Project Towards No Drug Abuse: A Review of the Findings and Future Directions

Objective: To provide a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior high-school-based drug abuse prevention program.Methods: Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 high school youth from 42 schools in southern California were surveyed.Results: The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization. Most of these results were replicated across the 3 trials. Conclusion: Project TND is an effective drug and violence prevention program for older teens, at least for one year follow-up

Exposure to Televised Alcohol Ads and Subsequent Adolescent Alcohol Use

Objective: To assess the impact of televised alcohol commercials on adolescents, alcohol use. Methods: Adolescents completed questionnaires about alcohol commercials and alcohol use in a prospective study. Results: A one standard deviation increase in viewing television programs containing alcohol commercials in seventh grade was associated with an excess risk of beer use (44%}, wine/liquor use (34%}, and 3-drlnk episodes (26%} in eighth grade. The strength of associations varied across exposure measures and was most consistent for beer. Conclusions: Although replication is warranted, results showed that exposure was associated with an increased risk of subsequent beer consumption and possibly other consumption variables

Psychosocial Variables as Prospective Predictors of Violent Events Among Adolescents

Violent events are main causes of mortality among children and include intentional (e.g., homicide) and unintentional (e.g., accidents) circumstances. This study investigated the prediction of the self-reported occurrence of 14 violent events among eighth-grade youth from psychosocial variables measured in these same youth in seventh grade. Psychosocial variables ineluded tobacco and alcohol use, demographic variables, interpersonal variables such as family conflict, and intrapersonal variables such as risk taking. An iterative procedure, involving selection of a set of predictors and a test of the correlation of the set of predictors to the set of events, provided support for an extension of problem behavior theory to violent events

One-Year Prospective Prediction of Violence Perpetration Among High Risk Youth from Personal and Social-Environmental Variables

Objective: Measures of drug use, law-abidance beliefs, sensation seeking, fear of victimization, high-risk group identification, self- protection needs and behaviors, and demographics were investigated as longitudinal predictors of violence perpetration among 870 high-risk adolescents. Method: Self-reports from the same youth were obtained 1-year apart. Results: In addition to baseline violence perpetration, marijuana use, relatively youn1 age, male sex, high-risk group self-identification, low perceived efficacy of the police department, and nonavoidance of dangerous places predicted later perpetrated violence. Conclusion: Personal and social factors beyond baseline violent behavior predict risk for future violent behavior

Identification of Which High Risk Youth Smoke Cigarettes Regularly

This study investigated which variables distinguish high school-aged adolescents who identify themselves as members of a high-risk group and, among them, those who report regular (weekly) vs. light levels of cigarette smoking. Youth who identified with a high-risk group were most likely to report problem-prone characteristics, such as a preference to take risks and smoke cigarettes. Yet, only half of them reported regular levels of smoking. Two variables delineated light smoking among these youth: not having a close friend who smoked and placing an importance on health as a value. Development of new tobacco-use prevention strategies to impart health values is suggested

Characteristics of Tobacco Users in the Lumber Industry

Cessation interventions for adult smokeless tobacco users may benefit from an improved understanding of the demographic, psychosocial, and tobacco-dependence characteristics of this group. In the current study, 143 employees of the Pacific Lumber Company were interviewed and completed questionnaires about their tobacco use product preference (smokeless tobacco only, cigarettes only, both, and former user), demographic, psychosocial, and tobacco-dependence characteristics. Results of a multivariate discriminant analysis revealed that smokeless-tobacco-only users were younger and reported in engaging in more exercise than did the other three groups; however, they also reported greater dependence on tobacco than did smokers. Formal cessation clinics similar to those that are being used effectively with smokers, and which are age appropriate, may be an effective treatment for adult smokeless tobacco users

Project EX: A Program of Empirical Research on Adolescent Tobacco Use Cessation

This paper presents the Project EX research program. The historical background for Project EX is presented, including a brief summary of reasons youth fail to quit tobacco use, the disappointing status of previous cessation research, and the teen cessation trial that provided the template for the current project (Project TNT). Next, program development studies for Project EX are described. Through use of focus groups, a theme study (concept evaluation of written activity descriptions), a component study, and pilot studies, an eight-session program was developed. This program involves novel activities (e.g., "talk show enactments," games, and alternative medicine-type activities such as yoga and meditation) in combination with motivation enhancement and cognitive-behavioral strategies to motivate and instruct in cessation initiation and maintenance efforts. The outcomes of the first experimental trial of Project EX, a school-based clinic program, are described, followed by a posthoc analysis of its effects mediation. A second EX study, a multiple baseline single group pilot study design in Wuhan, China, is described next. Description of a second experimental trial follows, which tested EX with nicotine gum versus a natural herb. A third experimental trial that tests a classroom prevention/cessation version of EX is then introduced. Finally, the implications of this work are discussed. The intent-to-treat quit rate for Project EX is approximately 15% across studies, double that of a standard care comparison. Effects last up to a six-month post-program at regular and alternative high schools. Through a systematic protocol of empirical program development and field trials, an effective and replicable model teen tobacco use cessation program is established. Future cessation work might expand on this work

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Project Towards No Drug Abuse: Generalizability to a General High School Sample

Objectives. We examined the generalizability of a successful classroom-based prevention program developed for youth at alternative high schools (high risk) to youth at general high schools. Method. A replication of a previously tested prevention program in a general high school population was conducted with 1-year follow-up data. Classrooms within each of three schools were randomly assigned to two conditions, classroom education or standard care control. Results. Statistically significant effects on alcohol and illicit drug use were achieved in this population through a 1-year period following the program, although effects were not achieved on cigarette smoking and marijuana use. Conclusions. These results suggest that this program (Project Towards No Drug Abuse) has applicability to a wide range of older teens

The Relations of Pro-Drug-Use Myths With Self-Reported Drug Use Among Youth at Continuation High Schools

Drug-use myths, questionable beliefs regarding the effects of drug use, may help to explain why people engage in self-injurious drug-use behavior. While clinicians and applied social researchers have used this concept of drug-use myths extensively when developing substance abuse prevention or cessation programs, drug belief-type myth measures have not been investigated empirically. The present study examined the internal consistency and discriminant validity of a drug-use myth measure among 362 continuation (alternative) high school youth and found it to be discriminable from demographic, drug use, and other psychosocial measures. Controlling for its relations with its correlates, social desirability, perceived friends\u27 drug use, ethnicity items, and gender, the myth measure remained significantly associated with 4 drug-use measures. Future research regarding drug use myths as predictors of drug use is encouraged based on these results