Self-report stability of adolescent substance use: are there differences for gender, ethnicity and age?

Effects of health-promoting school strategy on dental plaque control and preventive behaviors in schoolchildren in high-caries, rural areas of Taiwan: a quasi-experimental design

Background

We evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan.

Methods

A quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data.

Results

Compared with the CG, the IG had a greater reduction in plaque index among second graders (β =  − 0.36) and plaque control record scores among second, fourth, and sixth graders (β =  − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG.

Conclusions

The HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01927-z.

Substance Use Outcomes from Two Formats of a Cognitive-Behavioral Intervention for Aggressive Children: Moderating Roles of Inhibitory Control and Intervention Engagement

Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents’ inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children’s self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children’s level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children’s positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.

Comprehensive Assessment of Alcohol Consumption in People Living with HIV (PLWH): The New Orleans Alcohol Use in HIV Study

BACKGROUND

High frequency of alcohol use among people living with HIV (PLWH) warrants careful assessment and screening to better understand its impact on HIV disease progression and development of comorbidities. Due to the limitations of the tools used to measure alcohol use, the links to health consequences are not fully understood.

METHODS

We completed a cross-sectional analysis to examine the prevalence of alcohol consumption using multiple alcohol assessment tools and their correlation and consistency in a cohort of PLWH (N = 365) enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), timeline followback (TLFB) Calendar, lifetime drinking history, Alcohol and Drug Addiction Severity Index, and blood levels of phosphatidylethanol (PEth). Spearman's correlations were estimated for continuous measures of alcohol consumption; Wilcoxon rank-sum tests were used to compare means; and logistic regression was used to estimate odds of alcohol use by demographic characteristics.

RESULTS

Self-report of current alcohol use varied from 58.9 to 73.7% depending on the assessment. All the self-reported alcohol measures showed statistically significant correlations with the biological marker PEth. The highest correlation was with TLFB grams (r = 0.67, p < 0.001). Using TLFB, 73.7% of the cohort reported using alcohol in the last 30 days, and 61.6% had a positive PEth value. The prevalence of risky drinkers, meeting the TLFB > 3 (women) or >4 (men) drinks/day or>7 (women) or>14 (men) drinks/week, was 49.0%. Medium-risk drinking defined as an AUDIT score ≥ 8 was reported in 40.3%, and high-risk drinkers/probable AUD (AUDIT score ≥ 16) was met by 17.0% of the cohort.

CONCLUSIONS

Our results demonstrate the importance of comprehensive assessments for alcohol use, including self-report via multiple assessment tools administered by trained staff, as well as the addition of biomarkers for improved classification of subjects into different drinking categories.

Consistency of Adolescents' Self-Report of Gambling Age of Onset: A Longitudinal Study

Studies suggest that youth who are exposed to their first gambling experience at an earlier age are at increased risk of developing problems. However, studies reporting age of onset of gambling exposure as a risk factor for gambling problems are cross-sectional by design and the relationship between both variables are sometimes inferred over extending periods of time. Methodologically speaking, it could induce a recall bias, a fact already documented in numerous areas of research related to high-risk conducts in adolescence. Thus, the goal of this study was twofold: to longitudinally describe, among adolescents, the level of discrepancy between reports of age of initiation to gambling activities, and to assess if the discrepancies could be associated with a certain number of known predictors of gambling participation. Additionally, recall period effect (e.g. time passed between answering the same question) was also assessed. Data were collected from a large longitudinal study on gambling among youth and four measurement times at 1-year interval were used, with only young people who have been introduced to gambling retained in the analyses (n =297; 63.3% boys; mean age = 15.25 years). Results revealed significant inconsistencies about age of initiation to gambling activity between measurement times. Moreover, results also revealed that age (e.g. being older) and time passed are significantly associated to the level of inconsistencies of self-reported age of initiation of gambling activity. Theoretical and practical implications of these findings are discussed.

Recanting of Previous Reports of Alcohol Consumption within a Large-Scale Clustered Randomised Control Trial

The aim of this study was to examine the extent of recanting (inconsistencies in reporting of lifetime alcohol use) and its impact on the assessment of primary outcomes within a large-scale alcohol prevention trial. One hundred and five post-primary schools in were randomised to receive either the intervention or education as normal. Participants (N = 12,738) were secondary school students in year 8/S1 (mean age 12.5) at baseline. Self-report questionnaires were administered at baseline (T0) and at T1 (+ 12 months post-baseline), T2 (+ 24 months) and T3 (+ 33 months). The primary outcomes were (i) heavy episodic drinking (consumption of ≥ 6 units in a single episode in the previous 30 days for males and ≥ 4.5 units for females) assessed at T3 and (ii) the number of alcohol-related harms experienced in the last 6 months assessed at T3. Recanting was defined as a negative report of lifetime alcohol consumption that contradicted a prior positive report. Between T1 and T3, 9.9% of students recanted earlier alcohol consumption. Recanting ranged from 4.5 to 5.3% across individual data sweeps. While recanting was significantly associated (negatively) with both primary outcomes, the difference in the rate of recanting across trial arms was small, and adjusting for recanting within the primary outcome models did not impact on the primary outcome effects. Males were observed to recant at a greater rate than females, with a borderline small-sized effect (V = .09). While differential rates of recanting have the potential to undermine the analysis of prevention trial outcomes, recanting is easy to identify and control for within trial primary outcome analyses. Adjusting for recanting should be considered as an additional sensitivity test within prevention trials.

Trial Registration: ISRCTN47028486 (http://www.isrctn.com/ISRCTN47028486). The date of trial registration was 23/09/2011, and school recruitment began 01/11/2011.

Male-female differences in the onset of heavy drinking episode soon after first full drink in contemporary United States: From early adolescence to young adulthood

BACKGROUND

Globally, there is a male excess in the occurrence of heavy drinking once alcoholic beverages are consumed and some new evidence that this 'gender gap' might be null among underage drinkers. Here, we estimate age-specific male-female differences in heavy drinking episode (HDE) incidence across the first eight calendar-quarters after first full drink.

METHODS

Study population is non-institutionalized civilians in the United States (2006-2014). Standardized audio computer-assisted self-interviews were used to assess the date of first full drink and the date of first HDE (i.e., 5+ drinks on one occasion) among ∼33,000 12-to-21-year-old newly incident drinkers (all with 1st full drink and HDE evaluated within 24 months of drinking onset). Time-to-HDE survival analyses are used to estimate age-specific male-female ratios in the hazard of HDE onset.

RESULTS

We found that among early adolescent new drinkers (drinking onset at age 11-14), the newly incident drinking females progress to HDE more quickly than males (HR = 1.3, 95% CI = 1.1, 1.6). In contrast, male excess risk is observed when drinking starts at or after age 15 years. For underage drinkers, age-specific hazard ratios (HR) depend upon age at first full drink.

CONCLUSIONS

Based on recent survey data from the US, this study's survival analyses support early adolescent female excess in the onset of HDE. When drinking starts at or after age 15 years, a male excess becomes apparent within two years since first full drink. Future studies may probe any sex-specific mechanisms toward the rapid onset of HDE at different age groups.

