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PubMed1998

The association of educational achievement and school dropout with risk of alcoholism: a twenty-five-year prospective study of inner-city children.

OBJECTIVE: This prospective study is focused on the characteristics leading to alcohol use disorders in early adulthood among a cohort of black children. The principal aim of this work is to examine the impact of educational attainment, school dropout and early school adaptation on the development of alcohol abuse and dependence in adulthood. METHOD: From a population that consisted of 1,242 first graders in 1966-67, a total of 953 were interviewed at age 32-33 about their current alcohol and drug use, educational attainment, employment and family situation. RESULTS: Diagnoses of alcohol abuse and dependence were defined according to DSM-III-R criteria resulting in identification of 13.5% as having a lifetime alcohol use disorder. Early predictions of an alcohol use disorder in adulthood included early reports of underachievement in first grade by the child's teacher, dropping out of high school, whether the family set definite rules about school during adolescence, and how often the adolescent worked on homework with his/her family. CONCLUSIONS: The results suggest that educational achievement and some early adaptive behaviors in school are associated with risk for alcohol use disorders. The public health importance of the findings are discussed.

Achievement↗
PubMed2004

Exploring risk in early adolescent African American youth.

Two studies were conducted to explore the degree to which single- and multiple-risk profiles were evident in samples of African American early adolescents in low-income inner-city, rural, and suburban schools. Study 1 examined early adolescent risk status (i.e., single, multiple) in relation to later adjustment in a representative sample (70% European American, 30% African American). Youth who experienced a single risk in early adolescence had moderately increased levels of school dropout and criminal arrests, whereas youth with multiple risks (i.e., combination of 2 or more risks) had significantly increased levels of school dropout, criminal arrests, and teen parenthood. Study 2 examined the extent to which single- and multiple-risk profiles were evident in cross-sectional samples of African American youth from low-income inner-city and rural areas. About one fourth of both the inner-city and rural samples of African American youth were composed of youth in the single-risk category. A significantly greater proportion of boys in the inner-city sample (20%) than boys in the rural sample (13%) experienced multiple risks. Girls across the rural and inner-city samples did not differ in terms of risk. Overall, more than 60% of African American youth in these two low-income samples did not evidence risk for later adjustment problems. Implications for research and intervention are discussed.

Adolescent↗
PubMed2000

Early predictors of adolescent violence.

OBJECTIVES: This study sought to identify early predictors of adolescent violence and to assess whether they vary by sex and across different types and levels of violence. METHODS: Data from a 5-year longitudinal self-report survey of more than 4300 high school seniors and dropouts from California and Oregon were used to regress measures of relational, predatory, and overall violence on predictors measured 5 years earlier. RESULTS: Deviant behavior in grade 7, poor grades, and weak bonds with middle school predicted violent behavior 5 years later. Attending a middle school with comparatively high levels of cigarette and marijuana use was also linked with subsequent violence. Early drug use and peer drug use predicted increased levels of predatory violence but not its simple occurrence. Girls with low self-esteem during early adolescence were more likely to hit others later on; boys who attended multiple elementary schools were also more likely to engage in relational violence. CONCLUSIONS: Violence prevention programs for younger adolescents should include efforts to prevent or reduce troublesome behavior in school and poor academic performance. Adolescent girls may also profit from efforts to raise self-esteem; adolescent boys may need extra training in resisting influences that encourage deviant behavior. Programs aimed at preventing drug use may yield an added violence-reduction bonus.

Adolescent↗
PubMed1996

Teenagers and alcohol misuse in the United States: by any definition, it's a big problem.

Despite the fact that more adolescents use alcohol than any other drug, studies of teenage alcohol misuse are relatively rare. Those that exist frequently fail to include high school dropouts and often focus on only part of the problem, such as how much or how often the adolescent drinks. This study examines the prevalence and demographic predictors of teenage alcohol misuse in a diverse sample of 4390 high school seniors and dropouts. It focuses on three different dimensions of misuse--high-risk drinking, alcohol-related problems and high consumption--and provides prevalence estimates by gender and race/ethnicity that are weighted to represent the original seventh grade cohort of 30 California and Oregon schools. Results show that by grade 12, nearly 70% of these teenagers have exhibited some form of alcohol misuse within the past year. Two-thirds have engaged in high-risk drinking and over 50% have experienced one or more alcohol-related problems. More stringent estimates that require variety or persistence of risky drinking and/or alcohol-related problems still capture between 40% and 54% of this population. However, focusing solely on high consumption fails to identify as many as half of these at-risk misusers. Males and females both exhibit high rates of alcohol misuse, as do most racial ethnic groups. However, African Americans and Asians are less likely to misuse alcohol than whites and Hispanics. The results underscore the need for including different forms of alcohol misuse in prevention programs, for improving our understanding of its etiology, and for providing upper and lower bound estimates of alcohol misuse in future research.

