"Letting Go and Staying Connected": Substance Use Outcomes from a Developmentally Targeted Intervention for Parents of College Students.

We present results of a randomized, controlled, efficacy trial of a handbook intervention for parents of first-year college students. The aim of the interactive intervention was to decrease risk behaviors by increasing family protective factors. The handbook, based in self-determination theory and the social development model, provided evidence-based and developmentally targeted suggestions for parents to engage with their students in activities designed to support successful adjustment to college. We recruited 919 parent-student dyads from incoming students enrolled at a university in the U.S. Pacific Northwest and randomly assigned them to control and intervention conditions. We sent handbooks to intervention parents in June before students' August matriculation. Research assistants trained in motivational interviewing contacted parents to encourage use of the handbook. Control parents and students received treatment as usual. Participants completed baseline surveys during their final semester in high school (time 1) and their first semester at college (time 2). Self-reported frequency of alcohol, cannabis, and simultaneous use increased across both handbook and control students. In intent-to-treat analyses, odds of increased use were consistently lower and of similar magnitude for students in the intervention condition than in the control condition, and odds of first-time use were also lower in the intervention condition. Contact from research assistants predicted parents' engagement, and parent and student report of active engagement with handbook predicted lower substance use among intervention than control students across the transition to college. We developed a low-cost, theory-based handbook to help parents support their young adult children as they transition to independent college life. Students whose parents used the handbook were less likely to initiate or increase substance use than students in the control condition during their first semester in college.ClinicalTrials.gov Identifier: NCT03227809.

Mechanisms linking high school graduation to health disparities in young adulthood: a longitudinal analysis of the role of health behaviours, psychosocial stressors, and health insurance.

OBJECTIVES: This study examined three competing mechanisms in the link between educational attainment and health among young adults: (a) a health behaviour mechanism; (b) a psychosocial stressor mechanism; and (c) a health insurance mechanism. The central research question was the pervasiveness and specificity of these mechanisms in the link between low educational attainment and health outcomes during young adulthood. STUDY DESIGN: A prospective longitudinal study was conducted with 808 men and women followed to age 33 years in the USA. METHODS: Health outcomes included major depressive disorder, obesity, chronic health conditions, and self-rated health. The focal predictor was educational attainment at age 21. The roles of the health behaviour mechanism (heavy episodic drinking, cigarette smoking, and meeting physical activity guidelines), the psychosocial stressor mechanism (stressful life events, perceived financial stress, and lack of control at work), and having health insurance (either through their employer or union or via family members) in the link between education and varying health outcomes were assessed using path analyses. RESULTS: Lack of health insurance emerged as a statistically significant explanatory factor underlying the association of education with depression and self-rated health. Health behaviours, specifically smoking and physical activity, were statistically significant intervening factors for obesity and self-rated health. CONCLUSIONS: The processes linking educational attainment to health inequalities begin unfolding during young adulthood. The salience of different mechanisms is specific to a health outcome rather than pervasive across multiple health outcomes. Public health policies with a broad spectrum of components, particularly focussing on smoking, physical activity, and lack of health insurance, are recommended to promote educational equalities in multiple health outcomes among young adults.

General and substance-specific predictors of young adult nicotine dependence, alcohol use disorder, and problem behavior: replication in two samples.

BACKGROUND: This paper presents two replications of a heuristic model for measuring environment in studies of gene-environment interplay in the etiology of young adult problem behaviors. METHODS: Data were drawn from two longitudinal, U.S. studies of the etiology of substance use and related behaviors: the Raising Healthy Children study (RHC; N=1040, 47% female) and the Minnesota Twin Family Study (MTFS; N=1512, 50% female). RHC included a Pacific Northwest, school-based, community sample. MTFS included twins identified from state birth records in Minnesota. Both studies included commensurate measures of general family environment and family substance-specific environments in adolescence (RHC ages 10-18; MTFS age 18), as well as young adult nicotine dependence, alcohol and illicit drug use disorders, HIV sexual risk behavior, and antisocial behavior (RHC ages 24, 25; MTFS age 25). RESULTS: Results from the two samples were highly consistent and largely supported the heuristic model proposed by Bailey et al. (2011). Adolescent general family environment, family smoking environment, and family drinking environment predicted shared variance in problem behaviors in young adulthood. Family smoking environment predicted unique variance in young adult nicotine dependence. Family drinking environment did not appear to predict unique variance in young adult alcohol use disorder. CONCLUSIONS: Organizing environmental predictors and outcomes into general and substance-specific measures provides a useful way forward in modeling complex environments and phenotypes. Results suggest that programs aimed at preventing young adult problem behaviors should target general family environment and family smoking and drinking environments in adolescence.

