Prevention of Unwanted Sexual Contact Among Cadets at the United States Air Force Academy: A Brief Small-Group Intervention.

This study tested the effectiveness of a small-group preventive intervention designed to prevent unwanted sexual contact among cadets at the US Air Force Academy. Among cadets in the incoming class of 2021, unwanted sexual contact was cut by nearly half in the intervention group relative to the control group. This study is one of the first rigorously designed trials to demonstrate a significant impact on unwanted sexual contact among students attending a US military service academy.Trial Registration. ClinicalTrials.gov identifier: NCT03839797.

Preventing Adolescent Substance Use Through an Evidence-Based Program: Effects of the Italian Adaptation of Life Skills Training.

Evidence-based preventive interventions for adolescent substance use, violence, and mental health issues are increasingly being adapted and disseminated internationally. In the present paper, we report the results of an effectiveness study that was part of a comprehensive initiative by a coalition of health promotion organizations in the Lombardy region of Italy to select, culturally adapt, implement, evaluate, and sustain an evidence-based drug abuse prevention program developed in the USA. Findings are presented from a large-scale effectiveness study of the Life Skills Training prevention program among over 3000 students attending 55 middle schools in Italy. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. Relative to comparison group students, students who received the prevention program were less likely to initiate smoking at the post-test and 2-year follow-up, and less likely to initiate weekly drunkenness at the 1-year follow-up. The program had direct positive effects on several cognitive, attitudinal, and skill variables believed to play a protective role in adolescent substance use. The findings from this study show that a drug abuse prevention program originally designed for adolescents in the USA is effective in a sample of Italian youth when a rigorous and systematic approach to cultural adaptation is followed that incorporates the input of multiple stakeholders.

Affective Self-Regulation Trajectories During Secondary School Predict Substance Use Among Urban Minority Young Adults.

This study explored the relationship between trajectories of affective self-regulation skills during secondary school and young adult substance use in a large multi-ethnic, urban sample (N = 995). During secondary school, participants completed a measure of cognitive and behavioral skills used to control negative, unpleasant emotions or perceived stress. As young adults, participants reported on the frequency and quantity of their alcohol, cigarette, and marijuana use in a telephone interview. Controlling for demographic variables, self-regulation did not significantly change over adolescence, although there was significant variation in participants' rates of growth and decline. Lower seventh grade self-regulation and less steep increases in self-regulation were predictive of higher young adult substance use. Male participants had significantly lower initial self-regulation and higher young adult substance use. The results suggest that interventions that build affective self-regulation skills in adolescence may decrease the risk of young adult substance use.

Practice patterns of ANCA-associated vasculitis: exploring differences among subspecialties at a single academic medical centre.

OBJECTIVES: Clinical trial data help guide physician treatment choices for ANCA-associated vasculitis (AAV), but when data are lacking, treatment choices are largely driven by physician preference. Our aim was to examine AAV treatment preferences to determine if patient gender and age, and physician subspecialty affect treatment choices. METHODS: Rheumatologists, nephrologists and pulmonologists from an academic medical centre participated in a web-based survey. Three scenarios (remission induction in severe disease; remission maintenance in severe disease; remission induction in limited disease) were presented for 4 patient profiles (28- and 68-year-old female/male). Physician treatment choices and reasons for these choices were obtained. Differences between groups were analysed using Chi-Square and Fisher's exact tests. RESULTS: Physicians were significantly more likely to choose rituximab for young females for remission induction in severe AAV, with toxicity being the main reason for this choice. There was a trend toward rheumatologists choosing rituximab over cyclophosphamide compared with other subspecialties for this scenario. Most physicians switched to a less toxic agent for remission maintenance, but there was little agreement as to choice of maintenance therapy among subspecialties. For remission induction in limited disease, most physicians chose rituximab, particularly for young females. CONCLUSIONS: Currently, there are very few data for remission maintenance therapy following rituximab in severe disease, as well as the use of rituximab in limited disease. Choices for treatment of AAV differ among subspecialties, are affected by patient gender and age, and tend to be largely driven by physician preference when data are limited or lacking.

Perceived friend and peer smoking and direct and indirect refusal skills as predictors of cigarette smoking in U.S. and Japanese middle school students.

Adolescents (aged 12-14 years) from the United States (n = 539) and Japan (n = 644) completed surveys regarding tobacco use, perceptions of friend and peer smoking, and their own likelihood of using smoking refusal skills. U.S. youth were more likely to report lifetime or monthly tobacco use, whereas Japanese youth were more likely to smoke ≥20 cigarettes per week. High perceived friend and peer smoking prevalence predicted lifetime smoking, whereas direct refusal skill use (e.g., "saying no") predicted less lifetime tobacco use. Results are discussed in terms of cultural influences that may mediate the effect of risk factors on U.S. and Japanese youth.

