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Biomedical subjects

W B Hansen

Publications and source records attributed to W B Hansen.

At least 37 records · Page 2Linked to original sources

Seven ways to increase power without increasing N.

Many readers of this monograph may wonder why a chapter on statistical power was included. After all, by now the issue of statistical power is in many respects mundane. Everyone knows that statistical power is a central research consideration, and certainly most National Institute on Drug Abuse grantees or prospective grantees understand the importance of including a power analysis in research proposals. However, there is ample evidence that, in practice, prevention researchers are not paying sufficient attention to statistical power. If they were, the findings observed by Hansen (1992) in a recent review of the prevention literature would not have emerged. Hansen (1992) examined statistical power based on 46 cohorts followed longitudinally, using nonparametric assumptions given the subjects' age at posttest and the numbers of subjects. Results of this analysis indicated that, in order for a study to attain 80-percent power for detecting differences between treatment and control groups, the difference between groups at posttest would need to be at least 8 percent (in the best studies) and as much as 16 percent (in the weakest studies). In order for a study to attain 80-percent power for detecting group differences in pre-post change, 22 of the 46 cohorts would have needed relative pre-post reductions of greater than 100 percent. Thirty-three of the 46 cohorts had less than 50-percent power to detect a 50-percent relative reduction in substance use. These results are consistent with other review findings (e.g., Lipsey 1990) that have shown a similar lack of power in a broad range of research topics. Thus, it seems that, although researchers are aware of the importance of statistical power (particularly of the necessity for calculating it when proposing research), they somehow are failing to end up with adequate power in their completed studies. This chapter argues that the failure of many prevention studies to maintain adequate statistical power is due to an overemphasis on sample size (N) as the only, or even the best, way to increase statistical power. It is easy to see how this overemphasis has come about. Sample size is easy to manipulate, has the advantage of being related to power in a straight-forward way, and usually is under the direct control of the researcher, except for limitations imposed by finances or subject availability. Another option for increasing power is to increase the alpha used for hypothesis-testing but, as very few researchers seriously consider significance levels much larger than the traditional .05, this strategy seldom is used. Of course, sample size is important, and the authors of this chapter are not recommending that researchers cease choosing sample sizes carefully. Rather, they argue that researchers should not confine themselves to increasing N to enhance power. It is important to take additional measures to maintain and improve power over and above making sure the initial sample size is sufficient. The authors recommend two general strategies. One strategy involves attempting to maintain the effective initial sample size so that power is not lost needlessly. The other strategy is to take measures to maximize the third factor that determines statistical power: effect size.

Data Interpretation, Statistical↗

Diffusion of a school-based substance abuse prevention program: predictors of program implementation.

BACKGROUND: The present study addresses diffusion of a psychosocial-based substance abuse prevention program, including: (a) teacher adoption, implementation, and maintenance; (b) teacher characteristics associated with implementation; (c) the relationship between integrity of program delivery and program outcomes; and (d) the effectiveness of teacher training and school principal involvement in increasing implementation. METHODS: Participants were teachers (n = 60), school principals (n = 25), and fifth-grade students (n = 1147) from four Los Angeles area school districts. Districts were randomly assigned to an intensive or brief teacher training condition. Schools were randomly assigned to a principal-intervention or a no-principal-intervention condition. Assessments included teacher and principal self-reports, classroom observations of program delivery, and evaluation of immediate program outcomes. RESULTS: During the first year, 78% of trained teachers implemented one or more program lessons. During the second year, only 25% maintained implementation of the program. Implementors reported fewer years of teaching experience and stronger self-efficacy, enthusiasm, preparedness, teaching methods compatibility, and principal encouragement than did nonimplementors. The principal intervention increased rates of implementation, but the intensive teacher training did not. Integrity of program delivery was positively associated with immediate program outcomes. CONCLUSIONS: Program implementation was highly variable, suggesting that widespread teacher use of psychosocial-based programs cannot be taken for granted. Strategies for increasing implementation and maintenance need to be developed.

