WEDNESDAY, MAY 25, 2005
WEDNESDAY, MAY 25, 2005
7:00 AM – 5:00 PM
7:00 AM – 8:30 AM
7:15 AM – 8:25 AM
NIH/NIMH RESEARCH GRANT OPPORTUNITIES (pick up breakfast)
Chair: Peter Mueher, NIMH
This roundtable will provide an opportunity for interested SPR investigators to obtain information about NIMH research grant opportunities and pre-application technical assistance in the prevention of mental disorders across the lifespan. Especially encouraged is research on potent, modifiable risk and protective processes that will inform the development of preventive interventions aimed at mental disorders, symptoms, and related disability. Grant mechanisms support research at all stages of a research career, from pre- and post-doctoral fellowships to early-, mid-, and senior-level Career Awards that provide salary support for full-time research (at least 75% effort). Small Grants (RO3s, two years of support at up to $50,000 direct costs per year) and Exploratory/Developmental Grants (R34s, three years, up to $450,000 direct costs over three years) are available for pilot research and the development of intervention protocols. Regular Research Grants (RO1s) provide support for up to five years at funding levels commensurate with the science proposed.
SPR/NIDA INTERNS ORIENTATION
Chair: Tracy Harachi
8:30 AM – 10:15 AM
PLENARY SESSION 1
TRANSLATING PREVENTION SCIENCE TO DIVERSE SETTINGS AND OUTCOMES
Chair: Mary Jane Rotheram
TRANSLATING PREVENTION SCIENCE TO DIVERSE SETTINGS AND OUTCOMES., J. David Hawkins1, Cheryl Perry2, Leslie Lytle2, 1Social Development Research Group at University of Washington, Seattle, WA United States; 2University of Minnesota, Minneapolis, MN United States
There has been much progress in the development and testing of efficacious preventive interventions for health and behavior problems such as adolescent alcohol, tobacco and drug use. This plenary presents efforts to translate the results from these trials to broader populations and settings and explores how prevention science approaches are being applied to another youth related outcome, obesity. A roundtable discussion session will follow the plenary to allow audience participation.
Dr. J. David Hawkins: Prevention scientists have identified efficacious and effective policies and programs for preventing adolescent health and behavior problems. The Communities That Care operating system mobilizes communities to choose and implement tested prevention approaches matched to community need. This presentation describes a randomized controlled trial of Communities That Care in 24 communities across seven states co-funded by five federal institutes and centers.
Dr. Cheryl Perry: There are considerable challenges in designing and implementing a randomized control trial (RCT) in a developing country. MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) aims to reduce the onset and prevalence of tobacco use among 6th-9th grade students (n=12,484) in 32 schools in Delhi and Chennai, India, based on prior effective prevention programs and practices in the U.S. and India. In this talk, the process of “translation research,” of bridging the differences between evidence-based programs and community needs, in the context of the MYTRI RCT will be discussed, with emphasis on the steps taken to assure that the intervention program is culturally-appropriate and scientifically rigorous.
Dr. Leslie Lytle: Preventing Childhood Obesity: Issues and Challenges is a brief overview and etiology of the obesity epidemic in youth. Dr. Lytle will discuss the state of the science of obesity prevention intervention research in youth and some unique challenges in studying obesity prevention.
10:15 AM – 10:30 AM
10:30 AM – 12:00 AM
CONCURRENT SESSIONS 1 - 10
CONCURRENT 1, PLENARY ROUNDTABLE
Chair: Mary Jane Rotheram
TRANSLATING PREVENTION SCIENCE TO DIVERSE SETTINGS AND OUTCOMES, Plenary Roundtable Discussion. J. David Hawkins, Cheryl Perry, Leslie Lytle
CONCURRENT 2, ECPN SYMPOSIA
Chairs: Celene Domitrovich and David Wyrick
Irwin Sandler, Arizona State University, C. Hendricks Brown, Florida and Brian Flay, University of Illinois-Chicago
Dr. Irwin Sandler will present on integrating theory and preventive intervention research under sub-optimal conditions. While the prevention research cycle presents an idealized model of how ideally theory and preventive intervention research build on and reinforce each other, often sub-optimal real world conditions make it difficult to follow this idealized model. Dr. Sandler will present examples from his own career of integrating theory and intervention research under three sub-optimal conditions; a) when there is little theory underlying an existing program, b) when there are limited resources to test the program or the theory, and c) when there is a lack of theory and no program, but you have funds to make the situation better!
Dr. C. Hendricks Brown will discuss how successful prevention research requires the effective integration of theory and methods; in this part of the presentation he will present useful
models for how a research team, including scientists, practitioners, and methodologists, can best elicit and communicate theoretical principles, and use theory to drive the design and analysis. Dr. Brown will present a number of examples from the point of view of a methodologist, of how to collaborate effectively with others. These steps will be illustrated in reference to a course on biostatistical consultation and collaboration that he teaches at the University of South Florida.
