Mediating mechanisms in a school-based drug prevention program: first-year effects of the Midwestern Prevention Project

Describes (a) the effects of a social-influences-based drug prevention program (the Midwestern Prevention Project) on the mediating variables it was designed to change and (b) the process by which the effects on mediating variables changed use of drugs (tobacco, alcohol, and marijuana). Students in 42 middle schools and junior high schools in Kansas City, Missouri, and Kansas City, Kansas, were measured in the fall of 1984 (N = 5,065) and again 1 year later (N = 5,008) after 24 of the schools had been through the program. Compared to students in control schools, students in program schools became less likely to express belief in the positive consequences of drug use, less likely to indicate that they would use such drugs in the future, more likely to report that their friends were less tolerant of drug use, and more likely to believe that they were better able to communicate with their friends about drug or school problems. Change in perceptions of friends' tolerance of drug use was the most substantial mediator of program effects on drug use. There was evidence that intentions to use and beliefs about the positive consequences of use may also mediate program effects on drug use.     

Adolescent depression and risk factors

Seventy-nine high school seniors were administered the Center for Epidemiological Studies Depression Scale (CES-D), as well as a questionnaire on parent relationships, peer relationships, positive and negative feelings including suicidal thoughts, and lifestyle variables including academic performance, exercise, and drug use. The group of adolescents who scored above the clinical cutoff for depression on the CES-D (n = 29) had poorer relations with parents. Further, the incidence of paternal depression in that group was greater. The depressed adolescents also had less optimal peer relationships, fewer friends, and were less popular. They experienced less happiness and more frequent suicidal thoughts. They spent less time doing homework, had a lower grade point average, and spent less time exercising. The depressed group also reported more use of marijuana and cocaine. A stepwise regression indicated that physical affection with parents, homework, well-being, exercise, happiness, and parent relations explained 55% of the variance.     

Expanding the traditional user versus non‐user dichotomy amongst ecstasy users

Differences in the drug use characteristics and psychosocial variables in the use and non‐use of ecstasy within 845 16–25 year‐olds in the UK was examined. Based on levels of ecstasy use and intentions, two groups of non‐users (resistant and vulnerable), three groups of users (light, moderate and heavy) and an ex‐user group were identified. It was found that there is predictive utility in this way of expanding the widely employed ‘user versus non‐user’ dichotomy. Resistant non‐users were more likely to be younger, female, and were characterized by lower levels of use of four other drugs (amphetamine, cannabis, cocaine and LSD). Those ‘at risk’ of using ecstasy reported more frequent use of amphetamine, LSD, and cannabis than resistant non‐users. Heavy user groups reported using amphetamine, cocaine and LSD more frequently than all the other groups. Having ecstasy using friends increased the odds of being an ‘at risk’ non‐user or an ecstasy user. Normative influence also differentiated between the three user groups (light, moderate, and heavy). Beliefs about ecstasy use being immoral, ecstasy offers being difficult to resist, ecstasy use making one feel guilty and ecstasy being readily available differentiated between user and non‐user groups. These factors could usefully inform the content of health education materials designed to change ecstasy use. Copyright © 2003 John Wiley & Sons, Ltd.     

Substance use/abuse as a predictor to illegal and violent behavior: A review of the relevant literature

The preponderance of the research evidence supports the conclusion that abuse of certain types of illicit drugs, separately from the abuse of alcohol, predisposes to subsequent violent behavior. The relationship of cocaine/crack to violent crime has been established more clearly for users of crack in inner city areas than it has for those who are users of other forms of cocaine in the general population.In regard to any race/ethnic or socioeconomic factors in the relationships between substance use/abuse and violent behavior, most clearly established is that a higher proportion of young Black males, compared to other race/ethnic groups, are actively involved in dealing cocaine/crack in some inner city poverty areas.As for gender differences, the research evidence indicates that alcohol abuse as a predictor to and a precipitant of violent behavior, is more clearly established for males than for females. Drug abuse, as distinct from alcohol abuse, has been found to predict subsequent violent behavior, for females as well as for males. “Co-morbidity,” the combination of substance use with and psychopathology, appears more likely to predict for females to later violent behavior. Psychopathology and mental health problems are less likely to predict occurrence of either violent or criminal behavior in the future than are either alcohol abuse or drug abuse.     

