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1.  Major Article Social Facilitation Expectancies for Smoking: Psychometric Properties of a New Measure 
Expectancies about social outcomes for smoking are relevant to college student smokers, who frequently report “social smoking.” A new measure, the Social Facilitation Expectancies (SFE) scale, was developed to assess these beliefs.
The SFE was administered to undergraduate college student smokers (N=1096; study completed in May 2011).
Items were scored on a five-point scale with a summed total score. The sample was randomly split and principle axis factoring and confirmatory factor analysis applied to determine scale structure. The structure was tested across sex and smoking groups and validation analyses were conducted.
A nine-item, one-factor scale was replicated within each group. Higher SFE scores were observed among those with greater smoking experience and higher scores were associated with greater endorsement of other smoking related beliefs.
These preliminary findings provide support for the sound psychometric properties of this measure for use with young adult college students.
PMCID: PMC3922225  PMID: 24456515
college students; expectancies; questionnaire development; social facilitation; tobacco use
2.  Adolescent First Lapse Following Smoking Cessation: Situation Characteristics, Precipitants and Proximal Influences 
Addictive behaviors  2011;36(12):1253-1260.
Despite increased attention to adolescent smoking cessation, little is known about adolescent relapse following a quit attempt. To address this issue, the present study was designed to provide initial information regarding the characteristics of adolescent lapses to smoking following abstinence. Included in the present study were 204 adolescent participants in four independent smoking cessation trials. For the full sample, participants averaged 15.99 (1.27) years of age; 56% were female and 78% were white. Lapse characteristics and precipitants were assessed using the Adolescent Smoking Relapse Review. Three domains of the lapse experience were assessed: lapse situation characteristics, precipitants of use in the situation, and proximal influences (i.e., potential precipitants occurring on the same day, prior to the lapse situation). Participant reports indicated that the modal lapse situation occurred in the evening while socializing with friends at home. Urges or cravings and social pressure were commonly endorsed as occurring in lapse situations. The most frequently reported proximal influence was desire for a cigarette, followed by abstinence-violation cognitions (okay to smoke occasionally, wanted to see what it would be like) and negative emotions. The findings indicate that a broad range of factors appear to influence adolescent smoking lapse and commend the value of incorporating content relevant to managing social and affective cues, strategies for inhibiting the prepotent response to ask for a cigarette, addressing cognitions regarding the difficulty of not smoking (i.e., cessation expectancies) and combating perceptions of the ability to smoke occasionally.
PMCID: PMC3199975  PMID: 21903332
Adolescents; Smoking cessation; Relapse; High risk situation; Nicotine dependence
3.  Coping with temptations and adolescent smoking cessation: An initial investigation 
Nicotine & Tobacco Research  2009;11(8):940-944.
Although a great deal of research focuses on adolescent cigarette smoking, little is known about the process by which adolescents attempt to stop smoking. Resisting temptations to smoke is one of the key challenges encountered by individuals who attempt smoking cessation. A large body of literature has examined coping with temptation among adult smokers, and research on this issue for adolescents is lacking. To further our understanding in this area, the present study reports on an initial examination of the Smoking Temptation Coping Questionnaire (STCQ). The STCQ, which assesses coping in a social pressure situation involving cigarettes, was adapted from the Temptation Coping Questionnaire, a brief self-report measure of adolescent coping with temptations to use alcohol and other drugs.
The present study included 109 adolescent participants (aged 14–19 years) in a naturalistic study of smoking self-change. Participants completed baseline and 6-month follow-up interviews.
Exploratory factor analysis of the STCQ coping scale yielded a single factor including six strategies for coping with temptations. Analyses provided support for the concurrent, predictive, and construct validity of the STCQ. In particular, the coping scale score significantly predicted prospective duration of abstinence for adolescents who engaged in smoking cessation efforts.
These results provide preliminary support for the utility of the STCQ. In addition, findings support the role of temptation coping in the adolescent smoking cessation process.
PMCID: PMC2711982  PMID: 19602571
4.  A Prospective Study of Cigarette Smoking Initiation During College: Chinese and Korean-American Students 
The present study was a prospective investigation of baseline influences on initial smoking and transition to established smoking among college students who had not smoked prior to college.
