Although school truancy has received attention in regard to adolescent risk-taking, it is not generally included in physician recommendations as a risk factor to be assessed in primary health care. A consecutive sample of 444 12-17 year olds (45% male, 80% Black), with parent consent, receiving general health check-ups from five managed care organization (MCO) group practices in the Washington DC metropolitan area was surveyed as part of a longitudinal, office-based alcohol risk reduction trial. Surveys were conducted at baseline during the check-up and at 12-month follow-up. Baseline responses regarding how many class periods were cut without permission during the last three months of school were dichotomized as none (63.7%) vs. one or more times (36.6%). At baseline, truant adolescents were older, and more likely to have a regular job and be an average or below student; but did not differ on race, gender, attendance at religious services, gang membership, or involvement in extra curricular activities. Truant vs. non-truant adolescents were more likely to have risky behavior: smoke cigarettes (16.1%, 2.5%, p=.000), smoke marijuana (21.7%, 1.4%, p=.000), carry a weapon (27.3%, 3.9%, p=.000), drink alcohol (46%, 14.1%, p=.000), and have sex (37%, 8.5%, p=.000); and to have indicators of depressed mood: trouble sleeping (48.8%, 29.7%, p=.000), tired (46.6%, 27.7%, p=.000), poor appetite (32.9%, 14.8%, p=.000), little pleasure (35.0%, 15.2%, p=.000), hopeless (23.1%, 9.9% p=.000), feel like a failure (14.4%, 7.4%, p=.000), trouble concentrating (23.6%, 9.9%, p=.000), and suicidal thoughts (8.7%, 3.2%, p=.000). Controlling for demographic characteristics and baseline alcohol use, baseline truancy was a significant predictor of alcohol use at one year (Odds Ratio 95% C.I.=1.35, 3.71). In this population of health insured, care seeking adolescents with parent involvement, truancy was commonly reported and associated with risks and concerns. Truancy may be a generic risk indicator and salient risk factor to be discussed in primary care.
USING THE INTERNET TO MEASURE PERFORMANCE IN SUBSTANCE ABUSE PREVENTION PROGRAMS. Nikki Bellamy1, Donna D. Atkinson2, Kevin Mulvey1, 1Substance Abuse and Mental Health Services Administration, Rockville, MD United States; 2Westat, Rockville, MD United States
Systems are being developed for service organizations in the substance abuse prevention arena as accountability becomes vital in the allocation of funds for the programs they implement. The Substance Abuse and Mental Health Services Administration´s (SAMHSA) Center for Substance Abuse Prevention (CSAP) has implemented a system using the web to collect data from its grantees. This system allows CSAP to accomplish a number of goals: to monitor performance of its grant programs, to improve the quality of data collected, and to report to Congress on program activities.
SAMHSA is required by the Government Performance and Results Act of 1993 to develop and monitor performance measures so that it can demonstrate accountability for its programs. CSAP is required to report on its´ entire grant portfolio. Recent experience strongly indicates that CSAP needs to take action to strengthen the availability of information on its portfolio so that it can be better managed.
This paper focuses on the use of the web in monitoring public health activities in the substance abuse prevention arena. Analysis will be based on CSAP´s implementation of a web based system for data analysis and reporting. This system´s use as both a mechanism for monitoring CSAP´s grant portfolio and a tool by which to manage on an internal level will be examined. The paper will discuss the issues surrounding the effectiveness and efficiency of using the web to measure program performance, and the challenges faced by prevention programs in measuring and collecting performance data. It is important to monitor prevention activities that are being carried out nationwide to gain a better understanding of what works, how, and with what communities it works best. Through careful monitoring and analysis of the data, best practices can emerge that will be beneficial to all communities, serving diverse populations, across the country.
The web is a tool that can be used by to facilitate the implementation of programs and program evaluation. It can be used for many types of activities from information dissemination, to training and education. The web has most recently been used as a vehicle for improving programs through data collection, analysis and reporting. This method is beneficial in a number of ways: improves accountability, increases data quality, improves timeliness of data available for analysis and reporting, is easy to use , and increases ability to monitor performance and report outcomes. It will be a central component of evaluation activities in that it provides the mechanism for generating high quality data used in complying with GPRA and sets the standards for collecting quality data; data that program staff and evaluators have confidence in.
