... In practice, however, matching is unlikely to increase power for commu-nity drug prevention s... more ... In practice, however, matching is unlikely to increase power for commu-nity drug prevention studies. ... of freedom are then based on the number of pairs rather than number of communities. ... because data are not available at the community level assessing risk factors of drug use ...
ABSTRACT The rationale and design for a brief feedback and motivational intervention for substanc... more ABSTRACT The rationale and design for a brief feedback and motivational intervention for substance use among homeless adolescents is described. Homeless adolescents use substances at extremely high rates compared to other youth, and experience considerable negative consequences as a result. Yet homeless adolescents are not reached by, or are not responsive to, traditional prevention and treatment programs for substance use and abuse. The rationale for the use of brief feedback interventions is reviewed, and one such program that was designed to reduce substance use risk among homeless youth is described. The intervention is consistent with tenants of harm reduction in its effort to encourage engagement via its structure, minimal demands, and flexible clinical strategies and goals. Modifications made to the intervention based on lessons learned from an initial trial are described, and highlight the importance of tailoring harm reduction programs to facilitate engagement based on clients’ life circumstances, availability, and motivation.
This article evaluates the utility of social development model constructs toassess the correlates... more This article evaluates the utility of social development model constructs toassess the correlates of onset, escalation, deescalation, and desistance ofdelinquent behavior, from age 12 to age 15, using a dynamic classificationapproach. Dynamic classification places individuals into categories basedon changes in levels of delinquent behavior over time. These analyses assessthe extent to which specific constructs are associated with changes in thedelinquency status of individuals. Constructs of the social developmentmodel (SDM), including opportunities for conventional involvement, skillsfor conventional involvement, rewards for conventional involvement,proactive family management, bonding to conventional society, opportunitiesfor antisocial involvement, antisocial interactions, perceived rewards forantisocial involvement, and norms against drug use, were significantlyassociated with change in delinquent behavior over time. Many of theconstructs were particularly salient in distinguishing between youths whoremained involved in delinquency and youths who deescalated or desisted fromdelinquent behavior during this period. Implications for preventiveinterventions and criminological theory are discussed.
... Inc. Disentangling the Effects of Parental Drinking, Family Management, and Parental Alcohol ... more ... Inc. Disentangling the Effects of Parental Drinking, Family Management, and Parental Alcohol Norms on Current Drinking by Black and White Adolescents Peggy ... model-Page 5. DISENTANGLING PARENTAL INFLUENCES 207 ing ...
The short-term results of a randomized trial testing a brief feedback and motivational interventi... more The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.
A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized ... more A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth.
Research has documented the importance of individuals' social networks in facilitati... more Research has documented the importance of individuals' social networks in facilitating and inhibiting drug use. Sociological theories of deviance and drug use provide a useful framework for understanding the influence of social networks; however, these theories ...
This study sought to assess the efficacy of treatment for cocaine abuse and to compare the relati... more This study sought to assess the efficacy of treatment for cocaine abuse and to compare the relative effectiveness of a cognitive-behavioral relapse prevention treatment with that of a Twelve-Step recovery support group in an outpatient group treatment setting. One hundred ten subjects seeking treatment were alternately assigned to relapse prevention or Twelve-Step treatment. Self-report data were collected at baseline, posttreatment, and 6-month follow-up. There were no differential effects of treatment type on cocaine or marijuana use over time. However, subjects in both treatment conditions reduced cocaine and marijuana use at posttreatment. Subjects in both groups reduced their alcohol use from pretreatment to posttreatment. Subjects receiving Twelve-Step treatment showed greater increases from posttreatment to 6-month follow-up in alcohol use than did relapse prevention participants. Treatment attendance was negatively related to cocaine use at posttreatment and cocaine and marijuana use at 6-month follow-up. Difficulties in conducting cocaine treatment outcome research are discussed as are treatment and research implications of the findings.
This study examines how substance use is associated with the health and safety of homeless youth ... more This study examines how substance use is associated with the health and safety of homeless youth using cross-sectional, self-report data from 285 homeless adolescents. Path models were used to examine concurrent relationships between youth’s substance use and multiple aspects of their health and safety, including measures of psychological distress, housing risk and instability, and medical problems. Substance use was examined with both global (i.e., a composite of days of use across various drugs and alcohol) and specific (i.e., rates of use of specific drugs, injection drug use) measures. After controlling for demographic and historical variables, number of days of use was significantly related to psychological distress, whereas injection drug use was significantly related to housing risk. Examination of specific drugs revealed relationships between psychological distress and the use of alcohol, cocaine, and amphetamines, and a specific relationship between housing risk and the use of heroin. None of the measures of substance use was significantly related to youth’s medical problems. Implications for interventions with homeless adolescents are discussed.
Fetal alcohol exposure is a serious social and public health problem. However, most prevention pr... more Fetal alcohol exposure is a serious social and public health problem. However, most prevention programs in this area are solely informational. Important gaps in both understanding processes which underlie alcohol consumption during pregnancy and in the design of interventions to prevent fetal alcohol exposure are discussed. We argue that an important group missed by current interventions are women for whom abstinence is difficult, but who are not physically addicted. Cognitive behavioral interventions are proposed as appropriate for this target group. Recommendations for future directions in the area of fetal alcohol exposure are discussed.
