Robert P. Pack

Relative influences of perceived parental monitoring and perceived peer involvement on adolescent risk behaviors: An analysis of six cross-sectional data sets.

PURPOSE To assess: (a) the relative impact of monitoring and peer involvement among six cohorts of African-American youth in their mid-adolescent years, over a decade of research in one urban area, and (b) the consistency of the impact of the two influences over time. METHODS Baseline data were collected from six cohorts involving 1279 low income African-American youth aged 13 to 16 years involved in community based studies conducted over a decade in an urban area. Self-reported behaviors, and perceptions of parental monitoring and peer risk-involvement were assessed through structured questions. Data were analyzed by frequency distribution, one-way ANOVA, and multiple logistic regression. RESULTS There was a rapid increase in sexual activity and substance use behaviors during mid-adolescence. Monitoring had a protective influence on substance use behaviors and sexual activity, but had no impact on condom use or drug trafficking. Peer involvement influenced all evaluated risk behaviors. The influences overall did not statistically change over time. CONCLUSIONS Despite the marked increase in risk behaviors during mid-adolescence, monitoring and peer involvement both influenced adolescent behaviors across each cohort.

Longitudinal influence of perceptions of peer and parental factors on African American adolescent risk involvement

To explore the long-term contributions of perceived peer and parental influences on adolescent risk and protective behaviors (sexual involvement, condom use, and drug use), we assessed self-reported behaviors and perceptions of peer risk involvement and parental supervision and communication among 383 low-income, urban African Americans aged 9 to 15 years at baseline over a 4-year, period. Baseline perceptions of peer sexual involvement were significantly associated with youth sexual behavior at baseline and were predictive of sexual involvement through all 4 years of follow-up. Perceived parental monitoring was inversely correlated with sexual involvement ment through 3 years of follow-up. Perceptions of peer condom use were associated with increased levels of condom use at baseline and through 6 months of follow-up. Positive parental communication was correlated with increased condom use. Drug use was higher among youths who perceived peers or family members to be using drugs and was inversely correlated with increased parental monitoring and supervision. Stepwise regression revealed peer and parental influences for all three behaviors. Perceptions of both peer and parental behaviors influence long-term risk and protective behaviors of adolescents. Therefore, parents should be included in adolescent riskreduction intervention efforts. Inclusion of friends and/or changing youth perceptions of peer involvement may also be effective intervention strategies.

Predictors of infection with Chlamydia or gonorrhea in incarcerated adolescents.

Objective: The objective of this study was to examine the prevalence, multiple correlates, and gender differences in chlamydia and gonorrhea infections among adolescents, aged 13 to 18, incarcerated in a youth detention center in the southern region of the United States. Goal: The goal of this study was to identify factors associated with juvenile offenders’ sexually transmitted disease (STD) risk that may guide the development of interventions specifically tailored for this population. Study: The authors conducted a cross-sectional survey. Results: Rates of undiagnosed chlamydia were 24.7% for incarcerated girls and 8.1% for boys. Gonorrhea was detected in 7.3% of the girls and 1.5% of the boys. Predictors of STD positivity differed for boys and girls. Demographic characteristics (gender, race, and age) account for 52% of the total variance in STD infections; youths’ behavior accounts for approximately one third of the total variance, and psychologic and family variables account for 8.6% and 7.2% of the total variance, respectively. Conclusions: An approach that considers psychologic and social influences on adolescent sexual behavior is useful for identifying potential risk and protective factors of adolescent STD/HIV risk that are amenable to intervention.

Risk and Protective Factors Associated with Gang Involvement among Urban African American Adolescents

Data from 349 urban African American youth were analyzed to explore whether the differences in exposure to violence, resilience, and distress symptoms between gang members and nonmembers resulted from the risk behaviors in which youth participated or from the gang membership itself. Youth with current or past gang membership documented higher levels of risk involvement, lower levels of resilience, higher exposure to violence, and higher distress symptoms. These associations persisted even after controlling for age, gender, or risk involvement. This study provides evidence that gang membership itself may be associated with increased risk and ill-effects on psychological well-being and that strong family involvement and resiliency protect against gang involvement.

