October 14-16, 2015
Miami, Florida

 Presidential Symposium

Presidential Symposium on Prevention and Intervention in Emerging Adulthood

Date: Thursday, October 15, 2:15-3:45pm
Room TBA

Prevention Science: Using epidemiology to improve the lives of emerging adults

Chair: Richard F. Catalano, Ph.D., Social Development Research Group, School of Social Work, University of Washington, President, Society for Prevention Research


Over the past three decades, prevention science has emerged as a discipline built on the integration of life-course development research, community epidemiology, and preventive intervention trials. Prevention science is based on a framework that identifies empirically verifiable precursors, often called risk and protective factors, which affect the likelihood of undesired health outcomes. Risk and protective factors emerge at particular periods of development. Some factors are problem specific and some are more general, predicting multiple outcomes, including substance misuse, adolescent pregnancy, violence, delinquency, school dropout, and mental health disorders. The commonality in risk factors across problem behaviors means that interventions that address a risk factor will probably affect many problems, suggesting that such preventive interventions are an efficient approach to reduction of problems. Further, exposure to several risk factors, and lack of exposure to protective factors, strengthens the likelihood of problem outcomes, but preventive interventions that effectively reduce risk and enhance protective factors can have the reverse effect, and make healthy development more probable.

This presidential panel will open with a brief overview of prevention science, an illustration of the developmental salience of the risk factors for young adult substance use from a recent review, and three presentations of prevention approaches aimed at affecting young adult behavioral outcomes are being studied in controlled trials.

Title: Parent-Based Interventions in sensitive phases of life: Late Adolescence and Emerging Adulthood

Presenter: Rob Turrisi, Ph.D., Biobehavioral Health and Prevention Research Center, Penn State University

Abstract:

     Introduction. Heavy drinking represent a significant concern on our nation’s college campuses. In response, interventions have been developed to combat this public health problem. One specific strategy, Parent-Based Interventions (PBIs), developed by Turrisi and colleagues provides parents with materials developed and empirically tested that detail the problem of college drinking and best practices (Turrisi et al., 1999-2014). This presentation will report on the results on the systematic program of research on the PBI encompassing etiological and efficacy studies with special emphasis on the findings from a recent large-scale trial examining timing and dosage.
     Methods. Participants were randomly selected incoming first-year students (N =~1900) at a large, public northeastern university (65% response rate and 87% & 77% retention at 9 and 15 month follow-ups, respectively). Prior to baseline, students were randomized to pre-matriculation [PCM], pre-matriculation treatment with boosters [PCMB], post-matriculation treatment [ACM], or control. Treatment condition parents were asked to read and evaluate the PBI and have discussions with their teen. More than 70% of parents reported they had discussed all topics with no significant differences across conditions.
     Results. First, LTA identified subgroups of individuals, based on transitions in drinking patterns across the three measurement occasions during the first 15 months of college: non-drinkers (ND, 51%), weekend light drinkers (WLD, 15%), weekend heavy episodic drinkers (WHED, 30%), and heavy drinkers (HD, 5%). The next phase of the LTA analyses examined the effect of the intervention on the probability of transitioning from one drinking pattern to another between baseline and the follow-ups. The results revealed the PCM condition was significantly related to decreased odds of remaining in the HD pattern at the short and long-term follow-up (OR = 0.05; 20 times less likely to remain a HD at follow-up, relative to any other drinking pattern). Results also revealed a significant trend for the ND to remain in that pattern at follow-up.
Second, LCA analyses revealed four parent types: positive pro-alcohol, positive anti-alcohol, negative mother and negative father. Although the findings revealed the highest problematic drinking was observed for the negative father and positive pro-alcohol parenting types and lowest for positive anti-alcohol type, the effects of the PBI were consistent across the types.
     Finally, the results also revealed a significant interaction between student and parent types. If parents were positive anti-alcohol then the PCM and PCMB conditions were most likely to be associated with students transitioning to lower risk drinking profiles (WLD or ND).
     Conclusions. Taken together, these findings are suggestive that the benefits of PBIs can be of value for higher-risk drinkers transitioning to college. Further, to the extent that parents can modify their behaviors to increase positive communication and monitoring and decrease negative communication and permissiveness (which is what the PBI encourages parents to do), the influence of the PBI on student drinking and consequence outcomes can be that much greater.

