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Lifetime differences in antisocial behavior among alcoholic men historically have been useful in distinguishing alcoholic subtypes. However, the usefulness of this subtyping strategy for identifying differences in families that may put offspring at risk for developing later alcoholism has not been previously documented. Findings from a prospective study on the development of vulnerability for alcoholism among (initially) preschool-age children showed that children from families with antisocial alcoholism differ on a number of indicators of child risk, including measures of risky temperament, externalizing behavior problems, and hyperactivity. Risk differences among children from these family subtypes appear to be sustained into middle childhood. Differences between nonantisocial alcoholic families and nonalcoholic control families were less distinguishable in both early and middle childhood.

Individuals react differently to social experiences; for example, people who are more sensitive to negative social experiences, such as being excluded, may be more likely to adapt their behavior to fit in with others. We examined whether functional brain connectivity during social exclusion in the fMRI scanner can be used to predict subsequent conformity to peer norms. Adolescent males (N = 57) completed a two-part study on teen driving risk: a social exclusion task (Cyberball) during an fMRI session and a subsequent driving simulator session in which they drove alone and in the presence of a peer who expressed risk-averse or risk-accepting driving norms. We computed the difference in functional connectivity between social exclusion and social inclusion from each node in the brain to nodes in two brain networks, one previously associated with mentalizing (medial prefrontal cortex, temporoparietal junction, precuneus, temporal poles) and another with social pain (anterior cingulate cortex, anterior insula). Using cross-validated machine learning, this measure of global network connectivity during exclusion predicts the extent of conformity to peer pressure during driving in the subsequent experimental session. These findings extend our understanding of how global neural dynamics guide social behavior, revealing functional network activity that captures individual differences., Comment: 32 pages, 5 figures, 1 table

People from different cultural backgrounds respond differently to social cues, and may use their brains differently in social situations. Socioeconomic status (SES) is one key cultural variable that influences susceptibility to social cues, with those from lower SES backgrounds tending toward greater interdependence, and those from higher SES backgrounds tending toward greater independence. Building on past research linking brain sensitivity during social exclusion with tendency to take risks in the presence of peers, we examined whether SES moderated the relationship between neural measures of sensitivity during social exclusion and later conformity to peer pressure in a driving simulator. Our data show that SES does moderate the relationship between brain responses during social exclusion and conformity to peer influence on driving behavior. Specifically, increased activity in brain regions implicated in social pain and reward-sensitivity during social exclusion were associated with greater conformity to peer passenger driving norms for low SES and decreased conformity for high SES. In addition, increased activity brain regions implicated in understanding others’ mental states during exclusion was associated with similar patterns of decreased conformity for high SES. Overall, results highlight the importance of considering cultural factors, such as SES, in understanding the relationship between neural processing of social cues and how these translate into real-world relevant behaviors.

Teenage passengers might influence risky driving, particularly in certain mental states. Notably, social exclusion could increase social conformity. Two studies examined simulated intersection management among young drivers after a social exclusion activity (Cyberball). In Study 1 (112 males (mean = 17.3 years), risky driving was significantly greater among excluded males driving with a risk-accepting vs passive passenger; no effect of social exclusion. In Study 2 (115 females (mean = 17.1 years), risky driving was significantly greater among excluded females driving with a risk-accepting vs a passive passenger, and greater among those included (fair play) vs excluded when driving with a risk-accepting passenger. Risky driving behavior among male and female teenagers may be influenced uniquely by passenger norms and social exclusioninclusion.

OBJECTIVE Serious crashes are more likely when teenage drivers have teenage passengers. One likely source of this increased risk is social influences on driving performance. This driving simulator study experimentally tested the effects of peer influence (i.e., risk-accepting compared to risk-averse peer norms reinforced by pressure) on the driving risk behavior (i.e., risky driving behavior and inattention to hazards) of male teenagers. It was hypothesized that peer presence would result in greater driving risk behavior (i.e., increased driving risk and reduced latent hazard anticipation), and that the effect would be greater when the peer was risk-accepting. Methods Fifty-three 16- and 17-year-old male participants holding a provisional U.S., State of Michigan driver license were randomized to either a risk-accepting or risk-averse condition. Each participant operated a driving simulator while alone and separately with a confederate peer passenger. The simulator world included scenarios designed to elicit variation in driving risk behavior with a teen passenger present in the vehicle. Results Significant interactions of passenger presence (passenger present vs. alone) by risk condition (risk-accepting vs. risk-averse) were observed for variables measuring: failure to stop at yellow light intersections (Incident Rate Ratio (IRR) = 2.16; 95% confidence interval [95CI] = 1.06, 4.43); higher probability of overtaking (IRR = 10.17; 95CI = 1.43, 73.35); shorter left turn latency (IRR = 0.43; 95CI = 0.31, 0.60); and, failure to stop at an intersection with an occluded stop sign (IRR = 7.90; 95CI = 2.06, 30.35). In all cases, greater risky driving by participants was more likely with a risk-accepting passenger versus a risk-averse passenger present and a risk-accepting passenger present versus driving alone. Conclusions Exposure of male teenagers to a risk-accepting confederate peer passenger who applied peer influence increased simulated risky driving behavior compared with exposure to a risk-averse confederate peer passenger or driving alone. These results are consistent with the contention that variability in teenage risky driving is in part explained by social influences.

INTRODUCTION: Driver distraction is an important contributor to crash risk. Teenage driver distraction can be influenced by the attitudes and behaviors of parents. This study examined teens' and their parents' engagement in distracting behavior while driving. METHOD: Survey data were collected from a national sample of 403 parent-teen dyads using random-digit dialing telephone interviews. RESULTS: Results demonstrated few parent or teen sex differences in distracting behavior engagement while driving, or in their perceptions of each others' behavior. Parents and teens' frequencies of distracting behavior engagement were positively correlated. Parents' and teens' perceptions of each others' distracting behavior engagement while driving exceeded their own selfreports. Finally, the likelihood that teens reported engaging in distracting behavior while driving was more strongly associated with their perceptions of their parents' distracting behavior than by parents' self reports of their own behavior. CONCLUSIONS: These results suggest that parents' examples of driving behavior are an important influence on teen driving behavior, but potentially more important are teens' perceptions of their parents' behaviors. Keywords: Driver distraction; Language: en

Objectives. We estimated the injury prevention impact and cost savings associated with alcohol interlock installation in all new US vehicles. Methods. We identified fatal and nonfatal injuries associated with drinking driver vehicle crashes from the Fatality Analysis Reporting System and National Automotive Sampling System’s General Estimates System data sets (2006–2010). We derived the estimated impact of universal interlock installation using an estimate of the proportion of alcohol-related crashes that were preventable in vehicles Results. Over 15 years, 85% of crash fatalities (> 59 000) and 84% to 88% of nonfatal injuries (> 1.25 million) attributed to drinking drivers would be prevented, saving an estimated $342 billion in injury-related costs, with the greatest injury and cost benefit realized among recently legal drinking drivers. Cost savings outweighed installation costs after 3 years, with the policy remaining cost effective provided device effectiveness remained above approximately 25%. Conclusions. Alcohol interlock installation in all new vehicles is likely a cost-effective primary prevention policy that will substantially reduce alcohol-involved crash fatalities and injuries, especially among young vulnerable drivers.

