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Early adolescent girls' rates of drug use have matched, and in some instances, surpassed boys' rates. Though girls and boys share risk factors for drug use, girls also have gender-specific risks. Tailored interventions to prevent girls' drug use are warranted. This study developed and tested a web-based, drug abuse prevention program for adolescent girls. The nationwide sample of 13- and 14-year-old girls (N = 788) was recruited via Facebook ads. Enrolled girls were randomly assigned to the intervention or control condition. All girls completed pretest measures online. Following pretest, intervention girls interacted with the 9-session, gender-specific prevention program online. The program aimed to reduce girls' drug use and associated risk factors by improving their cognitive and behavioral skills around such areas as coping with stress, managing mood, maintaining a healthy body image, and refusing drug use offers. Girls in both conditions again completed measures at posttest and 1-year follow-up. At posttest, and compared to girls in the control condition, girls who received the intervention smoked fewer cigarettes and reported higher self-esteem, goal setting, media literacy, and self-efficacy. At 1-year follow-up, and compared to girls in the control condition, girls who received the intervention reported engaging in less binge drinking and cigarette smoking; girls assigned to the intervention condition also had higher alcohol, cigarette, and marijuana refusal skills, coping skills, and media literacy and lower rates of peer drug use. This study's findings support the use of tailored, online drug abuse prevention programming for early adolescent girls.

Introduction: Clinical trials require sufficient samples recruited within limited time and budget constraints. Trials with minors are additionally burdened by the requirement for youth assent and parental permission. This paper details the use of Facebook ads and traditional paper mailings to enroll 797 adolescent girls for a longitudinal, web-based, drug abuse prevention trial. Data on sample representativeness and retention are also provided., Methods: Facebook ads appeared on the pages of females aged 13 or 14years who reside in the U.S. Ads linked girls to a recruitment website. Girls who wanted more information submitted contact information and were mailed information packets to their homes containing, among other things, youth assent and parent permission forms. Returned forms were verified for accuracy and validity., Results: The Facebook ad campaign reached 2,267,848 girls and had a unique click-through rate of 3.0%. The campaign cost $41,202.37 with an average cost of $51.70 per enrolled girl. Information packets were mailed to 1,873 girls. Approximately one-half of girls returned the forms, and 797 girls were enrolled. The Facebook campaign's success varied by ad type, month, and day of the week. Baseline data revealed comparability to national data on demographic and substance use variables., Conclusions: Results suggest that Facebook ads provide a useful initial point of access to unparalleled numbers of adolescents. Clinical trials may benefit from a two-fold recruitment strategy that uses online ads to attract interested adolescents followed by traditional recruitment methods to communicate detailed information to adolescents and parents., Competing Interests: All other authors declare that they have no conflicts of interest., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Despite overall reductions in teenage substance use, adolescent girls' rates of substance use remain unacceptably high. This article examines whether girls' substance use is associated with general risk and protective factors (goal setting, problem solving, refusal skills, peer use, and self-efficacy) and gender-specific risk and protective factors (communication style, coping skills, self-esteem, body image, perceived stress, anxiety, and depression)., Methods: Cross-sectional data were collected in 2013 via online surveys from a nationwide sample of adolescent girls (N = 788), aged 13 and 14 years, who were recruited through Facebook., Results: In multivariate analyses, controlling for correlates of adolescent substance use, 11 of the 13 general and gender-specific risk and protective factors were consistently associated with past-month alcohol, cigarette, and other drug use in the expected direction; past-month marijuana use was associated with 8 of the 13 factors. Refusal skills, peer use, coping, and depressive mood were most consistently and strongly associated with substance use., Conclusions: Substance abuse prevention programs targeting adolescent girls should focus on such general risk and protective factors as problem solving, refusal skills, peer influences, and self-efficacy, as well as such gender-specific risk and protective factors as communication style, coping, self-esteem, body image, perceived stress, and mood management.

Intervention research is essential to help Hispanic American adolescents avoid drug use. This article describes an intervention research program aimed at preventing drug use among these youths. Grounded in salient epidemiological data, the program is informed by bicultural competence, social learning, and motivational interviewing theories. The program, called Vamos, is aimed at the risk and protective factors as well as the cultural prerogatives that demark the adolescent years of Hispanic American youths. Innovative in its approach, the program is delivered through a smartphone application (app). By interacting with engaging content presented via the app, youths can acquire the cognitive-behavioral skills necessary to avoid risky situations, urges, and pressures associated with early drug use. The intervention development process is presented in detail, and an evaluation plan to determine the program's efficacy is outlined. Lessons for practice and intervention programming are discussed.

