Drug Abuse Prevention

Research Findings from May, 1999 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.

Stress-Coping Factors in Adolescent Substance Use: Test of Ethnic and Gender Differences in Samples of Urban Adolescents

Addressing the question of whether and how the etiology of drug use differs for adolescents in various ethnic groups, researchers investigated group differences in the relationship between stress-coping variables and substance use with samples of inner-city students in 6th-8th grades (N = 1,289) and metropolitan-area students in 7th-9th grades (N = 1,702). Use of cigarettes, alcohol, and marijuana were considered, and measures of psychosocial predictor domains focused on affect, life events, parental support, and coping patterns. African-American adolescents had the lowest rate of substance use, Hispanics were intermediate, and Whites had the highest rate; there was no gender difference in overall substance use. Multiple regression analysis showed that the strength of predictive relationships for stress-coping variables was lower for African Americans and was greatest for Whites; methodological tests showed that these differences were not attributable to statistical artifacts. Hispanic adolescents showed greater vulnerability than did Whites at younger ages but this effect was reversed at later ages. Implications of the study include the importance of incorporating stress-coping components in the design of prevention programs for all ethnic groups. As affective factors were less predictive of substance use among African-American adolescents, programs should give greater attention to other domains when targeting programs to these adolescents. Earlier prevention efforts (before age 12) are likely to be most critical for Hispanic youth. Vaccaro, D. and Wills, T.A. Journal of Drug Education. Vol. 28(3), pp. 257-280, 1998.

Stress-Coping Factors in Adolescent Substance Use: Test of Ethnic and Gender Differences in Samples of Urban Adolescents

Addressing the question of whether and how the etiology of drug use differs for adolescents in various ethnic groups, researchers investigated group differences in the relationship between stress-coping variables and substance use with samples of inner-city students in 6th-8th grades (N = 1,289) and metropolitan-area students in 7th-9th grades (N = 1,702). Use of cigarettes, alcohol, and marijuana were considered, and measures of psychosocial predictor domains focused on affect, life events, parental support, and coping patterns. African-American adolescents had the lowest rate of substance use, Hispanics were intermediate, and Whites had the highest rate; there was no gender difference in overall substance use. Multiple regression analysis showed that the strength of predictive relationships for stress-coping variables was lower for African Americans and was greatest for Whites; methodological tests showed that these differences were not attributable to statistical artifacts. Hispanic adolescents showed greater vulnerability than did Whites at younger ages but this effect was reversed at later ages. Implications of the study include the importance of incorporating stress-coping components in the design of prevention programs for all ethnic groups. As affective factors were less predictive of substance use among African-American adolescents, programs should give greater attention to other domains when targeting programs to these adolescents. Earlier prevention efforts (before age 12) are likely to be most critical for Hispanic youth. Vaccaro, D. and Wills, T.A. Journal of Drug Education. Vol. 28(3), pp. 257-280, 1998.

Ethnic Identity Is Mediated by Family Factors In Protecting Against Drug Use

This study examined the multiple components of ethnic identity, the place of this ethnic identity set in the mediational model of the path to drug use predicted by a family interactional framework, and the protective role of each component of ethnic identity. The participants were 259 male and 368 female African Americans in late adolescence. They responded to a structured questionnaire in individual interviews. Few of the specific components of ethnic identity were significantly related as main effects to drug use, and most of the effect of ethnic identity was mediated by the family set of variables. Each of the components of ethnic identity offset risks or enhanced protective factors from the ecology, family, personality, and peer domains, thereby lessening drug use. This pattern highlights the importance of incorporating ethnic identity into drug prevention programs which serve African-American youth. Brook, J.S., Balka, E.B., Brook, D.W., et al. Drug Use Among African Americans: Ethnic Identity as a Protective Factor. Psychol Rep, 83(3 Pt 2): pp. 1427-1446, 1998.

Young Adult Drug Use May Be Reduced by Early Interventions, Stronger Parent-Child Bonds

This study examined young adult drug use stemming from childhood aggression, the parent-child mutual attachment relationship, and the effect of unconventionality. Youngsters and their mothers were interviewed when the youngsters were early adolescents, late adolescents, and young adults. Additional data were collected from the mothers when their youngsters were children. The analysis was conducted on youngsters who had complete data at all 4 points in time. The findings were in accord with the family interactional model; that is, the parent-child mutual attachment relationship affects unconventionality in the youngster, which, in turn, affects young adult drug use. The results indicate that the parent-child mutual attachment relationship does so through the stability of : (a) the attachment relationship from childhood to young adulthood, (b) unconventional personality and behavioral attributes from early adolescence to young adulthood, and (c) drug use from early adolescence to young adulthood. The findings imply that early intervention with respect to aggression, inter-ventions that focus on strengthening the parent-child bond and conventional behavior, and interventions aimed at early drug use should be most effective in reducing young adult drug use. Brook, J.S., Whiteman, M., Finch, S., and Cohen, P. Mutual Attachment, Personality, and Drug Use: Pathways from Childhood to Young Adulthood. Gen Soc Gen Psy Monogr, 124(4), pp. 492-510, 1998.

