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New this Month - January - July 2007
A computer-based approach to preventing pregnancy, STD, and HIV in rural adolescents
Zimmerman, R. S.; Roberto, A. J.; Carlyle, K. E.; and Abner, E. L.
Journal of Health Communication, vol. 12, pgs. 53-76 (2007)
A computer- and Internet-based intervention was designed to influence several variables related to the prevention of pregnancy, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV) in rural adolescents. The intervention was guided by the extended parallel process model and was evaluated using a pretest-post-test control group design with random assignment at the school level. Three hundred and twenty-six tenth-grade males and females enrolled in two rural Appalachian public high schools completed the survey at both points in time. Results indicate the vast majority (88.5%) of students in the experimental school completed at least one activity (M = 3.46 for those doing at least one activity). Further, both the overall program and all but one of the activities were rated positively by participants. Regarding the effects of the intervention, results indicate that students in the experimental school were less likely to initiate sexual activity and had greater general knowledge, greater condom negotiation self-efficacy, more favorable attitudes toward waiting to have sex, and greater situational self-efficacy than in the control school. In tandem, the results suggest that the computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.
A meta-analysis of direct and mediating effects of community coalitions that implemented science-based substance abuse prevention interventions
Johnson, K.; Collins, D.; and Becker, B. J.
Substance Use & Misuse, vol. 42, pgs. 985-1007 (2007)
This article reports results of a meta-analysis of the effects of a set of community coalitions that implemented science-based substance use prevention interventions as part of a State Incentive Grant (SIG) in Kentucky. The analysis included assessment of direct effects on prevalence of substance use among adolescents as well as assessment of what "risk" and "protective" factors mediated the coalition effects. In addition, we tested whether multiple science-based prevention interventions enhanced the effects of coalitions on youth substance use. Short-term results (using 8th-grade data) showed no significant decreases in six prevalence of substance use outcomes - and, in fact, a significant though small increase in prevalence of use of one substance (inhalants). Sustained results (using 10th-grade data), however, showed significant, though small decreases in three of six substance use outcomes - past month prevalence of cigarette use, alcohol use, and binge drinking. We found evidence that the sustained effects on these three prevalence outcomes were mediated by two posited risk factors: friends' drug use and perceived availability of drugs. Finally, we found that the number of science-based prevention interventions implemented in schools within the coalitions did not moderate the effects of the coalitions on the prevalence of drug use. Study limitations are noted.
A quantitative study on the condom-use behaviors of eighteen- to twenty-four-year-old urban African American males
Kennedy, S. B.; Nolen, S.; Applewhite, J.; Pan, Z.; Shamblen, S.; and Vanderhoff, K. J.
AIDS patient care and STDs, vol. 21, pgs. 306-20 (2007)
This research study sought to develop, pilot test, and assess a brief male-centered condom promotion program for urban young adult African American males. For study implementation, both qualitative and quantitative research methods were used, and the project was guided by tenets of two common but integrated theoretical frameworks in HIV/sexually transmitted disease (STD) prevention research: the social cognitive theory and the stages of change model. The purpose of the qualitative component was to identify and explore condom-use barriers and facilitators while that of the quantitative component was to identify the prevalence of condom-related behaviors and the feasibility of program administration. After recruitment of study participants from hang-out spots and street intercepts, study participants were self-administered a baseline survey regarding their perceived condom-use behaviors prior to random assignment to program conditions (a condom promotion program and an attention-matched comparison condition). In this paper, we report the findings from the analyses of the quantitative baseline survey data. While the occurrence of HIV/STD-related risk behaviors were highly prevalent among this population; importantly, regression analyses revealed that sexual debut, favorable attitudes toward condom use, social or personal connectedness to HIV/STDs, health beliefs, perceived susceptibility, unprotected sexual encounters, and refusal skills were predictive of retrospective (i.e., prior 30 days) condom use while positive reasons (pros) to use condoms, condom-use beliefs, condom-carrying, health belief, unprotected sexual encounters and refusal skills were also predictive of prospective (i.e., future 30 days) condom-use intentions. The implications and limitations of this study are described and recommendations provided for program development.
A Swedish alcohol ignition interlock programme for drink-drivers: Effects on hospital care utilization and sick leave
Marques, P.; Bjerre, B.; Selen, J.; and Thorsson, U.