Dr. Brian Flay: Most effective preventive interventions are based on one or more theories of a) the development of the behavior of concern and b) how to change the behavior. Given the commonality of causes of multiple problem behaviors, an integrated theory would seem to be useful. Brian Flay will present on the development of his integrated model, the Theory of Triadic Influence (TTI), and how he has applied it to the development of an intervention that addresses multiple problem behavior among high-risk inner-city youth.
CONCURRENT 3, CULTURAL SENSITIVITY, Poster Forum
OVERCOMING HEALTH DISPARITIES AND CHRONIC ILLNESS IN AFRICAN AMERICANS
Chair: Suzanne Boyd
OVERCOMING HEALTH DISPARITIES AND CHRONIC ILLNESS IN AFRICAN AMERICANS:. A. Suzanne Boyd1, 1University of North Carolina at Charlotte, Charlotte, NC United States
This Symposium examines the health disparities and chronic illness experienced by African Americans across the prevention spectrum and discusses culturally appropriate ways to promote well-being in this population using an interdisciplinary approach. This symposium focuses on African Americans with breast cancer, prostate cancer or mental health disorders. The first poster will present a conceptual framework for studying health and chronic illness. The second poster reports the results of an empirical study on the complex relationships between household income and assets and health care access and treatment, particularly among African American households, and highlights the lack of attention this topic has received in the literature. Given that income and asset building opportunities and adequate medical care continue to elude millions of low-income African Americans, identifying and addressing these inequities is warranted. Two posters will focus on the treatment of chronic illness in African Americans. The third poster examines the use of self-help groups for chronic disease, both physical and mental health, by African Americans. A typology of African American self-help groups is also offered. The fourth poster reports the results of an investigation to explore the interactive effects of race and socioeconomic status in explaining the disparities of prostate cancer among various minority groups. The findings of this study can provide insights to targeting at-risk groups for preventive care and treatment. The fifth and last poster in this series focuses on tertiary prevention and suggests culturally appropriate ways to promote sexual and interpersonal rehabilitation after breast cancer treatment. Collectively, these posters suggest culturally appropriate ways to promote well-being for African Americans with chronic illness. This poster symposium is one way to promote educational outreach through an interdisciplinary perspective. Each poster provides a critical linkage to the conceptual framework and tenants of the three levels of prevention that, taken together, can reduce health disparities in the African American population.
OVERCOMING: AFRICAN AMERICAN WOMEN, BREAST CANCER AND SEXUALITY. Margaret Wilmoth1, Lonnie Sanders1, 1University of North Carolina at Charlotte, Charlotte, NC United States
Purpose: Little is known about the impact breast cancer treatments have on the sexuality of African American women. Research on how women manage alterations in sexuality after breast cancer comes from studies composed primarily of Caucasian American women. The purpose of this study was to describe alterations in sexuality caused by breast cancer treatment grounded in the experiences of African American women.
Design: Qualitative descriptive using the grounded theory method as described by Glaser and Strauss.
Methods: Fifteen African American female survivors of breast cancer with an average age 60 (range 41-80) had been interviewed when data saturation was reached. Eight were more than 5 years post-diagnosis; 9 had had a mastectomy and 6 had a lumpectomy and all had received adjuvant therapy. Half were married and all were high school graduates. One-on-one interviews were conducted after Informed Consent was obtained. All interviews were audiotaped and transcribed for analysis. Constant comparative analysis after each interview led to modifications of interview questions. Interviews were analyzed line by line for identification of in- vivo codes then moved to thematic analysis and ultimately to the identification of a theory grounded in the experiences of African American women with breast cancer as they adjusted to an altered body image and changes in intimacy and sexuality.
Findings: The Core Process of Overcoming was grounded in participants´ Belief in a Higher Power, Social Support and Physician Information. Breast cancer was viewed as another obstacle to Overcome by dealing with physical scarring, working at being sexually spontaneous, working at living not giving up to death, “shooing away” bad relationships, and knowing that “changes in me didn´t change me”. This process was facilitated when there was positive couple communication. The outcome of Overcoming was the need to tell others to “Save a Breast and Save a Life” by getting mammograms.
Conclusions/Implications: In contrast with research with Caucasian women, African American women appear to have a spiritual base that helps them deal with the diagnosis of breast cancer. They also tended to rid themselves of relationships that took energy away from their focus on healing, while still maintaining their sexuality. The women in this study were more motivated than previously interviewed Caucasian women to become involved with advocacy for early detection and in encouraging other women that mammograms can help them find cancer early.
