SWL 579: Session 3 10/17/09. EPIDEMIOLOGY ETIOLOGY EFFICACY EFFECTIVENESS DISSEMINATION 1. Identify problem or disorder(s) and review information to determine

SWL 579: Session 3

10/17/0910/17/09

EPIDEMIOLOGY ETIOLOGY EFFICACY EFFECTIVENESS DISSEMINATION

1. Identify problem or disorder(s) and review information to determine its extent

2. With an emphasis on risk and protective factors, review relevant information-both from fields outside prevention and from existing preventive intervention research programs

3. Design, conduct, and analyze pilot studies and confirmatory and replication trials of the preventive intervention program

4. Design, conduct, and analyze large-scale field trials of the preventive intervention program

5. Facilitate large-scale implementation and ongoing evaluation of the preventive intervention program in the community.

The preventive intervention research cycle. Preventive intervention research is represented in boxes three and four. Note that although information from many different fields in health research, represented in the first and second boxes, is necessary to the cycle depicted here, it is the review of the information, rather than the original studies, that is considered to be part of the preventive intervention research cycle. Likewise, for the fifth box, it is the facilitation by the investigator of the shift from research project to community service program with ongoing evaluation, rather than the service program itself, that is part of the preventive intervention research cycle. Although only one feedback loop is represented here, the exchange of knowledge among researchers and between researchers and community practitioners occurs throughout the cycle.

Generalizations AboutRisk and Protective Factors

Risk & protective factors are found in many Risk & protective factors are found in many domainsdomains

The more risk factors present, the greater The more risk factors present, the greater likelihood of problem behaviors, and the less likelihood of problem behaviors, and the less likelihood of successful outcomeslikelihood of successful outcomes

Protective factors reduce effects of exposure to Protective factors reduce effects of exposure to risk -- the greater the level of protection, the less risk -- the greater the level of protection, the less likelihood of problem behaviorslikelihood of problem behaviors

Common risk & protective factors predict diverse Common risk & protective factors predict diverse behavior outcomesbehavior outcomes

Risk & protective factors show much consistency Risk & protective factors show much consistency in effects across different races & culturesin effects across different races & cultures

Unger, Yan, Shakib, et al. (2002). Peer Influences and Access to Cigarettes as Correlates of Adolescent Smoking: A Cross-Cultural Comparison of Wuhan, China and California. Prevention Medicine 34, 476-484.

Results of regression analysis estimating the association between childhood maltreatment (between the ages of 3 and 11 years) and adult depression (ages 18 to 26), as a function of 5-HTT genotype. Among the 147s/s homozygotes, 92 (63%), 39 (27%), and 16 (11%) study members were in the no maltreatment, probable maltreatment, and severe maltreatment groups, respectively. Among the 435 s/l heterozygotes, 286 (66%), 116 (27%), and 33 (8%) were in the no, probable, and severe maltreatment groups. Among the 265 l/l homozygotes, 172 (65%), 69 (26%), and 24 (9%) were in the no, probable, and severe maltreatment groups. The main effect of 5-HTTLPR was not significant (b _ –0.14, SE _ 0.11, z _ 1.33, P _ 0.19), the main effect of childhood maltreatment was significant (b _ 0.30, SE _ 0.10, z _ 3.04, P _ 0.002), and the G _ E interaction was in the predicted direction (b _ –0.33, SE _ 0.16, z _ 2.01, P _ 0.05). The interaction showed that childhood stress predicted adult depression only among individuals carrying an s allele (b _ 0.60, SE _ 0.26, z _ 2.31, P _ 0.02 among s/s homozygotes, and b _ 0.45, SE _ 0.16, z _ 2.83, P _ 0.01 among s/l heterozyotes) and not among l/l homozygotes

