BACKGROUND:The concurrent validity of subclinical ratings for psychiatric symptoms can help refine symptom definitions and threshold criteria. However, virtually no research has examined subclinical ratings for DSM-IV symptoms in psychiatric diagnostic interviews. This study examined the frequency, reliability, and concurrent validity of subclinical ratings for 11 symptoms of alcohol use disorders among adolescents.METHODS:Subjects were 239 male and 164 female adolescents ages 14 to 18 recruited from treatment and community sources. Symptoms and diagnoses were made with an adapted version of the Structured Clinical Interview for the DSM-IV.RESULTS:Subclinical ratings showed acceptable to high interrater reliability. The proportion of subclinical ratings tended to decrease with increasing levels of alcohol problems. For 10 of the 11 symptoms, subjects with subclinical ratings were distinguished from those with absent and/or those with present ratings. Subjects with subclinical ratings were often distinct from those with present ratings but less often distinct from those with absent ratings.CONCLUSIONS:For most of the DSM-IV alcohol use disorder symptoms, subclinical ratings appear to be reliable and valid and provide information beyond dichotomous symptom classifications for adolescents. Threshold criteria appear to be appropriate in many cases, but boundaries between absent and subclinical ratings are "fuzzy." Practical and research implications are discussed.

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.

Runaway and homeless youth are at high risk for substance abuse and unsafe sexual behavior. Our study describes the personal social networks of these youth and examines network characteristics associated with risky behaviors. In 1995 and 1996, we interviewed a purposive sample of youth aged 14 through 21 who were living in Washington, DC and were identified on the streets or through shelters or other service agencies (N = 327). Although we found that most youth reported current social relationships, a significant minority (26%) did not. Youth without a social network were significantly more likely to report current illicit drug use, multiple sex partners, and survival sex than youth with a network. For youth with a network, the networks were small, strong in affective and supportive qualities, comprised primarily of friends, typically included an alcohol or illicit drug user, and usually were not a source of pressure for risky behaviors. Our results indicate that networks had risk-enhancing and risk-decreasing properties in that network characteristics were associated in both positive and negative directions with risky behaviors.

Little is known about risky sexual activity among adolescents with alcohol use disorders. This study of 371 adolescent drinkers found that those with alcohol disorders were more likely than other drinkers to be sexually active, to have greater numbers of partners, and to initiate sexual activity at slightly younger ages. Independent of alcohol group, females were more likely than males to have unprotected sexual encounters.

OBJECTIVE:Researchers and clinicians have been struggling for more than 20 years to define problem drinking. This study focuses on young adults and aims to examine the construct validity of three dimensions of problem drinking and to empirically determine appropriate cutpoints for problem drinking along these dimensions.METHOD:A stratified sample of 1,269 young adults who reported drinking alcohol in the year prior to 1995 was used in these analyses. Respondents were originally interviewed in 1985 in middle schools in a southeastern U.S. county.RESULTS:Symptoms of dependency and drunkenness were relatively common in this sample, but adverse consequences were rare. Results of analyses using the Chi-squared Automatic Interaction Detector (CHAID) and the SUrvey DAta ANalysis (SUDAAN) software suggest that drunkenness and adverse consequences are the most significant predictors of problems in other areas of life. Symptoms of dependency were significant only in interaction with drunkenness, although the analyses were limited to only lifetime measures of dependency. Appropriate cutpoints, based on these analyses, appear to be (1) drunk at least six times in the past year, (2) four or more lifetime symptoms of dependency and (3) one or perhaps two or more adverse consequences in the past year.CONCLUSIONS:Results suggest that frequency of drunkenness may be the single best indicator of problem drinking among young adults and that adverse consequences may indicate a more serious form of problem drinking than do symptoms of dependency. In addition, appropriate cutpoints on these dimensions for young adults appear to be similar to those that have been used in studies of adolescents. Further study of both adolescents and young adults is suggested.