A COMPARATIVE ANALYSIS OF CSAP'S STATE INCENTIVE GRANTS ON PREVENTION SYSTEMS IN TWO MIDWESTERN STATES. Peter Mulhall1, Scott Hays2, 1University of Illinois at Urbana-Champaign, Champaign, IL United States; 2University of Illinois, Champaign, IL United States
Prevention science promoting well-being in populations is practiced in states and communities across the U.S. Most prevention programming is funded through federal and state funds that are dispersed to local communities for implementation. However, state and community prevention systems are fragmented, duplicative and highly inefficient because of the way that prevention programs are funded, implemented and evaluated. To that end, the Center for Substance Abuse and Prevention (CSAP) funded over 42 states and territories under their State Incentive Grant initiative. Under the governor's authority, the overarching goal of the SIGs was to reinvigorate state prevention systems and to increase coordination, leveraging and collaboration of statewide prevention resources and programs. Moreover, states were required to create or engage statewide advisory groups, conduct a strategic planning process and develop a statewide prevention plan that would guide them into the future. The underlying premise of the SIG was that a more comprehensive, coordinated and collaborative state system would produce a more effective and efficient prevention system and better results.
This presentation will describe a multi-method evaluation of the SIG state level processes and outcomes for adjoining midwestern states. The evaluation for each state included a Time 1 and Time 2 assessments and analysis of state funding for prevention, key informant and policy maker interviews, archival document review and cataloguing prevention programs and resources to assess the degree to which the SIG goals were attained. Additionally, the advisory council members were annually surveyed over the course of 3 years to understand the process, methods and perceived results of the SIG efforts. Both methods for conducting the statewide analysis and results will be discussed.
The comparative analysis showed commonalities and differences based on the goals and approachs used by the two state systems. In particular, the findings describe the how the governor´s role, agency location and status, leadership, advisory boards, prevention structures and funding can significantly influence state and community prevention systems. In particular, results show that both states have substantial prevention resources that are dispersed across multiple agencies and state units that appear to attenuate and delay effective policy and practices. Finally, the role that major and minor state prevention policies and practices can have on advancing community-based prevention will be discussed.
PROBLEM GAMBLING AND PREVENTION: THREE CHALLENGES. Keith Whyte1, Bethany Cara Bray2, 1National Council on Problem Gambling, Washington, DC United States; 2The Pennsylvania State University, University Park, PA United States
In the United States, gambling opportunities are widely available and state sanctioned and promoted – legalized gambling revenues approached $70 billion in 2003 and 48 states have some form of legalized gambling. Currently, population gambling participation rates approach 85% for lifetime use and 65% for use in the past year, and about 1.6% of the population report pathological gambling problems. As the availability of gambling becomes ubiquitous, prevention specialists and healthcare professionals are presented with a number of unique challenges for addressing gambling problems with policy, prevention, and treatment. This talk will focus on three challenges faced by those in the field of problem gambling – childhood and adolescent gambling, policy disparities, and limited resources for prevention and treatment.
The first challenge is determining how to address gambling problems in childhood and adolescence, while targeting its comorbidity with other risky behaviors – pathological gamblers in treatment report age of onset for gambling at approximately 10 years old for males and 12 for females, and research has also shown that children who gamble are also more likely to engage in other risk taking behaviors such as tobacco, alcohol, and drug use, delinquency, and risky sexual behavior. Additionally, the National Research Foundation (NRC) has found that the earlier a child starts gambling, the more likely he or she is to develop a gambling problem. A second challenge stems from the fact that gambling is regulated at the state, local, and even tribal levels, resulting in a hodgepodge of regulations with wide disparities in the minimum legal age to gamble, types of legalized games, and programs to prevent gambling problems. A third challenge is that only 16 states provide any funding for problem gambling services, requiring researchers and others seeking to develop prevention programs to compete for limited funding from private non-profit organizations. Coupled with the fact that problem and pathological gambling are specifically excluded under the Americans with Disabilities Act (ADA) and many private insurance providers refuse to reimburse for gambling related treatment, there are major barriers to preventing the development of gambling problems and providing treatment services for those who do.
