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author:("komfo, kellie")
1.  The influence of sexual partner on condom use among urban adolescents 
The influence of partner context (e.g., drinking alcohol in the 2 hours prior to sex, ≥ 3 years age discordant, met in public) on adolescent boys’ and girls’ condom use is unclear. Among an urban cohort of primarily (86%) minority 17–18 year olds who reported having sex (n=1469), we assessed the association between condom use and partner characteristics for the most recent sexual experience.
We used logistic regression to examine the odds of condom use by measured partner familiarity (casual or unexpected) and context characteristics. Analyses were stratified by gender.
Adolescent boys and girls were twice as likely to use condoms with partners they considered casual or unexpected. Adjusting for partner familiarity risk, adolescent boys’ tended to decrease condom use with risky context partners. Adjusting for partner familiarity risk, adolescent girls were half as likely to use condoms with partners drinking alcohol two hours prior to sex [Odds Ratio (OR)=0.6, 95% Confidence Interval (CI) =0.4–0.9]; ≥ 3 years age discordant (OR=0.5, 95% CI =0.3–0.8); or met in public places (OR=0.6, 95% CI =0.4–0.8).
Regardless of partner familiarity risk, adolescent boys and girls faced barriers to condom use with risky context partners. Increased understanding of adolescents’ perceptions of and control over partner risk and condom use with risky context partners is needed. Interventions aimed at decreasing adolescent sexually transmitted infections should include strategies for adolescents to choose less risky context partners and negotiate condoms with risky context partners.
PMCID: PMC3836835  PMID: 23932008
sexual partners; condom use; adolescents; alcohol use; age discordance
2.  Outcomes from a Randomized Controlled Trial of a Multi-component Alcohol Use Preventive Intervention for Urban Youth: Project Northland Chicago 
Addiction (Abingdon, England)  2008;103(4):606-618.
The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings.
Design and Setting
Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units, and randomly assigned to intervention or “delayed program” control condition.
The study sample (n=5812 students) was primarily African American, Hispanic and low-income.
Students, beginning in sixth grade (age 12), received three years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing).
Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey, and alcohol purchase attempts.
Overall the intervention, compared with a control condition receiving “prevention as usual,” was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e., related risk and protective factors). There was a nonsignificant trend (p = .066) that suggested the ability to purchase alcohol by young appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana, and tobacco use combined (p = .01), with alcohol use alone approaching statistical significance (p = .06).
Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.
PMCID: PMC4216561  PMID: 18261193
alcohol prevention; urban youth; intervention adaptation
3.  A Case-Control Study of Risk and Protective Factors for Incarceration Among Urban Youth 
Each day in the United States, approximately 100,000 youth are under correctional supervision. The purpose of this study is to examine the early risk and protective factors for incarceration using a high-risk sample of urban youth.
Data were obtained from 2,165 (54 who were incarcerated) youth who participated in Project Northland Chicago. Participants were matched exactly on gender, race/ethnicity, and aggressive behavior in sixth grade. Bivariate and multivariate conditional logistic regression analyses were used to examine the risk and protective factors present at sixth grade that increased the odds of incarceration at 12th grade.
The early risk factors for incarceration were age (odds ratio [OR] = 2.51; 95% confidence interval [CI] 1.71–3.69), having been sent to detention (1–3 times: OR = 2.24; 95% CI 1.15–4.37; 4+times: OR = 3.49; 95% CI 1.40–8.72), and the number of hours spent participating in a sport (OR = 1.11; 95% CI 1.03–1.20). Substance use was not significantly related to incarceration after adjusting for other behavioral and contextual risk factors.
General problem behaviors (nonaggressive) strongly predict incarceration among at-risk youth. Implications for prevention programs are discussed.
PMCID: PMC3799819  PMID: 23810428
Incarceration; Adolescent; Crime; Case-control; Detention; Aggression
4.  Prevention Trial in the Cherokee Nation: Design of a Randomized Community Trial 
Prevention Science  2014;16:291-300.
