to reduce use. They described reading themessages and finding themmotivating. Youth indicated a top-3 trigger context on36% (baseline),43% (intervention), and 38% (follow-up) of reports. Marijuana desirewhen in a top-3 trigger context decreased from baseline to follow-up(M difference � -1.60; p � .0001). Desire tended to be higher intrigger vs. other contexts at baseline (M difference � 0.42; p � .15)and intervention (M difference � 0.73; p � .10), but at follow-upthere was no difference in desire between context types (M differ-ence � -0.008; p � .98). Odds of using marijuana following top-3trigger exposure were reduced by almost 50% at follow-up vs. base-line (odds ratio [OR] 0.54; 95% confidence interval [CI] 0.31-0.95; p �

.03). Odds of avoiding use following trigger exposurewere also lowerat follow-up vs. baseline (OR 0.38; 95% CI 0.21-0.67; p � .0009).Use/day tended to decline frombaseline to follow-up (Mdifference�

-0.24; p� .15); readiness, importance, and confidence ratings did notchange significantly. Percent days abstinent increased slightly but non-significantly from baseline to follow-up (39.6% to 47.3%; p � .13).Conclusions: Youth found the intervention motivating and helpfulin reducing marijuana use. The observed decrease in use may berelated to decreased desire to use when in triggering contexts, not todecreased exposure to triggers or to increased avoidance of use.Further research using a comparison group is warranted.Sources of Support: Boston Children’s Hospital Clinical ResearchCenter.

2.

THE EMERGENT THREAT OF COMMUNITY COLLEGE HOOKAHWATERPIPE USEMaria De Borba-Silva, MPH1, Pramil Singh, DrPH2, Hildemar DosSantos, MD2, Jayakaran Job, MD, MPH2, T.L. Brink, PhD3, SusanneMontgomery, PhD2.1Loma Linda University/Crafton Hills College; 2Loma Linda University;3Crafton Hills College

Purpose: To examine prevalence and correlates of waterpipe useamong U.S. college students and explore differences between 4-yearschools and 2-year community colleges.Methods:Google Scholarwith its ‘cited by’ toolwas used to conducta literature search of U.S. collegiatewaterpipe use studies; no studiesat community colleges have been published. A fall 2011 cross-sectional in-classroom survey (n � 1,207) was undertaken at twodemographically diverse (43% Latino, 25% White, 14% Multirace, 9%African American, 4% Asian) community colleges, 1 urban, and 1suburban, in San Bernardino, Southern California. SPSS 20 was usedto run descriptive statistics and univariate logistic regression to iden-tify variables for processing fully adjusted multiple logistic models.Results: From 2004 to 2011, 15 peer-reviewed studies reported on4-year college student waterpipe use. Lifetime prevalence rangesfrom 11% to 61% and current 30-day use from 5% to 30%. Commoncorrelates of use are younger age (18-19), male gender, White race,past and concurrent substance use, the belief that the waterpipe isless harmful and addictive than cigarettes, and seeing it as highlysocially acceptable. Results from each of the 15 studies are summa-rized in a table highlighting demographic correlates, tobacco andsubstance use correlates, and waterpipe beliefs and behaviors. Re-sults from the community college study (n � 1,207) foundwaterpipeuse in the higher range of the collegiate literature (55.5%) reportedever using the waterpipe, and more than 1 in 3 (34.1%) used it in theprevious year. No gender differences in usewere found.More studentshaveexperimentedwith thewaterpipe than a cigarette; “ever” cigaretteusewas 48.8%. Currentwaterpipe use (10.8%) is associatedwith currentalcohol use (AOR � 2.8; p � .001), current cigar use (AOR � 2.5; p �

.01), current cigarette use (AOR � 1.8; p � .05), and female bingedrinking (AOR � 1.8; p � .05). Compared to African Americans,Whites are 2.9 times (p � .05) more likely to be current users.Students believing waterpipe use very socially acceptable are 21times (p � .001) more likely to be current users than those whobelieve it not at all acceptable. No associations were found betweensmokeless tobacco and illegal drugs and any measure of waterpipeuse.While “ever” use ofmarijuana (56.2%)was correlatedwith “ever”waterpipe use, current marijuana use (16.8%) was not associatedwith any waterpipe use. Economic variables such as receipt of finan-cial aid, first generation to attend college, and number of hoursworked each week had no bearing on use. Students who spent theleast amount of money ($0) per week on entertainment and thosewho spent more than $21 were more likely to have used the water-pipe than those who spent $0.Conclusions: Our findings raise the possibility that the communitycollege is a high risk environment for waterpipe use, adding a newdimension to this growing trend. Waterpipe health education andcessationprograms areneeded, aswell asmore stringent campus andmunicipal tobacco control measures. Regulations and ordinancesmust specifically reference the waterpipe and target locales where itis used, served, and sold.Sources of Support:Hulda Crooks Dissertation Award, Loma LindaUniversity.