Life skills training: preventing substance misuse by enhancing individual and social competence.

Research concerning the etiology and prevention of substance misuse has led to the development of preventive interventions that are theory-based and effective. One such approach, Life Skills Training (LST), targets key etiologic factors using a conceptual framework derived from social learning theory and problem behavior theory. LST has been extensively tested in a series of randomized trials and found effective in preventing the use/misuse of alcohol, tobacco, marijuana, and other psychoactive drugs. Research demonstrates that it is effective when implemented under different delivery conditions, by different program providers, with different age groups, and with different populations. Follow-up studies provide evidence of the long-term effectiveness of LST. Independent economic analysis indicates that LST produces cost savings of as much as $38 for every dollar invested. Finally, LST offers the potential of reducing other health risk behaviors and fostering academic success.

Longitudinal Relationships Between Self-Management Skills and Substance Use in an Urban Sample of Predominantly Minority Adolescents.

We explored changes in self-management skills and substance use from 7th to 11th grade in a multiwave study of predominantly minority adolescents (N = 1,756). Using latent growth curve analysis, we found that substance use significantly increased, whereas self-management skills significantly decreased. In a parallel process model, we found that participants who reported higher self-management skills in the 7th grade had smaller increases in substance use. Participants who had larger decreases in self-management skills tended to have greater increases in substance use. We also explored the influence of grades and gender and found that (a) participants with higher grades at baseline had lower initial substance use, higher initial self-management skills, and smaller increases in substance use, and (b) male participants had greater increases in substance use. These results suggest that the provision of self-management skills may be an effective strategy for preventing substance-use initiation and escalation during adolescence.

Onset of the Non-Medical Use of Prescription and Over-the-Counter Medications during Early Adolescence: Comparison with Alcohol, Tobacco, and Marijuana.

This study examined the prevalence and psychosocial predictors of the non-medical use of prescription and over-the-counter (OTC) medications and compared these to cigarette, marijuana, and alcohol use in a cohort of early adolescents (N = 1887) aged 11 to 13, a critical risk period for the initiation of substance use. Participants were students attending 22 middle schools in the northeastern United States. Participants completed surveys in the classroom, the first in the sixth grade and a second in the seventh grade, and the rate of overall substance use more than doubled from 5.5% to 11.9% over this period. Predictors of the onset of non-medical prescription and over-the-counter drug misuse overlapped substantially with those for marijuana and other substances. The perception of friends' substance use and the belief that substance use can help you deal with problems predicted the onset of marijuana use, OTC medication misuse, and prescription drug misuse. Decision-making skills were protective for the onset of all substance use outcomes. The findings of this study have important implications for prevention and suggest that a single comprehensive approach may be sufficient for preventing multiple forms of substance use onset during early adolescence.

Long-term behavioral effects of a school-based prevention program on illicit drug use among young adults.

Most universal drug abuse prevention efforts target early adolescents with the goal of delaying or preventing the onset of substance use. The present study examined long-term follow-up data from a large-scale randomized trial of a school-based prevention program that used cognitive-behavioral skills-training techniques to enhance social and personal competence skills and drug refusal skills. The preventive intervention was implemented in junior high schools, and pretest data were collected from students in the classroom. Approximately 13 years later, follow-up data were collected by mail from 2042 young adults. Rates of overall lifetime illicit drug use, as well as lifetime marijuana use, marijuana intoxication, and lifetime non-medical pill use, were lower among students who received the prevention program (Life Skills Training) during junior high school compared to control group participants. These findings support the hypothesis that comprehensive, universal school-based prevention programs can produce long-term effects on illicit drug use behavior.

Component analysis of a school-based substance use prevention program in Spain: contributions of problem solving and social skills training content.

The objective of the present research was to examine the contribution of two intervention components, social skills training and problem solving training, to alcohol- and drug-related outcomes in a school-based substance use prevention program. Participants included 341 Spanish students from age 12 to 15 who received the prevention program Saluda in one of four experimental conditions: full program, social skills condition, problem solving condition, and a wait-list control group. Students completed self-report surveys at the pretest, posttest and 12-month follow-up assessments. Compared to the wait-list control group, the three intervention conditions produced reductions in alcohol use and intentions to use other substances. The intervention effect size for alcohol use was greatest in magnitude for the full program with all components. Problem-solving skills measured at the follow-up were strongest in the condition that received the full program with all components. We discuss the implications of these findings, including the advantages and disadvantages of implementing tailored interventions to students by selecting intervention components after a skills-based needs assessment.

