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Programs to reduce adolescent cigarette or alcohol use by users in general populations have only recently been evaluated. Moreover, in spite of the substantial influence families have on their children, few family-directed programs designed to reduce the prevalence of adolescent smoking and drinking have been rigorously evaluated. This paper reports the findings of research designed to determine whether a family program reduced use of cigarettes or alcohol by users. The program consisted of a series of booklets mailed to families and follow-up telephone calls by health educators. A randomized experimental design involved families with children ages 12-14 throughout the United States. Data were collected by telephone at baseline and 3 and 12 months after the program was completed. No statistically significant program effects were observed for cessation or decrease in smoking and drinking by users. [ABSTRACT FROM AUTHOR]

Context: The main threats to adolescents' health are the risk behaviors they choose. How their social context shapes their behaviors is poorly understood.Objective: To identify risk and protective factors at the family, school, and individual levels as they relate to 4 domains of adolescent health and morbidity: emotional health, violence, substance use, and sexuality.Design: Cross-sectional analysis of interview data from the National Longitudinal Study of Adolescent Health.Participants: A total of 12118 adolescents in grades 7 through 12 drawn from an initial national school survey of 90118 adolescents from 80 high schools plus their feeder middle schools.Setting: The interview was completed in the subject's home.Main Outcome Measures: Eight areas were assessed: emotional distress; suicidal thoughts and behaviors; violence; use of 3 substances (cigarettes, alcohol, marijuana); and 2 types of sexual behaviors (age of sexual debut and pregnancy history). Independent variables included measures of family context, school context, and individual characteristics.Results: Parent-family connectedness and perceived school connectedness were protective against every health risk behavior measure except history of pregnancy. Conversely, ease of access to guns at home was associated with suicidality (grades 9-12: P<.001) and violence (grades 7-8: P<.001; grades 9-12: P<.001). Access to substances in the home was associated with use of cigarettes (P<.001), alcohol (P<.001), and marijuana (P<.001) among all students. Working 20 or more hours a week was associated with emotional distress of high school students (P<.01), cigarette use (P<.001), alcohol use (P<.001), and marijuana use (P<.001). Appearing "older than most" in class was associated with emotional distress and suicidal thoughts and behaviors among high school students (P<.001); it was also associated with substance use and an earlier age of sexual debut among both junior and senior high students. Repeating a grade in school was associated with emotional distress among students in junior high (P<.001) and high school (P<.01) and with tobacco use among junior high students (P<.001). On the other hand, parental expectations regarding school achievement were associated with lower levels of health risk behaviors; parental disapproval of early sexual debut was associated with a later age of onset of intercourse (P<.001).Conclusions: Family and school contexts as well as individual characteristics are associated with health and risky behaviors in adolescents. The results should assist health and social service providers, educators, and others in taking the first steps to diminish risk factors and enhance protective factors for our young people. [ABSTRACT FROM AUTHOR]

This paper evaluates the impact of federally subsidized family planning programs in the United States, from 1969 to 1974, on the reproductive behavior of ever-married women, 15-44 years old. The study began with an experimental design and the random assigment of areas to treatment and control but was completed as a multivariate analysis, treating program input as an interval-scaled independent variable. Using "before" and "after" area sample surveys and patient service data from operating programs, the demographic impact of the program was estimated. The impact detected was nonsignificant; according to our analysis, overall use of physician-administered contraception was not affected by the subsidized programs. The only program-induced change of activity related to reproduction that we recorded was increased use of subsidized services in study areas with high program input and increased use of private physician services where program input was low. These findings need to be interpreted with the caution usually exercised in evaluating imperfect field experiments. [ABSTRACT FROM AUTHOR]

