No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Evaluation of a Web-Based Alcohol Program Alone and in Combination With a Parent Campaign for Ninth-Grade Students
Abstract
This randomized controlled study evaluated the efficacy of a web‐based program alone and in combination with a parent campaign among 9th‐grade students (N = 205). Results indicate lower drinking rates in both programs compared with traditional education for female students.
... Eighty-seven articles were excluded: 58 articles were excluded because their interventions didn't promote social interaction; 13 papers were excluded because of the lack of new technologies component; 4 papers were excluded because they didn't assess alcohol consumption or substance use after the intervention; 8 were excluded because they weren't carried out in a high-school setting; 3 other studies were excluded because their programs were partially delivered through face-to-face methods and 1 review study was excluded because it only had information about one paper already included in our review. We consequently included 13 articles in the review (Lana et al., 2013(Lana et al., , 2014Balsa et al., 2014;Haug et al., 2014a,b;Epstein et al., 2016;Ip et al., 2016;Doumas et al., 2017;Evans et al., 2017;Gordon et al., 2017;Paz Castro et al., 2017;Hausheer et al., 2018;Doumas and Esp, 2019). One of these papers analyzed the results of a previous study, so we additionally included the previous one in the review (Balsa et al., 2010). ...
... The second study (Hausheer et al., 2018) was designed to assess if the web-program effect in alcoholdrinkers prevalence was affected by complementing the program with a family intervention. A sample of 205 students was randomized at the school level into three groups: eCHECKUP TO GO, eCHECKUP TO GO supplemented by a family intervention and a control group consisting of a 45-min classroom lecture-style lesson about alcohol-related risks, behaviors and refusal strategies. ...
... The 14 articles included in this review assessed 8 different programs. Six of them used web-based platforms (Balsa et al., 2010(Balsa et al., , 2014Lana et al., 2013Lana et al., , 2014Haug et al., 2014a,b;Ip et al., 2016;Doumas et al., 2017;Paz Castro et al., 2017;Hausheer et al., 2018;Doumas and Esp, 2019), one used a social media campaign (Evans et al., 2017) and another one used several educational videogames (Epstein et al., 2016). Two of the five WBPs supplemented the web platform with phone text messages (Lana et al., 2013(Lana et al., , 2014Haug et al., 2014a,b;Paz Castro et al., 2017). ...
Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF, and that target adolescents. Web of Science, Scopus and Google Scholar were electronically searched for all articles published between January 2011 and December 2020. Articles reporting on school-based, web-based interventions for adolescents to prevent alcohol consumption and that encouraged any kind of interaction between users (‘social interactions’) were eligible for inclusion. Fourteen articles were included in the review. These articles assessed eight preventive programs. Six programs showed positive results on outcome variables. In two of them, it was possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but the current evidence of their effectiveness is scarce. More evidence is required to assess the effectiveness of these features and to improve programs having the objective of preventing the consumption of alcohol among young people.
... If programming is to be effective, it must meet the needs of parents, both in content and accessibility. Hausheer et al. (2018) suggest investigating viable parent engagement strategies that promote prevention delivery. However, to our knowledge, there is no research that investigates specific approaches and resources that represent the parental perspective in engaging parents in adolescent substance misuse prevention programming. ...
Substance misuse during adolescence is an issue, and engaging parents in prevention efforts has significant positive impacts; yet barriers to engagement exist. The purpose of this qualitative parent focus group study was to understand the perspectives of participants ( n = 5) about information and delivery platforms that will promote, engage, and support parents in prevention efforts. Thematic analyses identified five key themes from the semistructured interview: (1) educational support, (2) community support, (3) venues and platforms, (4) influences of other countries, and (5) potential barriers. Implications for clinical mental health and school counselors, and future research are discussed.
... A further improvement for program developers to consider is the importance of transparency and detailed guidance, for those wishing to replicate programs and/or adapt the programs to be applied in other contexts. For example, within this review, e-CHUG was utilized for 10 separate projects by five different lead authors between 2008 and 2020 [37,[58][59][60][61][62][63][64][65][66] and each produced different results and outcomes. Generally, the quality scores increased as time progressed (scores ranged from 3 to 5) but there was no obvious improvement in behavioral outcomes over this time. ...
Numerous education programs have addressed young peoples’ alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15–24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.
... On the basis of this body of research, Doumas, Esp, Turrisi, and Schottelkorb (2015) suggested that the eCHECKUP TO GO may be a promising approach for reducing drinking and the associated consequences among high school students given that high school students often benefit from effective college interventions (Sher & Rutledge, 2007). Findings from recent research conducted with ninth-grade students provide support for the short-term efficacy of the eCHECKUP TO GO program in reducing alcohol use and alcohol-related consequences (Doumas, Esp, Turrisi, Hausheer, & Cuffee, 2014;Hausheer, Doumas, & Esp, 2018). Other research, however, suggests short-term effects are not sustained throughout the academic year , suggesting that this approach may be less suited for adolescents in this age group. ...
The authors examined the efficacy of a brief, web‐based personalized feedback intervention on reducing alcohol‐related consequences among high school seniors (N = 105) using a group‐randomized controlled design. Results of repeated measures mixed‐models analyses indicated significant intervention effects over time for alcohol‐related consequences at 30‐day and 6‐month follow‐up assessments. Drinking risk status moderated intervention effects such that results were only significant for high‐risk drinkers (i.e., students reporting initiation of heavy episodic drinking at baseline).
The purpose of this chapter is to describe the first wave of digital therapeutics, internet-based programs (IBPs), for substance use and mental health disorders. The first section of the chapter will describe the context for the development of IBPs, including factors within the behavioral health field that supported their emergence and treatment challenges that IBPs may uniquely address, as well as the differentiation between internet-based programs and mobile applications. The second and third sections of the chapter will summarize the knowledge base and highlight specific IBPs for substance use disorders and mental health disorders, respectively, with a specific emphasis on mood and anxiety disorders. The chapter will conclude with a summary of pros and cons of IBPs and next steps in the use and development of IBPs for behavioral health.
