IMPLEMENTATION QUALITY OF PROJECT ALERT DELIVERED IN SCHOOLS BY COOPERATIVE EXTENSION. Frances Burden1, Tina Kauh1, Tena St. Pierre1, 1Penn State University, University Park, PA United States
Current knowledge suggests that evidence-based drug prevention curricula are more likely to produce positive outcomes in real world settings if implemented with high quality. However, achieving quality implementation, sometimes referred to as fidelity, has had limited success.Some suggest it may be more practical to train outside providers who are enthusiastic and skilled at interactive teaching strategies.Trained outside providers may be more likely to implement programs with fidelity since teaching the curriculum is their sole responsibility.This paper examines implementation of Project ALERT and presents findings indicating that high quality implementation did not produce positive effects. ALERT was delivered in 8 middle schools by outside program leaders hired/supervised by Cooperative Extension Educators. Program leaders received the same curriculum training as provided to classroom teachers through ALERT´s training system. The 2-year curriculum was delivered to two 7th-grade cohorts who received 11 lessons in 7th grade and 3 lessons in 8th. Across the 48 classrooms, 654 lessons were delivered in 7th- and 8th- grades. For each lesson, observers completed observation forms created by ALERT´s developer. Before each program year, observers received training on how to properly complete the measures. Observation reports indicated that 87% of classrooms covered all of each activity;11% covered some of each activity. These levels were comparable to those reported by teachers in ALERT´s effectiveness study showing all or some of each activity was covered in 88% of 7th-grade lessons and in 93% of 8th-grade lessons. Implementation quality for each lesson also was assessed by an 8-item measure, created by the developer. Observers rated each item (e.g., participation in small group activities, student interest, class control, elicitation of response, correct use of feedback, respect for students) on a scale of 1- 7 (poor to high quality). Data from each year´s lessons were averaged to create a mean quality score. Results suggest that ALERT was implemented with high quality both years, reflected by mean ratings from 5.8 to 6.8 in 7th-grade and 4.8 to 6.7 in 8th. Student ratings of implementation quality on reaction forms (n=976 in 7th grade; n=1043 in 8th) after program completion also indicated high quality implementation. Mean ratings (scales 1-5) for regard for program leader were 4.0 in 7th grade and 3.7 in 8th; mean scores for perceived effect on students were 3.7 in 7th and 3.3 in 8th. Despite high implementation quality, hierarchical linear models indicated that high quality did not produce positive outcomes. Implications will be discussed for CE as a delivery model and the role of implementation in producing effective outcomes.
CONCURRENT 2, ETIOLOGY, EMERGING OPPORTUNITIES, WELL-BEING, Poster Forum
ADOLESCENT DRUG INVOLEMENT, RELIGIOUS COPING AND SUICIDE BEHAVIORS, RELIGIOSITY AND SUBSTANCE ABUSE AT-RISK YOUTH, LONGITUDINAL LINKS BETWEEN PARENTS ATTITUDES TOWARDS SUBSTANCE USE.
Chair: Dorothy Browne
PARENTAL FACTORS ASSOCIATED WITH ADOLESCENT DRUG INVOLVEMENT: A FACTOR ANALYSIS. Andrea Stone1, Howard Chilcoat1, 1Johns Hopkins University, Baltimore, MD United States
This study used factor analysis to explore aspects of parenting that are associated with adolescent drug use. Participants were 491 adolescents who took part in a longitudinal study that assessed school-going children and their parents when the children were in first grade (1993-1994 academic year), then followed the families as they proceeded through middle school and high school. To be included in the present study, it was required that participants had complete parent data (parent report), and adolescent drug use data (child report). A total of 20 parent variables were entered into one, two, three, four, and five factor models. Based on factor loadings, and prior theory, the four-factor model was selected as the most appropriate model. Descriptive titles given to the four factors were: (1) Parent-Child Bond; (2) Parent Discipline; (3) Parental Educational Involvement; (4) Parent Awareness. Total factor score were calculated for each individual, then adolescent alcohol use, tobacco use, and marijuana use were individual regressed onto the factor scores in bivariate and multivariate logistic regression equations. Results indicate no association with any of the factors and adolescent alcohol or tobacco use, however, Parent-Child-Bond was negatively associated with adolescent marijuana use. This association held after controlling for the three other factors using multivariate logistic regression analysis. Attaining a better understanding of factors that are associated with early adolescent drug use, or that are associated with the absence of drug use, should aid future prevention efforts aimed at youth drug involvement.