Despite advances in prevention science and practice in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and Native American youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavioral Health to create, implement, and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among Native American and other youth living in rural high-risk underserved communities. The intervention builds directly on results of multiple previous trials of two conceptually distinct approaches. The first is an updated version of CMCA, an established community environmental change intervention, and the second is CONNECT, our newly developed population-wide intervention based on screening, brief intervention, and referral to treatment (SBIRT) research. CMCA direct-action community organizing is used to engage local citizens to address community norms and practices related to alcohol use and commercial and social access to alcohol among adolescents. The new CONNECT intervention expands traditional SBIRT to be implemented universally within schools. Six key research design elements optimize causal inference and experimental evaluation of intervention effects, including a controlled interrupted time-series design, purposive selection of towns, random assignment to study condition, nested cohorts as well as repeated cross-sectional observations, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. The purpose of this paper is to describe the strong partnership between prevention scientists and behavioral health leaders within the Cherokee Nation, and the intervention and research design of this new community trial.
PMCID: PMC4308639  PMID: 24615546
Alcohol prevention; Native American; Rural; Community trial; SBIRT; Environment
5.  Perceived Racial/Ethnic Discrimination, Problem Behaviors, and Mental Health among Minority Urban Youth 
Ethnicity & health  2012;18(4):337-349.
We examined perceived frequency and intensity of racial/ethnic discrimination and associations with high-risk behaviors/conditions among adolescents.
With surveys from 2,490 primarily low socioeconomic status, racial/ethnic minority adolescents, we used regression analysis to examine associations between racial/ethnic discrimination and behavioral health outcomes (alcohol use, marijuana use, physical aggression, delinquency, victimization, depression, suicidal ideation, and sexual behaviors).
Most adolescents (73%) experienced racial/ethnic discrimination and 42% of experiences were “somewhat-” or “very disturbing.” Adolescents reporting frequent and disturbing racial/ethnic discrimination were at increased risk of all measured behaviors, except alcohol and marijuana use. Adolescents who experienced any racial/ethnic discrimination were at increased risk for victimization and depression. Regardless of intensity, adolescents who experienced racial/ethnic discrimination at least occasionally were more likely to report greater physical aggression, delinquency, suicidal ideation, younger age at first oral sex, unprotected sex during last intercourse, and more lifetime sexual partners.
Most adolescents had experienced racial/ethnic discrimination due to their race/ethnicity. Even occasional experiences of racial/ethnic discrimination likely contribute to maladaptive behavioral and mental health outcomes among adolescents. Prevention and coping strategies are important targets for intervention.
PMCID: PMC3914714  PMID: 23043428
6.  Influence of Grade-Level Drinking Norms on Individual Drinking Behavior 
To investigate which points of the middle-school drinking distribution are the most influential in the social contagion of drinking across the middle-school years, in order to identify potential social multipliers.
We measured drinking intentions and behaviors by gender, school, and grade among urban middle-school students who participated in Project Northland Chicago in a longitudinal cohort design.
Individual drinking behaviors were consistently influenced by extreme (80th percentile) drinking intentions and behaviors. This effect was mediated through normal or average levels of drinking, over time.
Interventions can target extreme drinkers as the influential persons in middle-school grades.
PMCID: PMC3707398  PMID: 22943103
social norms; drinking; middle school; gender; mediation
7.  Association between sex partner meeting venues and sexual risk-taking among urban adolescents 
To increase understanding of the association between sexual partner meeting venue types (school, through friends or family, organized groups, public places, or on the street) and sexual risk-taking among urban youth.
Data were from 17-18 year olds who reported having had sex (n=1,656) by the time they participated in the 2008-2009 follow-up of a multi-component alcohol preventive intervention, Project Northland Chicago. We used logistic regression to assess the association between partner meeting venue and sexual risk-taking.
