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Individual and family engagement in prevention programs has important implications for intervention outcomes. Although definitions of engagement vary widely between studies, beliefs and attitudes as well as sociodemographic characteristics have been identified as predictors of participation. Individuals and families who have fewer resources and experience more stress may perceive a greater need for help but may experience more barriers to participation.

The present study examines individual and couple-level predictors of engagement in a coparenting intervention for couples during the transition to parenthood. It was hypothesized that individual and couple well-being would be positively related to engagement but that positive expectations of parenthood would predict less engagement. Cognitions about parenthood were explored as mediators of the link between well-being and engagement.

The sample consists of couples expecting their first child and randomly assigned to Family Foundations (vs. a control condition). Family Foundations, currently in an efficacy trial, consists of prenatal and postnatal sessions designed to enhance coparenting quality. Participant engagement was measured in three ways: attendance, group leader ratings of individual participation, and participant ratings of program informativeness and homework completion. Individual well-being was indexed by depression, antisocial behavior, and substance use. Couple well-being was indexed by love, conflict, ineffective arguing, and couple efficacy. Cognitions about parenthood included readiness for parenthood, expectations of parenthood, and prenatal parental self-confidence.

Hierarchical regression analyses of two cohorts (N=76; analyses will be revised to include additional cohorts of couples, yielding N=150) indicated that the predictors were associated with participant engagement. Whereas only individual well-being was related to attendance, individual and couple well-being and expectations of parenthood were related to group leader ratings and participant feedback. Individual well-being was positively related, and couple well-being and positive expectations of parenthood were negatively related, to engagement. Cognitions about parenthood mediated the links between well-being and engagement. For example, the negative effect of fathers´ sense of couple efficacy on engagement was mediated by readiness for parenthood.

These results indicate that individual difficulties predict lower engagement whereas couple relationship difficulties predict greater engagement, suggesting a specificity of influence on participant engagement. Our discussion will focus on the unexpected differential pattern of findings at the individual and couple levels and the importance of cognitions about parenthood.



In an effort to demonstrate the efficacy of alcohol and other drug prevention, specifically for sport- and recreation-based programs, there has been a call for scientific inquiry (Witt & Crompton, 1997). Although some studies support the idea that athletes and nonathletes use at the same rate, more current studies (Carr, Kennedy & Dimick, 1990; Ewing, 1998; Moulton, et al., 2000) have found significant differences between the two groups, indicating athletes use alcohol and other drugs at a higher rate than nonathletes. Currently there are few substance abuse prevention outcome studies centering on college-aged athletes (Watson, 2002). The research on sport-based substance abuse prevention programs geared for this population is virtually non-existent (Carter, 1998; Hartmann, 2001). This investigation will examine the effectiveness of a sport-based alcohol and other drug prevention program called "Late Night Sports."

LNS program participants receive life skills training on the following topics: conflict resolution, goal setting, developing respect, positive self-talk, tools to manage pressure, and alcohol and other drug education. The purpose of this evaluation is to share evidence that participation by college-aged males, in the Late Night Sports (LNS) program, can increase participants´ abilities to effectively handle pressure, cope with adversity, and to set effective goals as measured by the Athletic Coping Styles Inventory-28 (ACSI—28) (Smith, Smoll, Schutz, & Ptacek, 1995). This presentation will also examine participants´ sense of personal competence as measured by the Individual Protective Factors Index (IPFI) (Phillips & Springer, 1992). Lastly, we will examine if participation in the LNS program prevents and/or reduces alcohol and other drug use for program participants.

