Aims This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics. Methods Patients (ages 12–18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences-CC) and secondary outcomes [alcohol use, other drug use (illicit and non-medical prescription drugs), and driving under the influence of cannabis (DUI)] assessed at 3, 6, and 12 months. Results 1416 adolescents were surveyed; 328 reported past year cannabis use and were randomized. Comparisons of the CBI relative to control showed that at 3 months the group by time interaction (GxT) was significant for other drug use and CC, but not for cannabis use, alcohol use, or DUI; at 6 months, the GxT interaction was significant for other drug use but not for cannabis use, alcohol use, or CC. For analyses comparing the TBI to control, at 3 months the GxT interaction was significant for DUI, but not significant for cannabis use, alcohol use, or CC; at 6 months, the GxT interaction was not significant for any variable. No significant intervention effects were observed at 12 months. Conclusion Among adolescent cannabis users presenting to primary care, a CBI decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term. Additional boosters may be necessary to enhance these reductions over time.

Aims To examine the efficacy of a brief intervention delivered by a therapist (TBI) or a computer (CBI), in preventing cannabis use among adolescents in urban primary care clinics. Design A randomized controlled trial comparing: CBI and TBI versus control. Setting Urban primary care clinics in the United States. Participants Research staff recruited 714 adolescents (ages 12-18) who reported no lifetime cannabis use on a screening survey for this study, which included a baseline survey, randomization (stratified by gender and grade) to conditions (control; CBI; TBI), and 3, 6, and 12 month assessments. Measurements Using an intent to treat approach, primary outcomes were cannabis use (any, frequency); secondary outcomes included frequency of other drug use, severity of alcohol use, and frequency of delinquency (among 85% completing follow-ups). Findings Compared with controls, CBI participants had significantly lower rates of any cannabis use over 12 months (24.2%, 16.8%, respectively, p<.05), frequency of cannabis use at 3 and 6 months (p<.05) and other drug use at 3 months (p<.01). Compared with controls, TBI participants did not differ in cannabis use or frequency, but had significantly less other drug use at 3 months (p<.05), alcohol use at 6 months (p<.01), and delinquency at 3 months (p<.01). Conclusions Among adolescents in urban primary care in the United States, a computer brief intervention appeared to prevent and reduce cannabis use. Both computer and therapist delivered brief interventions appeared to have small effects in reducing other risk behaviors, but these dissipated over time.

Women in drug treatment struggle with co-occurring problems, including trauma and posttraumatic stress disorder (PTSD), which can heighten HIV risk. This study examines the impact of two group therapy interventions on reduction of unprotected sexual occasions (USO) among women with substance use disorders (SUD) and PTSD. Participants were 346 women recruited from and receiving treatment at six community-based drug treatment programs participating in NIDA’s Clinical Trials Network. Participants were randomized to receive 12-sessions of either seeking safety (SS), a cognitive behavioral intervention for women with PTSD and SUD, or women’s health education (WHE), an attention control psychoeducational group. Participants receiving SS who were at higher sexual risk (i.e., at least 12 USO per month) significantly reduced the number of USO over 12-month follow up compared to WHE. High risk women with co-occurring PTSD and addiction may benefit from treatment addressing coping skills and trauma to reduce HIV risk.

Purpose-Data regarding sexual risk behaviors among adolescent patients presenting to urban Emergency Departments (ED) is lacking. This paper describes rates and correlates of sexual risk behaviors among adolescents screened in an urban ED.Methods-Over a one-year period, 1576 patients ages 14-18 self-administered a computerized survey (57.6% female, 59.3% African American).Results-Among sexually active adolescents (60%), 12.0% reported four or more partners, 45.3% reported using a condom all the time, and 14.7% reporting using substances before sex. Regression analyses examined correlates of sexual risk behaviors based on demographics, violence, and substance use. Males and younger teens were more likely to report condom use than females and older teens. Participants with poor grades were more likely to have had sex and using substances before sex, and were less likely to report condom use. Participants reporting dating violence were more likely to have had sex and less likely to use condoms, whereas participants reporting peer violence and weapon carriage were more likely to report substance use before sex. Binge drinking and marijuana use were associated with all sex risk behaviors.Conclusions-The urban ED visit may provide an opportunity to deliver interventions to address sexual risk behaviors among adolescents.

