Brent Teasdale

The Adolescent Substance Abuse Prevention Study: A randomized field trial of a universal substance abuse prevention program

OBJECTIVES The purpose of the study was to determine whether a universal school-based substance abuse prevention program, Take Charge of Your Life (TCYL), prevents or reduces the use of tobacco, alcohol, or marijuana. METHODS Eighty-three school clusters (representing school districts) from six metropolitan areas were randomized to treatment (41) or control (42) conditions. Using active consenting procedures, 19,529 seventh graders were enrolled in the 5-year study. Self-administered surveys were completed by the students annually. Trained Drug Abuse Resistance Education (D.A.R.E.) police officers presented TCYL in seventh and ninth grades in treatment schools. Analyses were conducted with data from 17,320 students who completed a baseline survey. Intervention outcomes were measured using self-reported past-month and past-year use of tobacco, alcohol, and marijuana when students were in the 11th grade. RESULTS Main effect analyses show a negative program effect for use of alcohol and cigarettes and no effect for marijuana use. Subgroup analyses indicated that the negative effect occurred among nonusers at baseline, and mostly among white students of both genders. A positive program effect was found for students who used marijuana at baseline. Two complementary papers explore the relationship of the targeted program mediators to the use of alcohol, tobacco, and marijuana and specifically for students who were substance-free or who used substances at baseline. CONCLUSIONS The negative impact of the program on baseline nonusers of alcohol and tobacco indicate that TCYL should not be delivered as a universal prevention intervention. The finding of a beneficial effect for baseline marijuana users further supports this conclusion. The programmatic and methodological challenges faced by the Adolescent Substance Abuse Prevention Study (ASAPS) and lessons learned offer insights for prevention researchers who will be designing similar randomized field trials in the future.

Adolescent Same-Sex Attraction and Mental Health: The Role of Stress and Support

This study draws on the social stress model from the sociology of mental health to examine the impact of same-sex attraction on depressed mood and suicidal tendencies. Specifically, we hypothesize that across multiple contexts, adolescents with same-sex attractions are likely to experience more social stress and less social support than heterosexual adolescents. In turn, these experiences increase the likelihood of negative mental health outcomes. Using data from the National Longitudinal Study of Adolescent Health (n = 11,911), we find that adolescents with same-sex attraction are more likely than their heterosexual counterparts to report depressed mood and suicidal tendencies. Moreover, stress and social support were found to mediate a substantial part of the relationship between same-sex attraction and depressed mood. In addition, stress and social support mediated about one third of the relationship between same-sex attraction and suicidal tendencies. These findings give strong support for the social stress model. We conclude with a discussion of the role that alienation plays in same-sex-attracted adolescent mental health.

The Influence of Being under the Influence Alcohol Effects on Adolescent Violence

The authors examine the relationship between intoxication, chronic alcohol use, and violent behavior using data from the National Longitudinal Study of Adolescent Health. The authors introduce a method for disentangling spuriousness from the causal effects of situational variables. Their results suggest that drinkers are much more likely to commit violence while sober than non-drinkers, suggesting that a considerable portion of the relationship between prevalence of drinking and violence is spurious. The authors find evidence of a causal effect of intoxication, however, when they examine the relationship between frequency of drinking and violence while sober or drinking. Intoxication has stronger effects on adolescents who are older, White, and who already have violent tendencies.

Methods for Synthesizing Findings on Moderation Effects Across Multiple Randomized Trials

This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Universal school-based substance abuse prevention programs: Modeling targeted mediators and outcomes for adolescent cigarette, alcohol and marijuana use

OBJECTIVE We examined the relationships among targeted constructs of social influences and competence enhancement prevention curricula and cigarette, alcohol and marijuana use outcomes in a diverse sample of high school students. We tested the causal relationships of normative beliefs, perceptions of harm, attitudes toward use of these substances and refusal, communication, and decision-making skills predicting the self-reported use of each substance. In addition, we modeled the meditation of these constructs through the intentions to use each substance and tested the moderating effects of the skills variables on the relationships between intentions to use and self-reported use of each of these substances. METHODS Logistic regression path models were constructed for each of the drug use outcomes. Models were run using the Mplus 5.0 statistical application using the complex sample function to control for the sampling design of students nested within schools; full information maximum likelihood estimates (FIML) were utilized to address missing data. RESULTS Relationships among targeted constructs and outcomes differed for each of the drugs with communication skills having a potentially iatrogenic effect on alcohol use. Program targets were mediated through the intentions to use these substances. Finally, we found evidence of a moderating effect of decision-making skills on perceptions of harm and attitudes toward use, depending upon the outcome. CONCLUSIONS Prevention curricula may need to target specific drugs. In addition to normative beliefs, perceptions of harm, and refusal and decision-making skills, programs should directly target constructs proximal to behavioral outcomes such as attitudes and intentions. Finally, more research on the effects of communication skills on adolescent substance use should be examined.

