Alcohol-Tolerant Workplace Environments Are a Risk Factor for Young Adult Alcohol Misuse on and off the Job in Australia and the United States.

The workplace has been understudied as a setting for the prevention of young adult alcohol misuse. This study examined if alcohol-tolerant workplace environments are associated with greater risk for alcohol use and misuse on and off the job among young adults. Data were collected in 2014 from state-representative, sex-balanced samples (51% female) of 25-year-olds in Washington, U.S. (n = 751) and Victoria, Australia (n = 777). Logistic regressions indicated that availability of alcohol at work, absence of a written alcohol policy, and alcohol-tolerant workplace norms and attitudes were independently associated with a 1.5 to 3 times greater odds of on-the-job alcohol use or impairment. Alcohol-tolerant workplace norms were associated also with greater odds of high-risk drinking generally, independent of on-the-job alcohol use or impairment. Associations were mostly similar in Washington and Victoria, although young adults in Victoria perceived their workplaces to be more alcohol-tolerant and were more likely to use alcohol or be impaired at work and to misuse alcohol generally than young adults in Washington. Cross-nationally, workplace interventions that restrict the availability of alcohol, ban alcohol at work, and reduce alcohol-tolerant norms have the potential to prevent and reduce young adults' alcohol use and misuse on and off the job.

The Potential for Prevention Science in Middle and Late Adulthood: a Commentary on the Special Issue of Prevention Science.

This commentary on the special issue of Prevention Science, "Toward a Lifespan Prevention Science: A Focus on Middle and Late Adulthood" reviews the studies included in the issue, compares findings, and makes recommendations for future directions in this emerging field. Articles in this issue addressed a number of the key elements of prevention science, including identifying proximal and distal risk and protective factors that play a role in middle and late adult health and well-being, providing preliminary evidence for a preventive intervention to moderate stress reactivity, and proposing a theoretical approach to preventing substance misuse across the lifespan. Our commentary centers around three critical areas for mid and later life prevention science: the importance of theory building, a focus on alcohol and its role in midlife health, and health disparities. Each of the articles in this issue touched on at least one of these areas. We conclude that a focus on prevention in mid and later life has strong potential, and further research is needed.

Adolescent Antecedents of Young Adult Homelessness: a Cross-national Path Analysis.

Adolescent and young adult health, development, and behavior lay a foundation for future population health. Increasing rates of young adult homelessness mean there is a need for research which generates evidence to support a stronger focus on population-level prevention. Using longitudinal data from a population-based sample of young adults participating in the cross-nationally matched International Youth Development Study, we examined adolescent antecedents of young adult homelessness in Washington State in the USA and in Victoria, Australia. Participants were surveyed using a modified version of the Communities That Care youth survey. Analyses of prospective, longitudinal data from 1945 participants, recruited as state-representative secondary school samples at grade 7 (average age 13, 2002) and longitudinally compared at young adulthood (average age 25, 2014), showed that young adults in Washington State reported higher rates of past year homelessness (5.24%) compared to those in Victoria (3.25%). Path modeling showed less positive family management strategies at age 13 uniquely increased risk for age 25 homelessness. This effect remained after accounting for age 15 antecedents in peer-group, school, and community environments. Friends' drug use, school suspension, academic failure, and low neighborhood attachment at age 15 mediated the association between less positive family management strategies at age 13 and age 25 homelessness. Despite observing some cross-national differences in levels of family, peer-group, school, and community antecedents, we found that these factors equally increased risk for age 25 homelessness in both states, suggesting similar cross-national influences for young adult homelessness. The findings indicate cross-nationally common adolescent antecedents for young adult homelessness that could be targeted by prevention strategies across international settings.

Parent-focused prevention of adolescent health risk behavior: Study protocol for a multisite cluster-randomized trial implemented in pediatric primary care.