Consequences of youth tobacco use: a review of prospective behavioural studies.

BACKGROUND: Cigarette smoking represents a significant health problem and tobacco has been identified as causing more preventable diseases and premature deaths than any other drug. Although health consequences from smoking have been documented, there has been a surprising lack of research into behavioural consequences. AIMS: To review what is known of the long-term relationship between patterns of tobacco use prior to age 18 years and behavioural consequences in adulthood. METHOD: A literature search of electronic abstraction services from 1980 to September 2005 was conducted. To be included in the review, studies had to have large, representative samples, be longitudinal studies with baseline age under 18 years and follow-up age 18 years or older and clarify effects due to attrition, leaving 16 articles that met the inclusion criteria. Two reviewers evaluated each paper. FINDINGS: Adolescent tobacco use predicts a range of early adult social and health problems. Surprisingly few studies met the inclusion criteria. The limited evidence available suggests that adolescent tobacco smoking increases the likelihood of early adult tobacco use and the initiation of alcohol use or the development of alcohol-related problems. The link between adolescent tobacco use and subsequent cannabis use was not resolved convincingly from the studies summarized. The effects of tobacco use on later illicit drug use tended to fall away when adjusting for underlying risk factors. Existing studies of the effects of tobacco use on later mental health have many limitations. Nevertheless, a finding that youth tobacco use may predict subsequent mental health problems deserves further investigation. The possible effects of tobacco use on academic/social problems and sleep problems also warrant further investigation. CONCLUSION: This review highlights links between youth tobacco use and subsequent behavioural and mental health problems. It provides health care professionals with evidence of the possible harmful effects of youth tobacco smoking on later social, emotional, and behavioural well-being.

Youth alcohol and other drug use in the United States and Australia: a cross-national comparison of three state-wide samples.

Although youth drug and alcohol harm minimization policies in Australia are often contrasted with the abstinence and zero tolerance policies adopted in the United States, there has been little research directly comparing youth substance use behaviour in the two countries. Three state representative samples in Victoria, Australia (n = 7898) and in the US states of Oregon (n = 15,224) and Maine (n = 16,245) completed a common cross-sectional student survey. Rates of alcohol use (lifetime alcohol use, recent use in the past 30 days), alcohol use exceeding recommended consumption limits (binge drinking: five or more drinks in a session), other licit drug use (tobacco use), and norm-violating substance use (substance use at school, use in the past 30 days of marijuana or other illicit drug use) were compared for males and females at ages 12-17. Rates were lower (odds ratios 0.5-0.8) for youth in Maine and Oregon compared to Victoria for lifetime and recent alcohol use, binge drinking and daily cigarette smoking. However, rates of recent marijuana use and recent use of other illicit drugs were higher in Maine and Oregon, as were reports of being drunk or high at school. In contradiction of harm minimization objectives, Victoria, relative to the US states of Oregon and Maine, demonstrated higher rates of alcohol use exceeding recommended consumption limits and daily tobacco use. However, findings suggested that aspects of norm-violating substance use (substance use at school, marijuana use and other illicit drug use) were higher in the US states compared to Victoria.

Preadolescent predictors of substance initiation: a test of both the direct and mediated effect of family social control factors on deviant peer associations and substance initiation.

