From early to late adolescence: alcohol use and anger relationships

Purpose: To evaluate the longitudinal relationship of alcohol use in early adolescence to anger in late adolescence.

Methods: Data were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Fifty percent of the 1201 students were female, 75%, white, and 69%, low socioeconomic status, who were surveyed in grades 6/7, 9/10, and 11/12. Subjects were asked four anger-related questions: “When I have a problem, I get mad at people,” “When I have a problem, I do bad things or cause trouble,” “When I have a problem, I say or do nasty things,” and “I am a hotheaded person.” Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios (OR) were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence.

Results: Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grade 6/7 increased the odds in grade 11/12 of saying or doing nasty things (OR = 8.23, p < .01), self-reported hotheadedness (OR = 9.72, p < .01), and high anger on a composite anger scale (OR = 4.84, p < .05). Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness (OR = 6.17, p < .05) and high anger on the anger scale (OR = 3.20, p < .05) in grade 9/10 and doing something bad to cause trouble in grade 11/12 (OR = 24.97, p < .01). For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble (OR = 2.79, p < .05), saying or doing nasty things (OR = 2.02, p < .05), and self-reported hotheadedness (OR = 2.51, p < .05).

Conclusions: The present study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. The findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior.     

Primordial Prevention of Cardiovascular Disease among African-Americans: A Social Epidemiological Perspective

Background. The primordial prevention of cardiovascular disease (CVD) among African-Americans represents a formidable challenge for public health. This paper discusses the nature of this challenge, highlighting the role that economic and cultural factors play in shaping the distributions of major CVD risk factors among African-Americans. The paper concludes with specific suggestions for research.Methods. Data from recent national health surveys on black/white differences in major CVD risk factors like hypertension, obesity, cholesterol, cigarette smoking, and physical inactivity were reviewed for the purpose of identifying promising avenues for primordial prevention research among African-Americans.Results. Cigarette smoking has a delayed onset among African-Americans compared to whites. Black/white differences in “vigorous” leisure-time physical activity (e.g., social dancing and team sports) are not apparent until around age 40. These findings have relevance for primordial prevention work in black communities since they suggest the existence of broad-based, health-relevant cultural norms which could support primordial prevention programs, such as regular physical activity, across the life cycle.Conclusions. CVD primordial prevention programs among African-Americans must be grounded in an understanding of how cultural values as well as economic conditions shape CVD risk factor distributions in this population. Ultimate success will depend on the strength of the partnerships that public health researchers, primary care providers, and community residents are able to build.     

The organisational and professional context of the first acpc conference

The theme of today's conference “Partnership in a Changing Environment” is highly significant and could be adopted for almost any major conference in the health and personal social services field. “Partnership” is an “in” word, and like quality and other euphemisms it has become part of our rhetoric. Its definition and translation into practice at different points in our organisations, is however more problematic. For example in the area of child protection there has been a tendency to think of partnership as based around case conferences, but that is too far into the process to be of value to families or professionals. Partnership starts at policy making and today's conference is an attempt at bringing together the principal partners who should influence policy, as well as what happens further into the system when parents and children become engaged. The second part of today's theme “a changing environment” also applies throughout the public service. In recent years we have become accustomed to rolling organisational change. The most recent manifestations of this in Northern Ireland have been the introduction of general management throughout the services, the separation and redefinition of purchaser and provider functions, and more recently, the establishment of HPSS trusts. But change to the environment within which partnership in child protection takes place is influenced by forces other than organisational development. Research in child care over the last 15 years, the introduction of the Children Act 1989 in Great Britain and the prospect of similar legislation here within the next year or two, the impact of major reports, sometimes focusing on tragic events and the publication by the Inspectorate of the investigation into the case of Martin Huston have served to perpetuate change.     

Building a Comprehensive School-based Drug/Alcohol Prevention Program

Concerned educators trying to help students who abuse alcohol and drugs want assurances that the process they use does work. They ask, “How are we doing? Are we making a difference in the lives of our students?”

Unfortunately, there often is no one person or group they can call on for a quick answer. The district personnel directing the prevention and intervention program, as well as trained outsiders, struggle to determine whether progress is being made. Self-made assessment tools can become subjective and selective.

Schools are struggling to find effective, cost-efficient programs that reduce drug use. Building a comprehensive Drug/Alcohol program is one of the most important tasks administrators can face.     

Education and young people in care

The Oxford Dictionary defines Education as the, “systematic instruction, development of character and mental powers”. To “Educate” is referred to as, “to train or to instruct intellectually”. Teachers and Tutors use education to pass on their own acquired knowledge, knowledge which will either be interesting or useful for those entering into the workplace. This article will look at the issues surrounding a young person in care and their education, it will also examine why other sections of society also tend to neglect their schooling. “Good practice” will also be highlighted and recommendations put forward for both discussion and implementation in the workplace.     

