Linda Trudeau

Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation.

In this article, the authors examine whether delayed substance initiation during adolescence, achieved through universal family-focused interventions conducted in middle school, can reduce problematic substance use during young adulthood. Sixth-grade students enrolled in 33 rural midwestern schools and their families were randomly assigned to 3 experimental conditions. Self-report questionnaires provided data at 7 time points for the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years (PDFY), and control groups through young adulthood. Five young adult substance frequency measures (drunkenness, alcohol-related problems, cigarettes, illicit drugs, and polysubstance use) were modeled as distal outcomes affected by the average level and rate of increase in substance initiation across the adolescent years in latent growth curve analyses. Results show that the models fit the data and that they were robust across outcomes and interventions, with more robust effects found for ISFP. The addition of direct intervention effects on young adult outcomes was not supported, suggesting long-term effects were primarily indirect. Relative reduction rates were calculated to quantify intervention-control differences on the estimated proportion of young adults indicating problematic substance use; they ranged from 19% to 31% for ISFP and from 9% to 16% for PDFY.

Substance use outcomes 5½ years past baseline for partnership-based, family-school preventive interventions

This article reports adolescent substance use outcomes of universal family and school preventive interventions 5(1/2) years past baseline. Participants were 1677 7th grade students from schools (N=36) randomly assigned to the school-based Life Skills Training plus the Strengthening Families Program: For Parents and Youth 10-14 (LST+SFP 10-14), LST-alone, or a control condition. Self-reports were collected at baseline, 6 months later following the interventions, then yearly through the 12th grade. Measures included initiation-alcohol, cigarette, marijuana, and drunkenness, along with a Substance Initiation Index (SII)-and measures of more serious use-frequency of alcohol, cigarette, and marijuana use, drunkenness frequency, monthly poly-substance use, and advanced poly-substance use. Analyses ruled out differential attrition. For all substance initiation outcomes, one or both intervention groups showed significant, positive point-in-time differences at 12th grade and/or significant growth trajectory outcomes when compared with the control group. Although no main effects for the more serious substance use outcomes were observed, a higher-risk subsample demonstrated significant, positive 12th grade point-in-time and/or growth trajectory outcomes for one or both intervention groups on all measures. The observed pattern of results likely reflects a combination of predispositions of the higher-risk subsample, the timing of the interventions, and baseline differences between experimental conditions favoring the control group.

Effects of a Preventive Intervention on Adolescent Substance Use Initiation, Expectancies, and Refusal Intentions

This study evaluated the effects of a school-based preventive intervention (Botvin, G. J. 1996, 2000) on growth trajectories of substance initiation (alcohol, tobacco, and marijuana), expectancies, and refusal intentions. A rural midwestern sample (N = 847) provided three waves of data from middle school students. Growth curve analyses demonstrated that the intervention significantly slowed the rate of increase in substance initiation and significantly slowed the rate of decrease in refusal intentions. The intervention also slowed the rate of decrease in negative outcome expectancies, although the significance level was only marginal. A multiple group comparison showed that the impact of initial levels of substance initiation on growth trajectories of refusal intentions differed between conditions, suggesting that the intervention decreased the effect of early substance initiation on the rate of change over time for refusal intentions. Gender differences also were found, although the intervention was effective in slowing the rate of increase in initiation for both genders.

Longitudinal Effects of Universal Preventive Intervention on Prescription Drug Misuse: Three Randomized Controlled Trials With Late Adolescents and Young Adults

OBJECTIVES We examined long-term prescription drug misuse outcomes in 3 randomized controlled trials evaluating brief universal preventive interventions conducted during middle school. METHODS In 3 studies, we tested the Iowa Strengthening Families Program (ISFP); evaluated a revised ISFP, the Strengthening Families Program: For Parents and Youth 10-14 plus the school-based Life Skills Training (SFP 10-14 + LST); and examined the SFP 10-14 plus 1 of 3 school-based interventions. Self-reported outcomes were prescription opioid misuse (POM) and lifetime prescription drug misuse overall (PDMO). RESULTS In study 1, ISFP showed significant effects on POM and PDMO, relative reduction rates (RRRs; age 25 years) of 65%, and comparable benefits for higher- and lower-risk subgroups. In study 2, SFP 10-14 + LST showed significant or marginally significant effects on POM and PDMO across all ages (21, 22, and 25 years); higher-risk participants showed stronger effects (RRRs = 32%-79%). In study 3, we found significant results for POM and PDMO (12th grade RRRs = 20%-21%); higher-risk and lower-risk participants showed comparable outcomes. CONCLUSIONS Brief universal interventions have potential for public health impact by reducing prescription drug misuse among adolescents and young adults.

Rural–urban differences in the distribution of parent-reported risk factors for substance use among young adolescents

PURPOSE We examined rural-urban differences in cumulative risk for youth substance use. A recent report [National Center on Addiction and Substance Abuse (CASA) 2000] found that the rural-urban distribution of substance use and known risk factors for substance use differed; in many cases rural youth showed higher levels of use, as well as higher levels of risk factors. The current investigation, while not directly examining substance use, further examined rural-urban differences in the distribution of risk factors for youth substance use, based on information from parent reports. METHOD Study 1 data were collected from a random sample of Midwestern parents (n = 339) with a young adolescent between the ages of 11 and 13 years. Study 2 data were collected from a second sample of Midwestern parents (n = 593). RESULTS Analyses of rural-urban comparisons demonstrated higher levels of cumulative risk among rural youth. An evaluation of the sensitivity of the analysis to rural-urban classification schemes indicated that the findings were robust, but that there was some minor variation in rural-urban differences by classification scheme. IMPLICATIONS Results contribute to an explanation of findings from earlier reports of rural-urban differences in substance use, and suggest directions for future research on rural-urban distributions of youth risk factors.

