Reduction of adolescent alcohol use through family-school intervention: a randomized trial.

PURPOSE: Two-year longitudinal follow-up data evaluated the behavioral impact of Resilient Families, a universal intervention that aimed to prevent early initiation and frequent and heavy adolescent alcohol use in secondary schools in Melbourne, Australia. METHODS: Of 24 secondary schools (62% of those approached), 12 were randomly assigned to intervention and 12 as controls. Intervention students received a social relationship curriculum; their parents received parent education handbooks and invitations to parent education events outlining strategies to encourage healthy adolescent development and reduce adolescent alcohol misuse. At Wave 1 (2004), students were in Year 7 secondary school (mean age, 12.3 years). Data were imputed for students completing at least two of three annual surveys (N = 2,354). Wave 3 (2006; mean, 14.5 years) main outcome measures for alcohol use were "any," "frequent" (at least monthly), and "heavy" (five or more drinks in a session at least once in the prior fortnight). Multivariate logistic regression assessed intervention exposure effects, adjusting for school classroom clustering and baseline measures. RESULTS: Relative to controls, intervention students showed significant reductions in any lifetime use (adjusted odds ratio [AOR], .78; 95% confidence interval [CI], .62-.97), and reduced progression to frequent (AOR, .69; CI, .56-.86) and heavy use (AOR, .75; CI, .60-.94). CONCLUSIONS: Randomized assignment to Resilient Families was associated with a significant reduction in adolescent alcohol use among families volunteering for the evaluation. Family-school-based interventions appear promising as a strategy to contribute to population reductions in currently high rates of adolescent alcohol misuse.

Stress reactivity and the Hemodynamic Profile-Compensation Deficit (HP-CD) Model of blood pressure regulation.

Considering the central role of the concept of blood pressure reactivity to explanations of the influence of life stress in the pathogenesis of cardiovascular disease, it is important that the underlying psychophysiological determinants of blood pressure change are elucidated. Empirical evidence is reviewed concerning the utility of the Hemodynamic Profile-Compensation Deficit (HP-CD) Model (Gregg et al., 2002), which draws on physiological theory that explains blood pressure regulation as a dynamic compensatory relation between cardiac output and total peripheral resistance. Core constructs and quantitative features of the Model are explained, accompanied by a focussed review of the Model's application in reactivity studies of stress, lifestyle behaviours, laboratory-to-field generalisability, and personality differences. Although the available studies are relatively few in number, evidence of the Model's utility is promising. Application of the Model in further research could help to elucidate cardiovascular pathogenesis in ways not achievable through the study of blood pressure reactivity alone.

Association between hemodynamic profile during laboratory stress and ambulatory pulse pressure.

Hemodynamic responses underlying blood pressure reactivity to laboratory stress are theoretically linked to cardiovascular pathophysiology. The present study investigated whether a vascular response predicted ambulatory pulse pressure, a known risk factor for cardiovascular disease. A new model of hemodynamic profile, previously developed by the authors, was applied to 24-h ambulatory data from 30 female and 34 male healthy young adults. Of these, 40 were monitored during a naturalistic stressor (university examination). For females, hemodynamic profile significantly predicted nighttime systolic blood pressure, and 24-h, day-, and nighttime diastolic blood pressure, but not ambulatory pulse pressure. A vascular or mixed hemodynamic profile significantly predicted 24-h and daytime ambulatory pulse pressure in males. The findings are consistent with theories of pathogenic mechanisms involving vascular changes and suggest that, for males, a vascular or mixed hemodynamic profile measured during laboratory stress may be a risk marker for cardiovascular disease, by its association with ambulatory pulse pressure.