Preventing substance use among Native American youth: three-year results.

This study developed and tested skills- and community-based approaches to prevent substance abuse among Native American youth. After completing pretest measurements, 1,396 third- through fifth-grade Native American students from 27 elementary schools in five states were divided randomly by school into two intervention arms and one control arm. Following intervention delivery, youths in all arms completed posttest measurements and three annual follow-up measurements. Youths in schools assigned to the intervention arms learned cognitive and behavioral skills for substance abuse prevention. One intervention arm additionally engaged local community residents in efforts to prevent substance use among Native American youth. Outcome assessment batteries measured youths' reported use of smoked and smokeless tobacco, alcohol, and marijuana. Over the course of the 3.5-year study, increased rates of tobacco, alcohol, and marijuana use were reported by youths across the three arms of the study. Though cigarette use was unaffected by intervention, follow up rates of smokeless tobacco, alcohol, and marijuana use were lower for youths who received skills intervention than for youths in the control arm. Community intervention components appeared to exert no added beneficial influence on youths' substance use, beyond the impact of skills intervention components alone. Finally, gender differences were apparent across substances, measurements, and study arms, with girls smoking more cigarettes and boys using more smokeless tobacco, alcohol, and marijuana.

Enhancing the educational achievement of at-risk youth.

This study examined a non-school program aimed at enhancing the educational performance of economically disadvantaged early adolescents who live in public housing. The educational enhancement program included discussions with adults, writing activities, leisure reading, homework, helping others, and games using cognitive skills. A three-arm research design juxtaposed program youth who received educational enhancements with comparison youth in affiliated facilities who did not receive the program and with control youth in other community programs without educational enhancements. From youths, follow-up data collected 2 1/2 years after baseline revealed uniformly positive outcomes for program youth on measures of reading, verbal skills, writing, and tutoring. Teacher reports at final follow-up favored program and comparison youth over controls on measures of reading, writing, games, overall school performance, and interest in class material. School grades were higher for program youth than for comparison and control youth for reading, spelling, history, science, and social studies. Overall grade averages were higher for program youth versus comparisons and controls, as was school attendance. Study data lend empirical support to the provision of educational enhancements in non-school settings for at-risk youths.

Organizational and individual factors influencing job satisfaction and burnout of mental health workers.

Job satisfaction and burnout are important areas of study because of the financial and social effects of job satisfaction and the damaging physical/psychological impacts of burnout. Two hundred family/children and psychiatric workers of seven social service organizations were surveyed. Instruments used were the Minnesota Satisfaction Questionnaire, the Maslach Burnout Inventory, and the Staff Burnout Scale for Health Professionals. Reported levels of job satisfaction and burnout are within normal limits. Psychiatric and family/children workers report equal job satisfaction levels, but the latter group reports significantly higher burnout levels. Both groups are particularly satisfied with the amount of praise delivered by supervisors and are reportedly dissatisfied with salary levels and promotional opportunities. These three factors are strongly associated with job satisfaction and burnout levels of both groups. Findings have practical implications for social service administrators and practitioners. Correlates of satisfaction and burnout can be altered in order to maintain employee satisfaction and reduce burnout, absenteeism and turnover.

Psychosocial determinants of alcohol use among minority youth living in public housing developments.

Youth residing in low income, inner city, public housing developments might be extremely vulnerable to psychosocial risk factors associated with alcohol use. In this study, we developed and tested a model of alcohol etiology with 624 African-American and Hispanic 7th graders residing in public housing developments. The students completed questionnaires concerning their alcohol use, social influences on their drinking, their drinking attitudes and knowledge, their psychosocial skills, and demographic and behavioral control information. Logistic regression analyses indicated that social influences from adults, friends, and family members predicted alcohol use. Individual psychosocial characteristics, e.g., drinking refusal, lowered the odds of drinking. These findings imply that effective prevention approaches targeting minority urban youths residing in public housing developments should provide them with an awareness of social influences to drink, correct misperceptions concerning the prevalence of drinking, and train them in relevant psychosocial skills.

Preventing teenage pregnancy: translating research knowledge.

