Elaine Adams Thompson

Preventing Adolescent Drug Abuse and High School Dropout Through an Intensive School-Based Social Network Development Program

Purpose. The hypothesis tested was that experimental subjects, relative to controls, would demonstrate significant increases in school performance and decreases in drug involvement at program exit (5 months) and at follow-up (10 months). Design. A two-group, repeated-measures, intervention trial was the design used. Setting. The study involved four urban Northwest high schools. Subjects. Participants included 259 youth at high risk of potential school dropout, 101 in the experimental group and 158 in the control group. Intervention. The Personal Growth Class experimental condition was a one-semester, five-month elective course taken as one of five or six regular classes. It had a 1:12 teacher-student ratio, and integrated group support and life-skills training interventions. The control condition included a regular school schedule. Measures. School performance measures (semester GPA, class absences) came from school records. Drug use progression, drug control, and adverse consequences were measured by the Drug Involvement Scale for Adolescents. Self-esteem, school bonding, and deviant peer bonding were measured using the High School Questionnaire: Inventory of Experiences. All multi-item scales had acceptable reliability and validity. Results. As predicted, trend analyses revealed significantly different patterns of change over time between groups in drug control problems and consequences; in GPA (but not attendance); and in self-esteem, deviant peer bonding, and school bonding. The program appeared to stem the progression of drug use, but group differences only approached significance. Conclusion. Program efficacy was demonstrated particularly for decreasing drug control problems and consequences; increasing GPA and school bonding; and desired changes in self-esteem and deviant peer bonding. Program effects on progression of drug use were less definitive.

Long-term outcomes of a telephone intervention after an ICD.

Background: The purpose of this study was to determine the long‐term benefits of participating in a structured, 8‐week educational telephone intervention delivered by expert cardiovascular nurses post‐ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self‐efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post‐ICD. This article reports on the 6‐ and 12‐month outcomes of the nursing intervention trial.

Short-term efficacy of a telephone intervention by expert nurses after an implantable cardioverter defibrillator.

The ICD is a common therapy for treatment of ventricular arrhythmias and prevention of sudden cardiac death. After ICD therapy, 50% of survivors are known to have significantly elevated anxiety, depression, anger, and fear in getting back to normal physical activities. Despite these problems, few interventions to improve adjustment have been rigorously evaluated within a clinical trial format. This article reports the short‐term efficacy of a structured weekly educational telephone intervention (8 weeks) delivered by expert cardiovascular nurses to recipients of an ICD. To test these effects, a two‐group (n = 84/group) randomized clinical trial design was used with measures at baseline (hospital discharge), 1 month, and 3 months after ICD therapy. The study sample were first time ICD recipients for secondary prevention of sudden cardiac arrest. Primary outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short‐Form Health Survey [SF‐12], ICD shocks), (2) psychological adjustment (State‐Trait Anxiety Inventory [STAI]), Centers for Epidemiologic Studies‐Depression (CES‐D), (3) knowledge (Sudden Cardiac Arrest [SCA] knowledge assessment), and (4) health care use (emergency room visits, outpatient visits, hospitalizations). The intervention group, as compared to the control group, significantly reduced mean PCA symptoms at 1 month (11.3–8.8 vs 9.7–9.3, respectively, P < 0.02), and reduced state anxiety (36.1–31.9 vs 33.1–33.0, respectively, P < 0.08), and enhanced knowledge (21.8–22.4 vs 21.4–21.7, respectively, P < 0.02) at 3 months. The intervention did not significantly impact short‐term health care use. A structured telephone intervention delivered during the first 8 weeks after ICD therapy by expert cardiovascular nurses decreased ICD related physical symptoms and anxiety, and increased SCA knowledge over 3 months.

Prevention Research Program: Reconnecting At-Risk Youth

This research program focuses on some of societys most profound problems: adolescent drug involvement, school failure, and suicide behaviors. The program goals address several interdisciplinary research challenges: (a) testing theory-driven preventive interventions focusing on the multifaceted etiology of adolescent drug involvement and suicide potential; (b) targeting potential school dropouts from a distinctly underserved high-risk population; and (c) integrating preventive interventions into school-based programs that utilize a multidisciplinary team of clinicians and researchers. Three sets of studies are described; they illustrate how ethnographic, experimental, and causal modeling designs and methods were intricately woven in successive theory construction and testing steps. Ethnographic and etiologic studies revealed a profile of vulnerabilities in personal, peer, family, and school contexts. Instrumentation studies led to reliable and valid process and outcome measures of key constructs. Tests of the preventive intervention demonstrated its efficacy for decreasing school deviance, drug involvement, and suicide potential among high-risk youth.