THE INFLUENCE OF CHARACTERISTICS OF PARENT-ADOLESCENT RELATIONSHIPS ON LONGITUDINAL LINKS BETWEEN MOTHERS´ AND FATHERS´ ATTITUDES TOWARD SMOKING AND DRINKING AND ADOLESCENT SUBSTANCE USE. Carolyn Ransford1, Marni Kan1, Susan McHale1, 1Pennsylvania State University, University Park, PA United States
Parental attitudes toward substance use are a risk factor for adolescent substance use. Adolescents engage in more frequent and heavier smoking, drinking, and drug use when their parents have more permissive attitudes. However, previous research has not examined characteristics of the parent-adolescent relationship that affect how parents´ attitudes are transmitted to their children and ultimately impact their substance use. Parent-adolescent relationship quality may provide a context for the influence of parents´ attitudes on adolescent substance use. A warm, intimate relationship may promote a respect for parents´ values and adoption of similar attitudes in their children (Darling & Steinberg, 1993). Parenting practices, including parental knowledge and time spent with their children, may also influence the transmission of parents´ attitudes. Also, the impact that parents´ attitudes have on their children´s substance use may vary depending on characteristics such as children´s sex or age. Parental warmth may be effective for transmitting attitudes in childhood, but attitudes may need to be buttressed by parenting practices when youth reach adolescence.The present study advances previous research by examining the combined effects of parents´ attitudes and parent-adolescent relationship characteristics in predicting adolescents´ substance use across a three-year period. Data came from interviews conducted in 190 White working- and middle-class families who participated in a longitudinal study of family relationships. Parents completed a questionnaire on smoking and drinking attitudes. Adolescents (mean age at time 1=12.8) reported on the frequency of their drinking, smoking, and other drug use. Assessments of intimacy, conflict, parental knowledge, and time spent together were collected from both parents and adolescents.Regression analyses, conducted separately by adolescent gender, were used to measure the links between mothers´ and fathers´ attitudes at Time 1, parent-adolescent warmth, conflict, time spent together, and parental knowledge of their offspring´s activities at Time 1, and the three measures of adolescent substance use at Time 2, controlling for adolescent substance use at Time 1. Results suggest that parent-adolescent relationship quality provides a context for the transmission of parents´ attitudes: More conservative parental attitudes in the context of an intimate parent-adolescent relationship at Time 1 predicted lower levels of adolescent substance use at Time 2, particularly for fathers and sons. These findings suggest that the quality of parent-adolescent relationships influences the transmission of parents´ substance use attitudes to their offspring. Findings are discussed in terms of implications for family-based prevention.
RELIGIOUS COPING AND SUICIDAL BEHAVIORS IN AFRICAN AMERICAN ADOLESCENTS. Sherry D Molock1, Rupa Puri1, Crystal Barksdale1, Samantha Gaiber1, 1George Washington University, Washington, DC United States
Suicide is currently the third leading cause of death for African American youth between 15-24 years of age. While several studies have focused on risk factors associated with suicidality in African American youth, few studies have also examined protective factors. One important protective factor that is culturally salient in the African American community is religious coping. Religious coping incorporates religious beliefs and practices to decrease negative reactions to stressful life events. A self-directed coping style for example, is characterized by an active, primarily self-initiated problem solving style, while collaborative coping is characterized by a cooperative relationship with God; relying on God to assist in problem solving while striving to develop and maintain a personal relationship with God. This paper examines self-directed and collaborative religious coping as they relate to suicidal behaviors among 212 African American high school students. Hierarchical and logistic regression analyses were used to determine relationships among study variables. Results suggest that collaborative religious coping serves as a protective factor for reasons for living, suicide attempts, and hopelessness. Self-directed religious coping style, however, serves as a risk factor for the same outcome variables. Religious coping was found to be unrelated to suicide ideation and depression. Results suggest that religious coping style is an important factor to address in interventions targeting suicidal behaviors among African American adolescents. The implications for developing culturally sensitive interventions and recommendations for prevention programs are discussed.