Title: The Safer California Universities intervention to reduce alcohol-related harm among young adults

Presenter: Robert F. Saltz, Ph.D., Prevention Research Center, Pacific Institute for Research & Evaluation

Abstract:

     Introduction: Efforts to reduce alcohol-related harm among college students have, until recently, largely employed individual-level prevention programs ranging from simple awareness campaigns to multi-component cognitive-behavioral interventions. Comprehensive prevention should complement these approaches with population-level universal strategies for maximum effectiveness. The Safer California Universities project aimed to evaluate the efficacy of alcohol control measures at the community level.
     Methods: We recruited 14 large public universities, half of which were randomly assigned to the Safer intervention condition after baseline data collection. Interventions included nuisance party enforcement operations, minor decoy operations, DUI checkpoints, social host ordinances, and use of campus and local media to publicize those operations. Two waves of baseline survey data were collected each Fall from random samples of undergraduates, three waves of post-intervention data (for first cohort) were collected, and four more waves of post-intervention data for the second cohort (delayed intervention) were collected. The surveys included questions regarding six venues where students drank (Greek party, dormitory, campus event, off-campus party, bar/restaurant, outdoor setting), and intoxication at each setting during the semester, and whether students drank to intoxication the last time they went to each setting.
     Results: Significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants were observed for Safer intervention universities compared to controls. A lower likelihood of intoxication was also observed for Safer intervention universities the last time students drank at an off-campus party (OR=0.81, 95% CI=0.68, 0.97), a bar or restaurant (OR=0.76, 95% CI=0.62, 0.94), or any setting (OR=0.80, 95% CI=0.65, 0.97). No increase in intoxication (e.g., displacement) appeared in other settings. Additional analyses revealed stronger intervention effects at Safer universities with the highest intensity of implementation. Similar results were also found for the second (delayed) intervention cohort.
     Conclusions: Environmental prevention strategies targeting settings where the majority of heavy drinking events occur appear to be effective in reducing the incidence and likelihood of intoxication among college students. The impact appears to be sufficiently robust as to be replicated in a second cohort of universities, but some decay in those effects is apparent among the first cohort.

Title: Effects of the Communities That Care Prevention System on Young Adult Men and Women’s Health-Risk Behaviors 9 Years after Baseline in a Community-Randomized Trial

Presenter: Margaret R. Kuklinski, Ph.D., Social Development Research Group, School of Social Work, University of Washington

Abstract:

     Introduction: Science-based prevention planning systems that bring together a comprehensive coalition of community stakeholders have been shown to advance the use of effective policies, programs, and practices and prevent adolescent health-risking behaviors community-wide. However, little is known about the lasting impact of such community prevention efforts on individuals who were exposed to them. If community prevention systems can move a community’s youth onto healthier trajectories, they could greatly contribute to long-term improved individual and public health. This presentation will report the results from a test of the effects of the Communities That Care (CTC) prevention system on youth health-risk behaviors in late adolescence 9 years post baseline in a community-randomized trial and 4 years after training, technical assistance, and financial support to CTC communities had ended.
     Methods: Data came from a community-randomized trial of CTC in 24 small towns in 7 states, matched in 12 pairs within state and assigned randomly to the control or CTC condition in 2003. The study followed a panel of 5th-graders attending public schools in 2003-04 in study communities. In 2012, 1 year after on-time high school graduation when panel members were, on average, 19 years old, 91% (n=3986) of the still-living sample completed the survey. Data were analyzed using generalized mixed regression models to account for the nesting of the data.
     Results: Despite early results showing universal impact on cigarette and alcohol use and delinquency 3 years post intervention at age 18, at age 19 significant effects of the intervention were only demonstrated for delinquency in the full sample. There were also significant long-term effects on males but not females. Analyses showed that lifetime rates of not initiating delinquency were significantly higher in CTC communities than control communities (35% v. 31%, adjusted risk ratio [ARR] = 1.16, 95% CI: 1.00, 1.33). Males in CTC communities compared to males in control communities were significantly more likely to never have smoked cigarettes (39% vs. 32%; ARR = 1.22; 95% CI: 1.01, 1.46) and never have engaged in delinquent behavior (31% vs. 24%; ARR=1.38; 95% CI: 1.08, 1.76). There were no significant differences in the expected direction by intervention group for young adult men or women in any other primary outcomes (cumulative incidence of substance use and prevalence of recent substance use, substance use disorder, delinquency, violence, incarceration, convictions) or secondary outcomes (high school graduation, college attendance, depression, suicidality, sexual risk behaviors, teenage pregnancy). The presentation will also discuss unexpected findings for young adult women.
     Conclusions: Nine years post baseline, CTC showed fewer long-term effects on youth health risk behaviors when adolescents followed in this study were, on average, 19 years old. However, lower rates of delinquency initiation in the full sample and males’ increased abstinence from smoking and not initiating delinquency through age 19 were achieved with minimal exposure beyond grade 9 to tested and effective prevention programs selected through the CTC process.