D. Paul Moberg

Understanding Adolescent Intentions to Smoke: An Examination of Relationships Among Social Influence, Prior Trial Behavior, and Antitobacco Campaign Advertising

Telephone interviews were conducted with more than 900 adolescents aged 12 to 18 as part of a multimillion dollar, statewide, antitobacco advertising campaign. The interviews addressed two primary questions: (1) Do counter-advertising campaign attitudes directly affect antismoking beliefs and intent in a manner similar to those of conventional advertisements? and (2) Can advertising campaign attitudes have a stronger effect on beliefs and intent for adolescents with prior smoking behavior and for adolescents exposed to social influence (i.e., friends, siblings, or adult smoker in the home)? The authors’ findings show that advertising campaign attitudes, prior trial behavior, and social influence all directly affect antismoking beliefs and that advertising campaign attitudes interact with prior trial behavior to strengthen antismoking beliefs. The results indicate that attitudes related to the campaign, prior trial behavior, and social influence directly influence intent, and advertising campaign attitudes interact with social influence and prior trial behavior to attenuate adolescent intent to smoke. In addition, the effect of advertising campaign attitudes in attenuating social influence and prior trial behavior effects on adolescent intent to smoke persists even when the authors account for strongly held beliefs about smoking. The authors discuss implications for countermarketing communications and the design and understanding of future antismoking campaigns.

Recidivism to the Criminal Justice System of Substance-Abusing Offenders Diverted into Treatment

In 1989, Wisconsin funded Treatment Alternative Programs (TAP), based on the Treatment Alternatives to Street Crime (TASC) model, to provide treatment alternatives in lieu of imprisonment for substance-abusing offenders. TAPs goal is to break the offenders drug/crime cycle, using a case management model. Follow-up studies assessed TAP participant recidivism over an 18-month period. Client recidivism information since admission to TAP was obtained from numerous public sources, including probation/parole and court records. Results strongly suggest that offenders completing TAP are significantly less likely to recidivate than offenders not completing the program. Cost analyses suggest TAP can be more cost-effective than incarceration.

The Healthy for Life Project: Behavioral Outcomes

The Healthy for Life program was designed to positively influence the health behaviors of middle school students in five related areas: alcohol, tobacco and marijuana use, nutrition and sexuality. The in-school, social influences program was supplemented by parent and community components. Twenty-one schools were assigned to two treatment conditions or a random control. Students (n = 2,483) were surveyed annually from grade 6 until grade 10. The results indicate that overall Healthy for Life had minimal effect on the participating students relative to those in the control schools. The Intensive version of the program was more effective than an Age Appropriate version, with small positive results on four measures (frequency of meals, perceptions of peer use, cigarettes and marijuana smoked) and small negative effects for drinking alcohol. Implications for prevention theory are suggested.

Recovery High Schools: A Descriptive Study of School Programs and Students

ABSTRACT High schools specifically designed for students recovering from a substance use disorder (substance abuse or dependence) have been emerging as a continuing care resource since 1987. This study of 17 schools provides the first systematic description of recovery school programs and their students. The most common school model is that of a program or affiliated school, embedded organizationally and physically with another school or set of alternative school programs. Although embedded, there are serious efforts to maintain physical separation of recovery school students from other students, using scheduling and physical barriers. Affiliation with public school systems is the case for most recovery schools and seems to be a major factor in assuring fiscal and organizational feasibility. The students in the recovery high schools studied were predominantly White (78%), with about one-half from two parent homes. Overall parent educational levels suggest a higher mean socio-economic status (SES)than in the general population. Most students (78%) had prior formal treatment for substance use disorders, often concomitantly with treatment for mental health concerns, and were often referred by treatment providers. Students came with a broad and complex range of mental health issues, traumatic experiences, drug use patterns, criminal justice involvement, and educational backgrounds. The complexity of these problems clearly limits the enrollment capacity of the schools. Retrospective pretest-to-posttest analysis suggests significant reduction in substance use as well as in mental health symptoms among the students. Students were very positive in their assessment of the therapeutic value of the schools but less enthusiastic regarding the educational programs. The school programs appear to function successfully as continuing care to reinforce and sustain the therapeutic benefits students gained from their treatment experiences.

The Economic Impact of Diverting Substance-Abusing Offenders into Treatment

Recognizing the relationship between substance abuse and criminal behavior, the Wisconsin legislature in 1989 mandated the establishment of the Treatment Alternative Programs (TAP) modeled after the national Treatment Alternatives to Street Crime (TASC) program. This study evaluates the economic impact of TAP by examining the benefits and costs and cost-effectiveness of diverting offenders from the criminal justice system into substance abuse treatment. The results suggest that the benefits of TAP outweigh its costs in the short run and TAP costs less than incarcerating offenders.