Adolescent↗
PubMed2001

Evaluation of indicated suicide risk prevention approaches for potential high school dropouts.

OBJECTIVES: This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up. METHODS: Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up. RESULTS: Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. CONCLUSIONS: School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.

Adaptation, Psychological↗
PubMed1992

Preventing low birth weight, child abuse, and school failure: the need for comprehensive, community-wide approaches.

Based on numerous examples from this country and abroad, we now have a reasonable idea of how we can reduce substantially the incidence of low-weight births, child abuse, adolescent pregnancy, school failure, and school dropout. The most effective long-term strategy appears to be the development of a comprehensive, coordinated, community-wide approach focused on preventing low- and medium-risk families from becoming high-risk as well as providing intensive services to those who already have reached a high-risk status. The best results can be obtained when all levels of government and the private sector work together. In this partnership, the best outcomes appear to result when the state and federal governments, private corporations, or both provide technical assistance, additional funding as needed, and help in setting program standards, and when the community maintains local control over establishing priorities and implementation strategies. However, to reach these goals and to maintain program support over the long time periods needed to show positive results (4 to 8 years), it is necessary to become skilled in social marketing techniques to turn program need into demand and to develop a strong local and statewide advocacy group to facilitate passage of needed legislation and prevent funding cutbacks. Pediatricians can modify their practices to make them more supportive to families and can work with other community leaders to bring about the changes in attitudes and about the changes in attitudes and funding priorities at the state and community levels that will be necessary to develop more effective preventive programs.

Adolescent↗
PubMed2002

Lifetime inhalant use among alternative high school students in Texas: prevalence and characteristics of users.

This cross-sectional study describes the prevalence of lifetime inhalant use and identifies demographic, psychosocial, and other risk behavior characteristics of students reporting lifetime inhalant use. The sample consisted of 354 students attending alternative high schools (dropout prevention/recovery schools) in Texas. The prevalence of lifetime inhalant use was 27.7%. After controlling for potentially confounding factors, students reporting lifetime inhalant use were less likely to be financially supported by their parents/guardians, more likely to use alcohol/tobacco, marijuana, and cocaine, and more likely to carry weapons and consider suicide. Study results may allow school officials, parents, researchers, and health care providers to gain a better understanding of inhalant use among students at risk for dropping out of school, a group which has not been extensively studied by previous researchers.

Administration, Inhalation↗
PubMed2003

Resident physicians who continue Balint training: a longitudinal study 1982-1999.

BACKGROUND AND OBJECTIVES: Balint seminars began in London in 1950 on a voluntary basis for general practitioners wishing to explore psychological problems in their practice. By 1964, there was a 36% early dropout rate among the 223 physicians who participated. This study sought to determine if those who leave Balint training during their residency, versus those who continue, have different psychological characteristics. METHODS: A retrospective analysis of 206 Medical University of South Carolina family practice residents from 1982 to 1999 was completed. All residents participated in 6 months of required Balint training and then could leave the Balint group or continue for the remaining 2 years. We examined gender and personality attributes, comparing residents who completed 2 years of weekly Balint training and residents who left after 6 months. Personality attributes were measured with the Myers-Briggs Inventory, the Work Environmental Preference Schedule, the Internal-External Locus of Control, the Fundamental Interpersonal Relationship Orientation Behavior test, and the Personal Orientation Inventory. RESULTS: A total of 132 residents completed 2 years of weekly Balint training, and 74 discontinued training after 6 months. Two-year attendees were significantly more intuitive on the Myers-Briggs Personality Inventory (MBTI). There were no significant differences on other MBTI items, nor were there significant differences in gender or in scores on the other psychological tests. CONCLUSIONS: Based on the rate of discontinuation of Balint training in our sample, Balint work does not appear to be suited to all physicians. With the exception of one MBTI characteristic, no significant differences could be demonstrated between those who did and did not continue participating. Further study is necessary to define other attributes characterizing Balint group attendees and nonattendees.

Family Practice↗
PubMed2005

Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus.