Included were 267 participants in a longitudinal study of tobacco use. Students of Chinese (52%) or Korean (48%) descent were enrolled during their freshman year in college. Data for the present study were collected during four annual in-person interviews. Main outcome measures: 1) Initial use of a cigarette reflected having first smoked a cigarette (more than a puff) during college. 2) Established smoking was defined as having smoked at least 100 cigarettes.
Over the course of the study 25% of baseline never-smokers tried their first cigarette and 9% became established smokers. Overall, men were significantly more likely to experiment and progress to established smoking. Baseline alcohol and drug use, behavioral undercontrol and parental smoking predicted smoking experimentation but not established smoking. Students of Korean ethnicity were more likely to become established smokers. However, acculturation was not a significant predictor of experimentation or established smoking after accounting for the effects of other predictors.
These findings suggest a need for efforts to prevent smoking uptake among Asian-American college students.
PMCID: PMC2742368  PMID: 19594269
Risk factors; etiology; smoking initiation; college students; prospective study
Alcoholism treatment quarterly  2008;26(4):10.1080/07347320802347053.
Adolescents treated for substance use disorders (SUD) appear to benefit from AA/NA participation. However, as compared to adults, fewer adolescents attend, and those who do attend do so less intensively and discontinue sooner. It is unknown whether this disparity is due to a lowered expectation for youth participation by the clinicians treating them, as they may adapt the adult-based model to fit a less dependent cohort, or whether recommendations are similar to those of clinicians who work with adults, and other factors are responsible. All clinical staff (N = 114) at five adolescent programs (3 residential, 2 outpatient) were surveyed anonymously about referral practices and other beliefs about 12-step groups. Staff rated AA/NA participation as very important and helpful to adolescent recovery and referral rates were uniformly high (M = 86%, SD = 28%). Desired participation frequency was over 3 times per week. The theoretical orientation and level of care of the programs influenced some results. Findings suggest lower adolescent participation in 12-step groups is not due to a lack of clinician enthusiasm or referrals, but appears to be due to other factors.
PMCID: PMC3846260  PMID: 24307753
groups; 12-step; adolescents; Alcoholics Anonymous; Narcotics Anonymous; mutual help group; self-help group
Referral to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) is a common continuing care recommendation. Evidence suggests some youth benefit, yet, despite referrals, youth participation is low. Little is known about adolescents’ experiences of AA/NA. Greater knowledge would inform and help tailor aftercare recommendations.
Two clinical samples of youth (N=74 and N=377) were asked about their perceptions of, and experiences with, AA/NA with responses categorized by content into domains assessed for face validity and reliability.
The aspects of AA/NA youth liked best were general group dynamic processes related to universality, support, and instillation of hope. The most common reason for discontinuing was boredom/lack of fit.
General group-therapeutic, and not 12-step-specific, factors are most valued by youth during early stages of recovery and/or degree of AA/NA exposure. Many youth discontinue due to a perceived lack of fit, suggesting a mismatch between some youth and aspects of AA/NA.
PMCID: PMC3811164  PMID: 19042324
Mutual-help groups; self-help; adolescents; Alcoholics Anonymous; Narcotics Anonymous; addiction; substance abuse; treatment; substance use disorder
7.  Intermittent exercise in response to cigarette cravings in the context of an Internet-based smoking cessation program 
Interventions using sustained aerobic exercise programs to aid smoking cessation have resulted in modest, short-term cessation rates comparable to conventional cessation methods. No smoking cessation trial to date has prescribed intermittent bouts of exercise in response to nicotine cravings.
This pilot randomized controlled trial examined the feasibility and efficacy of an Internet-based smoking cessation program alone (CON) vs. the same Internet-based program + intermittent exercise in response to cigarette cravings (EX).
Study population
Participants (N = 38; mean age = 43.6 [SD = 11.5]; 60.5% women) were generally healthy, inactive adult smokers who desired to quit.
