Kimberly Bender

Interventions for reducing adolescent alcohol abuse: a meta-analytic review.

OBJECTIVE To assess the effectiveness of substance abuse interventions for their ability to reduce adolescent alcohol use. DATA SOURCES MEDLINE; PsycINFO; ERIC; Wilson Social Science Abstracts; Criminal Justice Abstracts; Social Work Abstracts; Social Science Citation Index; Dissertations Abstracts International; National Criminal Justice Research Service; Social, Psychological, Criminological, Educational Trials Register; and the PsiTri databases from 1960 through 2008. STUDY SELECTION Of 64 titles and abstracts identified, 16 studies and 26 outcomes constituted the sample. The researchers calculated Hedges g effect sizes and used a random-effects model to calculate adjusted pooled effect sizes. Heterogeneity was explored using stratified analyses. Main Exposure Completion of a substance abuse intervention that aimed to reduce or eliminate alcohol consumption. MAIN OUTCOME MEASURES Abstinence, frequency of alcohol use, and quantity of alcohol use measured between 1 month and 1 year upon completion of treatment. RESULTS Pooled effects of standardized mean differences indicate that interventions significantly reduce adolescent alcohol use (Hedges g = -0.61; 95% confidence interval [CI], -0.83 to -0.40). Stratified analyses revealed larger effects for individual treatment (Hedges g = -0.75; 95% CI, -1.05 to -0.40) compared with family-based treatments (Hedges g = -0.46; 95% CI, -0.66 to -0.26). CONCLUSIONS Treatments for adolescent substance abuse appear to be effective in reducing alcohol use. Individual-only interventions had larger effect sizes than family-based interventions and effect sizes decreased as length of follow-up increased. Furthermore, behavior-oriented treatments demonstrated promise in attaining long-term effects.

Is Employment Associated With Reduced Recidivism

This article explores the association between employment and recidivism for parolees released from Texas prisons. Along with determining whether obtaining employment on release from prison is associated with decreased odds of reincarceration, this article analyzes whether obtaining employment is associated with increased time to reincarceration. Proportional hazard models were used to examine the effect of employment on reincarceration over time. This analysis allowed a unique view of desistance from crime as a process of behavioral change with multiple stages. Results generally support this perspective, finding that although obtaining employment is not associated with a significant decrease in likelihood of reincarceration, it is associated with significantly greater time to reincarceration. Thus, among parolees who are reincarcerated, those who obtain employment spend more time crime-free in the community before returning to prison. This article argues that increased time crime-free is an indicator of positive behavior change that should be supplemented with clinical interventions to help formerly incarcerated persons maintain the initial motivation associated with employment.

Runaway and Pregnant: Risk Factors Associated with Pregnancy in a National Sample of Runaway/Homeless Female Adolescents

PURPOSE Homeless youth are at particularly high risk for teen pregnancy; research indicates as many as 20% of homeless young women become pregnant. These pregnant and homeless teens lack financial resources and adequate health care, resulting in increased risk for low-birth-weight babies and high infant mortality. This study investigated individual and family-level predictors of teen pregnancy among a national sample of runaway/homeless youth in order to better understand the needs of this vulnerable population. METHODS Data from the Runaway/Homeless Youth Management Information System (RHY MIS) provided a national sample of youth seeking services at crisis shelters. A sub-sample of pregnant females and a random sub-sample (matched by age) of nonpregnant females comprised the study sample (N = 951). Chi-square and t tests identified differences between pregnant and nonpregnant runaway females; maximum likelihood logistic regression identified individual and family-level predictors of teen pregnancy. RESULTS Teen pregnancy was associated with being an ethnic minority, dropping out of school, being away from home for longer periods of time, having a sexually transmitted disease, and feeling abandoned by ones family. Family factors, such as living in a single parent household and experiencing emotional abuse by ones mother, increased the odds of a teen being pregnant. CONCLUSIONS The complex problems associated with pregnant runaway/homeless teens create challenges for short-term shelter services. Suggestions are made for extending shelter services to include referrals and coordination with teen parenting programs and other systems of care.

Factors associated with trauma and posttraumatic stress disorder among homeless youth in three U.S. cities: The importance of transience†

Homeless youth experience disproportionately high rates of trauma and posttraumatic stress disorder (PTSD). This study examined correlates of trauma and PTSD among homeless youth with a focus on the impact of homeless culture, substance addiction, and mental health challenges. Homeless youth (N = 146) from Los Angeles, California, Denver, Colorado, and St. Louis, Missouri, were recruited from organizations providing services to homeless youth using comparable methods. Results indicate that 57% of respondents had experienced a traumatic event and 24% met criteria for PTSD. A multinomial logistic regression model revealed greater transience, alcohol addiction, mania, and lower self-efficacy predicted PTSD whereas trauma exposure was associated with alcohol addiction only. Findings have implications for screening and intervening with traumatized homeless youth across service settings.