Background
Among high school students, seniors report the highest levels of alcohol use and hazardous drinking. Technology-based interventions are a promising approach for reducing alcohol use among this age group. Objectives: This randomized controlled trial investigated the efficacy of the eCHECKUP TO GO, an online personalized feedback intervention, on reducing alcohol use among high school seniors across the academic year (ClinicalTrials.gov Identifier NCT03613818). Drinker risk status, with students classified as high- or low-risk drinkers based on baseline reports binge drinking, was examined as a moderator of intervention effects. Method: Participants (N = 311) were recruited from two high schools. Class periods were randomized to the intervention condition or an assessment-only control condition. Participants completed online surveys at baseline, 30-day, and 6-month assessments. Results: Intervention effects were moderated by drinker risk status. Among high-risk drinkers, those in the intervention condition reported a significant reduction in weekly drinking quantity and estimated blood alcohol concentration (eBAC) at the 30-day follow-up relative to students in the control condition. By 6 months, reductions in alcohol outcomes among high-risk students in the intervention condition were sustained, but high-risk students in the control condition also reported reductions in weekly drinking. In contrast, for eBAC, intervention effects were significantly greater among students in the intervention condition relative to the control condition at 6 months. Conclusions: Results support the efficacy of the eCHECKUP TO GO for decreasing short-term alcohol use among seniors who are high-risk drinkers and provide preliminary evidence that reductions are sustained across the academic year.
Despite the escalation of alcohol use through high school, the majority of research on school‐based alcohol interventions has been conducted with junior high students or first and second‐year high school students. Preliminary research indicates a brief, web‐based personalized feedback intervention developed for college students (eCHECKUP TO GO) may be a promising program for high school seniors. Although these studies demonstrate positive intervention effects, there is some evidence for greater program efficacy for females in this age group. The current study investigates sex differences in program acceptability of the eCHECKUP TO GO and its relationship to short‐term alcohol outcomes among high school seniors (N = 135). Overall, the majority of students reported they found the program to be acceptable (i.e., user‐friendly and useful). However, contrary to our hypothesis, results indicated that male students reported significantly higher perceptions of program acceptability than females. Although we did not find sex differences in alcohol outcomes, program user‐friendliness was related to reductions in alcohol use for males. The results of this study add to the literature supporting the eCHECKUP TO GO for high school seniors and highlight the importance of program user‐friendliness for males. Implications for implementing the program as a school‐based intervention are discussed.
The log-transformation is widely used in biomedical and psychosocial research to deal with skewed data. This paper highlights serious problems in this classic approach for dealing with skewed data. Despite the common belief that the log transformation can decrease the variability of data and make data conform more closely to the normal distribution, this is usually not the case. Moreover, the results of standard statistical tests performed on log-transformed data are often not relevant for the original, non-transformed data.We demonstrate these problems by presenting examples that use simulated data. We conclude that if used at all, data transformations must be applied very cautiously. We recommend that in most circumstances researchers abandon these traditional methods of dealing with skewed data and, instead, use newer analytic methods that are not dependent on the distribution the data, such as generalized estimating equations (GEE).
After high school, college students escalate their drinking at a faster rate than their noncollege-attending peers, and alcohol use in high school is one of the strongest predictors of alcohol use in college. Therefore, an improved understanding of the role of predictors of alcohol use during the critical developmental period when individuals transition to college has direct clinical implications to reduce alcohol-related harms. We used path analysis in the present study to examine the predictive effects of personality (e.g., impulsivity, sensation seeking, hopelessness, and anxiety sensitivity) and three measures of alcohol perception: descriptive norms, injunctive norms, and perceptions regarding the perceived role of drinking in college on alcohol-related outcomes. Participants were 490 incoming freshmen college students. Results indicated that descriptive norms, injunctive norms, and the role of drinking largely mediated the effects of personality on alcohol outcomes. In contrast, both impulsivity and hopelessness exhibited direct effects on alcohol-related problems. The perceived role of drinking was a particularly robust predictor of outcomes and mediator of the effects of personality traits, including sensation seeking and impulsivity on alcohol outcomes. The intertwined relationships observed in this study between personality factors, descriptive norms, injunctive norms, and the role of drinking highlight the importance of investigating these predictors simultaneously. Findings support the implementation of interventions that target these specific perceptions about the role of drinking in college. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Online social networking sites (SNSs) have become a popular mode of communication among adolescents. However, little is known about the effects of social online activity on health behaviors. The authors examined the use of SNSs among friends and the degree to which SNS activities relate to face-to-face peer influences and adolescent risk behaviors.
Longitudinal egocentric friendship network data along with adolescent social media use and risk behaviors were collected from 1,563 10th-grade students across five Southern California high schools. Measures of online and offline peer influences were computed and assessed using fixed-effects models.
The frequency of adolescent SNS use and the number of their closest friends on the same SNSs were not significantly associated with risk behaviors. However, exposure to friends' online pictures of partying or drinking was significantly associated with both smoking (β = .11, p < .001) and alcohol use (β = .06, p < .05). Whereas adolescents with drinking friends had higher risk levels for drinking, adolescents without drinking friends were more likely to be affected by higher exposure to risky online pictures (β = -.10, p < .05). Myspace and Facebook had demographically distinct user characteristics and differential effects on risk behaviors.
Exposure to risky online content had a direct impact on adolescents' risk behaviors and significantly interacted with risk behaviors of their friends. These results provide evidence that friends' online behaviors should be considered a viable source of peer influence and that increased efforts should focus on educating adolescents on the negative effects of risky online displays.
This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Unlabelled:
The present study used a randomized clinical trial design to examine the effectiveness of personalized alcohol feedback delivered individually, in a group and via computer on alcohol use and related negative consequences in a sample of 173 college students referred for alcohol-related violations. Findings revealed statistically significant reductions in alcohol use and related harms for the individually delivered intervention, with significant reductions in alcohol-related harms for the electronically delivered intervention. No statistically significant results were found for the group-delivered intervention or between groups, and a main effect of time was noted for all outcome variables. This study adds to the literature by being the first randomized clinical trial to include analyses of an empirically supported individually delivered personalized alcohol feedback intervention with more cost-effective group-delivered and electronically delivered feedback formats within a single research design, by expanding the range of participant drinking habits reported at baseline to include all drinking levels and not solely those classified as 'heavy drinking' and by providing anonymity pre-intervention and post-intervention given the potential demand characteristics to underreport illegal and/or illicit behaviours in this vulnerable population.
