Correlates of alcohol use and misuse in fourth-grade children: psychosocial, peer, parental, and family factors.

To determine level of alcohol use/misuse and to examine correlates of these behaviors, 1,314 fourth-grade students were surveyed. The questionnaire included 55 items concerning tolerance of deviance, deviant self-image, self-efficacy, susceptibility to peer pressure, personal and peer approval of alcohol use, peer adjustment, parent nurturance and monitoring, family adjustment, parental permissiveness, peer use of alcohol, and exposure to alcohol. The items were factor analyzed and indices constructed. The indices generally had acceptable alpha coefficients (alpha = .61-.91); two exceptions were peer adjustment (alpha = .51) and parental permissiveness (alpha = .42). Tolerance of deviance, deviant self-image, susceptibility to peer pressure, personal and peer approval, peer use and exposure by peers, and parental permissiveness were positively correlated with alcohol use/misuse. Self-efficacy, child-parent interactions, family adjustment, and peer adjustment were negatively correlated with alcohol use/misuse. Implications for the design of family-based alcohol use/misuse prevention programs are discussed.

Effectiveness of a high school alcohol misuse prevention program.

An alcohol misuse prevention curriculum for tenth-grade students was developed, implemented, and evaluated through twelfth grade with 1041 students from four school districts. The curriculum emphasized social pressures resistance training, immediate effects of alcohol, risks of alcohol misuse, and social pressures to misuse alcohol. There were desirable program effects on alcohol misuse prevention knowledge (p < 0.001), alcohol misuse (p < 0.02), and refusal skills (p < 0.09). Gender by occasion differences were found on alcohol use, alcohol misuse, and driving after drinking, with boys' rates increasing more than those of girls. Exposure to a sixth-grade, as well as the tenth-grade, program did not result in better outcomes. Despite high levels of alcohol use among high school students, a tenth-grade curriculum can result in some desirable effects. Creative approaches are needed, however, especially for boys who tend to use and misuse alcohol at rates that increase more steeply than those of girls.

Measurement of alcohol use and misuse in a cohort of students followed from grade 6 through grade 12.

In following a cohort of students from grade 6 through grade 12 for the purpose of evaluating an Alcohol Misuse Prevention Study curriculum, a substudy of the measurement of alcohol use and misuse was conducted. The 6-year follow-up of young people over time afforded a good opportunity to assess the adequacy of the initially chosen measures to 1) provide data with statistically desirable properties, and 2) be sensitive to and representative of the wide range of alcohol use and misuse patterns among adolescents as they mature. Revised measures of alcohol use and misuse were developed from the data responding to the same questionnaire items that had been used throughout the study. The revised measures demonstrated good psychometric properties and may be useful in other studies.

Longitudinal evaluation of an enhanced alcohol misuse prevention study (AMPS) curriculum for grades six-eight.

For students progressing from sixth to eighth grade, an enhanced Alcohol Misuse Prevention Study (AMPS) curriculum that emphasized social pressure resistance training, peer support, and norm-setting was developed, implemented, and evaluated. Schools were randomly assigned within communities to curriculum or control groups. Students were pretested early in sixth grade before the intervention and posttested at the end of sixth, seventh, and eighth grades. Results indicated the curriculum was effective in increasing students' knowledge of curriculum material, and among the subgroup of students who had used alcohol unsupervised by adults before the pretest, in reducing the rate of increase of alcohol misuse. The findings result from a replication of the analytic approach used with the initial AMPS cohort data.

Parental drinking and gender factors in the prediction of early adolescent alcohol use.

This study examines the relationship between children's reports of their parents' drinking patterns, and the child's alcohol misuse and heavy alcohol use in early adolescence. Subjects were 2,213 fifth and sixth grade students. Data on the child's alcohol use and misuse, and parent alcohol use, were derived from classroom-administered questionnaires. Increased reported level of drinking by mother or by father was significantly associated with increased odds of alcohol misuse and heavy alcohol use among the children; these results held for both boys and girls when examined separately. Examination for possible confounding effects of assortative mating by parental drinking suggests that reports of heavy drinking in either parent increases the risk of alcohol misuse and heavy alcohol use in children. Implications for prevention efforts are discussed.

Structural equation model tests of patterns of family interaction, peer alcohol use, and intrapersonal predictors of adolescent alcohol use and misuse.

