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CORK Bibliography: Adolescents and Prevention

66 citations. January 2010 to present

Prepared: September 2011

Al-Bedah AM; Qureshi NA; Al-Guhaimani HI; Basahi JA. The Global Youth Tobacco Survey-2007: Comparison with the Global Youth Tobacco Survey 2001-2002 in Saudi Arabia. Saudi Medical Journal 31(9): 1036-1043, 2010. (22 refs.)

Objectives: To primarily describe both smoking pattern in the youth population and a comparison with the Global Youth Tobacco Survey (GYTS) in 2001-2002. Methods: The standard 2-stage methodology and a cross-sectional design were used to select randomly a representative sample of intermediate schools, classes, and students from all regions in the Kingdom of Saudi Arabia from January to June 2007. Result: Comparing results with the 2001 GYTS, the prevalence of ever and current smoking, use of other tobacco products, and initiation of smoking by never smokers in the next year increased among males, but with improvement in the students' knowledge and attitudes towards smokers. The second-hand tobacco smoke items were not distinguished, however, one or both parent smokers increased by 6% over 6 years. Media anti-smoking messages and awareness improved, however, the widespread display and proliferation of items with a cigarette brand logo on it, encourages participants to buy more cigarettes. Teaching hazards of smoking to students improved, however, the reasons why people of their age smoke were not discussed interactively. Females less than 18 years of age (minors) were not denied cigarette purchase compared to male participants of the same age. Conclusion: The National Tobacco Control Programs is apparently working effectively but differentially against smoking. The program needs to be evaluated systematically and accordingly and intensified further to reduce smoking among youths in the Kingdom of Saudi Arabia.

Babbin SF; Harrington M; Burditt C; Redding C; Paiva A; Meier K et al. Prevention of alcohol use in middle school students: Psychometric assessment of the decisional balance inventory. Addictive Behaviors 36(5): 543-546, 2011. (19 refs.)

A measurement model should be equivalent across the different subgroups of a target population. The Decisional Balance Inventory for the Prevention of Alcohol Use is a 2-factor correlated model with 3 items for Pros of alcohol use and 3 items for Cons. The measure is part of a tailored intervention for middle school students. This study evaluated the important psychometric assumptions of factorial invariance and scale reliability with a large sample of sixth grade students (N = 3565) from 20 schools. A measure is factorially invariant when the model is the same across subgroups. Three levels of invariance were assessed, from least restrictive to most restrictive: 1) Configural Invariance (unconstrained nonzero factor loadings); 2) Pattern Identity Invariance (equal factor loadings); and 3) Strong Factorial Invariance (equal factor loadings and measurement errors). Structural equation modeling was used to assess invariance over two levels of gender (male and female), race (white and black), ethnicity (Hispanic and non-Hispanic), and school size (large, indicating > 200 students per grade, or small). The strongest level of invariance, Strong Factorial Invariance, was a good fit for the model across all of the subgroups: gender (CFI: 0.94). race (CFI: 0.96), ethnicity (CFI: 0.93), and school size (CFI: 0.97). Coefficient alpha was 0.61 for the Pros and 0.67 for Cons. Together, invariance and reliability provide strong empirical support for the validity of the measure.

Bossarte RM; Swahn MH. The associations between early alcohol use and suicide attempts among adolescents with a history of major depression. Addictive Behaviors 36(5): 532-535, 2011. (30 refs.)

Objective: Previous studies have identified significant associations between alcohol initiation before the age of 13 years and risk for suicide attempts. However, these associations have not been extensively tested using data obtained from populations with clinically significant psychopathology. The current study seeks to extend knowledge of the associations between early alcohol initiation and risk for suicide by identifying the associations between age of first alcohol use and suicide attempts among a sample of youth age 13 to 15 years with a history of major depression. Methodology: Data were obtained from the National Study of Drug Use and Health (NSDUH), a household-based survey of U.S. adolescents and adults age 12 years and older. Results: Results from these analyses confirm previous reports of significant associations between age of first alcohol use and suicide attempts and extend previous understanding of risk by using data obtained from a household-based survey and from adolescents with clinically relevant psychopathology. Conclusions: These findings provide further support for the implementation, enforcement, and continued support of both targeted and universal prevention strategies designed to reduce underage drinking.

Brinn MP; Carson KV; Esterman AJ; Chang AB; Smith BJ. Mass media interventions for preventing smoking in young people. (review). Cochrane Database of Systematic Reviews 11: e-article CD001006, 2010. (164 refs.)

Background: The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community. Objectives: To evaluate the effectiveness of mass media interventions to prevent smoking in young people in terms of reduced smoking uptake, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy and perception. Search strategy: We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of MEDLINE and EMBASE in July 2010. Selection criteria Randomized trials, controlled trials without randomization and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. Data collection and analysis: Information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risk of bias was abstracted by two independent reviewers. Studies were combined using qualitative narrative synthesis. Main results: Seven out of a total of 84 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All seven studies used a controlled trial design. Three studies concluded that mass media reduced the smoking behaviour of young people. All of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages, and message broadcast was of reasonable intensity over extensive periods of time. Authors' conclusion: There is some evidence that mass media can prevent the uptake of smoking in young people, however the evidence is not strong and contains a number of methodological flaws.

Brown AK; Moodie C; Hastings G; Mackintosh AM; Hassan L; Thrasher J. The association of normative perceptions with adolescent smoking intentions. Journal of Adolescence 33(5): 603-614, 2010. (119 refs.)

The social norms approach suggests that tobacco use among a referent population will reduce provided they are presented with accurate information about the perceived norms of that behaviour. This study investigated adolescents' perceived tobacco-related norms on future smoking intentions, using a sample of 11-16 year olds (n = 804) from wave two of the Youth Tobacco Policy Survey. Structural equation modelling was used to analyse, simultaneously, the hypothesized normative model on future smoking intentions among both adolescent smokers and never smokers. While among adolescent smokers perceived prevalence, perceptions of the tobacco industry and risk from smoking were associated with future smoking intentions, among never smokers only perceived sibling approval was associated with future smoking intentions. The research highlights the need for more comprehensive anti-tobacco related campaigns that incorporate messages and stimuli relevant to behaviour reflecting these normative types.

Carson KV; Brinn MP; Labiszewski NA; Esterman AJ; Chang AB; Smith BJ. Community interventions for preventing smoking in young people. (review). Cochrane Database of Systematic Reviews 7(e-article CD001291), 2011. (166 refs.)

Background: Cigarette smoking is one of the leading causes of preventable death in the world. Decisions to smoke are often made within a broad social context and therefore community interventions using coordinated, multi-component programmes may be effective in influencing the smoking behaviour of young people. Objectives: To determine the effectiveness of multi-component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. Search strategy: The Tobacco Addiction group's specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and raw data was requested from study authors. Searches were updated in August 2010. Selection criteria: Randomized and non randomized controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years. Data collection and analysis: Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table. Main results: Twenty-five studies were included in the review and sixty-eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short-term smoking prevalence (twelve months or less), while nine studies detected significant long-term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. Authors' conclusions: There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws.

Chikere EIC; Mayowa MO. Prevalence and perceived health effect of alcohol use among male undergraduate students in Owerri, South-East Nigeria: a descriptive cross-sectional study. BMC Public Health 11: article 118, 2011. (15 refs.)

Background: Alcohol use during adolescence and young adulthood remains a prominent public health problem. Despite growing problems of global alcohol abuse, accurate information on the prevalence and pattern of use in Nigeria remain sparse. This study examines the prevalence and perceived health effects of alcohol use among undergraduate students in Owerri, Nigeria. Method: The prevalence and perceived health effects of alcohol was estimated for 482 male undergraduates of four higher institutions in Owerri, South-East Nigeria between October 2008 and March 2009. Information was obtained using a semi-structured, self-administered questionnaire. Result: The mean age of the students was 24.7 years. Majority of the respondents confirmed they were current users of alcohol given a prevalence of 78.4%, with twenty-seven percent of them being heavy drinkers (>= 4 drinks per day). Reasons given by respondents for alcohol drinking include: makes them feel high (24.4%); makes them belong to the group of "most happening guys" on campus (6.6%); makes them feel relaxed (52.6%) while (16.4%) drinks it because their best friends do. Perceived health impacts of alcohol use among current users include: it enhances pleasure during moment of sex (51.1%), causes drowsiness and weakness (63.8%), may precipitate defective memory and impaired perception (64.3%) and serves as risk factor for most chronic diseases (68.5%). Conclusion: High prevalence of alcohol use was established among study groups. Evaluation of full-scale community-level intervention, including community mobilisation and media advocacy aimed at supporting changes in policies on drinking, access and sales of alcohol to young people, could be helpful in reducing the trend.

Conner M; Higgins AR. Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: A cluster randomized controlled trial. Health Psychology 29(5): 529-538, 2010. (63 refs.)

Objective: To test the efficacy of implementation intentions in reducing smoking uptake in a sample of adolescents. Design: Classes of adolescents (aged 11-12 years) were randomly allocated to one of four conditions: implementation intention, self-efficacy, two control conditions. An implementation intention or a self-efficacy manipulation (both formed in relation to how to refuse offers of cigarettes) was completed by intervention condition participants at 0, 4, 8, 12, 16, 20, and 24 months. Main Outcome Measures: Long-term smoking behavior (self-report and objective) was assessed at 48 months post-baseline. Results: There were no differences between the two control conditions and the self-efficacy condition. Controlling for baseline smoking, sex, attitudes to smoking, friends and family smoking, and the multilevel nature of the data, intention-to-treat analyses indicated the implementation intention manipulation significantly reduced self-reported smoking compared to the other three conditions combined. Analyses on objectively assessed smoking (carbon monoxide breath measure) in a random subsample of participants also indicated that the implementation intention manipulation compared to the other three conditions significantly reduced smoking. Conclusion: Implementation intentions can reduce smoking in adolescent samples. Implications for using implementation intentions to reduce smoking in adolescents are discussed.

de Araujo VA; Loukas A; Gottlieb NH. Examining differences between light and heavier smoking vocational students: A pilot study. Health Education Journal 70(1): 67-75, 2011. (20 refs.)