In this paper, we examined the mediation effects of a family-based substance use prevention program on a sample of Asian American families. These families were randomized into an intervention arm or a non-intervention control arm. Using path models, we assessed the effect of the intervention on adolescent girls' substance use outcomes at 2-year follow-up through family relationships and adolescent self-efficacy pathways. Bias-corrected bootstrapping strategy was employed to assess the significance of the mediation effect by evaluating the 95% confidence interval of the standardized coefficient. The results show that receiving the intervention exerted a positive effect on girls' family relationships at 1-year follow-up. Such an improvement was associated with girls' increased self-efficacy, which in turn led to girls' decreased alcohol use, marijuana use, and future intention to use substances at 2-year follow-up. Considering the diverse cultural backgrounds, as well as languages, nationalities, and acculturation levels under the umbrella term "Asian Americans", we demonstrate that a universal web-based intervention that tackles the theoretical- and empirical-based risk and protective factors can be effective for Asian Americans. Despite its generic nature, our program may provide relevant tools for Asian American parents in assisting their adolescent children to navigate through the developmental stage and ultimately, resist substance use.

Peer and parent influences on alcohol use and related risky behaviors were examined in a sample of late adolescent ( M = 17.3 years; SD = 1.11 years) urban youth. Participants ( N = 400) completed an online measure assessing peer influences of alcohol use and alcohol offers, and parent influences of rules against alcohol use and perceived levels of emotional family support, relative to youths' alcohol use, binge drinking, alcohol-related consequences, and intentions to drink. Hierarchical regression analyses revealed that increased peer alcohol use and alcohol offers were associated with youths' increased drinking, binge drinking, alcohol-related consequences, and intentions to drink. Controlling for peer influences, parental rules against alcohol use were associated with decreased drinking, binge drinking, and intentions to drink; increased levels of family support was associated with decreased alcohol-related consequences and intentions to drink. These findings suggest that parental influences, albeit small relative to peer influences, are associated with fewer instances of monthly alcohol use and related risky behaviors among late adolescent urban youth.

Asian Americans have been largely ignored in the prevention outcome literature. In this study, we tested a parent-child program with a sample of Asian American adolescent girls and their mothers, and evaluated the program's efficacy on decreasing girls' substance use and modifying risk and protective factors at individual, family, and peer levels. A total of 108 Asian American mother-daughter dyads recruited through online advertisements and from community service agencies were randomly assigned to an intervention arm (n = 56) or to a test-only control arm (n = 52). The intervention consisted of a nine-session substance abuse prevention program, delivered entirely online. Guided by family interaction theory, the prevention program aimed to strengthen the quality of girls' relationships with their mothers while increasing girls' resilience to resist substance use. Intent-to-treat analyses showed that at 2-year follow-up, intervention-arm dyads had significantly higher levels of mother-daughter closeness, mother-daughter communication, maternal monitoring, and family rules against substance use compared with the control-arm dyads. Intervention-arm girls also showed sustained improvement in self-efficacy and refusal skills and had lower intentions to use substances in the future. Most important, intervention-arm girls reported fewer instances of alcohol and marijuana use and prescription drug misuse relative to the control-arm girls. The study suggests that a culturally generic, family-based prevention program was efficacious in enhancing parent-child relationships, improving girls' resiliency, and preventing substance use behaviors among Asian American girls., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Confronting developmental tasks and challenges associated with bridging two different cultures, Asian American adolescent girls face increasing risks for substance use. Identifying risk and protective factors in this population is essential, particularly when those factors can inform preventive programs. Guided by family interaction theory, the present cross-sectional study explored the associations of psychological and familial factors with use of alcohol, prescription drugs, and other drugs among early-adolescent Asian American girls. Between August 2007 and March 2008, 135 pairs of Asian American girls (mean age 13.21 years, SD=0.90) and their mothers (mean age 39.86 years, SD=6.99) were recruited from 19 states that had significant Asian populations. Girls and mothers each completed an online survey. Relative to girls who did not use substances, girls who did had higher levels of depressive symptoms, perceived peer substance use, and maternal substance use. Multiple logistic regression modeling revealed that they also had significantly lower levels of body satisfaction, problem-solving ability, parental monitoring, mother-daughter communication, family involvement, and family rules about substance use. Household composition, acculturation, and academic achievement were not associated with girls' substance use. These findings point to directions for substance abuse prevention programming among Asian American girls.

Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and (c) state-of-the art techniques are used to summarize the body of evidence on the effects of the interventions. Under real-world demands it is often not feasible to wait for multiple replications to accumulate before making decisions about intervention adoption. To help individuals and agencies make better decisions about intervention utility, we outline strategies that can be used to help understand the likely direction, size, and range of intervention effects as suggested by the current knowledge base. We also suggest structural changes that could increase the amount and quality of replication research, such as the provision of incentives and a more vigorous pursuit of prospective research registers. Finally, we discuss methods for integrating replications into the roll-out of a program and suggest that strong partnerships with local decision makers are a key component of success in replication research. Our hope is that this paper can highlight the importance of replication and stimulate more discussion of the important elements of the replication process. We are confident that, armed with more and better replications and state-of-the-art review methods, prevention science will be in a better position to positively impact public health.

Underage drinking among Asian American adolescent girls is not well understood. Based on family interaction theory, the study examined the interrelationships among acculturation variables, family relationships, girls' depressed mood, peer alcohol use, and girls' alcohol use in a sample of 130 Asian American mother-daughter dyads. The mediating role of family relationships, girls' depressed mood, and peer alcohol use on girls' drinking was also assessed. The study advances knowledge related to alcohol use among early Asian American adolescent girls, highlights the effect of immigrant generation status and family relationships, and has implications for culturally specific underage drinking prevention programs.

This 2008 study involved 546 Black and Hispanic American adolescent girls and their mothers from New York, New Jersey, and Connecticut. Participants provided self-report data. Analysis of covariance indicated that the experimental intervention reduced risk factors, improved protective factors, and lowered girls' alcohol use and their future intentions to use substances. The study supports the value of computer-based and gender-specific interventions that involve girls and their mothers. Future work needs to replicate and strengthen study results.

Purpose: This study examined the efficacy and generalizability of a family-oriented, web-based substance use prevention program to young Asian-American adolescent girls., Methods: Between September and December 2007, a total of 108 Asian-American girls aged 10-14 years and their mothers were recruited through online advertisements and from community service agencies. Mother-daughter dyads were randomly assigned to an intervention arm or to a test-only control arm. After pretest measurement, intervention-arm dyads completed a 9-session web-based substance use prevention program. Guided by family interaction theory, the program aimed to improve girls' psychological states, strengthen substance use prevention skills, increase mother-daughter interactions, enhance maternal monitoring, and prevent girls' substance use. Study outcomes were assessed using generalized estimating equations., Results: At posttest, relative to control-arm girls, intervention-arm girls showed less depressed mood; reported improved self-efficacy and refusal skills; had higher levels of mother-daughter closeness, mother-daughter communication, and maternal monitoring; and reported more family rules against substance use. Intervention-arm girls also reported fewer instances of alcohol, marijuana, and illicit prescription drug use, and expressed lower intentions to use substances in the future., Conclusions: A family-oriented, web-based substance use prevention program was efficacious in preventing substance use behavior among early Asian-American adolescent girls., (Copyright © 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: This study was undertaken to evaluate the efficacy of a skills-based CD-ROM intervention, with and without a parent component, to reduce alcohol use among urban youth at 6-year follow-up., Method: At recruitment, 513 youths with a mean age of 10.8 years were randomly assigned to one of three study arms: youth CD-ROM intervention plus parent component, youth CD-ROM intervention only, or control. All youths completed pretest, posttest, and annual follow-up measures. Youths and parents in their respective arms received the initial intervention program between pretest and posttest measures and received booster interventions between each follow-up measure., Results: With 80% sample retention at 6-year follow-up, youths in both intervention arms reported less past-month alcohol and cigarette use and fewer instances of heavy drinking and negative alcohol-related consequences. Despite having similar numbers of drinking peers as youths in the control arm, youths in both intervention arms reported greater alcohol-refusal skills. Only past-month cigarette use differed between the two intervention arms, with youths in the intervention-plus-parent-component arm smoking less than youths in the CD-ROM intervention-only arm., Conclusions: Six years after initial intervention, youths who received a culturally tailored, skills-based prevention program had reduced alcohol use and lower rates of related risky behaviors than youths in the control arm.

Purpose: This randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths., Methods: Study participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CD(P)), and control. Once all youths completed baseline measures, those in CD and CD(P) arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CD(P) arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD- and CD(P)-arm participants received annual booster intervention sessions., Results: Seven years following postintervention testing and relative to control-arm youths, youths in CD and CD(P) arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CD(P) arms., Conclusions: Study findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking., (Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.)

