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.

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.

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.

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.

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.

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.

Patterns of adolescent tobacco and alcohol use as predictors of illicit and prescription drug abuse in minority young adults.

The present longitudinal study examined the relationship between patterns of cigarette smoking and alcohol use during adolescence and illicit drug abuse (DA) and prescription drug abuse (PDA) in early adulthood. The sample consisted of 984 predominantly minority young adults (57% women) who completed (a) six annual surveys as adolescents attending New York City public schools (grades 7 through 12) and (b) a follow-up telephone interview as young adults (mean age = 23). Findings from a series of latent growth models indicated that growth in cigarette smoking and alcohol use during adolescence each independently predicted DA in adulthood. Baseline levels of alcohol use in 7th grade also predicted DA in adulthood. Growth in alcohol consumption during adolescence predicted PDA in young adulthood. Results indicate that an escalation during adolescence in the use of substances that are legal for adults (cigarettes and alcohol) contributes to greater DA and PDA in young adulthood. One implication of these findings is that interventions that can prevent cigarette smoking and alcohol use during adolescence may also reduce DA and PDA in young adults.

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.

Development of a group and family-based cognitive behavioural therapy program for youth at risk for psychosis.

OBJECTIVE: The onset of psychosis typically occurs during adolescence or early adulthood and can have a detrimental impact on social and cognitive development. Cognitive behavioural therapy (CBT) shows promise in reducing the risk of psychosis. Teaching families to apply CBT with their offspring may bolster therapeutic gains made in time-limited treatment. We developed a comprehensive group-and-family-based CBT (GF-CBT) program that aims to facilitate psychosocial recovery, decrease symptoms and prevent transition to psychosis in youth at risk. GF-CBT is grounded in ecological systems and cognitive theories, resilience models and research on information processing in delusions. The theoretical rationale and description of GF-CBT are presented together with a pilot study that evaluated the program's feasibility and explored participants' outcomes. METHODS: Youth ages 16-21 at risk for psychosis and their families participated in an open trial with pre, post and 3-month follow-up assessments conducted by an independent evaluator. The Comprehensive Assessment of At-Risk Mental States was the primary clinical outcome measure. RESULTS: All enrolled participants (n = 6) completed GF-CBT and all remitted from at-risk mental state (ARMS). As a group participants showed statistically significant decreases in attenuated psychotic symptoms, negative symptoms, depression, cognitive biases and improvements in functioning. Family members showed significant improvements in use of CBT skills, enhanced communication with their offspring, and greater confidence in their ability to help. Gains were maintained at follow-up. CONCLUSIONS: GF-CBT may delay or prevent transition to psychosis in youth at risk, and potentially facilitate recovery from ARMS. More rigorous, controlled research is needed to further evaluate this program.

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.

Predicting Alcohol-Impaired Driving among Spanish Youth with the Theory of Reasoned Action.

Alcohol consumption is a risk factor for motor vehicle accidents in young drivers. Crashes associated with alcohol consumption typically have greater severity. This study examines the prevalence of driving under the influence among Spanish youth and tests the theory of reasoned action as a model for predicting driving under the influence. Participants included 478 Spanish university students aged 17-26 years. Findings indicated that alcohol was the substance most associated with impaired driving, and was involved in more traffic crashes. Men engage in higher levels of alcohol and other drug use, and perceived less risk in drunk driving (p < .01). The study confirms that alcohol use and driving under the influence of alcohol are highly prevalent in Spanish young people, and some gender differences exist in these behaviors (p < .01). Furthermore, the study confirms the validity of theory of reasoned action as a predictive model of driving under the influence of alcohol among youth in Spain (p < .001) and can help in the design of prevention programs.

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers.

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.

International travel patterns and travel risks for stem cell transplant recipients.

BACKGROUND: Stem cell transplantation (SCT) is being increasingly utilized for multiple medical illnesses. However, there is limited knowledge about international travel patterns and travel-related illnesses of stem cell transplant recipients (SCTRs). METHODS: An observational cross-sectional study was conducted among 979 SCTRs at Memorial Sloan Kettering Cancer Center using a previously standardized and validated questionnaire. International travel post SCT, pre-travel health advice, exposure risks, and travel-related illnesses were queried. RESULTS: A total of 516 SCTRs completed the survey (55% response rate); of these, 40% were allogeneic SCTRs. A total of 229 (44.3%) respondents reported international travel outside the United States and Canada post SCT. The international travel incidence was 32% [95% confidence interval CI 28-36] within 2 years after SCT. Using multivariable Cox regression analysis, variables significantly associated with international travel within first 2 years after SCT were history of international travel prior to SCT [hazard ratio (HR) = 5.3, 95% CI 2.3-12.0], autologous SCT (HR = 2.6, 95% CI 1.6-2.8), foreign birth (HR = 2.3, 95% CI 1.5-3.3), and high income (HR = 2.0, 95% CI 1.8-3.7). During their first trip, 64 travelers (28%) had traveled to destinations that may have required vaccination or malaria chemoprophylaxis. Only 56% reported seeking pre-travel health advice. Of those who traveled, 16 travelers (7%) became ill enough to require medical attention during their first trip after SCT. Ill travelers were more likely to have visited high-risk areas (60 vs 26%, p = 0.005), to have had a longer mean trip duration (24 vs 12 days, p = 0.0002), and to have visited friends and relatives (69 vs 21%, p < 0.0001). CONCLUSIONS: International travel was common among SCTRs within 2 years after SCT and was mainly to low-risk destinations. Although the overall incidence of travel-related illnesses was low, certain subgroups of travelers were at a significantly higher risk. Pre-travel health counseling and interventions were suboptimal.

Predicting alcohol-impaired driving among Spanish youth with the theory of reasoned action

Alcohol consumption is a risk factor for motor vehicle accidents in young drivers. Crashes associated with alcohol consumption typically have greater severity. This study examines the prevalence of driving under the influence among Spanish youth and tests the theory of reasoned action as a model for predicting driving under the influence. Participants included 478 Spanish university students aged 17-26 years. Findings indicated that alcohol was the substance most associated with impaired driving, and was involved in more traffic crashes. Men engage in higher levels of alcohol and other drug use, and perceived less risk in drunk driving (p < .01). The study confirms that alcohol use and driving under the influence of alcohol are highly prevalent in Spanish young people, and some gender differences exist in these behaviors (p < .01). Furthermore, the study confirms the validity of theory of reasoned action as a predictive model of driving under the influence of alcohol among youth in Spain (p < .001) and can help in the design of prevention programs (AU)

No disponible

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.

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.