Objectives: MDMA/ecstasy use among college students has increased and reportedly leads to risky sexual behaviours. However, little is known about its association with sexually transmitted diseases (STDs). To evaluate this public health concern, this study examined the association between substance use (particularly MDMA) and self-reported STDs (chlamydia, gonorrhoea, herpes and syphilis) among college students and non-students aged 18-22 years (n = 20,858).Study design: A cross-sectional data analysis of a national survey.Methods: Data were drawn from the 2005-2006 National Surveys on Drug Use and Health; a nationally representative survey of non-institutionalized Americans. Self-reported STDs and substance use were assessed by the audio computer-assisted self-interviewing method. The association between MDMA use and STDs was determined while taking into account young adults' use of other substances, healthcare utilization and sociodemographic characteristics.Results: Overall, 2.1% of college students and 2.5% of non-students reported contracting an STD in the past year. MDMA use in the past year was not associated with STDs. Among non-students, onset of MDMA use before 18 years of age increased the odds of past-year STDs. In both groups, alcohol use. marijuana use, female gender and African American race increased the odds of both past-year and lifetime STDs. Additional analyses indicated that, regardless of college-attending status, greater odds of past-year STDs were noted among users of alcohol and drugs, and users of alcohol alone, but not among users of drugs alone.Conclusions: Alcohol use is a robust correlate of STDs. Irrespective of college-attending status. young women and African Americans have a higher rate of STDs than young men and Whites. (C) 2009 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

This paper examines factors associated with the adoption of evidence-based substance use prevention curricula (EBC) in a national sample of school districts. Substance abuse prevention coordinators in public school districts (n = 1593), which were affiliated with a random sample of schools that served students in Grades 5-8, completed a written survey in 1999. Results indicated that 47.5% of districts used at least one EBC in their schools with middle school grades. Substance use prevention coordinators reported they had the greatest input in decisions about curricula. In a multivariate analysis of factors positively associated with district-level decisions to adopt evidence-based programs, significant factors included input from a state substance use prevention group, use of information disseminated by the National Institute on Drug Abuse or Center for Substance Abuse Prevention, use of local needs assessment data, consideration of research showing which curricula are effective and allocation of a greater proportion of the coordinator's time to substance use prevention activities. State and federal agencies should increase their efforts to disseminate information about evidence-based programs, targeting in particular the district substance use prevention coordinator.

Purpose We examined the patterns and correlates of nitrite inhalant use among adolescents aged 12 to 17 years. Methods Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Logistic regression was used to identify the characteristics associated with nitrite inhalant use. Results Among adolescents aged 12 to 17 years, 1.5% reported any lifetime use of nitrite inhalants. The prevalence of lifetime nitrite inhalant use increased to 12% and 14% among adolescents who were dependent on alcohol and any drug in the past year, respectively. Many nitrite inhalant users used at least three other types of inhalants (68%) and also met the criteria for alcohol (33%) and drug (35%) abuse or dependence. Increased odds of nitrite inhalant use were associated with residing in nonmetropolitan areas, recent utilization of mental health services, delinquent behaviors, past year alcohol and drug abuse and dependence, and multi-drug use. Conclusions Adolescents who had used nitrite inhalants at least once in their lifetime tend to engage in delinquent activities and report co-occurring multiple drug abuse and mental health problems in the past year.

This study examined the effects of different aspects of parenting, father absence, and affiliation with delinquent peers on delinquent behavior in a cohort of African-American male adolescents. One round of survey data was collected from the youths' mothers or mother surrogates (N = 175) and two rounds of survey data were collected from the adolescents themselves. Analyses revealed that mothers' perceived control of sons' behavior was a deterrent of delinquent behavior, while other aspects of parenting (e.g., mother-son communication and relations) were not. The effect of mothers' perceived control was not mediated by adolescents' affiliation with delinquent peers. The effects of mothers' parenting variables and peer affiliation did not vary significantly by family structure, but socioeconomic disadvantage was more strongly associated with delinquent behavior in father-absent families. Though parenting effects were modest, this study suggests that African-American male adolescents are less likely to engage in delinquent behavior if they are closely monitored and supervised by their parents.