Objective: To examine differences between light and heavier smoking vocational/technical students in tobacco use, related behaviors, and cessation. Design: Cross-sectional. Setting and Methods: Two hundred and four smokers attending two vocational/technical colleges in east Texas, USA, completed an anonymous survey during a regularly scheduled class in Fall, 2004 or Spring, 2005. Results: Heavier smokers (39.7 per cent of the sample) were more likely than light smokers to be European American, to be dependent on cigarettes, to use cigarettes in a variety of situations, to use medication to quit smoking, and to be less likely to report a desire to quit on their own. The two groups did not differ on gender or the use of cigars and chewing tobacco. Conclusion: Given the disproportionately high rates of tobacco use among vocational/technical students, results from this study indicate that salient anti-tobacco programs that can be implemented at the vocational school and that target light and heavier smoking students are needed.

de Moor JS; Puleo E; Ford JS; Greenberg M; Hodgson DC; Tyc VL et al. Disseminating a smoking cessation intervention to childhood and young adult cancer survivors: Baseline characteristics and study design of the partnership for health-2 study. BMC Cancer 11(e-article 165), 2011. (40 refs.)

Background: Partnership for Health-2 (PFH-2) is a web-based version of Partnership for Health, an evidence-based smoking cessation intervention for childhood cancer survivors. This paper describes the PFH-2 intervention and baseline data collection. Methods: 374 childhood and young adult cancer survivors were recruited from five cancer centers and participated in the baseline assessment. At baseline, participants completed measures of their smoking behavior, self-efficacy and stage of change for quitting smoking as well as psychological and environmental factors that could impact their smoking behavior. Results: At baseline, 93% of survivors smoked in the past seven days; however, 89% smoked a pack or less during this period. Forty-seven percent were nicotine dependent, and 55% had made at least one quit attempt in the previous year. Twenty-two percent of survivors were in contemplation for quitting smoking; of those 45% were somewhat or very confident that they could quit within six months. Sixty-three percent were in preparation for quitting smoking; however, they had relatively low levels of confidence that they could quit smoking in the next month. In multivariate analyses, stage of change, self-efficacy, social support for smoking cessation, smoking policy at work and home, fear of cancer recurrence, perceived vulnerability, depression, BMI, and contact with the healthcare system were associated with survivors' smoking behavior. Discussions/Conclusions: A large proportion of the sample was nicotine dependent, yet motivated to quit. Individual- interpersonal- and environmental-level factors were associated with survivors' smoking behavior. Smoking is particularly dangerous for childhood and young adult cancer survivors. This population may benefit from a smoking cessation intervention designed to build self-efficacy and address other known predictors of smoking behavior.

Essau CA. Comorbidity of substance use disorders among community-based and high-risk adolescents. Psychiatry Research 185(1-2): 176-184, 2011. (74 refs.)

The aim of this article was to examine the frequency and comorbidity of substance use disorders (SUD) among community-based adolescents and high-risk adolescents, using the same methodology. Adolescents from the community (N = 1035) were recruited from 36 schools. High-risk adolescents (N = 374) comprised those whose parent(s) have the diagnosis of SUD and who were undergoing a treatment for their SUD. Adolescents were interviewed using the computerized Munich version of the Composite International Diagnostic Interview to access the presence of SUD and other major DSM-IV psychiatric disorders. The lifetime rate of SUD was significantly lower in the community-based (12.3%) than the high-risk (38.3%) groups of adolescents. In both settings. SUD co-occurred highly with other psychiatric disorders. About 52.7% and 62.2% of the community-based and high-risk adolescents with SUD, respectively, had at least one additional disorder. Adolescents with SUD and comorbid disorders were significantly more psychologically distressed, compared to adolescents with SUD only. Adolescents with SUD had significantly lower perceived attachment to parents, but significantly higher attachment to peers compared to adolescents without any psychiatric disorders. The implications of the present findings were discussed in terms of the need to design prevention program especially for high-risk children, and also stressed the importance of conducting comprehensive assessment among adolescents referred for the treatment of SUD.

Farajat MA. Beliefs of tenth grade Jordanian students regarding cigarette smoking. Implications for prevention. (editorial). Saudi Medical Journal 31(7): 831-832, 2010. (5 refs.)

Flynn BS; Worden JK; Bunn JY; Solomon LJ; Ashikaga T; Connolly SW et al. Mass media interventions to reduce youth smoking prevalence. American Journal of Preventive Medicine 39(1): 53-62, 2010. (33 refs.)

Background: Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported. Design: Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n = 19,966) and in 2005 after (n = 23,246) the interventions were completed. Setting/participants: Grade 7-12 students from public schools in these eight medium-sized metropolitan areas participated in the summative evaluations; Grades 4-12 students were targeted to receive mass media interventions in four of these markets. Intervention: Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years. Main outcome measures: Prevalence of youth smoking and psychosocial mediators of smoking. Results: No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas. Conclusions: Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, probably because of a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign.

Forster J; Chen V; Perry C; Oswald J; Willmorth M. The Minnesota Adolescent Community Cohort Study: Design and baseline results. Prevention Science 12(2): 201-210, 2011. (54 refs.)

The Minnesota Adolescent Community Cohort (MACC) Study is a population-based, longitudinal study that enrolled 3,636 youth from Minnesota and 605 youth from comparison states ages 12 to 16 years in 2000-2001. Participants have been surveyed by telephone semi-annually about their tobacco-related attitudes and behaviors. The goals of the study are to evaluate the effects of the Minnesota Youth Tobacco Prevention Initiative and its shutdown on youth smoking patterns, and to better define the patterns of development of tobacco use in adolescents. A multilevel sample was constructed representing individuals, local jurisdictions and the entire state, and data are collected to characterize each of these levels. This paper presents the details of the multilevel study design. We also provide baseline information about MACC participants including demographics and tobacco-related attitudes and behaviors. This paper describes variability in smoking prevalence and demographic characteristics for local units, and compares MACC participants to the state as a whole.

Goldstein BI; Bukstein OG. Comorbid substance use disorders among youth with bipolar disorder: Opportunities for early identification and prevention. Journal of Clinical Psychiatry 71(3): 348-358, 2010. (92 refs.)

Objective: The burden of substance use disorders (SUDs) among adults with bipolar disorder is well documented. Comparatively less is known regarding comorbid SUD among youth with bipolar disorder. This article aims to integrate the extant literature on this topic and to suggest strategies for delaying or preventing SUD among youth with bipolar disorder. Data Sources and Study Selection: Relevant studies in English were identified using Pub Med and MEDL1NE (1950-February 2009). Search terms were bipolar disorder cross-referenced with child, adolescent, or youth, and alcohol, drug, or substance, and abuse, dependence, or disorder. Articles were selected on the basis of containing data regarding both bipolar disorder and SUD. The search was supplemented by manually reviewing reference lists from the identified publications. Data Synthesis: Epidemiologic and clinical studies demonstrate that youth-onset bipolar disorder confers even greater risk of SUD in comparison with adultonset bipolar disorder. Recent studies of youth with bipolar disorder have not identified childhood SUD (0%); however, the prevalence of SUD escalates during adolescence (I6%-39%). Substance use disorder among bipolar youth is associated with legal and academic difficulties, pregnancy, and suicidality. Few studies have addressed interventions for this population, although studies are underway. Because bipolar disorder onset most commonly precedes SUD among youth (55%-83%), there is a window of opportunity for prevention. Conclusions: Pending the results of ongoing treatment studies, several strategies are suggested for curtailing the burden of SUD in youth with bipolar disorder. These include screening for substance use among bipolar youth beginning at age 10 irrespective of other risk factors, education and intervention at the family level, and implementation of preventive interventions that have been successful in other populations.

Goodman A. Substance use and common child mental health problems: Examining longitudinal associations in a British sample. Addiction 105(8): 1484-1496, 2010. (71 refs.)

Aims: To examine the longitudinal associations in both directions between mental health and substance use in adolescence. Design: Three-year longitudinal cohort. Setting Britain (nationally representative sample). Participants 3607 youths aged 11-16 years at baseline. Measurements: Externalizing and internalizing mental health problems were measured using brief questionnaires (parent-reported Strengths and Difficulties Questionnaire) and diagnostic interviews, including clinician-rated diagnoses of mental disorder. Substance use was measured by youth self-report, and included regular smoking, frequent alcohol consumption, regular cannabis use and ever taking other illicit drugs. Findings: Externalizing (specifically behavioural) problems at baseline independently predicted all forms of substance use, with a particularly strong effect on smoking. In all cases this association showed a dose-response relationship. In contrast, although internalizing problems had a strong univariable association with smoking, this disappeared after adjusting for comorbid externalizing problems. There was little or no evidence that baseline substance use predicted mental health at follow-up. Conclusions: Externalizing problems predict adolescent substance use, and adjusting for comorbid externalizing problems is vital when investigating the effects of internalizing problems. A dose-response effect of externalizing problems is seen across the full range. Programmes seeking to prevent adolescent substance use by reducing externalizing problems may therefore wish to consider population-wide interventions rather than targeting individuals only at the negative extreme.

