Eli Baker

A cognitive-behavioral approach to substance abuse prevention☆

The effectiveness of a 20 session cognitive-behavioral approach to substance abuse prevention was tested on seventh grade students (n = 1,311) from 10 suburban New York junior high schools. The prevention strategy attempted to reduce intrapersonal pressure to smoke, drink excessively, or use marijuana by fostering the development of general life skills as well as teaching students tactics for resisting direct interpersonal pressure to use these substances. Additionally, this study was designed to compare the relative effectiveness of this type of prevention program when implemented by either older peer leaders or regular classroom teachers. Results indicated that the prevention program had a significant impact on cigarette smoking, excessive drinking, and marijuana use when implemented by peer leaders. Furthermore, significant changes were also evident with respect to selected cognitive, attitudinal, and personality predisposing variables in a direction consistent with non-substance use. These results provide further support for the efficacy of a broad-spectrum smoking prevention strategy and tentative support for its applicability to the prevention of other forms of substance abuse.

A cognitive-behavioral approach to substance abuse prevention: One-year follow-up.

This study presents one-year follow-up data from an evaluation study testing the effectiveness of a cognitive-behavioral substance abuse prevention approach which emphasizes the teaching of social resistance skills within the larger context of an intervention designed to enhance general social and personal competence. The follow-up study involved 998 eighth graders from 10 suburban New York junior high schools. Two schools were assigned to each of the following conditions (a) peer-led intervention, (b) peer-led intervention with booster sessions, (c) teacher-led intervention, (d) teacher-led intervention with booster sessions, and (e) control. The original intervention was implemented in the seventh grade; the booster intervention was implemented during the eighth grade. Results indicate that this type of prevention strategy, when implemented by peer leaders in the seventh grade and when additional booster sessions are provided during the eighth grade, can reduce tobacco, alcohol, and marijuana use. Similar effects are evident for females when the prevention program is implemented with fidelity by classroom teachers. Moreover, the prevention program is also capable of producing a significant impact on several hypothesized mediating variables.

Smoking prevention among urban minority youth: assessing effects on outcome and mediating variables.

We tested the effectiveness of a social resistance/competence enhancement approach to smoking prevention among predominantly Hispanic seventh graders (N = 3,153) from 47 New York City schools. After blocking on school type (public and parochial) and ethnic composition (percent Hispanic), schools were randomly assigned either to receive the 15-session prevention program or to serve as no-contact controls. Using the school as the unit of analysis, significant program effects were found for cigarette smoking, normative expectations concerning peer and adult smoking, smoking prevalence knowledge, social acceptability knowledge, and knowledge of smoking consequences. Using structural modeling techniques, a significant relation was found between the normative expectation and knowledge variables affected by the intervention and posttest smoking, suggesting that changes on these variables mediated the impact of the intervention on cigarette smoking. This study extends the results of previous prevention research and demonstrates the generalizability of this approach to predominantly Hispanic urban minority students.

A skills training approach to smoking prevention among hispanic youth

The present study was designed to test the feasibility, acceptability, and effectiveness of a 15-session smoking prevention intervention with a predominantly hispanic (74%) sample of seventh-grade students (N=471) in eight urban schools in the New York area. The smoking prevention curriculum teaches social resistance skills within the context of a broader intervention promoting general personal and social competence and was implemented in this study by regular classroom teachers. Results of logistic regression analyses provided preliminary evidence of the efficacy of this type of smoking prevention strategy with urban minority youth when implemented with a reasonable degree of fidelity. The significance of these findings is that they provide support for the generalizability of an approach previously found to be effective with white middle-class populations to a predominantly hispanic inner-city population.