Addiction, vol. 102, pgs. 560-70 (2007)
AIMS: This project evaluates health outcomes following an alcohol ignition interlock programme (AIIP) by assessing hospital care utilization and sick-leave register data relative to controls with revoked licences, but with no comparable opportunity to participate in an AIIP. SETTING: In Sweden, driving while impaired (DWI) offenders can now select voluntarily a 2-year AIIP in lieu of 12 months' licence revocation. The AIIP includes regular medical check-ups designed to alter alcohol use. DESIGN: The study is a quasi-experimental intent-to-treat design; accordingly, the intervention group includes 48% of the participants who were dismissed from the AIIP before completion. FINDING: The control group (865 individuals) showed increased hospital care and sick leave after licence revocation following the DWI. Among the 1266 people in the AIIP, however, significantly fewer needed hospital care relative to controls, and relative to their own care utilization before the DWI offence. This occurred whether care reflected all diagnosis or only alcohol-related diagnosis. Also, sick-leave data showed significantly fewer AIIP group individuals using sick leave relative to the control group, and relative to their own pre-treatment period. These significant health benefits disappear in the post-treatment period. However, among those who actually do complete the entire AIIP, sustained positive health effects are observed 3 and 4 years after the DWI offence.
CONCLUSIONS: Voluntary participation in an AIIP has favourable effects with less need for hospital care or sick leave. This is probably linked to reduced alcohol consumption during the programme and to the ability to continue driving.
Alcohol involvement in fatal crashes under three crash exposure measures
Voas, R. B.; Fisher, D. A.; Tippetts, A. S.; Romano, E.; and Kelley-Baker, T.
Traffic Injury Prevention, vol. 8, pgs. 107-14 (2007)
Objective. A common method of normalizing crash fatality data for comparing subgroups of drivers has been the estimated vehicle miles traveled (VMT). Unfortunately, the VMT method fails to provide for exposure to risks such as those related to alcohol consumption (among others). Recently, the "crash incidence ratio" (CIR) has been introduced to address some of these limitations. The goals of this study are first, to show that the CIR method is intrinsically similar to an increasingly popular quasi-induced
method: the relative accident involvement ratio (RAIR); second, to compare the VMT-based, the CIR, and the RAIR methods when applied to the evaluation of alcohol-related crash fatalities across racial/ethnic groups. Methods. We use the 1990-1996 Fatal Accident Reporting System (FARS) with information on the drivers' race/ethnicity and alcohol involvement (BAC). Descriptive and statistical ratio tests were applied. Results. The RAIR and CIR are indeed closely related measures that, when used for comparisons against a reference group, yield exactly the same numerical estimates. Strikingly different outcomes were obtained depending on using the VMT or the CIR/RAIR. Conclusion. Choosing one measure over another should depend on the questions to be answered. The implication of this finding for researchers and policy makers is discussed.
Alcohol outlet characteristics and alcohol sales to youth: results of alcohol purchase surveys in 45 Oregon communities
Biglan, A.; Black, C.; Flewelling, R. L.; Paschall, M. J.; Ringwalt, C. L.; and Grube, J. W.
Prevention Science, vol. 8, pgs. 153-9 (2007)
Reducing youth access to commercial sources of alcohol is recognized as a necessary component of a comprehensive strategy to reduce underage drinking and alcohol-related problems. However, research on policy-relevant factors that may influence the commercial availability of alcohol to youth is limited. The present study examines characteristics of off-premise alcohol outlets that may affect alcohol sales to youth. Random alcohol purchase surveys (N = 385) were conducted in 45 Oregon communities in 2005. Underage-looking decoys who were 21 years old but did not carry IDs were able to purchase alcohol at 34% of the outlets approached. Purchase rates were highest at convenience (38%) and grocery (36%) stores but were relatively low (14%) at other types of outlets (e.g., liquor and drug stores). Alcohol purchases were less likely at stores that were participating in the Oregon Liquor Control Commission's Responsible Vendor Program (RVP), when salesclerks asked the decoys for their IDs, and at stores with a posted underage alcohol sale warning sign. Alcohol purchases were also inversely related to the number of salesclerks present in a store, but were not related to salesclerks' age and gender. Findings of this study suggest that more frequent compliance checks by law enforcement agents should target convenience and grocery stores, and owners of off-premise outlets should require training of all salesclerks to ensure reliable checks of young-looking patron IDs, and should post underage alcohol sales warning signs in clear view of patrons.
An evaluation of retail outlets as part of a community prevention trial to reduce sales of harmful legal products to youth
Johnson, K.; Collins, D.; Holder, H. D.; Courser, M. W.; and Ogilvie, K.
Evaluation Review, vol. 31, pgs. 343-63 (2007)
Communities across the nation have become increasingly concerned about inhalant use and use of harmful legal products among youth because of increasing prevalence rates and deleterious health consequences from abusing these products. The increasing concern of communities about inhaling and ingesting legal products has been coupled with increasing awareness and concern about ability of youth to access and abuse a variety of other legal retail products. There are few examples of scientifically designed community prevention projects that seek to reduce youth abuse of such legal products. This article describes a community prevention trial that is designed to reduce sales of inhalants and other harmful legal products to youth and demonstrates how the retailer component of the trial can be rigorously evaluated. It also shows how data from youth purchase attempts can complement survey data from retailers.