The US Department of Education's Principles of Effectiveness require recipients of Safe and Drug-Free Schools and Community Act funds to: a) base drug and violence prevention programs on needs assessment data, b) develop measurable program goals and objectives, c) implement programs with research evidence of effectiveness, and d) periodically evaluate programs relative to their goals and objectives. This paper reports the extent of awareness of the Principles of Effectiveness and plans for their implementation among public school districts and schools in the United States in the year following their announcement. Results showed a greater percentage of public school districts than individual schools knew about the principles and planned for implementation, but baseline levels of awareness for both districts and schools were relatively low. Schools were more likely to know about the principles when their associated school district also knew. Results suggest a need for greater communication about the principles to school districts, and in turn, a need for greater communication between district and school-level substance use prevention staff.

Teachers' fidelity of implementation of substance use prevention curricula is widely considered desirable and is linked empirically to effectiveness. The authors examine factors pertinent to teachers' fidelity to curricula guides, using data from a nationally representative sample of 1,905 lead substance use prevention teachers in the nation's public and private schools. Findings suggest that about one-fifth of teachers of substance use prevention curricula did not use a curriculum guide at all, whereas only 15% reported they followed one very closely. Positively associated with adherence were teachers' discretion in their coverage of prevention lessons, beliefs concerning the effectiveness of the most recent training they received and the curricula they taught, and level of support they received from their principals for substance use prevention. The authors conclude that some degree of curriculum adaptation is inevitable and suggest how adherence to curricula guides may be improved through teacher training.

PURPOSE:To assess how current practice in middle school substance use prevention programs compares with seven recommended guidelines adapted from the Centers for Disease Control and Prevention guidelines for school-based tobacco use prevention programs.METHODS:Substance use prevention practice was analyzed using data from a 1999 mailed questionnaire of a nationally representative sample of 1496 public and private schools with middle school grades that reported having a substance use prevention program. Respondents answered questions about substance use prevention education and activities in the whole school and in their own classroom. Weighted prevalence estimates for the seven recommendations are presented, and multiple regression was used to analyze correlates of implementation of the recommendations.RESULTS:An estimated 64.2% of schools met four or more of the recommendations for school-based substance use prevention practice; 4.0% met all seven recommendations. Schools were most likely to report having and enforcing substance use prevention policies (84.3%) and least likely to report training teachers in substance use prevention (17.9%). More recommendations were implemented in schools that were public and had larger enrollments, greater perceived availability of resources, greater school board and parental support for substance use prevention, and had hired a school substance use prevention coordinator.CONCLUSIONS:The low prevalence of comprehensive substance use prevention programs in U.S. middle schools may limit the potential impact of school programs on the prevalence of youth substance use.

Objective: The purpose ofthis study was to explain higher rates of alcohol use observed among working adolescents relative to nonworking adolescents. Method: In-home survey data were collected from a representative sample of 4,497 (50% male) 14-17 year olds who participated in the 1998 National Household Survey on Drug Abuse (NHSDA). Multivariate logistic regression analyses were conducted to determine whether relationships between work status and past-month alcohol use and heavy drinking would persist after adjusting for demographic characteristics and selected risk and protective factors in the community, family, school and peer-individual domains. Results: As anticipated, significantly higher rates of past-month alcohol use and heavy drinking were reported by working than nonworking adolescents. Multivariate analyses indicated that the higher rates of past-month alcohol use and heavy drinking among working adolescents were largely explained by demographic characteristics (e.g., age, race/ethnicity), together with perceived drinking norms among adults, other students and friends. Conclusions: Findings of this study suggest that the relationship between employment and alcohol use among adolescents is largely spurious, due to demographic differences between working and nonworking adolescents. Our findings also suggest, however, that working adolescents are more likely to be exposed to adults and peers who drink, which may be attributed in part to their work setting.

Purpose: To examine characteristics of youth homelessness associated with engaging in risk behaviors for human immunodeficiency virus (HIV).Methods: The sample included 288 currently homeless or runaway Washington, DC youth aged 14-21 years. Measures were self-reported homelessness characteristics, unsafe sexual behavior, injection drug use, and background characteristics. Bivariate and multivariable analyses of the relationships between homelessness characteristics and HIV risk behaviors were conducted.Results: Both male (n = 140) and female (n = 148) participants reported high rates of unsafe sexual behaviors, but low rates of injection drug use. HIV risk was significantly associated in bivariate analyses with severity of homelessness circumstances (i.e., spending the night in public place or with strangers, going hungry, and participating in the street economy), the duration of homelessness (i.e, greater number of episodes of homelessness, longer time length of current episode), and specific reasons for being homeless (i.e., thrown out). In addition, sexual victimization and older age were associated with increased HIV risk. In multivariable models, a smaller set of these homelessness characteristics remained significant independent correlates and explained a substantial amount of the variation in the HIV risk indices for both males and females.Conclusions: The results contribute to greater theoretical understanding of the characteristics of homelessness associated with increased risk of HIV infection within this vulnerable population of youth. The associations between homelessness characteristics and HIV risk suggest the need for HIV prevention efforts to focus directly on ameliorating the homelessness circumstances of youth. (C) Society far Adolescent Medicine, 1999.

