Linda Richter

The relationship between smoking, drinking, and adolescents' self-perceived health and frequency of hospitalization: Analyses from the 1997 National Household Survey on Drug Abuse

PURPOSE To investigate the more immediate health effects of smoking and drinking among adolescents. METHODS Secondary analyses of data from the 1997 National Household Survey on Drug Abuse were conducted to explore the relationship between subjective and objective health outcomes and the use of alcohol and tobacco among adolescents. RESULTS The findings suggest that adolescents who smoke or drink actually report poorer health during adolescence than those who do not. In fact, adolescents who are frequent or heavy alcohol and tobacco users report poorer subjective overall health and a greater number of overnight hospital stays during the previous year than less frequent or intense users and than nonusers. In addition, the data revealed a number of significant gender and age group differences in reports of health outcome as well. CONCLUSIONS Demonstrating to youngsters the more immediate, negative health consequences of alcohol and tobacco use might strengthen prevention messages and ultimately decrease the use of these substances among adolescents.

Coping with body image changes following a disfiguring burn injury

The influence of emotion-focused coping on distress following disfiguring injury was examined. Two types of emotion-focused coping (i.e., venting emotions vs. mental disengagement) were assessed in 78 patients with burn injury at baseline during acute hospitalization. Body image dissatisfaction (BID) was assessed 1 week and 2 months following discharge. Use at baseline of both venting emotions and mental disengagement, compared with use of only one or neither of these coping methods, was associated at the 2-month postdischarge follow-up with significantly higher BID related to nonfacial aspects of appearance and with a greater negative social impact of disfigurement. D. M. Wegners (1994) theoretical model of mental control and a proposed motivational analysis are used to interpret these findings.

Current Methods of Assessing Substance Use: A Review of Strengths, Problems, and Developments:

This article discusses various means of assessing and measuring substance use behaviors and describes the relative advantages and disadvantages of each of the measurement tools. Self-report instruments are the most convenient and widely used forms of substance use assessment. Self-report measures can be obtained through various modes of administration, including self-administration via paper-and-pencil questionnaires, computer assisted self-interviews or interactive voice recording, and through personal (interviewer-administered) interviews. The advantages and disadvantages of each of these modes of administration are discussed. Alternative assessment techniques, such as biological measurements, are also frequently used to measure substance use or to validate self-report measures of substance use. This article reviews the various available methods for validating self-report measures, highlighting self-report and biological testing techniques currently in use. It concludes by suggesting future avenues of research for improving upon current substance use measurement techniques.

Telescoping of Drinking-Related Behaviors: Gender, Racial/Ethnic, and Age Comparisons

Objective. To examine demographic differences in alcohol telescoping—the rate of self-reported movement from regular alcohol consumption to the onset of regular heavy drinking—as well as differences in ages of initiation of regular alcohol use and alcohol use to intoxication. Method. The present study compared the retrospective reports of 2037 clients (1252 males, 785 females) enrolled in substance user treatment facilities around the country in 1998 and 1999. Results. Overall, the findings support previous research, indicating that women generally move more rapidly than men from initiation of regular alcohol use to problem use (telescoping). The findings also indicate that African-Americans generally begin regular alcohol use later than their Anglo counterparts and move more rapidly from initiation of regular alcohol use to problem use (telescoping). Examining the sample by older vs. younger age groups demonstrates that gender and racial/ethnic differences in the age of initiation of regular alcohol use and in telescoping may be limited by age group, as these patterns appear in the older but not the younger cohort. Conclusions. These findings suggest that self-reported regular alcohol use, alcohol abuse, and telescoping differences vary dramatically by gender, race/ethnicity, and age cohort. Furthermore, the pattern of findings suggests that these differences are more likely the result of sociocultural than biological differences between the groups under study.

Coping with the stress of a painful medical procedure.

To evaluate its effect on procedure-related distress, the focus of attention was manipulated by providing training to hospitalized acute burn patients (n=42). Participants were randomly assigned to attention focusing (i.e. attending to procedural sensations) or music distraction (i.e. attention diverting) coping interventions, or to usual care during the target dressing change. Coping behavior (i.e. distraction, focusing, and three confounding methods, ignoring, catastrophizing, reinterpreting), tension and intrusiveness were evaluated 24 h retrospectively (i.e. for the prior procedure), during the targeted procedure, and 30 min after the target procedure. When coping during the target procedure by ignoring, reinterpreting, and catastrophizing were covaried, the music distraction group experienced significantly fewer intrusions, and the attention focus group had more intrusions. Additionally, secondary analyses revealed that coping by ignoring during the prior days procedure significantly predicted higher procedural tension during, and more intrusions following, the targeted procedure. Suppression-based forms of emotion-focused coping may be enhanced by training in the use of an explicit distractor.