This study developed and tested an Internet-based gender-specific drug abuse prevention program for adolescent girls. A sample of seventh, eighth, and ninth grade girls (N = 236) from 42 states and 4 Canadian provinces were randomly assigned to an intervention or control group. All girls completed an online pretest battery. Following pretest, intervention girls interacted with a 12-session, Internet-based gender-specific drug prevention program. Girls in both groups completed the measurement battery at posttest and 6-month follow-up. Analysis of posttest scores revealed no differences between groups for 30-day reports of alcohol, marijuana, poly drug use, or total substance use (alcohol and drugs). At 6-month follow-up, between-group effects were found on measures of 30-day alcohol use, marijuana use, poly drug use, and total substance use. Relative to girls in the control group, girls exposed to the Internet-based intervention reported lower rates of use for these substances. Moreover, girls receiving the intervention achieved gains over girls in the control group on normative beliefs and self-efficacy at posttest and 6-month follow-up, respectively.

This paper explores gender and mental health influences on alcohol, tobacco, and illicit drug use among late adolescent urban youths. Specifically, we examine whether rates of substance use differ by gender, whether mental health indices differ by gender and are predictive of substance use, and whether gender moderates the relationship between mental health and substance use. Data from our non-clinical sample of 400 youths were collected primarily online. Analysis of cross-sectional data revealed no differences in substance use by gender. Indices of mental health differed by gender, with girls reporting greater symptoms of depression and anxiety. Ratings of hostility were similar for boys and girls. Alcohol, tobacco, and drug use were associated with greater symptoms of depression, anxiety, and hostility; this relationship, however, was not moderated by gender. Study findings provide evidence that among late adolescent youths living in urban areas, poorer mental health status is associated with increased substance use. Evidence of a moderating effect of gender on the relationship between mental health and substance use was not significant.

This study tested a computerized gender-specific, parent-involvement intervention program grounded in family interaction theory and aimed at preventing substance use among adolescent girls. Following program delivery and 1 year later, girls randomly assigned to the intervention arm improved more than girls in a control arm on variables associated with reduced risks for substance use, including communication with their mothers, knowledge of family rules about substance use, awareness of parental monitoring of their discretionary time, non-acceptance of peer substance use, problem-solving skills, and ability to refuse peer pressure to use substances. Relative to control-arm girls, those in the intervention arm also reported less 30-day use of alcohol and marijuana and lower intentions to smoke, drink, and take illicit drugs in the future. Girls' mothers in the intervention arm reported greater improvements after the program and relative to control-arm mothers in their communication with their daughters, establishment of family rules about substance use, and monitoring of their daughters' discretionary time. Study findings lend support to the potential of gender-specific, parent-involvement, and computerized approaches to preventing substance use among adolescent girls.

Guided by family interaction theory, this study examined the influences of psychological, peer, and familial processes on alcohol use among young adolescent girls and assessed the contributions of familial factors. An ethnically diverse sample of 1,187 pairs of girls (M age = 12.83 years), and their mothers completed surveys online. Questionnaires assessed girls' lifetime and recent alcohol use, as well as girls' demographic, psychological, peer, and family characteristics. Hierarchical logistic regression models showed that although girls' drinking was associated with a number of psychological and peer factors, the contributions of family domain variables to girls' drinking were above and beyond that of psychological and peer factors. The interaction analyses further highlighted that having family rules, high family involvement, and greater family communication may offset risks in psychological and peer domains. Study findings underscore the multifaceted etiology of drinking among young adolescent girls and assert the crucial roles of familial processes. Prevention programs should be integrative, target processes at multiple domains, and include work with parents., (Copyright 2009 APA)

Objective: To test a computer-delivered program for preventing substance use among adolescent girls., Methods: Randomly, 916 girls aged 12.76+/-1.0 years and their mothers were assigned to an intervention arm or to a test-only control arm. Intervention-arm dyads engaged in exercises to improve the mother-daughter relationship, build girls' substance use prevention skills, and reduce associated risk factors. Study outcomes were girls' and mothers' substance use and mediator variables related to girls' substance use risk and protective factors. The study was conducted between September 2006 and February 2009 with participants from greater New York City, including southern Connecticut and eastern New Jersey., Results: At 2-year follow-up and relative to control-arm girls, intervention-arm girls reported lower relevant risk factors and higher protective factors as well as less past 30-day use of alcohol (p<0.006), marijuana (p<0.016), illicit prescription drugs (p<0.03), and inhalants (p<0.024). Intervention-arm mothers showed more positive 2-year outcomes than control-arm mothers on variables linked with reduced risks of substance use among their daughters, and mothers reported lower rates of weekly alcohol consumption (p<0.0001)., Conclusions: A computer-delivered prevention program for adolescent girls and their mothers was effective in changing girls' risk and protective factors and girls' and mothers' substance use behavior.