Many homeless youth may also be considered "thrownaway" in that they have specifically been told to leave home. In this study, thrownaway experiences among homeless youth are examined in two national samples: (a) a nationally representative sample of youth residing in youth shelters, and (b) a purposive sample of street youth in 10 cities. Prevalence of thrownaway experiences for the total samples and for demographic subgroups is provided, along with comparisons of the familial backgrounds and high-risk behaviors of youth with and without such experiences. In both samples, youth with thrownaway experiences (who constituted nearly half of each sample) were more likely than youth without such experiences to report (a) that they had attempted suicide, used marijuana and other drugs (excluding cocaine), and had been involved in the drug trade and carried hidden weapons; (b) that other family members had used illicit drugs during the 30 days before the youth left home; and (c) that they had spent at least 1 night away from home due to physical and/or emotional abuse or neglect, familial conflict, and familial substance use. Thrownaway youth constitute a particularly vulnerable subpopulation of homeless youth. A greater recognition and understanding of such youth will facilitate design of services that better address their needs.

OBJECTIVE:The purpose of this research was to determine whether risk factors for a maltreatment report in the first year of life, especially the interaction of life event stress and social support, persist into the second and third years of life. METHOD:Predominantly low income mothers who had been interviewed shortly after the birth of infants in a longitudinal cohort were re-interviewed around the infants' first birthdays, and reports to North Carolina's Central Registry of Child Abuse and Neglect were tracked for substantiated maltreatment reports. RESULTS:Variables significantly associated with a substantiated maltreatment report in the second or third year of life (p < .01) were first year maltreatment reports and participation in Medicaid. Three interactions between a stressful life event indicator variable and a social support indicator variable were significant predictors of substantiated second or third year reports (p < .05). CONCLUSIONS:Even in the presence of significant risk factors from the first year of life, life event stress can increase the risk of a substantiated maltreatment report in the second or third years of life, but social support may moderate the effect of life events.

OBJECTIVES:Standardized estimates of the prevalence of substance use by runaway and homeless youth between the ages of 12 and 21 in various settings were compared with each other and with estimates for youth in the general population.METHODS:Four surveys were used: (1) a nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelters; (2) a multicity survey of street youth; (3) a nationally representative household survey of youth with and without recent runaway and homeless experiences; and (4) a nationally representative household survey of youth whose previous runaway/homeless status was unknown.RESULTS:For almost every substance, substance use prevalence was highest among street youth. Shelter youth and household youth with recent runaway/homeless experiences reported similar rates. In the household surveys, substance use rates were lowest and were generally comparable.CONCLUSIONS:Many homeless and runaway youth use tobacco, alcohol, and other drugs at rates substantially higher than nonrunaway and nonhomeless youth, indicating a need for comprehensive and intensive substance abuse prevention and treatment services for these youth.

This study examined how youth suicide attempts are associated with youth and familial substance use among two samples of runaway and homeless youth (RHY): (a) a nationally representative sample of RHY residing in shelters, and (b) a multicity, purposive sample of RHY found on the street. Data were collected using personal interviews from 640 shelter youth and 600 street youth in 1992. Logistic regression analyses revealed that, after controlling for key demographic characteristics, youth who had used substances (particularly sedatives, hallucinogens, and inhalants) were much more likely than those who had not used substances to have ever attempted suicide. In addition, after controlling for their own substance use, youth with family members who had used substances were twice as likely as those without such family members to have ever attempted suicide. This study suggests the importance of developing and focusing suicide prevention.

