T. E. Dielman

Environmental Correlates of Adolescent Substance Use and Misuse: Implications for Prevention Programs

The research in the areas of peer, family and community environmental effects on adolescent substance use and misuse clearly and consistently shows that peer substance use behavior is the primary predictor of adolescent alcohol use. Peer norms, however, are more important in the prediction of adolescent alcohol misuse. Parental norms and monitoring are secondary to the peer variables, but still of significance in the prediction of adolescent alcohol use and misuse. The intrapersonal construct of susceptibility to peer pressure is as important as the peer and parent variables in the prediction of both alcohol use and misuse in adolescence.

Dimensionality, internal consistency and interrater reliability of clinical performance ratings

Summary. A total of 6444 ratings of the financial performance of 424 third‐ and fourth‐year medical students were made by house officers and attending teachers during 12 separate internal medicine rotations. Ratings were based on 13 behaviourally anchored rating scales. One rating was randomly selected per student per evaluator type (house officer and attending teacher) during each of the 12 rotation periods. Ratings were factor analysed separately within each rotation period. Two factors emerged consistently, and congruence coefficients across the 12 occasions were high (0.88 or greater). The factors were labelled ‘problem‐solving (10 items) and ‘interpersonal skills’ (three items) on the basis of their content. Internal consistency coefficients of the indices constructed from items in the two factors and the total of the 13 items were high (0.9 or greater) and did not differ substantially when computed separately on the ratings from house officers and attending teachers. Interrater reliabilities on the individual items ranged from 0.14 to 0.33.

Parental and Child Health Beliefs and Behavior

Personal interviews concerning health beliefs and behav iors were conducted with a parent and child in each of 250 households. Index scores were constructed for parental and child health beliefs, and these scores were entered, along with demographic variables, in a series of multiple regression analyses predicting child health beliefs and behaviors. The age of the child was the variable most highly associated with three of four child health behaviors and four of six child health beliefs. The childrens snacking between meals and cigarette smoking were related to several parental behaviors and, to a lesser extent, parental health beliefs. The childrens health beliefs were less predictable than were their health behaviors, and the observed significant relationships were with parental health beliefs and demographics. The implications for the design of health education programs are discussed.

Assessment of Adolescent Refusal Skills in an Alcohol Misuse Prevention Study

Although many substance abuse prevention programs seek to enhance the ability of adolescents to refuse offers of alcohol and other drugs, few report assessments of refusal skill ability or its relationship to substance use. This report describes a procedure to assess the ability of adolescents to refuse the offer of a beer, and presents the findings of those assessments as well as their relationships to alcohol misuse prevention knowledge, susceptibility to peer pressure, internal health locus of control, self-esteem, and alcohol use and misuse. A one-third random sample (n = 1012) of 10th graders participating in a longitudinal evaluation of an alcohol misuse prevention curriculum was assessed individually. Students rated their own refusals, which were also rated by trained female and male raters. The results indicated that adolescents refuse the offer of a beer only somewhat convincingly. Those adolescents with better refusal skills had higher levels of alcohol misuse prevention knowledge, especially regarding resisting pressures to use alcohol and the application of knowledge to typical alcohol-related situations. They also reported less susceptibility to peer pressure, greater internal health locus of control and self-esteem, and less alcohol use and misuse. The results provide support for teaching refusal skills in substance abuse prevention programs and for assessing refusal skills in the evaluation of such programs.

Correlates of Alcohol Use and Misuse in Fourth-Grade Children: Psychosocial, Peer, Parental, and Family Factors

To determine level of alcohol use/misuse and to examine correlates of these behaviors, 1,314 fourth-grade students were surveyed. The questionnaire included 55 items concerning tolerance of deviance, deviant self-image, self-efficacy, susceptibility to peer pressure, personal and peer approval of alcohol use, peer adjustment, parent nurturance and monitoring, family adjustment, parental permissiveness, peer use of alcohol, and exposure to alcohol. The items were factor analyzed and indices constructed. The indices generally had acceptable alpha coefficients (α = .61-.91); two exceptions were peer adjustment (α = .51) and parental permissiveness (α = .42). Tolerance of deviance, deviant self-image, susceptibility to peer pressure, personal and peer approval, peer use and exposure by peers, and parental permissiveness were positively correlated with alcohol use/misuse. Self-efficacy, child-parent interactions, family adjustment, and peer adjustment were negatively correlated with alcohol use/misuse. Implications for the design of family-based alcohol use/misuse prevention programs are discussed.

