WYOMING PARENTING INITIATIVE: LESSONS LEARNED FROM A STATEWIDE IMPLEMENTATION OF TRIPLE P. Dennis Embry1, 1PAXIS Institute, Tucson, AZ United States
Wyoming is the first state to fund a statewide initiative involving a multi-level parenting approach to reach parents of children from birth to age 12. This effort has involved multiple state agencies and service delivery entities. The successes and struggles of this effort provide guidance for prevention dissemination and effectiveness trials that aim to influence population. Key factors in long term sustainability may include: 1) constant alignment of an initiative with other statewide efforts, 2) feedback on how the effort is meeting expressed needs and changing conditions, 3) links to epidemiological information for the jurisdiction, and 4) social marketing. Statewide initiatives face exceptional burdens in terms of conflicting organizational needs and survival interests, which have little to do with the efficacy of the prevention strategies or their underlying scientific validity. The Wyoming Parenting Initiative is a logical outgrowth of a number of trends and experiences in the state, which could be replicated in other contexts. Developing a monitoring and evaluation system for non-research, long-term effort presents challenges for any statewide effort.
EXAMING THE IMPACT, IMPLEMENTATION AND SUSTAINABILITY OF PREVENTIVE INTERVENTIONS IN COMMUNITIES
Chair: Patrick Tolan
EFFECTIVENESS OF THE KEEPIN´ IT REAL UNIVERSAL PREVENTION PROGRAM FOR SUBSTANCE USERS: CESSATION AND REDUCTION EFFECTS AMONG MIDDLE SCHOOL STUDENTS. Stephen Kulis1, Tanya Nieri1, Scott Yabiku1, Layne Stromwall1, 1Arizona State University, Tempe, AZ United States
Efforts to address youth substance use have focused on prevention among non-users and treatment among severe users with less attention to youth who already use substances but have not yet progressed to serious abuse or addiction. Using a sample of 1,365 already-using youth from 35 middle schools, this study examined the effectiveness of the SAMHSA model universal prevention program keepin' it REAL (kiR) in promoting cessation and reduction of substance use. A previous evaluation of kiR in a randomized trial in Phoenix demonstrated the program's effectiveness in preventing the onset of gateway drug use, strengthening anti-drug attitudes, and increasing use of resistance strategies (Hecht et al., in Prevention Science, 4(4), 233-248, 2003). The evaluation did not, however, explore program effects on use cessation or reduction. Although not geared specifically toward youth already using substances and not explicitly promoting use cessation, kiR theorizes that some youth use drugs because they don't know how, despite their desire, to successfully refuse drug offers. By enhancing all kiR participants´ resistance skills, even youth with substance use experience may better succeed in resisting future offers, thereby ceasing or reducing their use. Using event history discrete time models, we estimated rates of ceasing and reducing substance use among 7th graders who reported using substances at the start of the randomized trial. Comparing pre-test self-reports of last 30 day substance use to post-tests 6, 12 and 18 months later, cessation was defined as reporting no use at a given post-test and reduction as less use than at baseline. Person-survey waves were the unit of analysis. We used the SAS %glimmix procedure to account for school level effects. Multivariate analyses modeled relative changes in the odds of cessation or reduction at earlier versus later post-tests, controlling for baseline use, use severity, age, grades, socioeconomic status, ethnicity and gender. Participation in kiR increased the odds of ceasing or reducing alcohol use but not cigarette or marijuana use. Among initial alcohol users (N=1,028), kiR participants had odds of ceasing use 65% higher than controls, and 73% higher odds of reducing alcohol use. Results were similar using variably strict definitions of events, e.g. whether or not earlier cessation or reduction was sustained at later post-tests. Sensitivity analyses indicated robust results even after adjusting for possibly different rates of attrition among those who did and did not cease or reduce their substance use. Study limitations, implications and plans for future research will be discussed.