Developmental awareness and moral stage development in child Abuse

In an attempt to better understand why children who have been sexually assaulted commonly fail to reveal their victimization to parents or other adults, a study was undertaken in which the “engagement strategies” of 41 perpetrators were examined, exploring common rationalizations, threats, etc. aimed at insuring continued silence on the part of the victim. The “appeal” for silence offered by the perpetrator to the child was analyzed according to Kohlberg's stages of moral development.

Results indicate that perpetrators appear to alter their engagement strategies to coincide with the developmental level of the child, thus further insuring silence by appealing to criteria for assessing “appropriate” or “inappropriate” behaviors (eg. sexual contact) which are developmentally consistent with the child's level of cognition and moral reasoning.     

Early Childhood Education Reinvention and Education Policy: Addressing Linguistic and Cultural Diversity

“Americanization” has been a goal of many programs for culturally and linguistically diverse students in America. This approach has not been successful. In its place is a need for forms of education that are directly relevant to the needs of culturally diverse children. While multicultural education is a necessary part of the early childhood curriculum, there is a need to go beyond muticultaralism, developing forms of education that allow all children to participate in “meaning making”.     

Consumer characteristics, food related attitudes and consumption of meat and meat products

Consumer respondents (203) in the metro-Atlanta statistical area answered a detailed questionnaire pertaining to their attitudes and perceptions of different food groups and food uses. Factor analyses resulted in five food attitude, two food item and three food-use appropriateness factors. The food attitude factors were “Like to Cook”, “Organizational”, “Adventurous”, “Convenience driven” and “Nutrition conscious but casual meal planner”. Food item factors were “Main dish” and “Snack”, Food-use appropriateness factors were “Social”, “Satiety” and “Casual”. A significant correlation between nutrition knowledge and nutrition concern, but not food attitude scores, was found. The “Organizational” factor correlated with the most numbers of variables and “Like to Cook” the least. Results of the respondents in this study indicate that consumers in this sample are leading mobile, dynamic and service oriented lifestyles.     

Between iatrotropic stimulus and interiatric referral: the domain of primary care research

The “iatrotropic stimulus” is a typical example of Alvan Feinstein's terminology and his clinical way of thinking about medical research. Feinstein specified “interiatric referral” as an additional important factor affecting “the likelihood that patients will appear at the particular setting in which research is being conducted.” He emphasized these phenomena as highly relevant for clinical judgment, clinical research, and clinical epidemiology. This has stimulated the realization of original clinical research in international primary medical care. It has helped to recognize the characteristics of the spectrum of health problem and morbidity patterns presented to primary care physicians and to acknowledge the position of generalistic primary care research between open population research and clinical research in referred (specialist) care. Accordingly, primary care-specific challenges in investigating (early) diagnosis, prognosis, treatment, and referral decisions have emerged. This research supports adequate decision-making by the primary care physician, which is important for effective health care. Although Feinstein was a clinical specialist and has always lived in a country without a very strong primary care tradition, he not only recognized the value of primary care research but also substantially contributed to its development.     

Children resolving conflict - lessons for adults

“And if (peer mediation) works in the playground, there's no reason why adults can't learn a lesson from what after all isn't just child's play”     

The teaching of preventive medicine in American medical schools, 1940–1980

The concept of incorporating prevention into clinical medicine has been addressed by academic medicine since the 1940s. Results reflect the dominant interests of academic medicine over time. This paper reviews this experience, as reflected in national conferences and related activities largely sponsored by the Association of Teachers of Preventive Medicine, and assesses implications for the 1980s. The consensus of the 1940s was that medical education should focus upon quantitative disciplines. Clinical applicability was considered important, but little was developed. Convening in 1952, deans, clinicians, and preventive medicine faculty strongly recommended teaching clinical prevention in “comprehensive care” programs. This movement was eclipsed by research and specialization. Academic preventive medicine focused on residency training and research, culminating in a major conference in 1963. Epidemiology and biostatistics flourished, while teaching clinical prevention received little attention. By 1970, dominant interest shifted to health services policy and research. Currently, some preventive medicine departments have affiliated with primary care training programs, and policy makers are focusing upon prevention. A number of nationally sponsored curriculum development projects deal with preventive aspects of primary care. Under these circumstances, incorporation of prevention into medical practice seems likely to succeed at the academic level. This may in turn stimulate similar occurrences in the medical care system.     

