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This study examined multiple risk behaviors (violence, delinquency, and substance use) among 240 African American and 262 Hispanic preadolescent boys from urban schools in the Midwest United States. Latent transition analysis allowed patterns of multivariate risk to emerge uniquely within and across these ethnic groups, highlighting patterns for subgroups that are overlooked by common aggregate statistics. Results revealed four risk classes for each ethnic group, with nuanced probabilities of endorsement and transition across classes and ethnic groups. Involvement with police and more severe use of substances were distinguishing factors of higher risk classes. African American boys showed a tendency to transition between risk classes over time, while Hispanic boys tended to exhibit stability. Personal involvement in school and community action among parents were highlighted as protective factors. Suggestions for prevention programming based on results include early timing, addressing criminal justice involvement, providing academic enrichment programs, and promoting community action among parents.

The World Health Organization's Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools' "core business" by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children's basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.

We examined frequency and intensity of racial/ethnic discrimination and the longitudinal relationship to substance use. The sample included (N = 1,421) American Indian, American Indian and White, and White adolescents. A high frequency of perceived racial discrimination was associated with an increased risk for heavy alcohol use, prescription drug misuse, and other illicit drug use. Experiences of perceived racial discrimination high in intensity were associated with further increased risk of prescription drug misuse and other illicit drug use. Race/ethnicity did not moderate the relationship between perceived racial discrimination and substance use. Interventions targeting the deleterious effects of racial discrimination may need to be designed to account for both the environment and the individual.

Objective: This research examines gender and racial/ethnic differences in substance use trajectories during early adolescence among American Indian and non-Native adolescents.Method: Substance use trajectories were evaluated among 684 adolescents (50% female, 51% American Indian) across five assessments over 9th and 10th grades. Youth were drawn from six rural towns within the Cherokee Nation, a nonreservation tribal jurisdiction that includes a high proportion of American Indians embedded within a predominantly White population. Past-month substance use was based on self-report and was dichotomized into "used" versus "did not use," with the exception of alcohol, which was trichotomized into "none," "1 or 2 days," or "3-30 days."Results: Using growth mixture modeling with full-information maximum-likelihood estimation, we determined that between two and three different trajectory classes best described the data for each substance. Males had a higher probability compared with females of following a trajectory of chewing tobacco use (20% vs. 6%, respectively) and using multiple substances (24% vs. 19%, respectively). Females had a higher probability compared with males of following a trajectory of prescription drug misuse (11% vs. 6%, respectively). Individuals who followed trajectories of alcohol use or heavy drinking were also more likely to follow trajectories of other substance use.Conclusions: Identifying gender and racial/ethnic differences in patterns of substance use at this stage of development will inform gender-sensitive and ethnically sensitive prevention programs targeting specific substance use. These results will be particularly informative given the lack of evidence regarding trajectories of substance initiation within largely American Indian populations. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate effects of 2 alcohol prevention interventions—Communities Mobilizing for Change on Alcohol (CMCA), a community organizing intervention designed to reduce youth alcohol access, and CONNECT, an individual-level screening and brief intervention approach—on other drug use outcomes. Methods. We conducted a community intervention trial with quarterly surveys over 3 years (2012–2015) of high school students living within the jurisdictional service area of the Cherokee Nation in Oklahoma. We used generalized estimating equations and linear probability models to examine intervention spillover effects on other drug use. Results. We found significant reductions in drug use other than alcohol attributable to CMCA and CONNECT. CMCA was associated with a 35% reduction in chewing tobacco use, a 39% reduction in marijuana use, and a 48% reduction in prescription drug misuse. CONNECT was associated with a 26% reduction in marijuana use and a 31% reduction in prescription drug misuse. Conclusions. Nonalcohol drug use was consistently reduced as a result of 2 theoretically and operationally distinct alcohol prevention strategies. Evaluations of alcohol prevention efforts should continue to include other drug use to understand the broader effects of such interventions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine gender differences in the substance-related etiology of teen dating violence using a high-risk sample of urban youth. Data were obtained from 2,991 students in grade 12 who participated in Project Northland Chicago, a group-randomized alcohol prevention intervention implemented in Chicago schools. Typologies of dating violence and physical aggression were created, and hierarchical multinomial regression procedures were used to examine risk and protective factors for membership in each group. The results suggested that there were no quantifiable gender differences in dating violence victimization; however, there were substantial differences in aggression and in the reporting of both dating violence victimization and physical aggression. Furthermore, substance use (alcohol, tobacco, and marijuana) was identified as a robust risk factor for each of the typologies for women. Among men, marijuana use was associated with only the most at-risk group (e.g., the victim-offender overlap group), whereas alcohol and marijuana use predicted membership in each typology among women. Study limitations and implications are also discussed. [ABSTRACT FROM AUTHOR]