Challenges in replicating interventions
Zimmerman, R.; Tortolero, S.; Bell, S. G.; Newcomer, S. F.; Bachrach, C.; and Jemmott, J. B., 3rd
Journal of Adolescent Health, vol. 40, pgs. 514-20 (2007)
PURPOSE: To describe and reflect on an effort to document, through a set of 6 interventions, the process of adapting effective youth risk behavior interventions for new settings, and to provide insights into how this might best be accomplished.
METHODS: Six studies were funded by the NIH, starting in 1999. The studies were funded in response to a Request for Applications (RFA) to replicate HIV prevention interventions for youth. Researchers were to select an HIV risk reduction intervention program shown to be effective in one adolescent population and to replicate it in a new community or different adolescent population. This was to be done while systematically documenting those processes and aspects of the intervention hypothesized to be critical to the development of community-based, culturally sensitive programs. The replication was to assess the variations necessary to gain cooperation, implement a locally feasible and meaningful intervention, and evaluate the outcomes in the new setting. The rationale for this initiative and description of the goals and approaches to adaptation of the funded researchers are described.
RESULTS: Issues relevant to all interventions are discussed, in addition to those unique to replication. The processes and the consequences of the adaptations are then discussed. The further challenges in taking a successful intervention "to scale" are not discussed.
CONCLUSIONS: Replications of effective interventions face all of the challenges of implementation design, plus additional challenges of balancing fidelity to the original intervention and sensitivity to the needs of new populations.
Drinking as an epidemic--A simple mathematical model with recovery and relapse
Gruenewald, P. J.; Miller, William C.; Sánchez, F.; and Castillo-Chávez, C.
In Therapist's guide to evidence-based relapse prevention pgs. 351-366 , (2007)
No abstract provided.
Drinking level, neighborhood social disorder, and mutual intimate partner violence
Cunradi, C. B.
Alcoholism, Clinical and Experimental Research, vol. 31, pgs. 1012-9 (2007)
BACKGROUND: Intimate partner violence (IPV) remains a significant public health problem. The purpose of this study is to assess the contribution of drinking patterns to risk for mutual IPV among married/cohabiting adults in the general population, and to determine if the association between drinking level and mutual IPV varies by level of neighborhood social disorder.
METHODS: The study sample consists of 19,035 non-Hispanic black, Hispanic, and non-Hispanic white married/cohabiting adults who participated in the 2000 National Household Survey on Drug Abuse (NHSDA), and whose responses were available through the NHSDA public use file. Gender-specific multivariate logistic regression models of mutual IPV were developed to assess the association between drinking level and mutual IPV, and to test whether these associations vary by neighborhood social disorder.
RESULTS: Compared with men who are abstainers, men who are past-30 day heavy drinkers are at a more than 6-fold increased risk for mutual IPV. Men in less hazardous drinking categories are at a 2- to 3-fold increased risk of mutual IPV. Neighborhood disorder is independently associated with men's risk for mutual IPV (odds ratio=1.61). Except for women in the most hazardous drinking category, neighborhood disorder moderates the association between women's drinking level and risk of mutual IPV such that risk for mutual IPV significantly increases under conditions of high neighborhood disorder, and decreases to insignificant risk under conditions of low neighborhood disorder. Compared with abstainers, women who are past-30 day heavy drinkers are at an approximate 6-fold risk for mutual IPV regardless of level of neighborhood disorder.
CONCLUSIONS: Drinking level and neighborhood characteristics should be taken into account when assessing risk for mutual IPV among married/cohabiting men and women in the general population. An environmental approach to IPV prevention and intervention which addresses the neighborhood context in which couples reside may be a promising strategy for reducing IPV occurrence.
Early initiation of substance use and subsequent risk factors related to suicide among urban high school students
Cho, H.; Hallfors, D. D.; and Iritani, B. J.
Addictive Behaviors, vol. 32, pgs. 1628-39 (2007)
OBJECTIVE: To examine the association between onset of substance use and risk factors related to suicide.
METHOD: 1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt.
RESULTS: In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors.
CONCLUSIONS: The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences.
Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing
Zaloshnja, E.; Miller, T. R.; and Spicer, R. S.
Accident; Analysis and Prevention, vol. 39, pgs. 565-73 (2007)
Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective in the workplace.
Exploring the spatial dynamics of alcohol outlets and Child Protective Services referrals, substantiations, and foster care entries
Freisthler, B.; Needell, B.; Gruenewald, P. J.; Remer, L. G.; and Lery, B.