Approximately 20% of Chicago adolescents met their most recent sex partner on the street or in public places. Adolescents who met their partner in a public place rather than school were more likely to report having ≥ 3 years age discordant partner [women Odds Ratio (OR) = 7.7, 95% Confidence Interval (CI) = 3.3-17.7, men OR=2.7, 95% CI=1.1, 6.6], alcohol use prior to sex (women OR=3.4, 95% CI 1.8-6.5, men OR=2.4, 95% CI=1.3-4.4), casual partner (women OR = not significant, men OR=2.4, 95% CI=1.3-4.5), anal sex (women OR = not significant, men OR=2.4, 95% CI=1.2-4.9), and unprotected sex (women OR=1.7, 95% CI 1.0-2.7, men OR=1.9, 95% CI=1.1-3.4). Meeting partners on the street was associated with increased probability of alcohol use prior to sex (women OR=2.2, 95% CI 1.1, 4.3, men OR=2.1, 95% CI=1.0-4.6), age discordant partnerships among women (OR=14.2, 95% CI 6.4-31.4), and casual sex partners among men (OR=2.5, 95% CI 1.4-4.8).
Targeting sexual risk-taking with partners selected from public places or the street may improve adolescent HIV preventive interventions.
PMCID: PMC3505279  PMID: 23174466
age discordance; venue; sexual partners; alcohol use; urban adolescents
8.  Beyond the clinic: improving child health through evidence-based community development 
BMC Pediatrics  2013;13:172.
Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.
To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990–2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.
Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.
Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.
PMCID: PMC4016148  PMID: 24138839
Child; Adolescent; Health promotion; Policy; Evidence-based practice; Review
9.  A Multi-Level Approach to Investigating Neighborhood Effects on Physical Aggression among Urban Chicago Youth 
The current study evaluates neighborhood effects, individual-level effects, and demographic characteristics that influence physically aggressive behavior among urban youth. Using data derived from 5,812 adolescents from Project Northland Chicago (PNC) and Heirarchical Linear Modeling (HLM) techniques, the results suggested that neighborhood problems significantly predicted physical aggression, before and after adjustment for individual-level risk factors (alcohol use, peer alcohol use, lack of adult supervision, and depression) and demographics. After accounting for baseline physical aggression, however, neighborhood problems were no longer a significant predictor of physical aggression. Implications for intervention at both the neighborhood and individual-level and study limitations are also discussed.
PMCID: PMC3774046  PMID: 24049432
Aggression; Neighborhood; Urban; Adolescence; Multilevel
Journal of drug education  2010;40(3):265-280.
Alcoholic beverage consumption among high school students has shifted from beer to liquor. The current longitudinal study examined the effects of beverage-specific alcohol use on drinking behaviors among urban youth. Data included 731 adolescents who participated in Project Northland Chicago and reported consuming alcohol in 7th grade. Logistic regression tested the effects of beverage-specific use on consequences (e.g., alcohol use in the past month, week, heavy drinking, and ever drunkenness). Compared to wine users, adolescents who reported drinking hard liquor during their last drinking occasion had increased odds of alcohol use during the past month (OR = 1.44; 95% CI = 1.01–2.05), past week (OR = 3.37; 95% CI = 1.39–8.18), and ever drunkenness (OR = 1.56; 95% CI = 1.07–2.29). Use of hard liquor was associated with increased risk of alcohol-related consequences. Early selection of certain alcoholic beverages (e.g., hard liquor) may result in negative health outcomes and problematic alcohol use over time.
