Dennis V. Ary

Development of Adolescent Problem Behavior

The developmental model of adolescent antisocial behavior advanced by Patterson and colleagues (e.g., Patterson, Reid, & Dishion, 1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent–child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers were strong predictors of engagement in problem behavior. These constructs accounted for 46% of the variance in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process.

The Influence of Parent, Sibling, and Peer Modeling and Attitudes on Adolescent Use of Alcohol

This 1-year prospective study of 173 families with two or more children examines the influence of parent, sibling, and peer modeling (i.e., use) and attitudes on adolescent use of alcohol. Independent questionnaire data were obtained from the adolescent, father, mother, and sibling(s). Structural equation modeling methods were employed to examine these relationships. Parent attitude toward youth alcohol use and parent modeling of alcohol use were strongly related to change in adolescent alcohol use, suggesting that parents can influence the future use of alcohol by their children. Peer and sibling modeling and peer attitudes also influenced adolescent alcohol use.

Adolescent problem behavior: the influence of parents and peers.

This paper presents evidence that the Patterson et al. (1992) model of development of antisocial behavior in children generalizes to the development of a wide array of problem behaviors during later adolescence and that youth antisocial behavior, high-risk sexual behavior, academic failure and substance use form a single problem behavior construct. Structural equation modeling methods were applied to 24-month longitudinal data from 204 adolescents and parents. The model fit the data well, accounting for 52% of the variance in adolescent problem behavior. Specifically, families experiencing high levels of conflict were more likely to have low levels of parent-child involvement. These family conditions were related to poor parental monitoring and association with deviant peers one year later. Poor parental monitoring and associations with deviant peers were strong proximal predictors of engagement in an array of problem behaviors at two-year follow-up.

The Value of Interrupted Time-Series Experiments for Community Intervention Research

Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes.

A randomised control study of a fully automated internet based smoking cessation programme

Objective: The objective of this project was to test the short term (90 days) efficacy of an automated behavioural intervention for smoking cessation, the “1-2-3 Smokefree” programme, delivered via an internet website. Design: Randomised control trial. Subjects surveyed at baseline, immediately post-intervention, and 90 days later. Settings: The study and the intervention occurred entirely via the internet site. Subjects were recruited primarily via worksites, which referred potential subjects to the website. Subjects: The 351 qualifying subjects were notified of the study via their worksite and required to have internet access. Additionally, subjects were required to be over 18 years of age, smoke cigarettes, and be interested in quitting smoking in the next 30 days. Eligible subjects were randomly assigned individually to treatment or control condition by computer algorithm. Intervention: The intervention consisted of a video based internet site that presented current strategies for smoking cessation and motivational materials tailored to the user’s race/ethnicity, sex, and age. Control subjects received nothing for 90 days and were then allowed access to the programme. Main outcome measures: The primary outcome measure was abstinence from smoking at 90 day follow up. Results: At follow up, the cessation rate at 90 days was 24.1% (n  =  21) for the treatment group and 8.2% (n  =  9) for the control group (p  =  0.002). Using an intent-to-treat model, 12.3% (n  =  21) of the treatment group were abstinent, compared to 5.0% (n  =  9) in the control group (p  =  0.015). Conclusions: These evaluation results suggest that a smoking cessation programme, with at least short term efficacy, can be successfully delivered via the internet.

Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin-dependent diabetes mellitus.

This study assessed potential psychosocial correlates of self-care behaviors (compliance) and of glycemic control in a community sample of 184 people diagnosed as having non-insulin-dependent (type II) diabetes mellitus. Four different diabetes self-care behaviors were studied (medication taking, glucose testing, diet, and exercise), and glycemic control was assessed by glycosylated hemoglobin analyses. Multiple measures were collected within each of several categories of psychosocial variables including knowledge, stress, depression, anxiety, diabetes-specific health beliefs, and social support. Findings indicate that ∼25% of the variance in self-care behaviors can be explained by psychosocial and demographic variables. In contrast, psychosocial variables were not significant predictors of level of glycemic control. The diabetes-specific psychosocial measures of health beliefs and social support were the most consistent and strongest predictors of self-care behavior across the different regimen areas studied. Possible reasons for these findings, limitations of the study, and directions for future research are discussed.