A survey of 1,340 students in grades six through twelve was conducted to test, in the context of structural equation models, the predictive validity of a theoretical model of antecedents of adolescent alcohol use and misuse. Constructs including parents' alcohol use, older siblings alcohol use, parents' approval of students alcohol use, older sibling approval of students alcohol use, peer use and approval of alcohol use (PUA), parental nurturance, parental permissiveness, child's grade in school, susceptibility to peer pressure (SPP), and deviant self-image, were included. The final iterations of the models accounted for more than half of the variance in both alcohol use and alcohol misuse. In a standardized solution, the two largest direct effects on both adolescent alcohol use and misuse were from SPP and PUA. When a seven item measure of SPP, including three items specific to alcohol use was used, the SPP latent variable accounted for a somewhat greater percentage of the variance in adolescent alcohol use and misuse than did the latent variable of PUA. When the three alcohol-specific items were deleted from SPP, however, PUA accounted for more variance than SPP. Other predictors, including parental behaviors, proved to be significant when their indirect effects were evaluated. Models predicting alcohol use and alcohol misuse were similar. SPP, PUA, and other significant predictors should be included in future models predicting adolescent alcohol use and misuse, as well as in future interventions targeting these behaviors. Longitudinal studies should be used to test these findings. Evaluation of prevention should include examination of possible interactions of these predictors with each other and with subject subgroup classifications.

Assessment of adolescent refusal skills in an alcohol misuse prevention study.

Although many substance abuse prevention programs seek to enhance the ability of adolescents to refuse offers of alcohol and other drugs, few report assessments of refusal skill ability or its relationship to substance use. This report describes a procedure to assess the ability of adolescents to refuse the offer of a beer, and presents the findings of those assessments as well as their relationships to alcohol misuse prevention knowledge, susceptibility to peer pressure, internal health locus of control, self-esteem, and alcohol use and misuse. A one-third random sample (n = 1012) of 10th graders participating in a longitudinal evaluation of an alcohol misuse prevention curriculum was assessed individually. Students rated their own refusals, which were also rated by trained female and male raters. The results indicated that adolescents refuse the offer of a beer only somewhat convincingly. Those adolescents with better refusal skills had higher levels of alcohol misuse prevention knowledge, especially regarding resisting pressures to use alcohol and the application of knowledge of typical alcohol-related situations. They also reported less susceptibility to peer pressure, greater internal health locus of control and self-esteem, and less alcohol use and misuse. The results provide support for teaching refusal skills in substance abuse prevention programs and for assessing refusal skills in the evaluation of such programs.

Susceptibility to peer pressure as an explanatory variable for the differential effectiveness of an alcohol misuse prevention program in elementary schools.

A school-based alcohol misuse prevention program had differential effects on students' susceptibility to peer pressure, depending on prior experience with alcohol. These effects paralleled those on alcohol use and misuse, indicating program effects on use and misuse were mediated by reductions in the rate of increase on susceptibility to peer pressure. Experimental group students with prior unsupervised use of alcohol showed a significantly greater reduction than their controls in the rate of increase in susceptibility to peer pressure, alcohol use, and alcohol misuse. This difference was not found among students without prior unsupervised use of alcohol.

An elementary school-based alcohol misuse prevention program: a follow-up evaluation.

An alcohol misuse prevention study (AMPS) curriculum for fifth- and sixth-grade students was developed, implemented and evaluated with over 5,000 students. The AMPS program emphasized social pressures resistance training, focusing on the immediate effects of alcohol, risks of alcohol misuse and social pressures to misuse alcohol. Schools were randomly assigned to curriculum, curriculum plus booster or control groups with half of each group pretested and all posttested. Measures focused on susceptibility to peer pressure, internal health locus of control, understanding of the curriculum material, alcohol use and alcohol misuse. After 26 months, there was a significant treatment by occasion interaction on internal health locus of control (sixth grade). A significant treatment by occasion interaction effect was also found with respect to curriculum measures in both grades. There was no significant treatment by occasion interactions with respect to alcohol use or misuse when the groups as a whole were considered. When subgroup analyses based on type of prior drinking experience were conducted, however, significant program effects on alcohol misuse were found among sixth-grade students who had experienced unsupervised as well as supervised drinking prior to the prevention program.

Environmental correlates of adolescent substance use and misuse: implications for prevention programs.

