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Heterogeneity often exists among behavioral growth trajectories in a study population. In the evaluation of intervention effects for longitudinal randomized trials, it is informative to examine the impact of an intervention on subgroups characterized by different types of growth trajectories. This paper presents an application of growth mixture modeling to an ordinal-scale substance-use behavior outcome from the Aban Aya Youth Project (AAYP), a longitudinal preventive intervention trial targeting health-compromising behaviors among adolescents. Results suggested two classes of adolescent substance use growth trajectories: Class 1 (44.7% of the sample) started at a higher level and had a relatively shallow increase over time; Class 2 had a lower baseline level and a rapid increase over time. The intervention effectively reduced the rapid increase of substance use for the adolescents in the second class.

Objectives. We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students. Methods. We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N = 1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N = 1225) substance use and violence. Results. Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR] = 0.41; 90% confidence interval [CI] = 0.25, 0.66) and violence (RR = 0.42; 90% CI = 0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio = 0.24; 90% CI = 0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors. Conclusions. Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior. (doi:10.2105/AJPH.2008.142919)

BACKGROUND: Recruiting schools into a matched-pair randomized control trial (MP-RCT) to evaluate the efficacy of a school-level prevention program presents challenges for researchers. We considered which of 2 procedures would be most effective for recruiting schools into the study and assigning them to conditions. In 1 procedure (recruit and match/randomize), we would recruit schools and match them prior to randomization, and in the other (match/randomize and recruitment), we would match schools and randomize them prior to recruitment. METHOD: We considered how each procedure impacted the randomization process and our ability to recruit schools into the study. Alter implementing the selected procedure, the equivalence of both treatment and control group schools and the participating and nonparticipating schools on school demographic variables was evaluated. RESULTS: We decided on the recruit and match/randomize procedure because we thought it would provide the opportunity to build rapport with the schools and prepare them for the randomization process, thereby increasing the likelihood that they would accept their randomly assigned conditions. Neither the treatment and control group schools nor the participating and nonparticipating schools exhibited statistically significant differences from each other on any of the school demographic variables. CONCLUSIONS: Recruitment of schools prior to matching and randomization in an MP-RCT may facilitate the recruitment of schools and thus enhance both the statistical power and the representativeness of study findings. Future research would benefit from the consideration of a broader range of variables (eg, readiness to implement a comprehensive prevention program) both in matching schools and in evaluating their representativeness to nonparticipating schools. Keywords: randomization; recruitment; school prevention programs., Comprehensive school-based prevention programs that address a broad range of student outcomes, such as academic achievement, prosocial behaviors, and self-esteem, are usually applied school wide. (1) Research designs involving random [...]

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence. (doi:10.2105/AJPH.2005.065268)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.02.011 Byline: Craig R. Colder (a), Elizabeth E. Lloyd-Richardson (b), Brian P. Flaherty (c), Donald Hedeker (d), Eisuke Segawa (d), Brian R. Flay (e) Keywords: Smoking; College students; Trajectory Abstract: Although the initiation of cigarette use typically occurs prior to age 18, there is evidence for considerable change in smoking behavior after this age. College may be a particularly important period to study smoking because it is a time when adolescents transition into a new social context where substance use is normative. Using a longitudinal design, daily assessments of smoking were collected during the entire first year of college for a large cohort of freshman (N =496). Findings suggested a weekly cycle of smoking such that the probability of smoking was much higher on weekends (Friday and Saturday) than on remaining days of the week. In addition to this weekly cycle, there was an overall trend for smoking to decline over the course of the year. Substantial individual variability in levels of smoking was observed. These findings provide new insights into college smoking, and have implications for assessment, policy, intervention, and future directions for research. Author Affiliation: (a) University at Buffalo, State University of New York, USA (b) Brown Medical School and The Miriam Hospital, USA (c) University of Washington, USA (d) University of Illinois at Chicago, USA (e) Oregon State University, USA