Key practitioner message:
Personalized alcohol feedback delivered in a one-on-one, face-to-face format serves to decrease both alcohol use and harms in mandated college students. The use of web-delivered personalized alcohol feedback may be clinically useful when working with a mandated student population to reduce alcohol-related harms. Personalized alcohol feedback delivered in a group setting may not be indicated for use with a mandated student population as it does not demonstrate decreases in either alcohol use or harms, possibly because of the normalization of deviant behaviour.
BACKGROUND: Alcohol and other substance use disorders (AUD/SUD) are common among youth and often continue into adulthood; therefore, the neurocognitive effects of substance use are of great concern. Because neuromaturation continues into young adulthood, youth with AUD/SUD may be at risk for lasting cognitive decrements. This study prospectively examines neuropsychological functioning over 10 years as a function of AUD/SUD history and outcomes. METHODS: The 51 participants consisted of 18 youth with persisting AUD/SUD, 19 youth with remitted AUD/SUD, and 14 community youth with no AUD/SUD history followed over 10 years (ages 16 to 27 on average) with neuropsychological testing and substance use interviews on 8 occasions. Neuropsychological performance from baseline to 10-year follow-up was compared between the three groups. RESULTS: Despite scoring higher than controls at intake, both AUD/SUD groups showed a relative decline in visuospatial construction at 10-year follow-up (p=.001). Regressions showed that alcohol use (β=-.33, p < .01) and drug withdrawal symptoms (β=-.31, p<.05) over follow-up were predictive of year 10 visuospatial function. Alcohol use also predicted verbal learning and memory (β=-.28, p<.05), while stimulant use predicted visual learning and memory function (β=-.33, p=.01). More recent substance use was associated with poorer executive function (β=.28, p<.05). DISCUSSION: These findings confirm prior studies suggesting that heavy, chronic alcohol and other substance use persisting from adolescence to young adulthood may produce cognitive disadvantages, primarily in visuospatial and memory abilities. Youth who chronically consume heavy quantities of alcohol and/or experience drug withdrawal symptoms may be particularly at risk for cognitive deterioration by young adulthood.
This study examined the association between age at alcohol use onset and adult alcohol misuse and dependence by testing the sensitive-period hypothesis that early adolescence (11-14) is a vulnerable period of development during which initiating alcohol use is particularly harmful.
Data came from a longitudinal panel of 808 participants recruited in 1981. Participants were followed through age 33 in 2008 with 92% retention.
Onset of alcohol use before age 11 (late childhood), when compared with initiation during early adolescence, was related to an increased chronicity of adult alcohol dependence, even after accounting for sociodemographic controls and other substance use in adolescence. The present study finds no evidence that early adolescence is a particularly sensitive period for the onset of alcohol use. Findings related to the onset of regular alcohol use and the chronicity of alcohol dependence suggest that the onset of regular drinking before age 21 is problematic, but no one adolescent period is more sensitive than others. Specifically, although all age groups that started drinking regularly before age 21 had a greater rate of alcohol dependence in adulthood, initiation of regular use of alcohol at or before age 14 was not related to greater chronicity of alcohol dependence than the initiation of regular use of alcohol in middle or late adolescence.
The findings suggest the importance of delaying the onset of alcohol use through prevention efforts as early as the elementary grades. In addition, prevention efforts should focus on preventing the onset of regular drinking before age 21.
To provide a more detailed analysis of the relationship between type and severity of mental disorders (substance use, anxiety and affective disorders) and help-seeking in those aged 16-24 years compared to those aged 25-44 and 45-85 years.
Data from the National Survey of Mental Health and Wellbeing (NSMHWB) which was conducted in 2007. The survey sample comprised residents of private dwellings across Australia aged 16-85 years.
More than one in four Australians aged 16-24 years experienced a mental disorder in the preceding 12 months. This compared to one in five in those aged 16-85 years. Fewer than one in four 16-24-year-olds with a 12-month mental disorder accessed health services in a 12-month period compared with just over one in three of those aged 16-85. The gap in help-seeking was primarily related to higher rates of substance use disorders and low help-seeking associated with these, particularly in young men.
Findings from the 2007 NSMHWB show that the gap in help-seeking in young people with mental health problems is largely due to high rates of substance use disorders and the low rates of help-seeking associated with these. In order to address this gap there is a need for better coordination and integration of mental health and alcohol and drug services within primary care settings. Population health approaches that tackle erroneous beliefs about alcohol and related harms and improve overall mental health literacy are also needed.
Prepartying and drinking game playing are associated with excessive alcohol consumption and alcohol-related negative consequences in college populations; however, research exploring the prevalence of these high risk drinking contexts among high school students, and how such engagement may impact both high school and subsequent college drinking risk, is lacking. The current study, which is the first study to assess prepartying during high school, examined how engaging in either prepartying or drinking game playing during high school was associated with risky high school drinking as well as alcohol use and consequences during the transitional first month of college. The study involved 477 first-year college students, the majority of whom were 18 years old (94%), female (66%), and Caucasian (59%). Prepartying was found to be highly prevalent in high school (45%). Further, students who prepartied or played drinking games during high school drank significantly more in high school than students who did not engage in these high risk activities. Finally, prepartying and game playing during high school were associated with greater collegiate alcohol consumption (controlling for high school drinking) and consequences (controlling for both high school and college drinking). This study establishes prepartying and drinking games as common high risk activities among both high school and incoming first-year college students, and addresses implications for prevention and targeted interventions.
No systematic review has focused on parental consenting procedures used in adolescent substance abuse treatment outcomes research. To address this gap, we examined parental consenting procedures in adolescent outcome studies (n = 34) published between 1980 and 2007. Although parental consent was required in 89% of adolescent treatment outcome studies we reviewed, consenting procedures were not routinely reported. We argue that parental consenting procedures should be routinely reported as a methodological feature of adolescent treatment outcome studies and, given concerns about sample bias in adolescent risk behavior research when parental consent is required, encourage outcomes researchers in this area to prospectively study the impact of consenting procedures on both the study participation rates and substance use reporting.