The research in the areas of peer, family and community environmental effects on adolescent substance use and misuse clearly and consistently shows that peer substance use behavior is the primary predictor of adolescent alcohol use. Peer norms, however, are more important in the prediction of adolescent alcohol misuse. Parental norms and monitoring are secondary to the peer variables, but still of significance in the prediction of adolescent alcohol use and misuse. The intrapersonal construct of susceptibility to peer pressure is as important as the peer and parent variables in the prediction of both alcohol use and misuse in adolescence.

Differential effectiveness of an elementary school-based alcohol misuse prevention program.

An elementary school social skills/peer pressure resistance curriculum for the prevention of alcohol misuse was developed, implemented, and evaluated. Schools were randomly assigned to curriculum and control groups, with half of each group pretested prior to intervention and all students posttested two months, 14 months, and 26 months following intervention. Students in grade five at the beginning of the study were randomly assigned to treatment, treatment plus booster, and control conditions. Students in grade six were randomly assigned to treatment and control conditions. Three way repeated measures analyses of covariance (treatment condition by type of prior drinking experience by occasion) were conducted for each grade level on indices of "frequency/quantity of alcohol use" and "total alcohol misuse." Results indicated the intervention was effective in reducing the rate of increase of alcohol use and misuse among grade six students who entered the study with prior unsupervised as well as supervised alcohol use. After corrections for intraclass correlations on the dependent variables, the significant finding regarding the alcohol misuse variable was maintained.

Pretest and treatment effects in an elementary school-based alcohol misuse prevention program.

Forty-nine schools (N = 5,680 fifth and sixth grade students) were assigned to pretest/treatment, pretest/no treatment, no pretest/treatment, and no pretest/no treatment conditions in the context of an alcohol misuse prevention study. At the first posttest, five months after the pretest and two months after the intervention, the effects of the pretest and of the intervention were examined. The analyses showed that failure to correct for the design effect due to clustering within schools resulted in the overestimation of the significance of treatment and pretest effects. After correction for the design effect, a significant treatment effect in the hypothesized direction was found with respect to students' awareness of the content of the curriculum. As hypothesized, significant treatment effects on the alcohol use and misuse measures had not yet developed but are expected to occur at subsequent posttest occasions. Significant pretest effects were found for indices measuring trouble with peers resulting from students' alcohol use, students' internal health locus of control, and their perceptions of adults as a locus of control for their health. Two of the three pretest effects were in the direction that would be hypothesized if the pretest were providing the same impetus as the intervention. Implications of these findings for school-based substance abuse prevention programs are discussed.

A covariance structure model test of antecedents of adolescent alcohol misuse and a prevention effort.

As part of an alcohol misuse prevention evaluation, questionnaires were administered to 4,157 junior high school students to determine levels of alcohol misuse, exposure to peer use and misuse of alcohol, susceptibility to peer pressure, internal health locus of control, and self-esteem. A conceptual model of the antecedents of adolescent alcohol misuse and the effectiveness of a prevention effort was tested using covariance structure modeling techniques. The factor loadings for the model were all moderate to high, indicating that the observed variables served well as measurement instruments for the latent variables. The hypothesized structural relationships among the latent variables of alcohol misuse, exposure to peer use and misuse of alcohol, susceptibility to peer pressure, internal health locus of control, and self-esteem were supported by the data. The full model explained 45 percent of the variance in alcohol misuse in the analysis based on the total sample. The direct effect of the intervention on alcohol misuse was small but significant in the hypothesized direction. The direct effects of the intervention on susceptibility to peer pressure and internal health locus of control were not significant. The model was tested separately for groups of students who had high versus low scores on susceptibility to peer pressure in order to test the interaction between susceptibility to peer pressure and exposure to peer use and misuse of alcohol. The percentage of variance accounted for in alcohol misuse did not increase upon testing the model separately for students who had high versus low scores on susceptibility to peer pressure. Observed differences in the significance of the parameter estimates between the high and low susceptibility to peer pressure groups suggest that different approaches to the design and evaluation of substance abuse prevention programs may be necessary for different subgroups of students.

Mechanisms of psychosocial effects on health: the role of social integration, coping style and health behavior.