Caspi, et. al. (2003) p. 388

Social Development Model

Prosocial opportunities

Prosocial involvement

Prosocial rewards

Bonding to prosocial

others

Belief in the moral order

Position in the social structure: race, SES, age,

gender

External constraints:Norms

Family & Classroom Management

Individual constitutional

factors

Problem Behavior

Belief in antisocial

values

Bonding to antisocial

others

Antisocial rewards

Antisocial involvement

Antisocial opportunities

Skills for interaction

( + ) ( - ) ( +, -

Positive Behavior

PROSOCIAL PATH

ANTISOCIAL PATH

SSDP Intervention

SSDP:Intervention Components

Component One: Component One: Teacher Training in Teacher Training in ClassroomClassroom Instruction and Instruction and ManagementManagement

Component Two:Component Two: Parent TrainingParent Trainingin Behavior Management and in Behavior Management and Academic SupportAcademic Support

Component Three: Component Three: Child Social and Child Social and Emotional Skill DevelopmentEmotional Skill Development

Perceived opportunities for prosocial

interaction/involvement with prosocial family,

classmates, teachers and classroom activities

Interaction/involvement with prosocial family, caregivers, teachers,

classmates, and classroom activities

Perceived rewards for interaction/involvement with prosocial family, caregivers, teachers,

classmates and classroom activities

Family management

Classroom management

School policies

Position in the social structure

Perceived opportunities for interaction with

antisocial family and caregivers, and/or

involvement in aggressive and other

problem behaviors

Interaction with antisocial family and caregivers, and/or


problem behaviors

Perceived rewards for interaction with

antisocial family and caregivers, and/or


problem behaviors

Skills for interaction/involvement

• Home-based services• Preparing for the Drug Free Years

• Respect & Responsibility• Proactive Family Management

• Newsletters

ANTISOCIAL PATH

PROSOCIAL PATH

(+) (-) (+,-)

Attachment and commitment to prosocial

family, caregivers, teachers, classmates

and classroom activities

Proactive ClassroomManagement

TeacherInstructional

Skills

Constitutional factorsInterpersonal and problem solving skills training and

summer camp

How to Help your Child Succeed in

SchoolAfter school study clubs

Belief in prosocial

family, caregivers, and school

values

Belief in antisocial family and caregivers’ values

Attachment and commitment to antisocial

family and caregivers

Drug and delinquency initiation

Note: Interaction or moderating effects are indicated by an arrowhead pointing to a structural path rather than a construct. Shaded circles indicate program interventions

The Social Development Model: Elementary School Period

Prevention Principles

• Include those at greatest risk, lowest protection– Target individuals exposed to high levels of risk, low

levels of protection– Target community areas exposed to high levels of risk,

low levels of protection

• Use data to prioritize risk and protective factors• Use approaches that demonstrate effects on prioritized

factors– Address risk and protective factors at appropriate

developmental stage– Intervene early– Address the racial, cultural, and economic diversity of

your community

Total Aggregated Risk Factors Perspective

John A. Pollard, Ph.D. Developmental Research and Programs

No stude nt sin this a re a.

Insufficie nt numbe r ofstude nt s in this are a.

Neighborhood #2

Neighborhood #1 Neighborhood #3

Principles for Culturally Competent Prevention Science

• Include multiple groups in studies.

SSDP Demographics

SESEligible for free/reduced lunch (5th,6th or 7th) 423 52%

Ethnic Group European-American381 47% African-American 207 26% Asian-American 177 22% Native-American 43 5% of these 44 5% were Hispanic

Gender Female 396 49% Male 412 51%


• Include multiple groups in studies.• Compare prevalences and rates of

positive and problem behaviors and outcomes.

Are there differences in high school drug use by ethnicity?

0

0.1

0.2

0.3

0.4

0.5

0.6

Binge Tobacco Marij. Hard

Average High School Drug Use

CaucasianAfrican AmericanAsian American

*

*

**

*

*

Seattle Social Development Project. African American and European American Proportions Initiating Alcohol Use by Age

Age 12-13

Age13-14

Age 14-15

Percent

current

Users14-15

African American 56.3%** 65.5%* 73.2% 56.6%

European American 71.8% 76.7% 79.6% 67.2%


• Include multiple groups in studies.• Compare prevalences and rates of

positive and problem behaviors and outcomes.