Griffin KW; Botvin GJ. Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America 19(3): 505-+, 2010. (19 refs.)

Substantial progress has been made in developing prevention programs for adolescent drug abuse. The most effective interventions target salient risk and protective factors at the individual, family, and community levels and are guided by relevant psychosocial theories regarding the etiology of substance use and abuse. This article reviews the epidemiology, etiologic risk and protective factors, and evidence-based approaches that have been found to be most effective in preventing adolescent substance use and abuse. Exemplary school- and family-based prevention programs for universal (everyone in population), selected (members of at-risk groups), and indicated (at-risk individuals) target populations are reviewed, along with model community-based prevention approaches. Challenges remain in widely disseminating evidence-based prevention programs into schools, families, and communities.

Gygax PM; Bosson M; Gay C; Ribordy F. Relevance of health warnings on cigarette packs: A psycholinguistic investigation. Health Communication 25(5): 397-409, 2010. (55 refs.)

Although most research on the effect of tobacco warnings has been focused on attitude changes following the presentation of tobacco warnings, this paper takes a somewhat new perspective by investigating cognitive processing of tobacco warnings by adolescents of different ages (i.e., 14-, 16-, and 18-year-olds). More specifically, this paper investigates the way adolescents encode different textual elements presented in tobacco warnings. By means of a standard psycholinguist paradigm (i.e., sentence evaluation paradigm), we evaluated tobacco warnings differing along three variables: (1) severity, (2) time consequence and (3) target (health vs. others). Our main result demonstrated noticeable differences between the age groups and between smoking experiences in the cognitive processing of tobacco warnings. Our experimental paradigm represents an important step in identifying the mechanisms through which certain types of written warnings are cognitively processed, which in turn may well set a critical base for understanding decision makers' responses to risky behaviors such as smoking and for constructing adequate health warnings.

Hanewinkel R; Isensee B; Maruska K; Sargent JD; Morgenstern M. Denormalising smoking in the classroom: Does it cause bullying? Journal of Epidemiology and Community Health 64(3): 202-208, 2010. (27 refs.)

Background: The Smokefree Class Competition, the largest school-based smoking prevention programme in Europe, aims to create a class climate that denormalises smoking. An analysis was carried out to assess whether it increases bullying or perception of isolation. Methods: A cluster randomised controlled trial was conducted, with two waves of assessment directly before the start and immediately after the end of the prevention programme. Some 3490 students were recruited from 84 secondary schools in Germany, of whom 3123 students (90%) provided data from both waves. Classes from the intervention group (IG) participated in the Smokefree Class Competition, committing themselves to stay smokefree for a period of 6 months, and self-monitoring their smoking status on a weekly basis. Classes that refrained from smoking were eligible for a prize draw. To test the hypotheses that participation in the competition might foster bullying, we measured students' self report of (1) being victimised, (2) engaging in bullying and (3) being isolated. Results: There was a strong association between daily smoking and higher odds of bullying others at baseline (adjusted proportional OR 4.66; 95% CI 3.38 to 6.43). No significant pre-post differences across treatment assignment groups were found on any bullying measure using generalised linear latent and mixed models. For being isolated, the trends suggested that the programme, if anything, fostered lower levels of isolation at follow-up, especially for those who perceived high levels of isolation at baseline. Conclusion: Participation in the intervention had no effect on bullying or perceptions of isolation.

Hedman E; Riis U; Gabre P. The impact of behavioural interventions on young people's attitudes toward tobacco use. Oral Health & Preventive Dentistry 8(1): 23-32, 2010. (26 refs.)

Purpose: The objective of the present study was to study the ability to influence young at-risk patients attitudes toward tobacco use through two intervention methods that were performed by dental health professionals. Materials and Methods: Two inteiventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group. Before and after interventions, a questionnaire was used. Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included. Results: Both before and after interventions, the results showed a generally negative attitude towards tobacco use. A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%) Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends. The older participants believed to a greater extent that they would try smoking as adults. No change in tobacco use was registered after intervention, although the participants reported an increased use among friends. Conclusions: The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent. However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models.

Holmila M; Karlsson T; Warpenius K. Controlling teenagers' drinking: Effects of a community-based prevention project. Journal of Substance Use 15(3): 201-214, 2010. (45 refs.)

Aims: The study presents the evaluation results of the age-limit component of a community-based prevention project called PARKA. The project aimed to reduce alcohol availability among those under 18, which is the legal age for purchasing alcohol. The interventions consisted of law enforcement, community coalitions and community mobilization. Data and methods: The effects of the interventions were measured in a quasi-experimental research-setting with a matched control area before (2004) and after (2006/7) the interventions. The data included under-age purchase trials, a population survey and a school-based survey. Results: According to the purchase trials, the age limit control in the shops improved between the measuring points, and the young people reported in surveys that it had become more difficult to obtain alcohol. However, changes in the intervention and the control areas were similar. This can partly be explained by increased surveillance in addition to spill-over effects of PAKKA-interventions into the control areas. Conclusions: Local coalitions can be important tools in reducing alcohol availability among minors. The quasi-experimental research-setting has its methodological limitations in assessing the intervention's impact given the overlap in local and national processes seen in the case of the PAKKA project.

Juric M; Carapina M; Gilja A; Simic G. Knowledge, attitudes and behaviors of young people related to drinking and driving in Mostar region, Bosnia and Herzegovina. Collegium Antropologicum 34(Suppl. 1): 39-44, 2010. (15 refs.)

The traffic accidents became the leading cause of morbidity and mortality among young population groups during the late 60s and early 70s. Among several European countries that are in transition, Bosnia and Herzegovina takes the leading place in fatal traffic accidents. In this study we have investigated knowledge, attitudes and behavior of young people related to alcohol impaired driving. Our aim was to investigate the patterns and behavior among young people that could be useful for public health intervention among them. This is of special interest as there is a lack of such information from Bosnia and Herzegovina. The study was performed in the city of Mostar, Bosnia and Herzegovina. The study included 189 examinees of both genders, aged between 18 and 24 years, who have been divided in two groups: students of the University of Mostar and those who did not go for further education after high school (nonstudents). Sampling was performed in July 2006 in Mostar and surrounding area. The Gallup organization questionnaire was used. Descriptive statistic test and chi-square were used in statistical analysis. Result of this study could be helpful in taking preventive measures for lowering number of traffic accidents among young people or they could be base in some protective programs for increasing traffic safety.

Kahn JA; Huang B; Ding LL; Geller A; Frazier AL. Impact of maternal communication about skin, cervical, and lung cancer prevention on adolescent prevention behaviors. Journal of Adolescent Health 49(1): 93-96, 2011. (10 refs.)

Purpose: To explore whether maternal communication about behaviors that prevent skin, cervical, and lung cancer is associated with adolescent cancer prevention behaviors. Methods: The study sample consisted of 10,409 girls and boys (14-21 years) who participated in a longitudinal survey study of U. S. adolescents. The independent variables were adolescent report of how often mothers had spoken with them (never, once, occasionally, sometimes, often) about sunscreen use, Pap screening, and quitting smoking. Outcome variables included adolescent self-report of sunscreen use, Pap screening, and quitting smoking (among past-year smokers). We used multivariate logistic regression models to determine whether maternal communication in 2001 was associated independently with the three adolescent cancer prevention behaviors in 2001 and 2003. Results: In adjusted logistic regression models, maternal communication about sunscreen use and Pap screening was positively associated with adolescent behaviors in 2001 and 2003, and maternal communication about quitting smoking was positively associated with adolescent behavior in 2001. Conclusions: In a national sample, maternal communication encouraging sunscreen use, Pap screening, and quitting smoking was associated with the corresponding behaviors in their adolescent children. The findings suggest that intergenerational interventions could enhance adolescent practice of cancer prevention behaviors.

Kinard BR; Webster C. The effects of advertising, social influences, and self-efficacy on adolescent tobacco use and alcohol consumption. Journal of Consumer Affairs 44(1): 24-43, 2010. (38 refs.)

Exploring the simultaneous effects of key variables on the unhealthy consumption behavior of adolescents, two studies focused on the relative effects of advertising, parental and peer influence, and self-efficacy on adolescent tobacco use and alcohol consumption. The results suggest that (1) advertising effects are largely neutralized by parental and peer influence; (2) peer and parental influence strongly predict adolescent tobacco use and alcohol consumption; and (3) self-efficacy is a weak predictor of both adolescent risk behaviors.

Klosky JL; Tyc VL; Hum A; Lensing S; Buscemi J; Garces-Webb DM et al. Establishing the predictive validity of intentions to smoke among preadolescents and adolescents surviving cancer. Journal of Clinical Oncology 28(3): 431-436, 2010. (36 refs.)

Purpose: A significant proportion of adults surviving childhood cancer are smokers. Although these estimated rates of smoking are slightly lower than those in the US population, they remain alarmingly high for this high-risk group. The purpose of this study was to examine the predictive validity of adolescent self-reported smoking intentions for later smoking among childhood cancer survivors. Patients and Methods: Baseline tobacco intentions were collected from 119 nonsmoking cancer survivors, age 10 to 18 years, who participated in a tobacco-based clinical trial during the late 1990s. Follow-up smoking status was systematically collected annually up to 10 years postintervention (median follow-up, 6.0 years; interquartile range, 3.0 to 6.9 years) as part of clinical survivorship care. Results: Twenty-seven participants (22.7%) subsequently initiated tobacco use within 5 years of study enrollment. The 5-year cumulative incidence was 29.8% +/- 6.0% for those who were susceptible to smoking compared with 12.8% +/- 5.4% for those who were committed never smokers (P = .022). Past use (P < .001) and having friends who smoked (P = .038) were also associated (univariate model) with tobacco initiation, and there was a trend for an association for older adolescents (P = .073). Every unit increase on the intentions scale was associated with a 17% increase in the risk for tobacco initiation (P = .002) after adjusting for age group and past tobacco use in a multivariable model. Conclusion: Because early intentions to smoke are predictive of later tobacco use, survivors as young as 10 years of age who waver in their commitment to remain tobacco abstinent should be targeted for tobacco prevention interventions.