Child Maltreatment, vol. 12, pgs. 114-24 (2007)
Controlling for neighborhood demographic characteristics, this study examined the relationship of alcohol outlets with rates of Child Protective Services (CPS) referrals, substantiations, and foster care entries from 1998-2003 in 579 zip codes in California. Data for this panel study were analyzed using spatial random effects panel models. Zip codes with higher concentrations of off-premise alcohol outlets (e.g., convenience or liquor stores) and proportions of Black residents had higher rates of maltreatment. Higher average household size and median household income were generally related to lower child maltreatment rates. More specifically, the model derived estimates that an average decrease of one off-premise outlet per zip code would reduce total referrals to CPS in the 579 zip codes by 1,040 cases, substantiations by 180 cases, and foster care entries by 93 cases. Characteristics of adjacent zip codes also were related to maltreatment rates in local neighborhoods, indicating a spatial dynamic to this relationship. Reductions in number of alcohol outlets per zip code, particularly off-premise outlets, may result in lower rates of child maltreatment.
Great minds don't always think alike: The challenge of conducting substance abuse prevention research in public schools
Ringwalt, C; Renes, S.L.; Clark, H.K.; and Hanley, S.
Journal of Drug Education, vol. 37, pgs. 97-105 (2007)
Prevention researchers and school personnel lack a common understanding concerning the opportunities and burdens of school-based drug prevention research. In this article, we review issues related to researching substance abuse prevention programs in school settings, and assess challenges related to recruitment, communication, research design, surveying, and ensuring program fidelity. We conclude that before any school is enrolled, there must be a mutual understanding as to the nature and extent of the study's requirements and what adjustments a school will have to make to support a successful collaboration. Further, researchers must understand that schools' responsibilities for preparing students to perform well on academic and standardized tests will always overshadow the value they place on participating in studies to evaluate the effectiveness of prevention curricula.
Joint impacts of minimum legal drinking age and beer taxes on US youth traffic fatalities, 1975 to 2001
LaScala, E. A.; Gruenewald, P. J.; and Ponicki, W. R.
Alcoholism, Clinical and Experimental Research, vol. 31, pgs. 804-13 (2007)
Background: There is a considerable body of prior research indicating that a number of public policies that limit alcohol availability affect youth traffic fatalities. These limitations can be economic (e.g., beverage taxation), physical (e.g., numbers or operating hours of alcohol outlets), or demographic (e.g., minimum legal drinking age). The estimated impacts of these policies differ widely across studies. A full-price theoretical approach suggests that people weigh the benefits of drinking against the sum of all the associated costs, including the price of the beverages themselves plus the difficulty of obtaining them and any additional risks of injury or punishment related to their use. This study tested one prediction of this model, namely that the impact from changing one availability-related cost depends on the level of other components of full cost.
Methods: The current analyses concentrate on 2 forms of limitations on availability that have been shown to affect youth traffic fatalities: minimum legal drinking age (MLDA) laws and beer taxes. The interdependence between the impacts of MLDA and taxes is investigated using a panel of 48 US states over the period 1975 to 2001. All age-group-specific models control for numerous other variables previously shown to affect vehicle fatalities, as well as fixed effects to account for unexplained crosssectional and time-series variation.
Results: The analyses showed that raising either MLDA or beer taxes in isolation led to fewer youth traffic fatalities. As expected, a given change in MLDA causes a larger proportional change in fatalities when beer taxes are low than when they are high.
Conclusions: These findings suggest that a community's expected benefit from a proposed limitation on alcohol availability depends on its current regulatory environment. Specifically, communities with relatively strong existing policies might expect smaller impacts than suggested by prior research, while places with weak current regulations might expect larger benefits from the same policy initiative.
Mandating interlocks for fully revoked offenders: The New Mexico experience
Voas, R.; Marques, P.; and Roth, R.
Traffic Injury Prevention, vol. 8, pgs. 20-5 (2007)
OBJECTIVE: In New Mexico, between July 1999 and December 2002, the installation of an ignition interlock was an optional judicial sanction for second and third driving-while-impaired (DWI) offenders. This is a study of the recidivism of 437 offenders who were convicted and installed interlocks for an average of 322 days during that period.
METHODS: The comparison group was a stratified random sample (N = 12,554) of the 20,949 offenders who were convicted during the same period but did not install interlocks. DWI arrest and conviction data for all study participants were received from the Motor Vehicle Department's Citation Tracking System.
RESULTS: Only 11 (2.5%) of the interlock offender group were rearrested for DWI while interlocks were installed, whereas 1,017 (8.1%) of the comparison group were rearrested during an equivalent 322-day period. Survival graphs and Cox proportional hazard regression analyses were used to compare the interlock and noninterlock groups during installation, after installation, and for the entire period up to December 2004. Results indicate a reduction in recidivism of 65% during installation. After removal, there was no significant difference in recidivism rates in a 3-year follow-up period. Following all offenders for 4 years, including both the period while the interlock was installed and the period after its removal, indicates that the difference in recidivism achieved during installation, though not increased, is maintained, so at the end of 4 years, interlock users still have lower total recidivism than nonusers.