Standardized Childhood Fitness Percentiles Derived from School-Based Testing

OBJECTIVE To develop a statewide school-based program of measuring and reporting cardiovascular fitness levels in children, and to create age- and sex-specific cardiovascular fitness percentile-based distribution curves. STUDY DESIGN A pilot study validated cardiovascular fitness assessment with Progressive Aerobic Cardiovascular Endurance Run (PACER) testing as an accurate predictor of cardiovascular fitness measured by maximal oxygen consumption treadmill testing. Schools throughout the state were then recruited to perform PACER and body mass index (BMI) measurement and report de-identified data to a centralized database. RESULTS Data on 20 631 individual students with a mean age 12.1 ± 2.0 years, BMI of 21.4 ± 5.1, and a cardiovascular fitness measured with PACER of 29.7 ± 18.2 laps (estimated maximal oxygen consumption of 36.5 mL/kg/min) were submitted for analysis. Standardized fitness percentiles were calculated for age and sex. CONCLUSIONS This study demonstrates the feasibility of performing, reporting, and recording annual school-based assessments of cardiovascular fitness to develop standardized childhood fitness percentiles on the basis of age and sex. Such data can be useful in comparing populations and assessing initiatives that aim to improve childhood fitness. Because health consequences of obesity result from both adiposity and physical inactivity, supplementation of BMI measurement with tracking of cardiovascular fitness adds a valuable tool for large-scale health assessment.

Collegiate Recovery Communities Programs: What Do We Know and What Do We Need to Know?

As the broad construct of recovery increasingly guides addiction services and policy, federal agencies have called for the expansion of peer-driven recovery support services. The high prevalence of substance use and abuse in colleges and universities in the United States constitutes a significant obstacle to pursuing an education for the unknown number of youths who have attained remission from substance use dependence. Collegiate recovery programs (CRPs) are an innovative and growing model of peer-driven recovery support delivered on college campuses. Although no systematic research has examined CRPs, available site-level records suggest encouraging outcomes: low relapse rates and above-average academic achievement. The number of CRPs nationwide is growing, but there is a noticeable lack of data on the model, its students, and their outcomes. We review the literature supporting the need for the expansion of CRPs, present information on the diversity of CRP services, and outline key areas where research is needed.

The effect of brief alcohol intervention on postpartum depression.

Purpose:To report on secondary results from the Healthy Moms Study, a clinical trial to test the efficacy of brief intervention on reducing alcohol use and alcohol-related harms in postpartum women. Study Design and Methods:Data from a randomized clinical trial conducted between 2002 and 2005 with a sample of Wisconsin women was analyzed. This report presents comparison data on depressive symptomatology between postpartum women drinking above recommended levels who received a brief alcohol intervention and those who received no intervention. Results:At 6-month follow-up, there was a significant reduction in mean depression scores compared to baseline in the women who received the alcohol intervention (p < .001). There was no significant reduction in depressive symptomatology in the control group. Mean level of depression at 6 months was significantly predicted by baseline depression and the alcohol intervention (p = .018). Alcohol use at either baseline or follow-up was not a predictive factor in determining mean depressive symptomatology. Clinical Implications:The results of the Healthy Moms Study support the importance of both alcohol and depression screening during the postpartum period. Brief alcohol intervention during this time may also positively affect depressive symptomatology.

Obtaining Active Parental Consent via Telephone in Adolescent Substance Abuse Prevention Research

There is ongoing concern among prevention researchers about how best to obtain parental consent for participation of minors in prevention trials involving confidential, but not anonymous, data collection from longitudinal panels of subjects. The requirement of written active parental consent leads to an inordinate level of case loss and very high costs in follow-up efforts to obtain consent. Passive consent procedures have been questioned and denied by many institutional review boards. This article reports on one solution to this problem-the acceptance of verbal active parental consent, obtained by telephone as a follow-up to mailings requesting written consent. Using this approach, we were able to contact a parent for 96% of the nearly 3,000 students being recruited for the Healthy for Life evaluation.

Characteristics of students participating in collegiate recovery programs: a national survey.

Relapse rates are high among individuals with substance use disorders (SUD), and for young people pursuing a college education, the high rates of substance use on campus can jeopardize recovery. Collegiate Recovery Programs (CRPs) are an innovative campus-based model of recovery support that is gaining popularity but remains under-investigated. This study reports on the first nationwide survey of CRP-enrolled students (N = 486 from 29 different CRPs). Using an online survey, we collected information on background, SUD and recovery history, and current functioning. Most students (43% females, mean age =26) had used multiple substances, had high levels of SUD severity, high rates of treatment and 12-step participation. Fully 40% smoke. Many reported criminal justice involvement and periods of homelessness. Notably, many reported being in recovery from, and currently engaging in multiple behavioral addictions-e.g., eating disorders, and sex and love addiction. Findings highlight the high rates of co-occurring addictions in this under-examined population and underline the need for treatment, recovery support programs and college health services to provide integrated support for mental health and behavioral addictions to SUD--affected young people.