Koning IM; van den Eijnden RJJM; Engels RCME; Verdurmen JEE; Vollebergh WAM. Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use. Addiction 106(3): 538-546, 2011. (43 refs.)

Aims: To examine the effects of a parent and student intervention offered separately and simultaneously (PAS) on onset of weekly drinking via its putative mediators. Design: A randomized trial with four conditions; (1) parent intervention, (2) student intervention, (3) combined parent-student intervention and (4) control group. Setting: High schools selected randomly, located in different areas. Participants: A total of 2937 early adolescents (mean age = 12.6, standard deviation = 0.49) and their parents. Measurements: Mediation effects were analysed using pretest data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated (Mplus) to examine the effect of the interventions on adolescent-reported mediators (self-control, perceived parental rules and attitudes about alcohol) and parent-reported mediators (parental rules and attitudes about alcohol). Outcome was onset of weekly drinking. Findings: The parent intervention modified rules and attitudes about alcohol as reported by parents. An indirect effect of the parent intervention via parental rules was found. The combined intervention affected both adolescent-reported and parent-reported rules and attitudes about alcohol and adolescents' perceived self-control, yet only perceived rules and self-efficacy, as reported by adolescents, and parental attitudes mediated the association between the combined intervention and onset of weekly drinking. No significant effects were found of the separate student intervention on the mediating factors. Conclusions: The PAS programme proved to be effective as predicted by the theoretical assumptions underlying the interventions. Interventions with parents and adolescents to prevent adolescent alcohol consumption may usefully target parental rules about alcohol and adolescents' self-confidence.

Kraus L; Metzner C; Piontek D. Alcopops, alcohol consumption and alcohol-related problems in a sample of German adolescents: Is there an alcopop-specific effect? Drug and Alcohol Dependence 110(1-2): 15-20, 2010. (27 refs.)

Aims: The objective of the present analysis was to investigate the impact of alcopops on drinking behaviour and alcohol-related negative consequences by controlling for alcohol consumption and the share of alcopops in total ethanol intake. Methods: Data from the 2003 European School Survey Project on Alcohol and other Drugs (ESPAD) in Germany were used. The final dataset comprised students aged 15-17 years who reported to have drunk alcohol in the past 7 clays (n = 5509). Measurements: Alcohol consumption was assessed by beverage-specific quantity measures for the last 7 days. Individuals were categorised into "non-alcopop" and "alcopop consumers"; according to the share in total ethanol intake, alcopop users were further divided into "only-alcopop", "mix-alcopop" and "mix-consumers". Analogous groups were constructed for the other beverages. Outcome measures were age of first alcohol use and drunkenness, frequency of drinking, binge drinking and drunkenness and alcohol-related problems. Hypotheses were tested using proportional hazard models, linear and logistic regressions. Findings: Controlling for overall volume few differences in consumption and problem measures were found when alcopop and non-alcopop users were compared. Further differentiation of the alcopop group also revealed only few differences. Similar associations were found for the other beverages. Only-alcopop and only-wine drinking was associated with less risky consumption patterns and negative consequences. Conclusions: An alcopop-specific effect on problematic drinking behaviour and negative consequences could not be identified. Concerted preventive actions tackling alcohol as a whole are needed in order to gain substantial effects on alcohol use and alcohol-related problems in adolescents.

Kristjansson AL; James JE; Allegrante JP; Sigfusdottir ID; Helgason AR. Adolescent substance use, parental monitoring, and leisure-time activities: 12-year outcomes of primary prevention in Iceland. Preventive Medicine 51(2): 168-171, 2010. (13 refs.)

Objective. To examine 12-year changes in alcohol use and cigarette smoking in response to community-based prevention activities among Icelandic adolescents. Methods. This study used a quasi-experimental, non-randomized control group design to compare outcomes in 4 Icelandic communities (n=3117) that participated in community-based substance use prevention activities designed to increase levels of parental monitoring and adolescent engagement in healthy leisure-time activities and a matched group of 7 comparison communities (n = 1,907). Annual, nationwide, population-based cross-sectional surveys of the prevalence of adolescent substance use were conducted among cohorts of Icelandic adolescents, aged 14-15 years (N = 5,024), in all communities from 1997 to 2009. Results. Parental monitoring and adolescent participation in organized sports increased in communities that adopted the intervention program compared to communities that did not, whereas unmonitored idle hours and attendance at unsupervised parties decreased. Over time, alcohol use (OR = 0.89,95% CI 0.82, 0.98, p = 0.012) and being intoxicated during the last 30 days (OR = 0.86, 95% CI 0.78, 0.96, p = 0.004) decreased more in the intervention than control communities. Conclusion. Community-based prevention designed to strengthen parental monitoring and participation in organized sports may confer some protection against adolescent substance use.

Kulis S; Marsiglia FF; Ayers SL; Calderon-Tena CO; Nuno-Gutierrez BL. Gender Differences in Drug Resistance Skills of Youth in Guanajuato, Mexico. Journal of Primary Prevention 32(2): 113-127, 2011. (55 refs.)

Research is limited or absent on Mexican adolescents' exposure to substance offers, ways of dealing with these offers, and possible gender differences in responses to offers. Extending U.S.-based research, this study examines how youth living in the Mexican state of Guanajuato employ the four drug resistance strategies-refuse, explain, avoid, and leave-that are part of the Keepin' It REAL evidence-based drug prevention intervention. The analysis uses cross-sectional survey data from 702 students enrolled in eight alternative secondary education sites in 2007. Participants reported the drug resistance behaviors they used to deal with offers of alcohol, cigarettes, and marijuana. Using multivariate regression, findings indicate most youth had developed repertoires of drug resistance strategies that involved multiple REAL strategies and some other strategy as well. For those receiving offers, the most common strategy was to refuse the offer with a simple "no." However, males used all the strategies significantly more often than females for situations involving cigarettes and marijuana as well as when using refuse and non-REAL strategies for alcohol. Possible reasons for the gender difference in use of strategies are discussed. The findings can help inform effective prevention programs based on teaching culturally appropriate drug resistance and communication skills.

Kumpfer KL; Whiteside HO; Greene JA; Allen KC. Effectiveness outcomes of four age versions of the Strengthening Families Program in statewide field sites. Group Dynamics 14(3, Special Issue): 211-229, 2010. (52 refs.)

Family dysfunction is unacceptably high nationally and internationally with high costs to society in adolescent problems. A number of evidence-based (EB) parenting and family interventions have been proven in research to improve children's outcome. The question remains whether these EB family programs are as effective in practice. This article summarizes research outcomes from a quasi-experimental, 5-year statewide study of the 14-session Strengthening Families Program (SFP) with over 1,600 high-risk families. The study compared outcomes including effect sizes for the four different age versions of SFP (SFP 3-5, 6-11, 10-14, and 12-16 years). Quality assurance and program fidelity were enhanced by standardized training workshops, site visits by evaluators, and online supervision. Outcomes were measured using the SFP Parent Retrospective testing battery containing self-report standardized clinical measures of 18 parent, family, and child outcomes. The 2 repeated measures by 4 group ANOVA compared the four different age versions of SFP. All of the outcome variables for the four programs were statistically significant at less than the p < .05 level except for reductions in Criminal Behavior and Hyperactivity in the older 10 to 16 year-olds. The effect sizes were larger than in prior randomized control design of SFP. The average effect sizes for both the Parenting and Family Cluster scores range from a high Cohen's d = .77 for SFP 6-11 years to effect size of d = .67 for SFP 3-5 and 10-14. The largest effect sizes were for improvements for the SFP 6-11 condition in Family Communication and Family Strengths and Resilience (d = .76 for both), Family Organization (d = .75), Parental Supervision (d = .73), Parenting Efficacy (d = .70), and Positive Parenting (d = .67). Parental alcohol and drug use was reduced most in the SFP 12-16 year version (d = .43).

Lane DC; Simmons J. American Indian youth substance abuse: Community-driven interventions. Mount Sinai Journal of Medicine 78(3): 362-372, 2011. (57 refs.)

Substance abuse among American Indians has a long history that dates back to the colonial era. American Indian youth today continue to have one of the highest substance abuse rates when compared with other groups. Researchers have implemented American Indian youth substance abuse interventions that previously have worked in the general population, but studies have found that they are generally unprepared and poorly designed for American Indian populations. The lack of inclusion of American Indian populations in the interventional studies, poor understanding of American Indian I diversity and cultures, and lack of consideration for the unique historical and sociopolitical context of each tribe were cited as reasons the interventions failed. It has been suggested that historical trauma plays a considerable role in American Indian youth substance abuse; however, much of this theoretical framework has yet to be rigorously tested. Contemporary trauma appears to contribute significantly more to American Indian youth substance abuse. The data on American Indian substance abuse are limited, but what is currently available appears to show a vast heterogeneity in the level of substance abuse among American Indian youth that varies across different American Indian tribes and geographical distribution. In summary, this article seeks to describe the special relationship American Indian tribes have with the federal government, review historical and contemporary trauma, review American Indian youth substance abuse and interventions today, and finally describe a unique intervention strategy that tribes in the Pacific Northwest are implementing in order to combat American Indian youth substance abuse.