OBJECTIVES: To longitudinally follow a cohort of adolescents with human immunodeficiency virus (HIV) and to investigate long-term antiretroviral therapy adherence and factors associated with adherence. DESIGN, SETTING, AND PATIENTS: Adolescents infected with HIV (N = 231; mean age, 18.4 years; 72.7% female; 74.9% African American) from 13 cities throughout the United States were assessed at 3-month intervals. MAIN OUTCOME MEASURES: Self-reported adherence measures were validated by comparison with HIV-1 RNA viral load, and behavioral factors that may be associated with antiretroviral therapy adherence were assessed. RESULTS: At the initial visit, approximately 69% of the adolescents reported being adherent to antiretroviral therapy. Adolescents in the later HIV disease stage were less likely to be adherent compared with those in the earlier disease stage. Less alcohol use and being in school were associated with adherence by adolescents on weekends and over the preceding month. Longitudinal adherence was investigated among 65 subjects initially adherent with available information for at least 4 consecutive visits. The median time to nonadherence was 12 months, and failure to maintain adherence was significantly associated with younger age and depression. Among adolescents who attained an undetectable viral load, only about 50% maintained an undetectable viral load for the year. CONCLUSIONS: These findings indicate an urgent need for better interventions to assist adolescents with HIV in adhering to their medication regimens. Adolescents with advanced disease are likely to need more intervention. New treatments recently found effective for adolescent depression may assist in improving adherence for a majority of adolescents with HIV.

Adolescent↗
PubMed1975

Drinking amid abundant illicit drugs. The Vietnam case.

We studied drinking patterns and problems of 451 US Army enlisted men after their return from Vietnam. Before Vietnam, nearly half were regular drinkers and one quarter had drinking problems. Problem drinking declined in Vietnam as opiate use rose sharply; half had tried opiates and 20% were opiate dependent. After Vietnam, opiate use decreased (now less than 2% opiate dependent) and problem drinking again became ascendant. At time of interview, 17% had drunk in an alcoholic pattern at some period in their lives and another 41% had had problems from drinking. The younger men were more likely to have had problems. Alcholism predictors included:becoming intoxicated at an early age; dropping out of school; truancy and expulsion from school; and having a father with a history of alcoholism or arrests.

Adolescent↗
PubMed1975

Personal violence in infantry combat.

Thirty-one soldiers who had killed while in combat and who had subsequent psychiatric examinations were asked about acts of 'personal violence' in Vietna m (acts against persons at close range judged to be unnecessary from a military point of view.) Fourteen reported engagement in personal violence, while nine others reported witnessing such behavior. In this group, all who reported participation in personal violence had volunteered to serve in Vietnam. Significantly more participants reported killing four or more persons in Vietnam than did nonparticipants, and the participants more frequently had a history of arrest prior to military service. As a group, participants could be distinguished from nonparticipants by the average number of positive items present in each of several groupings of precombat variables. Personal violence in combat results from an interaction of individual, group, and situational factors.

Adult↗
PubMed1996

Correlations among maternal rejection, dropping out of school, and drug use in adolescents: a pilot study.

Rejection and hostility scores of mothers whose sons had dropped out of school and of mothers whose sons were in good standing academically formed non-overlapping distributions. All mothers of drop-outs had higher hostility and rejection scores than mothers whose sons were doing well academically. Scores of mothers whose sons were still in school, but who were experiencing academic problems, fell midway between these two groups and were significantly different from both. Maternal rejection and hostility also correlated significantly with drug use. Possible causal linkages among these phenomena and clinical and preventive implications were discussed briefly.

Achievement↗
PubMedDate not supplied

The impact of alcohol consumption and marijuana use on high school graduation.

In this study we use data from the National Longitudinal Survey of Youth (NLSY) to estimate the relationship between high school graduation, and alcohol and marijuana use among high school students. We also estimate the demand determinants for each of these substances. Our results show that there are significant adverse effects of alcohol and marijuana use on high school graduation. In particular, increases in the incidence of frequent drinking, liquor and wine consumption, and frequent marijuana use, significantly reduce the probability of high school graduation. Our results also show that beer taxes, liquor prices and marijuana decriminalization have a significant impact on the demand for these substances. These findings have important policy implications. A ten percent increase in beer taxes, reduces alcohol consumption among high school students, which in turn raises the probability of high school graduation by about three percent. A 1 percent increase in liquor prices raises the probability of high school graduation by over 1 percent. Raising the minimum drinking age for liquor also reduces liquor and wine consumption, and thus, improves the probability of high school graduation. Although the relationship between marijuana decriminalization and marijuana use is not significant, decriminalization is found to reduce the probability of becoming a frequent drinker. This result suggests that marijuana use and frequent drinking are substitute activities. Illicit substance abuse reduces the rate of high school completion, reduces expected future earnings and creates potential health problems. Thus, high-school-based preventive programs which discourage alcohol consumption and marijuana use are highly recommended, in order to alleviate these problems.

Adolescent↗