Evidence-based parenting interventions play a crucial role in the sustained reduction of adolescent behavioral health concerns. Guiding Good Choices (GGC) is a 5-session universal anticipatory guidance curriculum for parents of early adolescents that has been shown to reduce substance use, depression symptoms, and delinquent behavior. Although prior research has demonstrated the effectiveness of evidence-based parenting interventions at achieving sustained reductions in adolescent behavioral health concerns, public health impact has been limited by low rates of uptake in community and agency settings. Pediatric primary care is an ideal setting for implementing and scaling parent-focused prevention programs as these settings have a broad reach, and prevention programs implemented within them have the potential to achieve population-level impact. The current investigation, Guiding Good Choices for Health (GGC4H), tests the feasibility and effectiveness of implementing GGC in 3 geographically and socioeconomically diverse large integrated healthcare systems. This pragmatic, cluster randomized clinical trial will compare GGC parenting intervention to usual pediatric primary care practice, and will include approximately 3750 adolescents; n = 1875 GGC intervention and n = 1875 usual care. The study team hypothesizes that adolescents whose parents are randomized into the GGC intervention arm will show reductions in substance use initiation, the study's primary outcomes, and other secondary (e.g., depression symptoms, substance use prevalence) and exploratory outcomes (e.g., health services utilization, anxiety symptoms). The investigative team anticipates that the implementation of GGC within pediatric primary care clinics will successfully fill an unmet need for effective preventive parenting interventions. Trial registration: Clinicaltrials.govNCT04040153.

Applying the Social Development Model in Middle Childhood to Promote Healthy Development: Effects From Primary School Through the 30s and Across Generations.

PURPOSE: This paper describes the origins and application of a theory, the social development model (SDM), that seeks to explain causal processes that lead to the development of prosocial and problem behaviors. The SDM was used to guide the development of a multicomponent intervention in middle childhood called Raising Healthy Children (RHC) that seeks to promote prosocial development and prevent problem behaviors. This paper reviews and integrates the tests of the SDM and the impact of RHC. While the original results of both model and intervention tests have been published elsewhere, this paper provides a comprehensive review of these tests. As such this integrative paper provides one of the few examples of the power of theory-driven developmental preventive intervention to understand impact across generations and the power of embedding controlled tests of preventive intervention within longitudinal studies to understand causal mechanisms. METHODS: Application of the SDM in the RHC intervention was tested in a quasi-experimental trial nested in the Seattle Social Development Project (SSDP). SSDP is a longitudinal study of 808 students who attended 18 public schools in Seattle, WA, and whose parents consented for their participation in longitudinal research when they were in Grade 5 (77% of the eligible population in participating schools). Students assented at each survey administration and consented to longitudinal follow-up when they turned 18. Panel subjects were followed and surveyed 15 times from Grade 5 through age 39, with most completion rates above 90%. RESULTS: We describe effects of the full multicomponent RHC intervention delivered in Grades 1 through 6 by comparing outcomes of those children assigned to the full RHC intervention condition to controls from middle childhood through age 39. We also report the effects of the full RHC intervention on the firstborn children of participants compared with the firstborn children of controls. CONCLUSIONS: We discuss use of the theory to guide development and testing of preventive interventions and the utility of nesting intervention tests within longitudinal studies for testing both theory and interventions.

Accounting for quality improvement during the conduct of embedded pragmatic clinical trials within healthcare systems: NIH Collaboratory case studies.

Embedded pragmatic clinical trials (ePCTs) and quality improvement (QI) activities often occur simultaneously within healthcare systems (HCSs). Embedded PCTs within HCSs are conducted to test interventions and provide evidence that may impact public health, health system operations, and quality of care. They are larger and more broadly generalizable than QI initiatives, and may generate what is considered high-quality evidence for potential use in care and clinical practice guidelines. QI initiatives often co-occur with ePCTs and address the same high-impact health questions, and this co-occurrence may dilute or confound the ability to detect change as a result of the ePCT intervention. During the design, pilot, and conduct phases of the large-scale NIH Collaboratory Demonstration ePCTs, many QI initiatives occurred at the same time within the HCSs. Although the challenges varied across the projects, some common, generalizable strategies and solutions emerged, and we share these as case studies. KEY LESSONS: Study teams often need to monitor, adapt, and respond to QI during design and the course of the trial. Routine collaboration between ePCT researchers and health systems stakeholders throughout the trial can help ensure research and QI are optimally aligned to support high-quality patient-centered care.