The current study used a retrospective pre-test design following program participants (n=30) through a LNS 12-week curriculum. ACSI subscale pre- and post-test means were compared with Bonferroni corrections to reveal differences. Significant differences were found for the subscales: Coping with Adversity (p = .04), Peaking Under Pressure (p = .02), Goal Setting/Mental Preparation (p = .001), Concentration (p = .08), Confidence (p = .01) and the Personal Coping Resource score (p = .001). No significant differences were found between pre- and post-test scores for the subscales Freedom from Worry and Coachability. IFPI subscale pre- and post-test means were compared to reveal differences for the subscales of Self Control (p = .030) and Cooperation (p = .030). Additionally, the Personal Competence Domain score was also found to have significant difference (p =.031). A significant difference (p = .026) was also found in alcohol reduction for program participants.


TAILORED INVITATION FOR CERVICAL CANCER SCREENING, A RCT IN THE NETHERLANDS BASED ON THE I-CHANGE MODEL. Resie Knops-Dullens1, Nanne De Vries2, Hein De Vries2, 1Maastricht University (Universiteit Maastricht), Maastricht, Limburg Netherlands; 2Maastricht University (Universiteit Maastricht), Maastricht, Netherlands

Objectives The first aim was to analyze the determinants of (non) attendance to the Durch cervical cancer-screening program by using and testing the I-CHANGE Model. The second aim was to test whether tailored invitations compared to standard letters lead to higher attendance rates.

Methods A computer assisted telephonic survey was used to collect data on determinants of (non) participation from (non) attendees of the screening program in 2001 (n= 200). Differences in determinants were analyzed by t-tests and the model was tested using logistic regression technique.

In the RCT, 815 30-year-old women received a tailored invitation based on the answers to the first survey (T0) for all respondents and 806 received a standard letter. Two weeks later (T1) all respondents received a short questionnaire assessing their opinion on the invitation. Six months later (T2) all respondents received a third survey assessing the determinants of participation again. Outcome measures were attendance rates, speed of attendance and changes in determinants between T0 and T2.

Results Non-attendees estimated their chance of getting cervical cancer lower than attendees. They experienced significantly more affective disadvantages of screening, were more insecure and afraid of smear taking, expected to experience more feelings of shame during smear taking and were more insecure and anxious about the result. Attendees had more positive role models, talked more often about screening and percieved a more positive norm. The self-efficacy score of attendees was significantly higher than in non-attendees. Attendees had a significant more positive intention on short and long term. Taking the initiative to schedule an appointment turned out to be a barrier for non-attendees. A lot of misconceptions still exist among both attendees and non-attendees. Weighing pros and cons of screening leads more often to ambivalence in non-attendees than in attendees.

The first results of the RCT are to be expected in Januari 2005.

Conclusions In order to motivate Dutch women to participate in the screening program they need to be convinced that the advantages of screening outweigh the disadvantages. Especially affective disadvantages need to be targeted. From the other proximal factors, preceived social norms need to be upgraded and the level of self-efficacy should be raised. In addition, awareness of the risk of cervical cancer and the potentials of screening need to be optimized and misconceptions minimized. These subjects were targeted in the RTC. To improve the I-CHANGE Model, further research is recommended to explore the relationship between ego-depletion and self-efficacy and between ambivalence and intention.


LACK OF EFFICACY OF A SMOKING CESSATION INTERVENTION BASED ON THE TRANSTHEORETICAL MODEL. Anja Schumann1, Ulrich John2, Ulfert Hapke2, Hans-Jürgen Rumpf3, Christian Meyer2, 1University Greifswald, Institute of Epidemiology and Social Medicine, Greifswald, Germany; 2University Greifswald, Greifswald, Germany; 3University of Lübeck, Lübeck, Germany