• Include measures of ethnic identify or acculturation to understand degree to which group differences reflect culture.

• Examine levels of risk and protection exposure in different groups.


• Examine the strength of risk and protective factors in different groups after controlling for socioeconomic status.

Peterson, et. al. (1994) p. 216

Hierarchical Logistic Regression: Parent Drinking, Family Management, and Parental Alcohol Attitudes and Norms Predicting Current Alcohol Use, With

Demographic Variable Controlled

StepStep Model Model dfdf

-2 log -2 log likelihood likelihood

Chi-SquareChi-Square

pp Step Step dfdf

ImprovemenImprovement t

Chi-SquareChi-Square

pp

DemographicsDemographics 246246 321.30321.30 .00.0011

33 5.415.41 .15.15

Youth’s Race (percent Youth’s Race (percent Black)Black)

245245 316.52316.52 .00.0022

11 4.784.78 .03.03

Parental DrinkingParental Drinking 244244 310.06310.06 .00.0033

11 6.466.46 .02.02

Family ManagementFamily Management 243243 275.81275.81 .08.08 11 34.2534.25 .00.0011

Parental Alcohol Parental Alcohol Attitudes and NormsAttitudes and Norms

239239 271.12271.12 .08.08 44 4.694.69 .33.33

Child’s InvolvementChild’s Involvement 238238 263.38263.38 .13.13 11 7.747.74 .00.0066

Interactions: Race x Interactions: Race x Parental Drinking, Parental Drinking, Family Management, Family Management, Parental Alcohol Parental Alcohol Attitudes and NormsAttitudes and Norms

231231 249.25249.25 .23.23 77 16.1316.13 .03.03


Hierarchical Logistic Regression: Parent Drinking, Family Management, and Parental Alcohol Attitudes and Norms Predicting Current Alcohol Use, With

Demographic Variable Controlled


β SE p

-0.57 0.31 0.07

0.36 0.14 0.02

Results Step 3

β SE p

-0.48 0.33 0.15

0.36 0.15 0.02

-1.03 0.21 0.00

Results Step 4

β SE p

-0.43 0.34 0.21

0.28 0.16 0.09

-1.05 0.21 0.00

-0.07 0.16 0.67

-0.13 0.19 0.50

-0.05 0.18 0.78

-0.24 0.18 0.18

Results Step 5

β SE p

-0.29 0.35 0.40

0.19 0.17 0.25

-1.10 0.22 0.00

-0.01 0.16 0.98

-0.06 0.20 0.76

0.03 0.18 0.88

-0.27 0.18 0.15

-0.96 0.35 0.01

Results Step 6

Variable β SE p

Youth's race -0.65 0.30 0.03

Parental drinking

Family management

Parental norms

Perceived harm

Use with parents

Use carefully

Child's involvement

Results Step 2

Etiology – Parent Drinking and Child Age 15 Alcohol use (odd ratios)

Child’s Alcohol Use

Age 15

ParentDrinking

1.4 **

Peterson et al. (1994)



Age 15

ParentDrinking

Good FamilyManagement

1.4**

.36***




Age 15

ParentDrinking


Parental Anti-Alc. Norms

1.3+

.35***




Age 15

ParentDrinking


Parental Anti- Alc. Norms

Chld’s Non-Invl in Parent’s

Alc Use

.33***

.38***



• Examine the strength of risk and protective factors in different groups after controlling for socioeconomic status.

• Use engagement approaches that effectively involve the focal audience.

• Use communication strategies that effectively communicate with the focal audience.

Academic Attainment by Ethnicity

0%

10%

20%

30%

40%

50%

60%

Elementary orJunior High

GED H.S. Diplomaor Vocational

Tech

AssociateDegree

BachelorDegree

MasterDegree

Ph.D.