Objective: This study evaluated a gender-specific, computer-mediated intervention program to prevent underage drinking among early adolescent girls., Method: Study participants were adolescent girls and their mothers from New York, New Jersey, and Connecticut. Participants completed pretests online and were randomly divided between intervention and control arms. Intervention-arm girls and their mothers interacted with a computer program aimed to enhance mother-daughter relationships and to teach girls skills for managing conflict, resisting media influences, refusing alcohol and drugs, and correcting peer norms about underage drinking, smoking, and drug use. After intervention, all participants (control and intervention) completed posttest and follow-up measurements., Results: Two months following program delivery and relative to control-arm participants, intervention-arm girls and mothers had improved their mother-daughter communication skills and their perceptions and applications of parental monitoring and rule-setting relative to girls' alcohol use. Also at follow-up, intervention-arm girls had improved their conflict management and alcohol use-refusal skills; reported healthier normative beliefs about underage drinking; demonstrated greater self-efficacy about their ability to avoid underage drinking; reported less alcohol consumption in the past 7 days, 30 days, and year; and expressed lower intentions to drink as adults., Conclusions: Study findings modestly support the viability of a mother-daughter, computer-mediated program to prevent underage drinking among adolescent girls. The data have implications for the further development of gender-specific approaches to combat increases in alcohol and other substance use among American girls.

Objective: To examine correlates of sexual experimentation and risk among urban, early adolescent girls (N=236, 12.38+/-1.2 years)., Methods: Measures of HIV risk-related attitudes, interpersonal influences, and intentions were compared based on girls' degree of sexual experimentation and risk., Results: Girls in high sexual experimentation and risk groups scored highest on deviant peer norms; endorsements of risky behaviors; and inability to refuse unprotected sex, offset negative partner influences, avoid intercourse, and assert sexual desires. Greater experimentation occurred among girls with older versus same-age or younger partners., Conclusions: Risk correlates should be considered in designing HIV prevention programs.

Disquieting rates of alcohol and drug use among adolescent girls call for original research on gender-specific risk and protective factors for substance use. Particularly salient are data on theory-driven factors that can inform prevention programming. Surveying 781 adolescent girls and their mothers, we found relationships between girls' use of alcohol, prescription drugs, and inhalants and girls' after-school destinations, body images, depression, best friend's substance use, maternal drinking behavior, mother-daughter interactions, and family norms surrounding substance use. Study findings have implications for the design of responsive gender-specific prevention programs.

Using measures of behaviors shown to predict low-fat intake in previous research, this study examined whether the behaviors would predict low-fat intake among urban African American adolescents. Recruited through youth services agencies in Philadelphia, Pa, participants were 399 African American adolescents (67% female subjects) with a mean age of 13.09 years (range, 10-15 years). Fat-related dietary behaviors were measured using items that were adapted from the Food Habits Questionnaire. Fat intake was measured using the Block Fat Screener. Spearman correlations examined the relationships between fat-related dietary behaviors and fat intake. Seven behaviors were significantly associated with low-fat intake: had chicken that was baked or broiled instead of fried; ordered pasta or pizza served without meat sauce or meat toppings; had a vegetarian dinner; used low-calorie instead of regular salad dressing; ate at least 2 vegetables (not green salad) at dinner; ate bread, rolls, or muffins without butter or margarine; and avoided foods that were fried in oil, shortening, or lard. Using multiple regression, fat intake was regressed on the linear combination of demographic variables and these fat-related dietary behaviors. The regression equation accounted for 17% of the variance in fat intake (adjusted R(2) = 0.13). Fat avoidance (ate bread, rolls, or muffins without butter or margarine) and replacement (ordered pasta or pizza served without meat sauce or meat toppings) behaviors were significant predictors of low-fat intake. Dietary interventions to lower fat intake among urban African American adolescents should promote the adoption of these behaviors.