This study tested a cognitive-behavioral intervention for reducing alcohol consumption among econ... more This study tested a cognitive-behavioral intervention for reducing alcohol consumption among economically disadvantaged pregnant women. The intervention included a 10-minute educational session and a nine-step self-help manual. Women attending public health maternity clinics completed a screening questionnaire, a pretest questionnaire, were randomly assigned to receive the self-help intervention or usual clinic care, and completed a posttest questionnaire. A higher alcohol quit rate was observed among the intervention participants (88%) than controls (69%). The effect was strongest for "light" drinkers, African-Americans, and non-Protestants. This approach may be useful in clinics where staff time is limited.
We hypothesize that specific attitudes or expectancies make people vulnerable to responding to st... more We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture.
We hypothesize that specific attitudes or expectancies make people vulnerable to responding to st... more We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture.
Behavioral intervention is the most urgent priority in preventing the further spread of HIV. To m... more Behavioral intervention is the most urgent priority in preventing the further spread of HIV. To maximize the efficacy of AIDS prevention and to most efficiently allocate resources, it is imperative that variables contributing to preventive behavior change be accurately identified, and interventions be critical evaluated prior to widespread dissemination. We review studies regarding homosexual/bisexual men in terms of: 1) epidemiological trends in HIV transmission; 2) models of behavior change organized around the initiation, consolidation, and maintenance of change, and; 3) preventive intervention outcomes. We conclude with recommendations for effective primary prevention programs.
This paper reports the results of a broad survey of homosexual males regarding AIDS-risk behavior... more This paper reports the results of a broad survey of homosexual males regarding AIDS-risk behavior. A very high proportion reported both anxiety over possible HIV infection, and a high probability of exposure to HIV. Although over 80% of respondents reported changes in sexual behavior, the frequency of monogamous, stable relationships is unchanged from that found 16 years ago, and 19% reported continued frequent sexual partners. Consistent with “health belief” models, fear of future exposure and perceived control over behavior were strongly related to behavioral change. However, those who felt they had already been exposed were not substantially more likely to decrease current AIDS-risk behavior, which may have important public health ramifications. Alcohol and drug abuse were related to “high risk” behavior, particularly among respondents who are generally motivated to use substances to decrease “tension” or self-monitoring. Thus, using substances to decrease stress may not only relate to substance abuse itself, but to the role of substances in increasing AIDS-risk behavior.
... In practice, however, matching is unlikely to increase power for commu-nity drug prevention s... more ... In practice, however, matching is unlikely to increase power for commu-nity drug prevention studies. ... of freedom are then based on the number of pairs rather than number of communities. ... because data are not available at the community level assessing risk factors of drug use ...
ABSTRACT The rationale and design for a brief feedback and motivational intervention for substanc... more ABSTRACT The rationale and design for a brief feedback and motivational intervention for substance use among homeless adolescents is described. Homeless adolescents use substances at extremely high rates compared to other youth, and experience considerable negative consequences as a result. Yet homeless adolescents are not reached by, or are not responsive to, traditional prevention and treatment programs for substance use and abuse. The rationale for the use of brief feedback interventions is reviewed, and one such program that was designed to reduce substance use risk among homeless youth is described. The intervention is consistent with tenants of harm reduction in its effort to encourage engagement via its structure, minimal demands, and flexible clinical strategies and goals. Modifications made to the intervention based on lessons learned from an initial trial are described, and highlight the importance of tailoring harm reduction programs to facilitate engagement based on clients’ life circumstances, availability, and motivation.
This article evaluates the utility of social development model constructs toassess the correlates... more This article evaluates the utility of social development model constructs toassess the correlates of onset, escalation, deescalation, and desistance ofdelinquent behavior, from age 12 to age 15, using a dynamic classificationapproach. Dynamic classification places individuals into categories basedon changes in levels of delinquent behavior over time. These analyses assessthe extent to which specific constructs are associated with changes in thedelinquency status of individuals. Constructs of the social developmentmodel (SDM), including opportunities for conventional involvement, skillsfor conventional involvement, rewards for conventional involvement,proactive family management, bonding to conventional society, opportunitiesfor antisocial involvement, antisocial interactions, perceived rewards forantisocial involvement, and norms against drug use, were significantlyassociated with change in delinquent behavior over time. Many of theconstructs were particularly salient in distinguishing between youths whoremained involved in delinquency and youths who deescalated or desisted fromdelinquent behavior during this period. Implications for preventiveinterventions and criminological theory are discussed.
... Inc. Disentangling the Effects of Parental Drinking, Family Management, and Parental Alcohol ... more ... Inc. Disentangling the Effects of Parental Drinking, Family Management, and Parental Alcohol Norms on Current Drinking by Black and White Adolescents Peggy ... model-Page 5. DISENTANGLING PARENTAL INFLUENCES 207 ing ...
The short-term results of a randomized trial testing a brief feedback and motivational interventi... more The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.
