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Background: Alternative (or continuation) high schools are institutions designed for students at risk for not graduating due to behavioral, educational, or medical problems. The present study explored the relationship between negative substance use consequences (eg, having trouble at school or work) and noncondom use in this at-risk population and whether these associations varied by sex. Methods: Participants (N = 1101; 62.9% Hispanic; M[subscript age] = 16.85) were sampled from 24 alternative high schools in California, and data were analyzed using cross-sectional multivariate logistic regression models. Results: We observed a relationship between the number of negative substance use consequences and probability of noncondom use at the last sexual encounter for boys (p < 0.001) but not girls (p > 0.05). There were significant associations between specific social consequences (missing school/work) and dependence symptoms (selling personal items to get alcohol or drugs) with noncondom use for boys only. There was a similar association between substance use frequency and noncondom use for boys. Conclusions: These findings suggest that substance use consequences may be a useful and advantageous indicator of risky sexual behaviors such as noncondom use for boys, but not girls, in alternative high school settings. Future research and intervention programming recommendations are discussed.

Objective: Although Hispanic adolescents in the USA are often the focus of sexual health interventions, their response to survey measures has rarely been assessed within evaluation studies. This study documents the test-retest reliability of a wide range of self-reported sexual health values, attitudes, knowledge and behaviours among Hispanic adolescents from low-income, urban communities. Method: Intraclass correlation coefficients were calculated for sexual health scales (knowledge, values about condom use, parent communication, protection self-efficacy and condom-use intentions) in a 2-week sample (N = 86). Cohen's kappa and intraclass correlation coefficients were calculated for behaviours (romantic and sexual behaviours, and sexual health services history) in two separate 2-week samples (N = 86, N = 202). Selected behaviours were also examined for retractions in both 2-week samples and in a 1-year sample (N = 291). Results: Among sexual health scales, test-retest reliability ranged from 0.37 for condom-use intentions to 0.93 for parent communication. Among behaviours, reliability ranged from .27 for use of sexual health services to 1.00 for use of birth control at first sex. Retractions ranged from below 10% for ever having had a steady partner to 50% or more for sexual health services and testing. Conclusion: Test-retest reliability differed greatly across self-reported sexual health values, attitudes, knowledge and behaviours for the three samples of Hispanic adolescents. Overall, however, most items and scales showed good to excellent reliability (i.e. a coefficient greater than 0.60), suggesting that Hispanic adolescents are moderately to highly stable reporters in response to sexual health measures.

Numerous classroom-based interventions have aimed to improve sexual health outcomes for young people, yet few have shown strong, lasting effects. Ecological approaches that address multiple levels of a young person's environment offer largely untapped potential to positively change sexual behaviour. This paper presents results of a cluster-randomised trial of a multicomponent sexuality education intervention that integrated a classroom curriculum, parent education workshops and materials, peer advocate programme, and sexual health services at 10 urban high schools. An implementation evaluation, employing quantitative and qualitative instruments, was conducted to examine whether the individual components of the intervention were delivered as planned and how they were received by the target populations. Multilevel modelling was used to evaluate the effect of the multicomponent intervention on outcomes at one-year follow-up. Results showed that the intervention components were successfully implemented with and well received by target populations. Students receiving the multicomponent intervention reported greater increases in the use of sexual health services (odds ratio [OR] = 1.73, 95% CI = 1.09-2.75) and the likelihood of carrying a condom (OR = 2.71, 95% CI = 1.44-5.09) relative to those receiving a control condition. No effects were found for other behaviours, possibly due to low prevalence of sexual activity in the sample and the small number of schools randomised.

The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n = 1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended. (Contains 3 tables.)