Alcoholism↗

Relations of coping effort, coping strategies, perceived stress, and cigarette smoking among adolescents.

Coping strategies may influence adolescent smoking behaviour because they provide alternative behavioral and cognitive outlets which facilitate or inhibit smoking, or because they are expressions of general coping effort to smoke or not smoke. The present investigation examined three possibilities regarding how coping strategies versus coping effort compare as predictors of adolescent smoking: (1) general coping effort to not smoke may be a better predictor of adolescent smoking behaviors than are specific coping strategies; (2) coping strategies may be relatively better predictors of smoking behaviors; or (3) these two constructs may be relatively better predictors of different parameters of smoking behavior. Analytic strategies included calculation of a series of multiple regression models, involving (a) 11 coping strategies previously studied in adolescent smoking research, (b) a new simple measure of coping effort to not smoke, and (c) perceived stress, as concurrent predictors of four smoking-related items. Of the 11 coping strategies, partying, relaxation, seeking spiritual guidance, and getting revenge were related to at least one of the four cigarette smoking items. Only coping effort was directly related to recent smoking behavior, whereas only the coping strategies were related to cumulative smoking. Both types of items predicted refusal self-efficacy and intention to smoke in the future. Apparently, these two types of items show unique as well as common predictive variance. These results suggest that coping strategies are related to cumulative smoking for reasons other than motivation to not smoke.

Adaptation, Psychological↗

School-based substance abuse prevention: a review of the state of the art in curriculum, 1980-1990.

Substance use prevention studies published between 1980 and 1990 are reviewed for content, methodology and behavioral outcomes. Studies were classified based on the inclusion of 12 content areas: Information, Decision Making, Pledges, Values Clarification, Goal Setting, Stress Management, Self-Esteem, Resistance Skills Training, Life Skills Training, Norm Setting, Assistance and Alternatives. Six groups of programs (Information/Values Clarification, Affective Education, Social Influence, Comprehensive, Alternatives and Incomplete programs) are identified. Reports are analyzed for two major threats to validity, selection bias and statistical power. Program groups generally have similar selection biases but have important differences in statistical power. Comprehensive and Social Influence programs are found to be most successful in preventing the onset of substance use.

Adolescent↗

Perceived personal immunity to the consequences of drinking alcohol: the relationship between behavior and perception.

Heavy drinkers, moderate drinkers, light drinkers, and nondrinkers were asked to rate a variety of negative health and social consequences of using alcohol. Subjects made probability ratings for fictional others who were heavy, moderate, or light drinkers or nondrinkers. Subjects also made probability ratings for themselves as hypothetical heavy, moderate, or light drinkers or nondrinkers and for themselves actually. A pattern of perceived personal immunity was found across groups. Subjects rated fictional others and themselves as hypothetical drinkers to be more likely to experience negative consequences than their actual selves. All groups of subjects (heavy, moderate, and light drinkers and abstainers) rated their actual chances of experiencing negative consequences to be approximately equal. In contrast, heavy drinkers saw the effects of drinking for other heavy drinkers as less likely than did subjects who had light or abstinent drinking patterns who rated fictional heavy drinkers. These findings suggest that individuals who drink more tend to deny the potential harm that may result from alcohol consumption. Short-term social consequences were viewed as most likely to occur. Long-term consequences were perceived as least likely to occur.

Adolescent↗

Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms.

BACKGROUND: Two strategies for preventing the onset of alcohol abuse, and marijuana and cigarette use were tested in junior high schools in Los Angeles and Orange Counties, California. The first strategy taught skills to refuse substance use offers. The second strategy corrected erroneous normative perceptions about prevalence and acceptability of use among peers and established conservative groups norms regarding use. METHODS: Four experimental conditions were created by randomly assigning schools to receive (a) neither of the experimental curricula (placebo comparison), (b) resistance skill training alone, (c) normative education alone, or (d) both resistance skill training and normative education. Students were pretested prior to the program and post-tested 1 year following delivery of the program. RESULTS: There were main effects of normative education for summary measures of alcohol (P = 0.0011), marijuana (P = 0.0096), and cigarette smoking (P = 0.0311). All individual dichotomous measures of alcohol, marijuana, and tobacco use indicated significant reductions in onset attributable to normative education. There were no significant main effects of resistance skill training. CONCLUSION: These results suggest that establishing conservative norms is an effective strategy for preventing substance use.