3.

CORRELATION OF SOCIETAL RISK FACTORS AND SUBSTANCE USEAMONG RURAL AFRICAN-AMERICAN YOUTHRonald Daniel Williams, Jr., PhD.

Mississippi State University

Purpose: Rural adolescents report higher rates of alcohol and mul-tiple illicit drug use than non-rural adolescents. Studies have indi-cated that African-American youth are more likely to experienceproblems related to drug use despite lower usage rates than Whiteyouth. The purpose of this study was to explore the relationship ofsubstance use and societal risk factors among a rural African-Americanadolescent sample.Methods: As part of a community-based drug prevention programcovering 4 rural southeasternMissouri counties, a sample of African-American adolescents (n � 201; 62.2% women; 37.8% � men) weresurveyed to determine their current consumption of licit and illicitsubstances and their perceptions of societal risk factors in their localcommunity. National Outcomes Measures were used to determine30-day use rates and age-at-first-use of cigarettes, other tobaccoproducts, alcohol, marijuana, other illegal drugs, and prescriptiondrugs. A 6-item scale was developed to measure societal risk factors(alpha � 0.78). Scale questions asked about pro-use messages frompeers, family, and community, as well as perceptions of communitydiscrimination, marginalization, and limited economic success.Results: Mean age of the sample was 14.6 � 3.1 (Mean � SD).Highest 30-day substance use rates among all participants werealcohol (71.3%), marijuana (32.7%), cigarettes (24.8%), and prescrip-tion drugs (19.8). Logistic regression revealed a significant relation-ship (p � .05) between 30-day use of alcohol, marijuana, cigarettes,and prescription drugs and high levels of societal risk. Participantswith high societal risk scores were more likely to indicate increasedconsumption of alcohol (odds ratio [OR] � 1.94; 95% confidenceinterval [CI] 1.12-2.38), marijuana (OR � 2.67; 95% CI 1.04-3.97),cigarettes (OR � 1.21; 95% CI 1.22-3.14), and prescription drugs(OR� 3.48; 95% CI 1.77-6.78). Feelings of discrimination andmargin-alization significantly predicted 30-day alcohol (p � .001), marijuana

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(p � .001), and cigarette (p � .011) use among all participants.Societal risk was also correlated to age-at-first use of alcohol (10.3years; p� .001),marijuana (12.1 years; p� .004), and cigarettes (12.4years; p � .028). Menweremore likely to perceive pro-usemessagesfrom peers and family members, while women were more likely toperceive pro-use messages from peers and community. No signifi-cant differences existed among men and women regarding theirperceptions of discrimination, marginalization, and limited eco-nomic success.Conclusions: Rural African-American youth who experience highsocietal risk show an increased probability of participation in early-onset and 30-day substance use. Because early onset drug use is apredictor of future abuse and related problems, it is important todevelop and deliver population-specific drug prevention programsfor this at-risk population. First-use occurs during pre-teen years,particularlywith alcohol; therefore, health educators and preventionspecialists should seek to deliver age-appropriate programs duringearly childhood years.Sources of Support: Southeast Regional Support Center.

4.

FIDELITY OF EVIDENCE-BASED DRUG PREVENTION PROGRAMIMPLEMENTATION IN RURAL SCHOOL AND COMMUNITY SITESRonald D. Williams, Jr., PhD, Barry P. Hunt, PhD.