Mental Disorder and Violent Victimization

Much research has focused on violence committed by individuals with mental disorders, but their victimization experiences have received less attention. This literature indicates that individuals with mental disorders are at a significantly higher risk of violent victimization than are individuals with no such diagnosis, but few studies have attempted to provide or test a theoretical explanation for these differences. This study analyzes data from the MacArthur Violence Risk Assessment Study, a longitudinal study of individuals released from three psychiatric hospitals, to test the effects of theoretically derived risk factors for victimization. Based on multilevel growth curve models, the author finds that symptomatology, homelessness, and alcohol abuse significantly increase the risk of victimization for persons with major mental disorders. In addition, stress and gender interact, predicting victimization, suggesting that—for men—stress increases the odds of victimization. The implications of these findings for research and practice are discussed.

Implementation fidelity: the experience of the Adolescent Substance Abuse Prevention Study

While researchers have developed more effective programs and strategies to prevent the initiation of substance use and increasingly communities are delivering these interventions, determining the degree to which they are delivered as they were designed remains a significant research challenge. In the past several years, more attention has been given to implementation issues during the various stages of program development and diffusion. This paper presents the findings from a substudy of an evaluation of a newly designed middle and high school substance abuse prevention program, Take Charge of Your Life delivered by local Drug Abuse Resistance Education officer instructors. A key aspect of the study was to determine the extent to which implementation fidelity, using the measures of content coverage and appropriate instructional strategy, was associated with improvement in the program mediators of realistic normative beliefs, understanding the harmful effects of substance use and the acquisition of decision-making and resistance skills. Although it was found that higher fidelity was associated with better scores on some of the mediators, this was not a consistent finding. The mixed results are discussed within the context of the lesson activities themselves.

An Exploration of Gender Differences in Measurement of Fear of Crime

Most studies that investigate differences in fear of crime between men and women assume measurement invariance. This study explores gender differences in two different scales that measure fear of crime—a four-item factor from a survey of 1,918 southern Californians and an eight-item factor from a statewide survey of 4,245 Californians. Measurement invariance of these factors is assessed with two structural equations modeling techniques—a two-groups confirmatory factor analysis and a test for differential item function. Significant gender differences are found in the measurement of fear of crime. These are explained by the presence of items that measure fear of crimes with the potential for physical harm, particularly sexual assault. The findings suggest that gender differences in fear of crime may be overestimated by a factor of two if differential item function is ignored.

The Impact of Alcohol On Different Types of Violent Incidents

The research examined whether alcohol intoxication is a greater risk factor for some types of violence than others, using data from the National Violence Against Women and Men Survey (NVAW). Analyses indicated that offenders were much more likely to be intoxicated when they physically assaulted a stranger than when they assaulted someone they knew and least likely to be intoxicated when they assaulted an intimate partner. Offenders who committed sexual assaults were no more likely to be drinking than offenders who committed physical assault. It is argued that conflicts involving people who know each other are more intense and may lead to an assault without the facilitative effect of alcohol.

Trajectories of Recurring Victimization Among People With Major Mental Disorders

Relatively little is known about the violent victimization experiences of people with major mental disorders. Moreover, to date, no studies have examined recurring violent victimization experiences of people with major mental disorders. Using a risk heterogeneity framework commonly used in the study of recurring victimization, the current study examines the extent of recurring victimization among people with Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I mental disorders and trajectories of recurring violent victimization (n = 262), across four waves of data collected during a 1-year longitudinal study. Multilevel logistic regression analyses tested disorder, time, and time by disorder cross-level interactions predicting recurring victimization. Results suggest that recurring violent victimization is not uncommon among mentally disordered victims of violence, with 64% of victims experiencing a recurring victimization at a later point in time. However, trajectories of recurring violent victimization are not uniform across types of mental illness. Indeed, individuals diagnosed with a substance abuse disorder or major depression show significantly declining trajectories across the follow-up period whereas individuals diagnosed with a manic disorder or a schizophrenia spectrum disorder have flat trajectories of recurring violent victimization across the study period. Results of tests for cross-level interactions between disorder type and time demonstrate that individuals with a major depression or substance abuse/dependence diagnosis are significantly different from those with a schizophrenia spectrum diagnosis in their trajectories of recurring victimization.