Adolescence is a period characterized by increased sensitivity to social cues, as well as increased risk-taking in the presence of peers. For example, automobile crashes are the leading cause of death for adolescents, and driving with peers increases the risk of a fatal crash. Growing evidence points to an interaction between neural systems implicated in cognitive control and social and emotional context in predicting adolescent risk. We tested such a relationship in recently licensed teen drivers. Participants completed an fMRI session in which neural activity was measured during a response inhibition task, followed by a separate driving simulator session 1 week later. Participants drove alone and with a peer who was randomly assigned to express risk-promoting or risk-averse social norms. The experimentally manipulated social context during the simulated drive moderated the relationship between individual differences in neural activity in the hypothesized cognitive control network (right inferior frontal gyrus, BG) and risk-taking in the driving context a week later. Increased activity in the response inhibition network was not associated with risk-taking in the presence of a risky peer but was significantly predictive of safer driving in the presence of a cautious peer, above and beyond self-reported susceptibility to peer pressure. Individual differences in recruitment of the response inhibition network may allow those with stronger inhibitory control to override risky tendencies when in the presence of cautious peers. This relationship between social context and individual differences in brain function expands our understanding of neural systems involved in top–down cognitive control during adolescent development.

Objectives: In this study, we sought to accomplish the following objectives: to (1) calculate the percentage of children considered appropriately restrained across 8 criteria of increasing restrictiveness; (2) examine agreement between age- and size-based appropriateness criteria; (3) assess for changes in the percentage of children considered appropriately restrained by the 8 criteria between 2011 (shortly after updates to U.S. guidelines) and 2015. Methods: Data from 2 cross-sectional surveys of 928 parents of children younger than 12 years old (n = 591 in 2011, n = 337 in 2015) were analyzed in 2017. Child age, weight, and height were measured at an emergency department visit and used to determine whether the parent-reported child passenger restraint was considered appropriate according to 8 criteria. Age-based criteria were derived from Michigan law and U.S. guidelines. Weight, height, and size-based criteria were derived from typical restraints available in the United States in 2007 and 2011. The percentage appropriate restraint use was calculated for each criterion. The kappa statistic was used to measure agreement between criteria. Change in appropriateness from 2011 to 2015 was assessed with chi-square statistics. Results: Percentage appropriate restraint use varied from a low of 19% for higher weight limits in 2011 to a high of 91% for Michigan law in 2015. Agreement between criteria was slight to moderate. The lowest kappa was for Michigan law and higher weight limits in 2011 (κ = 0.06) and highest for U.S. guidelines and lower weight limits in 2011 (κ = 0.60). Percentage appropriate restraint use was higher in 2015 than 2011 for the following criteria: U.S. guidelines (74 vs. 58%, P < .001), lower weight (57 vs. 47%, P = .005), higher weight (25 vs. 19%, P = .03), greater height (39 vs. 26%, P < .001), and greater size (42 vs. 30%, P = .001). Conclusions: The percentage of children considered to be using an appropriate restraint varied substantially across criteria. Aligning the definition of appropriate restraint use with current U.S. guidelines would increase consistency in reporting results from studies of child passenger safety in the United States. Potential explanations for the increased percentage of children considered appropriately restrained between 2011 and 2015 include adoption of the updated U.S. guidelines and the use of child passenger restraints with higher weight and height limits.

Objective We examined prevalence, frequency, duration, and recency of injury leave and the association of duty-related injury with perceived stress in U.S. police officers. Methods This cross-sectional study contained 422 active duty police officers from a mid-sized urban police department. For each participating officer, work history records were used to assess on-duty injuries that lead to work absences. Linear regression analyses were used for analyses. Results Most participants had experienced at least one injury (62%), and among those injured, 67% experienced more than one duty-related injury. The average number of injuries per officer was three (range 1 to 12). There was a significant linear trend in mean perceived stress across injury count even after adjusting for age, rank, and sex (P = 0.025). Conclusion Findings suggest that work-related injury is common and repeated work-related injuries are psychologically distressing in U.S. police officers.

Objectives In this study we sought to accomplish the following objectives: 1) to calculate the percentage of children considered appropriately restrained across eight criteria of increasing restrictiveness; 2) to examine agreement between age- and size-based appropriateness criteria; 3) to assess for changes in the percentage of children considered appropriately restrained by the eight criteria between 2011 (shortly after updates to United States (U.S.) guidelines) and 2015. Methods Data from two cross-sectional surveys of 928 parents of children younger than 12 years old (n = 591 in 2011, n = 337 in 2015) were analyzed in 2017. Child age, weight, and height were measured at an emergency department visit and used to determine if the parent-reported child passenger restraint was considered appropriate according to eight criteria. Age-based criteria were derived from Michigan law and U.S. guidelines. Weight, height, and size-based criteria were derived from typical restraints available in the U.S. in 2007 and 2011. The percent appropriate restraint use was calculated for each criterion. The kappa statistic was used to measure agreement between criteria. Change in appropriateness from 2011 to 2015 was assessed with chi-square statistics. Results Percent appropriate restraint use varied from a low of 19% for higher weight limits in 2011 to a high of 91% for Michigan law in 2015. Agreement between criteria was slight to moderate. The lowest kappa was for Michigan law and higher weight limits in 2011 (κ = 0.06) and highest for U.S. guidelines and lower weight limits in 2011 (κ = 0.60). Percent appropriate restraint use was higher in 2015 than 2011 for the following criteria: U.S. guidelines (74% vs. 58%, pConclusions The percent of children considered to be using an appropriate restraint varied substantially across criteria. Aligning the definition of appropriate restraint use with current U.S. guidelines would increase consistency in reporting results from studies of child passenger safety in the U.S. Potential explanations for the increased percentage of children considered appropriately restrained between 2011 and 2015 include adoption of the updated U.S. guidelines and the use of child passenger restraints with higher weight and height limits.