The authors provide a historical review of developments in the methods of school-based evaluations of problem behavior prevention interventions. The design and statistical methodologies used in school-based intervention research have advanced tremendously over the past twenty years. Methods have improved for approaches to the randomization of whole schools, the choice of appropriate comparison or control groups, solutions when randomization breaks down, limiting and handling of variation in integrity of the intervention received, limiting biases introduced by data collection, awareness of the effects of intensive and long-term data collection, limiting and analysis of subject attrition and other missing data, approaches to obtaining parental consent for children to engage in research, design and analysis issues when only small numbers of schools are available or can be afforded, the choice of the unit of analysis, phases of research, optimizing and extending the reach of interventions, and differential effects in subpopulations. The authors conclude that sequential planning, timing, keeping up with methodological advances, publication of results, and accumulation of knowledge are all important in conducting high-quality school-based intervention research, and that the devil is in the details. Keywords: school-based randomized trial; prevention research; educational research; health behavior; intervention development; causal statements; parental consent

J. Crocker and L. E. Park (2004) proposed both (a) that the importance of self-esteem lies more in how people strive for it rather than whether it is high or low and (b) that the benefits of pursuing self-esteem are of a limited, short-term nature and are outweighed by the significant costs that entail for functioning in multiple areas. The authors review research that raises questions about the validity of each of these assumptions. They conclude that findings are more consistent with a view in which (a) high self-esteem, or at least the avoidance of low self-esteem, is an important factor contributing to overall health and well-being and (b) the pursuit of self-esteem, when directed toward adaptive ends, can be instrumental in promoting long-term outcomes that are of value to both individuals and society. They also describe an integrative theoretical framework that encompasses both of these possibilities.

The prevention of youth problem behaviors is increasingly guided by science. Sound epidemiological research is coming to guide preventive efforts. Valid methods of monitoring the incidence and prevalence of youth problems increasingly shape preventive practice. The identification of empirically supported prevention interventions is becoming more sophisticated, and numerous scientific organizations have begun to engage in dissemination activities. These trends will be accelerated by increased media advocacy for the use of scientific methods and findings, the development of a registry of preventive trials, achievement of consensus about the standards for identifying disseminable interventions, and increased research on the factors that influence the effective implementation of science-based practices.

The current study sought to identify classes of growth trajectories of adolescent alcohol use and to examine the predictors and outcomes associated with the classes. Alcohol use was assessed from Grades 7 to 12 in a school-based sample. Latent growth mixture modeling was used, and results indicated 5 discrete longitudinal drinking patterns. The 2 most common drinking patterns included occasional very light drinking from Grades 7 to 12 and moderate escalation in both quantity and frequency of alcohol use. One group drank infrequently but at high levels throughout the study period. Another group exhibited rapid escalation in both quantity and frequency. The final group started at high levels of frequency and quantity in Grade 7 and showed rapid de-escalation in frequency. Emotional distress and risk taking distinguished the classes, and all classes, particularly rapid escalators, showed elevated levels of alcohol-related problems relative to occasional very light drinkers.

Byline: Paula Smith (1), Brian R. Flay (2), Carl C. Bell (2), Roger P. Weissberg (2) Keywords: parental closeness; prosocial peers; violence Abstract: Objectives: This study attempted to provide further insight into the roles of parents and peers as they influence youth involvement with violence. Specifically, this paper considers whether parents who are close to their children have children who affiliate with prosocial friends who may in turn serve as a buffer against violence. This study also considers how parent and peer influences may change as youth transition to adolescence. Methods: A cross-sectional health behavior survey was administered to 384 low-income, African-American youth aged 10--15 from three Chicago area schools. Structural equation models (SEM) were developed to assess the impact of youth reported prosocial friends and parental closeness on violence involvement. The overall model was tested to examine equivalence across preadolescent and adolescent age-groupings. Results: Results from the overall model indicated that parental closeness did not have a direct influence on youth violence involvement, but having a close parent--child relationship improved the youth's ability to select prosocial friends, which was directly related to decreased involvement with violence. Differences in the model by age-grouping suggested the presence of prosocial friends was a stronger factor for adolescent violence avoidance when compared to preadolescents. Conclusions: Parents can make a difference in the way in which their children choose their friends and therefore get involved with violence by maintaining a closely bonded relationship throughout preadolescence and adolescence. The importance of this closely bonded relationship has even greater effects for decreasing violence involvement for adolescents than preadolescents. Author Affiliation: (1) Department of Family and Consumer Studies, The University of Utah, Salt Lake City, Utah, 84112 (2) The University of Illinois at Chicago, Chicago, Illinois Article History: Registration Date: 07/10/2004