PIP: This paper explores the multiple dimensions of teenage pregnancy and suggests ways on how to prevent it. It reviews the contemporary historical context and the epidemiology of adolescent pregnancy, and describes past and promising approaches to its prevention. Although teenage pregnancy has long been recognized as a social problem by Americans, policymakers, and social scientists, little progress has been made to understand its social and behavioral origins. Previous efforts to delay conception and childbearing among adolescents have done little in changing the nature of the problem. However, recent studies are starting to discover not only the underlying causes of pregnancy among adolescents, but also the appropriate strategies for reducing the risks of unplanned teenage pregnancy. Such strategies include the use of theory-based interventions which can explain the sexual risk-taking that often leads to unplanned pregnancies among adolescents and interventions that consider cultural differences. Promising approaches are those that address the several dimensions of the problem and the social and behavioral contexts in which it occurs.^ieng

Reducing cancer risk among Native American adolescents.

BACKGROUND: This article discusses the development, implementation, and preliminary testing of an intervention to reduce cancer risks through tobacco use prevention and dietary modification among Native American youth in the Northeastern United States. METHODS: The intervention outcome study includes a research design and outcome measurement instruments. In collaboration with Native American communities, reservations, and organizations in the Northeastern United States, implementation of the design quantifies the separate and combined effects of a tobacco use prevention and a dietary modification intervention. RESULTS: Native American youths in the tobacco prevention intervention and in the combined tobacco and dietary intervention increased their knowledge of tobacco facts and their awareness of the motives of tobacco advertising, and showed higher ratings for an ability to resist peer pressure and to refuse offers of tobacco use between pretest and posttest. Youths in the combined intervention were significantly less apt to report smoking of any kind. Youths in the tobacco use prevention-only condition reported significantly less smoking than their counterparts in the dietary modification-only condition and control condition on 4 of 8 measurement items. As for dietary variables, pretest to posttest measurement scores showed that, after receiving the curriculum, youths in the dietary modification intervention and in the combined intervention improved their knowledge of the health implications of consuming dietary fat, fiber, fruits, and vegetables. Youths in the dietary modification and combined intervention also improved their scores of knowledge related to cancer risk-reducing nutritional practices, cultural dietary habits, and healthy food choices available for Native American cultures. Youths in the dietary modification-only condition report significantly increasing their consumption of complex carbohydrates and significantly decreasing their fat intake between pretest and posttest occasions. CONCLUSIONS: Data from this longitudinal study suggest the value of the FACETS curriculum for helping Native American youth reduce their risks for cancer associated with tobacco use and dietary preference and consumption patterns. In particular, results indicate the enhanced effects of the combined tobacco use prevention and dietary modification intervention for preventing tobacco use and for improving youths' knowledge and attitudes with regard to tobacco use and diet. Further, the study demonstrates the value of collaborating with Native American organizations to design a cancer risk-reducing curriculum and to implement tests of that curriculum.

Social and personal factors in marijuana use and intentions to use drugs among inner city minority youth.

Limited information is available about the etiology of illicit drug use among minority youth. This study examined predictors of marijuana use and intentions to use marijuana, cocaine/crack, and other drugs for African-American and Hispanic seventh graders (N = 757). Self-reports of marijuana use and intentions to use drugs were collected along with data concerning background, social environmental, and individual characteristics hypothesized to be related to drug use. Results indicated that social influences, including adults, friends, and the most admired person's marijuana use, predicted marijuana use. Individual characteristics, such as a lack of knowledge about the prevalence and negative social consequences of marijuana use, positive attitudes toward marijuana use, and inadequate social, communication, and refusal skills increased suspectability to marijuana use. Lack of self-efficacy was related to intentions to use cocaine and other drugs. Implications of these findings are discussed with respect to the development of effective prevention programs.

The role of social factors and individual characteristics in promoting alcohol use among inner-city minority youths.