Ma M; Dollar KM; Kibler JL; Sarpong D; Samuels D. The effects of priming on a public health campaign targeting cardiovascular risks. Prevention Science 12(3): 333-338, 2011. (35 refs.)

Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention. NB. While not addressed to alcohol/drug use, it sheds light on a potentially potent elements in prevention programming.

Malmberg M; Overbeek G; Kleinjan M; Vermulst A; Monshouwer K; Lammers J et al. Effectiveness of the universal prevention program 'Healthy School and Drugs': Study protocol of a randomized clustered trial. BMC Public Health 10: 541, 2010. (45 refs.)

Background: Substance use is highly prevalent among Dutch adolescents. The Healthy School and Drugs program is a nationally implemented school-based prevention program aimed at reducing early and excessive substance use among adolescents. Although the program's effectiveness was tested in a quasi-experimental design before, many program changes were made afterwards. The present study, therefore, aims to test the effects of this widely used, renewed universal prevention program. Methods/Design: A randomized clustered trial will be conducted among 3,784 adolescents of 23 secondary schools in The Netherlands. The trial has three conditions; two intervention conditions (i.e., e-learning and integral) and a control condition. The e-learning condition consists of three digital learning modules (i.e., about alcohol, tobacco, and marijuana) that are sequentially offered over the course of three school years (i.e., grade 1, grade 2, and grade 3). The integral condition consists of parental participation in a parental meeting on substance use, regulation of substance use, and monitoring and counseling of students' substance use at school, over and above the three digital modules. The control condition is characterized as business as usual. Participating schools were randomly assigned to either an intervention or control condition. Participants filled out a digital questionnaire at baseline and will fill out the same questionnaire three more times at follow-up measurements (8, 20, and 32 months after baseline). Outcome variables included in the questionnaire are the percentage of binge drinking (more than five drinks per occasion), the average weekly number of drinks, and the percentage of adolescents who ever drunk a glass of alcohol and the percentage of adolescents who ever smoked a cigarette or a joint respectively for tobacco and marijuana. Discussion: This study protocol describes the design of a randomized clustered trial that evaluates the effectiveness of a school-based prevention program. We expect that significantly fewer adolescents will engage in early or excessive substance use behaviors in the intervention conditions compared to the control condition as a direct result of the intervention. We expect that the integral condition will yield most positive results, compared with the e-learning condition and control condition.

Mason M; Pate P; Drapkin M; Sozinho K. Motivational interviewing integrated with social network counseling for female adolescents: A randomized pilot study in urban primary care. Journal of Substance Abuse Treatment 41(2): 148-155, 2011. (47 refs.)

This study tested the efficacy of a brief preventive intervention for substance use and associated risk behaviors among female adolescent patients of an urban primary care health clinic. We integrated an evidenced-based motivational interviewing (MI) approach with a social network component to develop a 20-minute session, a social network intervention delivered in an MI-consistent style. Female adolescents (N = 28) 14 to 18 years old were recruited, provided consent/assent, were screened, and were randomly assigned to the treatment or control (no treatment) condition. The sample was 82% African American and 18% mixed race, with 32% living below the U.S. poverty line. At 1-month follow-up, teens in the treatment condition reported less trouble due to alcohol use, less substance use before sexual intercourse, less social stress, less offers for marijuana use, and increased readiness to start counseling compared with the teens in the control condition. Results provide support for socially based brief interventions with at-risk urban adolescents.

McGrath BB; Ka'ili TO. Creating Project Talanoa: A culturally based community health program for US Pacific Islander adolescents. Public Health Nursing 27(1): 17-24, 2010. (30 refs.)

Objective: This is an evaluation of the process and outcome of a research study to determine a culturally targeted health promotion program for U.S. Pacific Islander youth who are at risk for co-occurring problem behaviors, including risky sexual behavior, substance abuse, and interpersonal violence. Design and Sample An exploratory design was used and included qualitative interviews (N=54), focus groups (N=16), participant observation (over 3 years), and surveys (N=24) with Pacific Islander adults and youth. After identifying key cultural values and reviewing existing evidence-based prevention interventions, "Project Talanoa" was developed around 4 constructs: (1) cultural identity and pride, (2) teen health, (3) peer relations, and (4) family ties. The program was pilot tested and evaluated by 24 Pacific Islander adolescents (ages 12-15 years). Results: Results indicate it was culturally appropriate, well liked by the participants, supported by parents and others in the community, and found to be feasible. Conclusions: Additional research is needed to test it for effectiveness. Project Talanoa provides a model for applying cultural concepts in the development of a risk reduction intervention for adolescents.

Nichols TR; Birnel S; Graber JA; Brooks-Gunn J; Botvin GJ. Refusal skill ability: An examination of adolescent perceptions of effectiveness. Journal of Primary Prevention 31(3): 127-137, 2010. (29 refs.)

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the second by a group of high school interns. Consistency with programming criteria was found for interns' ratings of several indicators of verbal and non-verbal assertiveness. However, a strategy previously defined by the program as effective was perceived as ineffective by adolescents while another deemed ineffective and problematic by intervention developers was viewed as effective. Interns endorsed presenting detailed and reasonable arguments as an effective refusal strategy while short, simple statements were deemed ineffective. This study suggests the importance of including adolescent perspectives in the design, delivery, and evaluation of drug prevention strategies.

Opler M; Sodhi D; Zaveri D; Madhusoodanan S. Primary psychiatric prevention in children and adolescents. (review). Annals of Clinical Psychiatry 22(4): 220-234, 2010. (177 refs.)

BACKGROUND: Approximately 21% of US children age 9 to 17 have a diagnosable mental illness with some degree of impairment. As early-onset mental illness may persist throughout the life span, effective primary mental health prevention programs are of paramount importance. METHODS: We conducted a literature review of various preventive programs targeting childhood-onset psychopathology. We attempted to select those programs that present the strongest data on efficacy and those that are most commonly cited. RESULTS: Modifiable and nonmodifiable risk factors and different primary prevention strategies with positive outcomes have been identified for anxiety disorders, eating disorders, substance abuse, disruptive behavior disorders, and suicide in children. The reported results for attention-deficit/hyperactivity disorder (ADHD) and early-onset schizophrenia are neither uniform nor encouraging. CONCLUSIONS: Based on our review, there is ample evidence to conclude that primary preventive intervention has the potential to be effective for some mental health disorders, promoting positive development, particularly in children of all ages in high-risk environments. Additional research is needed to further investigate the validity and reliability of various preventive strategies.

Peterson J. A qualitative comparison of parent and adolescent views regarding substance use. Journal of School Nursing 26(1): 53-64, 2010. (45 refs.)

Substance use is a major cause of adolescent morbidity and mortality. By age 14, 70% of adolescents have consumed alcohol and half of 12th graders report having used marijuana. The purpose of this study was to increase the understanding of parent and adolescent perceptions regarding adolescent use of alcohol, tobacco, and other drugs (ATOD) to enhance the development of effective prevention programs. Six adolescent focus groups and one parent focus group participated. Results were derived following elicitation of adolescents' and parents' beliefs regarding adolescent ATOD use and current prevention programs. Findings indicate that current prevention programs are ineffective; ATOD use is normalized by schools, community, and family; positive adult role models deter use; and programs should involve youth, parents, schools, and community. Focus group discussions can strengthen the development of tailored ATOD prevention programs. School nurses can foster collaboration between families, schools, and communities to reduce adolescent substance use.

Peterson EB; Thomsen S; Lindsay G; John K. Adolescents' attention to traditional and graphic tobacco warning labels: An eye-tracking approach. Journal of Drug Education 40(3): 227-244, 2010. (38 refs.)

The objective of this study was determine if the inclusion of Canadian-style graphic images would improve the degree to which adolescents attend to, and subsequently are able to recall, novel warning messages in tobacco magazine advertising. Specifically, our goal was to determine if the inclusion of graphic images would 1) increase visual attention, as measured by eye movement patterns and fixation density, and 2) improve memory for tobacco advertisements among a group of 12 to 14 year olds in the western United States. Data were collected from 32 middle school students using a head-mounted eye-tracking device that recorded viewing time, scan path patterns, fixation locations, and dwell time. Participants viewed a series of 20 magazine advertisements that included five U. S. tobacco ads with traditional Surgeon General warning messages and five U. S. tobacco ads that had been modified to include non-traditional messages and Canadian-style graphic images.

Rice E; Milburn NG; Monro W. Social networking technology, social network composition, and reductions in substance use among homeless adolescents. Prevention Science 12(1): 80-88, 2011. (51 refs.)

Peer-based prevention programs for homeless youth are complicated by the potential for reinforcing high-risk behaviors among participants. The goal of this study is to understand how homeless youth could be linked to positive peers in prevention programming by understanding where in social and physical space positive peers for homeless youth are located, how these ties are associated with substance use, and the role of social networking technologies (e.g., internet and cell phones) in this process. Personal social network data were collected from 136 homeless adolescents in Los Angeles, CA. Respondents reported on composition of their social networks with respect to: home-based peers and parents (accessed via social networking technology; e.g., the internet, cell phone, texting), homeless peers and agency staff (accessed face-to-face) and whether or not network members were substance-using or non-substance-using. Associations between respondent's lifetime cocaine, heroin, and methamphetamine use and recent (previous 30 days) alcohol and marijuana use were assessed by the number of non-substance-using versus substance-using ties in multivariate linear regression models. 43% of adolescents reported a non-substance-using home-based tie. More of these ties were associated with less recent alcohol use. 62% of adolescents reported a substance-using homeless tie. More of these ties were associated with more recent marijuana use as well as more lifetime heroin and methamphetamine use. For homeless youth, who are physically disconnected from positive peers, social networking technologies can be used to facilitate the sorts of positive social ties that effective peer-based prevention programs require.