Effects of Drug Testing High School Athletes

Data from numerous studies have shown that high school athletes initiate hazardous drug use behaviors at rates similar to non-athletic peers, with the added risk of anabolic steroids and other ergogenic drug use. Some investigators have found higher use of alcohol and other high risk behaviors among those engaged in aggressive contact sports. Currently, schools from many states have initiated drug testing of adolescent athletes using urinalysis. The use of drug surveillance as a deterrent was upheld by the US Supreme Court in 1995 and 1998. However, the acceptability of the technique and its impact on future drug use by adolescents have never been studied. To assess the use of alcohol and other drugs in athletes, (n=1506) male high school football players and adolescent females (n=2085) were surveyed. Results included lifetime use of alcohol (76.2% male, 65.3% female), marijuana (29.4% male, 14.8% female) and amphetamines (8.4% male, 7.8% female). Participants were also surveyed by confidential questionnaire (1299 students from 28 high schools) to determine potential deterrent effects and acceptability of drug testing. Of those surveyed, only a small minority (<9%) said they would use drugs or alcohol (12%) if random drug testing were school policy. Importantly, drug testing received broad student support. Goldberg, L., Elliot, D., Moe, E., Kuehl, K., and Clarke, G. Acceptability and Potential Deterrent Effects of Drug Testing. Medicine and Science in Sports and Exercise, 31(5)S, 1999. Gender Differences in Use of Prescribed Psychotropic Drugs Data from the 1989 National Ambulatory Medical Care Survey (NAMCS) was used to examine gender differences in aggregate psychotropic drug use and use of specific therapeutic categories--anxiolytics, sedative-hypnotics, antidepressants, and antipsychotics. Logistic regression analysis was used to estimate the probability of psychotropic drug use in aggregate. For equations where gender was statistically significant, separate logistic regression equations were estimated to determine the explanatory variables that vary by gender. The probability of receiving any psychotropic drug is 55% greater in office visits by women than by men, all else constant. Further, gender is a positive and significant predictor of anxiolytic and antidepressant use. Variables estimating anxiolytic and antidepressant use that differ by gender include diagnosis, physician specialty, and payment source for the office visit. Findings confirm research that has demonstrated that women are more likely than men to receive anxiolytics and antidepressants in office-based care. In addition, there were significant differences in the predictors of drug use for women and men. Simoni-Wastila, L. Gender and Psychotropic Drug Use. Medical Care 36(1), pp. 88-94, 1998.

Prevalence of Homelessness Among Adolescents in the United States

Homeless adolescents represent one of the nation's most vulnerable groups and are believed to be at high risk for drug abuse. This study, conducted by investigators at Research Triangle Institute, reports the 12-month prevalence of homeless episodes among US adolescents. Interviews were conducted in 1992 and 1993 with a representative household sample of 6496 adolescents aged 12 to 17 as part of the Youth Risk Behavior Survey sponsored by the Centers for Disease Control and Prevention. Respondents reported whether they had spent the night in any of a variety of locations other than home during the previous 12 months. Findings indicate 7.6% of the youths questioned reported that they had spent at least 1 night in a youth or adult shelter (3.3%), public place (2.2%), an abandoned building (1.0%), outside (2.2%), underground (0.4%) or with a stranger (1.1%). Boys were much more likely than girls to report having experienced a homeless episode. This study suggests that homelessness among adolescents is not simply an urban problem and that prevention programs targeting homeless youth should be implemented nationwide. Ringwalt, C., Greene, J., Robertson, M., McPheeters, M. American Journal of Public Health, 88(9), pp. 1325-1329, 1998.