PMCID: PMC3721330  PMID: 21313986
11.  Preventing the Link Between SES and High-Risk Behaviors: “Value-Added” Education, Drug Use and Delinquency in High-Risk, Urban Schools 
We examined whether schools achieving better than expected educational outcomes for their students influence the risk of drug use and delinquency among urban, racial/ethnic minority youth. Adolescents (n=2,621), who were primarily African American and Hispanic and enrolled in Chicago public schools (n=61), completed surveys in 6th (aged 12) and 8th (aged 14) grades. Value-added education was derived from standardized residuals of regression equations predicting school-level academic achievement and attendance from students’ sociodemographic profiles and defined as having higher academic achievement and attendance than that expected given the sociodemographic profile of the schools’ student composition. Multilevel logistic regression estimated the effects of value-added education on students’ drug use and delinquency. After considering initial risk behavior, value-added education was associated with lower incidence of alcohol, cigarette and marijuana use; stealing; and participating in a group-against-group fight. Significant beneficial effects of value-added education remained for cigarette and marijuana use, stealing and participating in a group-against-group fight after adjustment for individual- and school-level covariates. Alcohol use (past month and heavy episodic) showed marginally significant trends in the hypothesized direction after these adjustments. Inner-city schools may break the links between social disadvantage, drug use and delinquency. Identifying the processes related to value-added education in order to improve school environments is warranted given the high costs associated with individual-level interventions.
PMCID: PMC3707388  PMID: 21360062
Schools; Drug use; Delinquency; Urban; Adolescents
12.  Racial/Ethnic Differences in Trajectories of Aggression in a Longitudinal Sample of High-Risk, Urban Youth 
To estimate trajectories of aggression among African Americans and Hispanics using a longitudinal sample of urban adolescents, and test multiple domains of risk factors to differentiate profiles of aggression.
Participants included 3,038 adolescents followed from 6th–8th grade. Trajectories of aggression were estimated for African Americans and Hispanics separately, and multinomial regression procedures were used to evaluate the effect of multiple domains of risk and protective factors. Mediation analyses were conducted to evaluate the indirect effects of contextual variables on aggression.
Four profiles of aggression were identified. Among Hispanics, groups included: 1) low-aggression, 2) desistors, 3) escalators, and 4) consistent aggression; among African Americans: 1) low-aggression, 2) escalators, 3) moderate-consistent aggression, and 4) consistent aggression. Differences in the multiple domains of risk factors emerged between racial/ethnic groups.
Contextual variables (peer alcohol use, adult alcohol consumption, and home access to alcohol) increased risk for aggression differentially by racial/ethnic group.
PMCID: PMC3383599  PMID: 22727076
trajectory; aggression; longitudinal; adolescents; drug; alcohol
13.  Classroom Norms and Individual Smoking Behavior in Middle School 
To investigate whether smoking prevalence in grade-level networks influences individual smoking, suggesting that peers are important social multipliers in teen smoking.
We measured gender-specific, grade-level recent and life-time smoking among urban middle-school students who participated in Project Northland Chicago in a longitudinal cohort design.
Within schools, grade-level recent smoking had comparable effects on girls’ and boys’ individual-level smoking. Grade-level lifetime smoking had a greater effect on girls’ smoking.
Interventions can target middle school classes and schools broadly, without making the identification of friendship networks a concern.
PMCID: PMC3686270  PMID: 22251779
social norms; smoking; middle school; gender
14.  Creating Nurturing Environments: A Science-Based Framework for Promoting Child Health and Development within High-Poverty Neighborhoods 
Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes, and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities.
PMCID: PMC3686471  PMID: 21468644
child; adolescent; health; wellbeing; poverty; framework
16.  Do High Risk Urban Youth also have Older Friends? 
The purpose of this study was to explore how behavioral, intra-personal and socio-environmental factors were associated with the likelihood of having at least one older friend.
Participants included 3709 ethnically-diverse 8th grade students in the Project Northland Chicago intervention trial. Socio-demographic characteristics included gender, family composition, language spoken at home, race/ethnicity, and age. Behavioral factors included cigarette, alcohol, and marijuana use, depressed feelings, willingness to wear alcohol-branded merchandise, and violent and delinquent behavior. Intrapersonal factors included low refusal self efficacy and outcome expectations and expectancies. Socio-environmental factors included alcohol offers and access, normative estimates and expectations, and peer alcohol use. Having an older friend was defined as having at least one friend aged 16 or older (students’ mean age=14.2). Logistic mixed-effects regression models were used and controlled for gender, race/ethnicity, treatment status, and age.