OBJECTIVE: During seventh grade, many adolescents initiate alcohol use yet school drop-out rates are still low. Therefore, this is an ideal period of adolescence to examine predictors of alcohol use. The purpose of this study was to elucidate the etiology of alcohol use among an understudied population: disadvantaged inner-city minority youths. Specifically, we attempted to develop as complete a model of predictors of alcohol use as possible from three domains: background characteristics, social influences to drink and individual characteristics. METHOD: To explore alcohol use of youths who are living in poverty and are members of minority groups, New York City public schools from districts known to have predominantly minority student bodies with low socioeconomic status (SES) were identified. Self-reports of alcohol use and data concerning background, social environmental and individual characteristics hypothesized to promote drinking alcohol were collected from black and Hispanic seventh graders (N = 757). RESULTS: Logistic regression analyses indicated that social influences from friends, peers and parents predicted alcohol use. Most interestingly, the drinking status of the person the respondent most admired was related to drunkenness and future alcohol use. Individual characteristics, such as health-related knowledge concerning alcohol use and antidrinking attitudes, lowered the odds of drinking. CONCLUSIONS: These findings imply that effective prevention programs targeting inner-city minority youths should provide students with an awareness of the social influences to drink, provide them with positive role models and correct misperceptions about the prevalence of drinking among friends and peers.

Predictors of cigarette smoking among inner-city minority youth.

Limited information is available concerning the etiology of smoking among minority youth. We examined predictors of smoking among inner-city African-American and Latino seventh graders (N = 757). Enhanced self-reports of cigarette smoking were collected along with data concerning background, social environmental, and individual characteristics hypothesized to promote smoking. Results indicated that friends and peers were the most important social influences in predicting smoking. Several psychological factors, including feelings of hopelessness, low efficacy in life skills (social skills, communication skills, and refusal skills) and low self-esteem seemed related to increased susceptibility to smoking. We discuss implications of our findings for effective prevention programs for minority youth.

Native American youths and cancer risk reduction. Effects of software intervention.

PURPOSE: Toward developing attractive and effective means to reduce cancer risks faced by Native American people, this study developed and tested interactive computer software to improve dietary choices and prevent tobacco use among Native American adolescents. METHODS: Based on a legend of the Seneca Nation, a cancer prevention lesson was developed and programmed for software. A sample of 368 Native American adolescents were divided randomly into intervention and control arms. Youths in both arms were pre-tested, youths in the intervention arm interacted with the software, and all youths were post-tested. Pre-test and post-test measures covered information and attitudes about cancer risks from dietary practices and tobacco use. RESULTS: Pre-test scores differed between the two arms on youths' age and on one outcome variable. Relative to their counterparts in the control arm, youths in the intervention arm increased their post-test scores on 8 of 12 outcome measurement variables. Process data gathered during intervention delivery indicated that nearly all youths were involved with the interactive software and lesson. CONCLUSION: Interactive computer software holds promise for delivering cancer risk reduction intervention aimed at modifying dietary habits and preventing tobacco use among Native American youth.

Prevention science and practice: An agenda for action.

This paper reflects on relevant theories, target populations, channels, interventions, and evaluation methods for prevention within the social and behavioral sciences. After summarizing progress to date in these areas, the paper considers challenges to prevention researchers and practitioners that must be met to continue advances in the field.

Feasibility of interactive videodisc technology to teach minority youth about preventing HIV infection.

Hispanic and African American adolescents are more likely than white Anglo youth to harbor misconceptions about acquired immunodeficiency syndrome (AIDS) and are also more likely to engage in intravenous drug use and sexual intercourse. This paper describes the development of an AIDS prevention curriculum that uses an interactive videodisc program to teach skills for interventions. Focus group and expert panel studies yielded suggests for intervention vignettes and scenes relevant to Hispanic and African American adolescents. The authors then developed and produced a sample curriculum, specifically designed for Hispanic youth. Content was designed to build knowledge, attitudes, and skills in handling situations where young persons are at risk for human immunodeficiency virus (HIV) infection. The feasibility of the finished pilot product was tested with adolescents and with professionals who serve ethnic and racial minority youth. Adults and Hispanic adolescent viewers rated the videodisc as enjoyable, interesting, and likely to achieve positive effects with the intended target population. Findings suggest that the interactive videodisc is a useful way to interest and help Hispanic adolescents learn ways of reducing their risk of contracting and spreading HIV infection through lifestyle practices. This developmental research in the use of interactive videodisc also provides a basis for further investigation.