Adolescent↗

Modeling transitions in latent stage-sequential processes: a substance use prevention example.

This article illustrates the use of latent transition analysis (LTA), a methodology for testing stage-sequential models of individual growth. LTA is an outgrowth of latent class theory and is a particular type of latent Markov model emphasizing the use of multiple manifest indicators. LTA is used to compare the fit of two models of early adolescent substance use onset and to assess the effects of a school-based substance use prevention program on Ss measured in 7th grade and again in 8th grade. Several interesting findings emerged. First, a model of substance use onset including both alcohol and tobacco use as possible starting points fit better than a model that included alcohol use as the only starting point. Second, Ss who had tried tobacco but not alcohol in in 7th grade seemed to be on an accelerated onset trajectory. Third, the normative education prevention program was generally successful, except for the students who had tried only tobacco in 7th grade.

Age Factors↗

Mediating mechanisms in a school-based drug prevention program: first-year effects of the Midwestern Prevention Project.

Describes (a) the effects of a social-influences-based drug prevention program (the Midwestern Prevention Project) on the mediating variables it was designed to change and (b) the process by which the effects on mediating variables changed use of drugs (tobacco, alcohol, and marijuana). Students in 42 middle schools and junior high schools in Kansas City, Missouri, and Kansas City, Kansas, were measured in the fall of 1984 (N = 5,065) and again 1 year later (N = 5,008) after 24 of the schools had been through the program. Compared to students in control schools, students in program schools became less likely to express belief in the positive consequences of drug use, less likely to indicate that they would use such drugs in the future, more likely to report that their friends were less tolerant of drug use, and more likely to believe that they were better able to communicate with their friends about drug or school problems. Change in perceptions of friends' tolerance of drug use was the most substantial mediator of program effects on drug use. There was evidence that intentions to use and beliefs about the positive consequences of use may also mediate program effects on drug use.

Adolescent↗

Social influence processes affecting adolescent substance use.

Social influence is central to models of adolescent substance use. Nonetheless, researchers fail to delineate the various forms of social influence. A framework that distinguishes between active (explicit drug offers) and passive (social modeling and overestimation of friends' use) social pressure was tested. The effect of these processes on alcohol and cigarette use was examined with 526 seventh graders taking part in an alcohol prevention program. Hierarchical regression analyses demonstrated that pretest measures of alcohol use, offers, modeling, and overestimation each accounted for unique variance in posttest alcohol use. Similar results were obtained for cigarette smoking. The general model was not significantly different for boys and girls, or for prior users and prior nonusers, supporting the generalizability of the framework. Implications for intervention programs are discussed.

Adolescent↗

Program integrity as a moderator of prevention program effectiveness: results for fifth-grade students in the adolescent alcohol prevention trial.

This study reports the results of a test of the quality of program delivery (program integrity) as a variable that may moderate the effectiveness of alcohol prevention programs. Two theory-based programs, Resistance Training and Normative Education, were delivered to fifth-grade students who were then tested on program relevant mediating variables. Resistance Training was found to improve students' knowledge of peer pressure resistance strategies, their performance on a behavioral assessment of peer pressure resistance skills and the manifestation of their future intentions to drink alcohol. Normative Education was found to improve students' perceptions of a conservative norm regarding alcohol use, facilitated their belief that refusing unwanted offers to drink alcohol could be easily accomplished and reduced their perceptions of the prevalence of alcohol use. Program integrity was measured by program specialists who taught the programs to students and by trained observers. Ratings of program integrity were found to significantly moderate outcomes for three of seven mediating variables. Affected were knowledge of peer pressure resistance strategies, behavioral pressure resistance skills and perceived self-efficacy. These results suggest that the quality of program delivery and reception may play an important moderating function on prevention program effectiveness.