Risk and Protective Factors of Adolescent Drug Use: Implications for Prevention Programs

In conclusion, the current interest in the study of adolescent drug use is likely to broaden inquiry and yield a sounder base of evidence, both of which augur well for future investigations, for further comprehension of the etiology of drug use, and for prevention programs. Should the effect of prevention programs that address the childhood and adolescent risk factors identified in etiologic studies result in reduced drug use and abuse in future evaluations, empirical data will then be available that may yield further knowledge about the benefits of prevention programs.

Research Note: What If We're Wrong? Some Possible Implications of Systematic Distortions in Adolescents' Self-Reports of Sensitive Behaviors

Research in the social sciences is inherently plagued by the problem of biased or distorted self-reports of sensitive information. Participants in studies, when asked to provide truthful information about their own sensitive behaviors, might distort their responses because of self-presentation concerns or fear that their responses may not actually be completely anonymous or confidential. Researchers who study substance use and other problem behaviors must recognize the possibility that their findings may contain systematic distortions, must try to reduce such biases whenever possible, and must acknowledge them as limitations when little else can be done. This paper was written from the premise that systematic distortion is present in self-reports of substance use and other sensitive behaviors. We consider some of the most widely accepted theories and models from the fields of substance use and problem behavior from the perspective of this premise. Our purpose is not to suggest that these theories or findings are unfounded, but rather that the implications of systematic distortion for this field should be seriously considered when evaluating the validity of research findings and theory.

Addressing the Critical Health Problem of Adolescent Substance Use Through Health Care, Research, and Public Policy

The use of addictive substances-tobacco, alcohol, and other drugs-during adolescence interferes with brain development and increases the risk of serious health and mental health conditions, including addiction. Yet, adolescents live in a culture in which family, social, community, and media influences regularly bombard them with pro-substance use messages, creating an environment in which substance use is considered an expected behavior, rather than a considerable health risk. To prevent the significant harm that falls to teens and young adults because of substance use, The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) undertook a study to explore how adolescent brain development relates to the risk of substance use and addiction; the cultural influences that create an environment in which substance use is considered normative behavior; individual factors that make some teens more disposed to substance use and addiction; and evidence-based prevention and treatment strategies for addressing this problem. The recently published report Adolescent Substance Use: Americas #1 Public Health Problem concludes that risky substance use is a major public health problem that can be ameliorated through evidence-based public health measures, including education about the disease and its risk factors, screenings, and clinical interventions, and that addiction can be treated and managed effectively within routine health care practice and specialty care.

Rational Choice and Environmental Deterrence in the Retention of Mandated Drug Abuse Treatment Clients

Length of treatment stay is consistently associated with positive posttreatment outcomes in the rehabilitation of drug-abusing offenders. However, past retention research centered on the examination of individual-level determinants to the exclusion of environmental predictors. In this study, the authors propose a rational choice framework in which treatment retention is viewed as a decision-making process that involves calculation of costs and benefits of remaining in treatment. Environmental factors not directly related to the treatment process are theorized to either reward or punish the course of action taken by each treatment client. Retention data from 1,984 drug-abusing felons diverted for long-term residential treatment were analyzed to test the hypotheses that criminal sanctions against drug offenses, violence in local drug markets, and lack of legitimate job opportunities act as deterrents against premature termination of treatment. Results corroborated the criminal sanction and unemployment hypotheses, but not the violence hypothesis. These findings highlight the necessity of reinforcing perceptions of arrest risks and job prospects during treatment. The study concludes with some clinical recommendations.

Approach–avoidance coping conflict in a sample of burn patients at risk for posttraumatic stress disorder

Background: Following an acute burn injury, higher distress is consistently observed among individuals exhibiting a conflict between approach coping (e.g., processing) and avoidance coping (e.g., suppression) relative to those individuals who use only one of these methods. Study objectives were to determine if contradictory coping messages would lead to such approach–avoidance coping conflict and to determine if experiment‐induced coping conflict is also associated with higher distress. Methods: Participants (n=59 adults hospitalized with acute burn injuries) were assigned randomly to experimental conditions differing in the order in which training was provided in two ways of coping with posttrauma re‐experiencing symptoms (i.e., process‐then‐suppress versus suppress‐then‐process). The primary dependent variable was coping behavior during the 24‐hr posttraining period. Coping behavior was categorized as approach coping (processing), avoidance coping (suppressing), or approach–avoidance coping conflict (both) on the basis of median splits on subscales assessing these behaviors. Secondary analyses examined the relationship between this experiment‐induced coping conflict and re‐experiencing symptoms. Results: Results indicated that participants in the process‐then‐suppress condition, relative to the suppress‐then‐process condition, were significantly more likely to exhibit approach–avoidance coping conflict (i.e., above median split on both processing and suppressing) during the next 24 hr. Furthermore, approach–avoidance coping conflict was associated with greater re‐experiencing symptoms assessed via self‐report and by blinded coding of recorded speech. Conclusions: It is concluded that the order of coping skill training can influence treatment outcome, success of coping methods, and overall levels of distress. therefore, training in stabilizing and calming methods should precede training in active processing following stressful life events. Depression and Anxiety, 2009.