This study examined a family-directed program's effectiveness in preventing adolescent tobacco and alcohol use in a general population.
Adolescents aged 12 to 14 years and their families were identified by random-digit dialing throughout the contiguous United States. After providing baseline data by telephone interviews, they were randomly allocated to receive or not receive a family-directed program featuring mailed booklets and telephone contacts by health educators. Follow-up telephone interviews were conducted 3 and 12 months after program completion.
The findings suggested that smoking onset was reduced by 16.4% at 1 year, with a 25.0% reduction for non-Hispanic Whites but no statistically significant program effect for other races/ethnicities. There were no statistically significant program effects for smokeless tobacco or alcohol use onset.
The family-directed program was associated with reduced smoking onset for non-Hispanic Whites, suggesting that it is worthy of further application, development, and evaluation.
To examine whether starting to drink at an early age is associated with developing alcohol dependence at a younger age and chronic relapsing dependence, controlling for respondent demographics, smoking and illicit drug use, childhood antisocial behavior and depression, and family alcoholism history.
Cross-sectional survey.
Nationwide face-to-face survey with a multistage probability sample.
A total of 43,093 adults were surveyed in 2001-2002.
Based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, lifetime alcohol dependence, dependence within 10 years of starting drinking, multiple episodes, an alcohol dependence episode in the past year, episodes exceeding 1 year, and meeting 6 or 7 dependence criteria.
Relative to respondents who began drinking at 21 years or older, those who began drinking before age 14 years were more likely to experience alcohol dependence ever and within 10 years of first drinking (adjusted hazard ratios and 95% confidence intervals [CIs], 1.78 [1.51-2.11] and 1.69 [1.38-2.07], respectively). They also more often experienced past-year dependence and multiple dependence episodes (adjusted odds ratios, 1.93 [95% CI, 1.40-2.64] and 3.09 [95% CI, 2.19-4.35], respectively). Among alcohol-dependent persons, the odds were 2.62 (95% CI, 1.79-3.84) for having at least 1 episode exceeding 1 year and 2.89 (95% CI, 1.97-4.23) for meeting 6 or 7 dependence diagnostic criteria.
There is a need to screen and counsel adolescents about alcohol use and to implement policies and programs that delay alcohol consumption.
Adolescent Medicine: State of the Art Reviews is the official journal of the AAP Section on Adolescent Health Care. This volume highlights achievements in adolescent health research and practice that are advancing the state of the art. These researchers are taking advantage of a vulnerable period in the lifespan and wisely using it as a time to promote public health. The literature collected here shares the insight of a broad range of professionals throughout the country ready to advise policy-makers and practitioners on how to build a healthy society.
Topics in Advances in Health Promotion for Adolescents and Young Adults include:
Critical Junctures: Assuring Healthy Outcomes for Adolescents in the new Millennium
The Economic Impact of Adolescent Health Promotion Policies and Programs
Social Marketing: An Underutilized Tool for Promoting Adolescent Health and much more.
The eCHECKUP TO GO is identified as a highly effective, low-cost individually-focused alcohol intervention by the NIAAA CollegeAIM guide. The research on the eCHECKUP TO GO for High School is less consistent, suggesting that the program content, originally designed for college students, may need modification for this age group. This randomized controlled study examined the effectiveness of the eCHECKUP TO GO for High School on shifting risk and protective factors for alcohol use targeted by the program at a 4–6 week follow-up. Female high school students in the intervention group reported a reduction in perceptions of peer drinking, beliefs about alcohol, and positive alcohol expectancies, compared to students in the control group. There were no group differences in risk factors for males or in protective behavioral strategies for either males or females. Results indicate the eCHECKUP TO GO for High School may be more effective for females and that program content targeting protective behavioral strategies may need modification for this age group.
Objective:
Adolescence is a period of neuromaturation concomitant with increased substance involvement. Most substance use studies of adolescents have focused on categorical classifications (e.g., dependent vs. nondependent), but little is known about the influence of specific substance use behaviors on cognitive functioning in youth.
Method:
This study prospectively evaluated the quantitative effects of different substance use behaviors on neuropsychological functioning. A cognitive test battery was administered at baseline (ages 12-14 years), before substance use initiation, and at follow-up (M = 4.0 years, SD = 2.0) to evaluate changes in verbal memory, visuospatial ability, psychomotor speed, processing speed, and working memory. Robust regressions examined substance use behaviors as predictors of neuropsychological functioning (N = 234).
Results:
Several substance use behaviors predicted follow-up neuropsychological functioning above and beyond effects of baseline performance on the same measure (ps < .05). Specifically, more alcohol use days predicted worse verbal memory (β = -.15) and visuospatial ability (β = -.19). More postdrinking effects (β = -.15) and greater drug use (β = -.11) predicted worse psychomotor speed. Processing speed was not predicted by substance involvement (ps > .05). Unexpectedly, more alcohol use predicted better working memory performance (β = .12).
Conclusions:
The frequency and intensity of adolescent alcohol use may be more intricately linked to neuropsychological outcomes than previously considered. The low prevalence of substance use disorder in the sample suggests that subdiagnostic users may still experience adverse effects to verbal memory, visuospatial functioning, and psychomotor speed after initiating intense or frequent alcohol use.
Adolescent drinking represents a significant problem in the United States. Although high school juniors and seniors are particularly vulnerable to the negative consequences associated with alcohol use, evidence-based interventions for this age group are limited. The purpose of this article is to introduce a Web-based alcohol intervention with promising evidence as a best practice for a school-based program.
Introduction:
Alcohol use disorder symptoms frequently occur in adolescents and younger adults who seldom acknowledge a need for help. We identified sociodemographic, clinical, and familial predictors of alcohol problem recognition and help seeking in an offspring of twin sample.