Byline: Brian R. Flay (1), Carol G. Allred (2), Nicole Ordway (1) Keywords: prevention; achievement; matched-control; self-concept; violence; discipline Abstract: This paper reports on the effectiveness of an integrated comprehensive school model for character development, problem behavior prevention, and academic achievement enhancement. The Positive Action program consists of a school curriculum, together with schoolwide climate, family, and community components. As evaluated here, the yearly K-6 curriculum consists of over 140 fifteen-to-twenty-minute lessons per year delivered in school classrooms on an almost daily basis. The program is based on theories of self-concept, learning, behavior, and school ecology. We use a matched control design and school-level achievement and disciplinary data to evaluate program effects on student performance and behavior in two separate school districts. The program improved achievement by 16% in one district and 52% in another, and reduced disciplinary referrals by 78% in one district and 85% in the other. We discuss implications of these replicated findings for the prevention of substance abuse and violence, the improvement of school performance, and the reform of American schools. Author Affiliation: (1) Health Research and Policy Centers, School of Public Health, University of Illinois at Chicago, Illinois (2) Positive Action, Inc., Twin Falls, Idaho Article History: Registration Date: 10/10/2004

This article examines longitudinal smoking behavior patterns among adolescents. An analysis of epidemiological data reveal several distinct behavioral patterns which include rapid escalation to heavy smoking at a young age, a slow progression to moderate and light smoking, and stable smoking of less than two cigarettes a month

This article examines the effectiveness of substance abuse prevention programs that are included in the school curriculum and incorporate changes in the social environment. Findings indicate that although social environment changes from interventions like parent training or community programs can be effective, they add little benefit when combined with curriculum-based approaches.

This study provides a cross-sectional analysis of the relations between group self-identification and adolescent drug use in 3 samples of youth: comprehensive high-school, continuation high-school, and runaway/street youth. Youth identified with discrete groups in all 3 samples, and similar general groups were formed. In most comparisons, a high-risk group showed greater levels of drug use than did other groups. This is the first study to demonstrate that group self-identification (a) is a generalizable construct across different types of adolescent samples, (b) is related to use of drugs other than tobacco, and (c) remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables.

Objectives. This study identified behavioral and psychosocial/interpersonal factors in young adolescence that are associated with handgun carrying in later adolescence. Methods. A sample of 2200 high school students was surveyed at 9th grade and again at 12th grade. Results. Multivariate logistic regression analyses indicated that measures of risk-taking preference, depression, stress, temper, and drug use assessed while the students were in 9th grade were predictive of handgun carrying in 12th grade for both male and female students. Conclusions. These findings suggest the need for a comprehensive approach to prevention that focuses on both individual and interpersonal factors associated with adolescents' decision to carry a handgun. (Am J Public Health. 1998;88:960-963)

Research was conducted to examine the psychometric characteristics of the stage of readiness to change. The stage of readiness to change has been acknowledged as a valid independent measure of the transtheoretical model of health behavior change. A sample of 261 female smokers participated in a study to test the stability and reliability of the stage of readiness to change measure. Results suggest that the measure of stage of readiness to change has high levels of stability and reliability for the female smokers.

A unidimensional drug involvement model is used to determine the potential role of smokeless tobacco in drug abuse. The study, based on a sample of high school students, found that the smokeless tobacco place in the model's continuum is unstable. It was also found that the use of smokeless tobacco that fit in the model differs in relation to genders and ethnicity. Smokeless tobacco use, particularly among males, is found to be preceded by use of soft drugs and followed by use of hard drugs.

Methods are proposed and described for estimating the degree to which relations among variables vary at the individual level. As an example of the methods, M. Fishbein and I. Ajzen's (1975; I. Ajzen & M. Fishbein, 1980) theory of reasoned action is examined, which posits first that an individual's behavioral intentions are a function of 2 components: the individual's attitudes toward the behavior and the subjective norms as perceived by the individual. A second component of their theory is that individuals may weight these 2 components differently in assessing their behavioral intentions. This article illustrates the use of empirical Bayes methods based on a random-effects regression model to estimate these individual influences, estimating an individual's weighting of both of these components (attitudes toward the behavior and subjective norms) in relation to their behavioral intentions. This method can be used when an individual's behavioral intentions, subjective norms, and attitudes toward the behavior are all repeatedly measured. In this case, the empirical Bayes estimates are derived as a function of the data from the individual, strengthened by the overall sample data.