Ringwalt CL; Clark HK; Hanley S; Shamblen SR; Flewelling RL. The effects of Project ALERT one year past curriculum completion. Prevention Science 11(2): 172-184, 2010. (42 refs.)

School-based drug prevention curricula constitute the nation's most prevalent strategy to prevent adolescent drug use. We evaluated the effects of one such curriculum, Project ALERT, on adolescent substance use. In particular, we sought to determine if a single effect on 30-day alcohol use, noted shortly following the completion of the 2-year program, could be detected 1 year later. We also looked for delayed effects on other outcomes of interest, namely lifetime alcohol use, and 30-day and lifetime use of cigarettes, marijuana, and inhalants. We employed a randomized controlled trial that used school as the unit of assignment. Thirty-four schools with grades 6-8 from 11 states completed the study. Seventy-one Project ALERT instructors taught 11 core lessons to sixth graders and 3 booster lessons to seventh graders. Students were assessed prior to the onset of the intervention, as sixth graders, after the completion of the 2-year curriculum, as seventh graders, and again 1 year later as eighth graders. This paper examines data from the pretest and final posttest. Using hierarchical nonlinear modeling, we found that our earlier effect on 30-day alcohol use did not persist. Further, we continued to find no effects for lifetime alcohol use and both the lifetime and 30-day use of cigarettes, marijuana, and inhalants. Our findings do not support the long-term effectiveness of Project ALERT, when delivered to sixth graders.

Ryan SM; Jorm AF; Kelly CM; Hart LM; Morgan AJ; Lubman DI. Parenting strategies for reducing adolescent alcohol use: A Delphi consensus study. BMC Public Health 11: e-article 13, 2011. (21 refs.)

Background: International concern regarding the increase in preventable harms attributed to adolescent alcohol consumption has led to growing political and medical consensus that adolescents should avoid drinking for as long as possible. For this recommendation to be adopted, parents and guardians of adolescents require information about strategies that they can employ to prevent or reduce their adolescent's alcohol use that are supported by evidence. Methods: The Delphi method was used to obtain expert consensus on parenting strategies effective in preventing and reducing adolescent alcohol consumption. A literature search identified 457 recommendations for parents to reduce their adolescent child's alcohol use. These recommendations were presented to a panel of 38 Australian experts who were asked to rate their importance over three survey rounds. Results: There were 289 parenting strategies that were endorsed as important or essential in reducing adolescent alcohol use by >= 90% of the panel. These strategies were categorised into 11 sub-headings: things parents should know about adolescent alcohol use, delaying adolescent's introduction to alcohol, modelling responsible drinking and attitudes towards alcohol, talking to adolescents about alcohol, establishing family rules, monitoring adolescents when unsupervised, preparing adolescents for peer pressure, unsupervised adolescent drinking, what to do when an adolescent has been drinking without parental permission, hosting adolescent parties, and establishing and maintaining a good parent-child relationship. The endorsed strategies were written into a document suitable for parents. Conclusions: A comprehensive set of parenting strategies for preventing or reducing adolescent alcohol consumption were identified. These strategies can be promoted to parents to help them implement national recommendations for use of alcohol by young people.

Sakuma KLK; Sun P; Unger JB; Johnson CA. Evaluating depressive symptom interactions on adolescent smoking prevention program mediators: A mediated moderation analysis. Nicotine & Tobacco Research 12(11): 1099-1107, 2010. (58 refs.)

Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world's current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts. The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation. Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program x Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation. This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition x Social Environmental Influences may be important when developing future effective prevention programming.

Sanchez ZM; Opaleye ES; Chaves TV; Noto AR; Nappo SA. God forbids or mom disapproves? Religious beliefs that prevent drug use among youth. Journal of Adolescent Research 26(5): 591-616, 2011. (37 refs.)

Researches have emphasized religiosity as a protective factor against drug use although the mechanism through which it occurs is still unknown. This article aims to explore religious beliefs that could prevent drug use among youth. Three sources of qualitative data were used: participant observation in 21 religious institutions, semistructured interviews of 37 religious leaders, and 6 focus groups comprised of 55 religious drug-naive youths. The young people's discourses and the sermons of religious leaders revealed that conceptions about drugs were based on media content, with little religious or scientific context. Catholics and Spiritists considered the consumption of licit drugs less harmful than that of illicit ones and were especially tolerant of the use of alcohol. Protestants were more emphatic when describing all drugs as being harmful to one's health. Findings suggest that young people who practice a religion invoke several religious concepts to justify their choice for not using drugs, and they attribute this position more to the family legacy than to their own religiosity. Thus youths' antidrug position was more reflective of family values than religious beliefs.

Sargent JD; Tanski S; Stoolmiller M; Hanewinkel R. Using sensation seeking to target adolescents for substance use interventions. Addiction 105(3): 506-514, 2010. (47 refs.)

Aims: This study examines the predictive validity of sensation seeking as a predictor of adolescent substance use, in order to optimize targeting for substance use prevention programs. Design: Longitudinal study. Setting: Random-digit dial telephone survey. Participants: A total of 6522 US adolescents aged 10-14 years at baseline, resurveyed at 8-month intervals for three subsequent waves. Measurements: Two outcomes were assessed-onset of binge drinking (more than five drinks in a short time) and established smoking (> 100 cigarettes life-time). Sensation seeking level was assessed at baseline. Logistic regression was used to predict onset of substance use at any follow-up wave as a function of sensation seeking. The receiver operating characteristics curve was used to illustrate how well sensation seeking predicted substance use as a function of different cut-off points for defining high sensation seeking, and area under the receiver operating characteristics curve (AROC) was the metric of predictive validity. Findings: Of 5834 participants with one or more follow-up assessments, 5634 reported no binge drinking and 5802 were not established smokers at baseline, of whom 717 (12.7% of 5634) reported binge drinking and 144 (2.5% of 5802) reported established smoking at one or more follow-up interviews. Sensation seeking predicted binge drinking moderately well [AROC = 0.71 (95% confidence interval 0.69, 0.73)] and was a significantly better predictor of established smoking onset [AROC = 0.80 (0.76, 0.83)]. For binge drinking, predictive validity was significantly lower in blacks; for established smoking it was significantly higher for Hispanics. Implications for two targeting interventions are discussed. Conclusions: Sensation seeking works moderately well at identifying adolescents at risk for onset of binge drinking and established smoking. This study offers a guide for determining the appropriate targeting cut-off value, based on intervention efficacy, costs and risks.

Schinke SP; Fang L; Cole KC; Cohen-Cutler S. Preventing substance use among Black and Hispanic adolescent girls: Results from a computer-delivered, mother-daughter intervention approach. Substance Use & Misuse 46(1): 35-45, 2011. (77 refs.)

This 2008 study involved 546 Black and Hispanic American adolescent girls and their mothers from New York, New Jersey, and Connecticut. Participants provided self-report data. Analysis of covariance indicated that the experimental intervention reduced risk factors, improved protective factors, and lowered girls' alcohol use and their future intentions to use substances. The study supports the value of computer-based and gender-specific interventions that involve girls and their mothers. Future work needs to replicate and strengthen study results.

Schneider S; Gruber J; Yamamoto S; Weidmann C. What happens after the implementation of electronic locking devices for adolescents at cigarette vending machines? A natural longitudinal experiment from 2005 to 2009 in Germany. Nicotine & Tobacco Research 13(8): 732-740, 2011. (36 refs.)

Introduction: As of January 01, 2007, electronic locking devices based on proof of age (electronic cash cards or European driving licenses) were installed on 500,000 cigarette vending machines across Germany to restrict the purchase of cigarettes to those over the age of 16 years. In 2009, the age limit was raised to 18 years. The aim of this study was to compare the number of cigarette vending machines and other commercial sources before and after the enactment of the new law and to examine the association between commercial cigarette sources and area socioeconomic status (SES). Methods: We recorded and mapped using Geographical Information System software the total number of commercial cigarette sources in 4 selected districts in the major German city of Cologne. The city was the ideal setting for this study as we were able to use existing sociogeographical data from this area. We compiled a complete inventory of commercial cigarette sources in autumn 2005 and 2009. An interim inventory was also completed in 2007. Results: Between 2005 and 2009, the total number of cigarette sources decreased from 369 to 325 within the study area. Although the most obvious reduction was detected in the number of outdoor vending machines (-44%), the number of indoor vending machines also decreased by 5%. In 2005 as well as in 2009, we found significantly fewer commercial cigarette sources in districts with above-average SES than in districts with below-average SES. Conclusions: Although the number of overall cigarette vending machines decreased, the disparity in distribution of cigarette sources between socially advantaged and disadvantaged areas increased.

Schwinn TM; Schinke SP; Di Noia J. Preventing drug abuse among adolescent girls: Outcome data from an Internet-based Intervention. Prevention Science 11(1): 24-32, 2010. (40 refs.)