The purposes of this research were to identify risk factors for reported child abuse or neglect and to examine the roles of stress and social support in the etiology of child maltreatment. Mothers of newborn infants with biomedical and sociodemographic risk factors were recruited from community and regional hospitals and local health departments in 42 counties of North and South Carolina selected for geographic distribution and for large numbers of such newborns. For every four such mothers, the next mother to deliver an otherwise normal newborn was sought. Mothers were interviewed shortly after giving birth, and state Central Registries of Child Abuse and Neglect were reviewed when each infant was 1 year of age. Eight hundred forty-two of 1,111 recruited mothers were successfully interviewed in their homes between March 1986 and June 1987. Seven hundred forty-nine North Carolina births who resided in the state more than 6 months were eligible for inclusion in the analysis. Logistic regression with backward elimination procedures was used in the analysis. Maternal education (p < .01), number of other dependent children in the home (p < .01), receipt of Medicaid (p < .01), maternal depression (p < .05), and whether the maternal subject lived with her own mother at age 14 years (p < .05) were the best predictors of a maltreatment report. Further examination revealed an interaction effect between stressful life events, as measured by life event scores, and social well-being (p < .01). For children born at risk for social and/or medical problems, extreme low income (participation in public income support programs), low maternal education, maternal depression, the presence of any other young children in the home, and a mother's separation at age 14 years from her own mother significantly predict child maltreatment reports in the first year of life. In addition, stressful life events, even if perceived positively, may increase or decrease the risk of maltreatment reports, depending upon the presence of social support.

Project DARE (Drug Abuse Resistance Education) is the most prevalent school-based drug-use prevention program in the United States, but there is little evidence of its effectiveness. Results from a longitudinal evaluation of the program in 36 schools in Illinois provide only limited support for DARE's impact on student's drug use immediately following the intervention, and no support for either continued or emerging impact on drug use 1 or 2 years after receiving DARE instruction. In addition, DARE had only limited positive effects on psychological variables (i.e., self-esteem) and no effect on social variables (e.g., peer resistance skills). Possible substantive and methodological explanations for the relative lack of DARE's effectiveness observed in this study are discussed.

Objectives. Project DARE (Drug Abuse Resistance Education) is the most widely used school-based drug use prevention program in the United States, but the findings of rigorous evaluations of its effectiveness have not been considered collectively.Methods. We used meta-analytic techniques to review eight methodologically rigorous DARE evaluations. Weighted effect size means for several short-term outcomes also were compared with means reported for other drug use prevention programs.Results. The DARE effect size for drug use behavior ranged from .00 to .11 across the eight studies; the weighted mean for drug use across studies was .06. For all outcomes considered, the DARE effect size means were substantially smaller than those of programs emphasizing social and general competencies and using interactive teaching strategies.Conclusions. DARE's shortterm effectiveness for reducing or preventing drug use behavior is small and is less than for interactive prevention programs.

Research consistently has shown that cigarette use by adolescents is related to their parents' use and to particular characteristics of the family environment, but few studies have examined the linkages between parents' smoking behavior and other family characteristics to explain adolescents' smoking. In this study, we tested mediator, moderator, and independent models for their ability to characterize the relationship between parents' and their children's smoking. A sample of 719 matched pairs of parent (usually mother) and child was used. Respondents were part of an ongoing randomized evaluation of the Drug Abuse Resistance Education (DARE) Project in Illinois, and the subset of data used in these analyses was collected in 1991, when the youths were in the sixth or seventh grades. Results of logistic regression provided the greatest support for the independent model, which suggests that the effects of parents' smoking and familial characteristics on adolescents' smoking are not linked. Results also supported those found by other researchers by showing that parents' former smoking is associated with adolescents' current smoking. Significant family characteristics were family disunion and parents' awareness of their child's activities. These results suggest, in part, that children at any age may have the capability of storing memories of their parents' smoking, memories that influence their own smoking; also, characteristics of the family environment, independent of parents' smoking behavior, have an effect on adolescents' smoking. Prevention implications and recommendations are also discussed.

During spring 1987, North Carolina conducted a drug prevalence survey on a randomly selected, stratified cluster sample of 10,259 seventh-12th grade students enrolled in public schools. The survey assisted in development of new drug prevention programs funded by the Drug-Free Schools Act of 1986. Results indicated alcohol, tobacco, and marijuana were the most commonly used drugs; males and whites were more frequent users than females and blacks; and almost 20% of 11th and 12th grade students reported coming to school drunk in the year preceding the survey. Extensive use of wine coolers and smokeless tobacco was noted. The need is discussed for other states to conduct similar surveys to establish a data base from which better programming decisions can be made.