Biomedical subjects

Daniel F McCaffrey

Publications and source records attributed to Daniel F McCaffrey.

16 recordsLinked to original sources

PubMed2007

Reactions to dating violence among Latino teenagers: an experiment utilizing the Articulated Thoughts in Simulated Situations paradigm.

Dating violence is a serious problem among adolescents and young adults. Understanding teens' reactions to dating violence offers the potential to understand the factors that lead to perpetration of violent behavior and to elucidate prevention strategies. Knowledge concerning youth attitudes about dating violence is limited, and has largely come from self-report questionnaires to date. We utilized the Articulated Thoughts in Simulated Situations (ATSS) paradigm to assessing Latino teens' reactions to dating violence. Forty-one 9th grade students were presented with four simulated dating violence scenarios, and articulated their thoughts in response to them. Teens' reactions to dating violence differed on a variety of dimensions as a function of their gender, the gender of the perpetrator, and familiarity with the perpetrator.

Adolescent↗

PubMed2006

Improved hypothesis testing for coefficients in generalized estimating equations with small samples of clusters.

The sandwich standard error estimator is commonly used for making inferences about parameter estimates found as solutions to generalized estimating equations (GEE) for clustered data. The sandwich tends to underestimate the variability in the parameter estimates when the number of clusters is small, and reference distributions commonly used for hypothesis testing poorly approximate the distribution of Wald test statistics. Consequently, tests have greater than nominal type I error rates. We propose tests that use bias-reduced linearization, BRL, to adjust the sandwich estimator and Satterthwaite or saddlepoint approximations for the reference distribution of resulting Wald t-tests. We conducted a large simulation study of tests using a variety of estimators (traditional sandwich, BRL, Mancl and DeRouen's BC estimator, and a modification of an estimator proposed by Kott) and approximations to reference distributions under diverse settings that varied the distribution of the explanatory variables, the values of coefficients, and the degree of intra-cluster correlation (ICC). Our new method generally worked well, providing accurate estimates of the variability of fitted coefficients and tests with near-nominal type I error rates when the ICC is small. Our method works less well when the ICC is large, but it continues to out-perform the traditional sandwich and other alternatives.

Cluster Analysis↗

PubMed2006

Peer and family influences on adolescent anger expression and the acceptance of cross-gender aggression.

Past research has examined the relative impact of family and peers on adolescent behavior, but very little research has examined it in relation to youth dating violence. Eight hundred and sixty-five adolescents, primarily urban Latino youth, completed self-administered surveys at school. Multivariate analyses indicated that exposure to prior family violence was not significantly associated with adolescents' aggressive expression of anger or their acceptance of cross-gender aggression. However, current conflict--either family or peer--was associated with adolescent behavior and attitudes, with the exception that current peer conflict was not significantly associated with adolescents' acceptance of male on female aggression. Parental monitoring and attachment were not found to be moderators of these relationships. Implications for dating violence interventions and future directions for research are explored.

Adolescent↗

PubMed2005

Mediation analysis of a school-based drug prevention program: effects of Project ALERT.

This study used mediation analyses, implemented in a longitudinal structural equation modeling framework, to examine the mechanisms by which a social-influence-based school drug use prevention program (Project ALERT) achieved its effects on past month cigarette use and alcohol misuse. Participants were 4277 South Dakotan middle-school students (2554 treatment and 1723 control) measured at baseline and 1 year later on past month cigarette use and alcohol misuse, as well as cigarette- and alcohol-related mediating variables targeted by the Project ALERT curriculum (i.e., resistance self-efficacy, positive and negative beliefs about use, and peer influence). Results for cigarettes showed that all hypothesized mediating variables were significant mediators of ALERT's effect on intentions to smoke and past month cigarette use, with peer influence being the strongest. Results for alcohol point to positive beliefs about the consequences of drinking as an important mediator for alcohol misuse. Taken together, the findings highlight an avenue for program improvement through increased impact on peer influence to use alcohol and drugs.

Adolescent↗

PubMed2005

Saturated in beer: awareness of beer advertising in late childhood and adolescence.