To assess youth's ability to purchase alcohol in a city previously not assessed—Chicago, Illinois—we hired individuals aged 21 and older who appeared to be aged 18-20 (i.e., pseudo-underage buyers) to make alcohol purchase attempts without age identification in off-premise licensed alcohol establishments. We conducted two purchase attempts at each establishment across 44 community areas, resulting in a total of 652 purchase attempts. Our dependent variable was purchase attempt outcome (purchase, no purchase) and we used four categories of independent variables: characteristics of sellers, establishments, purchase attempts, and community areas. We analyzed our data using a logistic regression model, with purchase attempt outcome regressed on the independent variables. The overall purchase rate was 35.1%, ranging from 0% to 72% across community areas. Buyers were less likely to purchase alcohol in community areas that had populations with higher percentages of Hispanics (OR = 0.99; CI = 0.98, 1.0), and more likely to purchase alcohol in establishments that had more expensive beer (OR = 2.0; CI = 1.50, 2.67) and in areas with higher percentages of unemployed individuals (OR = 1.1; CI = 1.07, 1.14). Although progress has been made since the early 1990s in reducing sales to underage youth, youth still have relatively easy access to alcohol from licensed establishments. We recommend increased use of compliance checks—underage youth attempt to purchase alcohol under the supervision of enforcement agents; if alcohol is sold, the server/seller and/or license holder are penalized-which scientific studies have shown to be the most effective strategy in reducing sales to minors. [ABSTRACT FROM AUTHOR]

Aims The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings. Design and setting Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or ‘delayed program’ control condition. Participants The study sample ( n = 5812 students) was primarily African American, Hispanic and low-income. Intervention Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing). Measurements Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts. Findings Overall, the intervention, compared with a control condition receiving ‘prevention as usual’, was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend ( P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined ( P = 0.01), with alcohol use alone approaching statistical significance ( P = 0.06). Conclusions Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use. [ABSTRACT FROM AUTHOR]

Aims The purpose of the present study was to examine the effects of parental provision of alcohol and home alcohol accessibility on the trajectories of young adolescent alcohol use and intentions. Design Data were part of a longitudinal study of alcohol use among multi-ethnic urban young adolescents who were assigned randomly to the control group of a prevention trial. Setting Data were collected from a cohort of youth, and their parents, who attended public schools in Chicago, Illinois (2002–2005). Participants The sample comprised the 1388 students, and their parents, who had been assigned randomly to the control group and were present and completed surveys at baseline, in the beginning of 6th grade (age 12). The sample was primarily low-income, and African American and Hispanic. Measurements Students completed self-report questionnaires when in the 6th, 7th and 8th grades (age 12–14 years; response rates 91–96%). Parents of the 6th grade students also completed questionnaires (70% response rate). Findings Student report, at age 12, of parental provision of alcohol and home alcohol availability, and parental report of providing alcohol to their child and the accessibility of alcohol in the home, were associated with significant increases in the trajectories of young adolescent alcohol use and intentions from ages 12–14 years. Student report of receiving alcohol from their parent or taking it from home during their last drinking occasion were the most robust predictors of increases in alcohol use and intentions over time. Conclusions Results indicate that it is risky for parents to allow children to drink during early adolescence. When these findings are considered together with the risks associated with early onset of alcohol use, it is clear that parents can play an important role in prevention. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to outline the evaluation plan for the Minnesota D.A.R.E. Plus Project, a drug and violence prevention program for young adolescents, and to present the results of psychometric analyses on the measures that will be used in the assessment of the intervention program. The survey instrument was tested using different samples for each stage of its development. The main scale development sample included seventh grade students in urban, suburban and rural schools. The results indicate that the scales constructed are reliable and valid measures of young adolescents' drug use and violent behaviors, as well as intrapersonal, social, and environmental factors related to those behaviors. [ABSTRACT FROM AUTHOR]

US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose. • Acceptability of mobile treatment units among rural people who use opioids is high. • People under community supervision may be less willing to use mobile services. • Findings inform recent policy changes to expand treatment access using mobile units. [ABSTRACT FROM AUTHOR]