We present findings of a randomized controlled trial to test the efficacy of a secondary preventive, proactive, population-based smoking cessation intervention based on the in Germany. The intervention was based on the Transtheoretical Model of health behavior change (TTM). The model incorporates the stages of change (different phases of readiness to quit smoking), the processes of change (activities that people use to progress through the stages), decisional balance (pros and cons of changing a behavior), and self-efficacy (confidence to refrain from the problem behavior). Participants received up to 3 individualized written reports providing normative and ipsative feedback with respect to the TTM variables, and additional stage-tailored self-help manuals. The reports were produced by a special expert-system computer software. Subjects were recruited from a representative general population survey in northern Germany (“Study of Health in Pomerania”, SHIP). A total of 1315 smokers was eligible for the study, and there were n = 917 participants at baseline, 760 at the 6-month follow-up, 671 at 12-month, 650 at 18-month and 639 at 24-month. A number of outcome measures was employed, e.g. point prevalence abstinence, prolonged abstinence, number of cigarettes smoked per day, number of quit attempts in the last 12 months, and changes in the TTM constructs over time.

There were no significant differences between the intervention group and the control group for any of the outcome measures at any follow-up.

The efficacy of the intervention could not be proved. We present three arguments to discuss the failure of the intervention: (1) The intervention is expected to show delayed effects, since it is based on the TTM. This is especially true for behavioral outcome measures such as abstinence rates, since changes in these measures will be preceded by changes in motivational outcome measures such as the TTM constructs. However, even in the 24-month follow-up, behavioral and motivational outcome measures do not indicate a superiority of the intervention condition compared to the control condition. (2) The lack of efficacy might also be due to exceptionally high quit rates in the control group. Both study groups received comprehensive smoking assessments, that may have caused smokers, including those of the control group, to be very attentive to the topic of smoking, thus fostering cognitive, affective, and behavioral changes with regard to smoking. (3) Similar intervention studies in the United States have consistently been shown to be effective. A number of societal and cultural differences between Germany and the United States might have contributed to the failure of the intervention.



TOBACCO USE AMONG ASIAN AMERICANS: RESULTS FROM 2001 CHIS DATA. Hee-Soon Juon1, Marc Chow2, 1Johns Hopkins University, Baltimore, MD United States; 2Rand Corp., Arlington, VA United States

Background: There is a public perception that smoking is not a serious problem among Asian Americans. While tobacco use does not appear to be a major risk in the aggregated data for the Asian Americans, it is clear that for certain subgroups it is a major health concern. It is important to understand the Asian subgroups so as not to ignore the health disparities that are present and the opportunity to improve the health status of this subgroup.

Objective: The purpose of this study is to examine variations in smoking prevalence among Asian American subgroups such as Chinese, Filipino, Japanese, Korean, Vietnamese, and South Asian adults, ages 18 and older, using the 2001 California Health Interview Survey (CHIS).

Methods: CHIS is a population-based survey designed to be representative of California household residents. Using a random digit dialing telephone survey, CHIS interviewed 57,848 households. To increase the sample of several Asian ethnic subgroups, CHIS included an over-sample of Japanese, Koreans, Vietnamese, and South Asians. To take into account the design of the complex, multistage sample, SUDAAN (Survey Data Analysis) software was used to calculate population estimates, standard errors, and standard errors of differences between pairs of estimates.

Results: In 2001, the overall current smoking prevalence was 17.0% in California. The smoking prevalence of Asian Americans (13.9%) was lower than that of non-Hispanic whites (21.0%). There were significant gender differences in cigarette smoking among Asian Americans (21.7% for men, 7.6% for women). The variation in smoking among the Asian American men was as low as 12.4% for South Asian men and as high as 35.1% for Korean men. The rate was also high for Vietnamese men (31.6%) and Filipino men (26.2%). Chinese men (14.7%) and Japanese men (16.1%) men smoking prevalence was lower than the Asian American total of 21.7%.

Conclusions: This study suggests that at the Asian American aggregate data collection level, the Asian American smoking prevalence is low in the U.S. While this statement is true, it does not show any information beyond the aggregate Asian American population and masks any variations that may exist among the Asian American population. The need to address health risks and problems for Korean, Vietnamese, and Filipino men will be discussed.



