Drug Abuse Prevention

Research Findings from May, 1998 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Early Stages of Drug Use: Transitions from Opportunity to Use

In research at Johns Hopkins University focusing on the earliest stages of drug involvement investigators studied the transition from an initial opportunity to try marijuana to the subsequent use of this drug through secondary analysis of self-report interview data gathered from nationally representative samples of the United States National Household Surveys on Drug Abuse, 1979-1994. The evidence indicates that the estimated prevalence of an opportunity to try marijuana has been rather stable for 15 years. However, there are recent increases in the probability of rapidly progressing from first marijuana opportunity to first marijuana use, among persons given an opportunity to use. In addition, the transition from first marijuana opportunity to eventual marijuana use seems to depend upon age at first opportunity. This epidemiological evidence on the transition from marijuana opportunity to marijuana use, the first to be published based on a nationally representative US sample, highlights directions for future research and a focus for prevention efforts. Van Etten, M.L., Neumark, Y.D., Anthony, J.C. Drug and Alcohol Dependence., 49(1), pp. 1-7, 1997.

Students Who Bring Weapons to School and Drug Use

Social, demographic, and behavioral characteristics and self-reported carrying of a weapon to school among middle school students provide a statistical profile of youth most likely to bring weapons to school and help to identify characteristics that are only spuriously related to this behavior. Study respondents were part of an ongoing randomized evaluation of a school-based drug use prevention program in Illinois. Self-administered questionnaires were completed by 1,503 seventh and eight graders. Fifteen percent of respondents brought some type of weapon to school in the past month. Weapon carrying was significantly associated with being male, not living with both parents, not feeling close to parents, heavy drinking, participating in fights, damaging school property, and perceiving that at least a few other students bring weapons to school. Victimization and fear for safety in school were not significantly associated with weapon carrying. Study results suggest that the structure and the dynamics of the family and perceived normative influences play important roles in weapon carrying behavior. Weapon carrying also appears to cluster with other deviant behaviors including drug use. Bailey, S.L., Flewelling, R.L., Rosenbaum, D.P. Characteristics of Students Who Bring Weapons to School. Journal of Adolescent Health, 20, pp. 261-270, 1997.

Jump Start: A Targeted Anti-Drug Prevention Program

A substance abuse prevention and life skills program for economically disadvantaged, high sensation seeking African American teens was developed and tested. Formative research was conducted to determine program content and format. Over two implementations, 289 individuals in the target population were recruited as participants for the field test of the program. For the first implementation, participants were randomly selected from a summer youth employment program. For the second, a media campaign was designed to recruit participants. Participants evaluated the program extremely positively. Analysis indicated that the significant pretest difference in liquor and marijuana use between high and low sensation seekers was neutralized in both years of the program as were attitudes toward drugs in the first year of the program. These results suggest that sensation seeking is a useful message design and audience-targeting variable for substance abuse prevention program design. Harrington, N.G., & Donohew, L. Jump start: A Targeted Substance Abuse Prevention Program. Health Education and Behavior. 24(5), pp. 568-586, 1997.

Association between Attention Deficit Hyperactivity Disorder (ADHD) and Cigarette Smoking

In a follow-up study of siblings of ADHD and control probands, it was found that found that ADHD in probands increased the risk for cigarette smoking in siblings regardless of the sibling's own ADHD status or the presence of other psychiatric conditions. Moreover, ADHD in the siblings was associated with higher rates of cigarette smoking along with a significantly younger age at onset. In like manner, conduct disorder, major depression and drug abuse were associated with high rates of cigarette smoking. In addition, cigarette smoking appeared to be familial among the ADHD families but not the control families. Finally, male gender did not appear to be a risk factor for cigarette smoking in the sample. Using DSM-III-R structured diagnostic interviews and blind raters, we conducted a four-year follow-up of siblings from ADHD (N=149) and control families (N=117). The mean age of the siblings was 17.2 (range 9 to 41) and roughly half were males. First we analyzed the data using univariate methods (i.e., Chi-square tests) which were followed by multivariate logistic regression models which simultaneously controlled for confounding variables such as high risk status (i.e., whether a sibling of an ADHD or normal control proband), socioeconomic status, age, IQ, gender and psychiatric disorders. Since ADHD is a prevalent, childhood onset disorder that is often characterized by impulsive behavior, it could represent a large group of youth at high risk for smoking, illicit drug use, medical morbidity and premature mortality. Since ADHD children and their siblings comprise a large portion of the population at high risk for smoking, they may represent an excellent group to be targeted for prevention programs. Further Evidence of an Association between Attention Deficit Hyperactivity Disorder (ADHD) and Cigarette Smoking: Findings from a High Risk Sample of Siblings. Milberger, S., Biederman, J., Faraone, S.V., Chen, L., and Jones J. American Journal on Addictions, 6, pp. 205-217, 1997.

