Implementation of adolescent family-based substance use prevention programs in health care settings: Comparisons across conditions and programs.

BACKGROUND: The majority of knowledge related to implementation of family-based substance use prevention programs is based on programs delivered in school and community settings. The aim of this study is to examine procedures related to implementation effectiveness and quality of two family-based universal substance use prevention programs delivered in health care settings, the Strengthening Families Program: For Parents and Youth 10-14 (SFP) and Family Matters (FM). These evidence-based programs were delivered as part of a larger random control intervention study designed to assess the influence of program choice vs. assignment on study participation and adolescent substance use outcomes. We also assess the effects of program choice (vs. assignment to program) on program delivery. METHODS: A mixed method case study was conducted to assess procedures used to maximize implementation quality and fidelity of family-based prevention programs delivered in health care settings. Families with an 11 year old child were randomly selected for study participation from health plan membership databases of 4 large urban medical centers in the San Francisco Bay Area. Eligible families were initially randomized to a Choice study condition (families choose SFP or FM) or Assigned study condition (assigned to FM, SFP or control group); 494 ethnically diverse families were selected for participation in study programs. RESULTS: Successful implementation of family prevention programs in health care settings required knowledge of the health care environment and familiarity with established procedures for developing ongoing support and collaboration. Ongoing training of program deliverers utilizing data from fidelity assessment appeared to contribute to improved program fidelity over the course of the study. Families who chose FM completed the program in a shorter period (p<.0001) and spent more time implementing program activities (p=0.02) compared to families assigned to FM. SFP "choice" families attended more sessions than those assigned to SFP (3.5 vs. 2.8), (p=0.07). CONCLUSION: Program choice appeared to increase family engagement in programs. The goals and approach of universal family-based substance use prevention programs are congruent with the aims and protocols of adolescent preventive health care services. Future effectiveness trials should assess approaches to integrate evidence-based family prevention programs with adolescent health services.

A social contextual analysis of youth cigarette smoking development.

INTRODUCTION: We apply a social contextual perspective based on Bronfenbrenner's ecology of human development theory to understanding development of youth cigarette smoking. We examine the contributions of family, peer, school, and neighborhood contexts. Context attributes examined were derived from social learning and social control theories. METHODS: Data are from 6,544 youth who participated in at least one of five waves of data collection between Spring 2002 and Spring 2004, 1,663 randomly selected parents who participated in one or more of three waves of data collection in the same time period; and the U.S. Census. Three-level hierarchical growth models were used to examine the contributions of time-varying measures of the four social contexts to development of smoking from age 11-17 years. Interactions between variables were examined within and between social contexts. RESULTS: Attributes of each social context made independent contributions to adolescent smoking development; there also were significant interactions between variables from different contexts indicating joint contextual effects. Attributes of the social bond moderated exposure to models of smoking within and between the family and peer contexts. DISCUSSION: Results suggest the value of a social contextual perspective in research on the etiology of youth smoking development as well as the utility of guidance by social learning and social control theories. While all contexts were implicated in adolescent smoking, the family and peer contexts were primarily implicated, with findings suggesting the need for consideration of interactive effects between social learning and social control variables within and between these contexts.

Relationships of adolescents' perceptions of parental and peer behaviors with cigarette and alcohol use in different neighborhood contexts.

This study examined the relationships of adolescents' perceptions of parental and peer behaviors with cigarette and alcohol use in different neighborhood contexts. The sample included 924 adolescents (49% boys, 51% girls) 12-14 years of age whose addresses were matched with 1990 census block groups. Six neighborhood types were identified through a cluster analysis. The findings suggest that parental smoking was associated with increased adolescent smoking in suburban white middle socioeconomic status (SES) neighborhoods. Peer smoking was associated with increased adolescent smoking in rural neighborhoods. Parental monitoring was associated with decreased adolescent drinking in urban white high-SES neighborhoods and parental drinking was associated with increased adolescent drinking in urban white middle-SES neighborhoods, respectively. Peer drinking was associated with increased adolescent drinking in urban neighborhoods. This study demonstrates the importance of examining parental and peer influences on adolescent smoking and drinking in different neighborhood contexts.

The social ecology of adolescent alcohol misuse.