Spanish version of the Positive Expectancies for Drinking and Driving for Youth.

In most developed countries, motor vehicle accidents are a leading cause of death among young people, and a large proportion of motor vehicle accidents are alcohol-related. In Spain there are no currently available instruments for assessing positive expectancies related to drinking and driving behavior. Attempting to modify these expectancies may be an effective prevention approach, so there is a need for a valid and reliable scale to measure the construct. The aims of the present study were to translate, culturally adapt, and examine the psychometric properties of a Spanish-language version of the Positive Expectancies for Drinking and Driving for Youth (PEDD-Y) in a sample of Spanish young adults. A total of 352 college students with drivers licenses were recruited at a university in southeast Spain. We examined the factor structure, psychometric properties (reliability and validity) and temporal stability of the Spanish version of the PEDD-Y among Spanish young adult drivers. Findings indicated that the Spanish version of the PEDD-Y demonstrated satisfactory psychometric properties and was shown to significantly predict lifetime prevalence and future intentions to drink and drive as well as riding with a drunk driver. The Convenience factor performed with the most consistent reliability and predictive validity. Limitations and future research questions are discussed.

Effectiveness of a hybrid digital substance abuse prevention approach combining e-Learning and in-person class sessions.

Background: Effective school-based programs for preventing substance abuse offer considerable public health potential. Yet limited class time and uneven implementation fidelity can be barriers to widespread adoption and high-quality implementation. A hybrid digital approach may be effective and help address these barriers. Objective: To evaluate the effectiveness of a hybrid substance abuse prevention program for middle school students consisting of e-learning modules and in-person class sessions. Design: Twenty-three United States (U.S.) middle schools were randomly assigned either to an intervention condition (13 schools) or a treatment-as-usual control condition (10 schools) where standard health education material was delivered. There were 1,447 participants who completed the pre-test and post-test assessments, of which 48.3% were male and 51.7% female. Intervention: The hybrid digital intervention consisted of 14 brief e-learning modules and six classroom sessions adapted from an evidence-based program designed for classroom implementation to increase knowledge of adverse consequences of substance use and improve social skills, personal coping skills, and skills for resisting social influences to smoke, drink, or use drugs. Measures: Participating students completed online pre-test and post-test surveys to assess substance use, knowledge, and life skills. Results: There were significant reductions in substance use for the hybrid digital condition compared to the control condition as well as significant increases in health knowledge, skills knowledge, and life skills. Conclusions: A hybrid digital approach to substance abuse prevention is effective and offers potential for overcoming common barriers to widespread adoption and high-quality implementation.

Sexual Violence and Substance Use among First-Year University Women: Differences by Sexual Minority Status.

Sexual violence and substance use are important public health problems among university students. The present study examined rates of sexual violence victimization, perpetration, and substance use among first-year university women. Participants (n = 974) attending 14 universities across the United States completed an online confidential survey at the beginning and again later in their first year. The sample included women who identified as heterosexual, bisexual, lesbian, and asexual or questioning. The mean age was 19.1 years and 71.4% were White. Rates of victimization involving sexual harassment and sexual acts without consent were higher among sexual minority women relative to heterosexual women, with bisexual women being most likely to report these outcomes. Compared to heterosexual women, sexual minority women reported more frequent cigarette smoking, marijuana use and intoxication, use of club drugs, and overall illicit drug use. Across sexual violence and substance use outcomes, bisexual women reported the highest rates. Sexual minority women reported more accurate beliefs about sexual violence and consent relative to heterosexual women. Over the course of the first year, bisexual women and those who used illicit substances were more likely to report new incidents of sexual violence victimization. Implications for prevention of sexual violence among women, including sexual minorities, are discussed.

Multiple Health Behavior Programs in School Settings: Strategies to Promote Transfer-of-Learning Through Life Skills Education.

Typically, schools implement health promotion programs that focus on a single behavioral domain. Multiple related health topics may be addressed using separate interventions, potentially producing overlap in program content. However, integrative approaches in health promotion have the potential to produce interventions capable of improving multiple health behaviors. In particular, more research is needed to identify the conditions and the factors that can promote the transfer of learning to broaden the target outcomes of health promotion programs. The present study aims to identify the characteristics of an evidence-based life skills education program that can facilitate the transfer of learning to different health behaviors not initially targeted by the program, and the strategies for achieving successful transfer. A two round Delphi method was used with a diverse group of 21 experts in health promotion, life skills education, and methods of pedagogy for early adolescent students. Questionnaires with open and closed-ended questions were administered on-line. Content qualitative analysis was run, integrating codes, subcategories, and categories of the two rounds of the study. Results showed strong consensus among experts about the potential for promoting the transfer of skills from one health domain to another. Many elements were identified as important factors that facilitate the transfer of learning. Strategies for successful transfer were related to teaching methods, educational approaches, and consistency with the broader school curriculum. Findings suggest that the successful transfer of learning to a new health domain requires that educators recognize its importance and explicitly designate it as an educational aim.