WHAT HAPPENS AFTER THE DEMONSTRATION PHASE? EXAMINING THE SUSTAINABILITY OF A PREVENTION PROJECT. Ray Peters1, Kelly Petrunka1, 1Better Beginnings, Better Futures, Kingston, Ontario Canada
Better Beginnings, Better Futures is a community-based and community-driven prevention policy research demonstration project, located in eight low-income, disadvantaged communities in Ontario, Canada. The project has three major goals: (a) the prevention of problems in young children, (b) the promotion of competence and health of young children, and (c) strengthening vulnerable families and communities. During the planning phase (from 1991 to 1993), community residents, service-provider partners, and staff designed a comprehensive, ecological program model. During the demonstration phase (from 1994 to 1998), the project provided five years of intervention for children from birth to age 4 and their families in 5 sites (younger child sites) and for children from 4 to 8 years of age and their families in 3 sites (older child sites). Outcome analyses of data collected from 1993 to 1998 have been previously presented at SPR.
In 1998, all 8 project sites received continued annualized funding. Our current research examines the sustainability of these projects in the years after the demonstration phase. We examined whether short-term child and neighbourhood outcomes of the demonstration period were maintained, strengthened or weakened from the time period 1998-2003. We collected information about all children living in the Better Beginnings project sites and in three comparison neighbourhoods. In the younger child sites, information was collected from Kindergarten teachers in the spring of 2003 (n= 641). Teachers rated school readiness, health and behavioural problems for every pupil in their kindergarten class. This provided an ongoing comparison of children who had spent a good deal of their preschool years in Better Beginnings neighbourhoods, and allowed for ongoing determination of program effects via comparison both within the communities to previous years' data, and also with children in our comparison communities. A similar cross-sectional strategy was employed in the older child sites, when information was gathered from Grade 3 teachers in the spring of 2003 (n=853).
In addition, we collected information from the following third party databases in each local neighbourhood: Children's Aid Societies, police department crime reports, and local schools' Principals Report concerning the number of students receiving special education instruction.
Analyses of these measures are being carried out within each of the Better Beginnings and comparison sites. Also, for the third party databases, comparisons of the Better Beginnings sites to surrounding metropolitan areas and/or the Province as a whole are being carried out. Analyses of these outcome measures will provide an assessment of the sustainability of the Better Beginnings project.
MULTI-LEVEL FACTORS THAT IMPACT IMPLEMENTATION QUALITY OF THE PROMOTING ALTERNATIVE THINKING STRATEGIES CURRICULUM.. Celene Domitrovich1, Meg Small1, Mark Greenberg1, 1Pennsylvania State University, University Park, PA United States
A number of studies have documented the success of preventive interventions for children and youth. Communities are being required to use “evidence-based” programs to increase the likelihood of achieving positive outcomes. This assumes that programs are implemented with fidelity and essential elements are retained when interventions are replicated. Higher quality implementation has been related to better outcomes (Durlak, 1998). Most interventions are developed under conditions that are not consistent with the “real-world” so it is common knowledge that communities adapt programs when they use them in the field. There is a need to understand the factors related to the program, the system that supports the program, and the broader context that support or undermine implementation. The purpose of this study was to examine the relationship between implementation quality and child outcomes taking into account broader systemic factors present in the school environment. In one urban school district, teacher ratings of student behavior and social competence were gathered at the beginning and end of the school year. Teachers in two grades implemented the Promoting Alternative Thinking Strategies (PATHS; Kusche & Greenberg, 1994) curriculum during the school year. The sample included 434 students in 25 classrooms. Implementation quality was assessed with classroom observations. A district-wide staff survey assessing organizational climate was also gathered. Items on the survey were drawn from a measure developed by Byrk and Schneider (2002). HLM was used to take into account the natural nesting of children within classrooms. Standardized regression estimates of the relationship between observations of implementation quality and student outcomes were generated. Sex and race were controlled and pretest scores were entered as covariates. Results suggest that the change between pre and posttest teacher ratings of student adjustment was strongly related to the pretest rating. However, for social competence, attention, and motivation, quality of implementation contributed to posttest functioning beyond what was accounted for by pretest scores. In addition, PATHS specific aspects of implementation quality were more strongly related to these outcomes than the general indicator of implementation quality which included ratings of teacher´s discipline style and the overall classroom climate. As two grades levels (2nd & 3rd) are added over the course of this year (25 classrooms), additional analyses will be conducted to understand whether 1) the relationship between implementation quality and student outcomes functions the same way in buildings that have different climates and 2) to determine whether there are direct effects of building climate on child outcomes.