Effects of Parenting and Deviant Peers on Early to Mid-Adolescent Conduct Problems.

We investigated the influence of effective parenting behaviors (father and mother reports) and deviant peer association (adolescent reports) on subsequent young adolescent conduct problems (teacher reports) during grades 7–9, using structural equation modeling. Data were from a sample of 226 rural adolescents (n = 112 boys; n = 107 girls; n = 7 gender unknown), their parents, and teachers. Both effective parenting and association with deviant peers influenced later conduct problems; however, the pattern of influence varied across time and between fathers and mothers, with complex patterns of interactions between effective parenting and peer deviance. From seventh to eighth grade, effective parenting by both mothers and fathers buffered the effect of higher levels of peer deviance on conduct problems across adolescent gender. From eighth to ninth grade (i.e., transition into high school), fathers’ effective parenting buffered the effects of deviant peer association on their daughters’ conduct problems, whereas both fathers’ and mothers’ influence was stronger for sons when deviant peer associations were lower. Analyses also evaluated bi-directional longitudinal effects among adolescents, parents, and peers. Although varying by parent and adolescent gender or adolescent age, results generally supported the protective effects of parenting on their children’s conduct problems during early to mid adolescence.

Internalizing, social competence, and substance initiation: influence of gender moderation and a preventive intervention.

Using latent growth curve modeling, the current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency (i.e., social assertiveness) and the initiation of substance use (i.e., tobacco, alcohol, marijuana), as well as the effect of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment conducted in 1998. A latent growth curve comparison analysis found that internalizing was related inversely to initial levels of social assertiveness skill among girls; further, internalizing was related positively to substance use initiation growth trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance use initiation and a faster increase in social assertiveness. Gender moderation of the impact of internalizing and social assertiveness on substance use initiation and response to the intervention, as well as the utility of latent growth curve modeling in the study of longitudinal change, are discussed.

Assertiveness Among Young Rural Adolescents: Relationship to Alcohol Use.

ABSTRACT There is evidence of higher prevalence rates for alcohol use among rural adolescents relative to urban adolescents. Strategies aimed at preventing adolescent alcohol use typically include the development of social skills to resist peer pressure; among the social skills frequently targeted is assertiveness. Self-report data were collected from a sample of rural adolescents (N = 470) participating in a longitudinal preventive intervention study. Five hypothesized dimensions of assertiveness were validated with Confirmatory Factor Analysis: Specific Substance Refusal, Individual Rights, Transaction, Justice, and Social Approach. Using gender as a between-subjects factor, plus time and assertiveness as within-subjects factors to predict an alcohol use composite index, repeated measures analyses revealed a number of significant findings. Several assertiveness dimensions were found to have significant effects on the alcohol use index, and significant two-way and three-way interaction effects (gender × time × assertiveness dimension) also were found. Findings support the idea of including multidimensional assertiveness skill development as a component of preventive interventions, particularly for rural adolescents.

Benefits of Universal Intervention Effects on a Youth Protective Shield 10 Years After Baseline

PURPOSE An earlier randomized controlled study found that a universal, family-focused preventive intervention produced protective shield effects-reduced adolescent exposures to illicit substance opportunities-among adolescents in grade 12. This study examined a follow-up assessment of the sample during young adulthood. METHODS A randomized controlled trial evaluated the Iowa Strengthening Families Program that was implemented in 22 rural schools (N = 446 families) when the participants were in grade six. Measures included adolescent exposure to illicit substance use and young adult lifetime substance use (age 21; N = 331). Growth curve modeling examined indirect intervention effects through growth factors of adolescent exposure. RESULTS Findings from this study confirm protective shield effects that mediate long-term reduction of illicit substance use (β = -.14, p = .02, Relative Reduction Rate = 28.2%). CONCLUSIONS The benefits of decreasing exposure to substance use during adolescence through universal interventions were supported, with positive effects extending into young adulthood.

The Role of Assertiveness and Decision Making in Early Adolescent Substance Initiation: Mediating Processes

This study examined the mediating processes linking assertiveness and decision making to early adolescent substance initiation, along with the moderating effect of gender on those processes. Models specifying negative expectancies and refusal intentions as mediators of individual rights assertiveness and decision-making effects on substance initiation were evaluated across 18 months on a nontreatment cohort of young adolescents participating in a prevention trial (average age 12.3 years at baseline; N 5357). Results indicated that individual rights assertiveness and decision making had indirect effects on substance initiation through effects on negative outcome expectancies and refusal intentions. Gender differences were found in both the average level and the pattern of relationships among the variables. For girls, refusal intentions were negatively associated with later substance initiation. For boys, early levels of substance initiation were negatively associated with later levels of negative expectancies and refusal intentions. Implications for prevention programming are discussed.