Ethnic and Gender Differences in Drug Use and Resistance

A survey was conducted to measure drug use, drug offers and drug resistance and to compare male and female members of different ethnic groups in seventh grade classes in the Phoenix metropolitan area. The survey was administered to over 4,000 students, with usable data obtained from 3,080. Significant ethnic and gender differences were described in drug use and, more importantly, in the drug offer and resistance process. Results indicate younger adolescents (12-13) do not possess large or sophisticated repertoires of strategies to resist drug offers and most offers come from acquaintances while previous studies report offers come from more intimate relationships for older adolescents. Also illustrated was that ethnicity and gender are related to drug use and how drugs are offered and resisted. This suggests that ethnic and gender specific approaches are needed in prevention curricula and refusal and life skills should be stressed. Moon, D.G., Hecht, M.L., Jackson, K.M., & Spellers, R. Ethnic and Gender Differences and Similarities in Adolescent Drug Use and the Drug Resistance Process. Substance Use and Misuse, 34, pp. 1059-1083, 1999.

Parental Monitoring

The link between parental monitoring and child problem behavior has been established in three areas: substance abuse, anti-social behavior, and safety and injury. This paper reviews the work to date on the construct and accomplishes three goals: first, to provide an empirical rationale for placing parental monitoring of children's activities as a key construct in development and prevention research; second, to stimulate more research on parental monitoring and provide an integrative framework for various research traditions as well as developmental periods of interest; third, to discuss current methodological issues that are developmentally and culturally sensitive and based on sound measurement. Possible intervention and prevention strategies that specifically target parental monitoring are discussed. Dishion, T.J., and McMahon, R.J. Parental Monitoring and the Prevention of Child and Adolescent Problem Behavior: A Conceptual and Empirical Formulation. Clinical Child and Family Psychology Review, 1, pp. 61-75, 1998.

Sexual and Physical Abuse at Home Predicts Suicide Attempts by Homeless Street Youth

A study was conducted to examine the relationship between home life risk factors and suicide attempts among homeless and runaway street youth recruited from both shelters and street locations in Denver, New York City, and San Francisco. Street youth (N=775) age 12-19 years old were recruited in 1992 and 1993 by street outreach staff for interview. Cross-sectional, retrospective data were analyzed to examine the relationship between suicide attempts and antecedent home life variables. Suicide attempts were reported by 48% of the females and 27% of the males, with a mean of 6.2 times for females and 5.1 times for males. Among the females, 70% reported sexual abuse and 35% reported physical abuse; among males, 24% reported sexual abuse and 35% reported physical abuse. Sexual and physical abuse before leaving home were independent predictors of suicide attempts for both females and males. Among street youth in this study who were sexually or physically abused, the odds of attempting suicide were 1.9 to 4.3 times the odds of attempting suicide among those not sexually or physically abused. Interventions attempting to reduce risk behaviors in this population must include assessments of suicidal behaviors as well as components for assisting youth in dealing with the behavioral and emotional sequelae of sexual and physical abuse. Molnar, B.E., Shade, S.B., Kral, A., et al. Suicidal Behavior and Sexual/Physical Abuse Among Street Youth. Child Abuse and Neglect, 22 (3): pp. 213-222, 1998.

Prevention of Drug Use in Adolescent Athletes

To test the ATLAS (Adolescents Training and Learning to Avoid Steroids) program to reduce anabolic steroids (AS) and alcohol and other drugs among adolescent athletes, 31 football teams (n=3207) were assessed in a randomized controlled study. Three successive annual cohorts were entered (1994-1996). Classroom curriculum and exercise training sessions were delivered by peer leaders, facilitated by coaches and strength trainers. The program included sports nutrition and strength training, AS risks and benefits, effects of AS use in sports, drug refusal role play, and creating anti-steroid and health promotion messages. Questionnaires assessing AS use, potential risk and protective factors, and AOD use were administered before and after the intervention and up to one year later. All cohorts were combined for season's end findings and the first 2 cohorts are combined for the 1-year follow-up. At season's end, AS use was more than 50% lower among experimental subjects (p=0.035), with borderline level of significance at 1-year (p= 0.072). When alcohol and the illicit drug use index (marijuana, amphetamines and narcotics) was assessed, experimental students used fewer drugs (p=0.041). Other long-term intervention effects included fewer students reporting drinking and driving (p=0.004), lower supplement use (p=0.009), and better nutrition (p=0.015). Moe, E., Goldberg, L., Elliot, D., MacKinnon, D., and Cheong, J. Reducing Drug Use and Promoting Healthy Behaviors Among Athletes: the ATLAS Program. Medicine and Science in Sports and Exercise, 31(5)S, 1999.

