Eric F. Wagner

Cigarette Smoking, Major Depression, and Other Psychiatric Disorders among Adolescents

OBJECTIVEnTo examine cross-sectionally and prospectively relationships of cigarette smoking with major depressive disorder (MDD), controlling for comorbidity in a community sample of adolescents.nnnMETHODnA representative sample of 1,709 adolescents (aged 14 through 18 years) was assessed by using semistructured diagnostic interviews on two occasions, approximately 1 year apart. Logistic regression analyses were used to examine cross-sectionally and prospectively the relationships between smoking and each psychiatric disorder, while statistically controlling for the other disorders.nnnRESULTSnCross-sectional analyses revealed significant relationships of drug abuse/dependence and disruptive behavior disorders with adolescent smoking, even after the co-occurrence of all other disorders was controlled. Prospectively, smoking was found to increase the risk of developing an episode of MDD and drug abuse/dependence, after adjusting for other disorders. Finally, only lifetime prevalence of MDD remained a significant predictor of smoking onset, after controlling for other disorders. Gender did not moderate any of the relationships between psychopathology and smoking.nnnCONCLUSIONSnThe results suggest important relationships between cigarette smoking and psychiatric disorders among adolescents, particularly with regard to MDD, drug abuse/dependence, and disruptive behavior disorders. These findings have important clinical implications, both for psychiatric care and for smoking prevention and cessation efforts with adolescents.

Innovations in Adolescent Substance Abuse Intervention

Adolescent alcohol and other drug abuse is an important public health concern, and the past two decades has seen a dramatic increase in the demand for interventions to address substance use problems among teenagers. This demand has led to the development of multiple primary, secondary, and tertiary substance abuse prevention programs, some of which have little theoretical basis and most of which currently operate in the absence of data supporting their effectiveness. Very recently, there has been increased emphasis on the goal of developing and testing theoretically based and empirically supported intervention approaches for adolescent substance abuse. We describe five ongoing research programs devoted to meeting this goal. The background and rationale for each research program are discussed, and preliminary efficacy data concerning the specific interventions are presented.

Substance use and violent behavior in adolescence

The relation between substance use and violent behavior in adolescence is reviewed, and each of five competing models of this relation is examined. I begin by presenting background material on adolescent substance use and adolescent violence. I then describe five different models that have been proposed to explain the association between substance use and violent behavior. Next, I review the adolescent literature concerning substance use and violence, noting methodological weaknesses that have plagued this research. I conclude with an evaluation of the five models and suggestions for future research.

Validation of the Teen Addiction Severity Index (T-ASI): Preliminary Findings

The Teen Addiction Severity Index (T-ASI) is a semistructured interview that was developed to fill the need for a reliable, valid, and standardized instrument for periodic evaluation of adolescent substance abuse. A preliminary study indicated good clinical utility and satisfactory interrater reliability. This study had three objectives: 1) to determine whether the T-ASI discriminated between hospitalized psychiatric patients with and without comorbid psychoactive substance use disorders (PSUD); 2) to determine whether T-ASI scores were related to other indices of problem behavior, and, 3) to determine whether there was any specificity in the ratings of different domains of the instrument when compared with other criteria. The results of the study providesupportforthe goodpsychometricpropertiesofthe T-ASI.

The temptation-coping questionnaire: development and validation.

This study describes the development and validation of the Temptation-Coping Questionnaire (TCQ). The TCQ is designed to assess high-school students coping with situations presenting temptations for substance use. A principal components analysis of the questionnaire was conducted on data from 545 adolescents in Grades 9 to 12. Analyses yielded two coping components, of which one was retained following examination of construct and criterion validity. The resulting TCQ component was strongly correlated with measures of situation appraisal and predicted current substance use. The findings of this investigation are interpreted to provide support for the validity of the TCQ and initial evidence for the utility of the temptation-coping construct when applied to a general high-school population. These results reinforce the importance of behavioral and cognitive strategies for managing temptations to use alcohol, drugs, or both.

Considering individual differences in the design of preventive interventions: HIV primary prevention as an example

This study examined how individual differences in personality style influenced childrens receptivity to HIV primary prevention. Prior to taking part in a HIV prevention program, 123 fifth graders from an ethnically diverse inner city school district were administered the Weinberger Adjustment Inventory (WAI) and scales measuring HIV-related beliefs, attitudes, and knowledge. The HIV scales were readministered at the conclusion of the program. WAI groups (formed by contrasting dimensions of restraint and distress) were found to differ significantly on measures of knowledge about HIV, HIV-related fears, safe behavior attitudes, and risk behavior at pre-test. The interventions impact, as reflected in scale change scores, did not show significant differences among WAI groups. Although subtle differences were evident among groups, findings suggest that HIV primary prevention programs may be equally effective among children with differing degrees of self-restraint and distress.

Child Abuse and Neglect

Few social phenomena are as elusive as child abuse and neglect. From the beginning, the field has struggled to arrive at a clear operational definition of child maltreatment. Unfortunately, no satisfactory consensus has been achieved, beyond the broad view that abuse comprises the commission of acts that are or may be detrimental to the child’s health, development, or well-being, and neglect consists of the omission of care that may result in equally negative outcomes. Pinning down the specific elements of maltreatment, however, has been virtually impossible.