HOUSEHOLD ECONOMIC RESOURCES AND HEALTH DISPARITIES AMONG AFRICAN AMERICANS. Marcia Shobe1, 1University of North Carolina at Charlotte, Charlotte, NC United States
The US has one of the highest rates of income inequality in the world and lags behind other developed countries on many health indicators. Low-income groups are more likely to experience higher risk factors in health, such as obesity and smoking; have less access to health care and health insurance; and hold jobs in unhealthful environments than higher-income individuals. African Americans tend to experience more income inequalities than whites, thereby increasing their health risks.
Preliminary findings from the US and overseas indicate that household assets are also associated with health outcomes. More specifically, assets are negatively associated with smoking, lung cancer, and nursing home admissions, and positively associated with overall health for both genders. Asset inequities by race parallel income disparities, with the median net worth of white and African American households totaling $22,566 and $1166 respectively.
Despite gains in medical coverage for the poor, over 43 million individuals are uninsured. While Medicaid benefits help offset health care costs for many, racial inequities remain. For example, approximately 44% of whites versus 25% of African Americans received benefits in 2003. Turning to gender, African American women are more likely to be uninsured than white women, with corresponding rates of 23% and 13% respectively.
Inadequate health care access and treatment have important household and public consequences. Health care costs comprise enormous expenses for economically vulnerable households and often occur with little or no warning. The financial effects of illness contributed to almost 500,000 of all personal bankruptcies filed in the US in 2000. In addition, federal, state, and local governments reimburse more than $30 billion each year to hospitals and clinics to cover health care expenses for the uninsured.
Empirical study on the complex relationships between household income and assets and health care access and treatment, particularly among African American households, has not yet received the attention it needs. The importance of carefully describing and mapping that complexity cannot be overstated. Given that income and asset building opportunities and adequate medical care continue to elude millions of low-income African Americans, identifying and addressing these inequities is warranted. Further, we must develop equitable economic and health care policy initiatives that help “level the playing field” for low-income African Americans. This paper is a first step in identifying the inequities in household economic resources and health outcomes by race.
THE INTERACTIVE EFFECTS OF DEMOGRAPHIC AND RACIAL/ETHNIC FACTORS ON PROSTATE CANCER OUTCOMES: IMPLICATIONS FOR PREVENTION AND TREATMENT PROGRAMS.. Lutchmie Narine1, 1University of North Carolina at Charlotte, Charlotte, NC United States
Background: Extant research has noted that the prevalence of prostate cancer are higher among African Americans than European Americans. However, few studies have gone beyond mean differences between the two groups to explore the role of confounding demographic characteristics such as race/ethnicity and socioeconomic status. Researchers have postulated that the differences among these groups would not exist when other factors such as socioeconomic status are controlled for in the analysis. Another shortcoming of the literature has been the limited attention given to other minority groups such as Hispanics, Asians, and American Indians. Therefore, the purpose of this investigation is to explore the interactive effects of race and socioeconomic status in explaining the disparities of prostrate cancer among various minority groups. The findings of this study can provide insights to targeting at-risk groups for preventive care and treatment.
Methods: Data from the Surveillance, Epidemiology and End Results (SEER) Program from 11 registries across the United States were used in this investigation. The role of demographic characteristics such as race, age, marital status, and SES variables on treatment and survival outcomes was assessed. Treatment outcomes included the nature of radiation and radical prostatectomy care received. Statistical methods used in the study included logistic regression and mixed model analytic techniques.
Findings: Results indicated significant differences on treatment and survival outcomes along racial/ethnic categories. However when demographic and SES characteristics were included in the analysis, the earlier race/ethnic effects were no longer apparent. Findings suggest that higher SES groups irrespective of their racial and ethnic affiliations were more likely to survive and receive treatment for prostrate cancer.
Conclusion: This study sought to clarify the interactive effects of race/ethnic and SES variables on treatment and survival rates among prostate cancer patients (particularly various minority groups). The inclusion of SES variables provides empirical evidence for the confounding effects of SES and race/ethnic factors, and the importance of taking into account the complex interaction of these variables in the development of prevention and treatment programs.
AFRICAN AMERICANS AND SELF-HELP GROUPS: EMPOWERMENT AS A WAY TO PROMOTE WELL-BEING. A. Suzanne Boyd1, Margaret C. Wilmoth1, 1University of North Carolina at Charlotte, Charlotte, NC United States
Research examining the help-seeking patterns of African Americans diagnosed with chronic disease, both physical and mental health, is gaining more attention in the literature. Often, African Americans diagnosed with chronic disease prefer to obtain support from within their own cultural group, seeking out culturally-based alternatives, such as self-help groups. There is little information in the literature about African American involvement in self-help groups. Though the concept of empowerment in the African American community is reported in the literature, little information about the perceived empowerment experienced from participating in self-help groups as a way to promote well-being is available. This poster will highlight culturally-appropriate examples of self-help models in the African American community for mental health consumers and cancer survivors to illustrate current modes of self-help seeking behavior within the African American community. The evolution of self-help in the African American community will be reviewed, focusing on the black church and fraternal organizations, and a typology of African American self-help groups will be presented. Implications for social work and nursing practice will be presented.
