Using correlational analyses to improve prevention strategies based on survey data from youth

Clinically differentiating life-course-persistent and adolescence-limited conduct problems: Is age-of-onset really enough?

One important subtyping of behavior problems is Moffitt's (1993) "life-course-persistent" (LCP) and "adolescent limited" (AL) categories of antisocial behavior, which she differentiated in terms of high impulsivity, poor academic performance, and aggression. These problems may be exacerbated by the cumulative effects of chronic stress. Copious evidence has documented validity and developmental differences between these subtypes, whereas far fewer data exist regarding their clinical utility, in spite of the Diagnostic and Statistical Manual's nomenclature including corresponding subtypes based on age-of-onset of behavioral symptoms. The present study evaluated how well age-of-onset based subtyping identifies distinct developmental patterns of antisocial behavior corresponding to Moffitt's subtypes in terms of risk factors and gender between LCP and AL in a prospective sample of chronically stressed youth. A computerized assessment tool (ALEXSA©) was used to obtain data from 1,147 youth aged 8-16. Implications for clinical assessment and intervention strategy, particularly with stressed youth, are discussed.

Detecting initiation or risk for initiation of substance use before high school during pediatric well-child check-ups

BACKGROUND

Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index(©) (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups.

DESIGN

A high-risk longitudinal design with two cross-sectional replication samples, ages 9-13 was used. Analyses included receiver operating characteristics and regression analyses.

PARTICIPANTS

A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool.

RESULTS

YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratios=7.44, CI=4.3-13.0) and conduct problems (odds ratios=7.33, CI=3.9-13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service.

CONCLUSIONS

Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI's association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders.

High and low neurobehavior disinhibition clusters within locales: implications for community efforts to prevent substance use disorder

BACKGROUND

Knowledge of where substance use and other such behavioral problems frequently occur has aided policing, public health, and urban planning strategies to reduce such behaviors. Identifying locales characterized by high childhood neurobehavioral disinhibition (ND), a strong predictor of substance use and consequent disorder (SUD), may likewise improve prevention efforts.

OBJECTIVES

The distribution of ND in 10-12-year olds was mapped to metropolitan Pittsburgh, PA, and tested for clustering within locales.

METHODS

The 738 participating families represented the population in terms of economic status, race, and population distribution. ND was measured using indicators of executive cognitive function, emotion regulation, and behavior control. Innovative geospatial analyzes statistically tested clustering of ND within locales while accounting for geographic barriers (large rivers, major highways), parental SUD severity, and neighborhood quality.

RESULTS

Clustering of youth with high and low ND occurred in specific locales. Accounting for geographic barriers better delineated where high ND is concentrated, areas which also tended to be characterized by greater parental SUD severity and poorer neighborhood quality.

CONCLUSIONS AND SIGNIFICANCE

Offering programs that have been demonstrated to improve inhibitory control in locales where youth have high ND on average may reduce youth risk for SUD and other problem behaviors. As demonstrated by the present results, geospatial analysis of youth risk factors, frequently used in community coalition strategies, may be improved with greater statistical and measurement rigor.

The community epidemiology of underage drinking: variation across communities in relations of risk to alcohol use

To test the assumption embedded in state-of-the-art, community assessment and decision-making regarding prevention of underage drinking: that there is minimal variation in the way that risk and protective factors (RPF) are associated with underage drinking across communities. Three large datasets provided the same measures of adolescent alcohol use and RPFs. Multilevel ordered-logistic regression models were carried out separately for each dataset and separately for males and females in 8th and 10th grades, testing random slopes for each RPF index. Predicted school-level coefficients were derived from these models, representing the association between RPFs and alcohol use. The variation in associations between RPFs and alcohol use across schools was greatest for antisocial peer risk and community protection; the lowest variation across schools was found for family cohesion and individual antisocial behavior. Ranges in predicted coefficients indicate large differences across schools for many RPFs. Bivariate correlations indicated that school-level associations vary across RPFs in expected directions. Policy makers should recognize that the magnitude of associations between RPFs and adolescent alcohol use vary considerably across communities, and that such variability is greater for certain RPFs than others. These findings have implications for policies regarding how prevention resources are targeted within and across communities.

Developmental momentum toward substance dependence: natural histories and pliability of risk factors in youth experiencing chronic stress

BACKGROUND

Mitigation of substance use (SU) disorder (SUD) risk factors is a common goal of prevention. Research has clarified much about risk factors including their prediction of SU/SUD, associations with other etiological variables and mediation of SU outcomes. Greater understanding of the emergence of risk factors themselves may improve prevention. For example, in lieu of experimental data, the level of resistance to change of a risk factor (its pliability) could inform "dosage" of intervention needed to reduce the risk.

METHODS

Two attributes of 22 previously-documented predictors of SU/SUD were quantified: natural history (average age-related trend) and pliability (quantified using correlations between intercepts and growth parameters of hierarchical linear modeling trajectories). The longitudinal sample of 1147 8- through 16-year-olds were recruited from a northeastern summer camp for youth experiencing chronic stress due to one or more stressors (X¯=2.2stressors, SD=1.41) which typically last at least one year. Half were male, 69.3% were European-American, 8.5% were African-American, and the remaining were small proportions each of other or mixed races/ethnicities.