Comparing methods of misclassification correction for studies of adolescent alcohol use

BACKGROUND

Despite concerns over measurement error, self-report continues to be the most common measure of adolescent alcohol use used by researchers. Objective measures of adolescent alcohol use continue to advance; however, they tend to be cost prohibitive for larger studies. By combining appropriate statistical techniques and validation subsamples, the benefits of objective alcohol measures can be made more accessible to a greater number of researchers.

OBJECTIVES

To compare three easily implemented methods to correct for measurement error when objective measures of alcohol use are available for a subsample of participants, regression calibration, multiple imputation for measurement error (MIME), and probabilistic sensitivity analysis (PSA), and provide guidance regarding the use of each method in scenarios likely to occur in practice.

METHODS

This simulation experiment compared the performance of each method across different sample sizes, both differential and non-differential error, and differing levels of sensitivity and specificity of the exposure measure.

RESULTS

Failure to adjust for measurement error led to substantial bias across all simulated scenarios ranging from a 35% to 208% change in the log-odds. For non-differential misclassification, regression calibration reduced this bias to between a 1% and 23% change in the log-odds regardless of sample size. At higher sample sizes, MIME produced approximately unbiased (between a 0% and 9% change in the log-odds) and relatively efficient corrections for both non-differential and differential misclassification. PSA provided little utility for correcting misclassification due to the inefficiency of its estimates.

CONCLUSION

Concern over measurement error resulting from self-reported adolescent alcohol use persists in research. Where appropriate, methods involving validity subsamples provide an efficient avenue for addressing these concerns.

High-resolution Temporal Representations of Alcohol and Tobacco Behaviors from Social Media Data

Understanding tobacco- and alcohol-related behavioral patterns is critical for uncovering risk factors and potentially designing targeted social computing intervention systems. Given that we make choices multiple times per day, hourly and daily patterns are critical for better understanding behaviors. Here, we combine natural language processing, machine learning and time series analyses to assess Twitter activity specifically related to alcohol and tobacco consumption and their sub-daily, daily and weekly cycles. Twitter self-reports of alcohol and tobacco use are compared to other data streams available at similar temporal resolution. We assess if discussion of drinking by inferred underage versus legal age people or discussion of use of different types of tobacco products can be differentiated using these temporal patterns. We find that time and frequency domain representations of behaviors on social media can provide meaningful and unique insights, and we discuss the types of behaviors for which the approach may be most useful.

Predictors of Recall Error in Self-Report of Age at Alcohol Use Onset

OBJECTIVE

The present study examined factors associated with recall error in the measurement of alcohol use onset and whether there was a tendency toward earlier or later self-reported age at alcohol use onset.

METHOD

This study estimated the effect of predictors on the presence and direction of recall error for age at alcohol use onset. The sample (n = 1,044) was from an existing longitudinal alcohol prevention trial in urban Chicago. Estimates were derived from a series of logistic regression models comparing agreement between a retrospective and a prospective measure of age at alcohol use onset.

RESULTS

Eligibility for free or reduced-price lunch in 6th grade, alcohol use in 6th grade, cigarette use in 12th grade, and alcohol use in 12th grade were significantly associated with recall error of age at alcohol use onset. Self-reported substance use (alcohol and tobacco) in 12th grade was also found to predict a later self-reported age at alcohol use onset when recalled.

CONCLUSIONS

Those most at risk for the negative outcomes associated with early alcohol initiation are also those most likely to misreport their age at alcohol use onset.

Stability and change in reported age of onset of depression, back pain, and smoking over 29 years in a prospective cohort study

Accurate age of onset (AOO) measurement is vital to etiologic and preventive research. While AOO reports are known to be subject to recall error, few population-based studies have been used to investigate agreement in AOO reports over more than a decade. We examined AOO reports for depression, back/neck pain, and daily smoking, in a population-based cohort spanning 29 years. A stratified sample of participants from Zurich, Switzerland (n = 591) completed a psychiatric and physical health interview 7 times between 1979, at ages 20 (males) and 21 (females), and 2008. We used one-way ANOVA to estimate intraclass correlations (ICCs) and weighted mixed models to estimate mean change over time and test for interactions with sex and clinical characteristics. Stratum-specific ICCs among those with 2 + reports were 0.19 and 0.29 for depression, 0.46 and 0.35 for back pain, and 0.66 and 0.75 for smoking. The average yearly increases in AOO report from the wave of first 12-month diagnosis or reported smoking, estimated in mixed models, were 0.57 years (95% confidence interval: 0.35, 0.79) for depression, 0.44 (95%CI: 0.28, 0.59) years for back pain, and 0.08 (95%CI: 0.03, 0.14) years for smoking. Initial impairment and frequency of treatment were associated with differences in average yearly change for depression. There is substantial variability in AOO reports over time and systematic increase with age. The degree of increase may differ by outcome, and for some outcomes, by participant clinical characteristics. Future studies should identify predictors of AOO report stability to ultimately benefit etiologic and preventive research.

Relationship Between Current Substance Use and Unhealthy Weight Loss Practices Among Adolescents

OBJECTIVES

To determine the relationship between current substance use and unhealthy weight loss practices (UWLP) among 12-to-18 year olds.

METHODS

Participants were 12-to-18 year olds who completed the 2013 Youth Risk Behavior Survey in Florida (N = 5620). Current alcohol, tobacco, and marijuana use was self-reported based on last 30-day use. UWLP was defined based on self-report of at least one of three methods to lose weight in last 30-days: (1) ≥24 h of fasting, (2) diet pill use, and (3) laxative use/purging. The reference group included those with no reported UWLP. Logistic regression models adjusted for age, gender, race/ethnicity, academic performance, age-sex-specific body mass index percentiles, and perceived weight status were fitted to assess relationships between UWLP and current substance use.

RESULTS

About 15 and 41 % of adolescents reported ≥1 UWLP and use of ≥1 substance in the last 30-days, respectively. Over half (60.1 %) of adolescents who reported substance use engaged in UWLP (p < 0.0001). The prevalence of current alcohol use (50.6 %) was the highest among those who reported UWLP, followed by marijuana (31.9 %), tobacco (19.7 %), and cocaine (10.5 %) use. Adolescents who reported current tobacco [adjusted odds ratio (AOR) 2.7, 95 % confidence interval (CI) 2.1-3.6], alcohol (AOR 2.2, 95 % CI 1.9-2.6), or marijuana (AOR 2.1, 95 % CI 1.7-2.5) use had significantly higher odds of UWLP compared to their non-user counterparts.

CONCLUSIONS

This cross-sectional study shows that substance use and UWLP behaviors are likely to co-exist in adolescents. Further studies are necessary to determine the temporal relationship between substance use and UWLP. It is recommended that intervention programs for youth consider targeting these multiple health risk behaviors.