Females and older eighth graders were significantly more likely to have at least one older friend. Students who scored higher on all of the behavioral, intra-personal and socio-environmental risk factors were significantly more likely to have at least one older friend. Significant gender interactions were found for several of the relationships.
Overall this study found multiple risk-related factors are associated with having older friends in eighth grade. Particularly important factors appear to be cigarette, marijuana and alcohol use, having friends who use alcohol, having increased alcohol offers, and being willing to wear or use alcohol-branded merchandise.
PMCID: PMC3079854  PMID: 21501805
Peers; Friends; Risk Behaviors; Risk Factors; Adolescence
17.  Effects of Alcohol on Trajectories of Physical Aggression Among Urban Youth: An Application of Latent Trajectory Modeling 
Journal of youth and adolescence  2009;39(9):1012-1026.
Several studies have investigated factors associated with physical aggression during adolescence. Yet, little is known about the longitudinal relationship between drug use, particularly alcohol use, and physical aggression among minority youth. The present study examined the effects of alcohol and substance use at age 11 on trajectories of physical aggression over time (ages 12–14) among urban adolescents from Chicago, IL. Data from the Project Northland Chicago (n = 3038, 49.4% female) was used. The current study sample included 1,160 Black, 1,015 Hispanic and 863 White/other adolescents for a total of 3,038 adolescents. Four trajectories of physical aggression were identified: Non-aggressive (16%), Desistors (9%), Escalators (20%) and Chronic Aggressive (55%). After adjusting for physical aggression behaviors, delinquent friends, lack of supervised time, demographic variables, smoking and marijuana use, past year alcohol users at age 11 were 2.1 times more likely to be “Escalators” and 1.9 times more likely to be in the “Chronic Aggressive” group. Gender and ethnic differences were also observed in the trajectories of physical aggression. Black youth were 2.5 times more likely to be in the “Chronic Aggressive” group. Findings highlight the importance of targeting alcohol prevention to reduce physical aggression among urban young adolescents.
PMCID: PMC2890031  PMID: 20012555
Physical aggression; Group-based; Longitudinal; Urban; Adolescents; Alcohol
18.  Sex Similarities/Differences in Trajectories of Delinquency among urban Chicago Youth: The Role of Delinquent Peers 
A growing body of literature has recently emerged examining sex-specific pathways of offending. Yet, despite significant gains, this area of research is still rather underexplored. With a particular focus on the role of delinquent peers, this current study investigates the sex similarities/differences in offending trajectories among a large sample of urban Chicago male and female youth (n=3,038) from 6th through 8th grade (e.g., ages 12–14). The results suggest that the pathways of offending appear to be more similar than different across sex, and that associating with delinquent peers is significantly related to baseline delinquency. Furthermore, delinquent peers significantly distinguished the moderate and high-rate trajectory groups from the non-delinquents for both males and females, yet once estimated in a more fully specified model, the role of delinquent peers appeared to be indirect (operating through its effect on baseline delinquency). Study limitations and implications for theory and policy are also discussed.
PMCID: PMC3148146  PMID: 21814456
Sex; Trajectories; Deliquency; Social learning theory; Deliquent peers
20.  Longitudinal associations between family dinner and adolescent perceptions of parent-child communication among racially-diverse urban youth 
Growth curve models examined changes in adolescent self-reported parent-child communication conditional on family meal frequency over a 3.5 year period among a population of racially-diverse, low-income adolescents from an urban environment (n = 4750). Results indicated that although both family dinner frequency and adolescent perceptions of parent-child communication scores were characterized by negative linear growth over time (both p < .0001), family dinner frequency was positively associated with adolescent perceptions of parent-child communication scores over time (p < .0001). Study findings suggest that families with teenagers may enhance parent-child communication and ultimately promote healthy adolescent development by making family dinner a priority. Additionally, the communication benefits of family dinner at the beginning of 6th grade may be protective through 8th grade.