PURPOSE: The purpose of this study was to examine exposure, response to, and awareness of beer advertising in 2 age groups, including awareness of a Budweiser advertisement (ad) that portrayed lizards and an animated ferret. METHODS: In the spring of 2000, 1,996 fourth graders and 1,525 ninth graders attending 1 of 60 South Dakota schools participated in an in-school survey. Several indicators of advertising awareness, exposure, and response were assessed: recognition, product naming, brand naming, and liking in response to stills drawn from 4 masked television beer ads, listing of beer brands, exposure, attention to, and skepticism toward television beer ads. RESULTS: Fourteen percent of 4th graders and 20% of 9th graders recognized at least 3 of 4 sample beer ads. Seventy-five percent of 4th graders and 87% of 9th graders recognized the Budweiser ferret ad; about one in three 4th graders could name the brand it advertised, whereas more than three in four 9th graders could do so. When asked to list as many beer brands as they could, almost 29% of 4th graders listed 3 or more beer brands and 82% of 9th graders did so. Ninth graders liked beer advertisements more and paid greater attention to them, but 4th graders were exposed to them more often. CONCLUSION: Television beer ads result in high levels of beer advertising awareness in children as young as age 9, and even higher awareness among 14-year-olds. Practices that expose or appeal to youth, including use of animated characters, should be avoided by beer advertisers.

Adolescent↗

PubMed2005

Developmental considerations for substance use interventions from middle school through college.

This article summarizes a symposium organized by Dr. Elizabeth D'Amico and presented at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, Canada. The four presentations illustrate the importance of creating substance use interventions that are developmentally appropriate for youth. They represent innovative approaches to working with preteens, teenagers, and young adults. Dr. D'Amico's paper describes her research on the development of a voluntary brief intervention targeting alcohol use among middle school students. Findings indicated that by using school and community input, she was able to obtain a diverse a sample of youth across grades, sex, ethnicity, and substance use status. Dr. Ellickson's paper describes her research on Project ALERT, a school-based prevention program for middle school youth. Her findings indicate that Project ALERT worked for students at all levels of risk (low, moderate, and high) and for all students combined. Dr. Wagner's Teen Intervention Project was a randomized clinical trial to test the efficacy of a standardized Student Assistance Program for treating middle and high school students with alcohol and other drug problems. The study provided a unique opportunity to begin to examine how development may impact response to an alcohol or other drug intervention. Dr. Turrisi's paper examined processes underlying the nature of the effects of a parent intervention on college student drinking tendencies. Findings suggested that the parent intervention seems to have its impact on student drinking by reducing the influence of negative communications and decreasing the susceptibility of influences from closest friends. Dr. Kim Fromme provided concluding remarks.

Adolescent↗

PubMed2005

Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment.

AIMS: To examine the relationship between exposure to different forms of alcohol advertising and subsequent drinking among US adolescents and assess whether exposure to an alcohol and drug prevention program mitigates any such relationship. DESIGN: Regression models with multiple control variables examined the relationship between exposure to alcohol advertising in grade 8 and grade 9 drinking for two groups of South Dakotan adolescents: (1) seventh-grade non-drinkers (n = 1206) and (2) seventh-grade drinkers (n = 1905). Interactions between the intervention program and the significant advertising predictors were tested. SETTING: Forty-one middle schools in South Dakota, USA. PARTICIPANTS: A total of 3111 seventh-graders followed through grade 9. MEASUREMENTS: Advertising variables were constructed for four types of alcohol advertising-television, in-store displays, magazines and concession stands. Other predictors tested included measures tapping social influences, social bonds, problem behavior, alcohol beliefs, television exposure and demographics. FINDINGS: For seventh-grade non-drinkers, exposure to in-store beer displays predicted drinking onset by grade 9; for seventh-grade drinkers, exposure to magazines with alcohol advertisements and to beer concession stands at sports or music events predicted frequency of grade 9 drinking. Although exposure to television beer advertising had a significant bivariate relationship with alcohol use for grade 7 non-drinkers, it was not a significant predictor of drinking for either group in multivariate analyses. Participation in the prevention program, ALERT Plus, reduced future drinking for both groups and counteracted the effect of in-store beer displays. CONCLUSIONS: Several forms of alcohol advertising predict adolescent drinking; which sources dominate depends on the child's prior experience with alcohol. Alcohol prevention programs and policies should help children counter alcohol advertising from multiple sources and limit exposure to these sources.

Adolescent↗

PubMed2004

Direct medical costs attributable to acute myocardial infarction and ischemic stroke in cohorts with atherosclerotic conditions.