Research suggests that the onset of tobacco use (smokeless tobacco, cigarettes) in adolescents is associated with alcohol use, risk taking, and low self-esteem. A sample of 842 seventh grade boys and girls from south California who had not used tobacco were identified and surveyed a year later. Risk taking was more associated with initiation of tobacco use in females. Social influence is a bigger factor in initiation of smoking among boys.

This project assessed the impact of a school-based AIDS prevention program on student participation in sexual risk and protective behaviors such as use of condoms and use of condoms with foam and intention to participate in such behaviors. The paper focuses on students who became sexually active for the first time between the seventh and eighth grade ('changers,' n = 312). The school-based intervention was developed using social cognitive theory and the social influences model of behavior change. Using an experimental, longitudinal design, 15 high-risk school districts were divided randomly into two treatment (10 districts) and one control (five districts) conditions. Students in both treatment conditions received a 10-lesson classroom program in the seventh grade with a five-lesson booster in the eighth grade, while control students received basic AIDS education (current practice in their districts) in compliance with state mandates. Results indicated classroom programs had an impact on certain protective behaviors and on frequency of sexual activity the past month. Post-intervention measures also indicated the program affected students' intentions to perform specific protective behaviors. (J Sch Health. 1995;65(4):145-151), One major challenge in the battle to slow the spread of HIV, the pathogen that causes AIDS, involves reducing the risk behaviors in young adolescents. However, because the number of [...]

This article reviews 14 multivariate theories of experimental substance use (e.g., alcohol and marijuana use) among adolescents, including those theories that emphasize (a) substance-specific cognitions, (b) social learning processes, (c) commitment to conventional values and attachment to families, and (d) intrapersonal processes. Important similarities and differences among these theories are addressed, as are the conceptual boundaries of each theory. In an attempt to integrate existing theories, a framework is proposed that organizes their central constructs into 3 distinct types of influence (viz., social, attitudinal, and intrapersonal) and 3 distinct levels of influence (viz., proximal, distal, and ultimate). Implications for future theory development are discussed.

This paper examines levels of participation in and correlates of AIDS-related risk behavior for young adolescents in high-risk communities as determined by proxy indicators such as rates of reported STDs and adolescent pregnancies. Seventh and eighth grade students from two middle schools and ninth grade students from the receiving high school were surveyed. Descriptive and inferential techniques examined grade, racial, behavioral, and gender differences in participation in risk (substance use and sexual activity) and protective (use of condoms and use of condoms and foam) behaviors. Grade, race, and sexual activity were significant correlates of both licit and illicit drug use. Gender, grade, race, and licit and illicit drug use were significant correlates of sexual activity. Results demonstrate that not only are adults and older teens at risk in these communities, but younger adolescents also are at risk. Findings indicate a need for comprehensive HIV prevention programs at younger ages. (J Sch Health. 1995;65(1):28-32), A compelling case has been made by researchers and health care providers that adolescents are a major risk group for transmission and spread of the human immunodeficiency virus (HIV).[1-4] Although [...]

Smoking-related behaviors and attitudes of significant others (especially friends and parents) are among the most consistent predictors of adolescent smoking. However, theorists remain divided on whether the behaviors of significant others influence adolescent smoking directly or indirectly, and the relative influence of parental and peer smoking on adolescents' own smoking is still a matter of debate. In addition, little research has examined the role of significant others' behavior on different stages of smoking onset. In particular, not much information is available regarding gender and ethnic differences in social influences on smoking behavior. We use structural equatio modeling to address these issues. Different theoretical perspectives from cognitive-affective theories (Ajzen 1985; Ajzen and Fishbein 1980) and social learning theories (Akers et al. 1979; Bandura 1969, 1982, 1986) have been integrated into a structural model of smoking influence. The results show that friends' smoking affects adolescent initiation into smoking both directly and indirectly, whereas parental smoking influences smoking initiation only indirectly. The data also show that friends' and parents' smoking affect smokin escalation only indirectly. In general, friends' smoking has a stronger effect on adolescents' smoking behavior, particularly on initiation. Multiple group comparisons of the structural models predicting smoking initiation among males and females reveal that parental approval of smoking plays a significant mediating role for females, but not for males. Comparisons of Whites, Blacks, Hispanics, and other ethnic groups reveal that there are some significant differences in the pathways of friends' influences among the four groups.