A conceptual framework based on social ecology, social learning, and social control theories guided identification of social contexts, contextual attributes, and joint effects that contribute to development of adolescent alcohol misuse. Modeling of alcohol use, suggested by social learning theory, and indicators of the social bond, suggested by social control theory, were examined in the family, peer, school, and neighborhood contexts. Interactions between alcohol modeling and social bond indicators were tested within and between contexts. Data were from a longitudinal study of 6,544 students, 1,663 of their parents, and the U.S. Census. All contexts were uniquely implicated in development of alcohol misuse from ages 11 through 17 years, and most alcohol modeling effects were contingent on attributes of social bonds.

Moderation of the association between parent and adolescent cigarette smoking by selected sociodemographic variables.

This study examines variation in the associations between cigarette smoking by mother or father and adolescent cigarette smoking by selected sociodemographic characteristics. The study data are from nationally representative samples of adolescents aged 12 to 17 living with their mothers (n=4734) and/or fathers (n=3176). Mother cigarette smoking was more strongly associated with cigarette smoking by daughters than sons. The association between father cigarette smoking and adolescent cigarette smoking did not vary by adolescent gender. The association between mother or father cigarette smoking and adolescent cigarette smoking did not vary by parent's education, family structure, or adolescent age or race/ethnicity.

Serious psychological distress among parenting and nonparenting adults.

OBJECTIVES: We compared the prevalence of serious psychological distress among parenting adults with the prevalence among nonparenting adults and the sociodemographic correlates of serious psychological distress between these 2 populations. METHODS: We drew data from 14240 parenting adults and 19224 nonparenting adults who responded to the 2002 National Survey on Drug Use and Health. We used logistic regression procedures in our analysis. RESULTS: An estimated 8.9% of parenting adults had serious psychological distress in the prior year compared with 12.0% of nonparenting adults of similar age. In both groups, the adjusted odds of having serious psychological distress were higher among adults who were women, younger (between the ages of 18 and 44 years), low income, or receiving Medicaid. We found some differences in the correlates of serious psychological distress between parenting adults and nonparenting adults. The odds of having serious psychological distress were lower among parenting adults after we controlled for demographic characteristics. CONCLUSIONS: Serious psychological distress is fairly prevalent among parenting adults, and high-risk sociodemographic groups of parenting adults should be targeted to ensure access to coordination of services.

Typologies of adolescent dating violence: identifying typologies of adolescent dating violence perpetration.

Acts scales, the most common way of measuring partner violence, have been criticized for being too simplistic to capture the complexities of partner violence. An alternative measurement approach is to use typologies that consider various aspects of context. In this study, the authors identified typologies of dating violence perpetration by adolescents. They conducted in-depth interviews with 116 girls and boys previously identified by an acts scale as perpetrators of dating violence. They provided narrative descriptions of their dating violence acts. For boys and girls, many acts considered violent by the acts scale were subsequently recanted or described as nonviolent. From the narratives, they identified four types of female perpetration that were distinguished by motives, precipitating events, and the abuse history of the partners. One type of perpetration accounted for most acts by boys. The findings are discussed relative to dating violence measurement, prevention and treatment, and development of theory.

A Test of Biosocial Models of Adolescent Cigarette and Alcohol Involvement.

We tested biosocial models that posit interactions between biological variables (testosterone, estradiol, pubertal status, and pubertal timing) and social context variables (family, peer, school, and neighborhood) in predicting adolescent involvement with cigarettes and alcohol in a sample of 409 adolescents in grades 6 and 8. Models including the biological and contextual variables and their interactions explained significantly more variance in adolescent cigarette and alcohol involvement than did models including only the main effects of the biological and contextual variables. Post-hoc analyses of significant interactions suggested that, in most case, moderation occurred in the hypothesized direction. Consistent with dual hazards models of adolescent antisocial behaviors, the relationships between the biological and substance use variables became positive and stronger as the context became more harmful. Considerations of adolescent substance use, and perhaps other problem behaviors, should recognize the possible role of biological variables and how their influence may vary by social context.

Neighborhood influences on adolescent cigarette and alcohol use: mediating effects through parent and peer behaviors.