BACKGROUND: The cost of acute ischemic events in persons with established atherosclerotic conditions is unknown. METHODS: The direct medical costs attributable to secondary acute myocardial infarction (AMI) or ischemic stroke among persons with established atherosclerotic conditions were estimated from 1995-1998 data on 1,143 patients enrolled in US managed care plans. RESULTS: The average 180-day costs attributable to secondary AMI or stroke were estimated as USD 19,056 in the AMI cohort having a private insurance (commercial; n = 344), USD 16,845 in the AMI cohort having government insurance (Medicare, age >/=65 years; n = 200), USD 10,267 for stroke commercial (n = 108), USD 16,280 for stroke Medicare (n = 113), USD 15,224 for peripheral arterial disease commercial (n = 170), and USD 15,182 for peripheral arterial disease Medicare (n = 208). CONCLUSION: These estimates can be used to study the cost-effectiveness of interventions proven to reduce these secondary events.

Aged↗

PubMed2004

Effectiveness of community-based treatment for substance-abusing adolescents: 12-month outcomes of youths entering phoenix academy or alternative probation dispositions.

Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N = 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed.

Adolescent↗

PubMed2004

Propensity score estimation with boosted regression for evaluating causal effects in observational studies.

Causal effect modeling with naturalistic rather than experimental data is challenging. In observational studies participants in different treatment conditions may also differ on pretreatment characteristics that influence outcomes. Propensity score methods can theoretically eliminate these confounds for all observed covariates, but accurate estimation of propensity scores is impeded by large numbers of covariates, uncertain functional forms for their associations with treatment selection, and other problems. This article demonstrates that boosting, a modern statistical technique, can overcome many of these obstacles. The authors illustrate this approach with a study of adolescent probationers in substance abuse treatment programs. Propensity score weights estimated using boosting eliminate most pretreatment group differences and substantially alter the apparent relative effects of adolescent substance abuse treatment.

Evaluation Studies as Topic↗

PubMed2004

Modifying pro-drug risk factors in adolescents: results from project ALERT.

The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4276 eighth graders were assessed 18 months after baseline. Results indicate that Project ALERT had statistically significant effects on all the targeted risk factors associated with cigarette and marijuana use and more modest gains with the pro-alcohol risk factors. The program helped adolescents at low, moderate, and high risk for future use, with the effect sizes typically stronger for the low- and moderate-risk groups. Thus, school-based drug prevention programs can lower risk factors that correlate with drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

Adolescent↗

PubMed2003

New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools.

OBJECTIVES: We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. METHODS: Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. RESULTS: The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. CONCLUSIONS: School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

Adolescent↗

PubMed2003

Social context and adolescent health behavior: does school-level smoking prevalence affect students' subsequent smoking behavior?

This paper examines the links between individual adolescent smoking behavior and actual and perceived smoking behavior in the individual's school cohort. We hypothesized that students enrolled in schools with higher smoking prevalence among students in their grade are more likely to smoke subsequently. We also expected perceived school-level prevalence of smoking to have a greater impact than actual prevalence because the former is a more direct measure of perceived norms. Adjusting for demographics, actual school-level prevalence at baseline (grade 7) was strongly associated with smoking frequency one year later. However, the association disappeared after adjusting for individual smoking frequency at baseline. School-level prevalence did not moderate the association between individual's baseline and subsequent smoking frequency. Perceived prevalence of smoking among grade 8 students and two measures tapping the behavior of smaller peer groups--cigarette offers and exposure to friends and other peers who smoke--were associated with increased risk of smoking.

Adolescent↗

PubMed2002

Reassessing the marijuana gateway effect.