CONCLUSIONS: The magnitude of interlock effectiveness reported here is similar to those in other published studies with comparable samples.
Maternal depression and cognitive features of 9-year-old children prenatally-exposed to cocaine
Marques, P. R.; Long, T.; Pokorni, J. L.; and Teti, L. O.
American Journal of Drug and Alcohol Abuse, vol. 33, pgs. 45-61 (2007)
This study evaluated cocaine exposure and maternal characteristics as competing predictors of school-age cognitive, achievement, and language performance. One group of 47 exposed 9-year-old children were first studied in an earlier prenatal study. A non-exposed contrast group (n = 46) served as a reference. Maternal measures included: IQ, psychopathology, drugs, demographics, and environment. Child intelligence, language, and achievement scores were inversely related to maternal IQ and depression scores, with cocaine exposure significant secondary or tertiary predictors for many children. Verbal IQ scores of exposed children strongly reflected maternal depression (r = .54) but no such relationship was found among the non-exposed cohort (r = .00).
Medical costs and productivity losses due to interpersonal and self-directed violence in the United States
Miller, T. R.; Corso, P. S.; Mercy, J. A.; Simon, T. R.; and Finkelstein, E. A.
Am J Prev Med, vol. 32, pgs. 474-482 (2007)
BACKGROUND: Violence-related injuries, including suicide, adversely affect the health and welfare of all Americans through premature death, disability, medical costs, and lost productivity. Estimating the magnitude of the economic burden of violence is critical for understanding the potential amount of resources that can be saved if cost-effective violence prevention efforts can be broadly applied. From 2003 to 2005, the lifetime medical costs and productivity losses associated with medically treated injuries due to interpersonal and self-directed violence occurring in the United States in 2000 were assessed.
METHODS: Several nationally representative data sets were combined to estimate the incidence of fatal and nonfatal injuries due to violence. Unit medical and productivity costs were computed and then multiplied by corresponding incidence estimates to yield total lifetime costs of violence-related injuries occurring in 2000.
RESULTS: The total costs associated with nonfatal injuries and deaths due to violence in 2000 were more than $70 billion. Most of this cost ($64.4 billion or 92%) was due to lost productivity. However, an estimated $5.6 billion was spent on medical care for the more than 2.5 million injuries due to interpersonal and self-directed violence.
CONCLUSIONS: The burden estimates reported here provide evidence of the large health and economic burden of violence-related injuries in the U.S. But the true burden is likely far greater and the need for more research on violence surveillance and prevention are discussed.
Military culture and drinking behavior among U.S. Navy careerists
Ames, G. M.; Cunradi, C. B.; Moore, R. S.; and Stern, P.
Journal of Studies on Alcohol and Drugs, vol. 68, pgs. 336-44 (2007)
ABSTRACT. Objective: This study builds on research linking work culture and drinking behavior to examine the influence of the military work environment, especially deployment and liberty, on heavy and heavy episodic drinking among career enlistees and officers.
Method: Both quantitative (self-administered cross-sectional survey data collected from 2,380 respondents) and qualitative (home-base and shipboard observations and ethnographic interviews with 81 enlisted and officer personnel) methods provided data. Linear regression analyses were used to examine the relationship between occupational factors (enforcement of alcohol policy, work problems, work-related stress, and length of deployment) and positive normative beliefs for heavy drinking during deployment liberty. Logistic regression analyses were used to examine the relationship between positive normative beliefs and four drinking-related outcomes (past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], alcohol abuse and frequent heavy drinking, and heavy drinking and heavy episodic drinking during most recent deployment liberty).
Results: Occupational factors were significantly related to positive normative beliefs for heavy drinking during deployment liberty; in turn, positive normative beliefs were significantly associated with each drinking outcome. Although the prevalence of DSM-IV alcohol abuse differed significantly between men and women (28.2% vs 15.1%), as did the prevalence for frequent heavy drinking (13.7% vs 8.9%), no gender differences were found in the prevalence of heavy episodic drinking or heavy drinking during the most recent deployment liberty. Ethnographic results provided descriptions of the cultural context of drinking behavior in relation to ambivalent alcohol policy, relief from work-related stress, ritual of free-range behavior on deployment liberty, and long-standing traditions.
Conclusions: Prevention measures in the military may require policy and environmental changes.
Moving behavioral science from efficacy to effectiveness
Hallfors, D.; and Cho, H.