Purpose: To (a) characterize human immunodeficiency virus (HIV)-related risk behaviors of homeless youth; (b) determine whether substance use is associated with risky sexual behavior in this population; and, if so, (c) explore explanations for this relationship.Methods: A purposive sample of 327 homeless youth (ages 14-21 years) in Washington, DC, were surveyed in 1995 and 1996. Survey items were adapted from items used in a national study of adult substance use and sexual behavior and measured global (lifetime) and event-specific (most recent sexual encounter) behaviors.Results: Sexual activity with many partners, "survival" sex, and substance use were common. However, needle use was rare, and consistent condom use was evident in half the sample. Nearly all correlations between global measures of substance use and risky sex were statistically significant, but only a few of the event-specific correlations were significant. Marijuana use during the most recent sexual encounter was associated with nonuse of condoms, but this relationship disappeared in the multivariate model. However, crack use during the last encounter was associated with condom use; this relationship remained significant in the multivariate model. Lack of motivation to use condoms, longer histories of sexual activity and homelessness, symptoms of drug dependency, not discussing HIV risks with partner, and being female were also associated with nonuse of condoms.Conclusions: Homeless youth do use condoms, even within the context of substance use and casual sex. Results suggest that prevention and targeted intervention efforts have had some positive effect on this population, but young homeless women are in need of targeted prevention. Finally, additional research is needed to investigate the observed relationship between crack use and condom use in this sample. (C) Society for Adolescent Medicine, 1998.

Purpose. This study explores the relationships between social, demographic, and behavioral characteristics and self-reported carrying of a weapon to school among middle school students. The results provide a statistical profile of youth most likely to bring weapons to school and help to identify characteristics that are only spuriously related to this behavior.Methods. Study respondents were part of an ongoing randomized evaluation of a school-based drug use prevention program in Illinois. Self-administered questionnaires were completed by 1,503 seventh and eighth graders in the spring of 1992.Results. Fifteen percent of respondents brought some type of weapon to school in the past month. In a multivariate logistic regression model, being male, not living with both parents, not feeling close to parents, drinking heavily, participating in fights, damaging school property, and perceiving that at least a few other students brought weapons to school, were significantly associated with weapon carrying. Victimization and fear for safety in school were not significantly associated with weapon carrying in the multivariate model.Conclusions. Study results suggest that both the structure and the dynamics of the family play an important role in weapon carrying behavior. Weapon carrying also appears to cluster with other deviant behaviors. Furthermore, the findings suggest that weapons are not brought to school because of a heightened need for protection, but rather may be in response to normative influences in school. (C) Society for Adolescent Medicine, 1997.

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.

Although aggressive enforcement programs have been the backbone of our national drug control policy, school-based drug education has been widely praised as the most promising strategy for achieving long-term reductions in the demand for drugs and alcohol. Employing specially trained police officers in the classroom, Project DARE has become America's most popular and prevalent drug education program. Despite this status, the effectiveness of the program has yet to be demonstrated. A longitudinal randomized experiment was conducted with 1,584 students to estimate the effects of DARE on their attitudes, beliefs, and drug use behaviors in the year following exposure to the program. DARE had no statistically significant main effects on drug use behaviors and had few effects on attitudes or beliefs about drugs. However, significant interactions between DARE and other factors (e.g., metropolitan status) suggest that some program effects varied across subgroups of the target population. This research provides a test of the comprehensive model of school-based prevention and helps to identify possible differential effects of this drug education initiative.

Issues involved in defining and measuring adolescent problem drinking have occupied the attention of alcohol researchers since the mid-1970s. However, appropriate definitions and measures of problem drinking remain important and unanswered conceptual and research questions. The research reported in this study was designed to address these issues by identifying multiple dimensions of adolescent problem drinking and examining correlates of these dimensions using multivariate regression models. A longitudinal sample of 2,771 students who had tried alcohol was used in these analyses. The sample was followed over three waves of data collection, between 1985 and 1990, in middle and high schools located in a southeastern U.S. county. Data from the third wave were used to characterize problem-drinking behavior. Results of exploratory factor analyses supported the conclusion made by others that adolescent problem drinking is a multidimensional phenomenon. Three dimensions measuring (1) level or frequency of alcohol use, (2) problems related to drinking and (3) symptoms of dependency were identified and were only moderately intercorrelated. The independent measures used to model the three problem-drinking measures were the same for each model, and the significant predictors and proportions of variance explained by the predictors differed widely across models. Results of the regression models confirmed the uniqueness of the three measures and suggested that the potency of specific risk factors varies for different types of problem drinking. Prevention implications and recommendations for this area of research are discussed.