CONCURRENT 2, INTEGRATING BIOLOGICAL AND SOCIAL FACTORS IN PREVENTION SCIENCE, Roundtable
PREVENTION RESEARCH OPPORTUNITIES: AN NIMH PERSPECTIVE
PREVENTION RESEARCH OPPORTUNITIES: AN NIMH PERSPECTIVE. Robert Heinssen1, Belinda Sims1, Jane Pearson1, Eve Moscicki1, Christopher Gordon1, 1National Institutes of Health, Bethesda, MD United States
The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental illness and behavioral disorders through research on mind, brain, and behavior. In order to address this mission more effectively, NIMH recently reevaluated its scientific priorities and reorganized its extramural research programs from three research divisions to five. The aim of this strategic restructuring is to generate research that will transform both prevention of and recovery from mental disorders. This roundtable discussion will provide an overview of the reorganized NIMH extramural program structure, with special attention to current and future prevention research initiatives within the new organizational framework. Representatives from each of the newly configured research divisions -- basic science, translational research for children and adolescents, translational research for adults, mental health services and intervention research, and health behavior and AIDS research – will describe areas of scientific emphasis, factors that influence program priority setting (e.g., mission relevance, scientific traction, innovation, likely impact on service delivery), and how cross-disciplinary collaboration may facilitate translation of basic science discoveries into new prevention interventions. The roundtable format will allow audience members to exchange ideas with NIMH program staff about how recent breakthroughs in genomics, neuroscience, basic behavioral research, and services research apply to the development, testing, and dissemination of new approaches to universal, selective, and indicated prevention, as well as methods to prevent psychiatric co-morbidity, disability, and relapse.
CONCURRENT 3, CULTURAL SENSITIVITY, Poster Forum
SUBSTANCE ABUSE AMONG ASIAN INDIANS IN THE U.S., SUBSTANCE ABUSE AMONG WOMEN, ADOLESCENT TOBACCO USE IN URBAN INDIA, ALCOHOL USE AMONG ASIAN AMERICANS, CROSS-CULTURAL DIFFERENCES OF ALCOHOL ABUSE – HISPANIC AND CAUCASION ADOLESCENTS, PHYSICAL MEDICINE AND REHABILITATION IN SUBSTANCE ABUSE ASSESSMENT AND PREVENTION
Chair: Zili Sloboda
SUBSTANCE USE AMONG ASIAN INDIANS IN THE UNITED STATES. Gagan S. Khera1, 1George Washington University, Washington, DC United States
According to the 2000 U.S. Census data, there are nearly 2 million Asian Indians in the United States. Indians have been labeled a “model minority,” which has resulted in a lack of literature examining their adjustment difficulties (Sandhu & Malik, 2001). Thus, it becomes imperative to examine the substance use of Indians.
National databases that survey drug and alcohol abuse in the United States either ignore or aggregate the data for all Asian Americans (Ja & Aoki, 1993; Sandhu & Malik, 2001). The Uniform Facility Data Set, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA, 1998), found that Asians and Pacific Islanders composed .8 to 1% of the total population in substance abuse treatment. However, there is no information via national databases about the percentages of substance-abusing Indian-Americans in the United States. This does not mean that Indian-Americans do not drink or use drugs. In fact, a study by United Communications (1989) in Canada found that 25% of the Asian Indian sample had alcohol problems. It is likely that Indian-American college students and young professionals consume drugs and alcohol; however, the level of consumption is unknown. Substance use and abuse has not been studied with Indian-Americans.