A one-year study of longitudinal relations between self-identification and adolescent smoking suggests that group self-identification predicts smoking and is more than a substitute for other psychosocial variables. Examination of six types of peer groups shows that seventh-grade group self-identification foretells eighth-grade cigarette smoking, while seventh-grade smoking does not predict eighth-grade group self-identification.

A random-effects regression model is proposed for analysis of clustered data. Unlike ordinary regression analysis of clustered data, random-effects regression models do not assume that each observation is independent but do assume that data within clusters are dependent to some degree. The degree of this dependency is estimated along with estimates of the usual model parameters, thus adjusting these effects for the dependency resulting from the clustering of the data. A maximum marginal likelihood solution is described, and available statistical software for the model is discussed. An analysis of a dataset in which students are clustered within classrooms and schools is used to illustrate features of random-effects regression analysis, relative to both individual-level analysis that ignores the clustering of the data, and classroom-level analysis that aggregates the individual data.

Objectives. We present 1-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of three main components of social influence programs. The components teach refusal skills, awareness of social misperceptions about tobacco use, and misconceptions about physical consequences. Methods. Four different curricula were developed and tested in a randomized experiment involving 48 junior high schools. The outcome variables examined were changes in initial and weekly cigarette and smokeless tobacco use 1 year after the intervention. Results. Analyses indicated that each of the component programs were effective in decreasing both the initial and the weekly use of cigarettes except for the curriculum in which refusal skills were taught. Also, each curriculum was effective in decreasing the initial use of smokeless tobacco except for the one aimed at correcting social misperceptions. Only the combined curriculum showed an effect on the weekly use of smokeless tobacco. Conclusions. The combined intervention was the most effective overall in reducing the initial and weekly use of cigarettes and smokeless tobacco. This suggests that different reasons for use exist and need to be counteracted simultaneously. However, since single programs were also effective in reducing all but weekly smokeless tobacco use, any of these components may be worthwhile prevention tools. (Am J Public Health. 1993;83:1245-1250), Among junior high school students, tobacco prevention programs work, but some programs work better than others. A study involving 6,716 7th graders in 27 southern California school districts tested the effects of four different tobacco program curricula. After one year, participants were evaluated against four measures of behavioral change, two measuring the change in prevalence of attempting cigarette or smokeless tobacco and two measuring the change in weekly use of both products. The study found that cigarette use among this group did not differ by gender. However, more males both tried and used smokeless tobacco. Also, more rural students than urban students tried both cigarettes and smokeless tobacco. Weekly use of both products did not differ among urban and rural students. Regarding the curricula, the study also found that emphasizing physical consequences was as important as counteracting social influences; combatting peer pressure worked better against smokeless tobacco than against cigarettes; and that tobacco use school-based curricula can work equally well against both products.

It is estimated that from 2 to 6 million children under the age of 13 have no after-school adult supervision, so they essentially care for themselves. The majority of these children are adolescents. In a survey of almost 4,000 ninth-graders, a relationship was noted between unsupervised after-school care and an increased incidence of cigarette, alcohol and marijuana use, depression, risk-taking and poorer school performance. Problem behavior occurred less among those who were supervised at home than among those who were unsupervised, but it increased among adolescents at a neighbor's home, at school or on the a job. Those who "hung out" were especially likely to exhibit problem behavior. Girls who were supervised were less likely to engage in problem behavior than boys, but removal of supervision led to behavior problems for them as well., Objective. To examine the relationship between parental monitoring and six negative behaviors: cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Design. Survey of 3993 ninth-grade students in six school districts in southern California. Subjects. The sample consisted of 1930 boys and 2063 girls, self-classified as non-Hispanic white (32%), African-American (13%), Hispanic (46%), or Asian (9%). Results. A relationship was found between unsupervised care after school and susceptibility to cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Adolescents who were unsupervised at home were slightly more likely to engage in problem behavior than those who were supervised at home. Adolescents at a neighbor's house, at school, or at a job and especially those who -hang out- were most likely to engage in problem behavior. Risk was higher if the parent had an unengaged parenting style. Although girls were less likely than boys to engage in problem behavior when supervised, as supervision decreased they were significantly more likely to have each of these problems. Family structure had little impact on risk. Conclusions. Self-care, especially when it occurs outside of the home, is associated with substance use, risk taking, depressed mood, and lower academic grades. Pediatrics 1993;92:32-38; after-school care, alcohol, marijuana, smoking, cigarettes, depression, risk-taking behavior, academic performance, adolescence.

