Effectiveness of Prevention Interventions with Youth at High Risk of Drug Abuse

A recent report describes three types of prevention programs: universal, selected, and indicated (Institute of Medicine 1994). Universal prevention approaches are those that serve the entire population who share a general risk to the disorder without regard to specific risk status. Selected prevention approaches serve those whose precursors of problem behaviors are elevated but who have not yet manifested the problem behavior to be prevented. Indicated prevention approaches serve those who have initiated the problem behavior to be prevented but have not yet developed a serious or chronic behavior problem and do not warrant at that time a clinical diagnosis of the disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R or DSM-IV). The effects of universally applied prevention approaches for substance abuse and other problems are well documented in the literature (Hansen et al. 1990; Hawkins et al. 1992; Moskowitz 1989). Less attention has been given to the effects of prevention approaches with selected youth whose specific characteristics put them at higher risk. This chapter first examines several definitions of high-risk youth and chooses one based on youths’ exposure to consistently identified, longitudinal correlates or risk factors for substance abuse. This discussion is followed by a selective review of prevention program research studies chosen for their demonstrated effectiveness of program promise for reducing risk among high-risk populations

Social Services for Sexual Minority Youth: Preferences for What, Where, and How Services are Delivered

As part of an internet-based study to investigate experiences of sexual minority youth in the U.S., 544 youth, ages 14-19, were surveyed about their need for services, where they preferred to receive these services, and their preferred method of service delivery. The survey was anonymous and youth were recruited from LGBTQ-specific listservs and venues as well as through social networking sites as a way of reaching youth often not represented in LGBTQ surveys. Youth highly endorsed many types of services, settings, and modes of delivery. Some subgroup differences emerged. Transgender youth and those uncertain about their gender identity expressed stronger interest than others in services to address stress, family issues, and self-defense, and in receiving support and guidance from LGBTQ adults. Few differences in service preferences along demographic lines such as race/ethnicity emerged; however, African American youth were more likely than others to prefer services offered in a place of worship. Contrary to predictions, geographic and community variables were not related to service type, delivery format, or location preferences

A Latent Class Analysis of Heterosexual Young Men\u27s Masculinities

Parallel bodies of research have described the diverse and complex ways that men understand and construct their masculine identities (often termed masculinities ) and, separately, how adherence to traditional notions of masculinity places men at risk for negative sexual and health outcomes. The goal of this analysis was to bring together these two streams of inquiry. Using data from a national, online sample of 555 heterosexually active young men, we employed latent class analysis (LCA) to detect patterns of masculine identities based on men\u27s endorsement of behavioral and attitudinal indicators of dominant masculinity, including sexual attitudes and behaviors. LCA identified four conceptually distinct masculine identity profiles. Two groups, termed the Normative and Normative/Male Activities groups, respectively, constituted 88Ã¥ % of the sample and were characterized by low levels of adherence to attitudes, sexual scripts, and behaviors consistent with dominant masculinity, but differed in their levels of engagement in male-oriented activities (e.g., sports teams). Only eight percent of the sample comprised a masculinity profile consistent with traditional ideas about masculinity; this group was labeled Misogynistic because of high levels of sexual assault and violence toward female partners. The remaining four percent constituted a Sex-Focused group, characterized by high numbers of sexual partners, but relatively low endorsement of other indicators of traditional masculinity. Follow-up analyses showed a small number of differences across groups on sexual and substance use health indicators. Findings have implications for sexual and behavioral health interventions and suggest that very few young men embody or endorse rigidly traditional forms of masculinity

Predicting Sexual Assault Perpetration Among Heterosexually Active Young Men

Data from an online community sample of young men were analyzed to test predictors of sexual assault perpetration. We used structural equation modeling to test the relative contributions of specific sub-types of childhood adversity to subsequent sexual aggression. Mediators included hostile masculinity, impersonal sexual behavior and attitudes, and substance use variables. Findings suggested that childhood sexual abuse had direct and mediated effects on sexual assault perpetration, but hostile masculinity was the only proximal factor significantly related to aggression. Childhood polytrauma was also associated with increased perpetration risk, suggesting that prevention efforts may be aided by increased attention to childhood maltreatment