A FRAMEWORK TO EXAMINE HEALTH DISPARITIES ACROSS THE PREVENTION SPECTRUM. Margaret C. Wilmoth1, A. Suzanne Boyd1, 1University of North Carolina at Charlotte, Charlotte, NC United States
This poster will present a framework to examine health disparities across the prevention spectrum from an interdisciplinary perspective. The concepts of Self-efficacy and Empowerment provide an overarching framework for discussing various aspects of prevention within the African American (AA) community. Self-efficacy is the belief that one can carry out a behavior necessary to reach a desired goal or achieve an expected outcome and is a key cognitive personal factor that shapes behavior. Self-efficacy is an important construct when examining the success with which people manage chronic illness, including breast cancer, prostate cancer, and mental health disorders. Empowerment is defined as "the ability of individuals to exert some degree of control over their destiny” (Long, 1993, p.10). Empowerment can be conceptualized as a continuum across the community (macro level) to the individual (micro) level. For example, recent work suggests that African American women´s mental well-being is largely shaped by their social structure position within society (race, gender and class). The interaction between interpersonal personal factors, behavior and the external environment assists in examining health disparities in prevention, treatment, and rehabilitation of breast and prostate cancer in this population. Self-efficacy has been used in African American community outreach projects to increase early detection of breast cancer (e.g. The Witness Project). In addition, patient education about treatment side effects empowers individuals to have the self-confidence to manage their symptoms. Self-help groups for chronic disease management are an example of using self-efficacy and empowerment concepts in tertiary prevention. This framework suggests culturally appropriate ways to promote well-being in the African American population with chronic illness, historically faced by disadvantage
CONCURRENT 4, EPIDEMIOLOGY, Organized Symposia
POPULATION-BASED INQUIRY: METHODOLOGY TO INFORM LOCAL PREVENTION & INTERVENTION
Chair: John W. Fantuzzo
POPULATION-BASED INQUIRY: METHODOLOGY TO INFORM LOCAL PREVENTION & INTERVENTION. John W. Fantuzzo1, 1University of Pennsylvania, Philadelphia, PA United States
Recent national reports have emphasized the importance of the early childhood years for children's healthy growth and development. These reports identify populations of children exposed to significant early risk factors, such as poverty and family violence, who are less likely to develop social, emotional, and academic competencies. Though many of these risks occur in only a small percentage of the population, they have significant and far-reaching consequences throughout the lifespan. These findings have pushed lawmakers to pursue stricter mandates for early identification to inform appropriate prevention and intervention for vulnerable groups.
In response to these mandates, local government agencies are accountable to meet the complex, multidimensional needs of children and families. While national research studies have the capacity to provide broad information to inform agency practices, local prevention and intervention services need to take a closer look at specific population needs. Administrative data collected by local agencies can serve this need. These data provide on-going, updated information regarding the people they serve, the frequency and duration of services, and in some cases, outcomes. Though not designed with research in mind, these databases represent an extraordinary, population-based source of information.
The use of administrative data for population-based inquiry is an underutilized research tool that can be used to examine the specific well-being needs of local communities. Population-based research permits detailed exploration of low prevalence events that would not have been detected by representative sampling. For clients served by multiple agencies, the integration of administrative data can permit professionals to understand subpopulations of people served in a given agency, to examine the extent of cross-system service utilization, and to coordinate services across agencies to maximize benefits and resources.
This symposium consists of three studies that have used population-based research to examine the well-being needs of three distinct populations of children. The first study explored the prevalence of and relationship between risk factors, protective factors, and early school success for an entire cohort of children entering public school kindergarten in a large, low-income school district. The second study examined the prevalence and nature of children´s exposure to domestic violence using direct assessments conducted for all reported domestic violence events across an entire municipality. The final study evaluated the relationship between out-of-home placement histories and children´s early educational well-being across an entire kindergarten cohort in a large school district.
RISK, PROTECTION, AND SCHOOL SUCCESS: A POPULATION-BASED STUDY OF URBAN KINDERGARTENERS. Heather Cohen1, John W. Fantuzzo1, Yumiko Sekino1, 1University of Pennsylvania, Philadelphia, PA United States
National recognition of the current crisis in American public education has highlighted the significance of early childhood development. Research findings underscore the importance of early experiences on brain development and emergent competencies, and the significant threat posed by social and economic conditions under which families with young children are living (e.g. increased number of working parents, economic hardship, and adverse community conditions). In response, public education systems need to understand the children they are serving, including identified risk and protective factors evident prior to school entry.