Perceptions Held by Obese Children and their Parents: Implications for Weight Control Intervention

The study was designed to identify some of the psychosocial barriers to compliance in a hospital-based weight control intervention program for adolescents. Forty obese adolescents, 10 to 16 years of age, and their parents were surveyed prior to participa tion in a behavioral change weight control program at a major teaching hospital. Significant correlations were obtained between weight loss outcome and six factors. In obese adolescents, weight loss was significantly associated with their beliefs regarding: (1) personal control over weight, (2) barriers or difficulty of losing weight, (3) medical problems as a cause of their obesity, (4) family problems as a cause of their obesity, and (5) perceived willingness of family members to diet. It is suggested that greater weight loss in children who perceived more barriers/difficulty and less family willing ness to diet may reflect the importance of having realistic expectations related to be havioral compliance. In addition, a positive parental attitude or expectation that the child was less likely to be overweight in the future was associated with greater weight loss compliance. Other parental health beliefs, however, did not generally predict the childs weight loss response to the intervention. The findings lend support to the sig nificance of the adolescents beliefs regarding weight and family support in explaining weight loss response to a behavioral change intervention program.

A covariance structure model test of antecedents of adolescent alcohol misuse and a prevention effort.

As part of an alcohol misuse prevention evaluation, questionnaires were administered to 4,157 junior high school students to determine levels of alcohol misuse, exposure to peer use and misuse of alcohol, susceptibility to peer pressure, internal health locus of control, and self-esteem. A conceptual model of the antecedents of adolescent alcohol misuse and the effectiveness of a prevention effort was tested using covariance structure modeling techniques. The factor loadings for the model were all moderate to high, indicating that the observed variables served well as measurement instruments for the latent variables. The hypothesized structural relationships among the latent variables of alcohol misuse, exposure to peer use and misuse of alcohol, susceptibility to peer pressure, internal health locus of control, and self-esteem were supported by the data. The full model explained 45 percent of the variance in alcohol misuse in the analysis based on the total sample. The direct effect of the intervention on alcohol misuse was small but significant in the hypothesized direction. The direct effects of the intervention on susceptibility to peer pressure and internal health locus of control were not significant. The model was tested separately for groups of students who had high versus low scores on susceptibility to peer pressure in order to test the interaction between susceptibility to peer pressure and exposure to peer use and misuse of alcohol. The percentage of variance accounted for in alcohol misuse did not increase upon testing the model separately for students who had high versus low scores on susceptibility to peer pressure. Observed differences in the significance of the parameter estimates between the high and low susceptibility to peer pressure groups suggest that different approaches to the design and evaluation of substance abuse prevention programs may be necessary for different subgroups of students.

Psychometric Properties of Clinical Performance Ratings

A total of 7931 ratings of 482 third- and fourth-year medical students were gath ered over twelve four-week periods. Ratings were made by multiple raters, house officers, and attending faculty, on fifteen behaviorally-anchored rating scales. The data were factor analyzed separately for each of the twelve periods.

Mechanisms of Psychosocial Effects on Health: The Role of Social Integration, Coping Style and Health Behavior

To analyze the mechanisms by which psychosocial factors affect health, this re search investigated social integration and indicators of coping style and their relation to health behaviors and health status. The analysis was conducted using the results of a 1977 survey of 854 household interviews from a multi-stage probability sample of adult residents of Washtenaw County, Michigan. Physical-health status was evaluated by two indices: Self-rated global health and self reports of chronic disability. Mental health was assessed with the Center for Epidemiologic Studies Depression Scale. Over all, the effects of the psychosocial factors were stronger for mental health than physi cal health. Social integration was shown to have direct effects on both physical and mental-health status. Internal locus of control was associated with lower levels of de pressive symptoms. Chronic conditions were primarily affected by age, sex, and health behavior. Evidence from the path analyses suggested that part of the health benefit that women accrue from social integration and an active coping style is related to better health behavior. This mediation effect was not found for men.

What are raters rating? predicting medical student, pediatric resident, and faculty ratings of clinical teachers

Medical school evaluation literature reveals concerns about attitudes toward teaching, including cynicism toward the value of teaching in academics and alienation of students from the “work”; of learning. One might reasonably conclude, then, that these attitudes are reflected in higher evaluation scores for those professors who are kinder and gentler to students. Our study indicates otherwise. The important predictors of medical student, resident, and faculty ratings of teaching excellence were clinical competence, demonstrated sensitivity toward patients and their families, and recognition of the limits of ones abilities. Trainees and faculty generated ratings both reliable (αresidents = .93, αfaculty = .97) and rigorous (i.e., discriminating more from less effective teachers). Implications for designing and implementing clinical teaching evaluation systems include the need to identify criteria that the department members consider as underpinning responsible evaluation. In formulating these criteria, te...