Elizabeth R. Woods

Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program

OBJECTIVE. To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist, we compared those in a multisite randomized trial of such a program over the first 3 years of life (INT) to those with follow-up only (FUO) at 18 months of age. METHODS. This was a prospective follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics. Originally 985 children were randomized to the INT (n = 377) or FUO (n = 608) groups within 2 birth weight strata: heavier low birth weight (HLBW; 2001–2499 g) and lighter low birth weight (LLBW; ≤2000 g). Primary outcome measures were the Peabody Picture Vocabulary Test (PPVT-III), reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement, youth self-report on the Total Behavior Problem Index, and high-risk behaviors on the Youth Risk Behavior Surveillance System (YRBSS). Secondary outcomes included Weschler full-scale IQ, caregiver report on the Total Behavior Problem Index, and caregiver and youth self-reported physical health using the Medical Outcome Study measure. Assessors were masked as to study status. RESULTS. We assessed 636 youths at 18 years (64.6% of the 985, 72% of whom had not died or refused at prior assessments). After adjusting for cohort attrition, differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math (5.1 points), YRBSS (−0.7 points), and the PPVT-III (3.8 points) in the HLBW youth. In the LLBW youth, the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group (4.2). CONCLUSIONS. The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk. The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention.

The association of sexual risk behaviors and problem drug behaviors in high school students

PURPOSE To examine the associations among early age of onset of sexual intercourse and drug use, lifetime and current problem drug behaviors, and sexual risk behaviors. METHODS The 1993 Massachusetts Youth Risk Behavior Survey was administered to a sample of 3,054 students from randomly selected high schools and classrooms; 36% (1,078) consistently reported having had sexual intercourse. Three indicators of sexual risk behaviors were assessed: (1) number of lifetime sexual partners, (2) number of recent partners, and (3) condom nonuse at last intercourse. Three sets of independent variables were analyzed: (1) age of onset of sexual intercourse and drug use, (2) lifetime drug use, and (3) recent drug use. RESULTS Years of sexual intercourse, early age of onset of marijuana and cocaine use, lifetime frequency of marijuana, crack/freebase cocaine and alcohol use, and black race accounted for moderate amounts of the variation in the number of lifetime sexual partners. Years of sexual intercourse, early age of onset of marijuana use and cocaine use, lifetime frequency of crack/freebase and marijuana use, and recent use of cocaine, alcohol, and cigarettes accounted for smaller but significant amounts of the variation in the number of recent partners. Students more likely to report recent condom nonuse were older, females, had more years of sexual intercourse, had tried cocaine at a younger age, had used marijuana and cocaine more times (lifetime), and had more frequent recent use of marijuana. CONCLUSION Increased frequency and severity of drug use behaviors and more years of sexual intercourse are associated with an increased number of sexual partners and recent condom nonuse. These findings may guide history-taking and referral practices of health care providers. Programs designed to prevent sexually transmitted diseases and pregnancy should address drug use as well as sexual behavior.

Association of adolescent risk behaviors with mental health symptoms in high school students

PURPOSE To examine the hypothesis that self-reported symptoms of depression and stress may be associated with other risk behaviors. METHODS A secondary data analysis of the 1992 Massachusetts Adolescent Health Survey involving a representative sample of 2,224 ninth and twelfth grade students was performed. The dichotomous dependent variable was positive if the adolescent reported feeling depressed or stressed for 10 or more days in the past month. Potential independent variables examined were age, gender, race/ethnicity, and 14 risk or protective behaviors: each scored on a seven point scale representing increasing frequency of a behavior in the past month. A four-level sexual risk variable was constructed as well. Associations were assessed using Chi-square, and phi/contingency coefficients, and logistic regression analyses to predict the odds of reporting depression/stress. RESULTS The mean age of the sample was 16.2 +/- 1.6 years; 52% males; 78% were white, 9% black, 6% Latino, 2% Asian, and 4% other racial/ethnic heritage; 35% reported feeling depressed/stressed > or = 10 days in the past month. A logistic regression model found that feelings of depression/stress were associated with increasing age (OR = 1.09 with each additional year [95% CI, 1.02-1.18]), female gender (3.28 [2.62-4.12]); increasing levels of tobacco use (1.07 [1.01-1.12]), physical fights (1.19 [1.11-1.28]); and non-use of birth control compared with never having been sexually active (1.81 [1.31-2.49]). Independent variables of reporting depression/stress for males included increasing age (1.15 [1.03-1.28]), and physical fights (1.20 [1.10-1.30]), and non-use of birth control compared with never sexually active (1.91 [1.28-2.92]). Independent risk and protective factors for females included tobacco use (1.10 [1.02-1.19]), healthy diet (0.89 [0.83- 0.96]), and always (1.49 [1.03-2.28]) or sometimes used birth control (1.56 [1.03-1.28]) compared with never sexually active. CONCLUSIONS Female gender had greater than threefold increased odds of reporting depression/stress. Other associations, with some gender differences, include older age, physical fights, non-use of birth control, lack of a healthy diet, and use of tobacco.