The overall retention rate was 60.5% (n = 23), and no significant retention rate differences were found between groups (EX vs. CON). Although retained participants achieved a higher cessation rate (26.1%) than all enrolled participants (15.8%), adjusted intent-to-treat and per-protocol binary logistic regression analyses revealed no significant cessation rate differences between EX and CON groups. Linear regression results indicated that additional days of self-reported exercise on the study website during the intervention phase predicted significantly higher reduction rates among EX group participants, F(2, 16) = 31.08, p < .001.
Results were mixed with regard to the incremental benefit of exercise in the presence of the apparently valuable Internet-based smoking cessation program. The results support findings from related research and underscore the need for additional investigation into both the mechanisms underlying the effect of exercise on cigarette cravings and the challenges of poor adherence in the context of exercise-based smoking cessation interventions.
PMCID: PMC3743265  PMID: 23956792
Smoking cessation; Exercise; Internet; Intervention; Pilot; Randomized controlled trial
8.  Adolescent Reasons for Quitting Smoking: Initial Psychometric Evaluation 
Most adolescent smokers report intentions to quit and the majority attempt cessation. Yet, little is known regarding the relationship between adolescent motives for cessation and smoking cessation efforts. To this end, the present study describes an initial evaluation of the psychometric characteristics of the Adolescent Reasons for Quitting scale (ARFQ), a measure of adolescent motives for smoking cessation. Participants were 109 current smoking high school students assessed at baseline and 6-month follow up. The ARFQ item content and format was developed in a separate qualitative study with 36 high school students who had previously attempted to quit smoking. Exploratory factor analyses of ARFQ items yielded three subscales: short-term consequences, social disapproval, and long-term concerns. Validation analyses were conducted in relation to concurrent intentions to stop smoking and prospective smoking cessation attempts, providing evidence of concurrent, predictive and discriminant validity. In particular, the social disapproval and long-term concern subscales significantly predicted subsequent cessation attempts. As such, the ARFQ may prove valuable for informing interventions to encourage adolescent smoking cessation.
PMCID: PMC2757254  PMID: 18298239
Adolescent; cessation motives; smoking cessation; psychometric evaluation; prospective study
9.  Psychosocial, Cultural and Genetic Influences on Alcohol Use in Asian American Youth* 
Journal of studies on alcohol  2005;66(2):185-195.
Environmental and cultural factors, as well as a genetic variant of the aldehyde dehydrogenase gene (the ALDH2*2 allele) have been identified as correlates of alcohol use among Asian Americans. However, concurrent examination of these variables has been rare. The present study assessed parental alcohol use, acculturation and ALDH2 gene status in relation to lifetime, current and heavy episodic drinking among Chinese and Korean American undergraduates.
Participants (N = 428, 51% women; 52% Chinese American, age 18–19 years) were first-year college students in a longitudinal study of substance use initiation and progression. Data were collected via structured interview and self-report, and participants provided a blood sample for genotyping at the ALDH2 locus.
Gender, parental alcohol use and acculturation significantly predicted drinking behavior. However, none of the hypothesized moderating relationships were significant. In contrast with previous studies, ALDH2 gene status was not associated with alcohol use.
Results indicate that although the variables examined influence alcohol use, moderating effects were not observed in the present sample of Asian American college students. Findings further suggest that the established association ALDH2 status and drinking behavior in Asians may not be evident in late adolescence. It is possible that ALDH2 status is associated with alcohol consumption only following initiation and increased drinking experience.
PMCID: PMC2749922  PMID: 15957669
10.  Does Smoking Intervention Influence Adolescent Substance Use Disorder Treatment Outcomes? 
Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking part in a cigarette smoking intervention efficacy study, assessed at baseline and followed up at 3- and 6-months post-intervention. Analyses compared treatment and control groups on days using alcohol and drugs and proportion abstinent from substance use at follow up assessments. Adolescents in the treatment condition reported significantly fewer days of substance use and were somewhat more likely to be abstinent at 3-month follow up. These findings suggest that tobacco focused intervention may enhance SUD treatment outcome. The present study provides further evidence for the value of addressing tobacco use in the context of treatment for adolescent SUD’s.