Change in women's perceptions of parental child rearing attitudes in Turkey: a three generation comparison

The change in women's perceptions of parental child rearing practices, attitudes, and beliefs across three consecutive generations within the context of social change in the Turkish society was investigated. The total sample consisted of 48 subjects; 16 representing each consecutive generation of “daughters”, their “mothers”, and “grandmothers” from the same family. Each generation represented the time periods that signify the relatively different periods of social change in the Turkish society. Each subject sorted 87 socialization relevant items on a seven point scale for both parents. Mean difference and correlational analysis across generations was made. Perceived child rearing practices, attitudes, and beliefs show significant differences across generations. The direction of change indicates a trend towards decreasing emphasis on authoritarian control and an increasing emphasis on encouraging independence, open expression, and expression of affect.     

Feinstein and study design

Dr. Alvan Feinstein saw himself as the father of “clinical epidemiology” in the modern meaning of this term, of this “new intellectual domain of modern medical science.” In this role, he saw himself as drawing from his “clinical sophistication” and from “the rigorous scientific demands” to which “clinicians are accustomed,” while “public health” epidemiologists “often use a more arbitrary set of standards.” His conception of the scope of clinical epidemiology was remarkably Catholic and the same was the case in respect to cause-effect research in it. In the latter, he was firmly committed to the randomized-trial paradigm, including in his teachings on study design in etiologic research. Characteristically original, many of Dr. Feinstein's study-design ideas remain controversial.     

The efficacy of the parent-teacher “partnership” of the 1990s

The 1990s are times of rapid social and technological change. There are many unknowns that face both adults and children. We all have problems that need resolution. The time when adults “knew” the answers and children learned by “watching” echo faintly in the whirl of scientific change which is impacting on most aspects of our daily life. As early childhood teachers we have to learn to enquire, to listen, to think together with children, their families and society. The concept of negotiation is central to communication while the basic tenet of the process focusses not on the person but the issue. It is in these times of rapid change that we need to deepen our understanding of the family and further our professional insights by “tapping” the wealth of crucial kndowledge that parents have about their children. Hurst asserts that the partnership of parents in issues of their children's education:

“is probably the greatest single opportunity for educational advance open to teachers today”.

Hurst: 1987; 109     

A randomized controlled trial of a new behavioral home-based nutrition education program, "Eat Well with CF," in adults with cystic fibrosis

Cystic fibrosis (CF) remains the most common genetically inherited disease in the white population and its prognosis is affected by nutritional status. Adults with the disease are now surviving longer and new strategies are required to ensure that they maintain optimal nutrition. This article reports preliminary data from a randomized controlled trial of a 10-week home-based behavioral nutrition intervention, “Eat Well with CF.” Outcome measures of weight change over 6 and 12 months and changes in CF-specific nutrition knowledge score, self-efficacy score, reported dietary fat intake and health-related quality-of-life score were compared between the intervention group (n=34) and a standard care control group (n=34). The hypotheses to be tested were that adults with CF completing “Eat Well with CF” would have an improved nutritional status, improvement in specific nutrition knowledge, and an improvement in self-efficacy regarding their ability to cope with a special diet, compared to those receiving standard care. There were substantial improvements in the intervention group's specific CF nutrition knowledge score, self-efficacy score, and reported fat intake compared to control, but no substantial change in body mass index or health-related quality of life over time. Home-based nutrition education incorporating behavioral strategies can be an effective way to support adults with CF, enabling improvement in self-management skills in relation to diet and pancreatic enzyme replacement therapy. This study revealed gaps in basic nutrition knowledge and skills, inadequate knowledge of diet-disease links and pancreatic enzyme replacement therapy. These need to be identified when subjects progress from pediatric to adult care, and programs such as “Eat Well with CF” are a useful adjunct for registered dietitians trying to manage this diverse but growing population.     

A qualitative study of caregivers' attitudes about child care

Thirty-one caregivers and directors involved in various types of day care for young children were interviewed. Qualitative methods were used to assess their role identity constructs and attitudes toward parents and the child care profession. Caregivers thought of themselves as “mothers,” “grandmothers,” or “teachers.” These social role identities clustered with attitudes about parents and professional role (e.g., “mothers” tended to see parents as neglectful, while “teachers” felt parents failed to reinforce progress made in day care). The authors concluded that conflict over attachment issues contributed to problems between parents and caregivers.     