The effects of scheduling format and booster sessions on a broad-spectrum psychosocial approach to smoking prevention

The effectiveness of a fifteen session psychosocial smoking prevention strategy was tested on 902 seventh graders from seven junior high schools in suburban New York over 2 years. The prevention program was implemented by regular classroom teachers and consisted of a cognitive component dealing with the immediate consequences of cigarette smoking, a decision-making component, a relaxation-training component, a social skills training component, and a self-improvement component. In addition to testing the overall effectiveness of this approach, the relative efficacy of two different scheduling formats was compared and the extent to which “booster” sessions conducted during the year after completion of the program helped to maintain reductions in new smoking was also examined. Results indicated that the prevention program was able to reduce new cigarette smoking by 50% at the end of the first year and by 55% at the end of the second year for the intensive format condition. New regular cigarette smoking was reduced by 87% in the second year for the students in the booster condition. Significant changes consistent with nonsmoking were also evident on several cognitive, attitudinal, and personality variables.

CORRELATES AND PREDICTORS OF SMOKING AMONG BLACK ADOLESCENTS

Little is known about the etiology of cigarette smoking among minority populations. This study examines the correlates and predictors of smoking among inner-city black seventh graders (N = 608). Enhanced self-reports of cigarette smoking were collected along with data concerning demographic, social, and psychological factors hypothesized to promote smoking initiation. Results indicate that social environmental factors, such as the smoking status of friends and siblings, and individual factors, such as refusal assertiveness, general assertiveness, and age are predictive of current smoking. Similarly, the smoking status of friends, attitudes concerning the harmful effects of smoking, and low self-esteem concerning schools are predictive of behavioral intention to smoke in the future. Overall, the factors that were the most salient predictors of smoking for the black adolescents in this study are generally congruent with the existing literature for other populations.

Dimensions of Assertiveness: Differential Relationships to Substance Use in Early Adolescence

We tested a multidimensional formulation of assertiveness and substance (tobacco, alcohol, and marijuana) use in 3 metropolitan-area school samples of adolescents aged 12-14 years. Three studies (N = 675, N = 1,430, and N = 5,545) included inner-city and surburban settings and included White, Black, and Hispanic students. Factor analysis of versions of the Gambrill-Richey Assertion Inventory indicated five independent dimensions of assertive behavior. Multiple regression analysis indicated that a dimension of Substance-specific Assertiveness was inversely associated with substance use, whereas dimensions of Social Assertiveness and Dating Assertiveness were positively associated with substance use. A dimension of General Assertiveness was unrelated to substance use. Interaction effects indicated that relations were stronger for girls for Substance and Social Assertiveness and for boys for Dating Assertiveness. Implications of the findings for models of assertive behavior and for design of primary prevention programs are discussed.

NORMATIVE EXPECTATIONS AND THE BEHAVIOR OF SIGNIFICANT OTHERS: AN INTEGRATION OF TRADITIONS IN RESEARCH ON ADOLESCENTS' CIGARETTE SMOKING

Normative expectations for cigarette smoking are considered in the context of the smoking behavior which 854 adolescents in Grade 7 ascribe to their friends and parents.

Developmental Changes in Attitudes toward Cigarette Smokers during Early Adolescence

Attitudes of 104 sixth, 137 seventh, and 110 eighth graders concerning the social image of cigarette smoking were examined to identify potential developmental differences. Significant differences were found between the attitudes of sixth, seventh, and eighth graders; sixth graders had the least positive attitudes and the eighth graders the most positive attitudes. A significant interaction of sex × grade was also evident; the sixth grade boys had the least favorable attitudes toward smokers. No significant differences were evident between students who had friends who smoke and those who did not. These findings suggest that, in addition to the many other developmental changes occurring during early adolescence, there is a shift toward a more positive social image of cigarette smoking that is unrelated to the smoking status of friends.

Smokeless tobacco use among adolescents: correlates and concurrent predictors.

Seventh grade students (N = 1539) from three regions of New York State were surveyed to determine the prevalence of smokeless tobacco use and its relationship to seven background variables, 13 substance use variables, and 19 psychosocial variables. Significant correlations with smokeless tobacco use were found within each of these variable domains. Concurrent predictors for each domain were determined using logistic regression analysis. The resulting three models were combined in a stepwise fashion in an effort to determine the most complete prediction model. The final model indicated that individuals at the highest risk for using smokeless tobacco were rural males who had smoked more than four cigarettes in their lifetime, were more heavily involved with alcohol, had a lower degree of assertiveness and social anxiety, and had reported eating as a coping response. Implications for prevention are discussed.