Drug Abuse Prevention

Research Findings from September, 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.

Amphetamine, Substance Use and Its Relationship to Depression, Anxiety, and Isolation Among Youth Living With HIV

In a series of three papers, drug use and correlates were examined in youth living with HIV (YLH). Amphetamine use, other HIV-related risk acts, T-cell counts, emotional distress, coping style, and symptoms of HIV were examined in 337 HIV+ youth aged 13 to 24 (20% female; 22% African American, 27% Anglo, 35% Latino) from four cities (LA, NY, San Francisco, and Miami). One third of youth were found to have engaged in amphetamine use in their lifetime, and 21% of youths reported current use (i.e. in the last three months). Compared to non-users, users initiated other drug use at younger ages, used more types of drugs, reported more emotional distress, and employed escape coping significantly more often. Substance use pervaded the lives of these YLH. Among this sample, males had used more drugs, more often, and for longer periods than females. However, there had been major reductions in use. Being male, having high emotional distress, and having fewer negative social supports were significantly associated with greater reductions in substance use. The longer an individual had been diagnosed seropositive tended to be associated with reductions in use (p=.06). Compared to non-users, users also had more sexual partners and more sexual encounters. While users and non-users do not differ on physical symptoms or whether they have been diagnosed with AIDS, users of amphetamines report significantly higher T-cell counts than non-users. Despite poor psychosocial functioning, amphetamine users were found to have higher T-cell counts than other YLH. The continued high-risk profile of transmission acts among users suggests that preventive interventions must target specific drugs used by YLH. As the number of youths infected with HIV rises, secondary prevention programs are needed to help youths living with HIV meet three goals: 1) increase self-care behaviors, medical adherence, and health-related interactions; 2) reduce transmission acts; and 3) enhance their quality of life. Based on modifications of the social action model, a small group intervention was developed and tested in this population. Rotheram-Borus, M.J., Mann, T., and Chabon, B. Amphetamine Use Among Youths Living with HIV. AIDS Education and Prevention, In Press; Rotheram-Borus, M.J., Murphy, D.A., Swendeman, D., Chao, B., Chabon, B., Zhou, S., and Birnbaum, J. Substance Use and its Relationship to Depression, Anxiety, and Isolation Among Youth Living with HIV. International Journal of Behavioral Medicine, In Press; Rotheram-Borus, M.J., and Miller, S. Secondary Prevention for Youths Living with HIV. AIDS Care, 10(1), pp. 17-34. 1998.

Age of First Use: Its Reliability and Predictive Utility

In a study of the early-onset issue, researchers at Rutgers University posed three questions: (1) Is age of first licit use a predictor of differences in alcohol and drug use intensity during the period (age 20) when normative patterns of use reach a peak?, (2) Is age of first licit use a predictor of differences in use intensity in young adulthood (age 30) when most individuals have moderated their use? and (3) How consistent are adolescents in retrospectively recalling age of first use? Subjects (N=839) from the Rutgers Health and Human Development Project provided four waves of longitudinal data spanning the age range from 15 to 31. The vast majority of adolescents exhibited a sequential pattern of drug use initiation consistent with that found in previous studies. Retrospective recall of age of onset revealed a fair degree of relative agreement but a lack of absolute agreement; that is, as adolescents became older, recalled ages on onset exhibited an upward shift approximately equal across most individuals. Age of first licit use as recalled at age 18 did not predict differences in alcohol or drug use intensity at age 20. Age of first illicit use was a fairly strong predictor of drug use at 20 but a weak predictor of alcohol use at that age. Age of first licit use and age of first illicit use did not predict difference in useor use consequences at age 30. Regardless of age of onset, illicit drug use and heavier alcohol use constitute an adolescence-limited phenomenon for most individuals. The findings suggest that intervention efforts need to be aimed not only at delaying the onset of illicit use in adolescence but also at reducing use levels among young adult users by facilitating the maturing out process. Labouvie, E., Bates, M. E., and Pandina, R. J. Age of First Use: Its Reliability and Predictive Utility. Journal of Studies on Alcohol, 58(6), pp. 638-643, 1997.