Longitudinal Consequences of Adolescent Alcohol Use Under Different Policy Contexts in Australia and the United States.

OBJECTIVE: To test the premise that youth alcohol harm minimization policies (compared with abstinence policies) reduce later drinking and harmful consequences of alcohol use in young adulthood, we compared associations among adolescent alcohol use, young adult alcohol consumption, and alcohol-related harms in Victoria, Australia and Washington State, United States. METHOD: Data came from the International Youth Development Study, a longitudinal, cross-national study of the development of substance use. State-representative samples of seventh-grade (age 13) students in Victoria (n = 984, 53% female, 90% White) and Washington (n = 961, 54% female, 73% White) were surveyed in 2002, 2003, 2004, and 2014 (age 25). Participants self-reported alcohol initiation by age 15 and age 25 alcohol consumption (per the Alcohol Use Disorders Identification Test). Path modeling tested associations among age 15 alcohol use, age 25 consumption, and alcohol-related harms at age 25; multiple group modeling tested the equivalence of parameter estimates across states. RESULTS: Age 25 alcohol consumption was lower in Washington versus Victoria and was associated with poor physical and mental health, partner conflict, substance use, criminal behavior, and violence exposure in both states equally. Living in Washington predicted lower levels of multiple alcohol-related harms at age 25 indirectly via lower age 25 alcohol consumption. CONCLUSIONS: Young adults growing up in Victoria reported greater alcohol consumption in young adulthood, which was associated to the same degree with the harms measured regardless of alcohol policy context. Findings support state-level policies that promote alcohol abstinence in adolescence and reduced consumption in young adulthood.

Identifying and predicting criminal career profiles from adolescence to age 39.

Few longitudinal studies are capable of identifying criminal career profiles using both self-report and official court data beyond the 30s. The current study aims to identify criminal career profiles across three developmental periods using self-report data, validate these profiles with official court records and determine early childhood predictors. Data came from the Seattle Social Development Project (n = 808). Latent Class Analysis was used to examine criminal careers from self-reported data during adolescence (aged 14-18), early adulthood (aged 21-27) and middle adulthood (aged 30-39). Official court records were used to validate the classes. Childhood risk and promotive factors measured at ages 11-12 were used to predict classes. Findings revealed four career classes: non-offending (35.6%), adolescence-limited (33.2%), adult desister (18.3%) and life-course/persistent (12.9%). Official court records are consistent with the description of the classes. Early life school and family environments as well as having antisocial beliefs and friends differentiate membership across the classes. The results of this study, with a gender-balanced and racially diverse sample, bolster the current criminal career knowledge by examining multiple developmental periods into the 30s using both self-report and official court data.

Outcomes of Childhood Preventive Intervention Across 2 Generations: A Nonrandomized Controlled Trial.

Importance: Trials of preventive interventions for children that were implemented in the 1980s have reported sustained positive outcomes on behavioral and health outcomes into adulthood, years after the end of the intervention. This present study examines whether intervention in childhood may show sustained benefits across generations. Objective: To examine possible intervention outcomes on the offspring of individuals (now parents) who participated in the Raising Healthy Children preventive intervention as children in the elementary grades. Design, Setting, and Participants: This nonrandomized controlled trial was conducted in public elementary schools serving high-crime areas in Seattle, Washington. The panel originated in Seattle but was followed up locally and in out-of-state locations over time. Data analyzed in this study were collected from September 1980 to June 2011, with follow-up of the firstborn offspring (aged 1 through 22 years) of 182 parents who had been in the full intervention vs control conditions in childhood. Their children were assessed across 7 waves in 2 blocks (2002-2006 and 2009-2011). Data were analyzed for this article from September 2018 through January 2019. Interventions: In grades 1 through 6, the Raising Healthy Children intervention provided elementary school teachers with methods of classroom management and instruction, first-generation (G1) parents with skills to promote opportunities for children's active involvement in the classroom and family, and second-generation (G2) child with social and emotional skills training. Main Outcomes and Measures: Outcomes examined in the third-generation (G3) offspring were self-regulation (emotion, attention, and behavioral regulation), cognitive capabilities, and social capabilities. Risk behaviors, including substance use and delinquency, were examined from age 6 years to study completion. Early onset of sexual activity was examined from age 13 years to study completion. Intent-to-treat analyses controlled for potential confounding factors. Results: A total of 182 G3 children were included in this analysis (72 in the full intervention and 110 in the control condition; mean age at first wave of data collection, 7 [range, 1-13] years). Significant differences in the offspring of intervention parents were observed across 4 domains: improved early child developmental functioning (ages 1-5 years; significant standardized ß range, 0.45-0.56), lower teacher-rated behavioral problems (ages 6-18 years; significant standardized ß range, -0.39 to -0.46), higher teacher-rated academic skills and performance (ages 6-18 years; significant standardized ß range, 0.34-0.49), and lower child-reported risk behavior (ages 6-18 years; odds ratio for any drug use [alcohol, cigarettes, or marijuana], 0.27 [95% CI, 0.10-0.73]). Conclusions and Relevance: To our knowledge, this is the first study to report significant intervention differences in the offspring of participants in a universal childhood preventive intervention. Cost-benefit analyses have examined the benefits of childhood intervention in the target generation. The present study suggests that additional benefits can be realized in the next generation as well. Trial Registration: ClinicalTrials.gov Identifier: NCT04075019.