Alcohol Consumption Milestones: Comparing First- Versus Last-Reported Age of Onset

Multiple assessments of age of onset of alcohol use milestones may produce inconsistent reports, yielding potentially different results, depending on the report utilized. Using data from a prospective study of 1,023 middle-school students, we modeled risk of onset of four drinking milestones as a function of multiple correlates of alcohol use and compared models using first versus last reported age for each milestone. . While forward telescoping was evident, no significant differences were obtained for any models examined. Substantive conclusions about associations of correlates of early drinking are not greatly impacted by misreporting age of first use.

Rapid transition from drinking to alcohol dependence among adolescent and young-adult newly incident drinkers in the United States, 2002-2013

BACKGROUND

To study male-female and age differences in estimates of rapid transition from first full drink to alcohol dependence among youthful newly incident drinkers in the United States (US).

METHOD

The study population included 12-to-25-year-old non-institutionalized US civilian residents, sampled for US National Surveys on Drug Use and Health 2002-2013, with assessments via confidential computer assisted self-interviews. Newly incident drinkers are those who had their first full drink soon before the assessment (n=32,562 12-to-25-year- olds). Alcohol dependence (AD) criteria are from DSM-IV.

RESULTS

For 12-to-25-year-old females, the peak risk for making a rapid transition from first full drink to alcohol dependence is seen during adolescence, followed by declining estimates (meta-analysis summary=3% at 12-17 years of age, 95% CI=2%, 3%). Among males, corresponding estimates fluctuate around 2%, with no appreciable differences across age strata. Among 12-to-17-year-old newly incident drinkers, there is a female excess in the rapid transition to alcohol dependence; a male excess is observed among young adult newly incident drinkers. Evaluated cohort-wise, using an epidemiological mutoscope view, individual cohorts show a congruent pattern, with age at first drink held constant.

CONCLUSIONS

Studying multiple replication samples of young newly incident drinkers, we discovered a clear female excess in the risk of a rapid transition from first full drink to alcohol dependence among adolescents, with age patterns differing across males and females.

Perception of Time Since Smoking Cessation: Time in Memory Can Elapse Faster

Self-reports concerning smoking behaviors are subject to different types of response bias that may severely affect the data quality. This study examined the evidence and extent of backward telescoping bias in reports on time since completely quitting smoking among former smokers. The study goals were to determine whether the extent of bias differs, on average, across subpopulations with diverse sociodemographic characteristics, prior smoking habits and duration of smoking abstinence, and across the survey administration mode (phone, in-person, mixed). The sample included 1,611 subjects who responded to the 2002-2003 Tobacco Use Supplement to the Current Population Survey. Multiple regressions for subjects who quit smoking recently, some time ago, and a long time ago were fitted, where the variance was estimated via the Balanced Repeated Replications approach. The model-based estimates were used to compare the extent of response bias across diverse subpopulations of respondents. Analyses revealed a significantly smaller overall extent of response bias for respondents who were younger (p < 0.01), female (p < 0.01), Non-Hispanic White (p = 0.02), employed (p < 0.01), who were regular (rather than occasional) smokers in the past (p < 0.01), and who quit smoking recently or some time ago as opposed to a long time ago (p < 0.01); a significant overall effect of survey mode was also detected (p < 0.01). Male respondents who smoked occasionally in the past tended to provide the most disagreeing reports. The discrepancy in reports may be due to backward telescoping bias. Studies which use the national survey smoking cessation measures should be aware of not only possible forward telescoping (that has been addressed in the literature) but also backward telescoping. This will help correctly account for possible impaired perception of time elapsed since smoking cessation in former smokers.

Early Substance Use and Subsequent DUI in Adolescents

OBJECTIVE

Little is known about risk factors in early adolescence that lead to driving under the influence (DUI) and riding with a drinking driver (RWDD). In a diverse group of adolescents, we longitudinally explored the influence of alcohol and marijuana (AM) use, AM beliefs, and peer and family factors (including familism) on DUI/RWDD in high school.

METHODS

We conducted 3 surveys 2 years apart of 1189 students recruited from 16 middle schools in Southern California. We used multivariable models to evaluate the effects of AM use, AM beliefs, and peer and family factors at ages 12 and 14 on DUI/RWDD at age 16.

RESULTS

At age 12, adolescents with more positive beliefs about marijuana (odds ratio [OR] = 1.63, 95% confidence interval [CI]: 1.20-2.20) and more ability to resist marijuana offers (OR = 1.89, 95% CI: 1.22-2.92) had significantly higher risk of DUI/RWDD 4 years later. At age 14, youth with more past month alcohol use (OR = 2.10, 95% CI: 1.07-4.11), positive beliefs about marijuana (OR = 1.67, 95% CI: 1.31-2.13), exposure to peer AM use (alcohol: OR = 1.01, 95% CI: 1.00-1.02; marijuana: OR = 2.41, 95% CI: 1.28-4.53), and family marijuana use (OR = 1.54, 95% CI: 1.12-2.11) had higher risk of DUI/RWDD at age 16.

CONCLUSIONS

Findings indicate a need to target adolescents as young as sixth grade at multiple levels to help prevent DUI/RWDD in high school. Given recent changes in legislation in several states, research should begin to focus on the distinction between DUI/RWDD of AM.

Quantifying alcohol consumption: Self-report, transdermal assessment, and prediction of dependence symptoms

Research on alcohol use depends heavily on the validity of self-reported drinking. The present paper presents data from 647 days of self-monitoring with a transdermal alcohol sensor by 60 young adults. We utilized a biochemical measure, transdermal alcohol assessment with the WrisTAS, to examine the convergent validity of three approaches to collecting daily self-report drinking data: experience sampling, daily morning reports of the previous night, and 1-week timeline follow-back (TLFB) assessments. We tested associations between three pharmacokinetic indices (peak concentration, area under the curve (AUC), and time to reach peak concentration) derived from the transdermal alcohol signal and within- and between- person variation in alcohol dependence symptoms. The WrisTAS data corroborated 85.74% of self-reported drinking days based on the experience sampling data. The TLFB assessment and combined experience sampling and morning reports agreed on 87.27% of drinking days. Drinks per drinking day did not vary as a function of wearing or not wearing the sensor; this indicates that participants provided consistent reports of their drinking regardless of biochemical verification. In respect to self-reported alcohol dependence symptoms, the AUC of the WrisTAS alcohol signal was associated with dependence symptoms at both the within- and between- person level. Furthermore, alcohol dependence symptoms at baseline predicted drinking episodes characterized in biochemical data by both higher peak alcohol concentration and faster time to reach peak concentration. The results support the validity of self-report alcohol data, provide empirical data useful for optimal design of daily process sampling, and provide an initial demonstration of the use of transdermal alcohol assessment to characterize drinking dynamics associated with risk for alcohol dependence.