In 1999, the social cost of problem gambling per year was calculated at $5 billion by the National Gambling Impact Study Commission (NGISC). Clearly, problem gambling is a disorder with major public health consequences, creating a need for current prevention efforts to be expanded. By discussing these three challenges to problem gambling research, we hope to generate enthusiasm for the field and ideas about how to overcome these challenges.
THE METHODOLOGICAL STATE OF RESEARCH ON GAMBLING AMONG ADOLESCENTS. Bethany Cara Bray1, Keith Whyte2, Linda M. Collins1, 1The Pennsylvania State University, University Park, PA United States; 2National Council on Problem Gambling, Washington, DC United States
As opportunities for legalized gambling continue to increase in the United States, researchers are recognizing the need for an increasing amount of research into the development, prevention, and treatment of disordered gambling. Recent research has shown that gambling and problems with gambling are far from being exclusive to adults. For example, researchers at the Institute for Adolescent Risk Communication (IARC) of the Annenberg Public Policy Center recently reported that over half of adolescent boys, and about 16% of adolescent girls, have gambled for money. Additionally, IARC also found that about 7% of adolescents aged 14 to 18 have gambled on the Internet. Further, research has also shown that pathological gamblers in treatment report gambling onset at approximately 10 to 12 years of age. Finally, there is also evidence that adolescent gambling is related to adolescent substance use, suicide, risky sexual behavior, drug use, and popularity perception. As it becomes increasingly important to ask more complicated questions about adolescent gambling development, prevention, and treatment, it also becomes increasingly critical to employ sound methodology in this task. This talk summarizes the state of research on gambling among adolescents on two main methodological topics, measurement and sampling.
To begin, two features of the measurement methodology in recent studies are summarized to illustrate how research in this field is currently being conducted and some issues that need to be addressed. The first is what measures are being used (i.e. how adolescent gambling and gambling problems are measured), including differences in the definition of “problem” gambling and issues raised about these measures by researchers (e.g. Derevensky, Gupta and Winters; Jacques and Ladouceur). The second is the validity, reliability, and generalizability of research results using these measures. This feature of measurement is also directly related to the second methodological topic discussed, sampling. Samples from a few studies on adolescent gambling are compared to explore how adolescents are sampled for this kind of research, generalizability differences in samples, and implications for sampling in studies designed to examine adolescent gambling on the Internet.
INCIDENCE, PREVALENCE AND CO-OCCURING FACTORS OF YOUTH GAMBLING: AN IN-DEPTH LOOK AT GAMBLING BEHAVIORS IN 5TH, 8TH AND 11TH GRADE PUBLIC SCHOOL STUDENTS. Roberta Gealt1, George Meldrum2, 1University of Delaware, Newark, DE United States; 2Delaware Council on Gambling Problems, Wilmington, DE United States
Utilizing data from a statewide survey of over 20,000 public school 5th, 8th and 11th grade students, this presentation will provide information on incidence and prevalence of a spectrum of gambling behaviors, as well as identifying risk and protective factors associated with them and gambling typologies identified. Analyses will include differences by age and gender. Relationships to delinquency and substance use will also be discussed. Finally, the students' perceptions of what constitutes gambling will be explored.
GETTING THERE: A PATHWAY TO INSTITUTIONALIZING YOUTH GAMBLING PREVENTION PROGRAMS AT THE STATE LEVEL. George Meldrum1, Roberta Gealt2, 1Delaware Council on Gambling Problems, Wilmington, DE United States; 2University of Delaware, Newark, DE United States
This presentation will explore discrete steps in a clearly defined path to institutionalizing yuoth gambling prevention programs at the state level. The authors will detail methodologies for establishing partnerships with state agencies, including the Departments of Education and Children, Youth and Families; acquiring data and data products to expand knowledge as to the prevalence and incidence of youth gambling and its relationships to academics, delinquency, substance use and other risk areas; disseminate information from national and local sources to identified decision-makers; constructing changes in state law to mandate youth gambling prevention; providing professional development; providing a curriculum and universal access to it. In addition, information will be provided on findings of data analyses from state-wide public school surveys of gambling and its relationship to other risk behaviors.