Patterns Of Intimate Partner Violence And Sexual Risk Behavior Among Young Heterosexually Active Men

Intimate partner violence (IPV) victimization is linked to sexual risk exposure among women. However, less is known about the intersection of IPV perpetration and sexual risk behavior among men. This study used data from a diverse, community sample of 334 heterosexually active young men, aged 18 to 25, across the United States to examine whether and how men with distinct IPV-related behavior patterns differed in sexual riskÃrelated behavior and attitudes. Participants were recruited and surveyed online, and grouped conceptually based on the types of IPV perpetration behavior(s) used in a current or recent romantic relationship. Groups were then compared on relevant sexual risk variables. Men reporting both physical abuse and sexual coercion against intimate partners reported significantly higher numbers of lifetime partners, higher rates of nonmonogamy, greater endorsement of nonmonogamy, and less frequent condom use relative to nonabusive men or those reporting controlling behavior only. This group also had higher sexually transmitted infection (STI) exposure compared to men who used controlling behavior only and men who used sexual coercion only. Findings suggest that interventions with men who use physical and sexual violence need to account for not only the physical and psychological harm of this behavior but also the sexual risk to which men may expose their partners

Replicating A Teen Hiv/Std Preventive Intervention In A Multicultural City

Although there are now several adolescent HIV and STD preventive interventions of demonstrated efficacy in the literature, little is understood about the portability of these interventions. This study replicated Stanton\u27s Focus on Kids intervention, developed for inner city African American adolescents, in a different population, transferring it to a multicultural city. Despite careful replication of the original study\u27s procedures, youth in the preventive intervention condition of the replication study did not improve in attitudes, perceived norms, self-efficacy, or intentions toward sexual initiation, condom use, or abstinence compared with a carefully matched control condition. We discuss several possible reasons for this failure to replicate, concluding that the most likely reason is the lower rates of sexual activity among youth in the replication city

Effects Of Friendship Closeness In An Adolescent Group Hiv Prevention Intervention

Although many interventions for youth rely, explicitly or implicitly, on group effects, sparse theoretical or empirical attention has been paid to the rationale for choosing a small-group design. The present study assesses the role of friendship closeness among youth in prevention intervention groups in shaping their HIV risk-related attitudes, intentions, perceived self-efficacy and perceived norms. Data from an experimental test of a group HIV prevention intervention are used to assess the relationship of friendship on cognitive outcomes at posttest and 6-month follow-up, in a multilevel regression design. Friendship among group members was assessed at baseline and post-intervention, for youth in the experimental intervention and in a control, career exploration, condition. Level of friendship within the group was positively related to attendance and enjoyment of the intervention in the control group only. Most cognitive outcomes were unaffected by individual or group levels of friendship closeness, but those effects observed were opposite to those desired. Friendly groups were no more likely to converge in their cognitions over time than were less-friendly groups. The need for more research on the effects of friendship on intervention outcomes, and for multilevel analyses of group effects, are discussed

ÒHe Enjoys Giving Her PleasureÓ: Diversity And Complexity In Young MenÕs Sexual Scripts

Research on heterosexual menÕs sexual expectations has focused on self-described personal traits and culturally dominant models of masculinity. In a pair of studies, we used a sexual scripts perspective to explore the range and diversity of young menÕs thoughts about sex and relationships with women and to develop measures for assessing these scripts. In the first study, we conducted semi-structured interviews to elicit young menÕs accounts of their sexual relationships. We used these narratives to produce brief sexual script scenarios describing typical sexual situations, as well as conventional survey items assessing sexual behavior themes. In the second study, we administered the scenarios and theme items to an ethnically diverse, national sample of 648 heterosexually active young men in an online survey. Using exploratory factor analysis, we delineated sets of sexual scripts and sexual behavior themes. In the scenarios, we found both a traditional masculine ÒplayerÓ script and a script that emphasized mutual sexual pleasure. Analysis of theme items produced scales of Drinking and Courtship, Monogamy and Emotion, and Sexual Focus and Variety. We discuss the implications of these findings for understanding heterosexual menÕs thinking about sexuality and how cultural change in sexual thinking may arise. We also discuss the need for measures of sexual thinking that better integrate perceptions and expectations about the partner as well as the self in relation to the partner, rather than solely self-assessed traits