A review of the literature suggests that early substance initiation is related to a variety of negative outcomes, including substance misuse or abuse in adolescence and adulthood. This study examines potentially modifiable predictors of early substance initiation, including both family and peer factors known to influence early initiation. A theoretically derived model of substance initiation was tested using structural equation modeling. Results indicate that both family and peer factors have an impact on early substance initiation when children in this sample were 11 and 12 years old. The model explained 60% of the variance in substance initiation. Prosocial family processes (rules, monitoring, and attachment) had a significant impact on child peer association, decreasing involvement with antisocial peers. These prosocial family processes had a significant negative effect on substance initiation even while modeling the influence of antisocial peers. Implications for drug use prevention practice are discussed.

Assessing the effects of a school-based intervention on unscheduled school transfers during elementary school.

Raising Healthy Children is a cluster-randomized study of a school-based intervention aimed at preventing problem behaviors among children recruited into the project in the first or second grade of elementary school. Multilevel analysis was used to compare students in intervention and control schools with respect to whether they transferred out of their original schools. Students in intervention schools were less likely to transfer within the first 5 years of the project. A multilevel discrete-time survival model that included both time-varying and contextual variables revealed that the difference in hazard of transfer was greatest in the earlier years of the project.

The effect of neighborhood-based community organizing: results from the Seattle Minority Youth Health Project.

OBJECTIVE: To evaluate the effect of a community mobilization and youth development strategy to prevent drug abuse, violence, and risky sexual activity. DATA SOURCES/STUDY SETTING: Primary surveys of youth, parents, and key neighborhood leaders were carried out at baseline (1994) and at the end of the intervention period (1997). The study took place in four intervention and six control neighborhoods in Seattle. STUDY DESIGN: The study was designed as a randomized controlled trial with neighborhood as the unit of randomization. The intervention consisted of a paid community organizer in each neighborhood who recruited a group of residents to serve as a community action board. Key variables included perceptions of neighborhood mobilization by youth, parents, and key neighborhood leaders. DATA COLLECTION/EXTRACTION METHODS: Youth surveys were self-administered during school hours. Parent and neighborhood leader surveys were conducted over the phone by trained interviewers. PRINCIPAL FINDINGS: Survey results showed that mobilization increased to the same degree in both intervention and control neighborhoods with no evidence of an overall intervention effect. There did appear to be a relative increase in mobilization in the neighborhood with the highest level of intervention activity. CONCLUSION: This randomized study failed to demonstrate a measurable effect for a community mobilization intervention. It is uncertain whether the negative finding was because of a lack of strength of the interventions or problems detecting intervention effects using individual-level closed-end surveys.

Childhood risk factors for persistence of violence in the transition to adulthood: a social development perspective.

This study examined violent behavior from ages 13 to 21 and identified predictors at age 10. Logistic regression was used to assess predictors of developmental patterns of violence. The sample is from a study of 808 youth interviewed annually from age 10 to 16 years, and again at ages 18 and 21. Over 28% of the youth in the sample reported nonviolence throughout adolescence and into early adulthood. Most youth (55%) engaged in violence in adolescence but desisted from violence in early adulthood, while 16% persisted in violent behavior at age 21. Violence in adolescence was best predicted by male gender, Asian American ethnicity (a protective factor), childhood fighting, early individual characteristics, and early antisocial influences. Adult persistence of violence was best predicted by male gender, early school achievement (which was protective), and early antisocial influences. Early prosocial development was also protective against violence persistence for females. Implications for prevention are discussed.

Correlates contributing to involvement in violent behaviors among young adults.

The study examines the extent to which gender, personality attributes, household, community, and environmental factors are associated with violent behaviors in young adulthood. The authors present findings from a sample of 765 21-year-old individuals participating in a drug and delinquency prevention study. Personality attributes, opportunities, and social acceptability of antisocial behaviors were identified as accounting for gender differences and having more influence on violent behavior than environmental correlates. Implications for preventive intervention are discussed.

Etiology and prevention of substance use among Asian American youth.