Self-reported Barriers to Treatment Engagement: Adolescent Perspectives from the National Comorbidity Survey-Adolescent Supplement (NCS-A)

The objective of this study was to assess youth self-reported treatment barriers in the past 12 months to obtain youth's perspective on reasons they seek treatment, do not engage in treatment, or terminate treatment. The present study uses data from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey administered to youth ages 13-18 that was conducted between February 1, 2001 and January 30, 2004. A total of 10,123 youth participated in the NCS-A study and provided the information on which the current paper draws its data. Within the past 12 months over 63% of youth reported seeking treatment to manage and cope with emotions. The greatest percentage of youth reported that they did not seek treatment because they wanted to handle the problem on their own (59.3%). The greatest percentage of youth reported that treatment was terminated because they wanted to handle the problem on their own (57.5%). Findings suggest professionals need to educate youth about the importance of professional treatment to increase engagement. If providers can motivate youth to see the value of treatment and help them understand that there can be positive outcomes, they may be less likely to terminate prematurely.

Age of smoking milestones: longitudinal inconsistencies and recanting

PURPOSE

To determine (1) how reports of the ages of first cigarette smoked and daily smoking onset change from adolescence through emerging adulthood and into young adulthood and (2) what predicts reporting inconsistencies and recanting for both smoking milestones.

METHODS

Multinomial logistic regression models compared relative risks of the following: (1) consistent reporting of milestone age (reference group); (2) recanting at either subsequent wave; or (3) inconsistent reporting of age in at least one subsequent wave, using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health.

RESULTS

Instability and forward telescoping between adolescence and emerging adulthood leveled off by young adulthood. For smoking first cigarette, those who started younger had more inconsistencies and recanting than those who started later, as did African-American, Latino, and Asian respondents compared with non-Latino white respondents. Native American respondents also had higher relative risks of recanting, as did those with low parental education. Males were more inconsistent than females. Depression, same-sex attractions or relationships, and family structure were not associated with reporting stability. Binge drinking, marijuana, and other illegal drugs were associated with lower levels of recanting. For age of daily smoking, starting older versus younger, sex, race, ethnicity, and use of marijuana were significant predictors of report stability.

CONCLUSIONS

Stage of life may influence forward telescoping in smoking self-reports. Stability of reports of adolescent smoking by emerging and young adults in the United States appears biased by age of onset, sex, race, and other substance use.

Sources of Error in Substance Use Prevalence Surveys

Population-based estimates of substance use patterns have been regularly reported now for several decades. Concerns with the quality of the survey methodologies employed to produce those estimates date back almost as far. Those concerns have led to a considerable body of research specifically focused on understanding the nature and consequences of survey-based errors in substance use epidemiology. This paper reviews and summarizes that empirical research by organizing it within a total survey error model framework that considers multiple types of representation and measurement errors. Gaps in our knowledge of error sources in substance use surveys and areas needing future research are also identified.

Preliminary findings on the association between clients' perceived helpfulness of substance abuse treatment and outcomes: does race matter?

BACKGROUND

Few studies examine the helpfulness and effectiveness of substance abuse treatment from the clients' perspective.

METHODS

The current secondary analysis examined the perceived helpfulness of substance abuse treatment components and its relationship to treatment outcomes among 387 Black and White adults participating in a multisite randomized clinical trial (RCT) of Motivational Enhancement Therapy. Throughout the 16-week RCT, participants self-reported substance use. Upon completion of treatment, participants completed a self-report measure assessing the perceived helpfulness of treatment components.

RESULTS

Black participants rated 9 out of 12 treatment components (e.g., "learning skills that will help me cope with my problems") as being more helpful than their White counterparts, even after controlling for age, gender, employment status, primary drug type, and treatment assignment. However, perceived helpfulness ratings were not associated with substance use outcomes among Black or White participants.

CONCLUSIONS

Clients' perceived helpfulness of treatment components is an important factor to consider in improving the delivery of substance abuse treatment, especially for Black adults.

Covariance among multiple health risk behaviors in adolescents

PURPOSE

In a diverse group of early adolescents, this study explores the co-occurrence of a broad range of health risk behaviors: alcohol, cigarette, and marijuana use; physical inactivity; sedentary computing/gaming; and the consumption of low-nutrient energy-dense food. We tested differences in the associations of unhealthy behaviors over time, and by gender, race/ethnicity, and socioeconomic status.

METHODS

Participants were 8360 students from 16 middle schools in California (50% female; 52% Hispanic, 17% Asian, 16% White, and 15% Black/multiethnic/other). Behaviors were measured with surveys in Spring 2010 and Spring 2011. Confirmatory factor analysis was used to assess if an underlying factor accounted for the covariance of multiple behaviors, and composite reliability methods were used to determine the degree to which behaviors were related.

RESULTS

The measured behaviors were explained by two moderately correlated factors: a 'substance use risk factor' and an 'unhealthy eating and sedentary factor'. Physical inactivity did not reflect the latent factors as expected. There were few differences in the associations among these behaviors over time or by demographic characteristics.

CONCLUSIONS

Two distinct, yet related groups of health compromising behaviors were identified that could be jointly targeted in multiple health behavior change interventions among early adolescents of diverse backgrounds.

Telling truth from Ys: an evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy

OBJECTIVES

Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents' reports of condom use and predict subsequent pregnancy.

METHODS

The sample comprised 715 sexually active African-American female adolescents, ages 15-21 years. At baseline, 6 months and 12 months, participants completed a 40-min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted pregnancy from semen exposure under-report using multivariate regression controlling for oral contraception, reported condom use and coital frequency.

RESULTS

At the 3 surveys, 30%, 20% and 15% of adolescents who reported always using condoms tested positive for semen exposure. At 6 month follow-up, 20.4% and 16.2% of the adolescents who under-reported semen exposure reported pregnancy, a higher pregnancy rate than accurate reporters of semen exposure, even accurate reporters who reported never using condoms (14.2% and 11.8%). Under-reporters of semen exposure were 3.23 (95% CI (1.61, 6.45)) times as likely to become pregnant at 6-month follow-up and 2.21 (0.94, 5.20) times as likely to become pregnant at 12-month follow-up as accurate reporters who reported not using contraception, adjusting for self-reported coital frequency.

CONCLUSIONS

Adolescents who under-report semen exposure may be at uniquely high risk for unplanned pregnancy and STIs, and may also under-report coital frequency. Condom efficacy trials that rely on self-report may yield inaccurate results. Adapted to a clinical setting, the Y-chromosome PCR could alert women to incorrect or inconsistent condom use.

Evidence of telescoping in regular smoking onset age

INTRODUCTION

We examined the evidence of telescoping bias in self-reports of regular smoking onset age. Since the exact year of the onset was not available, the discrepancy (termed shift) in self-reports was explored. The study was targeted at establishing the relationships between the prevalence and the magnitude of shifting and respondent and survey characteristics and identifying the key factors contributing to forward and backward shifting.

METHODS

The 2002-2003 Tobacco Use Supplement to the Current Population Survey was administered using phone and in-person interviews to the same respondents in 2002 and 2003. The regular smoking onset age, reported by current and former smokers during both years, was used. All statistical analyses incorporated replicate weights to adjust for the complex survey design.