AIMS: Strong associations between marijuana use and initiation of hard drugs are cited in support of the claim that marijuana use per se increases youths' risk of initiating hard drugs (the 'marijuana gateway' effect). This report examines whether these associations could instead be explained as the result of a common factor-drug use propensity-influencing the probability of both marijuana and other drug use. DESIGN: A model of adolescent drug use initiation in the United States is constructed using parameter estimates derived from US household surveys of drug use conducted between 1982 and 1994. Model assumptions include: (1) individuals have a non-specific random propensity to use drugs that is normally distributed in the population; (2) this propensity is correlated with the risk of having an opportunity to use drugs and with the probability of using them given an opportunity, and (3) neither use nor opportunity to use marijuana is associated with hard drug initiation after conditioning on drug use propensity. FINDINGS: Each of the phenomena used to support claims of a 'marijuana gateway effect' are reproduced by the model, even though marijuana use has no causal influence over hard drug initiation in the model. CONCLUSIONS: Marijuana gateway effects may exist. However, our results demonstrate that the phenomena used to motivate belief in such an effect are consistent with an alternative simple, plausible common-factor model. No gateway effect is required to explain them. The common-factor model has implications for evaluating marijuana control policies that differ significantly from those supported by the gateway model.

Adolescent↗

PubMed2002

Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease.

BACKGROUND AND PURPOSE: Few data exist for large managed care populations on the occurrence of subsequent acute ischemic events in persons with established atherosclerotic vascular disease. We estimated the occurrence of secondary stroke, acute myocardial infarction (AMI), and vascular deaths among 2 large, managed care samples. METHODS: With the use of International Classification of Diseases, Ninth Revision, Clinical Modification codes, patients aged > or =40 years and with stroke, AMI, or peripheral arterial disease (PAD) were identified from administrative data of UnitedHealthcare plans during 1995-1998. Stroke, AMI, and PAD cohorts were identified within a commercial insurance sample and a Medicare sample. Cumulative occurrences of subsequent stroke, AMI, or vascular death were estimated by survival analysis. RESULTS: In the stroke commercial cohort (n=1631; mean age, 62.1 years), cumulative occurrence of subsequent events was 4.2%, 6.5%, 9.8%, and 11.8% at 0.5, 1, 2, and 3 years, respectively; cumulative secondary event occurrence in the AMI commercial cohort (n=6458; mean age, 56.0 years) was 3.5%, 4.8%, 7.3%, and 8.5% and in the PAD commercial cohort (n=5813; mean age, 59.2 years) was 1.5%, 2.8%, 4.8%, and 6.5%, respectively. Cumulative secondary event occurrences were even higher in stroke (n=1518; mean age, 79.5 years), AMI (n=2197; mean age, 76.2 years), and PAD (n=5033; mean age, 76.6 years) cohorts of the Medicare sample: 18.1%, 17.0%, and 8.7%, respectively, at 3 years. More than 75% of each stroke cohort's secondary events were strokes; more than 75% of each AMI cohort's secondary events were AMIs. Of the PAD cohorts' secondary events, 27% to 39% were strokes, 48% to 57% were AMIs, and 13% to 16% were vascular deaths. CONCLUSIONS: Among these managed care enrollees with existing atherosclerotic vascular disease, subsequent ischemic events represent a significant symptomatic disease burden. Given these findings, it is very important to determine whether secondary prevention strategies are being effectively used to manage patients with diagnosed atherosclerosis.

Adult↗

PubMedDate not supplied

Measurement of adolescent drug use.

There is widespread agreement that estimates of adolescent drug use prevalence from the National Household Survey of Drug Abuse (NHSDA) and Monitoring the Future (MTF) are subject to considerable measurement error. Nevertheless, some have suggested that trends over time in these prevalence estimates probably reflect true trends in drug use, since underreporting may be assumed to be constant over time. A recent National Research Council report criticizes this assumption on logical grounds. The present study examines adolescent drug use responses on the NHSDA and MTF for evidence of "drug omission," "jargon confusion" and "conceptual confusion," three types of misreporting expected to vary in magnitude with changes in drug use practices and changes in survey items. Results demonstrate that adolescent drug users are significantly more likely than adults to report use of drugs not listed in the NHSDA. Among adolescents who wrote in the "other" drugs they used, 66% and 86% of hallucinogen and inhalant responses showed confusion over the meaning of the pharmacological terms used in the NHSDA. Almost 20% of MTF respondents who report lifetime use of Rohypnol or ecstasy, when specifically queried about these drugs, deny lifetime use of any substances in the drug classes intended to assess use of Rohypnol and ecstasy. MTF respondents reporting lifetime use of PCP underreport use of hallucinogens at rates that vary substantially over time, from a high of 45% (in 1986), to a low of just 8% (in 1998). The implications of these findings for adolescent drug use prevalence estimation and survey design are discussed.

Administration, Inhalation↗