Method:
We analyzed longitudinal data from the Children of Alcoholics and Twins as Parents studies, which are combinable longitudinal data sources due to their equivalent design. We analyzed respondents (n=1073, 56.0% of the total sample) with alcohol use disorder symptoms at the baseline interview. Familial characteristics included perceptions of alcohol problems and help seeking for alcohol problems within the immediate family and a categorical variable indicating genetic and environmental risk. We used logistic regression to examine predictors of alcohol problem recognition and help seeking.
Results:
Approximately 25.9% recognized their alcohol problems and 26.7% sought help for drinking. In covariate-adjusted analyses, help seeking among family members predicted problem recognition, several clinical characteristics predicted both problem recognition and help seeking, and familial risk predicted help seeking. Alcohol problem recognition mediated the association between alcohol use disorder symptoms and incident help seeking.
Conclusions:
Facilitating the self-recognition of alcohol use disorder symptoms, and perhaps the awareness of family members' help seeking for alcohol problems, may be potentially promising methods to facilitate help seeking.
Research indicates that brief Web-based personalized feedback interventions are effective in reducing alcohol use and the negative associated consequences among college students. It is not clear, however, that this is an appropriate strategy for high school students. This study examined high school students' perceptions of a brief Web-based personalized feedback program to assess the appropriateness of this approach for this age group. Results indicated that the majority of students found the program to be user-friendly and to have high utility. Additionally, students reporting alcohol use found the program more useful and indicated that they would be more likely to recommend the program to other students relative to non-drinkers. Findings support the appropriateness of this approach for high school students, and suggest that Web-based personalized feedback may be more positively perceived by students who have initiated drinking.
This chapter presents analytic methods for matched studies with multiple risk factors of interest. We consider matched sample designs of two types, prospective (cohort or randomized) and retrospective (case-control) studies. We discuss direct and indirect parametric modeling of matched sample data and then focus on conditional logistic regression in matched case-control studies. Next, we describe the general case for matched samples including polytomous outcomes. An illustration of matched sample case-control analysis is presented. A problem solving section appears at the end of the chapter.
This study evaluated the effectiveness of a web-based personalized normative feedback program, electronic Check-Up to Go (e-CHUG), in decreasing heavy drinking among 1st-year university students. Results indicated high-risk students receiving the e-CHUG program during 1st-year orientation activities reported significantly greater reductions in heavy drinking and alcohol-related consequences than did students in an assessment-only control group at a 3-month follow-up. Recommendations for integrating e-CHUG into orientation activities are discussed.
This study evaluated the effectiveness of a web-based personalized feedback program using an objective measure of alcohol-related consequences. Participants were assigned to either the intervention group or an assessment-only control group during university orientation. Sanctions received for campus alcohol policy violations were tracked over the academic year. Results indicated high-risk drinkers in the control group received significantly more sanctions than other students. Results support the effectiveness of web-based interventions.
This study evaluated the efficacy of 2 brief personalized feedback interventions aimed at reducing drinking among mandated college students. Results indicated significant reductions in drinking for students in both conditions. Findings provide support for web-based interventions for mandated college students.
Alcohol use increases substantially during the transition from middle school to high school. This study tested a brief, web-based personalized feedback program aimed at reducing risk factors for drinking, alcohol use, and alcohol-related consequences among 9th grade students. At a 3-month follow-up, students in the intervention group showed positive results relative to those in the control group on variables associated with reduced risk, including positive alcohol expectancies and positive beliefs about alcohol. Students in the intervention group also reported a reduction in drinking frequency and alcohol-related consequences relative to those in the control group. There were, however, no differences in normative beliefs regarding peer drinking or quantity of weekly drinking between the two groups. Results indicate that a brief, web-based personalized normative feedback program delivered in the school setting is a promising approach to reducing alcohol use and the associated consequences among 9th grade students.
The efficacy of a Web-based personalized feedback program--electronic CHECKUP TO GO (e-CHUG), aimed at reducing heavy drinking in 1st-year university students--is evaluated. Results indicated that high-risk students in the e-CHUG group reported significantly greater reductions in weekly drinking quantity, frequency of drinking to intoxication, and occurrence of alcohol-related problems. Recommendations for integrating Web-based alcohol programs into a comprehensive prevention program are discussed. (Contains 1 figure and 1 table.)
Monitoring the Future (MTF) is a long-term study of American adolescents, college students, and adults through age 50. It has been conducted annually by the University of Michigan's Institute for Social Research since its inception in 1975 and is supported under a series of investigator-initiated, competing research grants from the National Institute on Drug Abuse. The 2011 the MTF survey encompassed about 46,700 8th-, 10th-, and 12th-grade students in 400 secondary schools nationwide. The first published results are presented in this report. Recent trends in the use of licit and illicit drugs are emphasized, as well as trends in the levels of perceived risk and personal disapproval associated with each drug. This study has shown these beliefs and attitudes to be particularly important in explaining trends in use. In addition, trends in the perceived availability of each drug are presented. A synopsis of the design and methods used in the study and an overview of the key results from the 2011 survey is presented in the introductory section. These are followed by a separate section for each individual drug class, providing figures that show trends in the overall proportions of students at each grade level (a) using the drug, (b) seeing a "great risk" associated with its use (perceived risk), (c) disapproving of its use (disapproval), and (d) saying they could get it "fairly easily" or "very easily" if they wanted to (perceived availability). For 12th graders, annual data are available since 1975, and for 8th and 10th graders, since 1991, the first year they were included in the study. The tables at the end of this report provide the statistics underlying the figures; in addition, they present data on lifetime, annual, 30-day, and (for selected drugs) daily prevalence. (Contains 17 tables and 9 footnotes.) [For "Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2010," see ED528077.]
Objective:
Among emerging adults, those who do not attain postsecondary education are at highest risk for experiencing longterm problems related to alcohol use, including alcohol dependence. The purpose of the current study was to identify latent classes of alcohol users among non-college-attending youth and examine correlates of class membership.
Method:
Screening criteria were used to select emerging adults between ages 18 and 22 years with no postsecondary education (N = 264) from a prerecruited probability-based Web panel. Latent class analysis (LCA) was used to identify common patterns of alcohol use. Grouping variables and demographic variables were added to the LCA model, and rates of alcohol-related consequences across the LCA classes were compared.