Academic Attainment by Age 24

CaucasianAfrican AmericanAsian American

Ethnic disparities in educational attainment

• Persistent disparity in educational attainment between African Americans and European Americans (Jencks & Phillips, 1998)

• African Americans are about 50% less likely to earn a bachelor’s degree by age twenty-nine compared to White individuals (Haycock, 2001; US Census data)

Explanations for the existence of this inequality – Socioeconomic Status

• differences in family socioeconomic status (Bond, 1981; Tate, 1997)

• while differences in SES seem to account for a proportion of the gap…

• large racial differences remain even after standard measures of family background are controlled (Wilson, 1998)

• other factors may be contributing to ethnic differences in academic attainment

Consequences of Drug Use on Attainment

High School

Drug Use

AcademicAttainment by Age 24

bin

ge

tob

acco

pot

hard

highest degree

by age 24

years of education

Prior work in SSDP and other studies (Ellickson, et al. 1998; Newcomb & Bentler, 1988) has shown that high school substance use predicts reduced academic attainment.

-.49

7 Doctoral Degree

6 Master Degree

5 Bachelor Degree

4 Associate Degree

3 H.S. Diploma or Voc-tech

2 GED

1 Elementary or Junior High

Controls for delinquency, gender, prior academic achievement and poverty

High School

Drug Use


gender (female)

povertyHigh SchoolDelinquency

prior schoolgrades

grades 5 & 6 grades 9, 10 & 12 age 24

Controls for delinquency, gender, prior academic achievement and poverty

High School

Drug Use


gender (female)

povertyHigh SchoolDelinquency

prior schoolgrades

High school drug use predicts reduced academic attainment after controlling for delinquency, gender, prior academic achievement and poverty

-.44

+.60

+.37

-.12-.23

-.15

-.10

p < .05

not sig.

Research Question

Do the consequences of adolescent drug use on academic attainment differ for African American, Asian American and European Americans in the SSDP study?

Longitudinal data have been collected on these Seattle youths and their parents from 1985 to 2002 (age 27).

SSDP Panel Ages and Retention

MEANAGE G2 10 11 12 13 14 15 16 (17) 18 21 24

27

% 87%69%81%96%97%95% -- 94%95% 93% 92%

Elementary

Middle High Adult

Panel retention has been high.

Are national differences in academic attainment reflected in the SSDP Sample?

3.362.78

3.65

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

Caucasian AfricanAmerican

AsianAmerican

Aca

dem

ic A

ttai

nm

ent

by

Ag

e 24 Caucasian

African American

Asian American

Ph.D.

Master Degree

Bachelor Degree

Associate Degree

H.S. Diploma orVocational-technical

GED

Elementary or Junior High

**

*

Are the consequences of high school drug use different for Caucasians, African Americans and Asian Americans?

Model tested

grades 5 & 6 grades 9, 10 & 12 age 24

Multiple Group SEM: Caucasian-African American-Asian American

Caucasian

African American

Asian American

AMOS

Model Fit:

CFI: .981TLI: .962RMSEA: .051

Fixed the measurement model to be the same across groups.


High School

Drug Use

High SchoolDelinquency

prior schoolgrades


gender (female)

poverty

-.39

.39-.21

Caucasian


High School

Drug Use


prior schoolgrades


gender (female)

poverty

-.77

African American

High School

Drug Use


prior schoolgrades


gender (female)

poverty

-.13, ns

.39

Asian American

-.20


• The consequences of high school drug use on academic attainment were worse for African Americans.

• The consequences of high school drug use on academic attainment were not significant for Asian Americans.

Prevention Implications

• Preventive interventions reducing adolescent drug use may have long-term benefits of greater educational attainment in adulthood.

• These benefits may be especially strong for African Americans.

Documents

SWL 579: Session 3 10/17/09. EPIDEMIOLOGY ETIOLOGY EFFICACY EFFECTIVENESS DISSEMINATION 1. Identify problem or disorder(s) and review information to determine