PMCID: PMC2896222  PMID: 20545399
adolescents; family dinner; family meals; parent-child communication; race/ethnicity; urban
21.  Trajectories of Physical Aggression Among Hispanic Urban Adolescents and Young Adults: An Application of Latent Trajectory Modeling from Ages 12 to 18 
This study sought to identify trajectories of physical aggression among urban Hispanic youth, and to examine the effects of risk and protective factors at age 11 on trajectories of physical aggression over time (ages 12–18). Relying on data from 731 urban Hispanic adolescents from Project Northland Chicago (PNC), latent trajectory modeling was used to determine the number of trajectories, and multinomial logistic regression was used to identify the predictors associated with trajectory membership. The results suggested five trajectories of physical aggression (non-aggressive, low stable, escalators, early-rapid desistors, and high aggression/moderate desistors). After adjusting for several risk and protective factors, language preference (e.g. speaking Spanish at home) was identified as a protective factor, while indirect exposure to alcohol, sadness/depression, fewer negative alcohol-related attitudes, and threatening to fight were associated with increased risk for physical aggression. Study implications indicate that early, multilevel prevention efforts are necessary to deter the initiation and promote the desistance of physical aggression over time among urban Hispanic adolescents.
PMCID: PMC2995259  PMID: 21132116
Physical aggression; Hispanics; Longitudinal; Urban; Adolescents; Alcohol; Trajectories
This study examined associations between patterns of alcohol use initiation and progression from age 12 to 14 years and recent cigarette and marijuana use, and violent and delinquent behavior at age 14. The study sample (n=2,193) was predominantly African American or Hispanic (43% and 37%, respectively) and low-income (68% receiving free, or reduced price, lunch). They completed classroom-based surveys when in 6th–8th grades. Multilevel latent class analyses were used to identify the heterogeneous alcohol use trajectories. Linear and logistic mixed-effects regression was then used to examine the association between these patterns and high-risk behaviors in 8th grade. Five alcohol use trajectories were identified: (1) No Use (63.3%), (2) Onset of Consistently Infrequent Use at Age < 12 (13.3%), (3) Onset of Monthly Use at Age 14 (9.9%), (4) Onset of Monthly Use at Age 13 to Heavy Use at Age 14 (6.6%), and (5) Onset of Consistently Heavy Use at Age 12 (6.9%). Relative to non-users, membership in any of the alcohol use trajectory classes was significantly associated with greater past month cigarette and marijuana use, as well as violent behaviors in 8th grade. Higher levels of delinquent behaviors were significantly associated with membership in all but one of the alcohol use trajectory classes relative to the “no use” class. Results suggest that any use of alcohol in early adolescence is associated with other high-risk behaviors and support the critical need for efforts to prevent early initiation and progression of alcohol use among youth as a key component to prevent future high-risk behaviors.
PMCID: PMC2822085  PMID: 19639410
alcohol use; high-risk behaviors; adolescent; trajectory classes
23.  Parents’ and children’s self report of parenting factors 
Health education journal  2010;69(1):31-42.
The purpose of this study was to determine if parents’ and children’s reports of parenting practices were correlated, if the reports were differentially associated with alcohol use, and which report had the strongest association with alcohol use.
Cross-sectional and longitudinal.
Public schools, Chicago, Illinois.
Participants included 1373 ethnically-diverse students and parents involved in an alcohol use prevention intervention. Surveys were conducted in sixth grade and eighth grade. Mixed-effects regression analyses were used to model relationships cross-sectionally and longitudinally.
Parents’ and children’s perceptions of parenting practices, while significantly correlated, were not strongly associated. Analyses within each parenting domain found parents’ report of parental monitoring and children’s reports of alcohol-specific communication, general communication, and relationship satisfaction were associated with alcohol use behaviors and intentions. After adjusting for all other parenting practices, parents’ report of parental monitoring and children’s report of alcohol-specific communication were most strongly related to alcohol use behaviors and intentions both cross-sectionally and longitudinally.