This study examined commonly consumed high-fat food sources to estimate dietary fat intake among 314 urban, African American adolescents (mean age (SD)=12.57 (.98) years; 66% female; 91% African American non-Hispanic; and 9% African American Hispanic). Youths' fat intake was measured using the Block Fat Screener. Most (77%) participants had diets very high in fat (i.e., 40% to 50% of energy). Mean frequencies of consumption revealed youths' preferences for the following high-fat food items: corn chips, potato chips, popcorn, and crackers; fried chicken; and doughnuts, pastries, cake, and cookies. Total fat intake differed based on youths' age. Urban, African American adolescents can benefit from intervention to lower their fat intake. Programs that target and address the food preferences and eating habits of this population are clearly needed.

This study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls. Intervention effects were examined in a randomized, pretest-posttest wait-list control-group design. Changes in HIV/AIDS knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors were tested using linear regression models that were controlled for baseline values of each outcome. Recruited through youth services agencies located in the greater New York City area, study participants comprised 204 adolescent girls aged 11-14 years. Girls exposed to Keepin' It Safe, relative to wait-list control girls, increased their HIV/AIDS knowledge, perceived efficacy and enjoyment of abstinence, perceived efficacy and enjoyment of condoms, and sexual assertiveness, suggesting that a theory-based, gender-specific, CD-ROM-mediated HIV prevention program can enhance knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors among urban early-adolescent girls.

Objective: Complementary alternative medicine use among Asian Americans is widespread, yet poorly understood. This study explored its use among Chinese Americans reporting mental health symptoms., Methods: A cross-sectional survey determined the prevalence and correlates of complementary alternative medicine use in an urban sample seen at a community mental health service., Results: Out of 153 Chinese-American patients, 126 (82%) reported current use of complementary therapies (megavitamin therapy, 46%; herbal medicine, 43%; massage, acupuncture, and spiritual healing, about 25% each). Compared with nonusers, users were older, female, employed, less well functioning physically, and less acculturated., Conclusions: Growing immigrant populations and increasing mental health services consumption by members of ethnic-racial groups in the United States call for more attention to complementary alternative medicine use and its potential to aid conventional medical and mental services delivery.

The criterion validity of a prototype version of the Healthy Eating Self-monitoring Tool (HEST), a computer-mediated food record for assessing fruit and vegetable consumption among economically disadvantaged black adolescents, was examined. A qualitative design employing focus group methodology gathered data for informing the design of the HEST (n=32) and the selection of screens for inclusion in the measure (n=6). The criterion validity of the HEST was examined in a cross-sectional design (n=60) using direct observation of intake as the validation standard. Pearson correlations and paired-samples t tests compared mean observed and mean HEST-recorded servings of fruits and vegetables measured over three consecutive meals. Correlations were significant for seven of the nine HEST items, ranging from r=0.41 (P<0.01) to r=0.65 (P<0.001); for the overall measure, the correlation was r=0.51 (P<0.001). Paired-samples t tests confirmed the absence of differences between observed and recorded intake for approximately half of the HEST items. The HEST offers a viable alternative to traditional paper-and-pencil food records. With further development and validation, the HEST can be used to measure fruit and vegetable consumption among economically disadvantaged black adolescents.

Purpose: To examine the application of the transtheoretical model (TTM) to fruit and vegetable consumption among economically disadvantaged African-American adolescents., Methods: Scales for measuring decisional balance, situational self-efficacy, and processes of change for fruit and vegetable consumption were developed and pretested with 57 economically disadvantaged African-American adolescents. The scales and measures for assessing stages of change, demographic variables, and fruit and vegetable consumption were administered to a separate sample of 262 participants. t-tests for independent samples and analysis of variance were used to examine differences in TTM variables and fruit and vegetable consumption across stages of change., Results: Two-factor solutions for decisional balance and processes of change and a three-factor solution for situational self-efficacy provided the best fit to the data. Alpha coefficients of reliability for the scales ranged from .77 (experiential change processes) to .91 (pros). Participants in action-maintenance stages evidenced higher pros, self-efficacy, and fruit and vegetable consumption and significantly lower cons than did participants in precontemplation and contemplation-preparation stages. Also, participants in action-maintenance stages used processes of change more frequently than did those in precontemplation-contemplation-preparation stages. The use of experiential and behavioral processes within these stages did not differ significantly, as posited., Discussion: Observed differences in TTM variables and fruit and vegetable consumption by stage of change in this sample of economically disadvantaged African-American adolescents were consistent with theory and previous applications of the model to fruit and vegetable consumption in adults. With replication studies, the TTM may be appropriate for designing interventions to increase fruit and vegetable consumption among this population.