Patterns of initiation of sex and drug-related activities among urban low-income African-American adolescents.

PURPOSE To examine the pattern of adolescents involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. SUBJECTS Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. RESULTS Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. CONCLUSIONS Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.

Prescription Drug Abuse: A Comparison of Prescriber and Pharmacist Perspectives

This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted. Year of data collection: 2012 Setting: Rural Appalachia Data Collection Instruments: Prescriber- and pharmacist-specific survey instruments Data Analysis Techniques: Independent samples t-test; Mann-Whitney U test

Factors Associated With Provision of Addiction Treatment Information by Community Pharmacists

Community pharmacists in the United States have significant opportunity to engage in community-level prescription substance abuse prevention and treatment efforts, including dissemination of information specific to available addiction treatment options. Our cross-sectional study of Tennessee community pharmacists noted that 26% had previously provided addiction treatment facility information to one or more patients in the past. The purpose of this study was to employ multivariate modeling techniques to investigate associations between community pharmacist and community pharmacy factors and past provision of addiction treatment information to pharmacy patients. Multivariate logistic regression indicated having addiction treatment facility information in a pharmacy setting (aOR=8.19; 95% CI=4.36-15.37), having high confidence in ability to discuss treatment facility options (aOR=4.16; 95% CI=2.65-6.52), having participated in prescription opioid abuse-specific continuing education (aOR=2.90; 95% CI=1.70-4.97), being male (aOR=2.23; 95% CI=1.38-3.59), and increased hours per week in the practice setting (aOR=1.02; 95% CI=1.004-1.05) were all significantly associated with provision of information about addiction treatment. Dissemination of addiction treatment information, improvements in communicative self-efficacy beliefs, and dissemination of prescription opioid abuse-specific continuing education are modifiable factors significantly associated with increased provision of addiction treatment information by community pharmacists.

Epidemiological criminology: drug use among African American gang members.

Epidemiological methods and public health theories can be tied to theories of crime and delinquency and used to create evidence-based policy. Interdisciplinary theoretical approaches to existing, and emerging, public health and criminal justice problems hold great promise. Differential association theory postulates that close association with delinquent peers leads to an increase in deviant activities such as illicit drug use. Social cognitive theory postulates that health behavior change is driven by the interaction of (a) cognitive states that support a health outcome, (b) the social and contextual environment, (c) and individual action. Combined, these theories can be applied to drug eradication programs as well as other health and crime issues. Focus groups and interviews were performed to identify rates of illicit substance use among incarcerated African American adolescent male gang members and nongang members. The policy recommendations illustrate the convergence of criminological and epidemiological theory under the new paradigm of epidemiological criminology or ‘‘EpiCrim.’’

Caregiver predictors of adolescent inhalant abuse in rural Appalachia.

OBJECTIVE To explore caregiver correlates of adolescent inhalant abuse. METHODS Youth were surveyed about inhalant use. Caregivers were surveyed about demographics, behaviors, family environment, perceptions of parent/ adolescent interaction, coping strategies, caregiver monitoring of youth and self-reported substance use. Multiple logistic regression with backward elimination was used. RESULT Of the 218 dyads recruited, 94% of the youth inhalant and inhalant non-users were correctly classified using a model constructed from independent variables. CONCLUSION We believe that parent-based educational training services should be studied that provide information about inhalant abuse and encourage open communication, adaptive coping, and adequate monitoring skills.

Community perceptions of bloody diarrhoea in an urban slum in South Asia: implications for introduction of a Shigella vaccine

Understanding local perceptions of disease causation could help public health officials improve strategies to prevent bloody diarrhoea. A cross-sectional survey was conducted in Dhaka, Bangladesh to elicit community beliefs about the causes of and prevention strategies for bloody diarrhoea. Between March and June 2003, we interviewed 541 randomly selected respondents. Overall, 507 (93%) respondents perceived that a vaccine could prevent bloody diarrhoea. If a vaccine provided lifetime protection, 445 (83%) respondents stated that they would opt to get the vaccine and would pay a median of