Heavy Caffeine Use and the Beginning of the Substance Use Onset Process: An Illustration of Latent Transition Analysis

This chapter has two objectives, the introduction of a relatively new methodology, latent transition analysis (LTA) and the demonstration of its usefulness in alcohol prevention research. LTA is an extension of latent class theory that allows the user to estimate and test models of stage-sequential development. Researchers may be more accustomed to thinking in terms of strictly quantitative development, in which change can be characterized by increases and decreases in a particular variable, such as test scores, self-esteem, or amount of alcohol consumed per week. Stage-sequential development is distinguished from quantitative development by the involvement of qualitatively different stages. Individuals develop by passing through these stages. In this study, LTA was used to investigate whether heavy use of caffeine would be a predictor in the early part of the substance use onset process. Heavy use of caffeine was defined in several different ways, in terms of both coffee and cola soft drinks. By all the definitions of heavy caffeine use, those in the high-caffeine-risk latent class were more likely to have initiated the substance use onset process by seventh grade, and those who had not initiated by seventh grade were more likely to do so by eighth grade. The increased risk of onset related to caffeine use was greater for coffee than for cola. For coffee, the probability of onset was greater for the more extreme definitions of caffeine risk. The level of caffeine consumption required to elevate risk was surprisingly low. Increased risk was found for as little caffeine consumption as 6 cups of coffee in one's lifetime and 6 cola drinks in the past week. The results replicated well and consistently across two cross-validation subsamples. In K. Bryant, M. Windle, and S.West (Eds.), The Science of Prevention: Methodological Advances from Alcohol and Substance Abuse Research (pp. 79-99). Washington, DC: American Psychological Association, 1998.

Problem and Conventional Behaviors Among American Indian Adolescents

Investigators from the National Center for American Indian and Alaska Native Mental Health Research at the University of Colorado Health Sciences Center report two related factor analytic studies that take Problem-Behavior Theory as a starting point. They examined the latent structure of problem and positive behaviors in a sample of 1894 American Indian adolescents (n=1894 in the first study and 2250 in the second study) and found a 2-factor 2nd-order structure in which problem behaviors (alcohol use, drug use, antisocial behavior, risky sexual behavior) and positive behaviors (school success, cultural activities, competencies, community-mindedness) represented two relatively uncorrelated aspects of behavior. The positive behaviors construct contributed significant incremental construct validity in the prediction of psychosocial outcomes (e.g., depression, competencies), relative to the problem behavior construct alone. Factor structures differed across gender primarily for alcohol use and school success. The second-order alcohol use factor was more closely related to "problem drinking" for girls, but for boys it was more closely related to "negative consequences following drinking". "Doing schoolwork carefully" was more closely related to school success for girls than for boys, reflecting others' reports that girls tend to attribute their successes in school to their own hard work whereas boys tend to attribute their school successes to greater intellectual ability. Across four sampled communities, the structures differed only slightly, suggesting commonalities on such dimensions as positive behaviors, possibly from consistent messages adolescents receive about appropriate ways to act. Results highlight the need to include a focus on positive behaviors in prevention/promotion activities, and community members need to understand not only how to circumvent the processes that result in maladaptive outcomes but also how to promote the development of successful adolescents. Mitchell, C.M., and Beals, J. The Structure of Problem and Positive Behavior Among American Indian Adolescents: Gender and Community Differences. American Journal of Community Psychology, 25, pp. 257-288, 1997; and Mitchell, C.M. and O'Nell, T.D. Problem and Conventional Behaviors Among American Indian Adolescents: Structure and Validity. Journal of Research on Adolescence, 8, pp. 97-122, 1997.