Protective effects of self-esteem and family support on suicide risk behaviors among at-risk adolescents.

PROBLEM If and how family support and self-esteem might interact to protect against adolescent suicide risk is not well understood. METHODS Hierarchical multiple regression was used to examine the moderating effect of family support on the relationship between self-esteem and suicide risk behaviors among potential high school dropouts (N = 849), using questionnaires and in-depth assessment interviews. FINDINGS Family support moderated the impact of self-esteem on suicide risk; the ameliorating effect of self-esteem was stronger among adolescents with low versus high family support. CONCLUSIONS Self-esteem influences adolescent suicide risk behaviors for youth with low as well as high family support. Interventions designed to strengthen both self-esteem and support resources are appropriate.

The relationship of physical activity to health status and quality of life in cerebral palsy

Purpose: To compare the influence of functional level, ambulatory, and physical activity performance on self-reported health status and quality of life (QOL) of youth with cerebral palsy (CP) and with typical development. Methods: A cross-sectional comparison cohort design was used in 81 youth with CP, ages 10 to 13 years and 30 youth with typical development. Participants wore the StepWatch™ monitor for 7 days and completed the Activity Scale for Kids, Child Health Questionnaire-Child Form, and Youth Quality of Life Questionnaire. Multiple regression analysis was used. Results: Self-reported activity performance influenced self-reported physical (β = 0.36), behavioral (β = 0.32), and emotional (β = 0.29) health. Functional level and performance did not influence QOL. Conclusions: Measures of ambulatory and physical activity and youth-reported health status separated from the measure of QOL seem helpful in defining the specific health issues of ambulatory youth with CP and have implications for physical activity intervention.

Power and equity: what counts in attributions for exchange outcomes?

This study combines two of the major theoretical perspectives in social psychology: social exchange and attribution theory. We propose a theoretical model that depicts the influence of two fundamental social factors―structural power and outcome equity―on causal attributions for exchange outcome, which in turn mediate behavioral reactions to the exchange outcomes. We manipulate the social factors in a vignette describing an exchange between a female typist and another student (male or female) who needs a paper typed. Female subjects play the role ot the typist and respond to a series of questions about their perceptiosn of the situation

Multi-System Influences on Adolescent Risky Sexual Behavior

We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.

Enhancing Outcomes in an Indicated Drug Prevention Program for High-Risk Youth

This study examined the net effects of refining a high school-based indicated drug prevention program. The Personal Growth Class (PGC), tailored to meet the needs of high-risk youth, was designed to increase control of drug use, school performance, and emotional well-being. The program integrates social support and life-skills training. Process evaluation revealed the need for program enhancements to address underestimated levels of depression, anger, and suicidal behaviors prevalent among high-risk youth and to ensure that core content was being emphasized consistently. Youth participating in Late cohorts received the refined PGC with enhanced skills training. Study participants (N = 280) were youth, primarily ages fifteen to seventeen, at high-risk for school failure or dropout. Indicators of emotional well-being (e.g., depression, stress, anger, self-esteem, personal control), drug involvement, and school performance were compared for Late versus Early cohorts. Regression analyses revealed the Late versus Early cohorts showed significantly greater decreases in hard drug use, depression, perceived stress, and anger; and greater increases in self-esteem. The results support arguments that effective indicated prevention programs should target specific high-risk youth employing strategies to counteract the multifaceted risk factors they experience and enhance needed protective factors.

Understanding Factors That Influence Success of Home- and Community-Based Services in Keeping Older Adults in Community Settings

Objectives: To understand factors that influence success of home- and community-based services in keeping older adults in community settings, we examined the causal relationships among older adults’ personal factors, older adults’ home- and community-based services use, and older adults’ remaining in communities. Methods: Structural equation modeling was employed to test a home- and community-based services model based on Andersen’s Health Behavioral Model. Data from 5,294 elders in a nationally representative dataset, the Second Longitudinal Study of Aging, were included for analysis. Results: Two significant supportive factors for older adults to remain in communities were use of paid instrumental activities of daily living (IADL) personal care services and awareness of unmet needs. Discussion: Our findings suggest the importance of encouraging older adults to acknowledge their unmet needs and to seek community-based support services early, rather than wait until they have developed more serious needs, such as difficulties in activities of daily living (ADL).