Purpose Adolescent drivers are at elevated crash risk due to distracted driving behavior (DDB). Understanding parental and peer influences on adolescent DDB may aid future efforts to decrease crash risk. We examined the influence of risk perception, sensation seeking, as well as descriptive and injunctive social norms on adolescent DDB using the theory of normative social behavior. Methods 403 adolescents (aged 16–18 years) and their parents were surveyed by telephone. Survey instruments measured self-reported sociodemographics, DDB, sensation seeking, risk perception, descriptive norms (perceived parent DDB, parent self-reported DDB, and perceived peer DDB), and injunctive norms (parent approval of DDB and peer approval of DDB). Hierarchical multiple linear regression was used to predict the influence of descriptive and injunctive social norms, risk perception, and sensation seeking on adolescent DDB. Results 92% of adolescents reported regularly engaging in DDB. Adolescents perceived that their parents and peers participated in DDB more frequently than themselves. Adolescent risk perception, parent DDB, perceived parent DDB, and perceived peer DDB were predictive of adolescent DDB in the regression model, but parent approval and peer approval of DDB were not predictive. Risk perception and parental DDB were stronger predictors among males, whereas perceived parental DDB was stronger for female adolescents. Conclusions Adolescent risk perception and descriptive norms are important predictors of adolescent distracted driving. More study is needed to understand the role of injunctive normative influences on adolescent DDB. Effective public health interventions should address parental role modeling, parental monitoring of adolescent driving, and social marketing techniques that correct misconceptions of norms related to around driver distraction and crash risk.

Objective Driver distraction has been identified as a threat to individual drivers and public health. Motor vehicle collisions remain a leading cause of death for children, yet little is known about distractions among drivers of children. This study sought to characterize potential distractions among drivers of children. Methods A 2-site, cross-sectional, computerized survey of child passenger safety practices was conducted among adult drivers of 1- to 12-year-old children who presented for emergency care between October 2011 to May 2012. Drivers indicated the frequency with which they engaged in 10 potential distractions in the past month while driving with their child. Distractions were grouped in 4 categories: 1) nondriving, 2) cellular phone, 3) child, and 4) directions. Information about other unsafe driving behaviors and sociodemographic characteristics was collected. Results Nearly 90% of eligible parents participated. Analysis included 570 drivers (92.2%). Non-driving-related and cellular phone–related distractions were disclosed by >75% of participants. Fewer participants disclosed child (71.2%) and directions-related distractions (51.9%). Child age was associated with each distraction category. Cellular phone–related distractions were associated with the child riding daily in the family car, non-Hispanic white, and higher education. Parents admitting to drowsy driving and being pulled over for speeding had over 2 times higher odds of disclosing distractions from each category. Conclusions Distracted driving activities are common among drivers of child passengers and are associated with other unsafe driving behaviors. Child passenger safety may be improved by preventing crash events through the reduction or elimination of distractions among drivers of child passengers.

Injury resulting from motor vehicle crashes is the leading cause of death among teenagers in the US. Few programs or policies have been found to be effective in reducing the risk of fatal car crashes for young novice drivers. One effective policy that has been widely implemented is Graduated Driver Licensing (GDL). Published articles have mostly reported on the temporal effectiveness of GDL in the US. This article reports on the development of spatial statistical modeling approaches to evaluate and compare the effectiveness of GDL policy across eighty-three counties in the state of Michigan. Data were gathered from several publicly available databases, including the US Fatality Analysis Reporting System (FARS), US Census Bureau, US Bureau of Labor Statistics, and US Department of Agriculture. To account for spatial dependence among crash counts from adjacent counties we invoke spatial random effects, which we provide with a Conditionally AutoRegressive (CAR) prior. Our analysis confirms previous findings that GDL in Michigan is an effective policy that significantly reduces the risk of fatal car crashes among novice teenage drivers. In addition, it indicates that rurality is an important contextual variable associated with spatial differences in GDL effectiveness across the state of Michigan. Finally, our findings provide information that can be used to strengthen GDL policy and its implementation to further enhance teenage-driver safety.

OBJECTIVE: Teenage passengers affect teenage driving performance, possibly by social influence. To examine the effect of social norms on driving behavior, male teenagers were randomly assigned to drive in a simulator with a peer-aged confederate to whom participants were primed to attribute either risk-accepting or risk-averse social norms. It was hypothesized that teenage drivers would engage in more risky driving behavior in the presence of peer passengers than no passengers, and with a risk-accepting compared with a risk-averse passenger. METHOD: 66 male participants aged 16 to18 years holding a provisional driver license were randomized to drive with a risk-accepting or risk-averse passenger in a simulator. Failure to Stop at a red light and percent Time in Red (light) were measured as primary risk-relevant outcomes of interest at 18 intersections, while driving once alone and once with their assigned passenger. RESULTS: The effect of passenger presence on risky driving was moderated by passenger type for Failed to Stop in a generalized linear mixed model (OR = 1.84, 95% CI [1.19, 2.86], p CONCLUSIONS: Exposure of teenage males to a risk-accepting confederate peer increased teenage males' risky simulated driving behavior compared with exposure to a risk-averse confederate peer. These results indicate that variability in teenage risky driving could be partially explained by social norms. (PsycINFO Database Record (c) 2014 APA, all rights reserved). Language: en

BACKGROUND: Seat belts are the most effective method of decreasing fatal and nonfatal motor vehicle crash injury. Advocacy groups have recently been successful in enacting repeals of mandatory motorcycle helmet laws in several states. In some states, this has prompted renewed efforts aimed at repealing mandatory seat belt laws. PURPOSE: To evaluate and quantify the potential impact of rescinding seat belt laws on annual crash-related fatalities, nonfatal injuries, and associated economic costs, using Michigan as a model, to inform the national debate. METHODS: Proportional injury rates were calculated utilizing police-reported statewide passenger vehicle crash data from 1999 and 2002, where belt use rates approximate estimates associated with repeal of primary and secondary seat belt laws. Proportional rates were applied to the most recent year of crash data (2011) to estimate changes in statewide fatalities and nonfatal injuries. National cost estimates were applied to injury data to calculate associated economic costs. RESULTS: Full repeal of the seat belt law is estimated to result in an additional 163 fatalities, 13,722 nonfatal injuries, and an associated societal cost of $1.6 billion annually. Repeal of the primary seat belt law only is estimated to result in an additional 95 fatalities, 9156 nonfatal injuries, and an associated societal cost of $1.0 billion annually. CONCLUSIONS: This analysis suggests that repealing the either the primary or full seat belt law would have a substantial and negative impact on public health, increasing motor vehicle crash related fatality, nonfatal injury, and associated economic costs.