Researchers, educators, and social service providers within the City of Philadelphia have responded to this need through the building of an integrated, cross-agency database – the Kids Integrated Data System (KIDS). KIDS contains all administrative information collected throughout the municipality, including physical and behavioral health, Department of Human Services, emergency shelter, and public school outcomes. This data system provides a unique opportunity to explore risk & protective factors for entire populations of children entering public school.
The purpose of this paper was to utilize KIDS to evaluate the differential impact of early learning experiences in the presence of known risk factors. It was a population-based study of children´s entire birth to age 8 histories of risk and protective factors. The primary sample was 7000 children geographically and demographically representative of one entire kindergarten cohort. There were three primary research questions. First, what is the prevalence of early care and educational experiences and early risk factors for children entering kindergarten? What is the relationship between early risk factors and academic and social adjustment in elementary school? And, what protective influence do early care and educational experiences have, in light of risk factors, on early school outcomes? Multiple linear regression and multiple logistic regression analyses explored relationships between these variables, and the probability of school success in the presence of risk and protective factors.
This utilization of population-based, administrative data across multiple municipal agencies allowed researchers to identify specific risk and protective factors facing children in a large, urban public school. Implications of the findings include within agency recommendations (i.e. how public schools can use this information to inform educational services), as well as the promotion of inter-agency collaboration to enhance prevention and intervention efforts from multiple perspectives to support young children and families.
THE PREVALENCE AND NATURE OF CHILDREN'S EXPOSURE TO DOMESTIC VIOLENCE. Rachel Fusco1, John Fantuzzo1, Marlo Perry1, 1University of Pennsylvania, Philadelphia, PA United States
Violence against women by intimate partners, and childhood exposure to such violence, is of epidemic numbers. Given the magnitude of the problem, there is growing awareness that the potential consequences for children in violent homes are severe and long-term. Research to date indicates that children exposed to domestic violence are at greater risk for social, cognitive, and academic maladjustment. However, close inspection of the current research shows that it is inadequate to inform policies and services, due many gaps and flaws in methodology. The present study involved collaboration with law enforcement to collect substantiated data on domestic violence when officers respond to the scene. As front line public health sentinels, law enforcement officials are in a unique position to provide direct assessment of domestic violence events. In the current study, all domestic violence events across an entire municipality were examined to determine the prevalence and nature of children´s exposure to domestic violence. This paper will report findings from child-level data collected from police officers responding to domestic violence events. The Domestic Violence Event Protocol – Child Enhanced (DVEP-C) was created to collect information about children´s gender, age, ethnicity, relationship to victim, and their sensory experience of the event. After extensive officer training and the establishment of reliability, DVEP-C was piloted across the entire county. Across the year approximately 1700 domestic violence cases were reported. Children were present in almost half of these cases. These data will be examined to answer three research questions. First, what are the descriptive characteristics (age, sex, race, relationship to victim) of children exposed to domestic violence? Second, what is the nature and level of children´s sensory exposure (e.g. visual, auditory, direct involvement, etc.) to this violence? Third, what are the different types of domestic violence events to which children are being exposed? Families affected by domestic violence often face multiple risks, including child abuse, poverty, and substance abuse. Many organizations that serve these families, including child welfare, education, and mental health agencies, lack the tools and training programs to guide and inform effective service provision. Scientifically credible information concerning domestic violence and children´s exposure is needed. The present research provides reliable and valid population-based data about the prevalence and nature of children´s exposure to domestic violence and offers policy makers and practitioners valuable information to inform prevention and intervention efforts.
EDUCATIONAL WELL-BEING OF YOUNG CHILDREN IN FOSTER CARE. Staci Perlman1, John Fantuzzo1, 1University of Pennsylvania, Philadelphia, PA United States
Research demonstrates that children with foster care placement histories do not fare as well as their peers academically. A recent national report indicated that 290,000 children entered foster care in Fiscal Year 2001, and of these children 38% were under the age of five. A handful of studies have examined the relationship between foster care placement and educational well-being, however most of these studies have used small samples of convenience and focused on school-aged children. This paper presents findings from a population-based study that examined the relationship between foster care placement history and school adjustment. The present study is a population-based inquiry of an entire cohort of kindergarten children (>13,000) attending public school in the northeast. The purpose of this study was to assess the relative risk for poor school adjustment of young children with foster care placement histories. Independent and dependent variables were measured using the Kids Integrated Data System (KIDS). This system represents a collaboration between the University of Pennsylvania and the participating municipality and provides integrated administrative records across relevant departments. This study integrated data from the School District and Department of Human Services, including the following data elements: age, ethnicity, neighborhood level variables, kindergarten performance assessments, early childhood experiences, and foster care placement history. There were three primary research questions. One, what is the descriptive picture of children entering kindergarten with foster care placement histories? Two, what is the unique risk of foster care placement histories for poor school performance? Three, to what extent do early childhood educational experiences serve as a protective factor for young children with foster care placement histories? Multiple logistic regression analyses were used to address questions two and three. Statistical models explored the relationships between these foster care placement history and early childhood educational experiences, and the probability of school success, controlling for demographic and neighborhood level risk factors. This population-based study permitted a detailed examination of the relationship between foster care histories and early school adjustment. Implications of the study findings include support for interagency collaborations to address the educational well-being needs of children with foster care placement histories, and directions for future inquiry.