Objective: A leading cause of morbidity and mortality among Native Americans, cancer is largely preventable through lifestyle habits. Ranked high among those habits is a diet low in fat and high in fiber, fruits, and vegetables. Because Native Americans are not included in national nutritional monitoring systems, limited data exist on the cancer-related dietary habits of this population. To bridge this gap, this study measured the eating patterns of Native American youths in the northeastern United States., Design: Cross-sectional., Setting: Urban Indian centers and tribal and reservation settings located in New York, Massachusetts, Connecticut, Vermont, and Maine., Participants: 191 self-identified Native American parents of children between 8 and 14 years of age., Main Outcome Measures: Frequency of intake of foods recommended for inclusion in or omission from a diet to reduce cancer risk., Results: Dietary patterns among Native American youths differed from a national US sample and varied between youths in reservation and non-reservation settings., Conclusions: A need exists for nutrition education and behavior change programs that reflect the culturally specific eating habits of the indigenous peoples of the Northeast. Ideally, developing nutrition curricula for specific communities will be done in cooperation with these communities and acknowledge barriers that may limit Native Americans' access to healthful foods.

SUMMARYThis study examined the feasibility of a CD-ROM intervention to prevent alcohol abuse among high-risk youths. Youths from 41 community-based agencies in greater New York City participated in a randomized trial of a skills-based interactive CD-ROM. Outcome data were collected on 489 early adolescents in these agencies before and after a randomized subset of youths interacted with a 10-session alcohol abuse prevention program on CD-ROM. Compared to control participants, youths in the intervention arm had a positive increase in perceived harm of alcohol use and increased assertiveness skills. At posttest, drinking rates for control and intervention participants were equal and unchanged from pretest. These findings suggest that CD-ROM technology offers a new and promising medium for engaging high-risk youth in an alcohol abuse prevention program. Study implications and future applications of the present approach are discussed.

Purpose: To evaluate the efficacy of a brief computer-mediated intervention, relative to no intervention, in altering HIV/AIDS-related knowledge, protective attitudes, and self-efficacy for risk reduction among early adolescent females aged 11 through 14 years., Method: Recruited through the auspices of a large social services agency with multiple sites across New York City, a volunteer sample of 205 Black, White, and Hispanic young women participated in this research. The efficacy of the software intervention was examined in a randomized blocks design with site as the unit of randomization. Young women at experimental arm sites interacted with the software in a single 30-minute session. Youths at control arm sites participated in regular programs offered at these sites, but did not receive the intervention until all planned assessments were concluded. Before and after intervention, participants completed measures of HIV/AIDS-related knowledge, protective attitudes, and self-efficacy for HIV risk reduction. Analyses of covariance were used to test for significant between-arm effects., Results: Between-arm effects were observed for HIV/AIDS-related knowledge and risk reduction self-efficacy. Experimental arm youths evidenced greater improvements from pretest to posttest than control-arm youths on these outcomes., Conclusion: Computer-mediated interventions may improve HIV/AIDS-related knowledge and risk reduction self-efficacy among early adolescent females. However, additional research is needed to find effective computer-mediated approaches for enhancing protective attitudes among this population.

Objective: This study tested a CD-ROM intervention with and without a parent involvement component to reduce risk of alcohol use among an urban sample of early adolescents., Method: Youths (N = 514, mean age 11.5 years at recruitment) were assigned randomly by community site to receive the CD-ROM intervention, the CD-ROM plus parent intervention, or no intervention. All youths completed pretest, posttest and three annual follow-up measurements. After pretesting, youths and parents received their respective interventions., Results: Main effects of the intervention and for measurement occasion as well as interaction effects of the intervention by measurement occasion were seen for substance use and related outcomes. Over time, youths in all 3 groups reported increased use of alcohol, tobacco and marijuana; youths who received the interventions reported smaller increases than control youths. At 3-year follow-up, alcohol use was lower for CD-ROM plus parent intervention youths than for CD-ROM only youths, who, in turn, reported less use than controls. Cigarette use was lower for youths in either intervention group than in the control group at posttest and at 1-, 2- and 3-year follow-ups. Marijuana use was lower for youths in either intervention than for controls at 1-, 2- and 3-year follow-ups. Youths in both intervention groups outperformed control youths at posttest and at 1- and 3-year follow-ups on levels of negative and peer influence toward substance use. Finally, at the 3-year follow-up, youths in the CD-ROM plus parent intervention group reported more family involvement in their alcohol use prevention efforts than did youths in the CD-ROM group, who, in turn, reported more positive levels of family involvement than youths in the control group., Conclusions: Study findings modestly support the CD-ROM intervention with and without the parent intervention to reduce alcohol use risks among urban early adolescents.