BACKGROUND: Most studies evaluating the effectiveness of Graduated Driver Licensing (GDL) have focused on the overall system. Studies examining individual components have rarely accounted for the confounding of multiple, simultaneously implemented components. The purpose of this paper is to quantify the effects of a required learner license duration and required hours of supervised driving on teen driver fatal crashes. METHODS: States that introduced a single GDL component independent of any other during the period 1990-2009 were identified. Monthly and quarterly fatal crash rates per 100,000 population of 16- and 17-year-old drivers were analyzed using single-state time series analysis, adjusting for adult crash rates and gasoline prices. Using the parameter estimates from each state's time series model, the pooled effect of each GDL component on 16- and 17-year-old drivers' fatal crashes was estimated using a random effects meta-analytic model to combine findings across states. RESULTS: In three states, a six-month minimum learner license duration was associated with a significant decline in combined 16- and 17-year-old drivers' fatal crash rates. The pooled effect of the minimum learner license duration across all states in the sample was associated with a significant change in combined 16- and 17-year-old driver fatal crash rates of -.07 (95% Confidence Interval [CI] -.11, -.03). Following the introduction of 30h of required supervised driving in one state, novice drivers' fatal crash rates increased 35%. The pooled effect across all states in the study sample of having a supervised driving hour requirement was not significantly different from zero (.04, 95% CI -.15, .22). CONCLUSION: These findings suggest that a learner license duration of at least six-months may be necessary to achieve a significant decline in teen drivers' fatal crash rates. Evidence of the effect of required hours of supervised driving on teen drivers' fatal crash rates was mixed. Language: en

Background Evidence is mixed on the effects of graduated driver licensing (GDL) on motor vehicle crashes involving drivers aged 18 years. Purpose This study examined the effects of GDL on crashes involving drivers aged 18 years in three states: Maryland, where GDL applies to novice drivers of all ages, and Florida and Michigan, where GDL applies only to new drivers aged Methods Monthly rates for three levels of crash severity (fatal/disabling injury, nondisabling injury, and possible injury/property damage only [PDO]) for drivers aged 16, 17, and 18 years were calculated using crash records and census data. Data for Maryland spanned 1998 to 2009, for Florida 1990 to 2009, and Michigan 1992 to 2009. GDL’s effects on teen driver crashes by age were estimated using time-series analyses, conducted in 2012. Results Crash rates for drivers aged 16 and 17 years declined in all three states following implementation or revision of GDL. For drivers aged 18 years, revision of an existing GDL law in Maryland was followed by a 6.9% decrease in possible-injury/PDO crashes; in Michigan, GDL implementation was followed by a 3.6% increase in possible-injury/PDO crashes; and in Florida, GDL had no effect. Conclusions GDL led to expected declines in crash rates for drivers aged 16 and 17 years. However, the findings suggest that when GDL applies only to novice drivers aged

Objectives. To evaluate the impact of the partial repeal of Michigan’s universal motorcycle helmet law on helmet use, fatalities, and head injuries. Methods. We compared helmet use rates and motorcycle crash fatality risk for the 12 months before and after the April 13, 2012, repeal with a statewide police-reported crash data set. We linked police-reported crashes to injured riders in a statewide trauma registry. We compared head injury before and after the repeal. Regression examined the effect of helmet use on fatality and head injury risk. Results. Helmet use decreased in crash (93.2% vs 70.8%; P Conclusions. Michigan’s helmet law repeal resulted in a 24% to 27% helmet use decline among riders in crashes and a 14% increase in head injury.

Addressing teen driver crashes, this study adapted an effective CheckpointsTMprogram for parents of teen drivers for dissemination by primary care practitioners (PCPs) and the web; distributed the PCP/web program through pediatric practices; and examined dissemination to/implementation by parents. The website, youngDRIVERparenting.org , and brief intervention protocol were developed. PCPs delivered interventions and materials to parents, referred them to the website, and completed follow-up surveys. Google Analytics assessed parents’ website use. Most PCPs reported delivering interventions with fidelity, and thought the program important and feasible. Brief interventions/website referrals, averaging 4.4 minutes, were delivered to 3465 (87%) of 3990 eligible parents by 133 PCPs over an 18-week average. Website visits (1453) were made by 42% of parents, who spent on average 3:53 minutes viewing 4.2 topics. This program costs little (its website, training and promotional materials are available) and could be one component of a comprehensive approach to reducing teen driver crashes.

Motorcycle crashes result in a significant health burden, including many fatal injuries and serious non-fatal head injuries. Helmets are highly effective in preventing such trauma, and jurisdictions that require helmet use of all motorcyclists have higher rates of helmet use and lower rates of head injuries among motorcyclists. The current study examines helmet use and characteristics of helmeted operators and their riding conditions in Michigan, following a weakening of the state's universal motorcycle helmet use law in April 2012. Data on police-reported crashes occurring during 2012-14 and from a stratified roadside observational survey undertaken in Southeast Michigan during May-September 2014 were used to estimate statewide helmet use rates. Observed helmet use was more common among operators of sports motorcycles, on freeways, and in the morning, and least common among operators of cruisers, on minor arterials, and in the afternoon. The rate of helmet use across the state was estimated at 75%, adjusted for roadway type, motorcycle class, and time of day. Similarly, the helmet use rate found from examination of crash records was 73%. In the observation survey, 47% of operators wore jackets, 94% wore long pants, 54% wore boots, and 80% wore gloves. Protective clothing of jackets and gloves was most often worn by sport motorcycle operators and long pants and boots most often by riders of touring motorcycles. Findings highlight the much lower rate of helmet use in Michigan compared with states that have a universal helmet use law, although the rate is higher than observed in many states with partial helmet laws. Targeted interventions aimed at specific groups of motorcyclists and situations where helmet use rates are particularly low should be considered to increase helmet use.

BACKGROUND AND OBJECTIVES: Emergency department (ED) visits present an opportunity to deliver brief interventions (BIs) to reduce violence and alcohol misuse among urban adolescents at risk for future injury. Previous analyses demonstrated that a BI resulted in reductions in violence and alcohol consequences up to 6 months. This article describes findings examining the efficacy of BIs on peer violence and alcohol misuse at 12 months. METHODS: Patients (14–18 years of age) at an ED reporting past year alcohol use and aggression were enrolled in the randomized control trial, which included computerized assessment, random assignment to control group or BI delivered by a computer or therapist assisted by a computer. The main outcome measures (at baseline and 12 months) included violence (peer aggression, peer victimization, violence-related consequences) and alcohol (alcohol misuse, binge drinking, alcohol-related consequences). RESULTS: A total of 3338 adolescents were screened (88% participation). Of those, 726 screened positive for violence and alcohol use and were randomly selected; 84% completed 12-month follow-up. In comparison with the control group, the therapist assisted by a computer group showed significant reductions in peer aggression (P < .01) and peer victimization (P < .05) at 12 months. BI and control groups did not differ on alcohol-related variables at 12 months. CONCLUSIONS: Evaluation of the SafERteens intervention 1 year after an ED visit provides support for the efficacy of computer-assisted therapist brief intervention for reducing peer violence.