Correlates of Street-Survival Behaviors in Homeless Young Adults in Four U.S. Cities

This study assessed the prevalence and correlates of behaviors used by homeless young people to survive on the streets. Survival behaviors include prostitution, selling blood or plasma, dealing drugs, stealing, and panhandling. One hundred ninety-six homeless young adults from 4 metropolitan areas-Los Angeles, CA (n = 50); Austin, TX (n = 50); Denver, CO (n = 50); and St. Louis, MO (n = 46)-participated in individual, semistructured, face-to-face interviews. Researchers predicted that youth transience would be related to high rates of survival behaviors. Multivariate logistic regression was used to test a model predicting relationships between survival behaviors and transience, employment, substance use, and social support. Young adults who were transient, unemployed, drug-addicted, and reliant on peers for help were more likely to use these survival behaviors. In addition, among the transient subsample, being White, more reliant on peers for help, more transient, and having been victimized were associated with high use of these survival behaviors. Identification of the environmental and demographic factors associated with survival behaviors suggests that there may be value in combining harm-reduction strategies with efforts to reduce the transience of homeless young adults.

Effects of Correctional-Based Programs for Female Inmates: A Systematic Review

Objective: To examine the effectiveness of interventions for incarcerated women. Method: The researchers use a two-model system: the risk-reduction model for studies analyzing interventions to reduce recidivism rates, and the enhancement model for studies that target psychological and physical well-being. Results: Incarcerated women who participate in substance abuse interventions appear less likely to reoffend than those who do not participate. Enhancement model studies report mixed results. Overall, psychological-oriented interventions and substance abuse programs improve mental health symptoms and substance use among participants as compared to control or comparison groups. Results for HIV prevention programs are ambiguous, and parenting skill programs show no significant effect. Conclusion: Results highlight interventions that appear useful with female inmates. More rigorous research is needed to address many of these evidence-based interventions.

A Meta-Analysis of Interventions to Reduce Adolescent Cannabis Use

Objective: This meta-analytic review assesses the effectiveness of substance abuse interventions to reduce adolescent cannabis use. Method: A systematic search identified 15 randomized controlled evaluations of interventions to reduce adolescent cannabis use published between 1960 and 2008. The primary outcome variables, frequency of cannabis use, and quantity of cannabis use, were measured between 1 month and 1 year posttreatment completion. Results: Analyses of random effects models revealed similarly moderate effects for individual (g = -.437; 95% CI = [-.671, -.203]) and family-based treatments (g = -.404; 95% CI = [-.613, -.195]). Substance abuse treatments are associated with moderate reductions in cannabis use although effect sizes tended to wane with greater length of time posttreatment. Discussion: Substance abuse treatment programs should consider implementing evidence-based interventions highlighted in this meta-analysis that fit the needs and characteristics of their client base and agency setting.

Multiple Victimizations Before and After Leaving Home Associated With PTSD, Depression, and Substance Use Disorder Among Homeless Youth

Exposure to multiple forms of maltreatment during childhood is associated with serious mental health consequences among youth in the general population, but limited empirical attention has focused on homeless youth—a population with markedly high rates of childhood maltreatment followed by elevated rates of street victimization. This study investigated the rates of multiple childhood abuses (physical, sexual, and emotional abuse) and multiple street victimizations (robbery, physical assault, and sexual assault) and examined their relative relationships to mental health outcomes (meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for post-traumatic stress disorder [PTSD], depression, and substance use disorder) among a large (N = 601) multisite sample of homeless youth. Approximately 79% of youth retrospectively reported multiple childhood abuses (two or more types) and 28% reported multiple street victimizations (two or more types). Each additional type of street victimization nearly doubled youths’ odds for meeting criteria for substance use disorder. Furthermore, each additional type of childhood abuse experienced more than doubled youths’ odds for meeting criteria for PTSD. Both multiple abuses and multiple street victimizations were associated with an approximate twofold increase in meeting depression criteria. Findings suggest the need for screening, assessment, and trauma-informed services for homeless youth who consider multiple types of abuse and victimization experiences.

Employment Status and Income Generation Among Homeless Young Adults Results From a Five-City, Mixed-Methods Study

This mixed-methods study identified correlates of unemployment among homeless young adults in five cities. Two hundred thirty-eight homeless young people from Los Angeles (n = 50), Austin (n = 50), Denver (n = 50), New Orleans (n = 50), and St. Louis (n = 38) were recruited using comparable sampling strategies. Multivariate logistic regression results indicate that homeless young adults were more likely to be unemployed if they had been on the streets longer, currently lived on the streets, earned an income from panhandling, and were addicted to drugs. Quantitative findings are expanded on with focus-group data from a group of homeless young people in Los Angeles regarding their challenges in locating and maintaining employment. Employment-related barriers for this population include prior homelessness, geographic transience, previous felonies, mental illness, and addiction. Findings suggest that homeless young adults’ employment status and use of specific income-generating activities may be influenced by demographic, environmental, and geographic contexts.

Preventing Childhood Bullying: Findings and Lessons From the Denver Public Schools Trial

Twelve-month follow-up outcomes from a group-randomized trial (GRT) of a classroom curriculum aimed at preventing bullying and victimization among elementary students in the Denver, Colorado, public school system are presented. Twenty-eight elementary schools were randomly assigned to receive selected modules of Youth Matters (YM), a skills-training curriculum that targets bullying and victimization, or to a no-treatment control group. Linear growth models were fitted to five waves of data collected over 3 years to test the effect of the intervention on the rate of change in self-reported bullying and victimization. Participation in YM was associated with a 7% decline in bully victimization 1 year after the intervention ended. Practice and methodological challenges encountered in the investigation are discussed in the larger context of intervention research in school settings. Strategies to increase school-based intervention research by social work investigators are outlined.