Among populations identified by the U.S. Bureau of the Census, it is anticipated that the Asian/Pacific Islander (API) population will experience the greatest change between 1990 and 2050 (U.S. Bureau of the Census. [1996, February]. Current population reports. Series P25-1130. Washington, DC: U.S. Government printing office). Limited studies focus on APIs as a racial group and still fewer disaggregate samples to specific ethnic Asian subgroupings. This paper begins with definitions of the API communities, then examines rates of adolescent drug use, risk and protective factors, and preventive intervention effectiveness focused on API communities. The limited epidemiological data suggest that in general, APIs are at a relatively lower risk for drug use than youth from most other ethnic groups. However, the available data also suggest that use may not be as low as generally assumed with rates for alcohol use, smoking, and some illicit drugs being equal to or exceeding those of African Americans and European Americans. Despite the paucity of available data on particular Asian subgroups, the available data demonstrate that there are differences among API subgroups, underscoring the importance of identifying Asian subgroups when studying substance use and when planning prevention and treatment. The limited data examining the etiology of drug use across API subgroups suggests that some of the risk and protective factors derived from majority based research may also be predictors for these populations. These data support the utility of examining the generalizability of existing tested prevention approaches among different API communities. Finally, further efforts should be made to encourage and support the evaluation of community-based programs that already target and deliver services to API youth.

The social predictors of adolescent alcohol misuse: a test of the social development model.

OBJECTIVE: This study was conducted to investigate the ability of the social development model (SDM) to predict alcohol misuse at age 16 and to investigate the ability of the SDM to mediate the effects of alcohol use at age 14 on alcohol misuse at age 16. METHOD: The sample of 807 (411 males) is from the longitudinal panel of the Seattle Social Development Project which, in 1985, surveyed all consenting fifth-grade students from 18 elementary schools serving high-crime neighborhoods in Seattle, Washington. Alcohol use was measured at age 14, predictors of alcohol misuse were measured at age 15 and alcohol misuse was measured at age 16. Structural equation modeling was used to examine the fit of the model to the data. RESULTS: All factor loadings were highly significant and the measurement model achieved a good fit with the data (Comparative Fit Index [CFI] = 0.93). A second-order structural model fit the data well (CFI = 0.91) and also explained 45% of the variance in alcohol misuse at age 16. The SDM partially and significantly mediated the direct effect of age-14 alcohol use on age-16 alcohol misuse. CONCLUSIONS: The risk and protective processes specified by the SDM serve as potential targets for the prevention or reduction of adolescent alcohol misuse.

Early adult outcomes of adolescent binge drinking: person- and variable-centered analyses of binge drinking trajectories.

BACKGROUND: Many studies of the consequences of binge drinking take a variable-centered approach that may mask developmentally different trajectories. Recent studies have reported qualitatively different binge drinking trajectories in young adulthood. However, analyses of developmental trajectories of binge drinking have not been examined for an important period of drinking development: adolescence. The purpose of this study was to examine young adult outcomes of adolescent binge drinking using an approach that combines person-centered and variable-centered methods. METHODS: Data were from the Seattle Social Development Project, an ethnically diverse, gender balanced sample (n = 808) followed prospectively from age 10 to age 21. Semiparametric group-based modeling was used to determine groups of binge drinking trajectories in adolescence. Logistic regression was used to examine how well the trajectory groups predicted young adult outcomes after demographics, childhood measures, and adolescent drug use were considered. RESULTS: Four distinct trajectories of binge drinking during adolescence were identified: Early Highs, Increasers, Late Onsetters, and Nonbingers. These trajectories significantly predicted positive and negative outcomes in adulthood after controlling for demographic characteristics, early proxy measures of the outcome, and adolescent drug use. CONCLUSIONS: This integrated person- and variable-centered approach provides more information about the effects of specific patterns of binge drinking than studies that employ variable-centered methods alone.

The dynamics of alcohol and marijuana initiation: patterns and predictors of first use in adolescence.