RESULTS

In our sample, about 31.6% (31.8%) of respondents forwardly (backwardly) shifted the smoking onset age, with the mean magnitude of discrepancy about 2.7 years (both directions). The elapsed time since the onset was shown to be the most important considered predictor of prevalence of shifting. The prevalence of forward (backward) shifting tends to increase (decrease) as elapsed time increases. Furthermore, the discrepancy in forwardly shifted responses tends to increase, on average, with elapsed time.

CONCLUSIONS

The findings indicate that both forward and backward shifting may be prevalent in reports on smoking onset age. The extent of shifting depends on elapsed time since the onset (and therefore, the respondent's age) and other respondent and survey characteristics. The findings are consistent with presence of both forward and backward telescoping biases.

Smoking and psychopathology increasingly associated in recent birth cohorts

BACKGROUND

In recent decades, smoking has become an increasingly non-normative behavior. Because deviant behaviors are associated with greater clinical and genetic risks, current-generation smokers may have greater concentrations of psychiatric comorbidity than previous generations. We examined this question empirically by testing whether associations between measures of smoking, psychiatric diagnoses, and risk-associated personality traits, increased across seven birth-cohorts of the 20th century.

METHOD

4326 subjects from a cross-sectional NIMH control sample were categorized into one of seven groups based on birth (born before 1930, and 1930s-80s) and one of three smoking levels (lifetime dependent smoker, never dependent smoker, never smoker). Smoking and ND were assessed using the Fagerstrom Test for Nicotine Dependence; psychiatric diagnoses (drug and alcohol dependence, major depression, and generalized anxiety disorder) using the Composite International Diagnostic Interview-Short Form, and personality traits (neuroticism and extraversion) with the Eysenck Personality Questionnaire.

RESULT

Lifetime prevalence of smoking decreased across the seven cohorts. Associations between smoking and drug dependence, generalized anxiety, and neuroticism, as well as total psychiatric comorbidity, were greater in more recent cohorts [smoking-by-cohort interaction: p<0.01], with greatest increases contributed by nicotine-dependent smokers. Smoking was also independently associated with alcohol dependence and depression, but these associations did not significantly vary across cohorts.

CONCLUSIONS

More recent generations included fewer persons who smoked, but their smoking was associated with greater psychiatric morbidity. Failure to account for systematic variation in comorbidity across smoking cohorts may lead to unwanted heterogeneity in clinical, and possibly genetic, studies of nicotine dependence.

Measurement equivalence of the Revised Helping Alliance Questionnaire across African American and non-Latino White substance using adult outpatients

Analyses of the effectiveness of substance abuse treatments across racial/ethnic groups should ensure that outcome measures have the same conceptual meaning (i.e., measurement equivalence) across groups. Because racial groups differ in perceptions and experiences of the therapeutic alliance, this study investigated measurement equivalence properties of the Revised Helping Alliance Questionnaire (HAq-II) across racial groups. The sample included 138 African American and 133 non-Latino White participants, age 18-64 years, who participated in a randomized clinical trial investigating the effectiveness of Motivational Enhancement Therapy in the National Institute on Drug Abuse Clinical Trials Network. Results demonstrated configural invariance and two forms of metric invariance (weak and strong/scalar), suggesting that conceptualizations of therapeutic alliance and overall levels of endorsement of therapeutic alliance are comparable across racial groups. The groups indicated partial, strict metric nonequivalence. No studies to date reported measurement equivalence properties of the HAq-II. Findings support valid measurement and interpretation of HAq-II outcomes.

Developmental trajectories of acculturation in Hispanic adolescents: associations with family functioning and adolescent risk behavior

This study examined longitudinal acculturation patterns, and their associations with family functioning and adolescent risk behaviors, in Hispanic immigrant families. A sample of 266 Hispanic adolescents (Mage  = 13.4) and their primary parents completed measures of acculturation, family functioning, and adolescent conduct problems, substance use, and sexual behavior at five timepoints. Mixture models yielded three trajectory classes apiece for adolescent and parent acculturation. Assimilated adolescents reported the poorest family functioning, but adolescent assimilation negatively predicted adolescent cigarette smoking, sexual activity, and unprotected sex indirectly through family functioning. Follow-up analyses indicated that discrepancies between adolescent and parent family functioning reports predicted these adolescent outcomes. Results are discussed regarding acculturation trajectories, adolescent risk behavior, and the mediating role of family functioning.

Callous-unemotional traits as unique prospective risk factors for substance use in early adolescent boys and girls

Youth with elevated conduct disorder (CD) symptoms who also have callous-unemotional (CU) traits exhibit more antisocial behavior than youth without CU traits. However, evidence regarding whether CU traits increase risk of substance use over and above CD symptoms, and whether these associations differ for boys and girls, is scarce. Using the Developmental Pathways Project sample of 521 middle school students, we examined whether adolescent- and parent-reported CU traits measured in 6th grade prospectively predicted the onset and recurrence of substance use and use-related impairment by 9th grade. We also examined the degree to which CU traits uniquely predicted substance use and impairment over and above CD symptoms, as well as whether gender moderated these associations. Results indicated that adolescent-reported CU traits increased the likelihood of substance use and impairment onset and recurrence by 9th grade. Analyses revealed that CD symptoms accounted for prospective associations between adolescent-reported CU and substance use, but gender moderated these associations. Boys with elevated CU traits and CD symptoms were not more likely to report alcohol use onset or recurrence, but they were at highest risk of recurrent marijuana use, use of both alcohol and marijuana, and use-related impairment by 9th grade. Girls with low CU traits and high CD symptoms were most likely to report onset and recurrent use of alcohol, as well as recurrent marijuana use, use of both substances and impairment. Study findings highlight the importance of accounting for CD symptoms and gender when examining links between CU traits and substance use in early adolescence.

Preventing alcohol use with a voluntary after-school program for middle school students: results from a cluster randomized controlled trial of CHOICE

There are many mandated school-based programs to prevent adolescent alcohol and drug (AOD) use, but few are voluntary and take place outside of class time. This cluster randomized controlled trial evaluates CHOICE, a voluntary after-school program for younger adolescents, which reduced both individual- and school-level alcohol use in a previous pilot study. We evaluated CHOICE with 9,528 students from 16 middle schools. The sample was 51% female; 54% Hispanic, 17% Asian, 15% white, 9% multiethnic and 3% African American. Fifteen percent of students attended CHOICE. All students completed surveys on alcohol beliefs and use at baseline and 6-7 months later. We conducted intention-to-treat (ITT) school-level analyses and propensity-matched attender analyses. Lifetime alcohol use in the ITT analysis (i.e., school level) achieved statistical significance, with an odds ratio (OR) of 0.70 and a NNT of 14.8. The NNT suggests that in a school where CHOICE was offered, 1 adolescent out of 15 was prevented from initiating alcohol use during this time period. Although not statistically significant (p = .20), results indicate that past month alcohol use was also lower in CHOICE schools (OR = 0.81; NNT = 45). Comparisons of attenders versus matched controls yielded results for lifetime use similar to school-wide effects (OR = 0.74 and NNT = 17.6). Initial results are promising and suggest that a voluntary after-school program that focuses specifically on AOD may be effective in deterring alcohol use among early adolescents; however, further research is needed as program effects were modest.