Results:
Four classes of drinking patterns were identified: (a) current nondrinkers (34%), (b) weekend light drinkers (38%), (c) weekend risky drinkers (23%), and (d) daily drinkers (5%). Class membership was associated with early onset of alcohol use (age 14 or younger), marital status, employment status, and urban residency (area populated by 50,000 or more people). The number of latent classes did not differ across sex and legal drinking age status, although proportions of subjects within classes varied by age. Weekend risky drinkers were most likely to report sickness and feelings of guilt because of drinking, whereas daily drinkers were most likely to report getting into fights, driving a car after drinking, and missing work.
Conclusions:
Similar to college samples of emerging adults, most of this noncollege sample belonged to latent classes defined by rare or moderate alcohol use. Nevertheless, nearly a quarter of the sample reported high-risk drinking behaviors, and a small number reported drinking alcohol on a daily basis. Both of these classes were at elevated risk for experiencing a number of alcohol-related consequences.
Issues:
The use of alcohol and drugs amongst young people is a serious concern and the need for effective prevention is clear. This paper identifies and describes current school-based alcohol and other drug prevention programs facilitated by computers or the Internet.
Approach:
The Cochrane Library, PsycINFO and PubMed databases were searched in March 2012. Additional materials were obtained from reference lists of papers. Studies were included if they described an Internet- or computer-based prevention program for alcohol or other drugs delivered in schools.
Key findings:
Twelve trials of 10 programs were identified. Seven trials evaluated Internet-based programs and five delivered an intervention via CD-ROM. The interventions targeted alcohol, cannabis and tobacco. Data to calculate effect size and odds ratios were unavailable for three programs. Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug-related knowledge.
Conclusion:
This is the first study to review the efficacy of school-based drug and alcohol prevention programs delivered online or via computers. Findings indicate that existing computer- and Internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school-based prevention.
The present study examined cognitive and attitudinal factors relevant to binge-drinking tendencies in a college sample. Results indicate that positive expectations about binge-drinking activities were related to binge-drinking tendencies. Binge-drinking tendencies were also negatively related to expectations regarding nonbinge-drinking alternatives. General attitudes toward drinking and normative influences were found to have complex influences on binge-drinking tendencies involving indirect, direct, and moderated effects. The findings are discussed with respect to developing prevention programs.
One in four youths aged 12 to 17 years and more than half of young adults aged 18 to 25 years in the United States have used an illicit drug in their lifetime. A significant number progress to problematic use, and only 1 in 10 young people who meet criteria for dependence or abuse receive some form of treatment. Despite advances in the field, effectively intervening along the continuum of drug use involvement remains a challenge. In this article, we review the current epidemiology of illicit drug use by young people; describe recent advances in assessment, intervention and treatment; and highlight how technology can help overcome barriers to effective management of drug use among young people.
The odds ratio (OR) is probably the most widely used index of effect size in epidemiological studies. The difficulty of interpreting the OR has troubled many clinical researchers and epidemiologists for a long time. We propose a new method for interpreting the size of the OR by relating it to differences in a normal standard deviate. Our calculations indicate that OR = 1.68, 3.47, and 6.71 are equivalent to Cohen's d = 0.2 (small), 0.5 (medium), and 0.8 (large), respectively, when disease rate is 1% in the nonexposed group; Cohen's d
Academic Emergency Medicine 2011; 18:1099–1104 © 2011 by the Society for Academic Emergency Medicine
Abstract
Regression techniques are versatile in their application to medical research because they can measure associations, predict outcomes, and control for confounding variable effects. As one such technique, logistic regression is an efficient and powerful way to analyze the effect of a group of independent variables on a binary outcome by quantifying each independent variable’s unique contribution. Using components of linear regression reflected in the logit scale, logistic regression iteratively identifies the strongest linear combination of variables with the greatest probability of detecting the observed outcome. Important considerations when conducting logistic regression include selecting independent variables, ensuring that relevant assumptions are met, and choosing an appropriate model building strategy. For independent variable selection, one should be guided by such factors as accepted theory, previous empirical investigations, clinical considerations, and univariate statistical analyses, with acknowledgement of potential confounding variables that should be accounted for. Basic assumptions that must be met for logistic regression include independence of errors, linearity in the logit for continuous variables, absence of multicollinearity, and lack of strongly influential outliers. Additionally, there should be an adequate number of events per independent variable to avoid an overfit model, with commonly recommended minimum “rules of thumb” ranging from 10 to 20 events per covariate. Regarding model building strategies, the three general types are direct/standard, sequential/hierarchical, and stepwise/statistical, with each having a different emphasis and purpose. Before reaching definitive conclusions from the results of any of these methods, one should formally quantify the model’s internal validity (i.e., replicability within the same data set) and external validity (i.e., generalizability beyond the current sample). The resulting logistic regression model’s overall fit to the sample data is assessed using various goodness‐of‐fit measures, with better fit characterized by a smaller difference between observed and model‐predicted values. Use of diagnostic statistics is also recommended to further assess the adequacy of the model. Finally, results for independent variables are typically reported as odds ratios (ORs) with 95% confidence intervals (CIs).
Early onset of drinking among Dutch adolescents is highly prevalent. A lower age of onset is associated with several developmental and social risks.
To evaluate the long-term effectiveness of two preventive interventions targeting heavy drinking in third-year high school students.
Cluster RCT using four conditions for comparing two active interventions (separately and simultaneously) with a control group.
152 classes of 19 high schools in the Netherlands; 3490 first-year high school students (M=12.6 years, SD=0.49) and their parents.
(1) parent intervention aimed at encouraging restrictive parental rule-setting concerning their children's alcohol consumption; (2) student intervention aimed at increasing self-control and healthy attitudes toward alcohol, consisting of four digital lessons based on the principles of the theory of planned behavior and social cognitive theory; (3) interventions 1 and 2 combined; and (4) the regular curriculum as control condition.
Incidence of (heavy) weekly alcohol use at 34 months (2009) after baseline measurement (2006).
There were 2937 students eligible for analyses in this study. At follow-up, only the combined student-parent intervention showed substantial and significant effects on heavy weekly and weekly drinking.