Similar and Different Precursors to Drug Use and Delinquency Among African- Americans and Puerto Ricans

Correlational and net regression techniques were used to examine the commonalities and differences in adolescent risks for later drug use and delinquency among African-Americans and Puerto Rican youths. Eighty-eight percent of the risks were significantly related to both problem behaviors. Within the personality, family, peer, ecology, and acculturation domains many risks independently contributed to the prediction of each problem. Only three risks had a significantly stronger relationship to one of the problem behaviors than to the other. Finding so many common intrapersonal and interpersonal predictors supports a general dimension of problem behavior. The commonalities suggest that interventions targeting these adolescent risks might reduce both problem behaviors. Brook, J.S., Whiteman, M., Balka, E.B., Win, P.T., and Gursen, M.D. Journal of Genetic Psychology, 159 (1), pp. 13-29, 1998.

Tobacco Policy Effects on Youth

Tobacco policy may be differentially enforced with youth, depending on their risk for school failure and other problem behavior. An analysis of the policy change component of a multi-component community intervention for adolescent drug abuse prevention was conducted. Effects of the community intervention (program or control) on tobacco policy change and tobacco were assessed, as well as effects of policy (level of restrictiveness) on tobacco use were evaluated. Results showed that intervention decreased tobacco use over the study period and had an effect on changing tobacco policy toward more restrictiveness. However, existing level of policy restrictiveness (prior to and independent of intervention) was associated with higher tobacco use, suggesting that schools adopt more restrictive policies on their own in reaction to a greater tobacco use problem. Pentz, M.A., Sussman, S., & Newman, T. The Conflict Between Least Harm and No Use Tobacco Policy for Youth: Ethical and Policy Implications. Addiction, 92(9), pp. 1165-1173, 1997.

Adolescent School Experiences and Dropout, Adolescent Pregnancy, and Young Adult Deviant Behavior

Predictive effects of school experiences were studies over a 7-year interval in a random community sample of 452 adolescents, 12 through 18 years of age. Outcomes examined included dropping out of school, adolescent pregnancy, engaging in criminal activities, criminal conviction, antisocial personality disorder, and alcohol abuse. Logistic regression showed academic achievement, academic aspirations, and learning-focused school settings to be related to a decline in deviant outcomes independent of the effects of disadvantaged socioeconomic background, low intelligence, childhood conduct problems, and having deviant friends during adolescence. Associations between school conflict and later deviancy were mediated by deviant peer relationships in adolescence and other school characteristics. Prior research reporting continuity of childhood conduct problems and the influence of adolescent affiliations with deviant peers on negative outcomes was supported. Implications for using the school context in risk factor research and the practical applications of such research for intervention are discussed. Kasen, S., Cohen, P., and Brook, J.S. Journal of Adolescent Research, 13(1), pp. 49-72, 1998.

Factors Associated with Early Sexual Activity among Urban Adolescents

This study uses lifespan and ecological frameworks to investigate the factors associated with early adolescent sexual activity. Data from a longitudinal study of urban teenagers of color address three issues: (1) the prevalence and pattern of sexual activity among boys and girls ages 15 and younger, (2) the link between early sexual activity and high-risk sexual behavior, and (3) the life contexts linked with early sexual activity. Results from 803 African American and Hispanic adolescents suggest a high prevalence of early sexual activity, which is associated with higher rates of childbearing and risky sexual behavior than sexual activity initiated in later adolescence. Somewhat different factors are associated with early sexual activity for boys and girls, although family composition, parent attachment, and substance use are important for both genders. Implications for intervention are discussed. Smith, C.A. Social Work, 42, pp. 334-346, 1997.

Interrelationships Between Adolescent Drug Use and Drug Use 5 Years Later

In 1990 (T1), African American (n=695) and Puerto Rican (n=637) youths in East Harlem schools completed questionnaires on six domains: personality attributes, family relationships, peer factors, ecological variables, acculturation measures, and stage of drug use. Five years later (T2), 459 of the African American youth and 423 of the Puerto Rican youth were re-contacted to complete a follow-up questionnaire on the same domains. At T1, there were no significant differences in self-reported drug use between the African American and Puerto Rican youths but at T2, significantly more Puerto Ricans used drugs than did African Americans. The variables within the different domains were analyzed to determine those in T1 which were related to T2 drug use. Acculturation, family, personality, and peer domains were found to be related to stage of drug use in young adulthood, with control for stage of drug use in adolescence. The study suggests that stability of drug use alone cannot explain the relationship between earlier domains and later drug use, and that specific adolescent risk factors have long-lasting effects into young adulthood. Targeting risk factors related to adolescent drug use during adolescence is likely to reduce contemporaneous and later drug use. Brook, J.S., et al. African-American and Puerto Rican Drug Use: A Longitudinal Study, J. Am. Acad. Child Adolesc. Psychiatry, 36 (9), pp. 1260-1268, 1997.

