Stella M. Resko

Alcohol Availability and Violence among Inner-City Adolescents: A Multi-Level Analysis of the Role of Alcohol Outlet Density

Researchers recognize that the connection between alcohol and peer violence may relate to community level ecological factors, such as the location of businesses that sell alcohol. Building on previous research among adults, this study examines the relationship between alcohol outlet density and violent behaviors among adolescents, taking into account demographic characteristics, individual alcohol use, and neighborhood level socioeconomic indicators. Data drawn from a diverse Emergency Department based sample of 1,050 urban adolescents, combined with tract level data from the state liquor control commission and U.S. Census, were analyzed. Results of multivariate multi-level regression analysis indicate that alcohol outlet density is significantly related to adolescents’ violent behaviors, controlling for demographic characteristics and individual alcohol use. Census tract level socioeconomic indicators were not significantly associated with youth violence. Findings suggest that alcohol outlet density regulation should be considered as part of broader violence prevention strategies for urban adolescents.

A Randomized Controlled Trial Testing the Efficacy of a Brief Cannabis Universal Prevention Program among Adolescents in Primary Care

AIMS To examine the efficacy of a brief intervention delivered by a therapist (TBI) or a computer (CBI) in preventing cannabis use among adolescents in urban primary care clinics. DESIGN A randomized controlled trial comparing: CBI and TBI versus control. SETTING Urban primary care clinics in the United States. PARTICIPANTS Research staff recruited 714 adolescents (aged 12-18 years) who reported no life-time cannabis use on a screening survey for this study, which included a baseline survey, randomization (stratified by gender and grade) to conditions (control; CBI; TBI) and 3-, 6- and 12-month assessments. MEASUREMENTS Using an intent-to-treat approach, primary outcomes were cannabis use (any, frequency); secondary outcomes included frequency of other drug use, severity of alcohol use and frequency of delinquency (among 85% completing follow-ups). FINDINGS Compared with controls, CBI participants had significantly lower rates of any cannabis use over 12 months (24.16%, 16.82%, respectively, P < 0.05), frequency of cannabis use at 3 and 6 months (P < 0.05) and other drug use at 3 months (P < 0.01). Compared with controls, TBI participants did not differ in cannabis use or frequency, but had significantly less other drug use at 3 months (P < 0.05), alcohol use at 6 months (P < 0.01) and delinquency at 3 months (P < 0.01). CONCLUSIONS Among adolescents in urban primary care in the United States, a computer brief intervention appeared to prevent and reduce cannabis use. Both computer and therapist delivered brief interventions appeared to have small effects in reducing other risk behaviors, but these dissipated over time.

Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.

AIMS This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics. METHODS Patients (ages 12-18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences - CC) and secondary outcomes [alcohol use, other drug use (illicit and non-medical prescription drugs), and driving under the influence of cannabis (DUI)] assessed at 3, 6, and 12 months. RESULTS 1416 adolescents were surveyed; 328 reported past year cannabis use and were randomized. Comparisons of the CBI relative to control showed that at 3 months the group by time interaction (G × T) was significant for other drug use and CC, but not for cannabis use, alcohol use, or DUI; at 6 months, the G × T interaction was significant for other drug use but not for cannabis use, alcohol use, or CC. For analyses comparing the TBI to control, at 3 months the G×T interaction was significant for DUI, but not significant for cannabis use, alcohol use, or CC; at 6 months, the G×T interaction was not significant for any variable. No significant intervention effects were observed at 12 months. CONCLUSION Among adolescent cannabis users presenting to primary care, a CBI decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term. Additional boosters may be necessary to enhance these reductions over time.

Latent class analysis of substance use among adolescents presenting to urban primary care clinics

Abstract Background: Polysubstance use during adolescence is a significant public health concern. However, few studies have investigated patterns of substance use during this developmental window within the primary care setting. Objectives: This study used an empirical method to classify adolescents into substance use groups, and examines correlates of the empirically defined groups. Methods: Data came from patients, ages 12–18 years, presenting to an urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n = 1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership. Results: LCA identified three classes: class 1 (64.5%) exhibited low probabilities of all types of substance use; class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; and class 3 (10.9%) had the highest probabilities of substance use, including heavy episodic drinking and misuse of prescription drugs. Those in class 2 and class 3 were more likely to be older and have poorer grades, poorer health, higher levels of psychological distress and more sexual partners than those in class 1. Individuals in class 3 were also less likely to be African-American than those in class 1. Conclusion: Findings provide novel insight into the patterns of substance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.

Early Attrition From Treatment Among Women With Cooccurring Substance Use Disorders and PTSD

Participant retention is one of the more challenging issues in the treatment of substance use disorders. Using data from the National Institute on Drug Abuse Clinical Trials Networks Women and Trauma Study (recruitment in 2004–2005), we examine prominent factors associated with early attrition among women with cooccurring substance use disorders and posttraumatic stress disorder (N = 340). Early treatment attrition is associated with a history of youth partner violence, perceived need for psychological treatment, and abuse of alcohol, opioids, and stimulants. Logistical barriers (e.g., transportation, having children) were not significantly associated with early attrition. Findings provide insight into characteristics of women who might need additional supports to engage in treatment.