Developmental trajectories of childhood obesity and risk behaviors in adolescence

Using group-based trajectory modeling, this study examined 5156 adolescents from the child sample of the 1979 National Longitudinal Survey of Youth to identify developmental trajectories of obesity from ages 6-18 and evaluate associations of such trajectories with risk behaviors and psychosocial health in adolescence. Four distinctive obesity trajectories were identified: "Chronically Obese," "Decreasing," "Increasing," and "Non-obese." Males were overrepresented in the Chronically Obese and Increasing groups; females were overrepresented in the Decreasing group. African-Americans were overrepresented in the Chronically Obese, Increasing, and Decreasing groups; in contrast, Whites were overrepresented in the Non-obese group. Obesity trajectories were not associated with greater trends in alcohol use, marijuana use, or delinquency, but Chronically Obese adolescents showed a greater increase in cigarette smoking over time compared to other trajectories. The Increasing trajectory, representing a transition into obesity status from childhood to adolescence, was associated with poorer psychosocial health compared to other trajectories.

Can the Medical Home eliminate racial and ethnic disparities for transition services among Youth with Special Health Care Needs?

The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.

Self-Reported Age of Onset and Telescoping for Cigarettes, Alcohol, and Marijuana Across Eight Years of the National Longitudinal Survey of Youth

Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. Although for some adolescents, substance use may last for only a brief period of experimentation, use of these substances in adolescence may have negative consequences. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures. The reliability and validity of self-reported substance use measures, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Our wave-to-wave analyses examined the accuracy of self-reported age of onset for cigarette, alcohol and marijuana users. Findings indicate that approximately one-fourth of cigarette users, one-fifth of alcohol users and one-third of marijuana users reported their age of onset exactly the same across waves. Of those who reported the age of onset inaccurately, the error tended to be in the direction of reporting their age of onset as older at a latter wave relative to what was reported previously, known as forward telescoping. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent and strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.

Analysis of influential factors associated with the smoking behavior of aboriginal schoolchildren in remote Taiwanese mountainous areas

BACKGROUND

A disparity in smoking behavior exists between the general and minority populations residing in Taiwan's mountainous areas. This study analyzed individual and environmental factors associated with children's smoking behavior in these areas of Taiwan.

METHODS

In this school-based study, data on smoking behavior and related factors for mountain-dwelling students were obtained from the 2008 and 2009 Control of School-aged Children Smoking Study surveys. A representative sample (N = 1239) from 26 primary schools was included. The association among 3 groups (never-, former-, and current-smokers) and the potential variables were simultaneously examined using unordered polytomous logistic regression analysis.

RESULTS

Between 13% and 34% of ever-smokers reported that their first smoking experience was in third grade. More than 70% were found to have bought cigarettes and 87% reported that the tobacco retailers had sold them cigarettes. The significant factors for current-smokers were predisposing factors, ie, attitude toward smoking (adjusted odds ratio [AOR] = 1.21); reinforcing factors, ie, family smoked in front of me (AOR = 2.44), friends smoked in front of me (AOR = 16.24), and school staff smoked in front of me (AOR = 2.98); and enabling factors, ie, cigarette availability and accessibility (AOR = 2.16 and 2.42, respectively). A student's perceived punishment for smoking at school had a positive significant effect on the risk of being former-smokers (AOR = 1.57).

CONCLUSION

The findings provide a basis for school and community to design and implement effective anti-smoking programs for remote mountain-based students to further reduce youth smoking.

Typologies of recanting of lifetime cigarette, alcohol and marijuana use during a six-year longitudinal panel study

AIM

To identify if there are different typologies for adolescent self-reporters and recanters for alcohol, cigarette and marijuana use.

METHODS

This study is a secondary data analysis and utilized four waves of the National Longitudinal Survey of Youth child panel data. The study included adolescents aged ten and older who self-reported ever use of cigarettes (n=872), marijuana (n=854) or alcohol (n=837). Consistent responders were those who reported lifetime use of a specific substance and continued to report such use at each latter wave of data collection. Latent class analyses were utilized to investigate if there are different types of self-reporters for each substance class.

RESULTS

Three unique groups for each substance was identified. The first group of users, who had a late age of onset, tended to be consistent self-reporters across waves. Those who were early onset users of cigarettes and marijuana tended to recant their use while early onset alcohol users were consistent reporters. Those with moderate ages of onset had no consistent recanting patterns. The highest degree of recanting was found among the early onset marijuana users.

CONCLUSIONS

The results suggest that youth who begin their use at an earlier age may not be as reliable reporters as youth who initiate use at later ages. Our results suggest that the veracity of prevalence estimates for licit and illicit substances could be different depending on the age of the respondent.

The Stability of Self-Reported Marijuana Use Across Eight Years of the National Longitudinal Survey of Youth

INTRODUCTION: This study examined teen marijuana report stability over eight years. The stability of self-reports refers to the consistency of self-reported use across several years. METHOD: This study used fives waves of data across eight years from the National Longitudinal Survey of Youth. Analyses were conducted to examine the internal or within wave consistency as well as external or across waves consistency for self-reported marijuana use. Further tests were conducted to identify if there were any differences for age, ethnicity and sex for report consistency. RESULTS: Report stability was higher for lifetime use reports than the age of onset reports. Wave-by-wave differences revealed stability remained at acceptable levels in nearly all comparisons at agreement being about 75%. Overall, report agreement was higher for females, older adolescents, and Non-Hispanic/Non-Black youth in bivariate analyses. However, only older chronological age remained consistently significantly associated with better report stability in multiple logistic regression models. Implications regarding misclassification of users for prevention programs and measurement issues are discussed.

Conducting research with racial/ethnic minorities: methodological lessons from the NIDA Clinical Trials Network

BACKGROUND

Multiple studies in the National Institute on Drug Abuse Clinical Trials Network (CTN) demonstrate strategies for conducting effective substance abuse treatment research with racial/ethnic minorities (REMs).

OBJECTIVES

The objectives of this article are to describe lessons learned within the CTN to (1) enhance recruitment, retention, and other outcomes; (2) assess measurement equivalence; and (3) use data analytic plans that yield more information.

METHOD

This article includes background information and examples from multiple CTN studies on inclusion, measurement, and data analysis.

RESULTS AND CONCLUSIONS

Seven recommendations are included for conducting more effective research on REMs.

Employment Trajectories: Exploring Gender Differences and Impacts of Drug Use

This study investigated the impact of drug use on employment over 20 years among men and women, utilizing data on 7,661 participants in the National Longitudinal Survey of Youth. Growth mixture modeling was applied, and five distinct employment trajectory groups were identified for both men and women. The identified patterns were largely similar for men and women except that a U-shape employment trajectory was uniquely identified for women. Early-initiation drug users, users of "hard" drugs, and frequent drug users were more likely to demonstrate consistently low levels of employment, and the negative relationship between drug use and employment was more apparent among men than women. Also, positive associations between employment and marriage became more salient for men over time, as did negative associations between employment and childrearing among women. Processes are dynamic and complex, suggesting that throughout the life course, protective factors that reduce the risk of employment problems emerge and change, as do critical periods for maximizing the impact of drug prevention and intervention efforts.