The ATLAS Program: Effects During Two Seasons

The largest group of adolescents who use anabolic steroids (AS) participate in high school football. The greatest risk for initiating AS appears to occur during the football season. The effect of an educational intervention designed to prevent AS use and promote healthy behaviors was tested. ATLAS capitalized on the social influences of a team sport setting. Thirty-one football teams were separated into experimental and control schools with new subjects assessed over two successive years in a randomized trial. An interactive intervention presented by coaches, research staff and student team leaders, included weight room sessions, sports nutrition and strength training, alternatives to AS use, drug knowledge, drug refusal role play, and anti-AS media campaigns. Pre- and post-intervention questionnaires assessed risk factors, intentions and use of AS, and dietary and exercise habits. Compared to the controls, experimental subjects reported greater understanding of the effects of alcohol, marijuana and AS, greater belief in personal harm by AS use, more negative feelings toward AS users, reduced impulsivity, improved feeling of athletic abilities and self-esteem, greater belief that coaches were anti-AS, less belief in media, and improved refusal skills. There was reduced intent to use AS and less than half the new AS users were among experimental group. In addition, beneficial changes in strength training self-efficacy and nutrition behaviors were present. Goldberg, L., Elliot D., MacKinnon, D., Moe, E., Clarke, G., Lapin, A., Green, C., Miller, D. & Greffrath, E., The ATLAS (Adolescents Training and Learning to Avoid Steroids) Intervention: Effects During 2 Seasons. Med Sci Sports Exercise (Supplement), pp. 29S:S293, 1997.

Childhood, Adolescent, Familial, and Peer Antecedents of Cigarette Smoking in Young Adults

This study examined the interrelation of personality, family, and peer determinants and their effects on tobacco use by young adults. Mothers were first interviewed about their children when they were between the ages of 1 and 10 years old. Three subsequent interviews were conducted with the children when they reached adolescence and young adulthood. Results show support for the mediational model, which is derived from the family interactional theory framework to examine pathways that may lead to adolescent legal and illegal drug use and other problem behavior. There was a sequence in patterning: from parenting during early adolescence, to personality and peer factors, extending to smoking in late adolescence and culminating in smoking in adulthood. With a developmental approach, a number of psychosocial measures appear related in both younger and older children. Developmental differences also emerged, suggesting four possible targets for therapeutic or preventive intervention: the parent, the child, the adolescent, and the peer group. Brook, J.S., et al. Cigarette Smoking in Young Adults: Childhood and Adolescent Personality, Familial, and Peer Antecedents, J. Genetic Psychology, 158(2), pp. 172-188, 1997.

Implementation Issues in Drug Abuse Prevention Research

Methodological issues evaluating quality of implementation of drug use prevention programs are reviewed: definition (adherence, exposure, reinvention), measurement (self-report, other's report, behavioral observation), and parameters of influence (person, situation, environment). When implementation is defined as the interaction of person, situation, and environment, the "true" drug use prevention program effect is established as the average of effect generated from experimental assignment and program implementation. Differences between researcher and programmer standards of implementation quality are interpreted in terms of an efficacy/effectiveness continuum. Pentz, M.A. & Trebow, E. Implementation Issues in Drug Abuse Prevention Research. Substance Use and Misuse, 32, pp. 1655-1660, 1997.

Delinquency and Antisocial Behavior: A Review of Family Processes and Intervention Research

Recent longitudinal research employing complex measurement and analytic strategies has generated new, more intricate conceptualizations of the relationship between family life and delinquency, all of which have important implications for intervention with delinquents and their families. This critical review of the current research on the role of the family, its implications for family-based interventions with delinquents, and the existing treatment outcome research highlights four areas: the link between different family processes and delinquency, reciprocal relationships between parenting and delinquency, the effects of family context on parenting and delinquency, and the family as one cause of delinquency among many. Smith, C.A., and Stern, S.B. Social Service Review, 71, pp. 382-420, 1997.