Substance use/abuse as a predictor to illegal and violent behavior: A review of the relevant literature

The preponderance of the research evidence supports the conclusion that abuse of certain types of illicit drugs, separately from the abuse of alcohol, predisposes to subsequent violent behavior. The relationship of cocaine/crack to violent crime has been established more clearly for users of crack in inner city areas than it has for those who are users of other forms of cocaine in the general population.In regard to any race/ethnic or socioeconomic factors in the relationships between substance use/abuse and violent behavior, most clearly established is that a higher proportion of young Black males, compared to other race/ethnic groups, are actively involved in dealing cocaine/crack in some inner city poverty areas.As for gender differences, the research evidence indicates that alcohol abuse as a predictor to and a precipitant of violent behavior, is more clearly established for males than for females. Drug abuse, as distinct from alcohol abuse, has been found to predict subsequent violent behavior, for females as well as for males. “Co-morbidity,” the combination of substance use with and psychopathology, appears more likely to predict for females to later violent behavior. Psychopathology and mental health problems are less likely to predict occurrence of either violent or criminal behavior in the future than are either alcohol abuse or drug abuse.     

Low prosocial attachment, involvement with drug-using peers, and adolescent drug use: a longitudinal examination of mediational mechanisms.

The process of disengagement from prosocial entities (e.g., family and school) and either simultaneous or subsequent engagement with antisocial entities (e.g., friends who use drugs) is a critical contributor to adolescent drug use and delinquency. This study provides a series of formal mediation tests to demonstrate the relationship between poor family attachment, poor school attachment, involvement with friends who use drugs, and a student's own use of drugs. Results indicate that poor family attachment exerts its effect on drug use through poor school attachment and involvement with friends who use drugs. In addition, poor school attachment exerts its effect on drug use through involvement with friends who use drugs. The results of this study corroborate theories that suggest disengagement from prosocial entities is associated with involvement with antisocial entities and eventual involvement in drug use. Implications for prevention strategies are discussed.     

The association between heroin use and anxiety sensitivity among inner-city individuals in residential drug use treatment

The current study represents an initial investigation of the association between heroin use and anxiety sensitivity (AS). Within a sample of 172 inner-city treatment seeking drug users, AS was compared across past year (1) heroin users with no crack/cocaine use (n=12); (2) crack/cocaine users with no heroin use (n=66); (3) users of both heroin and crack/cocaine (n=45); and (4) individuals with no use of heroin or crack/cocaine (n=49). Consistent with expectations, primary heroin users evidenced higher levels of AS than all other groups, with these differences also evidenced for the physical and social subscales. Differences in AS total score and physical subscale score persisted after controlling for demographic variables, depressive symptoms, and primary use of drugs other than heroin and crack/cocaine including alcohol, nicotine, marijuana, and hallucinogens. Findings suggest a unique relationship between AS and heroin, and set the stage for future work explicating the direction of the observed association.     

Adolescents' parent and peer relationships

High school seniors (N = 89) from a suburban private high school were administered a comprehensive questionnaire to determine differences between adolescents who rated the quality of their parent and peer relationships as high or low. Adolescents with high parent and high peer relationship scores had more friends, greater family togetherness, lower levels of depression and drug use, and a higher grade point average.     

A Cross‐National Comparison of Suicide Attempts,Drug Use,and Depressed Mood Among Dominican Youth

We compared suicide attempts, depressed mood, and drug use of 1,710 Dominican public high school students in New York City (NYC) and 9,573 in the Dominican Republic (DR) in 2009. Compared to DR Dominicans, NYC Dominicans were more likely to have reported lifetime marijuana use (27.6% vs. 1.5%), lifetime inhalant use (11.0% vs. 7.6%), lifetime other drug use (9.9% vs. 3.0%), depressed mood (31.3% vs. 27.2%), and suicide attempt (13.8% vs. 8.8%). The results of this study supported the hypothesis that substantial increases in illicit drug use, especially cocaine, heroin, ecstasy, and methamphetamines, among NYC Dominican youth account for their increased risk for suicide attempts compared to their DR Dominican counterparts. It also identified suicide attempts as a public health problem among NYC Dominicans, the largest NYC Latino immigrant population.     

Treatment Populations,Services, and Outcomes for Cocaine and Crack-Cocaine Dependence

This paper analyzes demographic and other pretreatment characteristics, measures of treatment services received, and treatment outcomes of participantsin the National Treatment Improvement Evaluation Study (NTIES), a large-scale longitudinal study of substance abuse treatment (D. R. Gerstein et al., 1997; R. A. Johnson & D. R. Gerstein, 2000). The focus here is those treated primarily for cocaine powder or crack-cocaine dependence, compared with those in treatment for other substances, particularly heroin. Crack-dependent users tend to be female and black, older than primary marijuana or alcohol users but younger than those in treatment for heroin. Primary cocaine powder or crack users are likely to have entered treatment under pressure from the criminal justice system. After treatment there are substantial reductions in use of cocaine powder and crack, especially among participants with fewer prior treatment episodes and lower pretreatment intensity of use. Longer duration and intensity of treatment result in greater reductions in cocaine and crack use.     