A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized ... more A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth.
Research has documented the importance of individuals' social networks in facilitati... more Research has documented the importance of individuals' social networks in facilitating and inhibiting drug use. Sociological theories of deviance and drug use provide a useful framework for understanding the influence of social networks; however, these theories ...
This study sought to assess the efficacy of treatment for cocaine abuse and to compare the relati... more This study sought to assess the efficacy of treatment for cocaine abuse and to compare the relative effectiveness of a cognitive-behavioral relapse prevention treatment with that of a Twelve-Step recovery support group in an outpatient group treatment setting. One hundred ten subjects seeking treatment were alternately assigned to relapse prevention or Twelve-Step treatment. Self-report data were collected at baseline, posttreatment, and 6-month follow-up. There were no differential effects of treatment type on cocaine or marijuana use over time. However, subjects in both treatment conditions reduced cocaine and marijuana use at posttreatment. Subjects in both groups reduced their alcohol use from pretreatment to posttreatment. Subjects receiving Twelve-Step treatment showed greater increases from posttreatment to 6-month follow-up in alcohol use than did relapse prevention participants. Treatment attendance was negatively related to cocaine use at posttreatment and cocaine and marijuana use at 6-month follow-up. Difficulties in conducting cocaine treatment outcome research are discussed as are treatment and research implications of the findings.
This study examines how substance use is associated with the health and safety of homeless youth ... more This study examines how substance use is associated with the health and safety of homeless youth using cross-sectional, self-report data from 285 homeless adolescents. Path models were used to examine concurrent relationships between youth’s substance use and multiple aspects of their health and safety, including measures of psychological distress, housing risk and instability, and medical problems. Substance use was examined with both global (i.e., a composite of days of use across various drugs and alcohol) and specific (i.e., rates of use of specific drugs, injection drug use) measures. After controlling for demographic and historical variables, number of days of use was significantly related to psychological distress, whereas injection drug use was significantly related to housing risk. Examination of specific drugs revealed relationships between psychological distress and the use of alcohol, cocaine, and amphetamines, and a specific relationship between housing risk and the use of heroin. None of the measures of substance use was significantly related to youth’s medical problems. Implications for interventions with homeless adolescents are discussed.
Fetal alcohol exposure is a serious social and public health problem. However, most prevention pr... more Fetal alcohol exposure is a serious social and public health problem. However, most prevention programs in this area are solely informational. Important gaps in both understanding processes which underlie alcohol consumption during pregnancy and in the design of interventions to prevent fetal alcohol exposure are discussed. We argue that an important group missed by current interventions are women for whom abstinence is difficult, but who are not physically addicted. Cognitive behavioral interventions are proposed as appropriate for this target group. Recommendations for future directions in the area of fetal alcohol exposure are discussed.
This study tested a cognitive-behavioral intervention for reducing alcohol consumption among econ... more This study tested a cognitive-behavioral intervention for reducing alcohol consumption among economically disadvantaged pregnant women. The intervention included a 10-minute educational session and a nine-step self-help manual. Women attending public health maternity clinics completed a screening questionnaire, a pretest questionnaire, were randomly assigned to receive the self-help intervention or usual clinic care, and completed a posttest questionnaire. A higher alcohol quit rate was observed among the intervention participants (88%) than controls (69%). The effect was strongest for "light" drinkers, African-Americans, and non-Protestants. This approach may be useful in clinics where staff time is limited.
We hypothesize that specific attitudes or expectancies make people vulnerable to responding to st... more We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture.
We hypothesize that specific attitudes or expectancies make people vulnerable to responding to st... more We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture.
Behavioral intervention is the most urgent priority in preventing the further spread of HIV. To m... more Behavioral intervention is the most urgent priority in preventing the further spread of HIV. To maximize the efficacy of AIDS prevention and to most efficiently allocate resources, it is imperative that variables contributing to preventive behavior change be accurately identified, and interventions be critical evaluated prior to widespread dissemination. We review studies regarding homosexual/bisexual men in terms of: 1) epidemiological trends in HIV transmission; 2) models of behavior change organized around the initiation, consolidation, and maintenance of change, and; 3) preventive intervention outcomes. We conclude with recommendations for effective primary prevention programs.
This paper reports the results of a broad survey of homosexual males regarding AIDS-risk behavior... more This paper reports the results of a broad survey of homosexual males regarding AIDS-risk behavior. A very high proportion reported both anxiety over possible HIV infection, and a high probability of exposure to HIV. Although over 80% of respondents reported changes in sexual behavior, the frequency of monogamous, stable relationships is unchanged from that found 16 years ago, and 19% reported continued frequent sexual partners. Consistent with “health belief” models, fear of future exposure and perceived control over behavior were strongly related to behavioral change. However, those who felt they had already been exposed were not substantially more likely to decrease current AIDS-risk behavior, which may have important public health ramifications. Alcohol and drug abuse were related to “high risk” behavior, particularly among respondents who are generally motivated to use substances to decrease “tension” or self-monitoring. Thus, using substances to decrease stress may not only relate to substance abuse itself, but to the role of substances in increasing AIDS-risk behavior.
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