RELIGIOSITY AS A PROTECTIVE FACTOR AGAINST SUBSTANCE USE FOR AT-RISK YOUTH. Sarah Wahl1, Robin Mermelstein1, Brian Flay1, 1University of Illinois at Chicago, Chicago, IL United States
Religiosity has been linked to the promotion of health and well-being and is often considered a protective factor against risk-taking behaviors like substance use. Less is currently known about the longitudinal impact of religiosity on substance use for at-risk youth. The present study examined the association between religiosity and cigarette smoking, alcohol, and marijuana use for adolescents. We hypothesized that religiosity would be protective against substance use; youth who reported higher levels of religiosity would be less likely to experiment with alcohol and marijuana and less likely to smoke or escalate in their smoking compared to those who endorsed lower levels of religiosity. Participants were 562 8th and 10th graders (55% female; 72% White; 53% 8th grade) who were susceptible to or early experimenters with cigarette smoking at baseline. Self-report questionnaires were completed at baseline, 6-, and 12-months, with a retention rate of 90.2% (N = 507) at the final wave. A composite measure of the frequency and importance of religious activity was used to define religiosity. Religiosity was highly stable over time and significantly positively (but weakly) related to self-esteem, ps<.05. Religiosity was also positively related to negative mood regulation abilties and inversely related to depression and perceived stress, and these relationships strengthened over time, ps<.05. Contrary to previous research, no racial differences were observed for religiosity. Latent growth curve analyses based on time-line follow-back questionnaires at each time point classified students into 7 cigarette smoking trajectory groups: never smoked; ever tried; current trier; escalator; rapid escalator; smoker; or quitter. Repeated measures analyses revealed that religiosity significantly differed across smoking trajectory group, F (2, 889) = 23.17, p <.001. Students who were susceptible to smoking at baseline, but never began smoking, reported the highest level of religiosity at all measurement waves. Lower levels of religiosity were associated with being drunk in the past year (p<.05) and recent marijuana use (p<.05) for both 8th and 10th graders. These results highlight the protective nature of religiosity against substance use, even for at-risk youth. Religiosity might be one important venue for promoting health and well-being among today's youth.
Supported by grant #CA80266 from NCI and a grant from the Tobacco Etiology Research Network, funded by RWJF. Additional support for the first author was provided by NIDA training grant DA07293.
CENTRAL AND PERIPHERAL PROCESSING OF ANTI-MARIJUANA MESSAGES:EFFECTS OF MESSAGE SENSATION VALUE, DISTRACTION, AND SENSATION SEEKING. Lauren C. Gudonis1, Donald Lynam1, Nancy Harrington1, 1University of Kentucky, Lexington, KY United States
Previous research has shown that high sensation value PSAs are most effective in reducing drug use among high sensation seekers. What is not known is the pathway by which these messages are processed by high sensation seekers. The route of processing has implications for prevention as centrally, versus peripherally, processed messages are more strongly linked to behavior change. The current study (N = 295) investigated the mechanism by which individuals varying in levels of impulsive sensation seeking (ISS) process marijuana public service announcements (PSAs). The study utilized a 2 (high vs. low sensation seeker) x 2 (high vs. low PSA) x 3 (high distraction, low distraction, no distraction) between subjects design. Participants viewed high sensation value programming (several episodes from popular MTV shows; actual commercials) in which high and low sensation value messages were embedded. While watching, participants in the low distraction condition heard an auditory beep approximately every 10 seconds and were required to make a response when an infrequent, oddball tone sounded; this tone sounded, on average, once a minute. In the high distraction condition, participants heard one of two auditory tones every ten seconds and were required to make a response when three of the same tones sounded consecutively. No auditory tones sounded in the control condition. Measures assessing behavioral intentions to use marijuana and several indices of cognitive processing served as dependent variables. Participants answered questions about the PSAs and other content, indicated how likely they were to smoke marijuana in the following weeks, and completed an implicit association task designed to assess attitudes towards marijuana. Prior to the task, participants completed questionnaires assessing their previous attitudes towards marijuana. Initial results indicated that among individuals high in ISS, the low distraction, low PSAs were the most effective. In general, central processing was more effective than peripheral processing. These results have implications for the design of prevention messages and assessment of implicit attitudes towards illegal activity.