POSTERS: INTEGRATING BIOLOGICAL AND SOCIAL FACTORS IN PREVENTION RESEARCH
EARLY PREDICTORS OF MARIJUANA USE TRAJECTORIES IN AN URBAN AFRICAN AMERICAN COHORT. Hee-Soon Juon1, Margaret Ensminger1, Kerry Green1, Judy Robertson1, Kate Fothergill1, 1Johns Hopkins University, Baltimore, MD United States
This study examined trajectories of marijuana use over a 25-year period in a cohort of African Americans followed from first grade to young adult. A semi-parametric group-based approach (Nagin 1999) was used to identify distinctive groupings of developmental trajectories of marijuana use. In this analysis the response variable of marijuana use was based on age of first use of marijuana and age of last use of marijuana. We found significant heterogeneity and gender differences in marijuana trajectories of African Americans. For males (n=455), a three-group model best fit the data. A group called “nevers” comprises individuals who never used marijuana in their lifetime (52.6%). A second group, “adolescent limited users,” is composed of men who used marijuana during adolescence but by age 20 desisted (23.5%). A third group, “persistent users,” started marijuana use in early adolescence and continued its use throughout young adulthood (23.9%). For females (n=495), a four-group model best fit the data. A first group is called “nevers” who constitute about 66% of the women. A second group is “early decliners” whose use of marijuana sharply declined by age 18 (10.1%). A third group called “late decliners” used marijuana by age 25 and then declined use (9.1%). A fourth group is called “persistent users” and started marijuana use in adolescence and continued throughout young adulthood (15.1%). Early individual characteristics, family resources, neighborhood characteristics, and adolescent social bonds were examined to distinguish trajectory group memberships. Individual characteristics were first grade teacher´s reports of shy and aggressive behaviors, mother´s reports of symptoms, and first grade readiness test scores. Family resources were mother´s educational background, welfare receipt, and having a teenage mother. Safety in streets and quality of housing were included as disorganized neighborhood. Social bonds during adolescence were school attachment and parental supervision. We will discuss the implication of the findings.
HERITABLE SHYNESS AND SOCIAL SUPPORT IN DEPRESSIVE SYMPTOMS AMONG WOMEN: MECHANISMS AND IMPLICATIONS FOR PREVENTION. Jongil Yuh1, Jenae Neiderhiser1, David Reiss1, Erica Spotts1, 1George Washington University, Washington, DC United States
Background. Recent research posits certain features of temperament and deficient social support as crucial risk factors in understanding depressive symptoms. Although the relationship between these risk factors and depressive symptoms has been recognized in recent decades, genetic effects accounting for the association among temperament, social support, and depressive symptoms remain to be probed. A genetic mechanism suggests that genetic influences are common to three constructs, meaning that heritable temperament may also in part be shared with genetic risk for depression and difficulties eliciting social support. This study aimed to explore genetic and environmental influences on the association among these constructs in a sample of female twins. The efforts clarifying underlying mechanisms can help expand our knowledge of depressive symptoms and develop preventive interventions for individuals at risk for depression by providing new focus of prevention.
Method. The sample consisted of 326 pairs of adult twin mothers of adolescents. The average age of the twin mothers was 44„b4.49 years. Mothers completed questionnaires on temperament, social support, and depressive symptoms. Shyness and fearfulness were assessed by the Temperament and Character Inventory (TCI; Cloninger, Svrakic, & Przybeck, 1993). The availability and adequacy of social support were assessed by the social support questionnaire (SSI; Henderson, Duncan-Jones, Byrne, & Scott, 1980). Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression scale (CES-D; Radloff, 1977).
Results. Findings suggest that genetic influences were the primarily influence for the association among the risk factors and depressive symptoms. Genetic analyses of temperament including shyness and fearfulness, social support, and depressive symptoms found that the moderate amount of shared variance could be accounted by genetic factors. Nonshared environmental influences also made a significant contribution to the covariation between temperament and depressive symptoms, but not to social support.
