TY - JOUR
T1 - Effect of middle school interventions on alcohol misuse and abuse in mexican American high school adolescents five-year follow-up of a randomized clinical trial
AU - Gonzales, Nancy
AU - Jensen, Michaeline
AU - Tein, Jenn-Yun
AU - Wong, Jessie J.
AU - Dumka, Larry E.
AU - Mauricio, Anne
N1 - Funding Information:
Outcome Measures | Alcohol and substance use were assessed in the present follow-up study using adolescent reports based on evidence that they are the best reporters on these types of behaviors.47 (The original RCT focused on mediators [coping, school engagement, parenting, and family relationships] and outcomes [internalizing symptoms, externalizing behavior problems, and substance use initiation] in middle school; trial ID NCT00051727, funded by National Institutes of Health grant MH064707.) The present study, funded by a competing renewal, examined secondary alcohol misuse and disorder outcomes in late adolescence. At T2, past-year drinking was assessed using 3 items from the 2001 Youth Risk Behavior Survey that demonstrate moderate to high reliability among high school students62: During the past year, on how many days did you have at least 1 drink of alcohol? During the past year, on how many days did you drink enough to feel pretty high/ drunk? During the past year, how often did you have 4 [girls] or 5 [boys] or more drinks containing any kind of alcohol in a 2-hour period?61 Responses ranged from 0 (0 days in the past year) to 9 (every day in the past year). Lifetime AUD (0, no diagnosis; 1, yes diagnosis) was based on the Diagnostic Interview Schedule for Children,63,64 a structured diagnostic interview based on DSM-IV criteria that demonstrate moderate to high reliability and validity as well as sensitivity in identifying adolescents with independent medical AUD diagnoses.65,66
Funding Information:
Funding/Support: This study was supported by the National Institute of Mental Health grants 2-R01 MH64707 and T32 MH018387.
PY - 2018/5
Y1 - 2018/5
N2 - IMPORTANCE Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations. OBJECTIVE To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with aMexican American sample. DESIGN, SETTING, AND PARTICIPANTS A previous randomized clinical trialwas conducted with 516Mexican American 7th graders and at least 1 parent who identified as havingMexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school. INTERVENTIONS The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish. MAIN OUTCOMES AND MEASURES Primary outcomeswere diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey. RESULTS Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11). CONCLUSIONS AND RELEVANCE Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders amongMexican American high school students and implementation of universal middle school interventions to reach Latino communities.
AB - IMPORTANCE Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations. OBJECTIVE To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with aMexican American sample. DESIGN, SETTING, AND PARTICIPANTS A previous randomized clinical trialwas conducted with 516Mexican American 7th graders and at least 1 parent who identified as havingMexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school. INTERVENTIONS The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish. MAIN OUTCOMES AND MEASURES Primary outcomeswere diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey. RESULTS Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11). CONCLUSIONS AND RELEVANCE Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders amongMexican American high school students and implementation of universal middle school interventions to reach Latino communities.
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U2 - 10.1001/jamapsychiatry.2018.0058
DO - 10.1001/jamapsychiatry.2018.0058
M3 - Article
C2 - 29562080
AN - SCOPUS:85046369699
VL - 75
SP - 429
EP - 437
JO - JAMA Psychiatry
JF - JAMA Psychiatry
SN - 2168-622X
IS - 5
ER -