This research evaluated a computer-mediated intervention for preventing drug abuse and violence. Research participants were economically disadvantaged youth, defined as early adolescents from households with family incomes below the Federal poverty line. Based on cognitive-behavioral skills approaches shown effective in past research, computer intervention was compared with conventionally delivered intervention in a pretest-posttest, control group design. Outcome findings revealed that youth assigned to the computer or conventional intervention arms achieved more positive pretest-to-posttest gain scores than youth in the control arm on several variables. These variables were: how youth regarded people who used drugs, strategies for avoiding trouble, and ways for controlling their tempers. One item, the ability to refuse drug offers, favored youth in the conventional intervention arm over those in the computer or control arms. Combined with prior work on computer-delivered interventions, data from this study lend added support to the viability of computer approaches for preventing drug abuse, violence, and other problem behavior among early adolescent youth.

Background: Despite the availability of an increasing array of empirically validated adolescent drug abuse prevention programs, program materials and evaluation findings are poorly disseminated. CD-ROM and the Internet hold promise for disseminating this information to schools and agencies that directly serve youth, and to policy-making bodies that exercise control over funds to support adolescent drug abuse prevention programming. However, data on the relative efficacy of these newer technologies over conventional print means of dissemination are lacking., Methods: Recruited through schools, community agencies, and policy-making bodies, 188 professionals were randomized to receive prevention program materials via pamphlets (55 participants), CD-ROM (64 participants), and the Internet (69 participants). Participants completed pretest, posttest, and 6-month follow-up measures that assessed their access to prevention program materials; self-efficacy for identifying, obtaining, and recommending these programs; and their likelihood of requesting, implementing, and recommending prevention programs to their constituents., Results: Participants exposed to dissemination via CD-ROM and the Internet evidenced the greatest short- and long-term gains on accessibility, self-efficacy, and behavioral intention variables., Conclusions: CD-ROM and the Internet are viable means for disseminating adolescent drug abuse prevention programs to schools, community agencies, and policy-making bodies, and should be increasingly used for dissemination purposes.

The spread of the acquired immunodeficiency virus (AIDS) virus, human immunodeficiency virus (HIV) infection, is increasingly evident. Despite the attention that HIV infection has received, few effective prevention strategies have been developed. The present paper reviews the epidemiology of AIDS among African-American and Hispanic adolescents. From epidemiological data, the authors argue for preventive approaches to reduce the risks of HIV transmission among African-American and Hispanic adolescents. Emphasizing culturally sensitive prevention strategies, the authors describe an intervention for these adolescents that combines skills-based and interactive computer approaches.

Teenage pregnancy is a growing social problem in the United States. Past interventive failures and current research suggest new directions for primary prevention. A comprehensive prevention program is outlined, and training techniques based on a cognitive-behavioral approach are proposed to help adolescents acquire skills necessary to avoid unwanted pregnancies.

Tobacco, alcohol, and drug use are problems for American-Indian people. We reviewed these problems and the explanations for them and described a bicultural competence skills approach for preventing substance abuse with American-Indian adolescents. Data from a study of that approach suggest its efficacy with American-Indian youth. At posttest and a 6-month follow-up, American-Indian subjects who received preventive intervention based on bicultural competence skills concepts improved more than did American-Indian subjects in a no-intervention control condition on measures of substance-use knowledge, attitudes, and interactive skills, and on self-reported rates of tobacco, alcohol, and drug use. Our findings have implications for future substance-abuse prevention research with American-Indian people.

This study was designed to empirically assess the potential of microcomputer-based intervention with black adolescents from economically disadvantaged backgrounds. Subjects were 26, 11 through 14-year-old black females and males recruited from three boroughs in New York City. A sample task was administered via microcomputer system followed by a postintervention measurement battery. Observational measures were also employed to assess interactional variables. Subjects' attitudes toward educational content in general, and toward drug and alcohol information delivery in particular, appeared to be a significant intervening variable that could alter the overall efficacy of computer-delivered interventions. Both observational and postintervention measures indicated an overall positive subject response to computer-administered instruction. In contrast, however, respondents indicated a negative response to microcomputer delivery of drug and alcohol related materials. Results of the experiment are discussed along with rationales and future research directions.