OBJECTIVES: This study assessed the association between county level material deprivation and urbanization with fatal road traffic crashes involving young unlicensed drivers in the United States (US). BACKGROUND: Road traffic crashes have been positively associated with area deprivation and low population density but thus far few studies have been concerned specifically with young drivers, especially those that are unlicensed. METHODS: A county material deprivation index was derived from the Townsend Material Deprivation Index, with variables extracted from the US Census (2000). An urbanicity scale was adapted from the US Department of Agriculture's Rural-Urban Continuum Codes (2003). Data on fatal crashes involving a young unlicensed driver during a seven-year period (2000-2006; n=3059) were extracted from the Fatality Analysis Reporting System. The effect of deprivation and urbanicity on the odds of the occurrence of at least one fatal crash at the county level was modeled by conditional and unconditional logistic regression. RESULTS: The conditional model found a positive association between material deprivation and a fatal crash involving a young unlicensed driver (OR=1.19, 95% CI 1.17, 1.21). The interaction between urbanicity and material deprivation was negatively associated in suburban counties for fatal crashes (OR=0.92, 95% CI 0.90, 0.95). CONCLUSIONS: An association with material deprivation and the likelihood of a fatal crash involving a young unlicensed driver is a new finding. It can be used to inform specific county-level interventions and promote state licensing policies to provide equity in young people's mobility regardless of where they live. Language: en

This study presents the results of an efficacy evaluation of a web-based brief motivational alcohol prevention/intervention program called Michigan Prevention and Alcohol Safety for Students (M-PASS). Four on-line sessions providing individually-tailored feedback were delivered to first-year college students over 9 weeks. Non- and low-risk drinking participants received risk prevention, while high-risk drinking participants received a risk-reduction intervention. Both intervention and control groups were surveyed at baseline and at a 3-month follow-up. Analysis showed positive effects for both men and women on stage of change, drinking behavior, drinking motivation and attitudes, and use of risk-reduction strategies. These results provided evidence of efficacy and found that M-PASS had both intervention and prevention effects, making it unique among currently developed brief alcohol interventions for college students.

An inner-city emergency department (ED) visit provides an opportunity for contact with high-risk adolescents to promote injury prevention. Objectives: To identify the prevalence of injuries sustained over the past year by teens presenting to an inner-city ED, and to identify factors associated with recent injury to inform future ED-based injury prevention initiatives. Methods: Over 1 year, 7 days a week, from 1:00-11:00 p.m., patients aged 14-18 years presenting to the ED participated in a survey regarding past-year risk behaviors and injuries. Results: Of the entire group of teens presenting to the ED (n = 1128) who completed the survey (83.8% response rate), 46% were male, and 58% were African-American. Past-year injuries were reported by 768 (68.1%) of the teens; 475 (61.8%) of those reported an unintentional injury and 293 (38.1%) reported an intentional injury. One-third of all youth seeking care reported a past-year sports-related injury (34.5%) or an injury related to driving or riding in a car (12.3%), and 8.2% reported a gun-related injury. Logistic regression found that binge drinking (adjusted odds ratio AOR. 1.95) and illicit weapon carrying (AOR 2.31) predicted a past-year intentional injury. African-American youth (AOR 0.56) and those receiving public assistance (AOR 0.73) were less likely to report past-year unintentional injuries. Conclusions: Adolescents seeking care in an inner-city ED, regardless of the reason for seeking care, report an elevated prevalence of recent injury, including violence. Future injury screening and prevention efforts should consider universal screening of all youth seeking ED care. Language: en

OBJECTIVES: Alcohol use and violent behaviors are well documented among adolescents and have enormous effects on morbidity and mortality. The authors hypothesized that universal computer screening of teens in an inner-city emergency department (ED), followed by a brief intervention (BI), would be 1) feasible (as measured by participation and completion of BI during the ED visit) and well received by teens (as measured by posttest process measures of intervention acceptability) and 2) effective at changing known precursors to behavior change such as attitudes, self-efficacy, and readiness to change alcohol use and violence. METHODS: Adolescent patients (ages 14-18 years) at an urban ED were approached to complete a computerized survey. The survey was conducted daily from 12 noon to 11 pm from September 2006 through November 2008. Adolescents reporting both alcohol use and violence in the past year were randomized to a control group or a 35-minute BI delivered by a computer or therapist as part of the SafERteens study. Validated measures were administered, including demographics, alcohol use, attitudes toward alcohol and violence, self-efficacy for alcohol and violence, readiness to change alcohol and violence, and process questions, including likeability of intervention. RESULTS: A total of 2,423 adolescents were screened. Thirteen percent of those approached refused. The population was 45% male, 58% African American, and 6.2% Hispanic. Of those screened, 637 adolescents (26%) screened positive; 533 were randomized to participate, and 515 completed the BI prior to discharge. The BIs were well received by the adolescents overall; 97% of those randomized to a BI self-reported that they found one intervention section "very helpful." At posttest, significant reductions in positive attitudes for alcohol use and violence and significant increases in self-efficacy related to alcohol/violence were found for both therapist and computer interventions. At 3-month follow-up there was 81% retention, and generalized estimating equations (GEE) analysis showed that participants in both interventions had significant reductions in positive attitudes for alcohol use (therapist p = 0.002, computer p = 0.0001) and violence (therapist p = 0.012, computer p = 0.007) and significant increases in self-efficacy related to violence (therapist p = 0.0.04, computer p = 0.002); alcohol self-efficacy improved in the therapist BI condition only (therapist p = 0.050, computer p = 0.083). Readiness to change was not significantly improved. CONCLUSIONS: This initial evaluation of the SafERteens study shows that universal computerized screening and BI for multiple risk behaviors among adolescents is feasible, well received, and effective at altering attitudes and self-efficacy. Future evaluations of the SafERteens study will evaluate the interventions' effects on behavioral change (alcohol use and violence) over the year following the ED visit. Language: en

OBJECTIVE: Teens drink/drive less often than adults but are more likely to crash when they do drink/drive. This study identified alcohol-related crash types for which teen drivers were at greater risk compared with adults. METHOD: Michigan State Police crash records for drivers ages 16-19 (teens) and 45-65 years (adults) who experienced at least one crash from 1989 to 1996 were used to create alcohol crash types consisting of alcohol-related crashes that included specific combinations of other crash characteristics, such as drinking and driving at night (i.e., alcohol/nighttime). These data were combined with data from the 1990 and 1995 National Personal Travel Surveys and the 2001 National Household Travel Survey to estimate rates and rate ratios of alcohol-related crash types based on person-miles driven. RESULTS: Teens were relatively less likely than adults to be involved in alcohol-related crashes but were significantly more likely to be in alcohol-related crashes that included other crash characteristics. Teen males' crash risk was highest when drinking and driving with a passenger, at night, at night with a passenger, and at night on the weekend, and casualties were more likely to result from alcohol-related nighttime crashes. All the highest risk alcohol-related crash types for teen female drinking drivers involved casualties and were most likely to include speeding, passenger presence, and nighttime driving. CONCLUSIONS: The frequency with which passengers, nighttime or weekend driving, and speeding occurred in the highest risk alcohol-related crash types for teens suggests that these characteristics should be targeted by policies, programs, and enforcement to reduce teen alcohol-related crash rates. Language: en