This study is part of a larger NICHD-funded-study examining Asian Indians in the U.S. Participants are 1100 Indian men and women (first- and second-generation), ages 18-34 years, and were recruited from targeted cities in the United States. Measures for this study include: the Abbreviated Multidimensional Acculturation Scale (Zea et al., 2003) and an adapted version of the National Household Drug Survey (NIDA). The measure assesses drug and alcohol use and smoking habits. Demographic information (education, language, SES, religion etc) were also collected.
It was hypothesized that substance use would be related to acculturation levels, specifically that individuals more acculturated to American culture would report more use of alcohol, cigarettes and drugs. Second, it was hypothesized that there would be differences between first- and second-generation individuals on substance use. Lastly, it was hypothesized that there would be gender differences, that men would report higher levels of substance use. Use of demographic information was used to control for various factors such as education. Preliminary analyses suggest that substance use is in fact related to acculturation, gender and generational status.
PARENTAL PRACTICES: EFFECTS ON MEXICAN AND MEXICAN AMERICAN ADOLESCENTS SUBSTANCE USE. Sarah Voisine1, Monica Parsai1, Flavio Marsiglia2, Stephen Kulis2, Tanya Nieri2, 1Arizona State University, Scottsdale, AZ United States; 2Arizona State University, Tempe, AZ United States
Adolescent substance use has long captured the attention of social science researchers who have found correlations between a number of demographic and ecological variables, including parental practices, and rates of substance use. Yet, little attention has been given in the existing literature to how Mexicans/Mexican Americans experience parental practices and substance use, even though this cultural group represents one of the largest minority groups in the United States. This investigation focused on exploring the relationship between parental practices and substance use among Mexican/Mexican American adolescents in the Southwest. The construct of parental practices is considered to be composed of three concepts: information-based monitoring, permissiveness, and injunctive norms. Information-based monitoring refers to the extent that parents are aware of their children´s activities (Bahr et al., 1998). Public service announcements have been instructing parents to “Ask who, ask where, and ask when.” In contrast, parental permissiveness is the degree to which parents have requirements for their children´s behaviors (Lamborn, et al., 1991), while injunctive norms refer to the perception the adolescents have concerning their parent´s expectations for their behavior (Li, et al., 2000). This study utilizes secondary analysis of data from a randomized trial of a drug prevention curriculum administered to 3,017 Mexican/Mexican American eighth grade students in a major Southwest metropolis. The outcome measures were gathered through self-report questionnaires administered at the beginning of the randomized trial. The analysis utilized bivariate correlations, and multivariate techniques. Outcome was measured by lifetime and recent use, positive drug expectations, and substance use norms for alcohol, cigarette, and marijuana. Results showed that controlling for age, gender, SES, grades, and acculturation, parental monitoring is not correlated with actual substance use among Mexican/Mexican American adolescents, while permissiveness and injunctive norms are highly related with alcohol, cigarettes and marijuana use. However, with respect to adolescents´ pro-drug expectations and norms, results were more variable and indicated interesting differences according to both gender and substance. For example, parental monitoring was significantly related to male´s norms towards all three substances use, but was only significant for female´s norms towards cigarette use. Parental permissiveness was found to be significant only for female´s attitudes towards substance use but not for males. Parental injunctive norms emerged as the most consistent significant factor related to all of the outcomes measured. Implications for substance use prevention are discussed.