Program Evaluation for Family-based Interventions

This article illustrates a program evaluation approach for the study of family intervention outcomes in general populations. Thirty-three rural schools were randomly assigned to 1 of 3 conditions: The Preparing for the Drug Free Years program (PDFY), the Iowa Strengthening families Program (ISFP), and a minimal-contact control group. Self-report and observational data collected from 523 families were used to develop measurement models of 3 latent parenting constructs that included measurement method effects. Analyses were conducted to ensure initial and attritional-related group equivalencies and to assess school effects. Structural equation models of the hypothesized sequence of direct and indirect effects for both PDFY and ISFP were then fit to the data. All hypothesized effects were significant for both interventions. Spoth, R., Redmond, C., Shin, C. Direct and Indirect Latent-variable Parenting Outcomes of Two Universal Family-focused Preventive Interventions: Extending a Public Health-oriented Research Base. Journal of Consulting and Clinical Psychology, 66(2), pp. 385-399, 1998.

Decreasing Drug Use in High-Risk Populations

Social-influence-based prevention programs can significantly delay the onset of tobacco, alcohol, and other drug use and slow the rate of increase in substance use prevalence among entire populations of early adolescents. Less is known about the capacity of these and other primary prevention programs to effect decreases in substance use. This is an important question since some youth have already begun to experiment with drugs by the time primary prevention programs are offered to them. In a 3.5-year follow-up of data from the Midwestern Prevention Project effects of a primary prevention program were found to decrease drug use among adolescents who were users at either sixth or seventh grade. This research suggests that social-influence-based primary prevention programs can have an impact on students who are users at baseline. The advantage of such a primary program is that it may reach and affect a "silent," not-yet-identified high-risk population of early drug users in a nonstigmatizing, nonlabeling fashion at an age when youth are more easily persuaded. Chou, P.C., et. al. Effects of a Community-Based Prevention Program on Decreasing Drug Use in High-Risk Adolescents. American Journal of Public Health, 88(6), June 1998.

Relation between Intervention Efficacy and Cumulative Family Risk

Family risk-related variations in proximal parent and young adolescent outcomes of a universal family-focused preventive intervention were examined using a cumulative index of risk incorporating sociodemographic characteristics and social-emotional adjustment measures. Results of an initial investigation involving 209 families of young adolescents suggested that intervention efficacy was largely unrelated to cumulative family risk. These findings were replicated with a second sample of 428 families. Spoth et al., Risk Moderation of Parent and Child Outcomes in a Preventive Intervention: A Test and Replication. American Journal of Orthopsychiatry, 68(4), pp. 565-579, 1998.

Assessing Change during Psychotherapy

This article provides an overview of methodological and conceptual issues underlying the assessment of change during psychotherapy with children and families. Three central considerations are discussed: (1) What changes do we measure? (2) When do we measure change? (3) How do we measure change? Measurement of change should be a priority of intervention research and is enhanced by: inclusion of multiple assessment points at theoretically important points during and after the intervention; use of reliable and valid measures of the change process; analysis of mediating, moderating, side effect, and clinical change variables; and protocols that assess dynamic rather than static constructs. Behaviors of interest should be measured in natural environments that are selected for their developmental relevance with regard to the age of the child and the problem behavior. Illustrations of key points are provided from the Adolescent Transitions Program, a theoretically based intervention program targeting high-risk youth. Eddy, J.M., Dishion, T.J., and Stoolmiller, M. The Analysis of Change in Children and Families: Methodological and Conceptual Issues Embedded in Intervention Studies. Journal of Abnormal Child Psychology, 26, pp. 53-69, 1998.

Comparative Perceptions of PSA Delivery

Video is a frequently used media for delivering drug prevention curriculum. Given the stress on identification, realism, and interest in curriculum development, it is important to assess the comparative perceptions of videos versus live performance. A Perception of Performance scale was developed and used to compare the two modalities for delivering drug prevention messages. The scale was developed using data from 334 undergraduate students at a large university in the southwestern United States. The age range was 17-42, median age of 19, 44% were female and 96% were European American. To validate the scale, 465 students in a single high school were randomly assigned to, either live or video performance conditions. 52% were female, 75% non-Hispanic White, 12% Hispanic, and 13% other. Participants viewed either a live performance or a video performance and then immediately completed the Perception of Performance Scale. Exploratory and Confirmatory Factor Analyses were conducted and three dimensions were identified: identification, interest, and realism with reliabilities of .86, .89, and .90 respectively. Live performance was perceived as significantly more interesting and realistic than video performance, suggesting that live performance may be a more effective medium for engaging high school aged youths. Miller, M., Hecht, M., and Stiff, J. An Exploratory Measurement of Engagement with Live and Film Media. Journal of the Illinois Speech and Theatre Association, 49, pp. 69-83, 1998.