CONCURRENT 5, ECONOMIC & COST-UTILITY ANALYSIS, Roundtable
Chair: Nicoletta Lomuto
PREVENTION AND RESOURCE ALLOCATION. Nicoletta Lomuto1, William Cartwright2, John Ernst3, Ted Miller4, John Carnevale5, 1DATACORP, Providence, RI United States; 2National Institute on Drug Abuse, Bethesda, MD United States; 3New York State Office on Alcoholism & Substance Abuse, Albany, NY United States; 4Pacific Institute for Research and Evaluation, Calverton, MD United States; 5Carnevale Associates, Darnestown, MD United States
As data-driven planning gains ground, prevention researchers are increasingly called upon to advise state and local governments on how to distribute resources among geographic areas, providers, or programs. Allocating prevention resources efficiently poses many methodological and practical challenges, yet the literature on this issue is limited. This panel discussion/scientific roundtable will explore the current state of scientific and anecdotal knowledge on prevention and resource allocation. Several key questions will guide the discussion: 1) What are the possible approaches to resource allocation? 2) What are the advantages and disadvantages of different approaches? 3) What is the role of economic theory versus political reality? and 4) Are there avenues for further research or has allocating prevention funding become purely an applied matter?
Four panelists will give their unique perspective on these questions, drawing upon their experiences both in research and in applied settings. John Ernst will open the discussion with the perspective of a State planner. William Cartwright will then speak from his experiences as an economist with the federal government in the United States. Ted Miller, the third panelist, will provide a prevention researcher´s perspective. The last panelist, John Carnevale, will comment from the viewpoint of a policymaker and consultant. A roundtable discussion with the panelists and audience will follow the panelists´ comments.
CONCURRENT 6, MIDDLE CHILDHOOD DEVELOPMENT, Grouped Papers
ADOLESCENT ALCOHOL AND TOBACCO USE, GENDER DIFFERENCES AND SUBSTANCE USE PATHWAYS AMONG MINORITY USE
Chair: Ray Peters
THE EFFECT OF PUBERTAL TIMING ON EARLY CIGARETTE AND ALCOHOL USE: AN EXPLORATION OF GENDER DIFFERENCES. Judy Andrews1, Erika Westling2, Missy Peterson1, 1Oregon Research Institute, Eugene, OR United States; 2University of California, Los Angeles, CA United States
Experimenting with cigarette or alcohol use in middle childhood is a significant risk factor for substance abuse and dependence later in life (Chassin et al., 1990; Grant & Dawson, 1997). Pubertal timing, or the child´s stage of pubertal development relative to same sex, same age peers, is clearly linked to early initiation of cigarette and alcohol use for girls (e.g., Wilson et al., 1994), such that early maturers are more likely to be early substance users. Research investigating the relation between pubertal timing and substance initiation in boys is less conclusive than in girls, but a few studies (e.g., Alsaker, 1996) suggest a link between early maturation and early use. The purpose of this paper is to examine a prospective model explaining the process through which pubertal timing is related to early use of cigarettes and alcohol without parental knowledge, exploring gender differences. Data are from the Oregon Youth Substance Use Project (OYSUP), an ongoing cohort-sequential longitudinal study, following over 1000 children for nine years, beginning when they were in the 1st through 5th grade. For this paper, we analyzed data from 360 children across three assessments, starting when they were in the 5th or 6th grade. We hypothesized that (a) affiliation with deviant peers mediates the relation between pubertal timing and substance initiation and that parental monitoring of their child´s activities either (b) moderates the relation between pubertal timing and affiliation with deviant peers or (c) mediates this relation. The literature supports all three models. As expected, we found a relation between pubertal timing and cigarette and alcohol use without parent´s knowledge for girls, but only a relation between pubertal timing and alcohol use for boys. Model A was supported for girls, but not for boys. For girls, affiliation with deviant peers mediated the effect of pubertal timing on both alcohol and cigarette use. Model B was partially supported: Parental monitoring moderated the association between pubertal timing and alcohol use (but not affiliation with deviant peers or cigarette use), for both boys and girls. Early maturation predicted alcohol use for those children who had parents who were poorer monitors. In contrast to the expectations of Model C, monitoring did not mediate the relation between pubertal timing and association with deviant peers. However, affiliation with deviant peers mediated the relation between parental monitoring and cigarette and alcohol use for both genders. As shown, components of the model were supported. However, further research is necessary to explain the relation between pubertal timing and cigarette use and alcohol use, particularly for boys.