EXPLORING THE UTILITY OF EARLY ANXIETY INTERVENTIONS FOR THE PREVENTION OF DEPRESSION AND OTHER PROBLEMS AMONG YOUTHS
Chair: Joel Sherrill
EXPLORING THE UTILITY OF EARLY ANXIETY INTERVENTIONS FOR THE PREVENTION OF DEPRESSION AND OTHER PROBLEMS AMONG YOUTHS. Joel Sherrill1, Golda Ginsburg2, 1National Institute of Mental Health, Bethesda, MD United States; 2Johns Hopkins University, Baltimore, MD United States
Retrospectively collected data from epidemiological surveys with adults as well as prospectively collected data from naturalistic studies with community-dwelling and clinically-referred youths indicate that anxiety disorders frequently precede depressive disorders. Discussions in the literature have focused on explanations for the observed co-occurrence and temporal patterning of these disorders, and some authors have highlighted the notion that anxiety disorders may function as gateway conditions to later depressive disorders. Yet, efforts to examine the potential utility of early anxiety intervention for preventing depression during childhood and adolescence have been limited to date. The current symposium will address epidemiological research, intervention models, and data from intervention trials that are relevant to the issue of whether treating early anxiety holds promise for achieving prevention of depression in youths. The first presentation will summarize the relevant epidemiological and risk literature, including findings regarding the continuity and well-documented sequencing of early anxiety and later depression among youths. The second presentation will summarize the longer-term outcomes and preventive effects observed in a seven-year follow-up of children treated for anxiety in a randomized clinical trial. The third presentation will focus on a model for early intervention and prevention of anxiety and discuss the intervention ´s relevance for preventing depression. Discussion will focus on the relative potential utility of targeting early anxiety versus other known risk factors (e.g., maternal/family history) for preventing depression among youth, methodological challenges in intervention research that complicate the detection of preventive effects associated with early anxiety interventions, and the degree to which existing anxiety interventions might require modifications to achieve depression prevention goals.
TEMPORAL PATTERNING OF EARLY ANXIETY WITH DEPRESSION AND OTHER PROBLEMS AMONG YOUTHS: IMPLICATION FOR PREVENTIVE EFFORTS. Scott Compton1, 1Duke University Medical Center, Durham, NC United States
There is now consensus among a variety of researchers that early onset pediatric mental disorders are predictors of a wide range of adverse effects in adolescence and young adulthood. However, less is known about the specific developmental trajectories of pediatric and adolescent mental disorders, and to date, information regarding some of the more commonly observed trajectories has not been systematically incorporated into preventive interventions. This paper will review and summarize data from a variety of empirical literatures that address the temporal continuity and sequence of mental disorders in pediatric and adolescent populations. Specific emphases will be placed on data that addresses the stability of early anxiety and on the roll of early childhood anxiety disorders as a risk factor for the development of depressive disorders in adolescence. In addition, the role that primary interventions have in preventing nontargeted mental health problems will be discussed.
LONGER-TERM OUTCOMES AND PREVENTIVE EFFECTS AMONG CHILDREN TREATED FOR ANXIETY. Philip Kendall1, 1Temple University, Philadelphia, PA United States
Reviews (e.g., Kazdin & Weisz, 1998) of randomized clinical trials (RCT; e.g., Kendall et al., 1997) indicate that cognitive-behavioral therapy (CBT) can be an effective treatment for anxious children and that the treatment effects can be robust over time (i.e., 1-year follow-up). Given that anxiety disorders in youth are associated with a trajectory toward adult anxiety, depression, and substance use problems, a meaningful question is to what extent does successful intervention for anxiety prevent or reduce its sequelae? A 7.4-year follow-up of the sample in the 1997 RCT (Kendall, Safford, Flannery-Schroeder, & Webb, 2004) examined the maintenance of treatment effects and the preventive effects of treatment on the sequelae of childhood anxiety. Results indicated that those children who responded positively to treatment (at the time they were initially treated as youth) evidenced preventive effects (e.g., used substances less and had fewer difficulties related to substance use than less positive treatment responders). Discussion will address the emerging methodological issues (e.g., absence of a control, base rates, optimal ages at the time of follow-up) and the suggested solutions. In addition, suggestions for modifying the treatment to be optimally effective in the prevention of sequelae will be addressed.