. Bob Voas1, Eduardo Romano2, A. Scott Tippetts1, Debra Furr-Holden1, 1Pacific Institute for Research and Evaluation, Calverton, MD United States; 2PIRE, Calverton, MD United States

Over the last two decades, the percentage of U.S. highway fatalities in crashes involving a drinking road user has fallen from 57% to 38% (National Highway Traffic Safety Administration [NHTSA], 1999). This decrease has occurred in conjunction with the enactment of a variety of prevention measures and drunk-driving laws. However, the beneficial influence of these measures is not uniform across drivers. Particularly intriguing is the efficacy of these measures on the "social" drinker versus "hard core” drinker. Because the interventions appropriate to each “type” of drinker very their relative involvement in alcohol related crashes is significant to the prevention community. However there is limited understanding, and substantial controversy, regarding the relative importance to the overall impaired driving problem of the relatively small group of drivers with alcohol use disorders compared to the much larger group of more normative drinkers in alcohol related crashes.

Such a lack of knowledge stems in part from lack of proper data. In this study we take advantage of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a survey conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to provide information on alcohol and drug use, abuse, and dependence in the US. For subjects in this file we identified “Alcohol Abusers” in conformity with the APA´s (American Psychiatric Association) criteria for the clinical diagnosis of abuse or dependence, as well as for variables that would help identify social drinkers. Subsequently, we aggregated this information at the state level and, using state as a unit of analysis, merge the proportion of alcohol abusers and social drinkers in each state with the proportion of alcohol-related fatalities identified in the Fatality Analysis Reporting System (FARS).

We applied factor and regression analyses to study the association between the alcohol abuser and the social drinker with alcohol related fatal crashes at the state level for different age and gender subgroups, adjusting also for alcohol-prevention policies in each state. Focusing on association rather than on any causal relationship, we found that the prevalence of alcohol-related fatal crashes in a state was closely and positively associated with the prevalence of social drinkers, but not with alcohol abusers. Such a relationship was particularly strong for males 35 to 64.


FEMALE OFFENDING: BUILDING GENDER SPECIFIC RISK MODELS TO INFORM INTERVENTION. Preeti Chauhan1, Mandi Burnette1, Candice Odgers1, N. Reppucci1, 1University of Virginia, Charlottesville, VA United States

The recent rise in female perpetrated aggression has prompted efforts to consider the unique victimization and mental health profiles of female juvenile offenders. Despite mandates to create gender-specific policies and interventions, a historical focus on boys and men in this field has left many unanswered questions with respect to how existing models of risk translate to girls. However, the groundwork for comprehensive theories and risk models for female offending does exist. For example, a number of studies document the high prevalence of victimization and psychopathology among high risk girls. One study found that 85% of girls who lived in an urban setting witnessed community violence, with 68% having been exposed to more than one violent event (Lipschitz, Rasmuon, Anyan, Cromwell, & Southwick, 2000). New data (Grisso, 2004; Teplin, 2003) suggest rates of depression, anxiety and other disorders are higher among female as compared to male offenders. In short, the victimization and mental health profiles of these young women is well established, the challenge now is to move beyond prevalence towards the integration of risk factors into comprehensive models. Integrative models are desperately needed to form the basis for intervention strategies and programming. The current study addresses this challenge through the testing of a series of risk models within a sample of girls.

Participants included 125 serious and violent juvenile female offenders convicted and sentenced to custody in the State of Virginia. The mean age of participants was 16.3 (SD = 1.3). The majority of the sample reported belonging to an ethnic minority group, 47% African – American, 2% Hispanic, and 9% other ethnicity, with the remaining 43% identifying themselves as Caucasian. Previous offense histories, mental health functioning, violence exposure and victimization were assessed through a multi-method approach (i.e., self report, diagnostic interviews, file information).

