective factors and intermediate levels of alcohol use. Despite these differences, structural equation modeling indicated that a latent factor consisting of cumulative risk, protection, and their interaction significantly predicted later alcohol use for the combined sample as well as for each ethnic/ gender subgroup. However, the proportion of variance explained in alcohol use varied across subgroups, and moderator analyses indicated that protection significantly buffered the effects of risk differentially across subgroups. The strongest protective effects were observed among black inner-city youth. Findings suggest that prevention approaches should focus on enhancing protection in addition to reducing risk, particularly among youth with lower levels of psychosocial protection.

Etiology of alcohol use among Hispanic adolescents: sex-specific effects of social influences to drink and problem behaviors.

BACKGROUND: Hispanic adolescents seem to be at greater risk for alcohol use; a greater understanding of the factors that predict alcohol use among Hispanic youth is needed. Social influences to drink and other problem behaviors often predict adolescent alcohol use. However, most past research has concentrated on samples of predominantly white adolescents residing in suburban areas. OBJECTIVES: To determine which demographic factors, social influences, and problem behaviors are associated with alcohol use among Hispanic adolescents and to eludicate the difference in the origins of alcohol use depending on sex. DESIGN: Cross-sectional study. SETTING: Middle schools in New York City. PARTICIPANTS: This study focuses on 1410 adolescents in grade 7 from inner-city schools who identified themselves as Hispanic at the baseline assessment of an investigation of alcohol and other drug use. MAIN OUTCOME MEASURES: Alcohol initiation, alcohol consumption, and future drinking. RESULTS: The findings showed that social influences to drink and reported problem behaviors were associated with alcohol use across and within sex groups. In particular, friends' drinking was related to alcohol initiation, consumption, and plans to drink in the future across sexes and within both sex groups. Other predictors (mother's drinking, siblings' drinking, ease of obtaining alcohol, deviance, cigarette smoking, and marijuana use) exhibited sex-specific effects. CONCLUSION: These findings lend support to teaching social resistance skills to improve Hispanic adolescents' ability to resist social influences to drink and use other drugs.