RESULTS

Average trajectories of 21 predictors correspond to increasing SUD risk with age. Predictor pliability varied greatly, ranging from extremely high for School Commitment to extremely low for Peer Pressure Susceptibility.

CONCLUSIONS

Results suggest different intervention strategies may be needed to manage risk factors over the long-term. To illustrate, maintaining a high school commitment appears to require boosters whereas reducing peer pressure susceptibility appears to require high initial "dosage" with less need for boosters.

Community epidemiology of risk and adolescent substance use: practical questions for enhancing prevention

To promote an effective approach to prevention, the community diagnosis model helps communities systematically assess and prioritize risk factors to guide the selection of preventive interventions. This increasingly widely used model relies primarily on individual-level research that links risk and protective factors to substance use outcomes. I discuss common assumptions in the translation of such research concerning the definition of risk factor elevation; the equivalence, independence, and stability of relations between risk factors and problem behaviors; and community differences in risk factors and risk factor-problem behavior relations. Exploring these assumptions could improve understanding of the relations of risk factors and substance use within and across communities and enhance the efficacy of the community diagnosis model. This approach can also be applied to other areas of public health where individual and community levels of risk and outcomes intersect.

Directionality Between Tolerance of Deviance and Deviant Behavior is Age-Moderated in Chronically Stressed Youth

Problem behavior theory posits that tolerance of deviance is an antecedent to antisocial behavior and substance use. In contrast, cognitive dissonance theory implies that acceptability of a behavior may increase after experiencing the behavior. Using structural equation modeling, this investigation tested whether changes in tolerance of deviance precede changes in conduct disorder criteria or substance use or vice versa, or if they change concomitantly. Two-year longitudinal data from 246 8- to 16-year-olds suggested that tolerance of deviance increases after conduct disorder criteria or substance use in 8-to-10- and 11-to-12-year-olds. These results were consistent with cognitive dissonance theory. In 13-to-16- year-olds, no directionality was suggested, consistent with neither theory. These results were replicated in boys and girls and for different types of conduct disorder criteria aggression (covert behavior), deceitfulness and vandalism (overt behavior), and serious rule-breaking (authority conflict). The age-specific directionality between tolerance of deviance and conduct disorder criteria or substance use is consistent with unique etiologies between early onset versus adolescent-onset subtypes of behavior problems.

Psychometrics and Cross-Cultural Comparisons of the Illustration-Based Assessment of Liability and Exposure to Substance Use and Antisocial Behavior© for Children

Elementary school-age child report instruments that do not require reading or interviews are lacking. In four samples, psychometric estimates for 5- to 9-year-olds were obtained for the Assessment of Liability and Exposure to Substance use and Antisocial behavior© (ALEXSA©), a child-report instrument that can be completed even by illiterate children. Invariance between minority groups vs Caucasians also was tested. Samples were: high-risk, low SES African-Americans (n=337), youth of varied ethnicities experiencing chronic stress (n=209), Mexican migrants in a reading remediation program (n=45), and U.S. twins (42 pairs) who were nearly all Caucasian. Validity criteria consisted of child-, parent-, teacher- and research evaluator-ratings on previously developed research and clinical instruments. Replicating results with older samples, ALEXSA factors had adequate or better reliabilities and demonstrated validity in all four studies. Ethnic invariance was found except for differences that were expected due to migrant's after-school program. In sum, psychometrics of the ALEXSA were supported for 5- to 9-year-olds of varied races/ethnicities, risk levels and academic skills.

The illustration-based Assessment of Liability and EXposure to Substance use and Antisocial behavior for children

BACKGROUND/OBJECTIVES

Ontogenetic prevention of substance abuse requires that an individual's "profile" of substance abuse predictors is assessed to guide intervention decision-making ( [1] ). For child intervention, self-report data provide information that cannot be obtained from other sources such as parents or teachers. However, efficient child report instruments of substance abuse risk factors are lacking. The Assessment of Liability and EXposure to Substance use and Antisocial behavior((c)) (ALEXSA((c))) is an illustration-based, computerized child report assessment for early manifestations and predictors of substance abuse and antisocial behavior.

METHODS

Construct validity and test-retest reliabilities of ALEXSA subscales were estimated in 272 nine to twelve-year old students from regular and remedial education classrooms.

RESULTS

Anecdotal and quantitative data demonstrated that children enjoy the ALEXSA format. All factors and 34 of 39 subscales had good or better reliabilities. Nine factors were extracted: Disinhibition (example subscales are Irritability, Impulsivity), Sensation Seeking (e.g., Gambling, Social Disinhibition), Self Management (e.g., Planning and Concentration, Problem Solving), Family Discord (e.g., Family Behavior Problems, Family Conflict), Parent Fortification (e.g., Parental Monitoring, Parent Attachment), Social Contagion (e.g., Friends' Conduct Disorder Criteria, Peer Pressure Susceptibility), Social Support (e.g., Social Support: Adults, Number of Friends), Neighborhood Risks (e.g., Gang Exposure, Neighborhood Atmosphere), and School Protection (e.g., Academic Competency, School Commitment).

SCIENTIFIC SIGNIFICANCE

The ALEXSA could provide efficient child reports for research, needs assessment, and outcomes to support etiology and prevention of substance abuse and antisocial behavior.