This study examined whether bullies, victims, and aggressive victims (those who are both bullies and victims) differed on classroom social network variables, gender, and ethnicity. Survey data were collected from a primarily Latino and Asian sample of 1,368 Southern California 6th graders (mean age = 11.3 years). Logistic regression analyses were performed to determine whether network characteristics and ethnicity were associated with each of the outcome variables. Consistent with social cognitive theory, friends' participation in aggressive behaviors was positively associated with being a bully or an aggressive victim, and negatively associated with being a victim. Consistent with social dominance theory, the number of friendship nominations received was negatively associated with being a victim. Female bullies received fewer friendship nominations, but had a higher proportion of reciprocated friendships. Victims were disproportionately Asian. The findings suggest that bullying prevention efforts targeting highly aggressive students may also diffuse to their friends, and that assertiveness training in handling aggressive situations may successfully combat bullying and aggression.

Background: Although there are now a number of evidence-based tobacco use cessation programs available for dissemination, almost all adolescent tobacco cessation research comprises efficacy and effectiveness studies. As a result, there is a need for more research to guide the scaling up of these programs.Methods: The current study utilized data from a cross-sectional sample of 205 administrators and tobacco prevention program coordinators in school districts and county offices of education throughout California, to explore factors that affect the adoption of tobacco cessation programs in schools.Results: We found that several characteristics of the community, organization and individual respondent were associated with the adoption of evidence-based tobacco cessation programs in schools, including identifying tobacco use prevention as a community priority, having school-level SUP coordinators, greater coordinator effort devoted to tobacco use prevention, having a program champion, and currently receiving TUPE funds (all ps < .05).Conclusions: Although the availability of dedicated tobacco education funds is an important factor in schools adopting tobacco cessation programs with proven effectiveness, our results suggest that strengthening education agencies' capacity to implement prevention programming, through dedicated resources and personnel, has the potential to lead to increased adoption of tobacco cessation programs. [ABSTRACT FROM PUBLISHER]

Background: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. Methods: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. Results: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. Conclusions: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. [ABSTRACT FROM AUTHOR]

We examined the association between a general construct of wellness beliefs, sense of coherence, and a specific measure of tobacco-related beliefs, tobacco use myths, as predictors of two smoking-related outcome measures-next year smoking expectation and last 30-day smoking. Self-report questionnaires were administered to 710 adolescents attending California continuation high schools at baseline and at 1-year follow-up between 2006 and 2008. Cross-sectionally, predictor and outcome measures were correlated. However, in longitudinal analyses, only tobacco use myths predicted change in outcome measures. We speculate that future smoking interventions among adolescents would achieve relatively efficacious outcomes by targeting specific health beliefs instead of global health beliefs. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

It is now presumed that youth do not move directly from adolescence to adulthood, but rather pass through a transitional period, "emerging adulthood." The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) is a self-report instrument developed to examine the attributes of this period. "At-risk" youth appear to enter emerging adulthood developmental tasks at a slightly earlier age than general population youth. In the present study, a 21-item version of the IDEA was administered to a sample of 1676 "at-risk" continuation (alternative) high school students in Southern California. Principal component factor analysis with orthogonal rotation revealed three factors the authors labeled "Identity Exploration," "Experimentation/Possibilities," and "Independence." Overall, the measure demonstrated high internal consistency. Construct validity analyses indicated that the measure was correlated with demographics, risk behaviors, and psychological measures. The authors conclude that the IDEA-R is a useful instrument for measuring emerging adulthood in at-risk populations. [ABSTRACT FROM AUTHOR]

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Background: This study examined the one year prospective associations between adolescent social self-control and drug outcomes (cigarette use, alcohol use, marijuana use, hard drug use, and problem drug use) among adolescents from regular and continuation high schools. In our previous cross-sectional study, poor social self-control was found to be associated with higher drug use, controlling for 12 personality disorder categories. In this study, we attempted to find out (a) whether lack of social self-control predicted drug use one year later, and (b) whether drug use at baseline predicted social self-control one year later. Methods: We surveyed 2081 older adolescents from 9 regular (N = 1529) and 9 continuation (alternative) (N = 552) high schools in the Los Angeles area. Data were collected at two time points in an interval of approximately 1 year. Results: Past 30-day cigarette smoking, marijuana use, hard drug use, and problem drug use at baseline were found to predict lower social self-control at follow-up, controlling for baseline social self-control and demographic variables. The effect of problem drug use as a one-year predictor of social self-control was found to be moderated by school type (regular or continuation high school), such that the relationship was significant for continuation high school students only. Conversely, social self-control was found to predict past 30-day alcohol use, marijuana use, and problem drug use, controlling for baseline drug use and demographic variables. For alcohol use, marijuana use, and problem drug use outcomes, school type was not found to moderate the effects of social self-control, though an interaction effect was found regarding cigarette smoking. Social self-control was a significant predictor of cigarette use only at regular high school. Conclusion: The results indicate that social self-control and drug use share a reciprocal relationship. Lack of social self-control in adolescents seems to result in increased drug use, which in turn is likely to further decrease social self-control. Thus, it seems that social self-control is an alterable cognitive-behavioral attribute which can be improved through skill-based interventions in order to prevent drug use among adolescents. Policies aimed at preventing drug abuse among adolescents may benefit from institutionalizing social self-control skills training. [ABSTRACT FROM AUTHOR]