RELAPSE PREVENTION FOR SUBSTANCE-ABUSING WOMEN. An-Pyng Sun1, 1University of Nevada Las Vegas, Las Vegas, NV United States
Many of the theories we use to understand addictive behavior, including relapse prevention, are based on the male population, despite the difference between males and females biologically, psychologically, and socially. It is only recently that more attention is being devoted to substance-abusing females. This paper presents part of the findings of a qualitative study exploring factors that contribute to women´s relapses. In-depth interviews (audio-taping and note-taking) were conducted with 30 women from treatment programs. Factors leading to relapses were identified: (1) “Abandonment” by men. Women emphasized the relationship with men. Losing the man could be the end of world. The factor of abandonment may have a different impact depending on whether a woman has something other than a man to hold on to. Losing a man is equal to losing self-worth; while holding a job she loves may have both practical and psychological support for the woman. This factor is damaging even for women who have maintained sobriety for many years. (2) Feelings of loss, anger, and powerlessness. It is not uncommon for the women to get involved with the child protective services (CPS), and to negotiate with the CPS workers to regain child custody, but the red tape of the various systems may frustrate the women and trigger relapses, particular in the beginning of recovery. (3) Delayed diagnosis of mental disorders (e.g., bipolar, eating disorder). Without proper medication, they may turn to AOD to self-medicate. (4) To reward/sabotage self. A few women used drugs to “reward” themselves because they felt they have been doing so well and believed that just “one hit” wouldn´t hurt. That one hit, however, led to uncontrollable relapses. Women may also interpret such behavior as being afraid of getting better or undeserving, and would thus sabotage their own recovery. (5) Old using circle. Addicts were often told to stay away from the thing, person, and place that would trigger their use. However, cutting ties with the old using circle may not be that straightforward for women for the following reasons: (a) Loyalty and friendship; (b) Sympathy and/or love; (c) Blood related network; (d) Unexpected reencounter; and (e) Inability to move out of the drug-infested community. The above results help us understand some of the women-specific psychosocial relapse risk factors. Targeting those risk factors with effective coping skills, case management, and self-efficacy, must be addressed in helping women prevent relapses.
ETHNIC-SPECIFIC NORMATIVE BELIEFS AS A MODERATOR OF RELATIONSHIP BETWEEN ETHNIC IDENTITY AND ALCOHOL USE AMONG ASIAN AMERICANS. Tina Kauh1, 1Pennsylvania State University, University Park, PA United States
Prior research has suggested that having a stronger ethnic identity leads to lower substance use among ethnic minority youth. Given such findings, many culturally-tailored intervention programs have integrated curriculum components intended to enhance youth's sense of ethnic identity, with the assumption that it may act as a protective factor for youth's health behavior. The extent to which the effect of ethnic identity on substance use may depend on other factors, however, has gone relatively unexamined. One potential moderator of this relationship may be youth´s beliefs about the prevalence rates of peer substance use (i.e., normative beliefs). Research on substance use among adolescents suggests that youth´s norm beliefs are strong predictors of their own use, such that youth who believe that a higher percentage of their peers drink are more likely to drink and to drink more heavily themselves. Ethnic identity may be a protective factor for health behaviors only to the extent that youth believe that members of their ethnic group behave in health-promoting ways. As such, having a stronger ethnic identity may lead to less alcohol use if youth believe that drinking is not prevalent among their same-ethnic peers. In contrast, youth who strongly identify with their ethnic culture may be more inclined to drink more frequently and more heavily if they believe that the behavior is consistent with how their ethnic peers behave. The current study examines the potential moderating effect of ethnic-specific norm beliefs on the relationship between ethnic identity and alcohol use within a sample of male (n = 48) and female (n = 80) Asian American undergraduates. Participants reported their norm beliefs about same-sex Asian peer alcohol use and responded to the Multigroup Ethnic Identity Measure (Phinney, 1992) as well as several indicators of alcohol-use (e.g., frequency of last month drinking, average quantity of last month drinking, and frequency of last month binge drinking). Results using multiple linear regression models indicate that the effect of ethnic identity on all three indicators of alcohol use was significantly moderated by students' Asian norm beliefs. Specifically, Asian norm beliefs had no effect on alcohol use among students with weak ethnic identities. Having a strong ethnic identity, however, was differentially associated with alcohol use, depending on Asian norm beliefs. Stronger ethnic identity predicted lower alcohol use only among students with low Asian norm beliefs. In contrast, stronger ethnic identity was associated with higher alcohol use if students reported high Asian norm beliefs. Implications are discussed within the context of culturally-tailored intervention programs.