Mississippi State University

Purpose: Substanceuse among rural adolescents is a significantpublichealth concern in the United States with rural youth reporting higherrates of alcohol and multiple illicit drug use than non-rural youth. Al-though evidence-based drug prevention programs are available, mostprovide specific implementation guidelineswhich increase difficulty insettings with limited time and resources. The purpose of the study wasto compare the implementationfidelityof evidence-baseddrugpreven-tion programs in rural school and community sites.Methods: Eleven evidence-based drug prevention programs (6community-based; 5 school-based) in 3 rural, southeasternMissouricounties were included in this study. Community-based programsincluded those that were implemented in non-academic settings,while school-based programswere implemented in local middle andjunior high schools. Programs provided prevention education toyouth (n � 200; mean age, 12.6 years) in grades 5-9. Through pro-gram facilitator interviews, program fidelity wasmeasured using theSPF-SIG Community Program Implementation Record which in-cluded the constructs of intensity, content, location, recipient, anddeliverer issues. Fidelity levels were classified as high, moderate, andlow. National OutcomesMeasures (NOMs)were collected at baselineand follow-up of each program to determine behavioral and attitu-dinal impact on 15 measures of drug use.Results: Implementation fidelity was significantly correlated to im-provements on drug use impact measures (p � .05). Five programsdelivered with high fidelity resulted in improvements on 8-12 impactmeasures, while 3 programs delivered with moderate fidelity resultedin improvements on 5-6 impact measures. Three programs deliveredwith low fidelity showed improvements on only 2-3 impact measures.Additionally, all 5 school-based programs reported high fidelity, whilecommunity programs included 3 moderate and 3 low fidelity levels.Program intensity, content, and locationwere themost consistentprob-lems in community programs with lack of institutional support identi-fied as a key barrier. Additionally, school programs showed fewer prob-lems with participant retention and were more likely to reach a highernumber of adolescents (n � 123; mean � 24.6 per program) thanwerecommunity programs (n � 77; mean � 12.9 per program).

Conclusions: When compared to community sites, school sitesprovided a more structured environment for the implementation ofevidence-based drug prevention programs. As implementation fidel-ity increases, the impact on drug-related attitudes and behaviors ofadolescents also improves. Health and prevention educators shouldseek school collaborations to increase implementation of evidence-based drug prevention programs as it may yield a higher impact onyouth behavior.Sourcesof Support: Thisprojectwas fundedbytheMODepartmentofMentalHealth Prevention Services SPF Project (SDA42007001).

5.

OPIATE ABSTINENCE AMONG ADOLESCENTS ENGAGED IN ANOUTPATIENT BUPRENORPHINE CLINIC FOR THE TREATMENT OFOPIATE DEPENDENCESteven C. Matson, MD1, Gerrit Hobson, BA2, Mahmoud Abdel-Rasoul,MS3, Andrea Bonny, MD4.1The Ohio State University, College of Medicine; 2NationwideChildren’s Hospital; 3The Ohio State University; 4The Ohio StateUniversity, Nationwide Children’s Hospital

Purpose: Buprenorphine is a relatively new option for treatment ofopiate-dependentadolescents. It is approvedtobeprescribedbytrainedoffice-based physicians, which thereby increases the availability of thisdrug to the largepopulationofopiateabusingadolescents. Theobjectiveof this study was to assess the effectiveness of outpatient sublingualbuprenorphine/naloxone (BUP/NAL) treatment for adolescent opiatedependence asmeasured by opiate abstinence.Methods: A retrospective chart review was conducted of adoles-cents (ages 15-21) who presented to an outpatient BUP/NAL clinicfrom January 1, 2011, to June 30, 2012. Patients were identified asaddicted to either heroin or prescription opiates. Demographics andpast medical history were collected. Urine drug screens (UDS) andBUP/NAL screens from each visit were documented. Opiate absti-nence was defined as (# negative screens for opiates � total screensfor opiates) x 100. BUP/NAL compliance was defined as (# positivescreens for BUP/NAL � total screens for BUP/NAL) x 100.Results: One hundred eighty-five subjects presented for treatment.The mean age was 19.3 � 1.6 years with a range from 15.7 to 24.4years. Patients were 51% female and 97%White non-Hispanic. Forty-eight percent of subjects had private insurance, 43% public, and 9%none. Sixty-eight percent identified as heroin abusers and 32% asprescription opiate abusers. Themost commonhistorical problems atpresentationwere: depression (40%), anxiety (32%), suicidal ideation(14%), and insomnia (17%). At initial clinic visit, 49% of subjects had aUDS which was negative for opiates. Opiate abstinence increasedwith subsequent clinic visits and averaged 87% for all clinic visitsafter baseline. Mean BUP/NAL compliance was similarly 89% for allvisits after baseline. Average time in the program varied widely(mean 118 days � 141), but for subjects who remained in the pro-gram at least 5 months (26%), opiate abstinence averaged 94% fromthis point on.Conclusions:Opiate abstinence rateswere high among adolescentswhile engaged in an outpatient BUP/NAL clinic for the treatment ofopiate dependence. Patient retentionwas the largest barrier to treat-ment success. BUP/NAL can be successfully provided in the outpa-tient setting for treatment of opiate dependence among adolescents.Future research should focus on mechanisms to increase patientretention.Sources of Support: The Research Institute of Nationwide Chil-dren’s Hospital, Columbus, OH.

S17Platform Abstracts / 52 (2013) S1–S20