PMCID: PMC2721717  PMID: 19042327
adolescent; substance abuse; smoking cessation; treatment outcome
11.  Thinking and Drinking: Alcohol-Related Cognitions across Stages of Adolescent Alcohol Involvement 
Psychology of Addictive Behaviors  2011;25(3):415-425.
Alcohol-related cognitions, particularly expectancies for drinking and non-drinking and motives for non-drinking, are involved in the initiation, maintenance, and cessation of alcohol use and are hypothesized to play key roles in adolescent decision making. This study explored (a) the relationships between alcohol use expectancies, non-drinking expectancies and non-drinking motives, (b) the roles of these cognitions across hypothesized developmental stages of adolescent alcohol use and (c) the relationships between these cognitions and recent or intended future changes in drinking behavior in a cross-sectional sample.
Surveys assessing alcohol use behaviors and attitudes were administered to 1648 high school students.
Heavier drinkers reported more positive alcohol use expectancies and fewer non-drinking motives than lighter drinkers or non-drinkers, however non-drinking expectancies only differed between non- and rare- drinkers and all subsequent drinking classes. Alcohol use expectancies, non-drinking expectancies and non-drinking motives differentiated students who recently initiated alcohol from those who had not, while non-drinking expectancies and non-drinking motives differentiated binge drinking students who had made recent efforts to reduce/stop their drinking from those who had not. Intentions to initiate or reduce drinking in the coming month were also associated with these alcohol-related cognitions.
Drinking and non-drinking expectancies, and motives for not drinking may play critical roles in decisions to alter alcohol-use behavior during adolescence. Future exploration of temporal relationships between changes in alcohol-related cognitions and behavioral decision making will be useful in the refinement of effective prevention and intervention strategies.
PMCID: PMC3372460  PMID: 21534645
alcohol expectancies; non-drinking expectancies; non-drinking motives; adolescent alcohol use; alcohol use transitions
12.  Do Adolescents Affiliate with 12-Step Groups? A Multivariate Process Model of Effects* 
Journal of studies on alcohol  2002;63(3):293-304.
Research with adolescents has revealed salutary effects for 12-step attendance on substance use outcomes, but no studies have examined the effects of 12-step affiliation, or active involvement, beyond simple measures of attendance. Prior research with adults has shown that measures of affiliation are more predictive than measures of attendance. This study (1) assessed attributes that may influence 12-step attendance and affiliation; (2) tested whether 12-step affiliation in the first 3 months posttreatment possessed unique predictive power above that attributable to attendance alone; and (3) examined the extent to which motivation, coping and self-efficacy measured at 3 months mediated the relation between 12-step affiliation and substance use outcome in the ensuing 3 months.
Adolescent inpatients (N = 74, 62% female), who were aged 14-18 years (mean [SD] − 15.9 [1.19] years), were interviewed during treatment and at 3 and 6 months postdischarge.
More severely substance-involved youth were more motivated for abstinence and more likely to attend and affiliate with 12-step groups. A high degree of collinearity between 12-step attendance and affiliation suggested that those attending were also likely to be those actively involved. As a consequence, affiliation did not predict outcome over and above frequency of attendance. Motivation was found to influence the relationship between 12-step affiliation and future substance use outcome.
Given the widespread treatment recommendations for adolescent 12-step involvement, more study is needed to determine what kinds and what aspects of 12-step groups and fellowships are helpful to adolescent change efforts and what alternatives should be developed.
PMCID: PMC1978185  PMID: 12086130
13.  Constructing a Short Form of the Smoking Consequences Questionnaire With Adolescents and Young Adults 
Psychological assessment  2003;15(2):163-172.
The goal of the present studies was to construct and validate a short form of the 50-item Smoking Consequences Questionnaire (SCQ; T. H. Brandon & T. B. Baker, 1991), a measure of smoking outcome expectancies. In Study 1, a 21-item short form (S-SCQ) was derived from a sample of 107 young adults previously treated for substance abuse. In Study 2, the measure was cross-validated on 125 adolescents in treatment for substance abuse. Confirmatory factor analyses revealed good model fit and factorial invariance for the 4 S-SCQ subscales across both samples. Validation analyses on each sample found that subscale scores generally correlated significantly with smoking-related variables. The present studies provide initial evidence for the utility of the S-SCQ when used with young adults and adolescents.