Adolescent↗

Drug use prevention programs, gender, and ethnicity: evaluation of three seventh-grade Project SMART cohorts.

One-year follow-up data from three seventh-grade cohorts of Project SMART were examined to assess the effects of two social psychology-based programs within each of six subgroups: males, females, Asians, blacks, Hispanics, and whites. The three cohorts (total N = 5,070) were those receiving curriculum or serving as controls as seventh-graders in 1982-1983, 1983-1984, and 1984-1985 school years. The outcome measures used were composite indices based on lifetime and recent use items for cigarettes, alcohol, and marijuana. The major analysis was ANCOVA on classroom means for the composite indices at post-test, using pretest classroom means for the indices as a covariate. The results showed clear prevention effects for females but not for males. Overall prevention effects were strongest for cigarette smoking, but were also evident for alcohol. Significant sex by program interactions, showing differential program effects for males and females, were found for cigarettes and marijuana, but not for alcohol. There was a nonsignificant trend suggesting that the programs were most effective for Asians and least effective for whites.

Adolescent↗

Adolescents' first and most recent use situations of smokeless tobacco and cigarettes: similarities and differences.

This study compared first and most recent use situations of adolescent smokeless tobacco experimenters with those of adolescent cigarette experimenters. Structured, open-ended interviews were conducted with 320 seventh and tenth grade youths in 16 Southern California schools. Students were categorized as nonusers (those who had never experimented with any tobacco product), minimal experimenters (those who had experimented with smokeless tobacco or cigarettes between 1 and 9 times), and persistent experimenters (those who had experimented with smokeless tobacco or cigarettes 10 or more times). The situations reported by smokeless tobacco were similar to those reported by cigarette experimenters. The most important differences between the two groups are highlighted. In particular, smokeless tobacco users seemed less concerned about negative social consequences of use than cigarette smokers. In addition, nonusers' observations of use and implications for prevention and cessation are discussed.

Adolescent↗

Peer-group association and adolescent tobacco use.

Mosbach & Leventhal (1988) examined the relation of cigarette smoking to peer-group identification in rural Wisconsin adolescents. They found that among dirts (problem-prone youth), regulars (average youth), hot-shots (good social or academic performers), and jocks (athletes), youth most likely to smoke were dirts and hot-shots. We performed a replication with a Southern California cohort and also for use of smokeless tobacco. We hypothesized that jocks would be the main users of smokeless tobacco. We identified the same groups and an additional one, skaters (skateboarders or surfers). As Mosbach & Leventhal found, cigarettes were used most by dirts. Contrary to their results, but consistent with other research, we found that hot-shots were least likely to smoke. Contrary to our prediction, we found that skaters and dirts were more likely to use smokeless tobacco than were jocks. Our data show that both tobacco forms are used by problem-prone youth.

Adolescent↗

Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents.

This article reviews major risk factors for cigarette smoking, alcohol, and other drug abuse and promising community-based approaches to primary prevention. In a longitudinal experimental study, 8 representative Kansas City communities were assigned randomly to program (school, parent, mass media, and community organization) and control (mass media and community organization only) conditions. Programs were delivered at either 6th or 7th grade, and panels were followed through Grade 9 or 10. The primary findings were (a) significant reductions at 3 years in tobacco and marijuana use and (b) equivalent reductions for youth at different levels of risk. This study provides evidence that a comprehensive community program-based approach can prevent the onset of substance abuse and that the benefits are experienced equally by youth at high and low risk.

Adolescent↗

Characteristics of eighth-grade students who initiate self-care in elementary and junior high school.

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (greater than or equal to 11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).

Adolescent↗

A multicommunity trial for primary prevention of adolescent drug abuse. Effects on drug use prevalence.