Preliminary analysis indicate moderate to strong relationships between victimization (Odgers, Moretti, Reppucci & Burnette, 2004) and mental health status (Burnette & Reppucci, 2004) with concurrent aggression. Further analyses will test the strength of these relationships simultaneously within an integrated framework using structural equational modeling techniques, and nested evaluations of comparative model fit. Models will be tested in order to determine the relative contributions each risk domain with concurrent aggression (as measured by the YSR: Achenbach, 2001) and future offending (as measured by VA-DJJ official recidivism). The implication for these findings in the development of gender specific interventions and treatment will be discussed.



Both sensation seeking and disinhibition in adolescence have often been described as predictors of substance use, delinquency, and risky sexual behaviors (Donohew et al, 1990; Donohew et al, 2000; Newcomb & McGee, 1989). The interaction of arousability and negative affect has been demonstrated to be a significant indicator of vulnerability to drug use and abuse (Pandina et al, 1992). In addition, it has been found that expectancies regarding the effects of substance use are predictive of both onset and intensity of use (Cohen et al, 2002; Carey, 1995).

As part of a study within the NIDA funded Transdisciplinary Prevention Research Center, a sample 100 male and female students attending an urban high school in New Jersey provided data taken within freshman year. Approximately 90% of these students are of minority status (predominantly African American and Latino).

Since recent national studies have shown that the use of alcohol and marijuana among school age youth increases from middle school to high school (Monitoring the Future Survey, 2003), we wish to clarify the relationship between arousability, affect, and alcohol and marijuana expectancies among urban high school students.

Arousability has been hypothesized to be a biologically based and relatively stable attribute. Therefore, drug and alcohol prevention programs might be better served if they were to target more malleable mediators such as affect and expectancies. Differences between alcohol and marijuana expectancies are also examined, as these differences between substance types may provide insight to prevention foci.


SUICIDAL BEHAVIOR AMONG CHINESE ADOLESCENTS: A STRESS-DIATHESIS MODEL. Xianchen Liu1, Jenn-Yun Tein1, 1Arizona State University, Tempe, AZ United States

Suicidal behaviors among adolescents are determined by multiple biological, psychological, social, and family risk factors in numerous Western studies. Despite high rates of suicide among rural, female youths in China, little research has been conducted to examine risk factors and their mechanisms leading to suicidal behaviors with Chinese youths. Several recent studies have indicated that life stress, locus of control, and psychopathology are significant risk factors of suicidal behaviors among Chinese youths, controlling for various potential psychosocial factors. The present study examined the stress-diathesis model of suicidal behavior with a sample of 1,362 Chinese adolescents. The sample consisted of 817 junior and 548 senior high-school students from five schools in one prefecture of Shandong Province, China. Of the sample, 60% were boys, and 80% were from families whose fathers were farmers. A SEM approach was used to examine whether external locus of control and coping mediated the effects of life stress on psychopathology leading to suicidal behavior. Separate mediation models across junior and senior male and female students were constructed. Four types of stressful life events (family, school, peers, and individual) formed a latent factor of general stressors. The latent suicidal behavior variable was measured by suicidal ideation, attempts, and wish of death. Coping, locus of control, internalizing problems, and externalizing problems were single measurement variables. For children across age and gender, each of the path coefficients for the mediation pathway from general stressors to external locus control, then to internalizing problems, and finally to suicidal behavior was significant in a positive direction. After accounting for the mediator variables, general stressors had significantly direct paths to both internalizing and externalizing problems. Externalizing problems were also significantly or marginally related to suicidal behavior. For junior high school students across gender, general stressors were positively related to avoidance coping. On the other hand, for senior high school students across gender, general stressors were negatively related to active coping. Avoidance coping was positively related to internalizing problems for all four groups. In addition to general stressors, family related negative life events were negatively related to externalizing problems for all junior high school students and peer-related negative events were positively related to internalizing problems for junior high school girls. These findings suggest the mediating effects of external locus of control and coping on psychopathology leading to suicidal behavior and support the stress-diathesis model of suicidal behavior in Chinese adolescents.

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