This study developed and tested an Internet-based gender-specific drug abuse prevention program for adolescent girls. A sample of seventh, eighth, and ninth grade girls (N = 236) from 42 states and 4 Canadian provinces were randomly assigned to an intervention or control group. All girls completed an online pretest battery. Following pretest, intervention girls interacted with a 12-session, Internet-based gender-specific drug prevention program. Girls in both groups completed the measurement battery at posttest and 6-month follow-up. Analysis of posttest scores revealed no differences between groups for 30-day reports of alcohol, marijuana, poly drug use, or total substance use (alcohol and drugs). At 6-month follow-up, between-group effects were found on measures of 30-day alcohol use, marijuana use, poly drug use, and total substance use. Relative to girls in the control group, girls exposed to the Internet-based intervention reported lower rates of use for these substances. Moreover, girls receiving the intervention achieved gains over girls in the control group on normative beliefs and self-efficacy at posttest and 6-month follow-up, respectively.

Schwinn TM; Schinke SP. Preventing alcohol use among late adolescent urban youth: 6-year results from a computer-based intervention. Journal of Studies on Alcohol and Drugs 71(4): 535-538, 2010. (25 refs.)

Objective: This study was undertaken to evaluate the efficacy of a skills-based CD-ROM intervention, with and without a parent component, to reduce alcohol use among urban youth at 6-year follow-up. Method: At recruitment, 513 youths with a mean age of 10.8 years were randomly assigned to one of three study arms: youth CD-ROM intervention plus parent component, youth CD-ROM intervention only, or control. All youths completed pretest, posttest, and annual follow-up measures. Youths and parents in their respective arms received the initial intervention program between pretest and posttest measures and received booster interventions between each follow-up measure. Results: With 80% sample retention at 6-year follow-up, youths in both intervention arms reported less past-month alcohol and cigarette use and fewer instances of heavy drinking and negative alcohol-related consequences. Despite having similar numbers of drinking peers as youths in the control arm, youths in both intervention arms reported greater alcohol-refusal skills. Only past-month cigarette use differed between the two intervention arms, with youths in the intervention-plus-parent-component arm smoking less than youths in the CD-ROM intervention-only arm. Conclusions: Six years after initial intervention, youths who received a culturally tailored, skills-based prevention program had reduced alcohol use and lower rates of related risky behaviors than youths in the control arm.

Shandley K; Austin D; Klein B; Kyrios M. An evaluation of 'Reach Out Central': an online gaming program for supporting the mental health of young people. Health Education Research 25(4): 563-574, 2010. (46 refs.)

The objective of this study was to conduct an evaluation of Reach Out Central (ROC), an online gaming program designed to support the mental health of people aged 16-25. The evaluation sought to determine the benefit of playing ROC on alcohol use, use of coping strategies, psychological distress, resilience and satisfaction with life. Changes in mental health literacy, mental health stigma and willingness to seek help and program satisfaction were also investigated. A single group (N = 266) quasi-experimental repeated measures (pre-, post-program, 2-month follow-up) design was employed. The results demonstrated positive improvements across all outcome measures for females; however, a non-significant worsening effect was observed for males on seeking support, avoidance and resilience. Improvements for both genders were observed on mental health literacy and help-seeking. However, literacy levels and help-seeking were significantly higher, and stigma significantly lower for females. Program satisfaction ratings were high irrespective of gender. Although some inconsistencies between genders were noted, ROC appears to enhance protective factors for the prevention or early intervention of mental health disorders. The results of this study need to be viewed with its limitations in mind, specifically, the use of an open trial methodology and the small number of male participants.

Shapiro GK; Buckley-Hunter L. What every adolescent needs to know: Cannabis can cause psychosis. Journal of Psychosomatic Research 69(6): 533-539, 2010. (73 refs.)

Objective: Cannabis is a widely used substance that may be becoming more socially accepted, legally tolerated, and utilized by younger individuals. This review explores the relationship between cannabis and the onset of psychosis as well as the policy ramifications of current research. Method: This article synthesizes published work that was considered by the author to be relevant to the discussion of cannabis and the onset of psychosis. Results: The evidence suggests that, along with other harms, cannabis is a significant risk factor in the etiology of psychosis. Adolescents are more vulnerable to using cannabis, and because of their stage of mental development, the cognitive effects are more pronounced. The mechanism for this change is thought to be neuro-chemical with a stronger effect in those with a diathesis for psychosis. Conclusion: The risk that cannabis poses to adolescent health should not be neglected. Policy measures should use a multifaceted and strategic perspective in order to prevent adolescents from using this drug.

Shope JT. Adolescent motor vehicle crash risk: What's needed to understand and reduce the risk? Journal of Adolescent Health 46(1): 1-2, 2010. (15 refs.)

Sloan F; Platt A. Information, risk perceptions, and smoking choices of youth. Journal of Risk and Uncertainty 42(2): 161-193, 2011. (58 refs.)

Conventional wisdom maintains that youths take risks because they underestimate probabilities of harm. Presumably if they knew the true probabilities, they would behave differently. We used the National Longitudinal Survey of Youth 1997 to assess whether differences between subjective and objective probabilities that an adverse outcome to self will occur are systematically related to a harmful behavior, initiating smoking. We find that youths are generally pessimistic about probabilities of their own deaths and being violent crime victims. After smoking initiation, youths increase subjective probabilities of death by more than the objective increase in mortality risk, implying recognition of potential harms. Virtually all 12-14 year-olds know that smoking causes heart disease. The minority who believe that smoking causes AIDS are less likely to become smokers; i.e., risk misperceptions deter rather than cause smoking initiation. Messages designed to deter smoking initiation should stress other disadvantages of smoking than just probabilities of harm.

Strasburger VC; Fuld GL; Mulligan DA; Altmann TR; Brown A; Christakis DA et al. Policy Statement. Children, Adolescents, Substance Abuse, and the Media. Pediatrics 126(4): 791-799, 2010. (129 refs.)

The causes of adolescent substance use are multifactorial, but the media can play a key role. Tobacco and alcohol represent the 2 most significant drug threats to adolescents. More than $25 billion per year is spent on advertising for tobacco, alcohol, and prescription drugs, and such advertising has been shown to be effective. Digital media are increasingly being used to advertise drugs. In addition, exposure to PG-13- and R-rated movies at an early age may be a major factor in the onset of adolescent tobacco and alcohol use. The American Academy of Pediatrics recommends a ban on all tobacco advertising in all media, limitations on alcohol advertising, avoiding exposure of young children to substance-related ( tobacco, alcohol, prescription drugs, illegal drugs) content on television and in PG-13- and R-rated movies, incorporating the topic of advertising and media into all substance abuse-prevention programs, and implementing media education programs in the classroom.

Terry-McElrath YM; Emery S; Szczypka G; Johnston LD. Potential exposure to anti-drug advertising and drug-related attitudes, beliefs, and behaviors among United States youth, 1995-2006. Addictive Behaviors 36(1-2): 116-124, 2011. (32 refs.)

Using nationally representative data from the Monitoring the Future Study on United States middle and high school students, we related exposure to anti-drug television advertising as measured by Nielsen Media Research ratings points, to student self reported drug-related outcomes from 1995 to 2006. Multivariate analyses controlling for key socio-demographics and accounting for the complex survey design included 337,918 cases. Results indicated that attitudes beliefs and behaviors regarding substance use were significantly related to such advertising exposure over the six months prior to the date the youth were surveyed. However the observed relationships varied by grade level over time and by advertising tagline and marijuana focus. Findings differed markedly between middle and high school students across the study. Interval One factor that may partially explain observed differences may be variation in the degree to which the ads focused on marijuana. Putting a concerted effort into increasing anti-drug advertising will likely increase the exposure to and recall of such ads among youth. However the likelihood that such advertising will result in youth being less likely to use drugs seems to depend heavily on the type of advertising utilized and how it relates to different ages and characteristics of targeted youth.

Tobler AL; Komro KA; Dabroski A; Aveyard P; Markham WA. Preventing the link between SES and high-risk behaviors: "Value-added" education, drug use and delinquency in high-risk, urban schools. Prevention Science 12(2): 211-221, 2011. (38 refs.)

We examined whether schools achieving better than expected educational outcomes for their students influence the risk of drug use and delinquency among urban, racial/ethnic minority youth. Adolescents (n = 2,621), who were primarily African American and Hispanic and enrolled in Chicago public schools (n = 61), completed surveys in 6th (aged 12) and 8th (aged 14) grades. Value-added education was derived from standardized residuals of regression equations predicting school-level academic achievement and attendance from students' sociodemographic profiles and defined as having higher academic achievement and attendance than that expected given the sociodemographic profile of the schools' student composition. Multilevel logistic regression estimated the effects of value-added education on students' drug use and delinquency. After considering initial risk behavior, value-added education was associated with lower incidence of alcohol, cigarette and marijuana use; stealing; and participating in a group-against-group fight. Significant beneficial effects of value-added education remained for cigarette and marijuana use, stealing and participating in a group-against-group fight after adjustment for individual- and school-level covariates. Alcohol use (past month and heavy episodic) showed marginally significant trends in the hypothesized direction after these adjustments. Inner-city schools may break the links between social disadvantage, drug use and delinquency. Identifying the processes related to value-added education in order to improve school environments is warranted given the high costs associated with individual-level interventions.

Van De Luitgaarden J; Knibbe RA; Wiers RW. Adolescents binge drinking when on holiday: An evaluation of a community intervention based on self-regulation. Substance Use & Misuse 45(1/2): 190-203, 2010. (25 refs.)