PMCID: PMC1855290  PMID: 12847776
14.  The Alcohol Relapse Situation Appraisal Questionnaire: Development and Validation 
Drug and alcohol dependence  2011;116(1-3):45-51.
The role of cognitive appraisal of the threat of alcohol relapse has received little attention. A previous instrument, the Relapse Situation Appraisal Questionnaire (RSAQ), was developed to assess cocaine users’ primary appraisal of the threat of situations posing a high risk for cocaine relapse. The purpose of the present study was to modify the RSAQ in order to measure primary appraisal in situations involving a high risk for alcohol relapse.
The development and psychometric properties of this instrument, the Alcohol Relapse Situation Appraisal Questionnaire (A-RSAQ), were examined with two samples of abstinent adults with alcohol abuse or dependence. Factor structure and validity were examined in Study 1 (N=104). Confirmation of the factor structure and predictive validity were assessed in Study 2 (N=161).
Results demonstrated construct, discriminant and predictive validity and reliability of the A-RSAQ.
Results support the important role of primary appraisal of degree of risk in alcohol relapse situations.
PMCID: PMC3105175  PMID: 21237586
alcohol; relapse prevention; appraisal; coping
15.  A Multivariate Process Model of Adolescent 12-Step Attendance and Substance Use Outcome Following Inpatient Treatment 
A common recommendation for youth treated for substance abuse is to attend 12-step groups. However, little is known regarding the effects of this adult-derived prescription on substance use outcomes for teens. This study examined (a) the relation between 12-step attendance and substance use outcome in the 6 months postdischarge from inpatient care and (b) a process model of how 12-step attendance during the first 3 months postdischarge affects proximal outcomes of motivation, coping, and self-efficacy, measured at 3 months, and how these, in tum, affect ultimate substance use outcome in the following 3 months. Adolescent inpatients (N = 99) were assessed during treatment and 3 and 6 months postdischarge. Results revealed modest beneficial effects of 12-step attendance, which were mediated by motivation but not by coping or self-efficacy. Findings suggest that closer attention be paid to motivational factors in the treatment of adolescent substance abuse.
PMCID: PMC1945122  PMID: 11130156
16.  Examination of a Process Model of Adolescent Smoking Self-Change Efforts in Relation to Gender 
Little information describes how adolescents change their smoking behavior. This study investigated the role of gender in the relationship of motivation and cognitive variables with adolescent smoking self-change efforts. Self-report and semi-structured interview data from a prospective study of smoking self-change efforts were examined among 98 adolescent smokers ages 14–18 (55% female). Social disapproval motives and short-term consequence reasons for quitting, quit self-efficacy and intentions to quit were modeled in relation to prospective self-quit attempts assessed at a 6-month follow-up, separately by gender. Hypothesized mediating relationships were not supported although gender differences were noted. Social influence motives related to intention to quit and prospective self-quit attempts among girls. For boys, intention to quit predicted making a self-quit attempt. Findings emphasize the importance of examining adolescent models separately by gender and contribute to understanding of mechanisms involved in adolescent smoking change efforts.
PMCID: PMC3179428  PMID: 21949472
adolescent; smoking; process model; self-change; gender
17.  Self-efficacy mediates the relationship between depression and length of abstinence after treatment in youth but not adults 
Substance use & misuse  2010;45(13):2301-2322.
We present two studies testing whether self-efficacy mediates the relationship between depression symptoms and initial abstinence duration after substance abuse treatment in adolescents and adults. Study 1: Adolescents (N = 208) were recruited from substance abuse treatment in an urban/suburban area in the United States between 1999–2005, and followed monthly after discharge. Measures used were affective state (depression symptoms), drug-taking coping self-efficacy, and length of abstinence after treatment. Self-efficacy fully mediated the relationship between depression and time to use. Study 2: In a similar study design, adult Veterans (N = 160) in outpatient substance abuse treatment were interviewed during treatment and monthly following treatment. Depression was negatively associated with self-efficacy, and self-efficacy predicted time to first substance use, but there was no mediation. Study implications and limitations are noted.