Blacks are more likely than whites to have unwanted births. A common explanation for that difference is that blacks use less effective contraceptive methods, use contraception less effectively, and use contraception less often than whites. Analysis of data from 17 cities in our family planning evaluation project suggested that, among women living in low-income neighborhoods, the black-white difference in unwanted births was not due to (1) blacks reaching desired completed parity at younger ages than whites, (2) differences in age or parity in our black and white samples, (3) black-white differences in current use of physician-administered contraception, or (4) blacks being more likely than whites to adopt physician-administered contraception after having an unwanted birth. Black-white differences which might have contributed to relatively more unwanted births among blacks were (1) blacks desired fewer children, (2) blacks were less likely than whites to use nonphysician-administered methods and more likely than whites to use no contraception, and (3) blacks had higher failure rates than whites subsequent to the adoption of physician-administered methods and when not using those methods. Comparisons are made with the 1965 and 1970 National Fertility Studies, and program implications of the findings discussed. [ABSTRACT FROM AUTHOR]

A goal of the federal family planning program is to enable women to have only those children they want, with priority given to the poor. Is that compatible with the goal of those who want zero population growth? This analysis shows that prevention of all unwanted births to women in low-income families would have yielded completed fertility much above that required for zero population growth. [ABSTRACT FROM AUTHOR]

Background: Family Matters is a universal intervention designed to prevent adolescent tobacco and alcohol use through involvement of family members and by targeting family risk factors for tobacco and alcohol use. Previously reported findings suggest that the program reduced the prevalence of both adolescent smoking and drinking in the 12 months after program completion. This paper reports analyses conducted to identify the mediators through which the program influenced adolescent smoking and drinking., Methods: One thousand fourteen adolescents ages 12 to 14 years and their families, identified by random-digit dialing, were entered into a randomized trial. Adolescents and their parents provided data by telephone for measuring mediator and behavioral variables at baseline, 3 months, and 12 months after program completion. Repeated-measures logistic regression with generalized estimating equations was used to assess mediation processes., Results: The program resulted in statistically significant changes in several substance-specific aspects of the family, such as rule setting about tobacco and alcohol use. However, the intermediate family effects did not account for the program effects on adolescent behavior., Conclusions: The variables hypothesized to explain program effects were not identified by direct empirical examination., (Copyright 2001 American Health Foundation and Academic Press.)

This study examined correlates of program initiation and completion in a family-directed program that involved families of adolescents throughout the United States. Correlates varied by whether program initiation, program completion, or the number of activities completed was the indicator of participation. In final regression models, participation was relatively likely by non-Hispanic whites when compared with persons of race/ethnicity other than white, black, and Hispanic; by families with a female adolescent as the program recipient; by families with mothers who had many years of education; and by families with both parents living in the household. There was more participation if parents thought their child would smoke in the future and if the parent thought the adolescent did not smoke currently. Participation was higher if the adolescent felt strongly attached to the parent and if parents did not smoke. The findings are considered in the context of similar programs and future research on family-directed programs to prevent adolescent tobacco and alcohol use.

Objectives: This study examined a family-directed program's effectiveness in preventing adolescent tobacco and alcohol use in a general population., Methods: Adolescents aged 12 to 14 years and their families were identified by random-digit dialing throughout the contiguous United States. After providing baseline data by telephone interviews, they were randomly allocated to receive or not receive a family-directed program featuring mailed booklets and telephone contacts by health educators. Follow-up telephone interviews were conducted 3 and 12 months after program completion., Results: The findings suggested that smoking onset was reduced by 16.4% at 1 year, with a 25.0% reduction for non-Hispanic Whites but no statistically significant program effect for other races/ethnicities. There were no statistically significant program effects for smokeless tobacco or alcohol use onset., Conclusions: The family-directed program was associated with reduced smoking onset for non-Hispanic Whites, suggesting that it is worthy of further application, development, and evaluation.