Prevalence of homelessness and co-occurring problems: A comparison of young adults in Victoria, Australia and Washington State, United States.

Homelessness is associated with various co-occurring health and social problems yet; few contemporary international studies have examined these problems in young adulthood. This descriptive study presents cross-state comparison of the prevalence of young adult homelessness in Washington State, USA and Victoria, Australia using state representative samples from the International Youth Development Study (IYDS; n = 1,945, 53% female). Associations between young adult homelessness and a range of co-occurring problems were examined using a modified version of the Communities That Care youth survey. Results showed significantly higher rates of past year homelessness were reported by young adults in Washington State (5.24% vs. 3.25% in Victoria). Cross-state differences were evident in levels of friends' drug use, antisocial behavior, weekly income and support from peers. Unemployment (Adjusted Odds Ratio [AOR] = 2.67), antisocial behavior (AOR = 3.54) and victimization (AOR = 3.37) were more likely among young adults reporting homelessness in both states. Young adults with higher weekly income were less likely to report homelessness (AOR = .69) in both states. No significant association between mental health problem symptoms, substance use, family conflict or interaction with antisocial peers and homelessness were found in either state. Rates of violent behavior were more strongly related to young adult homelessness in Washington State than Victoria. The current findings suggest that programs that enable young adults to pursue income and employment, reduce antisocial behavior and include services for those who have been victimized, may help to mitigate harm among young adults experiencing homelessness.

Longitudinal Associations Between Early-Mid Adolescent Risk and Protective Factors and Young Adult Homelessness in Australia and the United States.

Homelessness is associated with a range of negative health and behavioral outcomes, yet life-course pathways to homelessness from adolescence to early adulthood are not well-documented. This study asks to what extent do early-mid adolescent risk and protective factors predict young adult homelessness, and whether the predictive nature of these factors is similar in Victoria, Australia, and Washington State in the USA. As part of the International Youth Development Study, adolescents were recruited as state representative secondary school samples at grade 7 (age 13, 2002) and longitudinally compared at average age 25. Higher rates of past year homelessness were reported by Washington State (5.24%), compared to Victorian young adults (3.25%). Although some cross-state differences in levels of adolescent demographic, individual, family, peer group, school, and community predictors were found, cross-state comparisons showed these factors were equally predictive of young adult homelessness in both states. In univariate analyses, most adolescent risk and protective factors were significant predictors. Unique multivariate adolescent predictors associated with young adult homelessness included school suspension (adjusted odds ratio [AOR] = 2.76) and academic failure (AOR = 1.94). No significant unique protective effects were found. Prevention and intervention efforts that support adolescents' academic engagement may help in addressing young adult homelessness. The similar cross-state profile of adolescent predictors suggests that programs seeking to support academic engagement may influence risk for homelessness into young adulthood in both states. The similarity in life-course pathways to homelessness suggests that the USA and Australia can profitably translate prevention and intervention efforts to reduce homelessness while continuing to identify modifiable predictors.