Racial/ethnic differences in adolescent substance use: mediation by individual, family, and school factors

OBJECTIVE

This study examined racial/ethnic differences in alcohol, cigarette, and marijuana use among a diverse sample of approximately 5,500 seventh and eighth graders. We also evaluated the extent to which individual, family, and school factors mediated racial/ ethnic disparities in use.

METHOD

Students (49% male) from 16 participating middle schools in southern California reported on lifetime and past-month substance use, individual factors (expectancies and resistance self-efficacy), family factors (familism, parental respect, and adult and older sibling use), and school factors (school-grade use and perceived peer use). We used generalized estimating equations to examine the odds of consumption for each racial/ethnic group adjusting for sex, grade, and family structure. Path analysis models tested mediation of racial/ethnic differences through individual, family, and school factors.

RESULTS

After adjusting for sex, grade, and family structure, Hispanics reported higher and Asians reported lower lifetime and past-month substance use, compared with non-Hispanic Caucasians. Rates of substance use did not differ between non-Hispanic African Americans and Caucasians. Several individual factors mediated the relationship between Hispanic ethnicity and substance use, including negative expectancies and resistance self-efficacy. Higher use among Hispanics was generally not explained by family or school factors. By contrast, several factors mediated the relationship between Asian race and lower alcohol use, including individual, family (parental respect, adult and older sibling use), and school (perceived peer use, school-grade use) factors.

CONCLUSIONS

Results highlight the importance of targeting specific individual, family, and school factors in tailored intervention efforts to reduce substance use among young minority adolescents.

Reporting bias in the association between age at first alcohol use and heavy episodic drinking

BACKGROUND

Given the weight placed on retrospective reports of age at first drink in studies of later drinking-related outcomes, it is critical that its reliability be established and possible sources of systematic bias be identified. The overall aim of the current study is to explore the possibility that the estimated magnitude of association between early age at first drink and problem alcohol use may be inflated in studies using retrospectively reported age at alcohol use onset.

METHODS

The sample was comprised of 1,716 participants in the Missouri Adolescent Female Twin Study who reported an age at first drink in at least 2 waves of data collection (an average of 4 years apart). Difference in reported age at first drink at Time 2 versus Time 1 was categorized as 2 or more years younger, within 1 year (consistent), or 2 or more years older. The strength of the association between age at first drink and peak frequency of heavy episodic drinking (HED) at Time 1 was compared with that at Time 2. The association between reporting pattern and peak frequency of HED was also examined.

RESULTS

A strong association between age at first drink and HED was found for both reports, but it was significantly greater at Time 2. Just over one-third of participants had a 2 year or greater difference in reported age at first drink. The majority of inconsistent reporters gave an older age at Time 2 and individuals with this pattern of reporting engaged in HED less frequently than consistent reporters.

CONCLUSIONS

The low rate of HED in individuals reporting an older age at first drink at Time 2 suggests that the upward shift in reported age at first drink among early initiates is most pronounced for light drinkers. Heavy drinkers may therefore be overrepresented among early onset users in retrospective studies, leading to inflated estimates of the association between early age at initiation and alcohol misuse.

Socio-environmental factors associated with pubertal development in female adolescents: the role of prepubertal tobacco and alcohol use

PURPOSE

Alcohol administered to laboratory animals has been shown to suppress puberty-related hormones and delay puberty by interfering with ovarian development and function. The effects of early substance use on human pubertal development are relatively unexplored.

METHODS

This cross-sectional study of 3,106 female adolescents, aged 11-21 years, evaluated the association between prepubertal alcohol and tobacco use and the onset of puberty. Ages at initial breast development, body hair growth, and menarche were self-reported. Prepubertal alcohol and tobacco use were defined as the age at first use before the age of pubertal development and accompanied by regular use. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models. Logistic regression was used to estimate the association between substance use and delayed puberty, defined as lack of breast development by the age of 13 years.

RESULTS

Unadjusted models indicated prepubertal tobacco use was associated with a longer time required for breast development (HR = 0.74; 95% CI, 0.65-0.85) and body hair growth (HR = 0.81; 95% CI, 0.71-0.93). Prepubertal alcohol use was associated with late breast development (HR = 0.71; 95% CI, 0.57-0.88). The direction of the observed associations remained consistent after adjusting for covariates, but the magnitude of effects were attenuated and the upper bound of the 95% CIs exceeded the null value. Girls who used alcohol before puberty had four times the odds of having delayed puberty (OR = 3.99; 95% CI, 1.94-8.21) as compared with nonusers.

CONCLUSION

The results of this study suggest that the endocrine-disrupting effects of alcohol and tobacco use may alter the timing of pubertal development. These cross-sectional findings warrant further investigation.

Testing the length of time theory of recall decay: examining substance use report stability with 10 years of national longitudinal survey of youth data

AIM

This article examines whether the proportion of recanters increases (or decreases) as a function of time o test length of time theory.

SAMPLE

2,221 US respondents in the National Longitudinal Survey of Youth child data. Bivariate and logistic regression analyses were used.

RESULTS

Among recanters, 50% of cigarette and alcohol users recanted use by 4 years, and 50% of marijuana users recanted by 3 years. Predictors of recanting was being Black or Hispanic and younger age. The theory was not supported. Further research is needed to identify potential reasons why adolescents recant their use is such a short time span. The study's limitations are noted.

Marijuana use among Latino adolescents: gender differences in protective familial factors

Given the important contextual function of family dynamics and traditional gender roles in Latino cultures, parental influences on substance use among Latino adolescents may differ across genders. This study examined associations between family factors (parental monitoring, parent-child communication, family cohesion, and familism) and marijuana use among 1,369 Latino adolescents in Southern California. Students from seven schools completed surveys in 9th and 11th grades. Longitudinal hierarchical linear regression analyses evaluated the associations between family factors in 9th grade and lifetime marijuana use in 11th grade, as well as gender differences in these associations. Girls reported higher levels of parental monitoring, parental communication, and familism than boys did, but there were no gender differences in family cohesiveness. In a regression model controlling for covariates and previous marijuana use, parent-child communication and family cohesion in 9th grade were each uniquely predictive of lower levels of marijuana consumption in 11th grade. Gender was a statistical moderator, such that higher levels of parent-child communication predicted lower marijuana use among boys, whereas girls' use was relatively low regardless of parent-child communication levels. Results are discussed in the light of the concurrent socialization processes of family and gender in Latino culture and its relation to preventing delinquent behaviors such as marijuana use.