This study uses the Diffusion of Innovations Theory to examine the role of mass media–generated interpersonal communication in the adoption of antitobacco norms among opinion leaders in California. Data were collected from 503 key community opinion leaders within 18 California counties in 1997 as part of the Independent Evaluation of the California Tobacco Control Program. Results provide support for the proposition that tobacco control policies and behaviors of opinion leaders can be categorized according to stages in the innovation decision process. As hypothesized, the level of mass media–generated interpersonal communication was dependent upon an individual's stage of adoption such that the frequency of ad discussion increased with advancing stages on the continuum. Regression analyses also confirmed a strong positive associative trend between ad discussion and stage of adoption. Further analysis provided evidence that the impact of campaign exposure on adoption of antitobacco norms was mediated through discussion of the ads, highlighting the importance of social diffusion processes. This study provides evidence regarding the importance of using a stage-based framework to understand the role of communication channels at distinct stages of innovation adoption and among various community opinion leaders. [ABSTRACT FROM AUTHOR]

Objectives. This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors. Methods. In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure. Results. Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes. Conclusions. These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke. (Am J Public Health. 2002;92:975-983) [ABSTRACT FROM AUTHOR]

Presents a study which examined the correlates of smoking prevalence estimates among 8th-grade adolescents in California. Influences on the inferences adolescents make regarding their peers' smoking behavior; Respondents' smoking prevalence estimates; Variables significantly associated with smoking prevalence estimates.

Using data from a diverse statewide sample of 10th-grade adolescents in California, in 1996–97, this study investigated the associations between peer influence variables and susceptibility to smoking. Peer influence variables included attitudes about the social consequences of smoking and subjective norms, as described by the Theory of Reasoned Action. Among never-smokers (N = 2681) and ever-smokers (N = 4248), attitudes about social consequences of smoking and subjective norms each were associated with an increased risk of susceptibility to smoking. The model explained a larger proportion of the variance in susceptibility among ever-smokers than among never-smokers. Results indicate that peer influences, including perceptions of the social consequences of smoking and perceived social norms, may make adolescents susceptible to smoking. [ABSTRACT FROM AUTHOR]

: BackgroundPrevious studies have documented a high prevalence of tobacco use among Native American adolescents. However, little is known about the smoking behavior of Native American adolescents who live in urban areas. This study used statewide data from California to examine the smoking behavior and related psychosocial risk factors among Native American adolescents living in urban and rural counties.: MethodsThe Independent Evaluation of the California Tobacco Control Program conducted three population-based statewide surveys of 10th-grade California public school students in 1996, 1998, and 2000. Past-month smoking and psychosocial correlates were examined among 22,440 respondents, including 1060 Native Americans.: ResultsNative Americans had a 32% excess risk of past-month smoking compared with other ethnic groups. Smoking prevalence did not differ between urban (27.7%) and rural (29.3%) Native Americans. Native Americans reported higher access to cigarettes and exposure to smoking peers than other groups. Those psychosocial variables explained some, but not all, of the excess risk of smoking among Native Americans.: ConclusionsEffective smoking prevention and cessation interventions are needed for Native American adolescents in urban and rural areas of California. [Copyright &y& Elsevier]