Affectivity and Impulsivity: Temperament Risk for Adolescent Alcohol Involvement

Researchers at Arizona State University studied the joint effects of impulsivity, positive affectivity, and negative affectivity on adolescent alcohol use and alcohol-related impairment. Participants were 427 adolescents (aged 12-18, mean age=14.6) from the third wave of an ongoing study of adolescent children of alcoholics and demographically matched controls. Data were gathered using in-person interviews with adolescents and their parents. Results showed that impulsivity moderated the effects of positive affectivity on both alcohol use and alcohol-related impairment. Impulsive adolescents who were also characterized by low levels of positive affectivity showed higher alcohol involvement and more alcohol-related impairment than did either impulsive adolescents with high levels of positive affectivity or non-impulsive adolescents. These results suggest that multiple dimensions of temperament (and their interaction) must be taken into account in trying to predict alcohol involvement, and that positive affectivity is important above and beyond negative affectivity. Practically, the results suggest that positive affectivity is a potentially important target for intervention programs. Although intervention programs often focus on teaching adolescents how to cope with negative affect, less attention has been paid to interventions that increase positive affect, and strategies that target positive affect may be helpful additions to prevention programs. Colder, C.R., and Chassin, L. Psychology of Addictive Behaviors, 11, pp. 83-97, 1997.

Drug Use and Parenting in Adolescence

This project at the University of Washington conducted longitudinal analyses of 241 adolescent mothers' use of 3 substances -- marijuana, alcohol and tobacco -- from the time of pregnancy through 1 year post-partum. Variables measured for each substance included use, verified with urinalysis; intentions to use; attitudes and perceived norms about using; and specific outcome and normative expectations about use of each substance. Substance use increased dramatically from pregnancy to 6 months post-partum, leveling off between 6 and 12 months post-partum. Consistent with the Theory of Reasoned Action model, as substance use increased after pregnancy, so did intentions to use, favorable attitudes toward use, perceived norms regarding use, and beliefs favorable to use. Changes in specific outcome and normative beliefs were observed and that, over time, the young mothers saw bad outcomes of using substances (such as negative effects on their health) as less likely, and positive outcomes (such as helping them to forget their problems) as more likely. They also perceived less disapproval from their families, friends, and doctors after their babies were born. These findings suggest that young mothers are heeding warnings about the danger to their babies of using substances during pregnancy, but are less convinced that substance use has negative effects on parenting or on their own health. The contrast between the abundance of messages warning about substance use during pregnancy and the very few messages aimed at reduce substance use among parents may unwittingly reinforce a notion that substance use is not very harmful when one is not pregnant. A promising intervention approach for young mothers may be to capitalize on their concerns for their babies' health. Morrison, D.M., Spencer, M.S., and Gillmore, M.R. J. Res. Adoles., 8, pp. 69-95, 1998.

Social Context Predictors of Adolescent Substance Use Development

This study examined the form of growth in alcohol, cigarette, and marijuana use among adolescents and covariates influencing this growth. Participants were 664 male and female adolescents (ages 14 to 17 years) assessed at three time points. A common trajectory existed across the developmental period with significant increases in all three substances. Second-order multivariate extensions of the basic latent growth modeling framework indicated that associations among the individual differences parameters representing growth in the various substance use behaviors, could be adequately modeled by a higher-order substance use construct. Inept parental monitoring, parent-child conflict, peer deviance, academic failure, gender, and age, were significant predictors of initial levels and the trajectory of substance use. Results indicate considerable similarity in the development of alcohol, cigarettes and marijuana during adolescence, and suggest that it may be possible to reduce the upward trajectory of adolescent substance use if we improve the prevalence of effective parental monitoring, reduce parent-child conflict and associations with deviant peers, and increase academic success. Duncan, S.C., Duncan, T.E., Biglan, A., and Ary, D.V. Contributions of the Social Context to the Development of Adolescent Substance Use: A Multivariate Latent Growth Modeling Approach. Drug and Alcohol Dependence, 50, pp. 57-71, 1998.