International Journal of Behavioral Consultation and Therapy, vol. 3, pgs. 236-250 (2007)
The gap between scientific knowledge and real world practice continues to be a major conundrum for the behavioral sciences. This paper briefly reviews the development of behavioral research and describes problems that have arisen in meeting the goal of improving behavioral interventions through science. Based on published literature and personal observations, the authors argue that behavioral research has followed too closely after the pharmaceutical research model, with reliance on small efficacy trials under optimal conditions. Specific problems are outlined along with three recommended solutions. In brief, real world feasibility testing is essential, and external validity must become as important as internal validity for evidence of effectiveness.
Physical and social availability of alcohol for young enlisted naval personnel in and around home port
Ames, G. M.; Cunradi, C. B.; and Moore, R. S.
Substance Abuse Treatment, Prevention, and Policy, vol. 2, pgs. 17 (2007)
ABSTRACT: BACKGROUND: Heavy alcohol consumption rates are higher in the young adult military enlisted population than among civilians of the same age. The literature on alcohol availability, both generally and specifically with respect to work-related drinking, establishes clear links between ease of access, alcohol consumption rates and alcohol-related problems.
METHODS: In this paper, a qualitative analysis of 50 semi-structured interviews with U.S. Navy personnel was combined with quantitative findings from a mail survey of 713 young enlisted men and women in order to shed light on alcohol availability and its correlates in the home port environments of young adult enlisted personnel. The interviews were analyzed by two anthropologists seeking recurring themes or topics related to alcohol availability. These qualitative data were contexualized by descriptive statistics of the survey responses regarding ease of obtaining alcohol on and around naval bases, and from friends in and out of the Navy.
RESULTS: Findings associated with social and physical availability of alcohol include low prices in Navy Exchange base stores, frequent barracks parties, drink promotions in bars surrounding bases, and multiple opportunities for underage drinking despite age limits on alcohol purchases and official efforts to deglamorize alcohol use in the Navy. Both qualitative and qualitative findings suggest that respondents found alcohol and opportunities to drink overwhelmingly available in both on-base and off-base settings, and from friends both in and out of the Navy.
CONCLUSIONS: There is qualitative and quantitative evidence for extensive physical and social availability of alcohol in and around bases for young adults in the military. Policy implications include raising the presently tax-free alcohol prices in base stores and enforcing existing policies regarding underage drinking, particularly the provision of alcohol by people of legal drinking age, and by bars in and around bases. Cooperative preventive efforts with surrounding communities also offer promising ways for bases to reduce alcohol availability for young adult servicemembers.
Preventing Alcohol-Related Convictions: The Effect of a Novel Curriculum for First-Time Offenders on DUI Recidivism
Voas, R. B.; Kelley-Baker, T.; Rider, R.; Murphy, B.; and Grosz, M.
Traffic Injury Prevention, vol. 8, pgs. 147-52 (2007)
Objective. To determine whether DUI offenders can better avoid future drinking and driving by controlling their vehicle usage rather than by controlling their drinking. Methods. Using a randomized experimental post-test only design, 9,571 first-time DUI offenders were randomly assigned to receive one of two 12-hour educational programs: a traditional DUI curriculum or the PARC (Preventing Alcohol-Related Convictions) curriculum, which uses a novel theoretical approach to preventing DUI recidivism. Whereas traditional programs focus on participants controlling their drinking to avoid future drinking and driving, the PARC curriculum focuses on participants controlling their driving. Instead of trying to control alcohol consumption after driving to a drinking venue (previously found to be a flawed strategy), PARC teaches students to make a decision before leaving home not to drive to a drinking event, thus greatly limiting the possibility of drinking and driving. Driving records were obtained from the Florida Department of Motor Vehicles using driver's license numbers to assess DUI recidivism rates among the students in the PARC and Traditional curricula for the first year following program participation and again at 2 years post-intervention. Results. Binary logistic regression analyses revealed that offenders receiving the PARC curriculum exhibited significantly lower 1-year and 2-year recidivism rates than those receiving the Traditional curriculum. The effect was consistent across two different measures of recidivism, and across gender, race, ethnicity, and location. Conclusion. Results suggest that the PARC educational approach may be more effective than the traditional approach in reducing DUI recidivism.
R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents
Jackson, C.; Brown, J. D.; and L'Engle, K. L.
Archives of Pediatrics and Adolescent Medicine, vol. 161, pgs. 260-8 (2007)
OBJECTIVE: To test movie exposure and television use as predictors of smoking initiation among white and black adolescents who had never smoked cigarettes. DESIGN: Survey research using audio computer-assisted self-interviews at baseline and at 2-year follow-up (2002-2004). SETTING: Participants' homes located in central North Carolina. PARTICIPANTS: A sample of 735 12- to 14-year-old adolescents drawn from 14 public middle schools. MAIN EXPOSURE: Frequency of exposure to movies rated R, PG-13, PG, or G; frequency, location, and parental oversight of television viewing. MAIN OUTCOME MEASURE: Initiation of smoking, indicated by the first occasion of puffing on a cigarette.