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.

OBJECTIVESKnowledge about the roles that heavy alcohol and cigarette use play in patterns of concurrent substance use among adolescents is lacking despite studies showing that adolescent substance users are typically multisubstance users and that alcohol and cigarettes are commonly used heavily by those who use illicit substances.METHODSThe roles of increasing use and heavy first-time use of alcohol and cigarettes in multisubstance use patterns were examined in a cohort of 4192 secondary students who were surveyed three times over a 4-year period.RESULTSWhen subsequent use patterns were compared for students who increased their levels of alcohol or cigarette use and those who initiated use for the first time but at heavy frequencies, analyses indicated that the former group was more likely to initiate the subsequent use of other substances and to maintain and increase use already initiated.CONCLUSIONSThese results suggest that adolescents are likely to have been involved in a history of licit substance use characterized by increasing levels of use before progressing to and maintaining the use of other substances. Increasing frequencies of alcohol and cigarette use, therefore, may be markers for more serious patterns of substance use.

The reliability of self-reported measures remains an important issue for research on adolescent alcohol and drug use. Many studies have concluded that adolescents' self-reports are valid and reliable, but few studies have excluded consistent nonusers from their reliability estimates, and no study has examined in detail the reliability of reported age at first use of substances. This study explores the consistency of self-reports of frequency of use and age of first use of alcohol and marijuana in a sample of 5,770 secondary school students in a southeastern U.S. county. Two waves of data were collected between 1985 and 1988 using state-of-the-art data collection procedures and self-administered instruments. Consistency of reports was examined by comparing reports at T1 and T2, approximately 1 year apart. Results showed that when consistent nonusers were dropped from the analysis, consistency rates of lifetime frequency of use dropped from 82.7% to 74.7% for alcohol and from 95.6% to 83.2% for marijuana. Reports were more consistent for lifetime marijuana use than for alcohol use, but these results must be interpreted with caution given differences in the measures for the two substances. Reliability of reported age of first use was very low for both substances. When consistent nonusers were dropped from the analysis, only 27.8% of respondents made consistent estimates of their age at first alcohol use and 34.4% for their age at first marijuana use. Implications and recommendations for this area of research are discussed.

Most research on the determinants of adolescent drug use has focused on predictors of either initiation or current use. Little attention has been given to the determinants of continued use of drugs after initiation, even though some researchers have found that the consequences of continued use are more serious than those associated with experimental or occasional use. In this study, a longitudinal sample of 456 secondary and high school students who had already tried marijuana was used to examine the determinants of continued use of marijuana. Nearly 38 percent of those who had tried marijuana continued using, according to the definition operationalized in this study. Potential predictor measures were grouped in a drug-specific domain and a social context domain, and their effects on continued use, controlling for background characteristics, were examined in logistic regression models. Results showed that only the drug-specific domain had a statistically significant effect on the likelihood of continued use. Students who felt that the adverse physical and psychological effects of marijuana were not very important reasons for discontinuing use and those who had gotten stoned during their experimental stage of use were the most likely to continue use after initiation. The results suggest that the perceived physical and psychological effects of the drug are more important determinants of continued use than are social factors or benefits related to use. Any relationships between social factors and continued use are mediated by the perceived effects and risks of the drug.

A longitudinal sample of 3,454 secondary school students is used to examine the variations in the contexts of marijuana initiation which may be attributable to developmental changes during adolescence. Concepts representing the context of initiation include attachments to parents and peers, exposures to drug-related attitudes of parents and peers and behaviors of peers, and the decision-making process, which involves the weighing of expected costs and benefits of use. Measures representing these concepts are included in logistic regression models predicting initiation. Regression parameters are compared for students in the sixth, seventh, and eighth grades. Results show that only parental attachment measures influence initiation for the youngest group; a mix of parental and peer attachment and peer exposure measures affects initiation for the middle group; and only measures of peer attachment and exposure and of the relative importance of the costs of use predict initiation for the oldest group. The results suggest that developmental factors do influence the context of marijuana initiation.