PMCID: PMC3031168  PMID: 20388012
Relapse; comorbidity; self-efficacy; depression; developmental psychopathology
18.  Intentions to quit smoking among youth in substance abuse treatment 
Drug and alcohol dependence  2009;106(1):48.
Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.
Participants were 178 adolescents who were in inpatient (n=90) or outpatient (n= 88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD=1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).
SUD youth intention to quit smoking averaged 4.9 out of 10 (SD=3.2), comparable to intention to quit drinking (M=5.3, SD=3.6), but lower than their intention to quit using drugs (M=6.0, SD=3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r=−.30, p<.01) and smoking-cessation related self-efficacy (r=.36, p<.01), but not with pretreatment substance use severity (r=−.15). Controlling for nicotine dependence, teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr=.26, p<.01) and intention to quit using illicit drugs (pr=.15, p<.05), but unrelated to intention to quit drinking.
Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.
PMCID: PMC2815104  PMID: 19699041
Youth tobacco use; Substance use; Comorbidity
19.  Effects on Substance Use Outcomes in Adolescents Receiving Motivational Interviewing for Smoking Cessation during Psychiatric Hospitalization 
Addictive behaviors  2009;34(10):887-891.
The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus a brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n=116) or BA (n=75). All patients were assessed at baseline, immediately after hospitalization, and at 1-, 3-, 6-, 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD = 18.5) to a high of 15.4% (SD = 30.0) substance use days. Whereas in BA, substance use days increased from a low of 8.4% (SD = 20.8) to a high of 21.4% (SD = 35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first six months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.
PMCID: PMC2720434  PMID: 19342179
Adolescents; substance use outcomes; motivational interviewing; smoking cessation; inpatient treatment; psychiatric comorbidity
20.  Psychometric Properties of a Revised Form of the Drug-Taking Confidence Questionnaire for Use with Adolescents 
Self-efficacy is an important cognitive predictor of substance abuse treatment outcome. While measures of coping self-efficacy are related to substance use relapse in adults, their properties are not well known in adolescent populations. The present study examined 223 adolescents while in treatment for substance abuse and comorbid psychiatric disorders. Responses on the Drug-Taking Confidence Questionnaire (DTCQ; Sklar et al., 1997) were used to construct a 37-item, 5-factor version for use with adolescents. Exploratory and confirmatory factor analysis identified the following factors: 1) Negative Situations, 2) Social/Drugs, 3) Pleasant Emotions, 4) Testing Personal Control, and 5) Physical/Intimate. Data preliminarily support the construct, concurrent, and predictive validity of the revised instrument.
PMCID: PMC2846704  PMID: 20354581
Psychometrics; Self-efficacy; Comorbidity; Relapse prevention
21.  Telephone Counseling to Implement Best Parenting Practices to Prevent Adolescent Problem Behaviors 
Contemporary clinical trials  2007;29(3):324-334.
There is considerable suggestive evidence that parents can protect their adolescents from developing problem behaviors if they implement recommended best parenting practices. These include providing appropriate limits on adolescent free time, maintaining a close personal relationship with the adolescent, and negotiating and providing incentives for positive behavior patterns. However, retention of the study samples has limited conclusions that can be drawn from published studies. This randomized controlled trial recruited and randomized a national population sample of 1036 families to an intensive parenting intervention using telephone counseling or to a no-contact control group. At enrollment, eligible families had an eldest child between the ages of 10–13 years. The intervention included an initial training program using a self-help manual with telephone counselor support. Implementation of best parenting practices was encouraged using quarterly telephone contacts and a family management check-up questionnaire. A computer-assisted structured counseling protocol was used to aid parents who needed additional assistance to implement best practices. This, along with a centralized service, enabled implementation of quality control procedures. Assessment of problem behavior is undertaken with repeated telephone interviews of the target adolescents. The study is powered to test whether the intervention encouraging parents to maintain best parenting practices is associated with a reduction of 25% in the incidence of problem behaviors prior to age 18 years and will be tested through a maximum likelihood framework.