Adolescent suicidal ideation

Adolescent suicidal ideation and its relationship to other variables was tapped by a self-report questionnaire administered to 88 high school seniors. Eighteen percent responded positively to the statement "sometimes I feel suicidal." Those who reported suicidal ideation were found to differ from those who did not on a number of variables, including family relationships (quality of relationship with mother, intimacy with parents, and closeness to siblings), family history of depression (maternal depression), peer relations (quality of peer relationships, popularity, and number of friends), emotional well-being (happiness, anger, and depression), drug use (cigarettes, marijuana, and cocaine), and grade point average. Stepwise regression indicated that happiness explained 46% of the variance in suicidal ideation, and number of friends, anger, and marijuana use explained an additional 20%, for a total of 66% of the variance. While 34% of the variance remained unexplained, it is suggested that the questions used to measure these four variables be included in global screenings to identify adolescents at risk for suicidal ideation.     

Depression and decision-making among intravenous drug users

Two short scales, the TCU Depression Scale and the TCU Decision-making Scale, were psychometrically evaluated in a sample of 145 intravenous drug users. Coefficient alpha reliabilities were .78 for the 6-item TCU Depression Scale and .77 for the 9-item TCU Decision-making Scale. Concurrent validity of the former scale was assessed by correlating scores with those on the Beck Depression Inventory, r = .75. Based on the Beck Depression Inventory Clinical cutoff scores, 83% of the sample showed some depression, with 23% severely depressed, 39% moderately depressed, and 21% mildly depressed. Individuals scoring higher on depression on both tests tended to score lower on decision-making. Significant demographic associations of age, gender, education, and race-ethnicity were found for the depression and decision-making scales. More depression was noted for women, those younger, white, and having less education. Older and more educated intravenous drug users tended to score higher on decision-making. Validity for the depression and decision-making scales was assessed by examining correlations with behaviors. Significant positive correlations were found between depression scores and intravenous use of cocaine only, heroin and cocaine combined, and heroin only. Also, intravenous use of cocaine only and of cocaine and heroin combined were negatively related to decision-making. AIDS sex-risky behavior was positively correlated with depression and negatively correlated with decision-making.     

Movement patterns of persons with HIV receiving treatment in public clinics in the Southern Health Region,Puerto Rico

A survey conducted among 187 HIV-infected patients from publicly supported HIV clinics in the Puerto Rican Southern Health Region (SHR) failed to substantiate health planners' concern that this group travels frequently to the US to receive medical services. Respondents were questioned about all places of residence and all sites of HIV treatment in the past 12 months. Movement was defined as being anywhere outside of the SHR for 2 weeks or longer. 7% of the sample had moved at least once in the past year; 4% had moved outside the SHR but within Puerto Rico, while 3% had been in the continental US. Compared to the heterosexual risk group, intravenous drug users and men who have sex with men were 7-8 times more likely to have moved. The attainment of at least a high school education was also significantly and independently associated with increased probability of movement. Medical care was not identified by any of these respondents as the primary reason for travel. 58% indicated they were in their current place of residence to be near family, friends, and relatives. Both the small sample size and the low socioeconomic status of respondents may have limited the ability of this study to identify the so-called "air bridge," however.     

Drug-Intake Methods and Social Identity: The Use of Marijuana in Blunts Among Southeast Asian Adolescents and Emerging Adults

This article examines why Southeast Asian American adolescents and emerging adults in two urban settings prefer to use "blunts," or hollowed-out cigars filled with marijuana, over other methods of drug intake. Rationales for preferring blunts were both instrumental and social. Blunts allowed users to more easily share marijuana, the preferred drug among their peers, and protected against potential adverse effects associated with the "high." Blunts also allowed users to identify with the dominant style of drug use and differentiate themselves from users of stigmatized drugs such as crack cocaine and methamphetamine. This article highlights the importance of drug-intake methods in the formation and performance of drug-using behaviors among adolescents, emerging adults, and members of ethnic minority subgroups.     