DESIGNING A PREVENTIVE INTERVENTION FOR ANXIETY DISORDERS: A CONCEPTUAL MODEL. Ellen Flannery-Schroeder1, Elizabeth Gosch2, 1University of Rhode Island, Kingston, RI United States; 2Philadelphia College of Osteopathic Medicine, Philadelphia, PA United States
Numerous researchers (e.g., Dadds, Holland, et al., 1997; Donovan, & Spence, 2000; Greenberg et al, 2001; Spence, 2001) have suggested the need for early identification and intervention for children at risk for anxiety; however, empirical studies aimed at reducing the prevalence of anxiety disorders are few in number. Anxiety prevention studies may be instrumental in reducing rates of anxiety disorders as well as in preventing concomitant problems (e.g., depression, substance use). A conceptual model for intervening for anxiety disorders will be presented. Preliminary evidence will address feasibility of early intervention of anxiety in the prevention of both anxiety and depression. Discussion will include consideration of the relevance of anxiety prevention to depression prevention, including how the conceptual model and intervention targets of anxiety prevention overlap with those commonly used in prevention of depression. That is, why would one expect prophylaxis against depression? Last, an indicated prevention strategy for children at risk for anxiety disorders will be presented. The strategy involves a randomized controlled evaluation of the effectiveness of a group cognitive-behavioral intervention (GCBI) for children deemed at-risk for an anxiety disorder(s). Ninety-eight children/adolescents, age 8-13, identified as "at risk" by a screening procedure involving the use of the Multidimensional Anxiety Scale for Children (MASC, March, Parker, Sullivan, Stallings, & Conners, 1997), are randomly assigned to either a GCBI or a group smoking education control condition (SEC). Groups consist of 5-6 children. The intervention study is a 7-week between-subjects comparison of GCBI and SEC with evaluation of outcome at post-intervention and durability of intervention effects at a 6-month follow-up.
WELL-BEING AMONG OVERWEIGHT ADOLECENTS, ROLE OF THE FAMILY IN HEALTHY FAMILIES, RELIGIOUSITY AND EMOTIONAL DEVELOPMENT
Chair: Tony Biglan
PROMOTING PSYCHOSOCIAL WELL-BEING AMONG OVERWEIGHT ADOLESCENTS: THE ROLE OF THE FAMILY. Jayne Fulkerson1, Jaine Strauss2, Dianne Neumark-Sztainer1, Mary Story1, Kerri Boutelle1, 1University of Minnesota, Minneapolis, MN United States; 2Macalester College, St. Paul, MN United States
Background: Adolescent obesity is a major public health problem. Twenty-two percent of US adolescents are overweight, and the prevalence of obesity has increased over the past few decades. Obesity is associated with increased morbidity, mortality, and negative psychosocial consequences. An important unanswered question relates to the role of parents in helping their overweight teens develop healthy eating patterns and experience positive emotional well-being. Hypotheses: The main hypothesis is that a supportive family environment will enhance the well-being of overweight adolescents. Further, we hypothesize that eating and weight-specific supportive factors within the home environment, such as family mealtime practices and the absence of weight-teasing, will enhance the well-being of overweight adolescents beyond associations with general family connectedness. Participants: Overweight (BMI > 85th percentile) adolescents (n=657 males, n=678 females) from an ethnically diverse school-based survey sample of 4746 students in grades 7 and 12 at 31 public middle schools and high schools. Analysis: Linear regression analyses, stratified by gender, were conducted to identify relationships between family variables (connectedness, making family meals a priority, positive family mealtime environment, orderliness (rules) of family meals, weight-based teasing by family members, and parental encouragement to diet) and weight-control behaviors and psychosocial well-being. Results: For both males and females, family connectedness scores were positively associated with self-esteem scores (p<.001), and negatively associated with depression scores (p<.001) and unhealthy weight-control behaviors (p<.001). Being teased about weight by family members was positively associated with depression scores (p<.001) and negatively associated with body satisfaction for both sexes (both p´s <.001), even after controlling for family connectedness. Among females, positive family meal environment was related to higher levels of self-efficacy for eating healthy foods and reports of healthy weight-control behaviors (both p´s <.001); likewise, making family meals a priority was negatively associated with unhealthy weight-control behaviors (p<.001). Conclusions: Family connectedness and the absence of family weight-based teasing are important for emotional well-being and the promotion of healthy weight-control behaviors among overweight youth. Our novel findings suggest that the family mealtime environment, including making family meals a priority and providing a positive atmosphere surrounding family meals, may further enhance the well-being of overweight adolescents, especially females.