The influence of neighborhoods on adolescent behaviors has received increasing research attention. In the present study, we use structural equation models to specify pathways from neighborhoods to adolescent cigarette and alcohol use through parental closeness, parental monitoring, parent substance use, and peer substance use. We use a national sample with 959 adolescents 12 to 14 years of age whose residential addresses were matched with 1990 Census tracts to provide neighborhood characteristics. We found that for adolescent cigarette use low socioeconomic status (SES) neighborhoods were associated with increased parental monitoring, which was further associated with decreased adolescent cigarette use. For adolescent alcohol use, high SES neighborhoods were associated with increased parent drinking, which was further associated with increased adolescent alcohol use. Low SES neighborhoods were associated with increased parental monitoring and increased peer drinking, which were in turn associated with decreased and increased adolescent alcohol use, respectively.

State legislators' beliefs about legislation that restricts youth access to tobacco products.

Better understanding of the cognitive framework for decision making among legislators is important for advocacy of health-promoting legislation. In 1994, the authors surveyed state legislators from North Carolina, Texas, and Vermont concerning their beliefs and intentions related to voting for a hypothetical measure to enforce legislation preventing the sale of tobacco to minors, using scales based on the theory of planned behavior. Attitude (importance), subjective norm (whether most people important to you would say you should or should not vote for the law), perceived behavioral control (ability to cast one's vote for the law), and home state were independently and significantly related to intention to vote for the law's enforcement. The results, including descriptive data concerning individual beliefs, suggest specific public health strategies to increase legislative support for passing legislation to restrict youth tobacco sales and, more generally, a framework for studying policy making and advocacy.

Assessing the effects of Families for Safe Dates, a family-based teen dating abuse prevention program.

PURPOSE: To examine the effects of a family-based teen dating abuse prevention program, Families for Safe Dates, primarily on outcomes related to testing the conceptual underpinnings of the program including (1) factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities, and 2) risk factors for teen dating abuse, and secondarily on dating abuse behaviors. METHODS: Families were recruited nationwide using listed telephone numbers. Caregivers and teens completed baseline and 3-month follow-up telephone interviews (n = 324). Families randomly allocated to treatment condition received the Families for Safe Dates program including six mailed activity booklets followed-up by health educator telephone calls. RESULTS: There were significant (<.05) treatment effects in hypothesized directions on most of the factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities including caregiver perceived severity of dating abuse, response efficacy for preventing dating abuse, self-efficacy for talking about dating abuse, knowledge of dating abuse, acceptance of dating abuse, communication skills with the teen, and belief in the importance of involvement in their male (but not female) teen's dating. The latter effect was the only one moderated by sex of the teen. The targeted risk factor affected by the program was teen acceptance of dating abuse. Treatment was also significantly associated with less physical dating abuse victimization. CONCLUSIONS: Modifications to the program are warranted, but overall, the findings are very favorable for the first family-based teen dating abuse prevention program to be evaluated.

Risk and protective factors distinguishing profiles of adolescent peer and dating violence perpetration.

PURPOSE: Violence profiles were created on the basis of whether adolescents used violence against both peers and dates, against dates but not peers, against peers but not dates, or against neither peers nor dates. We determined (1) whether risk and protective factors from five domains (individual attributes and behaviors, the peer, family, school, and neighborhood contexts), based primarily on social learning and social control theories, were associated with violence profiles, (2) whether factors distinguishing profiles varied by gender, and (3) which of the domains was most important in distinguishing profiles. METHODS: Data are from adolescents in grades 8 through 10 from schools in three nonmetropolitan Counties (n = 2,907). RESULTS: Adolescents who used violence against both peers and dates used more of each type of violence compared with those who used only one type of violence. They also had more maladaptive risk and protective scores than adolescents perpetrating only peer violence or neither type of violence, although they had few differences from those perpetrating only dating violence. Most social learning theory risk factors and social control theory protective factors distinguished the profiles as did psychological attributes and substance use. Factors distinguishing profile membership were generally the same for boys and girls, although some associations were stronger for boys than for girls. The model fit statistics suggest that the individual attributes and behaviors and the peer context models fit the data the best. CONCLUSIONS: Suggestions for developing theoretically based interventions for preventing both peer and dating violence are presented.

The Development of Four Types of Adolescent Dating Abuse and Selected Demographic Correlates.

This study determined the shape of trajectories from ages 13 to 19 of four types of dating abuse perpetration and examined whether the demographic characteristics of sex, minority status, socioeconomic status, and family structure systematically explained variation in the trajectories. The data are from 5 waves of data collected from 973 adolescents participating in the control group of a randomized trial. The mean trajectory for psychological dating abuse was positive linear, but the mean trajectories were curvilinear for moderate physical, severe physical, and sexual dating abuse. At all ages, boys reported more severe physical and sexual dating abuse than girls, minorities reported more moderate and severe physical dating abuse than whites, adolescents in single-parent-households reported more psychological and severe physical dating abuse than those in two-parent-households, and parental education was negatively associated with psychological and moderate physical dating abuse perpetration. The findings have implications for future research and for practice.