Recognition of problem drinking among young adult prisoners

Alcohol is a preventable cause of illness, offending and other adversities worldwide. Prisoners are especially vulnerable. The aim of this study was to test the hypotheses that younger adult male prisoners are more likely to be hazardous drinkers than their older peers, but less likely to recognize this. The study cohort comprised 100 male prisoners aged 18-20 years and 157 aged 21 and over, who were interviewed and completed standard alcohol and drug questionnaires just after reception into prison. It was found that younger men were significantly more likely to be hazardous drinkers than their older peers but less likely to recognise this, even at scores on the Alcohol Use Disorders Identification Test (AUDIT) indicating dependency. They were also less likely to experience withdrawal symptoms, the main factor associated with problem drinking recognition at any age. Younger prisoners were less likely to be depressed, more likely to rate their social support as good and less likely to be dependent drug users. We conclude that reliance on younger prisoners to recognise their hazardous drinking would identify about one-fifth of them. With a lower likelihood of withdrawal symptoms than older men, they are probably still metabolizing alcohol more effectively. Given their similarities to older prisoners in terms of any previous imprisonment and likely personality disorder, formal screening for hazardous drinking might prevent decline into problem drug use, depression, reoffending, re-imprisonment, and social disconnection.     

Smoking on School Property as a Risk Factor for Substance Use Among Adolescent Smokers

The purpose of the current study was to determine if smoking on high-school property was associated with increased risk for other substance use among U.S. adolescents. Secondary analyses were carried out with data from the 2011 Youth Risk Behavior Survey (YRBS, N = 15,503). Only adolescents who reported smoking at least one cigarette in the last 30 days were selected for analyses (n = 2531, 44% female). Alcohol, marijuana, and cocaine use was assessed among participants. Binary logistic regression analysis was carried out to examine the relationship between smoking on school property (yes versus no) with each of the substance use variables. Adolescent smokers who reported smoking on school property were significantly more likely to report substance use across all substances examined compared to smokers who did not smoke on campus. For example, campus smokers were 3.91 times more likely to use marijuana in their lifetime and 3.85 times more likely to have used crack or cocaine in their lifetime compared to smokers who did not smoke on campus. Health care providers who provide services to adolescents should screen for smoking on school property to help identify adolescents at increased risk for substance use.     

The Other Side of the Story: Knowledge Transfer and Advice-Giving in a Drug Subculture

Widely used as a framework for understanding drug use initiation, social learning theory has lacked considerations of peer effects from the standpoint of the experienced user and applications to hard drugs. This study aims to extend social learning theory by examining the advice an experienced drug user would give a younger friend or relative expressing desire to experiment with club drugs. Forty qualitative interviews with club drugs users were analyzed. The experienced user’s own initiation, previous experiences, and risk perceptions are important in how advice is constructed. We discovered variations in advice-giving for friends and family members that may be based on considerations of age appropriateness.     

Body image and psychological well-being in adolescents: the relationship between gender and school type

Adolescents (N=1281; M age = 15.2 years, SD = 0.51 years) from a state-wide sample of schools provided information about their psychological well-being, family functioning, extraversion, and perceived physical attractiveness and weight, using a questionnaire completed at school. Consistent with previous research, girls were significantly more likely than boys to be dissatisfied with their weight and physical appearance, and these factors explained significantly more variation in self-esteem than in life satisfaction or other measures of psychological well-being. The strong relationship between body dissatisfaction and self-esteem for adolescent girls was not moderated by school type (single sex or educational). However, girls who were dissatisfied but psychologically well adjusted tended to be more extraverted, have more close friends and receive greater family support.     

Determinants of Property Crime Among Illicit Opiate Users Outside of Treatment Across Canada

Criminal activities account for a major proportion of the social costs related to illicit drug use. This article examines the factors contributing to property crime activity among a community sample of 653 untreated regular illicit opiate users in 5 Canadian cities (OPICAN study). Multivariate analyses showed the frequency of heroin, cocaine, and crack use, gender, housing status, and past criminal justice involvement as predictors of property crime. Furthermore, crack use had a significantly different impact on property crime depending on housing status and city. These findings underline the need for targeted intervention efforts toward a reduced crime burden.     

Do Written Reports of Suicide Induce High-School Students to Believe that Suicidal Contagion Will Occur?1

To see if high-school students who read that a distressed adolescent knew about suicide thought that suicidal contagion would occur, 66 consenting high-school students read a written account of John, a high-schooler with multiple problems including knowing someone who had died (either by suicide or viral illness). They then anonymously completed the UCLA Loneliness scale and a questionnaire about what John (or they in the same situation) might do. When John knew of a sympathetic response to a viral illness death, or an unsympathetic response to suicide, he was rated as relatively more likely to make new friends and less likely to want to die. These high school students saw themselves as immune to suicidal contagion from a written report, but thought that others might be vulnerable if people were sympathetic.