OBJECTIVES: This study, guided by the social development model, examined the dynamic patterns and predictors of alcohol and marijuana use onset. METHODS: Survival analysis and complementary log-log regression were used to model hazard rates and etiology of initiation with time-varying covariates. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. RESULTS: Alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. CONCLUSIONS: This study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother.

Developmental risk factors for youth violence.

PURPOSE: To replicate earlier research findings on risk factors for youth violence and to explore the effects on violent behavior of constructs shown to increase risk for other problem behaviors, within a developmental frame. METHODS: Data were from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985. Potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Bivariate relationships involving risk factor constructs in the individual, family, school, peer and community domains and violence were examined at each age to assess changes in their strength of prediction over time. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years. A final set of analyses explored the extent to which youths were correctly classified as having committed a violent act (or not) at age 18 years on the basis of their overall level of risk at ages 10, 14, and 16 years. RESULTS: At each age, risk factors strongly related to later violence were distributed among the five domains. Ten of 15 risk factors constructs measured at age 10 years were significantly predictive of violence at age 18 years. Twenty of 25 constructs measured at age 14 years and 19 of 21 constructs measured at age 16 years were significantly predictive of later violence. Many constructs predicted violence from more than one developmental point. Hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence from ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were notably more likely than others to engage in later violence. The odds for violence of youths exposed to more than five risk factors compared to the odds for violence of youths exposed to fewer than two risk factors at each age were seven times greater at age 10 years, 10 times greater at age 14 years, and nearly 11 times greater at age 16 years. However, despite information gained from all significant risk factors, the overall accuracy in predicting youths who would go on to commit violent acts was limited. CONCLUSIONS: Findings from the study have important implications for preventive intervention programs. Prevention efforts must be comprehensive and developmentally sensitive, responding to large groups or populations exposed to multiple risks.

Early elementary school-aged child attachment to parents: a test of theory and implications for intervention.

Child attachment to parents has been shown in the literature to reduce the likelihood of problem behaviors through enhancing resiliency. Research examining attachment and its relationship to antisocial behavioral outcomes in adolescents has been shaped largely by social control theorists who have theorized that attachment to prosocial others inhibits the expression of antisocial behavioral outcomes (Hirschi, 1969). This paper seeks to expand the literature by investigating the development of child attachment to parent(s) during the early elementary school years as specified theoretically by the social development model (Catalano & Hawkins, 1996). Using structural equation modeling, the results support the theoretical model as proposed by the social development model. School-aged children's attachment to parents can be successfully predicted by constructs outlined in the social development model. Finally, implications for interventions that enhance child attachment to parent(s) are discussed.

An experimental intervention with families of substance abusers: one-year follow-up of the focus on families project.

AIMS: Children whose parents abuse drugs are exposed to numerous factors that increase the likelihood of future drug abuse. Despite this heightened risk, few experimental tests of prevention programs with this population have been reported. This article examines whether intensive family-focused interventions with methadone treated parents can reduce parents' drug use and prevent children's initiation of drug use. DESIGN: Parents were assigned randomly into intervention and control conditions and assessed at baseline, post-test, and 6 and 12 months following the intervention. Children were assessed at baseline, and 6- and 12-month follow-up points. SETTING: Two methadone clinics in Seattle, Washington. PARTICIPANTS: One hundred and forty-four methadone-treated parents, and their children (n = 178) ranging in age from 3 to 14 years old. INTERVENTION: The experimental intervention supplemented methadone treatment with 33 sessions of family training combined with 9 months of home-based case management. Families in the control condition received no supplemental services. MEASUREMENT: Parent measures included: relapse and problem-solving skills, self-report measures of family management practices, deviant peer networks, domestic conflict and drug use. Child measures included self-report measures of rules, family attachment, parental involvement, school attachment and misbehavior, negative peers, substance use and delinquency. FINDINGS: One year after the family skills training, results indicate significant positive changes among parents, especially in the areas of parent skills, parent drug use, deviant peers and family management. Few changes were noted in children's behavior or attitudes. CONCLUSIONS: Programs such as this may be an important adjunct to treatment programs, helping to strengthen family bonding and to reduce parents' drug use.