Peer smoking, other peer attributes, and adolescent cigarette smoking: a social network analysis.

Peer attributes other than smoking have received little attention in the research on adolescent smoking, even though the developmental literature suggests the importance of multiple dimensions of adolescent friendships and peer relations. Social network analysis was used to measure the structure of peer relations (i.e., indicators of having friends, friendship quality, and status among peers) and peer smoking (i.e., friend and school smoking). We used three-level hierarchical growth models to examine the contribution of each time-varying peer variable to individual trajectories of smoking from age 11 to 17 while controlling for the other variables, and we tested interactions between the peer structure and peer smoking variables. Data were collected over five waves of assessment from a longitudinal sample of 6,579 students in three school districts. Findings suggest a greater complexity in the peer context of smoking than previously recognized.

What accounts for demographic differences in trajectories of adolescent dating violence? An examination of intrapersonal and contextual mediators.

PURPOSE: To identify intrapersonal and contextual factors that mediate associations between demographic variables (minority status, socioeconomic status, family structure, gender, and neighborhood disadvantage) and trajectories of moderate and severe physical dating violence perpetration from ages 13-19 years. METHODS: Multi-wave data from 959 adolescents were analyzed using formal mediation analysis in a multilevel analytical framework. RESULTS: Gender and neighborhood disadvantage were not associated with trajectories of dating violence, and therefore mediation was not examined for those variables. At all ages, minority adolescents reported perpetrating significantly more moderate and severe physical dating violence than non-minority adolescents. Destructive communication skills, acceptance of dating abuse, gender stereotyping, and exposure to family violence significantly mediated those associations. Parental education was significantly negatively associated with moderate physical dating violence. Acceptance of dating abuse, gender stereotyping, and exposure to family violence significantly mediated that association. At all ages, adolescents from single-parent households perpetrated significantly more severe physical dating violence than adolescents from two-parent households, but no variables mediated that association. CONCLUSIONS: Each of the identified mediating variables is amenable to change through interventions targeted at high-risk subgroups of adolescents identified by these demographic characteristics.

Moderation and mediation in the relationship between mothers' or fathers' serious psychological distress and adolescent substance use: findings from a national sample.

PURPOSE: This study estimated percentages of adolescents living with a mother or father with serious psychological distress (SPD), and examined moderation and mediation of the relationships between mother or father SPD and adolescent substance use. METHODS: We analyzed data from nationally representative samples of adolescents interviewed with their mothers (n = 4734) and fathers (n = 3176) in the combined 2002 and 2003 National Surveys on Drug Use and Health (NSDUHs). RESULTS: An estimated 4.1% of adolescents living with their father had a father with SPD during the past year, and 11.5% of adolescents living with their mother had a mother with SPD during this time period. A positive association was found between mothers' SPD and adolescent binge drinking (OR = 1.49, 95% CI = 1.01-2.21), but no association was found between fathers' SPD and adolescent binge drinking. Mothers' SPD was associated with increased risk of binge drinking among adolescents aged 14-15 years (OR = 2.52, 95% CI = 1.38-4.60), and fathers' SPD was associated with lowered risk of binge drinking among black adolescents (OR = .08, 95% CI = .01-.79). A positive association was found between mothers' SPD and adolescent illicit drug use (OR = 1.55, 95% CI = 1.08-2.23), but no association was found between fathers' SPD and adolescent illicit drug use. Mothers' SPD was associated with increased risk of illicit drug use among female adolescents (OR = 2.14, 95% CI = 1.24-3.70) and among adolescents of white ethnicity (OR = 1.78, 95% CI = 1.19, 2.68). Parental involvement partially mediated the relationship between mothers' SPD and daughters' illicit drug use; mothers' SPD was associated with lower levels of parental involvement, which in turn were associated with an increased probability of daughters' illicit drug use. CONCLUSIONS: Overall, parents' SPD is associated differentially with adolescent substance use depending on the gender of parent and adolescent, adolescent age, race/ethnicity, and substance used. Parental involvement appears to be one mechanism through which mothers' SPD influences daughters' illicit drug use. Future research should further consider the interindividual effects of parents' SPD and associated parenting behaviors on adolescent risk behaviors.