The entire early adolescent population of the 15 communities that constitute the Kansas City (Kansas and Missouri) metropolitan area has participated in a community-based program for prevention of drug abuse since September 1984. The Kansas City area is the first of two major metropolitan sites being evaluated in the Midwestern Prevention Project, a longitudinal trial for primary prevention of cigarette, alcohol, and marijuana use in adolescents. The project includes mass media programming, a school-based educational program for youths, parent education and organization, community organization, and health policy components that are introduced sequentially into communities during a 6-year period. Effects of the program are determined through annual assessments of adolescent drug use in schools that are assigned to immediate intervention or delayed intervention control conditions. In the first 2 years of the project, 22,500 sixth- and seventh-grade adolescents received the school-based educational program component, with parental involvement in homework and mass media coverage. Analyses of 42 schools indicate that the prevalence rates of use for all three drugs are significantly lower at 1-year follow-up in the intervention condition relative to the delayed intervention condition, with or without controlling for race, grade, socioeconomic status, and urbanicity (17% vs 24% for cigarette smoking, 11% vs 16% for alcohol use, and 7% vs 10% for marijuana use in the last month), and the net increase in drug use prevalence among intervention schools is half that of delayed intervention schools.

Adolescent↗

The television, school, and family project. V. The impact of curriculum delivery format on program acceptance.

Social psychological interventions have been successful in preventing drug and tobacco use in adolescents, but target audience involvement has not been well documented. Examination of program acceptance is necessary to avoid ambiguity when interpreting findings within and across studies. This report presents results from a program acceptance study of a seventh-grade smoking/drug-use prevention and cessation field trial. The research design is an assessment of two experimentally manipulated variations in program delivery on the program acceptance of all provider and target groups involved. Experimental manipulations included classroom and mass broadcast television demonstrations of social resistance skills against pressures to smoke and use drugs. Three aspects of target audience program acceptance were assessed: participation, satisfaction, and perceived program efficacy. Respondents included the target audience (seventh-grade students and parents), instructors, classroom observers, and school administrative staff. Strong main effects of television delivery on student and parent participation were observed. The findings suggest the usefulness of student homework assignment to view television segments with parents at home as a strategy to achieve family involvement in school-based programs. Both television and classroom delivery separately demonstrated significant positive effects on overall program acceptance with moderate interactive effects on perceived program efficacy. While classroom teacher/observers and school administrators reported strong preferences for the experimental (social resistance) classroom curriculum, acceptance of experimental and comparison (information-based) curricula by the student/parent target audience was equivalent.

Curriculum↗

Longitudinal effects of the midwestern prevention project on regular and experimental smoking in adolescents.

The purpose of this study was to compare longitudinal smoking prevention program effects estimated on a population-based cohort sample of sixth- and seventh-grade students (average n per year = 4,664) using different schools as units of analysis (middle/junior high school as the school of origin or high school as the endpoint school of intervention). Fifty schools in 15 school districts were demographically matched and assigned to either a school and community-based program for prevention of cigarette, alcohol, and marijuana use, or a health education as usual control group. Smoking was measured by questionnaires administered to the students. An expired air (CO) measure of smoking was also administered to increase accuracy of self-reports. Program effects were estimated with regression analyses, controlling for school-level socioeconomic status, racial/ethnic make-up, urbanicity, and grade. Using school of origin as the unit of analysis, program effects showed 1 year net reductions of -8, -6, and -5% in prevalence rates of smoking in the last month, last week, and last 24 hr; 2-year program effects showed similar net reductions of -6, -5, and -3% (P's less than 0.10-0.001). Analyses with endpoint school as the unit showed slightly weaker effects at the 2-year follow-up, the year during which 64% of students had moved to a junior high or high school. The findings are discussed in terms of the potential contamination of experimental groups in longitudinal studies from school consolidations, family mobility, and feeder patterns to high schools, and the different smoking environments represented by middle, junior high, and high schools.

Adolescent↗