This paper presents a case study of a community intervention aimed at reducing excessive drinking in young men on holiday in seaside camping resorts in the Netherlands. The self-regulated voluntary covenant of parties concerned was evaluated on the basis of several types of data (all collected in 2004): questionnaires administered to young men (N = 191), observations carried out by trained "peers", nuisance questionnaires among city center residents (N = 121), and interviews with local actors. Compliance with measures as well as the effects of measures are discussed. Limitations are noted and recommendations for optimizing the potential of community interventions are made.

van Hemel-Ruiter ME; de Jong PJ; Wiers RW. Appetitive and regulatory processes in young adolescent drinkers. Addictive Behaviors 36(1-2): 18-26, 2011. (67 refs.)

Dual-process models of addiction propose that alcohol (mis)use develops because of an imbalance between a fast automatic appetitive system in which stimuli are valued in terms of their emotional and motivational significance and a slower controlled regulatory system which acts on deliberate considerations. This study focused on the automatic and regulatory processes that are involved in the early stages of young adolescent alcohol use. Participants were 43 young adolescent drinkers who completed an explicit alcohol valence measure ,two versions of an Affective Simon Task (AST), a working memory task, and an alcohol use questionnaire. Alcohol use was associated with relatively positive self-reported valence of alcohol pictures, especially for adolescents with lower inhibition capacity. The Affective Simon Tasks did not show stronger automatic approach tendencies in heavier drinkers. This study suggests that in early stages of alcohol use appetitive valence is a more important stimulator for the initiation of alcohol use than automatic approach tendencies, and supports the view that young adolescents with low inhibition capacity are especially at risk for developing alcohol misuse. Prevention therefore should be focused on reducing the attractive valence of alcoholic drinks and strengthening the cognitive control of at-risk children.

Van Hout MC. Differentiated normalization and drug transitions among rural youth in Ireland. Drugs: Education, Prevention and Policy 18(2): 124-131, 2011. (36 refs.)

Prevalence surveys in Ireland indicate an increased trend of youth drug use with rural areas reporting comparable drug availability and prevalence of use in urban settings (Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R., & Currie, D. (Eds.). (2008). Inequalities in young people's health: HBSC international report from the 2005/2006 survey. Copenhagen: WHO Regional Office for Europe). Few studies have explored the contexts and meaning of drug use on rural youth transitions in terms of increased drug prevalence, recent influx of rural drug activity, normative tolerance of recreational drug consumption and fragmentation of traditional rural communities. Qualitative interviews were conducted with 220 young people (15-17 years), and 78 service providers in a rural area of Ireland, in order to yield contextualized narratives of their experiences of drug use and achieve a wider exploration of processes, drug transitions and realities of rural youth. The thematic analysis of the research described varied pathways, attitudes and typologies of rural youth drug use, ranging from abstinent, recreational and moderated to maturing out. The research suggests support for a 'differentiated' normalization theory (Shildrick, T. (2002). Young people, illicit drug use and the question of normalisation theory. Journal of Youth Studies, 5, 35-48) in terms of consumerist and normative rural youth drug use transitions in their negotiation of risk within integrating rural and urban dichotomies. In conclusion, it is recommended that drug education programmes need to situate localized rural drug taking behaviours within a wider understanding of rural community life.

Vardavas CI; Symvoulakis EK; Connolly GN; Patelarou E; Lionis C. What defines an effective anti-tobacco tv advertisement? A pilot study among Greek adolescents. International Journal of Environmental Research and Public Health 7(1): 78-88, 2010. (21 refs.)

As the Framework Convention on Tobacco Control (FCTC) calls for public health awareness on tobacco use, mass media campaigns should be appropriately designed so as to maximize their effectiveness. In this methodological pilot study, 95 Greek adolescents (mean age 15 +/- 1.8 years), were shown seven different anti tobacco ads, and asked to rate the ad theme, message and emotional context on a 1-7 Likert scale. Health related ads were rated the highest, and as identified through the logistic regression analysis, adolescents who perceived an ad to be emotional or to have a clear message that was relevant to them, were more likely to rate the ad as more effective. The strong agreement between the above findings and the existing literature indicates the applicability of this pilot study's methodological approach.

Wakschlag LS; Metzger A; Darfler A; Ho J; Mermelstein R; Rathouz PJ. The Family Talk About Smoking (FTAS) Paradigm: New directions for assessing parent-teen communications about smoking. Nicotine & Tobacco Research 13(2): 103-112, 2011. (29 refs.)

Smoking experimentation represents transient risk taking for some youth, whereas for others, it is the onset of a chronic smoking trajectory. However, distinguishing these groups during the experimentation phase has proved challenging. We theorized that variations in parent and teen discourse about smoking might be informative for characterizing this heterogeneity. However, standardized methods for direct assessments of these family processes have been lacking. We examined the predictive utility of directly observed facets of smoking-specific communication for predicting persistence of teen smoking experimentation using a novel method, the Family Talk About Smoking (FTAS) paradigm. The FTAS was tested in a sample of 344 teens with a history of smoking experimentation during interactions with their mothers and fathers. Level of disapproval, smoking expectancies, elaboration of consequences, and quality of personal disclosure were coded during videotaped parent-teen discussions about smoking. Patterns of observed smoking-specific communication varied by teen and parent smoking status. Predictive validity of the FTAS for teen persistent experimentation was demonstrated, net effects of reported smoking-specific socialization, general quality of communication, and parental smoking status. Teen smoking expectancies, disclosure, and disapproval predicted teen persistent experimentation with some differences based on whether interactions were with mothers or fathers. Prediction of persistent experimentation by observed maternal disclosure and elaboration of consequences was moderated by maternal smoking status. Direct observations show promise for generating detailed characterization of individual differences in patterns of family communication about smoking. Implications for targeted prevention and future research are discussed.

Walsh SM; Donaldson RE. Invited Commentary. National Safe Place: meeting the immediate needs of runaway and homeless youth. (editorial). Journal of Youth and Adolescence 39(5): 437-445, 2010. (23 refs.)

An estimated 1.6 million youth run away from home each year. While on the run, these youth are vulnerable to exploitation, victimization, increased dangers and perpetration of criminal behavior. Runaway and homeless youth are far more likely to engage in substance use and delinquent behavior, drop out of school and suffer from sexually transmitted diseases and mental illness at greater rates than the norm. Timely and direct intervention in runaway and throwaway cases is imperative to protect youth from the high risks of living on the streets. National Safe Place is an outreach and prevention program that is uniquely designed to provide immediate safety and access to services for any youth in need. In partnership with over 360 youth serving agencies and over 10,000 businesses and community organizations across the United States, the Safe Place program educates youth about alternatives to running away and homelessness and provides easily accessible links to service providers. Ongoing data collection indicates that National Safe Place has been successful in reaching endangered youth at risk of abuse, neglect or serious family problems but that expanded program models remain needed. The challenges and successes of current programming and the future of National Safe Place program expansion are discussed.

Weiss JW; Mouttapa M; Cen S; Johnson CA; Unger J. Longitudinal effects of hostility, depression, and bullying on adolescent smoking initiation. Journal of Adolescent Health 48(6): 591- 596, 2011. (39 refs.)

Purpose: The present study examined the associations between smoking initiation and, hostility, depressive symptoms, and bullying (bullies and bully-victims) among a culturally diverse sample of 1,771 adolescents who reported never having smoked at baseline. Methods: Data were obtained from a longitudinal school-based experimental trial of smoking prevention programs in Southern California. Annual survey was performed for students of the sixth, seventh, and eighth grades. All students in the 24 participating schools were invited to participate in the study during the sixth grade. Results: The risk of smoking initiation was significantly higher among students who scored higher on hostility and depressive symptoms, and were bully-victims. Conclusion: The findings suggest that tobacco prevention programs should include strategies for managing hostile feelings and negative effect as part of the curriculum. In addition, it might be helpful to identify youth who score high on these psychosocial factors and teach them skills to handle interpersonal conflict and negative feelings to prevent their involvement in substance use.

Werch CE; Bian H; DiClemente CC; Moore MJ; Thombs D; Ames SC et al. A brief image-based prevention intervention for adolescents. Psychology of Addictive Behaviors 24(1): 170-175, 2010. (26 refs.)

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Windle M; Zucker RA. Reducing underage and young adult drinking how to address critical drinking problems during this developmental period. Alcohol Research & Health 33(1-2): 29-44, 2010. (104 refs.)

Forty years ago, when the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded, alcoholism was considered an adult disease driven principally by physiological determinants. As NIAAA expanded its research portfolio, new data and insights were obtained that led to an increased focus on underage and young adult drinking. Fostered by interdisciplinary research, etiologic models were developed that recognized the multiplicity of relevant genetic and environmental influences. This shift in conceptualizing alcohol use disorders also was based on findings from large-scale, national studies indicating that late adolescence and early young adulthood were peak periods for the development of alcohol dependence and that early initiation of alcohol use (i.e., before age 15) was associated with a fourfold increase in the probability of subsequently developing alcohol dependence. In recent years, developmental studies and models of the initiation, escalation, and adverse consequences of underage and early young adult drinking have helped us to understand how alcohol use may influence, and be influenced by, developmental transitions or turning points. Major risk and protective factors are being identified and integrated into screening, prevention, and treatment programs to optimize interventions designed to reduce drinking problems among adolescents and young adults. In addition, regulatory policies, such as the minimum drinking age and zero-tolerance laws, are being implemented and evaluated for their impact on public health.

Zaidi SMA; Bikak AL; Shaheryar A; Imam SH; Khan JA. Perceptions of anti-smoking messages amongst high school students in Pakistan. BMC Public Health 11: article 117, 2011. (20 refs.)

Background: Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages. Methods: This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers. Results: Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers. Conclusion: Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.