Tobacco and alcohol use behaviors portrayed in music videos: a content analysis.

OBJECTIVES Music videos from five genres of music were analyzed for portrayals of tobacco and alcohol use and for portrayals of such behaviors in conjunction with sexuality. METHODS Music videos (n = 518) were recorded during randomly selected days and times from four television networks. Four female and four male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. All videos were observed by rotating two-person, male-female teams who were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi-squared tests. RESULTS A higher percentage (25.7%) of MTV videos than other network videos portrayed tobacco use. The percentage of videos showing alcohol use was similar on all four networks. In videos that portrayed tobacco and alcohol use, the lead performer was most often the one smoking or drinking and the use of alcohol was associated with a high degree of sexuality on all the videos. CONCLUSIONS These data indicate that even modest levels of viewing may result in substantial exposure to glamorized depictions of alcohol and tobacco use and alcohol use coupled with sexuality.

Exposure to violence and victimization and depression, hopelessness, and purpose in life among adolescents living in and around public housing.

This study examines the relationships between exposure to violence and depression, hopelessness, and purpose in life among black adolescents living in or around public housing developments. Black adolescents (N= 225, males = 44%) ages 11 to 19 years in a southern city were administered an anonymous questionnaire. Depression was correlated with the exposure to violence (r= .28), family conflict (r= .29), and corporal punishment (r= .32) scales, perceived probability of being alive at age 25 years (r = -.14), socioeconomic status of head of household (r = .14), anticipated socioeconomic status as an adult (r = .21), and number of sexual partners (r = .22). Based on multiple regression analysis, corporal punishment, family conflict, educational level of head of household, and perceived probability of being alive at age 25 years explained 18% (p ≤ .0001) of the variation in depression. Family conflict, corporal punishment, and unemployed head of household explained 11% of the variation in the hopelessness scale. Unemployed head of household, the corporal punishment scale, and number of sexual partners explained 9.7% of the variation in purpose in life. Even when accounting for other social factors, exposure to violence in the home was associated with psychological distress in this sample of adolescents.

The association between weapon carrying and the use of violence among adolescents living in and around public housing

PURPOSE To test the hypothesis that adolescents who carry lethal weapons are more likely to engage in violent behavior than adolescents who do not carry weapons. DESIGN Cross-sectional Survey. SUBJECTS Black adolescents (N = 225) from a lower socioeconomic (SES) background living in or around nine Housing and Urban Development housing projects. MEASUREMENTS An anonymous questionnaire containing scales from the CDC Youth Risk Behavior Survey and Self-Reported Delinquency Questionnaire was administered. Data were analyzed with Spearman rho correlation coefficients (r), followed by partial correlation coefficients controlling for age and gender. RESULTS Thirty-five percent of males and 16% of females reported carrying a weapon during the previous 30 days. Frequency of weapon-carrying was correlated (r = .33, p < or = 0.0001). with the frequency of physical fights in the last month, but the relationship was stronger among males than females. Weapon-carrying was also associated (r = .20, p < or = 0.003) with frequency of receiving a serious injury during a fight and the frequency of attacking someone with a weapon with the idea of seriously hurting or killing them (r = .48, p < or = 0.0001). Although males were more likely to carry a hidden weapon than females, the frequency of weapon-carrying was more highly correlated with the frequency of carrying a hidden weapon by females (r = .63, p < or = 0.0001) than males (r = .49, p < or = 0.0001). Females who carried weapons were more likely than males to be involved in gang fights. Among males (r = .27, p < or = 0.008), frequency of weapon-carrying was correlated with frequency of attacking someone with whom they lived. This was not so among females (r = .02). CONCLUSION These data support the hypothesis that the lower SES black adolescents in this sample who carried weapons were more likely to engage in violent behaviors than those who did not carry weapons.

Body modification and substance use in adolescents: is there a link?