When comparing results across studies, it is important to identify whose report was used, parent or child, as the results may differ based on reporter. Studies with limited resources may consider using parents’ reports about parental monitoring and using children’s reports for alcohol-specific communication, general communication, and relationship satisfaction.
PMCID: PMC2885720  PMID: 20563227
Parenting; parent-child relationships; alcohol use; early adolescence
24.  Real Longitudinal Data Analysis for Real People: Building a Good Enough Mixed Model 
Statistics in medicine  2010;29(4):504-520.
Mixed effect models have become very popular, especially for the analysis of longitudinal data. One challenge is how to build a good enough mixed effects model. In this paper, we suggest a systematic strategy for addressing this challenge and introduce easily implemented practical advice to build mixed effect models. A general discussion of scientific strategies motivates the recommended five step procedure for model fitting. The need to model both the mean structure (the fixed effects) and the covariance structure (the random effects and residual error) creates the fundamental flexibility and complexity. Some very practical recommendations help conquer the complexity. Centering, scaling, and full-rank coding all predictor variables radically improves the chances of convergence, computing speed, and numerical accuracy. Applying computational and assumption diagnostics from univariate linear models to mixed model data greatly helps detect and solve related computational problems. Applying computational and assumption diagnostics from univariate linear models to mixed model data can radically improve the chances of convergence, computing speed, and numerical accuracy. The approach helps fit more general covariance models, a crucial step in selecting a credible covariance model needed for defensible inference. A detailed demonstration of the recommended strategy is based on data from a published study of a randomized trial of a multicomponent intervention to prevent young adolescents' alcohol use. The discussion highlights a need for additional covariance and inference tools for mixed models. The discussion also highlights the need for improving how scientists and statisticians teach and review the process of finding a good enough mixed model.
PMCID: PMC2811235  PMID: 20013937
Longitudinal data analysis; mixed effects models; model building
25.  Relationship Between Neighborhood Context, Family Management Practices and Alcohol Use Among Urban, Multi-ethnic, Young Adolescents 
We examined relationships between alcohol-related neighborhood context, protective home and family management practices, and alcohol use among urban, racial/ethnic minority, adolescents. The sample comprised 5,655 youth who were primarily low SES (72%), African American (43%) and Hispanic (29%). Participants completed surveys in 2002–2005 (ages 11–14 years). Items assessed alcohol use, accessibility of alcohol at home and parental family management practices. Neighborhood context measures included: (1) alcohol outlet density; (2) commercial alcohol accessibility; (3) alcohol advertisement exposure; and (4) perceived neighborhood strength, reported by parents and community leaders. Structural equation modeling was used to assess direct and indirect relationships between alcohol-related neighborhood context at baseline, home alcohol access and family management practices in 7th grade, and alcohol use in 8th grade. Neighborhood strength was negatively associated with alcohol use (β=−0.078, p≤.05) and exposure to alcohol advertisements was positively associated with alcohol use (β=0.043, p≤.05). Neighborhood strength and commercial alcohol access were associated with home alcohol access (β=0.050, p≤.05 and β=−0.150, p≤.001, respectively) and family management practices (β=−0.061, p≤.01 and β=0.083, p≤.001, respectively). Home alcohol access showed a positive association with alcohol use (β=0.401, p≤.001). Tests for indirect effects suggest that home alcohol access may partially mediate the relationship between neighborhood strength and alcohol use (β=0.025, p<.062). Results suggest inner-city parents respond to environmental risk, such that as neighborhood risk increases, so also do protective home and family management practices. Parent engagement in restricting alcohol access and improving family management practices may be key to preventive efforts to reduce alcohol use.
PMCID: PMC2783307  PMID: 19381808
Adolescents; Communities; Family; Context; Alcohol

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