The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.

In the current study, we used a qualitative approach to investigate relevant beliefs and norms associated with codeine and promethazine hydrochloride cough syrup (CPHCS) consumption, initiation, and perceived addiction among 48 alternative school students who identified themselves as current CPHCS users. In general, both boys and girls believed that CPHCS addiction started during an individual's initial consumption. A majority of both groups reported that their second CPHCS event was initiated during the same or next day after their first event. Our findings suggest that friends and an innovative form of hip-hop music called "screw" are strong reinforcers of CPHCS use.

The use of 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy") appears to be increasing worldwide, with "rave" attendees being one high-risk population. To date, however, only one study has collected ecstasy use information from rave attendees in the United States. To address this limitation, we collected self-report drug use information from 70 adult "club rave" attendees within the Baltimore-Washington corridor in April and May 2002. Data collection was scheduled between 12 A.M. and 5 A.M. Participation rates were high, with 85 percent of the club rave attendees completing the interview. Eighty-six percent of the respondents reported lifetime ecstasy use, 51 percent reported 30-day use, and 30 percent reported using ecstasy within the two days preceding the interview. While past-year ecstasy users were comparable to non-users with respect to a host of demographic and drug use variables, non-ecstasy users were significantly more likely than past-year users to perceive risks associated with the regular use of alcohol and ecstasy. Not surprisingly, non-ecstasy users were significantly more likely than past-year users to perceive harmful long-term physical and psychological effects associated with ecstasy ingestion. These findings suggest that rave attendees may be an important population for ecstasy-related prevention efforts.

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In this study a qualitative approach is used to investigate relevant beliefs and norms concerning the consumption, initiation, and perceived addiction of codeine and promethazine hydrochloride cough syrup (CPHCS) among 61 college-age students who identified themselves as current CPHCS users. In general, a majority of students stated that doctors and pharmacists were the greatest facilitators of CPHCS acquisition. A majority of students believed that their friends felt codeine promethazine use was "normal" and "cool" among college students their age, and that reinforcing factors, such as peer pressure and curiosity, contributed to initial CPHCS use.

Self-reported substance use data were collected from 963 alternative school students in grades 7-12 who were surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001. Logistic regression analyses indicated that lower levels of future orientation was significantly associated (OR = 0.88, 95% CI = 0.81-0.97) with thirty-day substance use after controlling for age and gender. In addition, lower levels of future orientation was found to have a significant association with students' lifetime substance use (OR = 0.93, 95% CI = 0.87-.99) after controlling for age, race, and gender. While the relationships tested in this study are exploratory, they provide evidence for an important connection between future orientation and substance use among adolescents attending alternative schools.

Past studies have concluded that individuals under criminal justice supervision often underreport their recent use of illicit drugs. To address this underreporting, objective biological measures, such as urine, saliva, and hair testing, have been used to gain better estimates of illegal drug use. While urinalysis is generally recognized as the reference standard, a method recently introduced in nonlaboratory settings for ascertaining drug use-saliva testing-may offer an alternative to urinalysis. To date, however, no studies have compared saliva testing to urinalysis among criminal justice populations. In the current study, urine and saliva specimens were collected from 114 adult arrestees interviewed as part of Maryland's Substance Abuse Need for Treatment among Arrestees (SANTA) project. With urinalysis as the reference standard, analysis of the saliva test results indicated sensitivity of 100% and specificity of 99% for cocaine and sensitivity of 88% and specificity of 100% for heroin. For marijuana, however, the saliva results indicated a sensitivity of only 5%. Anecdotal reports from the field suggest that saliva may have some advantages over urine because of the ease of collection, invulnerability to adulteration, and minimal personal invasiveness. These findings suggest that a more comprehensive study to evaluate the efficacy of saliva testing in field research may be warranted.

This study explored job satisfaction and changes needed to help boost levels of job satisfaction. Self-reported job satisfaction data were collected from 71 school nurses employed in elementary, middle, and high school settings via interactive focus groups. The subjects participated in a 30- to 45-minute focus group session that was audiotaped and transcribed by the principal investigator. Beliefs about job satisfaction were identified and classified into exclusive categories or themes. While the majority of school nurses expressed contentment with their jobs, certain factors that would increase job satisfaction, such as salary and control issues, were discussed. Overall, 83% of school nurses in this study were satisfied in their present positions; however, issues of coping and role strain were identified as major contributors to low morale. Only 17% of the school nurses voiced job dissatisfaction, primarily attributed to low salaries and lack of trust and support from administration. As school nurses face a diverse community with complex needs, adaptation is needed for job satisfaction to be maintained. For this to occur, school nurses must take the initiative to educate administrators, parents, and communities about their role in the school setting.