PURPOSE To describe the characteristics of body modification among adolescents and to determine whether adolescents who engage in body modification are more likely to screen positive for alcohol and other drug problems than those who do not. METHODS Adolescents aged 14 to 18 years presenting to an urban adolescent clinic for routine health care completed a questionnaire about body modification and a substance use assessment battery that included the 17-item Problem Oriented Screening Instrument for Teenagers Alcohol/Drug Use and Abuse Scale (POSIT-ADS). Body modification was defined as piercings (other than one pair of bilateral earlobe piercings in females), tattoos, scarification, and branding. Problem substance use was defined as a POSIT-ADS score > or =1. Data were analyzed using logistic regression to determine whether the presence of body modification was an independent predictor of problem substance use. RESULTS The 210 participants had a mean (+/- SD) age of 16.0 (+/- 1.4) years and 63% were female. One hundred adolescents (48%) reported at least one body modification; girls were more likely than boys to have body modification (59% vs. 28%, p < or = .0005). Ninety (42%) reported piercings, 22 (10%) tattoos, 9 (4%) scarification, and 1 (< 1%) branding; 21 (10%) had more than one type of body modification. These were in a variety of locations, most commonly the ear and the nose (piercings) or the extremities (tattoos). One-third of the sample (33%) screened positive for problem substance use on the POSIT-ADS questionnaire. Controlling for age, adolescents with body modification had 3.1 times greater odds of problem substance use than those without body modification (95% CI 1.7, 5.8). CONCLUSIONS Body modification was associated with self-reported problem alcohol and other drug use among middle adolescents presenting for primary care. More research is needed to determine the clinical and sociocultural significance of body modification and its relationship to substance use in this population.

Comparison of Two Violence Prevention Curricula for Middle School Adolescents

OBJECTIVE To compare the effectiveness of the Violence Prevention Curriculum for Adolescents to the Conflict Resolution: A Curriculum for Youth Providers among middle school students. METHODS A sample (N = 225) of adolescents (males = 48%) representing 20% of the student population in two middle schools were administered a pretest questionnaire. Of these students, 89% were African-American, 10% were white, and 1% were Native-American and lived in public housing (40%) or in neighborhoods adjacent to public housing (60%). Each school was randomly assigned to one of the curricula. Each curriculum was administered during 10 50-min sessions held twice a week over 5 weeks. One week later, 209 students who completed the 10 sessions were tested with the same questionnaire. The data were analyzed with a repeated-measures analysis of variance. RESULTS Students who received either curriculum reported significant decreases in their self-reported use of violence in hypothetical conflict situations, frequency of use of violence in the previous 30 days, and frequency of physical fights in the previous 30 days. The conflict resolution curriculum was more effective in reducing the frequency of fights resulting in an injury requiring medical treatment in the previous 30 days. CONCLUSIONS Both curricula were successful in reducing three indicators of violence. However, the conflict resolution approach was more successful in reducing the frequency of more severe physical fights requiring medical treatment. The latter finding is of particular importance, because that physical fighting is the form of violence behavior in which young adolescents most often engage.

Depression, Parenting Attributes, and Social Support among Adolescent Mothers Attending a Teen Tot Program

OBJECTIVE To investigate the associations between depressive symptoms in adolescent mothers and their perceived maternal caretaking ability and social support. PATIENTS AND METHODS Subjects were participants enrolled in a parenting program that provided comprehensive multidisciplinary medical care to teen mothers and their children. Baseline data of a prospective cohort study were collected by interview at 2 weeks postpartum and follow-up, and standardized measures on entry into postnatal parenting groups. Demographic data included education, social supports, psychological history, family history and adverse life events. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale for Children short version (CES-DC). The Maternal Self-report Inventory (MSRI) measured perceived maternal self-esteem, and Duke-UNC Functional Social Support Questionnaire measured social support. Data were analyzed with bivariate analyses and linear regression modeling focusing on depressive symptoms as the outcome variable. RESULTS In the 168 teen mothers, mean age 17.6 +/- 1.2 years, African American (50%), Latina (31%) or Biracial (13%), the prevalence of depressive symptoms was 53.6%. In the linear model, controlling for babys age, teens age, ethnicity, Temporary Aid for Families with Dependent Children (TAFDC), and previous suicidal gesture, increased depressive symptoms were associated with decreased perceived maternal caretaking ability (P = 0.003) and lower social support (P < 0.001). In a linear model controlling for the same variables, MSRI total score (P = 0.001) and social support (P < 0.001) contributed significantly to the model as did the interaction term (MSRI x Social Support, P = 0.044). CONCLUSIONS Depression is associated with decreased maternal confidence in their ability to parent and decreased perceived maternal social support, with a possible moderating effect of social support on the relationship of maternal self-esteem and depression.

Community Asthma Initiative: Evaluation of a Quality Improvement Program for Comprehensive Asthma Care

OBJECTIVES: The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work. METHODS: Urban, low-income patients with asthma from 4 zip codes were identified through logs of ED visits or hospitalizations, and offered enhanced care including nurse case management and home visits. QI evaluation focused on parent-completed interviews at enrollment, and at 6- and 12-month contacts. Hospital administrative data were used to assess ED visits and hospitalizations at enrollment, and 1 and 2 years after enrollment. Hospital costs of the program were compared with the hospital costs of a neighboring community with similar demographics. RESULTS: The program provided services to 283 children. Participants were 55.1% male; 39.6% African American, 52.3% Latino; 72.7% had Medicaid; 70.8% had a household income <