Correlates of past year gambling were examined in a diverse sample of 1128 youth ages 14-18 (45.9% female, 58.0% African American) presenting to an inner city emergency department (ED). Overall, 22.5% of the sample reported past year gambling. Male youth were more likely to gamble than female youth and African American youth reported higher rates of past year gambling than non-African American youth. Significant bivariate correlates of gambling included lower academic achievement, being out of school, working more than 20 hours per week, alcohol and marijuana use, alcohol problems, severe dating violence, moderate and severe general violence, and carrying a weapon. When examined simultaneously, being male, African American, out of school, working for pay, alcohol and marijuana use, severe general violence and carrying a weapon all emerged as significant correlates of past year gambling, largest amount of money gambled, and gambling frequency. In addition, involvement in severe dating violence was associated with frequency and largest amount gambled. The results suggest that gambling is common among youth in the inner city and is associated with several risk behaviors. The inner city ED may provide a context for screening and intervention to address multiple risk behaviors. KeywordsAdolescents; Alcohol; Gambling; Emergency Department; Substance Use; Violence Gambling among adolescents has been identified as a growing concern, particularly due to increased rates of gambling and increased availability of legal gambling venues over the past ten years. For example, in Michigan, legal gambling includes the state lottery, horse racing, charitable gaming, Native American-owned casino gaming, and non-Native American-owned casino gaming venues. Although adolescents do not meet the legal age required for entry into most gaming venues (i.e., 21 for entry in casinos, 18 for entry into some Native AmericanCorrespondence should be addressed to Abby L. Goldstein, who is now with the Department of Adult Education and Counseling Psychology, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Suite 7-228, Toronto, Ontario, M5S 1V6. E-mail: agoldstein@oise.utoronto.ca. (Winters & Anderson, 2000), although older age is not always associated with higher rates (Gupta & Derevensky, 1998a). Although not all youth who experiment with gambling will go on to experience a range of gambling-related consequences (i.e., problem gambling), research shows that those who initiate gambling in adolescence are more likely to become problem gamblers in young adulthood (Winters et al., 2002) and are more likely to experience physical and psychiatric difficulties (Burge, Pietrzak, Molina, & Petry, 2004). Thus, identifying factors associated with adolescent gambling may assist in early detection and intervention to prevent the development of future problems. Several correlates of adolescent gambling have been identified, including alcohol, tobacco, other drug use, and delinquency (Duhig, Maciejewski, Desai...

Background Polysubstance use during adolescence is a significant public health concern; however, few studies have investigated patterns of use during this developmental window within the primary care setting. Objectives This study uses an empirical method to classify adolescents into polysubstance use groups, and examines correlates of the empirically-defined groups. Methods Data come from patients, ages 12-18 years, presenting to urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n=1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership. Results LCA identified three classes: Class 1 (64.5%) exhibited low probabilities of all types of substance use; Class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; Class 3 (10.9%) had the highest probabilities of polysubstance use, including heavy episodic drinking and misuse of prescription drugs. Those in Class 2 and Class 3 were more likely to be older, and have poorer grades, poorer health, higher levels of psychological distress, and more sexual partners than those in Class 1. Individuals in Class 3 were also less likely to be African-American than those in Class 1. Conclusion Findings provide novel insight into the patterns of polysubstance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.

Researchers recognize that the connection between alcohol and peer violence may relate to community level ecological factors, such as the location of businesses that sell alcohol. Building on previous research among adults, this study examines the relationship between alcohol outlet density and violent behaviors among adolescents, taking into account demographic characteristics, individual alcohol use, and neighborhood level socioeconomic indicators. Data drawn from a diverse Emergency Department based sample of 1,050 urban adolescents, combined with tract level data from the state liquor control commission and U.S. Census, were analyzed. Results of multivariate multi-level regression analysis indicate that alcohol outlet density is significantly related to adolescents' violent behaviors, controlling for demographic characteristics and individual alcohol use. Census tract level socioeconomic indicators were not significantly associated with youth violence. Findings suggest that alcohol outlet density regulation should be considered as part of broader violence prevention strategies for urban adolescents.

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