Adolescents tend to categorize themselves and their peers into discrete ingroups and outgroups. A comparison of ingroup versus outgroup perceptions of the characteristics of high-risk youth was investigated. Based on current stereotype research, we examined the perspective that outgroup members would hold a more extreme stereotype of high-risk youth compared to the perceptions of ingroup members. A total of 955 7th- and 10th-grade southern California adolescents completed a questionnaire regarding the characteristics of their own peer group and a high-risk group. Support was obtained for an extremity of judgement effect. Outgroup youth perceived that their high-risk peers engaged in fewer school and nonschool low-risk activities, more high-risk activities, and greater drug use than did ingroup members. Outgroup members also held perceptions of high-risk youth as less likely to hold a white-collar job than did the ingroup members. The perceptions that adolescents have of these groups may play major roles in their own social behavior. The implications of these results for future tobacco use prevention programs are considered.

Objectives. As smoking decreases in the population, the remaining smoking population will change, and cessation initiatives will have to incorporate strategies designed for these smokers. Methods. To study patterns of response to a cessation intervention composed of 20 televised segments and the American Lung Association Freedom from Smoking in 20 Days manual, this study compared cessation rates over 24 months in a cohort of smokers who registered for a cessation program with those in a cohort selected from the smoking population at large. Results. At post intervention, multiple point prevalence of cessation among participants, adjusted for baseline smoking, was 14% among registrants and 6% in the population; at 24 months the adjusted rates were 6% and 2%, respectively. Heavy smokers benefited more than light smokers, and there was a consistent dose-response relationship between extent of exposure to the intervention and cessation. Conclusion. The effects of the intervention were strongest for those who read the manual and watched the programs daily. Manual use was important, and those who did not read it did not appear to benefit. Compared to the population and given full participation, heavy smokers benefited more than lighter smokers. (Am J Public Health. 1992;82; 835-840)

The relationship between cigarette smoking and peer-group affiliation among 340 seventh-grade and 615 tenth-grade boys and girls of mixed ethnic backgrounds was examined. Students completed a lengthy questionnaire to assess current and past tobacco or smokeless tobacco use, as well as personality and peer-group traits. They were assigned to one of five groups: hot-shots, regulars, jocks, dirts, or skaters. Hot-shots were popular academic or social leaders who had moderate ratings in risk-taking and self-esteem. Regulars were typical teens who scored low in risk-taking and high in self-esteem. Jocks were very interested in team and individual sport activities and had moderately low scores on measures of self-esteem and risk-taking. Dirts demonstrated problem behaviors such as smoking, drinking, poor grades and high risk-taking, and had the lowest ratings of self-esteem. Skaters tended to be risk-takers and interested in outdoor activities. Like the dirts, they had low self-esteem and low grade point averages, but they did not use alcohol or drugs. More girls than boys were in the regular (63 percent) and hot-shot groups (66 percent). More boys (72 percent) were jocks. Fifty-one percent of the dirts were girls. Most skaters (68 percent) were boys. Data analysis revealed that the dirts had the highest percentage of current tobacco use; skaters ranked second and regulars ranked third. Hot-shots had the lowest percentage of current use. Although the jocks, dirts and skaters rated high in having tried smokeless tobacco, the skaters ranked highest in current use, while the dirts ranked second highest. Patterns of smoking among the groups were not related to age, ethnicity or gender. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study investigated the moderating influence of expectancy accessibility on the relation between outcome expectancies and drug use intentions. Specifically, it was hypothesized that expectancies made temporarily more accessible would predict smokeless tobacco intentions to a greater degree than would less accessible expectancies. In addition, it was anticipated that expectancies regarding positive outcomes of smokeless tobacco use would be better predictors of intention than would expectancies about negative outcomes. Results partially supported the accessibility hypothesis, but this effect occurred for positive outcome expectancies only. In addition, the anticipated prepotency of positive over negative expectancies in predicting drug use intentions was strongly supported. These findings are consistent with theories of problem behavior which differentiate between positive and negative outcome expectancies and which postulate that accessibility of expectancies plays an important role in expectancy-behavior relations.

The smoking habits of first year college students is analyzed.