Raising Healthy Children

In 1993, ten schools were randomly assigned to program or control conditions resulting in a sample of 562 program and 478 control first and second grade students. Students are currently in grades 5 and 6. Teachers, parents and students have been surveyed annually, teachers are observed twice a year, and school records are collected. The intervention includes teacher staff development, parenting workshops, and individual work with students. After 1.5 years of the intervention, teacher reports indicated academic and behavioral improvements for children in the experimental condition. Recent analyses focused on students in the top tertiles on antisocial behavior and depression. High anti-social students demonstrated higher academic achievement compared with their control group counterparts. Among the depressed children, those in the experimental group maintained their baseline level of social competence, whereas those in the control group decreased. Analyses focused on the hypothesized processes of development revealed significant prediction of family attachment (in year 3) from earlier protective processes (involvement, opportunities, and rewards) and child social, emotional and cognitive skills. Additional analyses examined the long-term effects of parental transitions and family stress on the development of anti-social behavior in children. Results suggest that family bonding partially mediates the effects of parental transitions on antisocial behavior. Haggerty, K.P., Catalano, R.F., Harachi, T.W., and Abbott, R.D. Criminology, 31(1), pp. 25-48, 1998.

Beliefs About Substance Use Among Pregnant and Parenting Adolescents

Substance use among pregnant and parenting adolescents has health implications for both mother and baby. Utilizing the Theory of Reasoned Action, a social psychological model, this research investigates the cognitive structure underlying substance use, based on longitudinal analyses of data from 3 waves of interviews with a cohort of young mothers who were 17 years old or younger during pregnancy. Use of cigarettes, alcohol, and marijuana were lowest during pregnancy, increased sharply at 6 months postpartum, and remained level at 12 months postpartum. Changes in intentions, attitudes, perceived social norms, outcome beliefs, and normative beliefs followed the same pattern. The content of changing beliefs about substance use is examined and implications for substance use interventions among postpartum adolescent mothers is discussed. Morrison, D., Spencer, M., and Gillmore, M. J. Res. Adoles., 8(1), pp. 69-95, 1998.

An Ecological Model for School-Based Mental Health Services for Urban Low-Income Aggressive Children

An ecological model for school-based mental health services that targets urban low-income aggressive children--a highly vulnerable and underserved population--is presented. The goals of the model are to increase children's and teachers' involvement in the delivery of services and to increase the integration of these services into existing school resources and activities. The model proposes that mental health service providers work in collaboration with teachers to deliver services that (1) can be managed by existing school resources and personnel, (2) are related to empirically based factors associated with reduced aggression and increased social functioning, and (3) are group administered to increase the number of children served and to reduce stigmatization associated with mental health services. The model is individualized and flexible by acknowledging that contexts for aggression differ across classrooms and children by providing services specific to those contexts. Two studies are presented illustrating the application of this model to decrease aggression and increase academic engagement in low-income urban public schools. Atkins, M.S., McKay, M.M., Arvantis, P., London, L., Madison, S., Costigan, C., Haney, P., Zevenbergen, A., Hess, H., Bennett, D., and Webster, D. The J. of Behav. Health Serv. & Res., 5(1), pp. 64-75, 1998.

Information Exposure

A theoretical model of attention to messages has been used to guide an extensive series of laboratory and field experiments involving the mass media and, more recently classroom instruction and health interventions. The model draws on individual differences in need for novelty as a basis both for identifying target audiences most likely to engage in a number of health risk behaviors, such as drug and alcohol abuse and risky sex, and as a guide for designing messages to attract and hold the attention of some individuals who make up the prime target audience for many campaigns. These strategies have been successful in bringing about changes in attitudes and behavioral intentions in experimental studies and in reaching at-risk audience segments in field studies through novel televised public service announcements placed in appropriate television programming. Donohew, L.R., Lorch, E.P., and Palmgreen, P. Applications of a Theoretical Model of Information Exposure to Health Interventions. Health Communication Research, 24(3), pp. 454-468, 1998.