Does Adolescent Alcohol Harm Minimization Policy Exposure Reduce Adult Alcohol Problems? A Cross-National Comparison.

PURPOSE: Adolescent alcohol use carries risks for problem behaviors, such as injury and school dropout, as well as increases the risk of alcohol dependence later on, making public health approaches that curb youth alcohol use a key concern. The present study uses a two-state comparison of alcohol-related policies in Victoria, Australia and Washington State, U.S. (harm minimization in Australia and zero tolerance in the U.S.) to examine whether youth alcohol use in each state is related to alcohol-related problems in young adulthood. METHODS: Data were drawn from the International Youth Development Study (N = 1,965) that followed youth in Victoria and Washington states from age 13 years, with follow-up at ages 14 and 15 years, and then again at age 25 years. Multiple-group structural equation modeling was used to test whether early alcohol use was equally related to alcohol problems (measured by the Alcohol Use Disorder Identification Test) at age 25 years and whether the relationship was moderated by family and school environments that were tolerant of youth drinking and by gender. RESULTS: Youth in Victoria reported greater rates of alcohol use compared with youth in Washington, as well as more permissive family and school environments. Early alcohol use was equally associated with Alcohol Use Disorder Identification Test problems at age 25 years in the two nations, and none of the moderators significantly changed the association. CONCLUSIONS: Results suggest that harm minimization policies adopted in Victoria are less effective at reducing alcohol problems during young adulthood compared with the stricter zero-tolerance approaches adopted in Washington State.

Neighborhood Structural Factors and Proximal Risk for Youth Substance Use.

This study examined associations of neighborhood structural factors (census-based measures, socioeconomic disadvantage, and residential stability); self-reported measures of general and substance use-specific risk factors across neighborhood, school, peer, and family domains; and sociodemographic factors with substance use among 9th grade students. Data drawn from the Seattle Social Development Project, a theory-driven longitudinal study originating in Seattle, WA, were used to estimate associations between risk factors and past month cigarette smoking, binge drinking, marijuana use, and polysubstance use among students (N = 766). Results of logistic regression models adjusting for neighborhood clustering and including all domains of risk factors simultaneously indicated that neighborhood socioeconomic disadvantage was associated with a significantly higher likelihood of cigarette smoking, binge drinking, and polysubstance use, but not marijuana use. In fully controlled models, substance use-specific risk factors across neighborhood, school, peer, and family domains were also associated with increased likelihood of substance use and results differed by the outcome considered. Results highlight substance-specific risk factors as an intervention target for reducing youth substance use and suggest that further research is needed examining mechanisms linking neighborhood socioeconomic disadvantage and youth substance use.

Longitudinal Associations Between the Adolescent Family Environment and Young Adult Substance Use in Australia and the United States.

Introduction: Harmful alcohol and cannabis use are social concerns associated with a range of negative outcomes. Prior research has identified links between disrupted parent-child attachment and child-adolescent substance use. Materials and Methods: This study used cross-national data from the International Youth Development Study (IYDS; Victoria, Australia and Washington State, USA) to investigate the relationship between early adolescent family environment characteristics, mid-adolescent attachment to parents, and young adult harmful alcohol and cannabis use. The moderating role of state on these relationships was also tested. State-representative samples of students in Grade 7 (age 13, 2002) were recruited and followed longitudinally at ages 14, 15, and 25 (n = 1,945, 53% female, 50% in Victoria). Results: Cross-state differences were evident in levels of family management, parent attitudes favorable to drug use, sibling alcohol and cannabis use, attachment to parents, and past year alcohol and cannabis use. Significantly higher rates of problematic alcohol use were reported by young adults in Victoria (25% vs. 14% in Washington State). Young adults in Washington State reported significantly higher rates of problematic cannabis use (14% vs. 10% in Victoria). Path modeling showed that characteristics of positive family environments (e.g., low conflict) in early adolescence were associated with higher attachment to parents and lower alcohol and cannabis use in mid-adolescence. Sibling substance use and more favorable parent attitudes to drug use were associated with past year alcohol and cannabis use in mid-adolescence. Results showed higher attachment to parents in mid-adolescence did not uniquely predict lower problematic alcohol or cannabis use in young adulthood. No significant cross-state differences in this pattern of associations were found. Discussion: The implications of the current findings suggest that prevention and intervention strategies targeted at reducing problematic substance use into young adulthood may benefit from considering the influence of behavioral norms and attitudes in family relationships.