Public Perceptions and Attitudes Toward Adolescent Marijuana Use: Results of a Statewide Survey

The purpose of the current study is to examine patterns in public perceptions and attitudes toward marijuana use among adolescents. Computer-assisted telephone interviewing (CATI) was used to collect data from a statewide sample of adults in Michigan identified through random-digit dialing (n = 560). CATI interviews were supplemented with web- and paper-based surveys for nonrespondents. We used latent class analysis to characterize patterns in public perception, using a vignette technique that assessed (a) whether adults recognize adolescent marijuana use as a problem, (b) how they view the efficacy of treatment, (c) how they view help-seeking with mental health professionals, and (d) whether they support prevention services for adolescents. Multinomial logistic regression was used to examine the relationship between class membership and demographics, substance use, and methodological factors. Three latent classes were identified: (a) a discriminating group, (b) a low-concern group, and (c) a high-concern group. Age and substance use were among the strongest determinants for membership in the discriminating group. Results provide insight into how the general public perceives marijuana use and marijuana-related problems among adolescents.

Therapist competence and treatment adherence for a brief intervention addressing alcohol and violence among adolescents

This study examines therapist competency and treatment adherence for a brief intervention addressing alcohol misuse and violent behaviors among adolescents aged 14-18 years. Three observational measures of fidelity were used by independent raters to evaluate 60 therapist-delivered sessions (M = 32.5 minutes). Individual items from the Content Adherence scale, the Global Rating of Competence (Global Rating of Motivational Interviewing Therapist [GROMIT]), and the Self Exploration and Change Talk (SECT) demonstrated fair to excellent interrater reliability (intraclass correlations ranged from .40 to 1.0). Principal components analysis was used to identify the underlying factor structure of the Content Adherence and the GROMIT. Parallel analysis suggested the extraction of three components for the Content Adherence reflecting the three distinct goals for each segment of the intervention. Two components were identified for the GROMIT representing the general spirit of motivational interviewing and empowerment. Findings provide support for the fidelity instruments adapted for this study and offer direction for future training and clinical supervision.

Reasons for Fighting among Violent Female Adolescents: A Qualitative Investigation from an Urban, Midwestern Community.

This qualitative study examines the self-reported reasons for fighting among female adolescents (N = 72). Data are drawn from brief intervention sessions addressing violent behavior and alcohol use. Young women age 14 to 18 (Mean = 16) were recruited in an urban emergency department (58.3% African American/Black, 31.9% White, and 9.7% other races/ethnicities). Participants identified multiple reasons that they engage in fights including self-protection/self-defense, enhancing social status and respect, safety (e.g., preventing future fights or sexual assaults), revenge/retaliation, social motivations (e.g., defending family or friends, fighting over romantic interests), coping, and enjoyment. Results provide insight into opportunities and challenges in developing interventions addressing aggression among female adolescents.

Peer Victimization and Substance Use Among African American Adolescents and Emerging Adults on Chicago's Southside

Urban African-American youth residing in poorly resourced communities are at a heightened risk of peer victimization, which consequently increases their likelihood of risky behaviors such as substance use. The present study examined whether there was a direct relationship between peer victimization and substance use and whether it was mediated by negative peer norms, internalizing problems, and bullying perpetration. African-American youth (n = 638) completed a self-administered questionnaire on age, biological sex, socioeconomic status, lifetime substance use, peer victimization and bullying perpetration, negative peer norms, and internalizing problems. There were no direct effects between peer victimization and substance use. However, negative peer norms and bullying were both independently associated with substance use, although internalizing problems were not significant. In addition, peer victimization increased the odds of internalizing problems. Social services must be expended in low-income communities to effectively address peer victimization and substance use among urban African-American youth.

Predictors of Attrition for a Sexual Assault Forensic Examiner (SAFE) Blended Learning Training Program

Introduction: Participant attrition is a major concern for online continuing education health care courses. The current study sought to understand what factors predicted health care professionals completing the online component of a sexual assault forensic examiner (SAFE) blended learning training program (12‐week online course and 2‐day in‐person clinical skills workshop). Methods: The study used a Web‐based survey to examine participant characteristics, motivation, and external barriers that may influence training completion. Hierarchical logistic regression was utilized to examine the predictors of training completion, while the Cox proportional hazards (Cox PH) regression model helped determine the factors associated with the timing of participant attrition. Results: Results show that 79.3% of the enrolled professionals completed the online component. The study also found that clinicians who work in rural communities and those who were interested in a 2‐day clinical skills workshop were more likely to complete the online course. In terms of when attrition occurred, we found that participants who were motivated by the 2‐day clinical workshop, those who worked in a rural community, and participants interested in the training program because of its online nature were more likely to complete more of the online course. Discussion: Blending an online course with a brief in‐person clinical component may serve as a motivator for completing an online course because it provides the opportunity to develop clinical skills while receiving immediate feedback. Participant attrition appears to be less of a concern for rural clinicians because this modality can reduce their barriers to accessing continuing education.