Sexual behavior, attitudes toward safer sex, and gender among a cohort of 244 recovering i.v. drug users.

Heterosexual contact with drug users is a major route of AIDS transmission. This study of 135 male and 109 female methadone maintenance patients described subjects' sexual behavior, preventive practices and attitudes toward safer sex; explored ethnic-racial differences in high risk sexual behavior and attitudes; and examined the relationship between attitudes toward safer sex and frequency of condom use for men and women. Reported condom use was low, and it correlated with attitudes toward safer sex. Men tended to report higher rates of sexual risk-taking, although women reported more frequent sex with IV drug users. Study findings have implications for developing intervention strategies to reduce risk behavior associated with HIV transmission.

Building skills of recovering women drug users to reduce heterosexual AIDS transmission.

Although most women infected with HIV are intravenous drug users, some contact the virus through sexual contact with IV drug users. To reach at-risk women, public health officials must develop a range of prevention strategies. One approach, skills training, holds promise as a means of altering risk-related sexual behavior. In this study, 91 women methadone patients were pretested and randomly assigned to an information-only control control group or a skills-building intervention group. Skills-building intervention consisted of five sessions of small groups in which participants identified their own high risk sexual behaviors, discussed their negative associations with condoms, and practiced skills which involved asking partners to use condoms. Compared with members of the control group, respondents in the intervention group reported that they initiated discussion of sexual issues with their partners more frequently, felt more comfortable talking with them about safer sex, and reported using and carrying condoms more frequently. The high rates of attendance and program retention by skills-building participants suggest that such groups may be supportive and useful in the design of risk reduction and drug abuse treatment programs. The modest outcomes of this study underscore the difficulty of altering risk behavior but also serve as a basis for future AIDS prevention studies.

Psychosocial correlates of adolescent substance use: a review of current etiological constructs.

This article reviews psychosocial correlates of adolescent substance use by focusing on the recent empirical literature. Using a tabular format, an attempt is made to provide a facile tool for referencing the literature. Examination of the literature reveals considerable diversity among explanations regarding the variance explained by many of the correlates studied. While the field strives toward a consistent theoretical base from which effective interventions may be developed, researchers must specify the nature of their study populations, designs, methodological approaches, and any issues of generalizability. Only in this way will inconsistencies in study findings be reconciled and progress toward culturally specific intervention techniques be furthered.

Self-instruction to prevent HIV infection among African-American and Hispanic-American adolescents.

This study tested the efficacy of self-instruction intervention to reduce avoidable risks for HIV infection associated with drug use and unsafe sexual activity among African-American and Hispanic adolescents (N = 60). After completing pretests, adolescent participants in the study were randomly divided into three conditions. Participants in one condition received a self-instructional guide about AIDS and its transmission along with group instruction in using the guide. Adolescents in another condition received the guide without group instruction. Participants in the third condition received neither the guide nor group instruction. Outcome findings indicate that participants in the two self-instruction conditions improved more between pretest and posttest assessments on measures of HIV infection risk compared with adolescents in the control condition.

Self-efficacy of children and adolescents: a meta-analysis.

The current study analyzed empirical work examining the relationship of self-efficacy to subsequent behavior in children under the age of 16. Applying meta-analytic techniques to 26 studies (N = 1692) published in the psychological literature between 1977 and 1989 resulted in a mean effect size (r) of .334 across studies.

African-American and Hispanic-American adolescents, HIV infection, and preventive intervention.

This paper considers strategies for preventing human immunodeficiency virus (HIV) infection among African-American and Hispanic-American adolescents. We describe culturally sensitive interventions based on social learning theory. The interventions combine elements of cognitive-behavioral skills for problem solving, coping, and interpersonal communication with elements of ethnic pride and HIV facts. The paper discusses the strengths and limitations of skills intervention for AIDS prevention and concludes with directions for research.