A multilevel-based study of school policy for tobacco control in relation to cigarette smoking among children in elementary schools: gender differences

The aim was to comprehensively examine school-based tobacco policy status, implementation and students' perceived smoking at school in regard to gender-specific differences in smoking behavior. We conducted a multilevel-based study to assess two-level effects for smoking among 2350 grades three to six students in 26 randomly selected elementary schools in southern Taiwan. A series of multilevel models were analyzed separately for male and female students. The school-level variables appear to be related to smoking behavior in male students. Among males, the risk of ever-smoking was significantly associated with those schools without antitobacco health education activities or curricula [adjusted odds ratio (aOR) = 6.23, 95% confidence interval (CI): 2.55-15.24], with a high perceived smoking rate (aOR = 3.08, 95% CI: 1.41-6.72) and located in a mountainous region (aOR = 2.53, 95% CI: 1.15-5.58). The risk of ever-smoking among females was significantly associated with those schools without antitobacco activities or curricula (aOR = 3.10, 95% CI: 1.27-7.55). As compared with female counterparts, the specific school that the male students attended had a positive significant effect on the risk of being ever-smokers. The findings suggest that effective tobacco policy implementation should be considered in elementary schools that are currently putting children at the greatest risk for cigarette smoking, especially in regard to male students.

Seven years later: developmental transitions and delinquent behavior for male adolescents who received long-term substance treatment

OBJECTIVE

Few studies have applied the "life course perspective" to the study of drug use, a noticeable omission in the field. The current study addresses this gap by examining patterns of interpersonal crime, substance use, and emotional problems over 7 years for a sample of 196 high-risk males as they transition from adolescence to young adulthood, with a specific focus on the role of transitions (living alone, employment, marrying or cohabiting with a romantic partner, graduating from high school or acquiring a General Equivalency Diploma, and becoming a parent) on these patterns.

METHOD

We surveyed youth who were adjudicated as delinquent in Los Angeles between February 1999 and May 2000 and referred by probation officials to Phoenix Academy, a long-term residential substance-treatment provider for adolescent probationers. Males ages 13-17 (N = 196) were given face-to-face interviews at study entry and at 3, 6, 12, 24, 30, 72, and 87 months.

RESULTS

Living independently and cohabiting were associated with decreased substance problems. Living with children was associated with increased interpersonal crime. Living away from parents was associated with an increase in substance problems following the transition and then a subsequent decrease in problems over time. No effects were found for receiving a diploma or having employment.

CONCLUSIONS

It is crucial to begin to understand how developmental transitions may affect high-risk adolescents' involvement in criminal behavior, substance use, and emotional problems. The current study suggests that several transitions were associated with a reduction in problems as these youth transitioned into young adulthood.

What are the consequences of relying upon self-reports of sexually transmitted diseases? Lessons learned about recanting in a longitudinal study

PURPOSE

Self-reports are the standard measure of STD history used in survey research. We explored to what extent self-reports of ever having an STD are recanted in a follow-up data collection.

METHODS

Using the National Survey of Adolescent Males (NSAM), we assessed consistency over time in self-reports of ever having an STD in a sample of young men transitioning from adolescence to young adulthood (aged 15-26 years), a population in which STDs are particularly prevalent.

RESULTS

Approximately 7% of all sexually experienced young men rescinded STD self-reports over time. Thus, self-reports at one point in time likely underestimate true STD history, using earlier self-reports as the criterion. Among men who ever report an STD, 94-98% recant their reports in later waves.

CONCLUSIONS

Knowledge of the extent of underreporting can potentially be used to adjust cross-sectional estimates of STDs based on survey self-reports. These study findings move us one step closer to estimating just how much underreporting of STDs in self-reports is.

Truth or consequences: the intertemporal consistency of adolescent self-report on the Youth Risk Behavior Survey

Surveys are the primary information source about adolescents' health risk behaviors, but adolescents may not report their behaviors accurately. Survey data are used for formulating adolescent health policy, and inaccurate data can cause mistakes in policy creation and evaluation. The author used test-retest data from the Youth Risk Behavior Survey (United States, 2000) to compare adolescents' responses to 72 questions about their risk behaviors at a 2-week interval. Each question was evaluated for prevalence change and 3 measures of unreliability: inconsistency (retraction and apparent initiation), agreement measured as tetrachoric correlation, and estimated error due to inconsistency assessed with a Bayesian method. Results showed that adolescents report their sex, drug, alcohol, and tobacco histories more consistently than other risk behaviors in a 2-week period, opposite their tendency over longer intervals. Compared with other Youth Risk Behavior Survey topics, most sex, drug, alcohol, and tobacco items had stable prevalence estimates, higher average agreement, and lower estimated measurement error. Adolescents reported their weight control behaviors more unreliably than other behaviors, particularly problematic because of the increased investment in adolescent obesity research and reliance on annual surveys for surveillance and policy evaluation. Most weight control items had unstable prevalence estimates, lower average agreement, and greater estimated measurement error than other topics.

Measurement and data analysis in research addressing health disparities in substance abuse

This article describes concrete strategies for conducting substance abuse research with ethnic minorities. Two issues associated with valid analysis, measurement and data analysis, are included. Both empirical (e.g., confirmatory factor analysis, item response theory, and regression) and nonempirical (e.g., focus groups, expert panels, pilot studies, and translation equivalence) approaches to improve measures are described. A discussion of the use of norms and cutoff scores derived from a different ethnic group along with the effects of the ethnicity of the interviewer or coder on measurement is included. The section on data analysis describes why the use of race-comparison designs may lead to misleading conclusions. Alternatives to race-comparison analysis including within-group and between-group analyses are described. The shortcomings of combining ethnic groups for analyses are discussed. The article ends with a list of recommendations for research with ethnic minorities.

An emerging problem: methamphetamine abuse among treatment seeking youth

This study examined correlates of methamphetamine (MA) and marijuana (MJ) use and treatment response among treatment-involved youth (N = 4,430) in Los Angeles County, California treated between 2000 and 2005. Of the sample, 912 (21%) were primary MA and 3,518 (79%) were primary MJ users. Correlates of increased MA use included being female, White, Asian or Latino, older age, previous treatment involvement, legal status of probation or parole, and initiating drug use at an older age. Treatment trends showed a rise in treatment admissions for MA, with more MA users enrolling in residential treatment compared to outpatient treatment. Predictors of retention, drug use at discharge, and completion by treatment modality are discussed. Results can guide the development of effective strategies for treatment assessment and planning tailored towards minimizing drug use and maximizing treatment response among youth.

Adolescent cannabis problems and young adult depression: male-female stratified propensity score analyses

Cannabis use and depression are two of the most prevalent conditions worldwide. Adolescent cannabis use is linked to depression in many studies, but the effects of adolescent cannabis involvement on young adult depression remain unclear and may differ for males versus females. In this cohort study of youth from a mid-Atlantic metropolitan area of the United States, repeated assessments from 1985 (at age 6 years) through 2002 (at age 21 years) were made for 1,494 individuals (55% female). Measured covariate differences between individuals with and without cannabis problems were controlled via propensity score techniques. The estimated risk of young adult depression for adolescents with cannabis problems was not significantly different from that for comparison adolescents for either females (odds ratio = 0.7, 95% confidence interval: 0.2, 2.3) or males (odds ratio = 1.7, 95% confidence interval: 0.8, 3.6). The evidence does not support a causal association linking adolescent-onset cannabis problems with young adult depression.