The short-term effects found in the present study further support that adolescents as well as their parents should be targeted in order to delay the onset of (heavy) drinking.
NTR649.
As part of a parent intervention to reduce heavy-drinking, college freshmen were assessed for their attitudes toward drinking and reasonable alternatives to drinking on the weekends, as well as cognitive variables underlying attitudinal variables. Intervention parents received a handbook the summer prior to college entrance with information about college drinking and best practices for parent-teen communication. Results revealed that the association between intervention condition and drinking outcomes was mediated by attitudes favorable to drinking and reasonable alternatives to drinking, as well as beliefs about alcohol related behavior. This parent program was shown to be efficacious for changing high-risk drinking in college. Findings are discussed regarding the further development of college drinking prevention programs involving parents.
This study evaluated the efficacy of two brief personalized normative feedback interventions aimed at reducing heavy drinking among mandated college students (N = 135). Students were randomly assigned to one of two conditions: Web-based assessment with self-guided personalized normative feedback (SWF) or Web-based assessment with counselor-guided personalized normative feedback (CWF). Results indicated that students in the CWF condition reported significantly greater reductions in weekly drinking quantity and binge drinking frequency than those in the SWF group at follow-up (M = 8 months). Students in the CWF group also reported significantly greater reductions in estimates of peer drinking from baseline to the follow-up assessment than students in the SWF group. In addition, changes in estimates of peer drinking partially mediated the effect of the intervention on changes in drinking. Results suggest that counselor-guided feedback may be more effective in reducing drinking among mandated students relative to self-guided feedback in the long term.
To examine the effects of a parent and student intervention offered separately and simultaneously (PAS) on onset of weekly drinking via its putative mediators.
A randomized trial with four conditions; (1) parent intervention, (2) student intervention, (3) combined parent-student intervention and (4) control group.
High schools selected randomly, located in different areas.
A total of 2937 early adolescents (mean age = 12.6, standard deviation = 0.49) and their parents.
Mediation effects were analysed using pretest data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated (Mplus) to examine the effect of the interventions on adolescent-reported mediators (self-control, perceived parental rules and attitudes about alcohol) and parent-reported mediators (parental rules and attitudes about alcohol). Outcome was onset of weekly drinking.
The parent intervention modified rules and attitudes about alcohol as reported by parents. An indirect effect of the parent intervention via parental rules was found. The combined intervention affected both adolescent-reported and parent-reported rules and attitudes about alcohol and adolescents' perceived self-control, yet only perceived rules and self-efficacy, as reported by adolescents, and parental attitudes mediated the association between the combined intervention and onset of weekly drinking. No significant effects were found of the separate student intervention on the mediating factors.
The PAS programme proved to be effective as predicted by the theoretical assumptions underlying the interventions. Interventions with parents and adolescents to prevent adolescent alcohol consumption may usefully target parental rules about alcohol and adolescents' self-confidence.
This study evaluated a gender-specific, computer-mediated intervention program to prevent underage drinking among early adolescent girls.
Study participants were adolescent girls and their mothers from New York, New Jersey, and Connecticut. Participants completed pretests online and were randomly divided between intervention and control arms. Intervention-arm girls and their mothers interacted with a computer program aimed to enhance mother-daughter relationships and to teach girls skills for managing conflict, resisting media influences, refusing alcohol and drugs, and correcting peer norms about underage drinking, smoking, and drug use. After intervention, all participants (control and intervention) completed posttest and follow-up measurements.
Two months following program delivery and relative to control-arm participants, intervention-arm girls and mothers had improved their mother-daughter communication skills and their perceptions and applications of parental monitoring and rule-setting relative to girls' alcohol use. Also at follow-up, intervention-arm girls had improved their conflict management and alcohol use-refusal skills; reported healthier normative beliefs about underage drinking; demonstrated greater self-efficacy about their ability to avoid underage drinking; reported less alcohol consumption in the past 7 days, 30 days, and year; and expressed lower intentions to drink as adults.
Study findings modestly support the viability of a mother-daughter, computer-mediated program to prevent underage drinking among adolescent girls. The data have implications for the further development of gender-specific approaches to combat increases in alcohol and other substance use among American girls.
Research finds a strong association between substance use and risky sexual behavior but more needs to be known about this relationship. Few studies have examined this relationship among rural sixth- to eighth-grade students. As such, the purposes of this study were to provide a descriptive profile of rural sixth- to eighth-grade students' substance use behavior and sexual activity and to examine the relationship between substance use behaviors and sexual activity.
Participants consisted of a convenience sample of 10,273 middle school students (sixth to eighth grade) attending 10 public schools in rural Tennessee. The middle school Youth Risk Behavior Survey was administered to these students during April and May 2004.
Analysis found that a large percentage of students had tried cigarettes, alcohol, and inhalants. Additionally, it was found that sexual intercourse had been initiated by 18.8% of females and 25.4% of males. Of those students who reported ever having had sexual intercourse, 75% had reported the use of cigarettes and alcohol. In addition, approximately 50% of those students reported marijuana and inhalant use.
The results suggest that substance use behavior has a relationship with the likelihood of initiating sexual activity. Additional longitudinal research with this population will be needed for explaining whether these select substance use behaviors are probable risk factors predisposing young rural adolescents to report engaging in sexual behaviors or a result of other factors.
Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk.
This study examined associations between AFD (ages <15 and 15-17 vs. 18+ years) and first incidence of DSM-IV alcohol dependence, abuse, and specific AUD criteria over a 3-year follow-up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline (n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors.
After adjusting for all risk factors, the incidence of dependence was increased for AFD <15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy-volume drinkers. In a population of low-risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse.
There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision-making and/or reward-processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low-risk adolescents.
To examine the relationship of adolescent substance use and dependence to sexual risk-taking behavior in late adolescence and young adulthood.