Introduction: This article focuses on affectionate behaviors of adolescent mothers with their infants in a neonatal intensive care unit (NICU). Hypotheses derived from behavioral science theory posited the direct influence of social support and perceived stress on affectionate behaviors, the statistical interaction of social support and perceived stress on affectionate behaviors, and perceived stress as a mediator of the relationship between social support and affectionate behaviors., Method: Subjects were enrolled from July 1993 through September 1994. Information about perceived stress and social support was obtained twice by means of an interview. Affectionate behaviors were measured by NICU nurse observations. Analyses were conducted on subsamples ranging from 57 to 107 subjects., Results: All hypotheses were rejected. Neither social supports nor perceived stress were related to affectionate behaviors, and no statistical interactions among the 3 variables were identified., Discussion: The findings are considered in the context of the methodology used, stress and social support theory, and implications for practice and future research.

Objectives: An earlier report described desirable 1-month follow-up effects of the Safe Dates program on psychological, physical, and sexual dating violence. Mediators of the program-behavior relationship also were identified. The present report describes the 1-year follow-up effects of the Safe Dates program., Methods: Fourteen schools were in the randomized experiment. Data were gathered by questionnaires in schools before program activities and 1 year after the program ended., Results: The short-term behavioral effects had disappeared at 1 year, but effects on mediating variables such as dating violence norms, conflict management skills, and awareness of community services for dating violence were maintained., Conclusions: The findings are considered in the context of why program effects might have decayed and the possible role of boosters for effect maintenance.

Background: The most recent major U.S. trials that evaluated community-level programs to influence risk factors and health behaviors identified secular trends in the risk factors and health behaviors among the factors that might have limited community-level effects. The research reported in this paper uses data from one of the trials to examine the secular trend explanation directly., Methods: Data from the 22-community Community Intervention Trial for Smoking Cessation (COMMIT) were analyzed to test a hypothesis based on secular trend reasoning: program effects for smoking prevalence were larger for treatment communities matched to control communities with small declines in smoking than in treatment communities matched to control communities with larger declines in smoking., Results: Consistent with the secular trend explanation, program effects were larger when control communities had relatively small declines in smoking prevalence., Conclusions: The findings suggest that secular trends masked community-level program effects in COMMIT., (Copyright 1999 American Health Foundation and Academic Press.)

This paper describes two studies that had three purposes: (a) to modify a parent-child interaction tool used previously in a neonatal intensive care unit (NICU); (b) to demonstrate interrater reliability, Chronbach's Alpha reliability, and construct validity of the tool with adolescent mothers, and (c) to determine the ability of nurses engaged in usual work duties to observe maternal behaviors. The first study tested interrater reliability. Two NICU nurses were trained, observed adolescent mothers (n = 20) for the same 15 min, and then separately completed the measure. The second study tested internal consistency reliability and construct validity with 107 adolescent mothers with infants in a NICU. Nurses in the neonatal intensive care unit completed the measure, and data on maternal visits were gathered for construct validity. The intraclass correlation coefficient for the first study was r = .83. Results of the second study demonstrated a Chronbach's Alpha of .85 and a significant correlation between ratings of maternal behavior and visits. The instrument obtained acceptably reliable and valid estimates of adolescent mothers' affectionate behaviors toward their infants. In addition, the studies demonstrated that nurses can observe maternal behaviors while performing their usual duties.

Background: This study analyzed influences on state legislators' decisions about cigarette tax increase votes using a research strategy based on political science and social-psychological models., Methods: Legislators from three states representing a spectrum of tobacco interests participated in personal interviews concerned with tobacco control legislation (n = 444). Measures of potential predictors of voting intention were based on the consensus model of legislative decision-making and the theory of planned behavior. Multiple logistic regression methods were used to identify social-psychological and other predictors of intention to vote for cigarette tax increases., Results: General attitudes and norms concerning cigarette tax increases predicted legislators' intention to vote for cigarette tax increases. More specific predictors included perceptions of public health impact and retail sales impact of cigarette tax increases. Constituent pressure was the strongest perceived social influence. Political party and state also were strong predictors of intention. Results were consistent with related research based on political science models., Conclusions: Legislators' votes on cigarette tax increases may be influenced by their perceptions of positive and negative outcomes of a cigarette tax increase and by perceived constituent pressures. This research model provides useful insights for theory and practice and should be refined in future tobacco control research.