RESULTS: Among white adolescents, high relative exposure to R-rated movies predicted a significantly greater likelihood of smoking initiation at follow-up, and private access to television during early adolescence, indicated by having a bedroom television, was also a significant independent predictor of smoking initiation at follow-up. No significant associations were observed between any movie-exposure or television-use variables and likelihood of smoking among black adolescents.
CONCLUSIONS: Indicators of risky media use were associated with a significantly greater likelihood of smoking for white but not for black adolescents. These results diverge strongly from past results, which have indicated that all adolescents, regardless of race or place of residence, have a higher risk of smoking initiation as their exposure to movie smoking increases. Research is needed to identify the antecedents of risky media use and to understand how audience attributes, including race and other factors, moderate the effects of risky media use on health-related behaviors.
Substance abuse and the uninsured worker in the United States
Miller, T. R.; Waehrer, G. M.; Spicer, R. S.; and Galvin, D. M.
Journal of Public Health Policy, vol. 28, pgs. 102-17 (2007)
Although millions of US workers lack health insurance, the relationship of insurance coverage with substance abuse and access to workplace treatment services remains unexplored. Our analysis shows uninsured workers have higher rates of heavy drinking and illicit drug use than insured workers. Young and part-time workers are, moreover, less likely to have insurance coverage than workers with lower substance abuse risks. Compared to the insured, uninsured workers have less access to employee assistance programs (EAPs) and less drug and alcohol testing by employers. The effectiveness of workplace substance abuse programs and policies designed for insured populations is untested among uninsured workers. Issues include EAP effectiveness with referrals to public treatment and the return on investment for adding coverage of substance abuse treatment. Workers in countries with universal health insurance but inadequate treatment capacity may face similar problems to uninsured workers in the US.
Temporal changes in the spatial pattern of disease rates incorporating known risk factors
Banerjee, A.
Social Science & Medicine, vol. 65, pgs. 7-19 (2007)
Examining the geographical pattern of temporal changes in infant mortality rates illustrates the methodological problems of documenting and understanding temporal changes in any spatial pattern of disease. Early research on geographical differences in infant mortality rates showed strong ecological correlations with socio-economic factors such as poverty rates. More recent research established relationships between individual-level socio-economic values and probabilities of death. With geographic information available at the level of individuals, it is possible to estimate the probabilities of death on a person-by-person basis from knowledge of the relationships between individual factors and socio-economic measures. These estimated probabilities provide an expected geographic pattern of deaths. The difference between the observed spatial pattern and the expected pattern is the remaining spatial variation adjusted for this knowledge. For the study area, individual factors and some socio-economic measures were available for each year of the study period. Using data from the Iowa Birth Defects Registry and the Iowa Department of Public Health (USA), I tested the stability and continuity of these cross-sectional relationships and investigated whether any temporal lags in these variables relate to the unexplained spatial variations in infant mortality rates that remain. I accounted for the 'Change of Support Problem' [Gotway C. A. & Young L. J. (2002). Combining incompatible spatial data. Journal of the American Statistical Association, 97458, 632-648] inherent in frame-based geographical analysis. The analysis involved a generalized linear model (GLM) to estimate individual risks and a Monte Carlo simulation model to generate the non-linear probability density functions for disease rates whose densities are theoretically intractable. Results show the temporal changes in the observed spatial pattern and the expected spatial pattern differ by geographic location. In conclusion such differences are the result of a combination of unexplained place-based risk and unmeasured individual risks.
The role of public policies in reducing smoking prevalence in California: Results from the California Tobacco Policy Simulation Model
Hyland, A.; Compton, C.; Remer, L.; Levy, D. T.; and Higbee, C.
Health Policy, vol. 82, pgs. 167-85 (2007)
Tobacco control policies are examined utilizing a simulation model for California, the state with the longest running comprehensive program. We assess the impact of the California Tobacco Control Program (CTCP) and surrounding price changes on smoking prevalence and smoking-attributable deaths. Modeling begins in 1988 and progresses chronologically to 2004, and considers four types of policies (taxes, mass media, clean air laws, and youth access policies) independently and as a package. The model is validated against existing smoking prevalence estimates. The difference in trends between predicted smoking rates from the model and other commonly used estimates of smoking prevalence for the overall period were generally small. The model also predicted some important changes in trend, which occurred with changes in policy. The California SimSmoke model estimates that tobacco control policies reduced smoking rates in California by an additional 25% relative to the level that they would have been if policies were kept at their 1988 level. By 2004, the model attributes 59% of the reduction to price increases, 28% of the overall effect to media policies, 11% to clean air laws, and only a small percent to youth access policies. The model estimates that over 5000 lives will be saved in the year 2010 alone as a result of the CTCP and industry-initiated price increases, and that over 50,000 lives were saved over the period 1988-2010. Tobacco control policies implemented as comprehensive tobacco control strategies have significantly impacted smoking rates. Further tax increases should lead to additional lives saved, and additional policies may result in further impacts on smoking rates, and consequently on smoking-attributable health outcomes in the population.