PARENTING, ADOLESCENT SMOKING COGNITIONS AND BEHAVIOR. Rosemarie Huver1, Rutger Engels2, Hein De Vries1, 1Maastricht University (Universiteit Maastricht), Maastricht, Limburg Netherlands; 2Radboud University Nijmegen, Nijmegen, Gelderland Netherlands
Background and aim. Parenting practices and styles have been found to influence adolescent smoking behavior. Moreover, according to the I-Change Model (De Vries et al., 2003), smoking behavior is determined by smoking-related cognitions, namely attitude, social influence and self-efficacy. Studies 1 and 2 aimed to explain effects of parenting practices and styles, respectively, by showing mediating effects of smoking-related cognitions.
Methods. For Study 1, Dutch data from the European Smoking prevention Framework Approach (ESFA) were used (T1: n = 2,312, Mean age = 13.22, SD = 0.61; T2: n = 2,421, Mean age = 15.25, SD = 0.86). In Study 2, data were gathered within the context of the Study of Medical Information and Lifestyles in Eindhoven (SMILE) (n = 482, Mean Age = 15.89, SD = 2.06). To test the relationship between parenting and cognitions, regressions of attitude, social influence and self-efficacy on parenting practices and styles were carried out. In addition, logistic regression analyses were performed to examine the associations between parenting practices and styles, adolescent smoking-related cognitions, intention to smoke and never/ever smoking.
Results. Parenting practices and styles influenced smoking behavior. While some practices were associated with less smoking (communication about health risks of smoking, health risks of breathing in smoke, addictive qualities of smoking, attention for smoking in school), others were related to higher chances of smoking (rewards for not smoking; frequency of communication about smoking; communication about being allowed to smoke, price of cigarettes, friends smoking). With regard to parenting style, most effects were found for the behavioral control dimension. Effects of parenting style were dependent upon parental and adolescent gender. Parenting practices and styles were associated with smoking related cognitions. Furthermore, associations between parenting and smoking decreased after cognitions and intention were accounted for, indicating mediating effects of smoking-related cognitions.
Conclusions. Parenting practices and styles are associated with smoking cognitions and behavior of adolescents. The effects of practices and styles are partly mediated by cognitions.
Results of a third study will be presented as well, of which the aim was to provide an integrated model of both parenting styles and practices, adolescent smoking-related cognitions and smoking behavior, using structural equation modeling techniques.
A STRUCTURAL MODEL OF THE SUBSTANCE USE PATHWAYS AMONG MINORITY YOUTH. Min Qi Wang1, Resa Matthew2, Nikki Bellamy3, Syretta James2, 1University of Maryland College Park, College Park, MD United States; 2Mcfarland Institute, Silver Spring, MD United States; 3SAMHSA/CSAP, Rockville, MD United States
Studies have shown that reducing family risk factors and enhancing protective factors can significantly delay the onset of alcohol, tobacco, and other drug use. The purpose of this study was to test the substance use pathways of adolescents with a structural equation modeling based on family risk and protective factors. The data were collected from minority adolescents (N=790, aged 11-16) who completed the baseline data survey in the Mentoring-Family Strengthening Initiative, funded by the Center for Substance Abuse Prevention (CSAP). A structural equation model (SEM) was developed to test the substance use pathways. The exogenous variables were family supervision, family involvement, and social support. The endogenous variables included self-control, school connectedness, and substance use. The structural model included (a) paths from family supervision, family involvement, and social support to self-control; (b) paths from social support, family supervision, and self-control to school connectedness; (c) paths from school connectedness to adolescent substance use. The SEM analyses were conducted using the SAS System´s CALIS procedure. The analysis employed a two-step procedure using maximum likelihood estimation. The first step was confirmatory factor analysis to test the measurement model. The second step developed and tested the structural model.
The overall measurement model was adequate: ÷2 = 1394.54, p<.001, the chi-square and its degrees of freedom ratio is 2.56, goodness-of-fit index (GFI) =.90, Adjusted GFI=.89, root mean square error approximation (RMSEA) = .044 (90%CI =.42-.47). The t scores obtained for the coefficients ranged from 8.45 through 23.78, indicating that factor loadings were significant, p<.001. All three exogenous variables (i.e., family involvement, social support, and family supervision) showed a positive relationship with the self-control latent variable. Only family involvement was significant (coefficient= .54, t=6.03, p<.001). Self-control (coefficient= .56, t=6.94, p<.001) and social support (coefficient= .34, t=4.99, p<.001) were significant on school connectedness. School connectedness, the sole pathway to the adolescents´ substance use, was significant (coefficient =-.42, t = -7.6, p<.001). The explained variance was 43% for self-control, and 56% for school connectedness. The school connectedness counted for 18% of the substance use variable. Further, gender comparisons showed that male and female adolescents were similar in these pathways. These findings provide empirical support for the theoretical model that family risk and protective factors can significantly influence adolescents´ substance use, and should be adopted into substance use prevention interventions.