Preventing adolescent health-risk behaviors by strengthening protection during childhood.

OBJECTIVE: To examine the long-term effects of an intervention combining teacher training, parent education, and social competence training for children during the elementary grades on adolescent health-risk behaviors at age 18 years. DESIGN: Nonrandomized controlled trial with follow-up 6 years after intervention. SETTING: Public elementary schools serving high-crime areas in Seattle, Wash. PARTICIPANTS: Of the fifth-grade students enrolled in participating schools, 643 (76%) were given written parental consent for the longitudinal study and 598 (93%) were followed up and interviewed at age 18 years. INTERVENTIONS: A full intervention provided in grades 1 through 6 of 5 days of in-service training for teachers each intervention year, developmentally appropriate parenting classes offered to parents when children were in grades 1 through 3 and 5 through 6, and developmentally adjusted social competence training for children in grades 1 and 6. A late intervention, provided in grades 5 and 6 only, paralleled the full intervention at these grades. MAIN OUTCOME MEASURES: Self-reported violent and nonviolent crime, substance use, sexual activity, pregnancy, bonding to school, school achievement, grade repetition and school dropout, suspension and/or expulsion, and school misbehavior; delinquency charges from court records; grade point average; California Achievement Test scores: and disciplinary action reports from school records. RESULTS: Fewer students receiving full intervention than control students reported violent delinquent acts (48.3% vs 59.7%; P=.04), heavy drinking (15.4% vs 25.6%; P=.04), sexual intercourse (72.1% vs 83.0%; P=.02), having multiple sex partners (49.7% vs 61.5%; P=.04), and pregnancy or causing pregnancy (17.1% vs 26.4%; P=.06) by age 18 years. The full intervention student group reported more commitment (P=.03) and attachment (P=.006) to school, better academic achievement (P=.01), and less school misbehavior (P=.02) than control students. Late intervention in grades 5 and 6 only did not significantly affect health-risk behaviors in adolescence. CONCLUSIONS: A package of interventions with teachers, parents, and children provided throughout the elementary grades can have enduring effects in reducing violent behavior, heavy drinking, and sexual intercourse by age 18 years among multiethnic urban children. Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods.

Opening the black box: using process evaluation measures to assess implementation and theory building.

The past decade has seen increasing recognition in prevention science of the need to move away from a black box approach to intervention evaluation and toward an approach that can elaborate on the mechanisms through which changes in the outcomes operate (Chen & Rossi, 1989; Durlak & Wells, 1997; Spoth et al., 1995). An approach that examines issues of program implementation is particularly critical in the design of efficacy studies of school-based preventive interventions. Numerous preventive intervention strategies are now delivered within the schools, often by regular classroom teachers. The extent to which teachers faithfully deliver a particular curriculum or incorporate instructional strategies emphasized by an intervention is a critical question for the overall project evaluation. This article illustrates the utilization of process measures from a multicomponent school-based prevention program to examine implementation of a teaching staff development intervention, and the program's underlying theoretical basis. Given the nested study design, the analyses utilize hierarchical linear models (Bryk & Raudenbush, 1992) to examine changes in teaching strategies by condition and investigate the hypothesized relationships between teaching practices and student behaviors based on the program's theoretical framework. Results suggest that teaching practices in two of the six intervention focus areas were positively impacted in the first 18 months of the project. Findings also support the relationships between teachers' instructional practices and students' behavior.

Drug use predictors of partner violence in opiate-dependent women.

This paper examines the use of specific drugs as longitudinal predictors of violence between domestic partners in a sample of women in methadone treatment for opiate addiction. Crack cocaine use, use of other forms of cocaine, and tranquilizer use are each modestly to moderately positively associated with partner violence victimization. Women who were heavy users of these drugs were more likely to be hit, slapped, or shoved by their partners than light users or nonusers of these drugs. Three possible explanations of these associations are considered.