PMCID: PMC2409275  PMID: 17964223
adolescent; family; parent; parenting; prevention; problem behavior; smoking; telephone counseling; tobacco
22.  Adolescent definitions of change in smoking behavior: An investigation 
Although adolescent smoking cessation has received increased research attention, little information exists as to how adolescents define change efforts for smoking behaviors. This issue is of particular importance because surveys routinely incorporate items assessing smoking cessation, yet how adolescents interpret such items is unclear. The present study investigated definitions of smoking behavior change efforts among adolescents. A total of 94 adolescent smokers—of average age 16.7 years (SD=1.0), 56% female, and 71% White—were asked to define the terms quit, stop, and cut down smoking. Responses to the three questions were categorized using content analysis. Definitions of quit and stop were categorized as (a) stop permanently, (b) stop temporarily, (c) stop except in certain situations, and (d) reduce smoking (for quit only). Definitions of cut down were categorized as (a) reduce the number of cigarettes, (b) smoke less in a time frame, (c) reduce smoking occasions, and (d) smoke less. Three trained raters sorted responses into each of the categories. Definitions of quit and stop were most frequently categorized in the stop permanently category (86% and 75%, respectively). Definitions of cut down were distributed across categories, with 51% categorized as smoke less, 25% smoking less in a time frame, and 25% reducing number of cigarettes. Different definitions of stop were related to smoking history and motivation to quit, although the other two terms were not related to adolescent individual characteristics. Findings highlight the importance of using clearly defined questionnaire items when assessing adolescent smoking change efforts.
PMCID: PMC1855291  PMID: 17008195
23.  The Effects of Age Composition of 12-Step Groups on Adolescent 12-Step Participation and Substance Use Outcome 
Youth substance use disorder treatment programs frequently advocate integration into 12-Step fellowships to help prevent relapse. However, the effects of the predominantly adult composition of 12-step groups on adolescent involvement and substance use outcome remain unstudied. Greater knowledge could enhance the specificity of treatment recommendations for youth. To this end, adolescents (N = 74; M age = 15.9, 62% female) were recruited during inpatient treatment and followed up 3 and 6 months later. Greater age similarity was found to positively influence attendance rates and the perceived importance of attendance, and was marginally related to increased step-work and less substance use. These preliminary findings suggest locating and directing youth to meetings where other youth are present may improve 12-step attendance, involvement, and substance use outcomes.
PMCID: PMC2136436  PMID: 18080000
Adolescent; substance use disorders; 12-step; alcohol treatment; drug treatment; addiction; self-help; mutual help; substance abuse
The present study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders.
The present study was based on a sample of 166 adolescents recruited during inpatient AOD abuse treatment. Included in this study were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Data for the present study were drawn from interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment.
Twenty six percent of participants had quit smoking for >1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Subjects associated with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points.
The significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behaviour may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviours. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes.
PMCID: PMC1931416  PMID: 17526632
25.  Cigarette Smoking Among Adolescents With Alcohol and Other Drug Use Problems 
Cigarette and alcohol use often develop concurrently, and smoking is especially common among youth treated for alcohol and other drug (AOD) use disorders. Special considerations for adolescent smoking cessation treatment include peer influences, motivation, and nicotine dependence. Little research has addressed smoking cessation treatment for youth with AOD use disorders, but the few available studies suggest that tobacco cessation efforts are feasible and potentially effective for this population. Findings to date suggest that adolescents with AOD use disorders may benefit more from relatively intensive multicomponent programs rather than brief treatment for smoking cessation. Additional research is needed to further address the inclusion of tobacco-specific interventions for adolescents in AOD use disorder treatment programs.
PMCID: PMC1931414  PMID: 17373413
Alcohol and tobacco; alcohol, tobacco, and other drug (ATOD) use, abuse, and dependence; smoking; gateway drug; nicotine dependence; adolescent; youth; high-risk youth; alcohol and other drug use (AODU) treatment method; smoking cessation treatment; co-treatment; intervention; brief intervention; motivational interviewing; peer relations; treatment outcome

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