Contributions of the social context to the development of adolescent substance use: a multivariate latent growth modeling approach

This article demonstrates a latent growth curve methodology for analyzing longitudinal data of adolescent substance use. Hypotheses concerning the form of growth in alcohol, cigarette, and marijuana use, and covariates influencing the form of growth, were tested. Participants were male and female adolescents (n = 664) assessed at three time points. A common trajectory existed across the developmental period with significant increases in all three substances. Second-order multivariate extensions of the basic latent growth modeling framework suggested that associations among the individual differences parameters, representing growth or change in the various substance use behaviors, could be adequately modeled by a higher-order substance use construct. Inept parental monitoring, parent-child conflict, peer deviance, academic failure, gender, and age, were significant predictors of initial levels and the trajectory of substance use.

Patient Perspective on Factors Contributing to Nonadherence to Diabetes Regimen

This study assessed levels of regimen adherence and reasons for nonadherence to different aspects of diabetes regimen for persons with type I (insulin-dependent, N = 24) and type II (non-insulin-dependent, N = 184) diabetes. Standardized questions revealed few differences between type I and type II participants on either levels of reported adherence or reasons for nonadherence. Subjects reported adhering least well to dietary and physical activity components of the regimen. Open-ended questions revealed that the most common reasons for dietary nonadherence were the situational factors of eating out at restaurants and inappropriate food offers from others. In contrast, negative physical reactions were the most frequently reported reasons for exercise nonadherence. The implications of these findings for diabetes education are discussed.

A randomised controlled trial of a community intervention to prevent adolescent tobacco use

OBJECTIVE Experimental evaluation of comprehensive community wide programme to prevent adolescent tobacco use. DESIGN Eight pairs of small Oregon communities (population 1700 to 13 500) were randomly assigned to receive a school based prevention programme or the school based programme plus a community programme. Effects were assessed through five annual surveys (time 1–5) of seventh and ninth grade (ages 12–15 years) students. INTERVENTION The community programme included: (a) media advocacy, (b) youth anti-tobacco activities, (c) family communications about tobacco use, and (d) reduction of youth access to tobacco. MAIN OUTCOME MEASURE The prevalence of self reported smoking and smokeless tobacco use in the week before assessment. RESULTS The community programme had significant effects on the prevalence of weekly cigarette use at times 2 and 5 and the effect approached significance at time 4. An effect on the slope of prevalence across time points was evident only when time 2 data points were eliminated from the analysis. The intervention affected the prevalence of smokeless tobacco among grade 9 boys at time 2. There were also significant effects on the slope of alcohol use among ninth graders and the quadratic slope of marijuana for all students. CONCLUSION The results suggest that comprehensive community wide interventions can improve on the preventive effect of school based tobacco prevention programmes and that effective tobacco prevention may prevent other substance use.

Longitudinal changes in adolescent cigarette smoking behavior: Onset and cessation

Employing a 1-year longitudinal design, this study examined factors related to change in adolescent smoking. Predictors of smoking onset differed from predictors of continued smoking, underscoring the importance of studying factors related to adolescent smoking onset separately from mechanisms associated with changes in smoking among current smokers. Peer smoking predicted continuation of smoking after smoking initiation. Smokers received over 26 times more offers to smoke than did nonsmokers, suggesting that smokers attempting to quit need effective refusal skills to be successful. Habitual smoking was found to develop slowly, providing a substantial time window for refusal skill training and other prevention efforts. Predictors of smoking onset differed by developmental level. Peer smoking and marijuana use were stronger predictors of smoking onset for high-school students, and number of cigarette offers predicted better among middle-school students. Parent variables were not significant predictors of later smoking. Intention to smoke was unrelated to onset and was redundant with pretest smoking behavior in predicting cessation.