The spatial ecology of alcohol problems: niche theory and assortative drinking
Gruenewald, P. J.
Addiction, vol. 102, pgs. 870-8 (2007)
AiMS: This paper summarizes several theoretical perspectives that serve to explain observed associations between concentrations of alcohol outlets and alcohol-related problems. A critique of each perspective discusses how each addresses the social etiology of these problems; that is, how, where and why these problems arise in association with alcohol outlets?
METHODS: This theoretical work is based upon mathematical and computational models of the ecology of alcohol-related problems developed in the 'Ecosystems Modeling Project', an advanced research project of the National Institute on Alcohol Abuse and Alcoholism, United States.
RESULTS: Associations between outlets and problems are thought to arise from the concentration of individuals in drinking places ('flow models'), the attraction of some places for people at risk for problems ('gravity models'), or because outlets are located in high-risk neighborhoods and have negative social normative effects ('social contextual models'). None of these approaches explain how some outlets come to have more problems than others (e.g. violent outlets). An alternative social ecological model is introduced which asserts that the complementary processes of niche marketing and assortative drinking form the social dynamic that explains these relationships. Alcohol sellers 'niche market' to select social strata, drinkers return to establishments at which they find people like themselves, and consequent social stratification of the market-place increases the levels of related problems in some outlets.
CONCLUSIONS: The proposed mechanism is very general, and suggests that over-concentrations of outlets will lead to stratification of drinking groups and intensification of problems related to those outlets.
Timevarying predictors of smoking cessation among individuals in treatment for alcohol abuse and dependence: Findings from project match
Pagano, M. E.; and Friend, K. B.
Alcohol and Alcoholism, vol. 42, pgs. 234-40 (2007)
AIMS: Individuals in treatment for alcohol use disorders are more likely to die from cigarette use than from alcohol consumption. Advanced statistical methodologies that increase study power and clinical relevance have been advocated to examine the timevarying nature of substance use relapse and abstinence, including drinking and smoking. The purpose of this investigation was to examine timevarying factors that are associated with smoking cessation among smokers in the general population, including alcohol use, self-efficacy, and depression, to determine if they were also related to smoking cessation during and after treatment for alcohol use disorders.
METHODS: Data were garnered from Project MATCH, a longitudinal prospective study of the efficacy of three behavioural treatments for alcohol use disorders. Timevarying covariate analyses were conducted to examine future smoking cessation.
RESULTS: Results showed that greater self-efficacy regarding resisting temptations to drink and lower levels of depression were independently associated with increased likelihood of stopping smoking. In contrast, drinks per drinking day and confidence regarding not drinking did not demonstrate such associations.
CONCLUSIONS: Clinical implications of these findings suggest that interventions to help alcoholics in recovery avoid temptations to drink, as well as decrease depression, may be warranted. By using advanced statistical techniques, these results can help clinicians and organizations working with smokers in treatment for alcohol use disorders to make informed decision regarding how best to use limited resources.
Understanding the geospatial relationship of neighborhood characteristics and rates of maltreatment for black, hispanic, and white children
Freisthler, B.; Needell, B.; and Bruce, E.
Social Work, vol. 52, pgs. 7-16 (2007)
The disproportionate number of racial and ethnic minority children in the child welfare system concerns many child welfare professionals. Few studies have investigated how neighborhood processes may contribute to this disparity. This study examined how neighborhood characteristics are associated with rates of child maltreatment for black, Hispanic, and white children. Spatial regression procedures were used to analyze data from 940 census tracts in California. For black children, higher rates of poverty and higher densities of off-premise alcohol outlets were positively associated with maltreatment rates, but increases in population since 1990, a higher percentage of residents who had moved, and a higher percentage of black residents were associated with lower rates. Percentage of female-headed families, poverty, and unemployment were positively related to maltreatment rates among Hispanic children. For white children, the percentage of elderly people, percentage of poverty, ratio of children to adults, and percentage of Hispanic residents were positively associated with neighborhood rates. Reducing neighborhood poverty may reduce rates of child maltreatment for all children, but additional efforts to prevent maltreatment at the neighborhood level may need to be tailored to the specific demographic characteristics to be most effective.
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