The Indian Health Service approach to alcoholism among American Indians and Alaska Natives

The transfer to the Indian Health Service (IHS) of 158 alcohol treatment programs that had been administered by the National Institute on Alcohol Abuse and Alcoholism began in 1978. Today, approximately 300 alcohol and substance abuse treatment programs offer services to American Indians, among them primary residential treatment, halfway houses, outreach, and aftercare. This system provides a national network upon which additional activities may be established. Along with increasing its attention to health promotion and disease prevention, the IHS has moved toward the prevention of alcoholism. A variety of preventive programs are in place that emphasize improved self-image, value and attitude clarification, decision-making, and physical and emotional effects of alcohol and substance abuse. Many begin as Head Start programs and continue through adulthood. In 1986, after consulting with both academic and tribal experts, the IHS devised a strategic plan for alcoholism control that stresses comprehensive care and prevention activities; it serves as a guide for further program development. The Secretary of Health and Human Services created a Task Force on Indian Alcoholism in 1986 to serve as a coordinating body for activities carried out by the IHS and other agencies and units of the Department. Passage of the Anti-Drug Abuse Act in 1986 added resources for the development of adolescent treatment centers and, more importantly, for community-based pre- and post-residential care for youths and their families. Concomitant with these initiatives have been several instances of increased attention by various tribes to the problem of alcoholism.(ABSTRACT TRUNCATED AT 250 WORDS)     

When, How and Why Child Caregivers Respond to Children's Behaviors

In a qualitative study, 42 child caregivers participated in one of six focus groups. They were asked to address three questions in open-ended discussion. “What child behaviors are of concern to you?”, “How do you respond to these behaviors?”, and “How do you make the decision about your response?” Responses were analyzed and categorized to examine when, how, and why caregivers discipline young children. Results showed that aggression, not listening, and sexually-related behaviors were most often mentioned by caregivers as behaviors of concern to them. The most frequently mentioned disciplinary strategies were time-out, explanation, and redirection. The question related to how caregivers make decisions about responding to misbehaviors was analyzed in terms of attributions made by caregivers about misbehaviors. The majority of caregivers indicated that their response was dependent of the circumstances. Most frequently mentioned attributions were about the children themselves, for instance, their age, gender, or state. Also mentioned were home and family, society, caregiver emotion, and the child care setting. Results also showed that caregivers with higher levels of early childhood education and more experience, and those working with smaller group sizes and smaller adult-to-chiid ratios provided more thoughtful answers that were more congruent with developmental appropriateness.     

Social skills and attitudes associated with substance use behaviors among young adolescents

Purpose: To examine how adolescents’ attitudes and social skills affect current substance use and intentions to use substances in the future.

Methods: An anonymous questionnaire was administered to 2646 seventh graders in their classrooms. The questionnaire was developed to measure the frequency of tobacco, alcohol, and other substance use, anticipated use, positive attitudes toward drug use, self-efficacy to say “no,” decision-making skills, advertising-viewing skills, anxiety-reducing skills, communication skills, drug-resistance skills, perception of peer substance use, and weapon-carrying behavior. Ethnicity classified respondents as “white” or “students of color” and family structure indicated one vs. two-parent families. Data were analyzed with Spearman’s r, analysis of variance, and multiple linear regression.

Results: Forty-one percent of students were minority, 50.6% female, over 90% were either 12- or 13-year-olds, and 69.9% lived in two-parent families. A multiple linear regression model demonstrated that self-efficacy to say “no, positive attitudes toward drug use, perception of peer substance use, male gender, weapon-carrying, and fighting accounted for 51% of the variation in the current use multiple substance scale. Anticipated substance use during the subsequent year was significantly associated with current substance use, positive attitudes toward drug use, self-efficacy to say ”no, drug-resistance skills, weapon-carrying, and fighting behavior. This model accounted for 73.9% of the variance in anticipated substance use.

Conclusions: In today’s world, where drug use is common, building adolescents’ drug-resistance skills and self-efficacy, while enhancing decision-making capacity, may reduce their use of illegal substances.     

Indexes and boundaries for “quantitative significance” in statistical decisions

Boundaries for S, representing a “quantitatively significant” or “substantively impressive” distinction, have not been established, analogous to the boundary of , usually set at 0.05, for the stochastic or probabilistic component of “statistical significance”. To determine what boundaries are being used for the “quantitative” decisions, we reviewed pertinent articles in three general medical journals. For each contrast of two means, contrast of two rates, or correlation coefficient, we noted the investigators' decisions about stochastic significance, stated in P values or confidence intervals, and about quantitative significance, indicated by interpretive comments.

The boundaries between impressive and unimpressive distinctions were best formed by a ratio of 1.2 for the smaller to the larger mean in 546 comparisons, by a standardized increment of 0.28 and odds ratio of 2.2 in 392 comparisons of two rates; and by an r value of 0.32 in 154 correlation coefficients. Additional boundaries were also identified for “substantially” and “highly” significant quantitative distinctions.

Although the proposed boundaries should be kept flexible, indexes and boundaries for decisions about “quantitative significance” are particularly useful when a value of δ must be chosen for calculating sample size before the research is done, and when the “statistical significance” of completed research is appraised for its quantitative as well as stochastic components.