This study examined the association between psychosocial maturation and problem driving behavior in young adulthood. Psychosocial maturation is the process of adopting adult roles, attitudes and behaviors and completing developmental tasks associated with becoming an adult. Past research has demonstrated that individuals' participation in health-risk behaviors decreases as psychosocial maturity increases. Not surprisingly, decreases in driving risk that occur over the first years of driving have often been assumed to result in large degree from general maturation; however, no research has tested this assumption. This study used data from a telephone survey of young adults to begin addressing this gap in the literature by testing three hypotheses: (1) indicators of higher psychosocial maturity are associated with lower problem driving behavior; (2) the association between the level of psychosocial maturity and problem driving behavior is cumulative; and, (3) these associations are moderated by sex. Problem driving behavior was evaluated by assessing three measures: high-risk driving, drink/driving, and drug/driving. Results supported all three hypotheses. Participants with greater psychosocial maturity had lower levels of problem driving behavior than participants who were less psychosocially mature. Second, problem driving behavior was lower with higher psychosocial maturity. Third, these associations between psychosocial maturity and problem driving behavior were moderated by sex. The primary contributions of this study are: (1) initial evidence that psychosocial maturation may play a role in improvements in the safety of young drivers; and (2) the generation of questions and hypotheses that provide direction for future research on the role of maturation in observed declines in risk among young drivers.

Adolescents are more likely to be involved in motor vehicle crashes in the presence of peer passengers, and risky driving behaviors of male teenagers increase in the presence of male peer passengers. There could be several mechanisms of the influence of peer passengers, however it is evident that the male teenage driver with a male peer passenger makes riskier decisions than when alone. The developing teenage brain’s activity is different from that of adults during decision-making, especially in regions associated with impulse control, response inhibition, and risk taking. This study tested the feasibility of using functional nearinfrared spectroscopy (fNIRS), a non-invasive brain imaging method that allows in vivo measurements of oxygenated and deoxygenated hemoglobin in cortical tissue, to study drivers’ brain activation during simulated driving. Cortical activity was measured in participants driving alone and in the presence of a passenger. When at a dilemma zone at a signalized intersection participants showed increased activation in regions of the left and right medial pre-frontal cortex when driving with a passenger as compared to when driving alone.

Signalized intersection management is a common measure of risky driving in simulator studies. In a recent randomized trial, investigators were interested in whether teenage males exposed to a risk-accepting passenger took more intersection risks in a driving simulator compared with those exposed to a risk-averse peer passenger. Analyses in this trial are complicated by the longitudinal or repeated measures that are semi-continuous with clumping at zero. Specifically, the dependent variable in a randomized trial looking at the effect of risk-accepting versus risk-averse peer passengers on teenage simulator driving is comprised of two components. The discrete component measures whether the teen driver stops for a yellow light, and the continuous component measures the time the teen driver, who does not stop, spends in the intersection during a red light. To convey both components of this measure, we apply a two-part regression with correlated random effects model (CREM), consisting of a logistic regression to model whether the driver stops for a yellow light and a linear regression to model the time spent in the intersection during a red light. These two components are related through the correlation of their random effects. Using this novel analysis, we found that those exposed to a risk-averse passenger have a higher proportion of stopping at yellow lights and a longer mean time in the intersection during a red light when they did not stop at the light compared to those exposed to a risk-accepting passenger, consistent with the study hypotheses and previous analyses. Examining the statistical properties of the CREM approach through simulations, we found that in most situations, the CREM achieves greater power than competing approaches. We also examined whether the treatment effect changes across the length of the drive and provided a sample size recommendation for detecting such phenomenon in subsequent trials. Our findings suggest that CREM provides an efficient method for analyzing the complex longitudinal data encountered in driving simulation studies.

Motor vehicle injury is the major cause of mortality among young adults. Information about the individual characteristics of those who drive dangerously could enhance traffic safety programs. The goal of this research was to examine the association between various personality-related characteristics and risky driving behaviors.Young adults in Michigan, USA (n = 5,362) were surveyed by telephone regarding several personality factors (risk-taking, hostility, aggression, tolerance of deviance, achievement expectations) and driving behaviors (competitive driving, risk-taking driving, high-risk driving, aggressive driving, and drink/driving). Michigan driver records were obtained to examine offenses, serious offenses, driving offense points, crashes and serious crashes in the three pre-interview years. Multivariate regression analyses, adjusting for age, race, and marital status were conducted separately by sex to identify personality factors related to driving.For men and women, greater risk-taking propensity, physical/verbal hostility, aggression, and tolerance of deviance were significant predictors of a competitive attitude toward driving, risk-taking driving, high-risk driving, driving aggression, and drink/driving. Greater risk-taking propensity, physical/verbal hostility, aggression, and to a small degree, expectations for achievement predicted higher numbers of offenses, serious offenses, and points.Traffic safety policies and programs could be enhanced through recognition of the role personality factors play in driving behavior and the incorporation of this knowledge into the design and implementation of interventions that modify the behaviors associated with them.

This article examines adolescent psychosocial and problem behavior characteristics as predictors of traffic offenses from licensure to early young adulthood.Data for this study were from a school-based sample that was surveyed in 10th and 12th grades, and again in early young adulthood. In addition, state driver history records were obtained for each participant in the study and provided a complete traffic offense history.Models adjusted for driving exposure showed varying patterns of prediction for men and women across three types of ticketed moving violations (offenses): minor offenses, serious offenses, and alcohol offenses. Although which predictors were significant varied across gender and type of offense, results suggested that more positive psychosocial adjustment predicted lower numbers, greater decreases, and a lower likelihood of increases in offenses from licensure through the early 20s.Based on this research, implications for intervention include providing parents with the tools and knowledge needed to effectively supervise their teens' driving during the first years of licensure. Also potentially important for their broad positive effects on problem behaviors, including problem driving, are programs that strengthen adolescents' bonds to conventional social institutions and increase their attachment to the people who represent those institutions. Future research should examine the longitudinal sequencing of associations among psychosocial and problem behavior variables, including problem driving.