We prospectively examined self-reported sexual behaviors and substance involvement questionnaires in a sample of youth in substance abuse treatment programs and a comparison sample of sociodemographically similar community youths without histories of substance use disorders recruited from media ads. Assessments of sexual behaviors and substance involvement (78% white, 51% female) were collected at 2, 4, and 6 years after initial assessments, as they transitioned from middle adolescence to young adulthood (from age 15.5 to age 21.5 years, on average). The two samples were compared using Chi-square, analysis of variance, and multivariate analysis of variance approaches. Continuous indicators of high-risk sexual behaviors and substance involvement were analyzed with multiple regression.
Earlier age of onset to sexual activity, more sexual partners, less consistent use of condoms, more sexually transmitted diseases (STDs), and greater prevalence of human immunodeficiency virus testing were reported by youth in the clinical treatment sample relative to sociodemographically comparable nonabusing community youth. High rates of STDs were found among females, and more substance-abusing females reported pregnancies than community females. Substance involvement continued to be associated with high-risk sexual behavior throughout the transition into young adulthood.
Youth identified with substance problems are more likely to engage in risky sexual behaviors during adolescence and to continue risky sexual behaviors to the extent that substance problems persist. Risk reduction education should be included with adolescent substance abuse treatment.
This study examined correlates of program initiation and completion in a family-directed program that involved families of adolescents throughout the United States. Correlates varied by whether program initiation, program completion, or the number of activities completed was the indicator of participation. In final regression models, participation was relatively likely by non-Hispanic whites when compared with persons of race/ethnicity other than white, black, and Hispanic; by families with a female adolescent as the program recipient; by families with mothers who had many years of education; and by families with both parents living in the household. There was more participation if parents thought their child would smoke in the future and if the parent thought the adolescent did not smoke currently. Participation was higher if the adolescent felt strongly attached to the parent and if parents did not smoke. The findings are considered in the context of similar programs and future research on family-directed programs to prevent adolescent tobacco and alcohol use.
The present study surveyed 930 high school students regarding self-reported alcohol use, their perceptions of parents and peers, and the negative consequences of drinking. Two-fifths of males and one-fifth of females reported frequent problem (binge) drinking. Problem drinkers reported more negative consequences associated with drinking. In addition, problem drinkers reported greater susceptibility to peer pressure, perceived their peers as drinking more, and reported less parental monitoring and more use of alcohol by parents. The results demonstrate the importance of both parent and peer variables in adolescent substance use and highlight the negative consequences of drinking reported by high school students.
There is a paucity of test-retest reliability data for adolescent self-reports of a wide range of risk behaviours. Grade 8 and 11 students (N = 358) completed a questionnaire on two occasions between 10 and 14 days apart. It included items about use of various substances, violent behaviour, suicidality, and sexuality. Cohen's kappa was almost perfect for 1 item (kappa = 85.4%); in the substantial range (61-80%) for 4 items; and in the moderate range (41-60%) for 3 items. For the remaining 7 items, the percentage agreement was higher than 92.0%. The questionnaire thus demonstrates adequate test-retest reliability.
To study the reliability of adolescents' self-reported drinking and perceived drunkenness in surveys.
The data from two cross-sectional school-based questionnaire surveys with representative cluster samples (the European School Survey Project on Alcohol and Other Drugs, ESPAD) in Finland were used; there were 2161 (1995) and 3109 (1999) 15-year-old respondents. The response rates were 94% and 90% respectively. The measurements analysed were an open-ended and a set of closed-category questions concerning the latest drinking occasion.
The set of three closed questions used in 1995 yielded mean amounts of 6.6 (girls) and 8.7 (boys) centilitres of pure alcohol whereas the figures obtained from the open question were 8.5 (girls) and 11.8 (boys) centilitres. With the closed set extended in 1999 into five questions, the two figures among girls were 7.7 (closed) and 7.7 (open) centilitres; the corresponding figures among boys were 11.3 (closed) and 11.7 (open) centilitres. Individual level correlations between the two measures among girls were 0.69 in 1995 and 0.69 in 1999; and 0.69 (1995) and 0.65 (1999) among boys. The numbers of students reporting specific beverage type use were higher when using closed questions compared with an open question. Drunkenness self-reports related logically to amounts of alcohol drunk.
The adolescent drinking amount self-reports seem reasonably reliable and valid both on a population and individual level. A set of closed questions may capture the amount drunk even better than an open question.
To examine the relationship between substance use, other health risk behaviors, and sexual victimization among adolescent females.
A cross-sectional telephone survey of 16-20-year-olds, including 647 female "ever drinkers" (1999) and 1236 female "never drinkers" and "ever drinkers" (2000) from 17 states, was conducted as part of the National Evaluation of the Enforcing Underage Drinking Laws Program. The survey assessed underage alcohol use, sexual victimization, and other risky behaviors. Logistic regression modeling was used to measure the association among sexual victimization, substance use, and other risk behaviors.
In 1999, 8.2% and in 2000, 7.1% of the participants reported having experienced actual or attempted sex against their will. Logistic regression analyses revealed that binge drinking in the past 2 weeks (1999), age at first drink (2000), sex without birth control (1999 and 2000), marijuana use in the past 30 days (1999 and 2000), and ever having been in a fight (2000) were associated with sexual victimization.
Indicators of substance abuse and other health risk behaviors were strongly associated with sexual victimization among adolescent females. Implications for the direction of causal relationships are discussed.
To review current knowledge about the most effective school-based interventions for child and adolescent problems, and to present dilemmas and potential solutions in mounting and evaluating school-based interventions for adolescent alcohol and other drug (AOD) use problems.
Two literature reviews were conducted: (1) a broad and encompassing review of English-language articles published from 1990 to the present concerning school-based interventions for child and adolescent problems and (2) an exhaustive review of articles concerning Student Assistance Programs, which are the most popular approach to school-based AOD intervention in the United States.
Ten key components of effective school-based interventions were identified. In addition, six pervasive dilemmas in school-based AOD intervention research were discussed. Examples of potential solutions to these dilemmas were gleaned from an ongoing randomized clinical trial of a Student Assistance Program.
School-based AOD interventions have several potential advantages over more traditional clinic-based AOD interventions. Nonetheless, there are many challenges and dilemmas to conducting and evaluating interventions in school settings. With patience and guidance, these challenges can be addressed successfully.