Assessing the effects of the dating violence prevention program "safe dates" using random coefficient regression modeling.

The Safe Dates Project is a randomized trial for evaluating a school-based adolescent dating violence prevention program. Five waves of data were used to examine the effects of Safe Dates over time including primary and secondary prevention effects, moderators, and mediators of program effects. Using random coefficients models, with multiple imputation of missing data, significant program effects were found at all four follow-up periods on psychological, moderate physical, and sexual dating violence perpetration and moderate physical dating violence victimization. Marginal effects were found on sexual victimization. Effects on severe physical perpetration at all four follow-up periods were moderated by prior involvement in that type of violence. Primary and secondary prevention effects were found and the program was equally effective for males and females and for whites and non-whites. Program effects were mediated by changes in dating violence norms, gender-role norms, and awareness of community services.

Longitudinal predictors of serious physical and sexual dating violence victimization during adolescence.

BACKGROUND: This study identifies potentially modifiable risk factors for the onset of and chronic victimization from serious physical and sexual dating violence. METHODS: One thousand two hundred ninety-one 8th and 9th graders from a county in North Carolina were assessed annually for 5 and 4 years, respectively. RESULTS: For males, having been hit by an adult with the intention of harm, having low self-esteem, and having been in a physical fight with a peer predicted onset of serious physical dating violence victimization. Those variables, plus having a friend who has been a victim of dating violence, alcohol use, and being white, predicted chronic victimization for males. For females, onset of serious physical dating violence victimization was predicted by having been hit by an adult; that variable, plus living in a single-parent household, predicted chronic victimization from serious physical violence. Also for females, onset of sexual violence victimization was predicted by having a friend who has been the victim of dating violence and being depressed; those variables and gender stereotyping predicted chronic victimization from sexual dating violence. CONCLUSIONS: The findings identify high-risk groups and risk factors to target for intervention and have implications for approaches to delivering dating violence prevention programs.

An assessment of the validity of adolescent self-reported smoking using three biological indicators.

This research examined the validity of self-reports of adolescent smoking and explored factors that may influence agreement between self-reported smoking and biological indicators. Data were obtained from 1,881 adolescents as part of a household probability study in the southeastern United States. Adolescents aged 12-14 years reported their tobacco use and provided breath and saliva samples. The sensitivity and specificity of self-reports of smoking were calculated with measures of carbon monoxide, salivary cotinine, and salivary thiocyanate as standards. When the self-report items were compatible with the half-life of the biological indicator, and values were adjusted for smokeless tobacco use, sensitivity varied widely (carbon monoxide, 38%; cotinine, 81%-87%; thiocyanate, 80%). The range for specificity was more constrained (carbon monoxide, 98%; cotinine, 98%; thiocyanate, 80%). Sensitivity of self-report was influenced by the biological indicator examined and the timeframe of questions on smoking. Specificity of self-report was influenced by the biological indicator examined and use of other tobacco products. Overall, sensitivity and specificity were highest when recent smoking was assessed and when cotinine was the standard and smokeless tobacco use was considered. Examination of inhalation patterns suggested that detection of smoking may be influenced by recency of smoking and whether the adolescent smoker inhales. Assessments of individual adolescents' smoking were most accurate when smoking was recent and when cotinine was used and smokeless tobacco could be identified. Prevalence estimates of smoking were similar with self-reports and cotinine.

Assessing the long-term effects of the Safe Dates program and a booster in preventing and reducing adolescent dating violence victimization and perpetration.

OBJECTIVES: This study determined 4-year postintervention effects of Safe Dates on dating violence, booster effects, and moderators of the program effects. METHODS: We gathered baseline data in 10 schools that were randomly allocated to a treatment condition. We collected follow-up data 1 month after the program and then yearly thereafter for 4 years. Between the 2- and 3-year follow-ups, a randomly selected half of treatment adolescents received a booster. RESULTS: Compared with controls, adolescents receiving Safe Dates reported significantly less physical, serious physical, and sexual dating violence perpetration and victimization 4 years after the program. The booster did not improve the effectiveness of Safe Dates. CONCLUSIONS: Safe Dates shows promise for preventing dating violence but the booster should not be used.