Objective: This study used a randomized controlled trial design to compare the effectiveness of four interventions at reducing alcohol consumption, consequences, and heavy episodic drinking among injured, at-risk drinkers in the emergency department (ED). Method: Injured patients (n = 4,476) completed a computerized survey; 575 at- risk drinkers were randomly assigned to one of four intervention conditions: tailored message booklet with brief advice, tailored message booklet only, generic message booklet with brief advice, and generic message booklet only. Regression models using the generalized estimating equation approach were constructed comparing the intervention conditions at baseline, 3-month follow-up, and 12-month follow-up. Gender and age were entered in models along with their interaction. Results: Each of the intervention groups significantly decreased their alcohol consumption from baseline to 12-month follow-up; subjects in the tailored message booklet with brief advice group significantly decreased their average weekly alcohol consumption by 48.5% (p < .0001). Those in the brief advice conditions (tailored or generic) significantly decreased their average consumption during the 12 months of the study compared with the no brief advice conditions. Younger adult women (ages 19-22) who received some brief advice were the most likely to decrease their heavy episodic drinking. Conclusions: This was the first large-scale, brief intervention trial that included development and testing of computerized, highly tailored interventions with injured drinkers in the ED. ED-based interventions for alcohol problems would benefit from computerized screening, brief advice, and booklets to positively impact risky drinking practices. Language: en

Background: Recent serious alcohol-related events have raised public awareness of the prevalence of at-risk alcohol use among college undergraduates, but heavy alcohol consumption during late adolescence and young adulthood is not limited to college students. Alcohol consumption typically peaks in young adulthood regardless of education level, and risks related to alcohol misuse are shared by young adults, regardless of their educational choices. Differences in alcohol risk between college-attending and non-college-attending young adults are generally small, and emphasize the need for research examining the drinking patterns of both of these groups. Methods: To better understand patterns of at-risk alcohol use and its association with education, this study compared at-risk alcohol use from 12th grade to young adulthood (age 24) in a sample of never-married young adults. Three groups were formed based on completed education when the survey was administered in young adulthood: high school or less, postsecondary education without a four-year college degree, and completed college. Results: Men who completed college experienced the greatest increase in at-risk drinking from grade 12 to young adulthood; however, their at-risk alcohol use did not differ markedly from men in the other education groups in young adulthood. Men who did not complete college had high levels of alcohol risk in 12th grade and maintained or increased those levels in young adulthood, demonstrating a pattern of prolonged risk. Women whose completed education was high school or less experienced the fewest increases in at-risk alcohol use. Education group differences were not explained by place of residence or employment status. Conclusions: These results emphasize the need to intervene early to prevent at-risk alcohol use, and emphasize that at-risk alcohol use is neither unique, nor necessarily the highest among individuals who complete college.

Research and education aimed at reducing the crash risk of young drivers has become a top priority to researchers and educators around the world. This panel provides an overview of some of these recent and ongoing efforts. To that end, the purpose of this panel is to: 1) raise awareness of human factors and ergonomics researchers of research needs and problems relevant to teen drivers and education, 2) provide a forum for discussion in this area, and 3) provide a paper summarizing key issues including teenage drivers, driver education, and driver licensing.

Although many older adults with serious psychiatric illnesses share common concerns, such as medical comorbidity, personal loss, greater propensity for adverse medication effects, and greater dependence on others for basic needs such as transportation, individualized treatment needs must be differentiated by underlying psychiatric disorders. This retrospective study evaluated clinical characteristics and resource use among 137 older adults with bipolar disorder, schizophrenia or schizoaffective disorder, depression, and dementia who were discharged from an urban, academic medical center’s inpatient geropsychiatric unit. The authors found women to be significantly overrepresented among individuals with schizophrenia or schizoaffective disorder compared to those with bipolar disorder, depression, and dementia ( P= .034). Among those with bipolar disorder, anticonvulsant medications were predominantly used as mood stabilizers, with only the rare use of lithium. Individuals with schizophrenia or schizoaffective disorder were the youngest group of patients; individuals with dementia were the oldest group ( P< .001). This shows significant differences in clinical characteristics among hospitalized older adults with serious mental illnesses. Additional studies are needed on outcomes of serious chronic psychiatric illnesses in later life to optimize care environments for older adult psychiatric patients.

Many patients with schizophrenia are poorly adherent with antipsychotic medications. The newer, atypical antipsychotics may be more acceptable to patients and result in increased adherence. We used national Department of Veterans Affairs (VA) pharmacy data to examine whether patients receiving atypical agents are more adherent with their medication and explored patient factors associated with adherence. Patients who received a diagnosis of schizophrenia or schizoaffective disorder between October 1, 1998, and September 30, 1999, were identified in the VA National Psychosis Registry. We calculated medication possession ratios (MPRs) for patients filling prescriptions for one (n = 49,003) or two (n = 14,211) antipsychotics during the year. We examined cross-sectional relationships among adherence, type of antipsychotic, and patient characteristics and explored adherence among patients switching antipsychotics during the year. Among patients receiving one antipsychotic, 40 percent had MPRs < 0.8, indicating poor adherence. African-Americans and younger patients were more likely to be poorly adherent. Cross-sectionally, patients on atypical agents were more likely to be poorly adherent (41.5%) than patients on conventional agents (37.8%). However, among a small group of patients switching from a conventional to an atypical agent (n = 1,661) during the year, the percentage who were poorly adherent decreased from 46 percent to 40 percent. We describe the continuum of antipsychotic adherence among a large sample of patients with schizophrenia and confirm that poor adherence is common. African-Americans and younger patients are particularly at risk. Unfortunately, atypical antipsychotics may not be associated with substantial improvements in adherence. More intensive interventions are likely needed.

Health care organizations may be able to use pharmacy data to identify patients with schizophrenia and poor antipsychotic adherence.To determine whether a pharmacy-based measure of outpatient adherence, the medication possession ratio (MPR), is associated with adverse outcomes among patients with schizophrenia, as evidenced by increased psychiatric admission.Cohort study linking pharmacy and utilization data for veterans with schizophrenia. MPRs were calculated by dividing the number of days' supply of antipsychotic medication the veteran had received by the number of days' supply they needed to receive to take their antipsychotic continuously. Using multivariate regression, the relationship between MPRs and psychiatric admission was examined.Sixty-seven thousand seventy-nine veterans who received a diagnosis of schizophrenia and had outpatient antipsychotic medication fills between October 1, 1998 and September 30, 1999.Patients with MPRs close to 1.0 had the lowest rates of admission. As patients secured progressively smaller proportions of required antipsychotic medication (and had smaller MPRs), rates of admission climbed. Among patients on one antipsychotic (n = 49,003), patients with poor adherence (MPRs0.8) were 2.4 times as likely to be admitted as patients with good adherence (MPRs from 0.8-1.1). 23% of poorly adherent patients but only 10% of adherent patients were admitted. Once admitted, poorly adherent patients had more hospital days. Patients who received excess medication also had higher admission rates.Many health care systems may be able to use pharmacy data to identify poorly adherent patients with schizophrenia. These patients are at-risk for admission and may benefit from intervention.

Structural equation modeling was used to test the hypothesis that parental distress would mediate the relations between parental lifetime alcohol and physical health problems and child behavior problems. Participants were 182 alcohol-involved families and 83 matched controls with 3- to 5-year-old biological sons. Results show that sons of parents with alcohol and physical health problems are at elevated risk for behavior problems, partly related to the increased levels of distress their parents are experiencing.