To analyze the mechanisms by which psychosocial factors affect health, this research investigated social integration and indicators of coping style and their relation to health behaviors and health status. The analysis was conducted using the results of a 1977 survey of 854 household interviews from a multi-stage probability sample of adult residents of Washtenaw County, Michigan. Physical-health status was evaluated by two indices: Self-rated global health and self reports of chronic disability. Mental health was assessed with the Center for Epidemiologic Studies Depression Scale. Overall, the effects of the psychosocial factors were stronger for mental health than physical health. Social integration was shown to have direct effects on both physical and mental-health status. Internal locus of control was associated with lower levels of depressive symptoms. Chronic conditions were primarily affected by age, sex, and health behavior. Evidence from the path analyses suggested that part of the health benefit that women accrue from social integration and an active coping style is related to better health behavior. This mediation effect was not found for men.

Perceptions held by obese children and their parents: implications for weight control intervention.

The study was designed to identify some of the psychosocial barriers to compliance in a hospital-based weight control intervention program for adolescents. Forty obese adolescents, 10 to 16 years of age, and their parents were surveyed prior to participation in a behavioral change weight control program at a major teaching hospital. Significant correlations were obtained between weight loss outcome and six factors. In obese adolescents, weight loss was significantly associated with their beliefs regarding: (1) personal control over weight, (2) barriers or difficulty of losing weight, (3) medical problems as a cause of their obesity, (4) family problems as a cause of their obesity, and (5) perceived willingness of family members to diet. It is suggested that greater weight loss in children who perceived more barriers/difficulty and less family willingness to diet may reflect the importance of having realistic expectations related to behavioral compliance. In addition, a positive parental attitude or expectation that the child was less likely to be overweight in the future was associated with greater weight loss compliance. Other parental health beliefs, however, did not generally predict the child's weight loss response to the intervention. The findings lend support to the significance of the adolescent's beliefs regarding weight and family support in explaining weight loss response to a behavioral change intervention program.

New markers for type A behavior: pupil size and platelet epinephrine.

This study tested the hypothesis that the Type A behavior pattern and its components are associated with increased activity of the sympathetic nervous system. To do this, we employed two new markers of sympathetic tone--pupil size and platelet catecholamine content. Thirty-three healthy males were blindly rated for Type A behavior and verbal stylistic components by Structured Interview. Adrenergic tone to the pupils was assessed from pupil diameter recorded by infrared television pupillometry, and pupil alpha-adrenergic sensitivity was estimated from mydriatic response to ophthalmic phenylephrine. Platelet epinephrine and norepinephrine contents were assayed because these levels are associated with chronic, long-term circulating catecholamine levels. The results showed Type As had consistently larger pupil diameters than Type Bs (p = 0.03, 0.03, and 0.01). There was no difference in pupillary response to phenylephrine instillation between groups. Platelet epinephrine content was greater in Type A subjects (chi 2 = 4.25, p less than 0.04, t = 1.6, p = 0.06). Only the component of explosiveness was modestly associated with resting pupil size, and no components significantly predicted platelet catecholamines. We conclude that the results of these two new markers of autonomic activity, namely, pupil size and platelet epinephrine, suggest that Type A behavior is characterized by increased sympathetic nervous system tone although we cannot rule out the possibility of decreased activity of the parasympathetic nervous system.

Psychometric properties of component and global measures of structured interview assessed type A behavior in a population sample.

Structured interview (SI) assessments of global and component Type A behavior were conducted in a general population sample of 903 respondents. Correlations among all the measures were positive and significant. A factor analysis revealed that the common component variance was explained by a single underlying factor. Interrater reliabilities were approximately 0.5 to 0.7 for the individual components and 0.8 for both the SI global Type A and a second global measure that was assigned independently by assessors who did the component scoring. Prediction of the SI-assessed global measure from the components accounted for 56% of the variance, and prediction of the second global measure from the components accounted for about 83% of the variance. Implications of the psychometric properties of the SI component and global measures of Type A behavior for future research are discussed.

Practice preferences of primary medical care and traditional internal medicine house officers.

In an academic medical centre between 1980 and 1985, the attitudes, preferences and career goals of house officers in a primary medical care residency training programme were assessed at entry and at the end of each house officer year. Primary care trainees who went on to practise in a general medicine setting were compared to primary care trainees who subsequently received subspecialty training and also to traditional internal medicine trainees. House officers in the primary care programme generally maintained attitudes and preferences central to the practice of primary care, and scored significantly higher than traditional track house officers on attitudes and preferences compatible with the practice of medicine in a primary care setting. However, primary care house officers who later went into subspecialty training received scores similar to those of traditional track house officers on practice preferences relating to specialty care. There were no significant differences between primary care and traditional track house officers on standard measures of knowledge and clinical skill.