Youth marijuana use: a review of causes and consequences.

The legalization of medical and recreational marijuana has raised concerns about a potential increase in the availability and illegal use of marijuana by adolescent minors. To better understand the etiology, patterns, and consequences of adolescent marijuana use, this article reviews high quality, methodologically rigorous, longitudinal studies that focus on the role of personality factors such as sensation-seeking in the etiology of use, developmental trajectories of use and the effects of chronic use, potential gateway effects of marijuana on other illicit drugs, and its role in the onset of psychiatric disorders in adolescents and young adults. Implications are discussed in terms of mechanisms that account for initial and continued use of marijuana by adolescents, how use is associated with key developmental milestones and adult role socialization, and the potential of marijuana use during adolescence in furthering later drug involvement.

Adolescent Transitions in Self-Management Strategies and Young Adult Alcohol Use.

Individuals use a variety of strategies to manage their thoughts, emotions, and behaviors across the lifespan. In this study, we used latent class analysis to derive distinct subtypes of self-management skills in early adolescence and latent transition analysis to examine whether movement between different classes was associated with later young adult alcohol use. Assessments of behavioral self-control, affective self-regulation, and cognitive self-reinforcement were obtained in the seventh and 10th grades from students participating in two independent drug prevention trials (control group participants only, N = 3,939). Assessment of alcohol use was obtained when participants were young adults (23-26). A model distinguishing four subtypes of self-management skills fit best for both the seventh and 10th grades. While findings indicated modest stability in class structure over time, maintaining class membership characterized by high cognitive self-reinforcement and high affective self-regulation was consistently protective in terms of young adult alcohol use relative to movement from this to other classes. Transitions in class membership involving an expansion of self-management strategies were protective and associated with lower levels of young adult alcohol use and transitions involving a contraction of self-management strategies associated with higher young adult alcohol use. This study illustrates the important use of person-centered techniques to exemplify how typologies of self-management during adolescence can play a protective role in young adult alcohol use.

Testing an evidence-based drug abuse and violence preventive approach adapted for youth in juvenile justice diversionary settings.

BACKGROUND: Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at risk for substance use and violence in juvenile justice settings. METHOD: The present study tested the feasibility, appropriateness, and efficacy of a preventive intervention to reduce risk factors for substance use and delinquency among youth in juvenile justice diversionary settings by promoting positive youth development and building personal strengths and prosocial relationships. Participants in the study (N = 288) were predominantly male (69%) and in the 9th grade (14 years old) or higher (91%), received the preventive intervention, and completed confidential questionnaires at the pre-test and post-test. RESULTS: The majority of youth who participated in the intervention rated the program topics (77.9%) and activities (72%) as appropriate for their age, would recommend it to their peers (73.6%), and would use the skills learned in the future (85.4%). Comparison of post-test adjusted means revealed that the prevention program had a significant positive impact on key knowledge, attitudes, and skills including goal-setting, stress-management, and communication skills. CONCLUSIONS: The findings indicate that an evidence-based prevention approach adapted for youth diversionary settings can be effectively implemented and well-received by participating youth, and can produce positive changes in psychosocial skills and protective factors known to prevent multiple risk behaviors among youth. Future efforts to implement substance use prevention in community juvenile justice settings may benefit from highlighting a positive youth development, skills-based approach.

Maternal depression and parental distress among families in the Early Head Start Research and Evaluation Project: Risk factors within the family setting.

This study examined the influence of risk factors within the family environment (inadequate resources, insufficient caregiving support from child's father, higher family conflict) on maternal well being (depression and parental distress) using a longitudinal panel research design. Participants consisted of 2,040 low-income mothers of young children enrolled in the Early Head Start (EHS) Research and Evaluation Project. Findings indicated that greater family resources at 14 months had a protective effect on maternal well-being at 36 months, controlling for demographic variables and maternal well-being at 14 months. Furthermore, the effect of family resources on maternal well-being was moderated by father caregiving support, such that family resources were protective, particularly when father caregiving support was lower. Family conflict at 14 months was associated with lower maternal well-being at 36 months, controlling for demographic variables and maternal well-being at 14 months. Our findings suggest that low-income mothers need the support and resources of programs such as EHS to overcome the hurdles and challenges of parenting in high-risk settings. Implications for clinical practice and EHS are discussed.