To evaluate the impact of race on mental health care utilization among older patients within given clinical psychiatric diagnoses, the authors examined a retrospective sample of 23,718 elderly veterans treated in Department of Veterans Affairs inpatient facilities in 1994. Significant racial differences in mental health care utilization found over a subsequent 2-year period were related to outpatient (but not inpatient) care; for instance: 1) African American patients with psychotic disorders had significantly fewer outpatient psychiatric visits; and 2) African American patients with substance abuse disorders had significantly more psychiatric visits than Caucasian patients in their respective groups. Although inpatient utilization appeared to be similar among races, findings related to outpatient utilization may be associated with such factors as compliance, treatment efficacy, access to health care, or possible clinician bias.

This study examined family and individual processes influencing the future expectancies of adolescents (N = 345) from an economically stressed rural community. The anticipated timing and sequencing of key role transitions (school completion, job entry, marriage, and parenthood) were examined for each gender. In addition, factors contributing to individual differences in expected timing were examined, and gender differences in predictors were tested. Results indicated that rural adolescents' expectancies about adult role transitions diverged somewhat from societal norms with respect to timing. Family background and relationships, adolescents' attitudes and behaviors, and educational aspirations all contributed to individual differences in expected timing, with somewhat different factors being salient for boys and girls. These findings provide clues to the psychological processes linking adolescent experiences to the construction of the adult life course.

This is the first study to test concurrently the effectiveness of four treatment programs for patients with serious mental illness. Three-year outcome data on utilization and functioning demonstrated important positive changes for seriously mentally ill veterans enrolled in specialized, enhanced inpatient and community case management treatment programs, when compared to patients in an enhanced day treatment program or traditional standard care.

Purpose: Social influence is prominent across the lifespan, but sensitivity to influence is especially high during adolescence and is often associated with increased risk taking. Such risk taking can have dire consequences. For example, in American adolescents, traffic-related crashes are leading causes of nonfatal injury and death. Neural measures may be especially useful in understanding the basic mechanisms of adolescents’ vulnerability to peer influence. Methods: We examined neural responses to social exclusion as potential predictors of risk taking in the presence of peers in recently licensed adolescent drivers. Risk taking was assessed in a driving simulator session occurring approximately 1 week after the neuroimaging session. Results: Increased activity in neural systems associated with the distress of social exclusion and mentalizing during an exclusion episode predicted increased risk taking in the presence of a peer (controlling for solo risk behavior) during a driving simulator session outside the neuroimaging laboratory 1 week later. These neural measures predicted risky driving behavior above and beyond self-reports of susceptibility to peer pressure and distress during exclusion. Conclusions: These results address the neural bases of social influence and risk taking; contribute to our understanding of social and emotional function in the adolescent brain; and link neural activity in specific, hypothesized, regions to risk-relevant outcomes beyond the neuroimaging laboratory. Results of this investigation are discussed in terms of the mechanisms underlying risk taking in adolescents and the public health implications for adolescent driving.

L. Benjamin's (1984) structural analysis of social behavior (SASB) system was used as the organizing framework within which to characterize the phenomenology of self and other relationship experience among subtypes of alcoholic men. Within the context of a community-based study of psychopathology, groups of antisocial alcoholic (A AL), nonantisocial alcoholic (NAAL), and nonalcoholic (control) men completed ratings of their introject (self-concept) and spousal experience. Group differences in demography and psychopathology provided strong support for subtype variations among alcoholic men that could not be attributed to global differences in adaptive functioning. SASB data showed consistency in circumplex ordering across the groups in ratings of self-experien ce and in ratings of the spousal relationship. AAL men were the most self-neglecting, blaming, and least trusting, and control men were the most relationally connected, with NAAL men falling in between. Despite the importance of the subtyping distinction, in some areas, alcoholism, regardless of subtype, was the core differentiating factor. In this article, we make use of Benjamin's (1984, 1993) structural analysis of social behavior (SASB) methods and technology to characterize the phenomenology of self and other intimate relationship experiences among alcoholic men.1 Of special interest is the sensitivity of this method to articulate experiential variations within the alcoholic diagnostic entity, given the substantial literature that now supports the existence of at least two symptomatically and etiologically distinct types of alcoholism (Babor& Lauerman, 1986; Zucker, Fitzgerald, & Moses, 1995). Before turning to the empirical work, we briefly summarize the literature on phenomenology among alcoholic individuals focusing on self-concept research, the relationship of self-experience to interpersonal experience, and the subtype literature that forms the background for the study.

This study examined the association between psychosocial development and the timing offirst sexual intercourse in a sample of White, rural adolescents. Two theoretical models were tested. The first model, derived from problem behavior theory, proposed that earlier timing of first sexual intercourse is associated with longitudinal patterns of transition proneness and poor psychosocial adjustment. The second model, the stage termination model, proposed that early first sexual intercourse interferes with subsequent development, thereby resulting in negative developmental outcomes. Problem behavior theory was supported. For both boys and girls, earlier timing of first sexual intercourse was associated with longitudinal patterns of greater transition proneness and poorer psychosocial adjustment. The stage termination model was not supported. No evidence was found suggesting that early timing of first sexual intercourse results in negative psychosocial outcomes.

Research has suggested the roles of several factors and processes which may affect the timing of first intercourse among adolescents. The roles of pubertal timing, family socialization, psychosocial adjustment, bonds to conventional institutions, problem behavior, and socioeconomic status in the timing of first intercourse were assessed in a sample of 123 male and 166 female White rural adolescents in one rural school district in the eastern US. The sample comprised all students in grades 7-9 in the district's two junior high schools. Respondents' median household income was $14,000, with 12% of families under the poverty level. Most of the written survey questionnaire data is from a 1985 sampling. The majority of students in this longitudinal study had experienced sexual intercourse by age 17. Family socialization and problem behavior were important determinant factors of the timing of first intercourse for both sexes. For boys, the earlier timing of puberty was associated with earlier timing of first intercourse, while social control processes were important for girls. Social class and poor psychosocial adjustment were found to be important for neither gender. Multiple processes influence the timing of first intercourse.

Within the framework of a cumulation/nesting theory for the emergence of adult psychopathology, a typing structure for alcoholism based upon variations in life course continuity of antisocial behavior over childhood and adulthood was examined for its ability to differentiate symptomatic and life history variations among alcoholic and nonalcoholic men accessed by way of a population-based recruitment strategy. Results supported the theory and identified two alcoholic types, one high on lifetime antisociality (antisocial alcoholic = AAL), the other low (nonantisocial alcoholic = NAAL), and a third nonalcoholic type with low lifetime antisociality. Types differed in age of onset, severity, number, and life course of alcohol problems, measures of social adaptation, amount and severity of other psychopathology, and salience of family history load of alcoholism. Antisociality and alcoholism tended to be nested characteristics.