CONCURRENT 7, PROMOTING WELL-BEING, Organized Symposia
UNDERSTANDING ADULT WELL BEING IN THE CHICAGO LONGITUDINAL STUDY
Chair: Arthur Reynolds
UNDERSTANDING ADULT WELL BEING IN THE CHICAGO LONGITUDINAL STUDY. Arthur Reynolds1, 1University of Wisconsin-Madison, Madison, WI United States
By early adulthood, many indicators of well-being are becoming established, including educational attainment, health and social behavior, and economic self-sufficiency. Failure to achieve these levels of health and well-being has large costs to individuals and society. The total cost savings achieved by significantly reducing the most consequential early adult problem behaviors--school dropout, unemployment, criminal behavior, substance abuse, and depression are estimated to be hundreds of billions of dollars per year. The highest levels of problem behavior occur for urban children.
In this symposium, we investigate the predictors of adult well being in the Chicago Longitudinal Study (CLS), an on-going 20-year investigation of the life course development of 1,500 children. Born in 1979 or 1980, these low-income children, most of whom are African American (93%), attended early childhood interventions in the Chicago schools and have been followed from ages 3 to 24. Data have been collected prospectively from administrative data and surveys with participants and their parents. At the age 24 follow up, the project has achieved a sample recovery of 1,390 participants with at least two indicators of well being (e.g., educational attainment, substance use).
The first paper investigates links between participation in the Child-Parent Centers, a public-school early intervention that provides educational and family-support services on measures of adult well-being for participants and their parents, including educational attainment, crime, substance abuse, health status, income, and public aid receipt. No previous studies of larger scale public preschool programs have investigated effects on multiple measures of well being into adulthood.
The second paper examines the contribution of child maltreatment and child welfare services on educational attainment, crime, and public aid. Previous studies in the CLS have found that maltreatment is a significant predictor of juvenile delinquency. Whether this link carries over to adult outcomes has not been investigated. The paper also describes the prevalence of child maltreatment and service utilization.
The third paper examines a comprehensive set of child and family predictors on educational attainment, income, criminal behavior and substance use. While the determinants of educational attainment and income are well established, much less is known about the extent to which there is a common set of predictors for indicators of adult well being. Although our proposal is for analysis within a single longitudinal study, this is justified given the rarity of longitudinal studies spanning early childhood to adulthood and the focus on alterable predictors for enhancing well being.
ALTERABLE PREDICTORS OF EDUCATIONAL ATTAINMENT, INCOME, CRIME, AND SUBSTANCE USE. Suh-Ruu Ou1, Joshua Mersky1, Erin Cowell1, Kristy Kohler1, 1University of Wisconsin-Madison, Madison, WI United States
Understanding the factors that influence adult well being has become a goal of social welfare policy. The present study investigated four indicators of adult well being that have significant consequences for society: educational attainment, income, crime, and substance use. Two questions are addressed: 1) What are the rates of educational attainment, crime, substance use, and income status for the study sample? How are they correlated with each other? 2) What common explanatory factors are associated with the outcomes?
The study sample was drawn from the Chicago Longitudinal Study (CLS), an on-going investigation of a panel of low-income minority children growing up in high-poverty neighborhoods in Chicago. A substantial proportion of the sample participated in the Child-Parent Center Program, an early-childhood educational program, similar to Head Start.
A longitudinal design was used. All explanatory factors were measured prior to outcomes. Outcome measures in this preliminary analysis included highest grade completed, quarterly income, incarceration, and substance use. Exploratory factors were classified into six categories: sociodemographic factors, CPC program participation, early adjustment indicators, school commitment, intervening school-based factors, and high school experiences.
Preliminary results indicate that the four outcomes are significantly inter-correlated with each other. For example, highest grade completed is positively correlated with income, while negatively correlated with incarceration and substance use. Regression results show that school mobility and juvenile delinquency were associated with all four outcomes. Maternal education, early classroom adjustment, student´s expectation of attending college, and reading scores at age 14 were related to educational attainment and income. Substantiated maltreatment experience by age 4 was significantly associated with increased substance use. In addition, attending a technical high school was associated with a higher rate of substance use, whereas attending a magnet school between ages 10-14 was associated with a lower rate of substance use. Perceived competence between ages 9-12 and reading scores at age 14 were negatively associated with adult incarceration. Substantiated maltreatment experience between ages 4-17 and attendance at a career academy high school were associated with incarceration positively.
Findings suggest that there are few common factors across the outcomes. Educational attainment and income have similar explanatory factors, while incarceration and substance use are associated with a different set of factors. Understanding alterable, policy-relevant predictors of those adult outcomes can help design effective preventive intervention programs.