Conclusions. This study indicates that genetic mechanisms explain the association among certain features of temperament, social support, and depressive symptoms in middle-aged women. Heritable temperament may in part contribute to individual differences in obtaining social support. Thus, the role of heritable temperament in the evolution of depression may depend on its role in eliciting social support. These findings suggest a new focus for prevention: the detailed process by which shy and fearful people fail to maintain supportive social ties.
HEALTH RELATED RISKY BEHAVIORS AND THE PREDICTIVE VALIDITY OF THE IAT: RESULTS FROM 3 STUDIES. Lauren Gudonis1, Donald Lynam1, 1University of Kentucky, Lexington, KY United States
Recent research has shown that attitudes exist at both explicit and implicit levels (Greenwald & Nosek, 2001). Moreover, these attitudes need not be the same, particularly when individuals are either incapable or unwilling to report their attitudes. General models of health-related behavior have often failed to consider the distinction between implicit and explicit attitudes although research demonstrates that each level of attitude may have different behavioral consequences. In an effort to remedy this oversight and investigate the importance of implicit attitudes towards health-risk behaviors, we assessed the predictive validity of the Implicit Attitude Test (IAT; Greenwald, McGhee, & Schwartz, 1998) in relation to marijuana use, condom use, and aggression The first study (N = 264) developed a modified version of the IAT that measured implicit attitudes toward the single target category of condom use. In accordance with predictions, implicit attitudes toward condoms as measured by the IAT were related to safe sex behavior in situations where external cues for condom use are less obvious and automatic processing dominates. In the second study (N = 295), scores on a marijuana IAT were related to self-report measures of marijuana use even after controlling for explicit attitudes towards marijuana use, suggesting that the IAT captured information not present in the explicit measures. Similarly, a third study (N = 276) investigated the predictive ability of an aggression IAT in relation to self-reported aggressive behavior. Results indicated that implicit attitudes towards aggression predicted lifetime aggression above and beyond explicit attitudes. Results from these studies have implications for the assessment and prevention of potentially damaging and maladaptive behavior choices.
EMOTION AND SELF-REGULATION. Marsha Bates1, Paul Lehrer2, Evgeny Vaschillo1, Bronya Vaschillo1, Robert Pandina1, Suchismita Ray1, Jennifer Buckman1, 1Rutgers, The State University of New Jersey, Piscataway, NJ United States; 2University of Medicine and Dentistry of New Jersey, Piscataway, NJ United States
Better understanding of individual differences in emotional reactivity and regulatory processes, especially during key developmental transitions for substance use behaviors, is important because emotional coping and suppression motivations for drug use have consistently been linked to the development of substance use problems. The development of substance use behavior is thus arguably dependent upon how an individual learns to respond to the emotional salience of environmental stimuli. Emotions evoke various autonomic reactions, and the strength and type of emotions can be objectively evaluated by the pattern of autonomic reaction. In turn, the state of the autonomic nervous systems influences emotions. Thus, study of autonomic reactivity and regulation may be particularly informative because there is substantial evidence that autonomic measures of emotional self-regulation are related to, and predict, externalizing, internalizing, and social competence problems in childhood. Unfortunately, little research has examined emotional reactivity and self-regulation in late adolescence and early adulthood. Yet, this developmental period is a critical one for transitions in alcohol and other drug use; it is a time when peak levels of substance use begin to moderate, or sustain and escalate into adulthood. Here we report the results of a pilot study aimed at characterizing reliable indices of autonomic reactivity and regulation in late adolescents/young adults between the ages of 21 and 24 years. Participants rated neutral, positively emotionally valenced, and negatively emotionally valenced slides that were selected from the International Affective Picture Set (Bradley et al., 1990). Positive and negative pictures were matched on normative arousal and valence ratings. Reactivity to emotional stimuli was operationalized by the psychophysiological response of heart rate. Emotional self-regulation was assessed using heart rate variability. The influence of positive versus negative emotional valence of picture stimuli on reactivity and regulation will be characterized. These results will provide the foundation for examining drug exposure effects on emotional reactivity and regulation, and the relation of individual differences in these autonomic indices to variation in risk for problematic substance use transitions.