Effects of Social Development Intervention in Childhood on Adult Life at Ages 30 to 39.

Elementary schools can be effective sites for universal preventive interventions. Less is known about how long effects of intervention in elementary grades last. Can they improve outcomes in adulthood? To test effects of a social developmental intervention in the elementary grades on adult life through the 30s, the Seattle Social Development Project, a nonrandomized controlled trial, followed all consenting 5th-grade students (N = 808) from 18 Seattle public elementary schools from age 10 (in 1985) to age 39 (in 2014), with 88% retention. The sample was gender balanced and ethnically and economically diverse. The full intervention, called Raising Healthy Children, continued from Grades 1 through 6 and consisted of teacher in-service training in classroom management and instructional methods; cognitive, social, and refusal skills training for children; and parent workshops in child behavior monitoring and management, academic support, and anticipatory guidance. Using structural equation modeling, we examined intervention effects from age 30 to age 39 across 9 constructs indicating 3 domains of adult life: health behavior, positive functioning, and adult health and success. An omnibus test across all 9 constructs indicated a significant positive overall intervention-control difference. Examined individually, significant intervention effects included better health maintenance behavior, mental health, and overall adult health and success. Significant effects were not found on substance use disorder symptoms, sex-risk behaviors, or healthy close relationships in the 30s. Results indicate that sustained, theory-based, multicomponent intervention in the elementary grades can produce lasting changes in health maintenance, mental health, and adult functioning through the 30s.

Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy.

PURPOSE: Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs). METHODS: Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation. RESULTS: Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators. CONCLUSIONS: There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.

Optimizing Assessment of Risk and Protection for Diverse Adolescent Outcomes: Do Risk and Protective Factors for Delinquency and Substance Use Also Predict Risky Sexual Behavior?

Assessments of youth risk and protective factors (RPFs) for substance use, delinquency, and violence have been used by communities to identify priorities and target them with prevention interventions. These same RPFs may also predict other youth problems. This study examined the strength and consistency of relationships of 41 ecological RPFs that predict antisocial behavior and substance use with sexual behavior outcomes in a sample of 2150 urban youth in 10th and 12th grade. After adjusting for controls, findings identify significant associations among the majority of community, school, family, peer, and individual risk factors, and family, peer, and individual protective factors, with sexual behavior outcomes, specifying unique associations among multiple factors with risky sex relative to both safe sex and not being sexually active. Prevention programming that targets common predictors for multiple problems may address a broad array of outcomes, including sexual health risk behaviors.

The Interplay Between Marijuana-Specific Risk Factors and Marijuana Use Over the Course of Adolescence.

Permissive attitudes and norms about marijuana use and perceptions of low harm from use are considered risk factors for adolescent marijuana use. However, the relationship between risk and use may be reciprocal and vary across development and socializing domains. We examined the bidirectional relationships between marijuana-specific risk factors in individual, parent, peer, and community domains and adolescent marijuana use. Longitudinal data came from a sample of 2002 adolescents in 12 communities. Controlling for sociodemographic covariates and communities in which the individuals resided, autoregressive cross-lagged models examined predictive associations between the risk factors and marijuana use. After accounting for concurrent relationships between risk and use and stability in behavior over time, early adolescence and the transition to high school were particularly salient developmental time points. Specifically, higher risk in all four domains in grades 7 and 9 predicted greater use 1 year later. Moreover, youth's perception of lax community enforcement of laws regarding adolescent use at all time points predicted increases in marijuana use at the subsequent assessment, and perceived low harm from use was a risk factor that prospectively predicted more marijuana use at most of the time points. Finally, greater frequency of marijuana use predicted higher levels of risk factors at the next time point in most socializing domains throughout adolescence. Prevention programs should take into account developmental transitions, especially in early adolescence and during the transition to high school. They also should focus on the reciprocal relationships between use and risk across multiple socializing domains.