This Web site is a component of the SAMHSA Health Information Network.

Click here to download this publication from our FTP site.

From the Director of CSAP...

The listing of materials or programs in this resource guide does not constitute or imply endorsement by the Center for Substance Abuse Prevention, the Public Health Service, or the Department of Health and Human Services. The materials have been reviewed for accuracy, appropriateness, and conformance with public health principles.

This Substance Abuse Resource Guide was compiled from a variety of publications and data bases and represents the most current information to date. It is not an all-inclusive listing of materials on this topic. This guide will be updated regularly, and your comments or suggestions are welcome. To suggest information or materials that might be included in future editions, please write to the National Clearinghouse for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 20847-2345, or to info@health. org.

Produced by the National Clearinghouse for Alcohol and Drug Information, Andrea B. Miller, editor.

For further information on substance abuse, call 301-468-2600, 800-729-6686, or TDD 800-487-4889. Or visit us on our World Wide Web site at http://ncadi.samhsa.gov.

Please feel free to be a "copy cat," and make all the copies you want. You have our permission!

Inventory Number MS446 

Contents

Section 1: Prevention Material
Section 2: Studies, Articles, & Reports
Section 3: Groups, Organizations, & Programs
Section 4: Internet Access Sites

Materials for Youth and Family Members

Each of these colorful trifold brochures present facts and resources on the following subjects: alcohol (PH323), crack and cocaine, (PHD640), hallucinogens (PHD642), marijuana (PHD641), inhalants (PHD631), and smoking (PHD633). Designed to attract attention and concern, the brochures state the long-term and short-term effects, physical and psychological risks, impact on sexual performance, and legal implications. Teens are advised to stay away from all drugs and encouraged to seek help from a counselor, friend, or parent whenever necessary. Also available on audiocassette.

Keeping Youth Drug-Free is a four-color, graphically appealing guide targeting the caregivers of children ages 9 to 13. Divided into five sections, this guide is based on the five reasons young people give for using alcohol, tobacco, and other drugs. The guide provides role-playing and skill-building exercises to help prevent alcohol, tobacco, and other drug problems.

This colorful handbook outlines what children at four key stages of development should know about drugs and suggests family activities to reinforce children's motivation to avoid alcohol and other drugs. Also available on audiocassette and in Spanish.

This low-literacy brochure outlines healthy habits for pregnancy. Avoiding alcohol, cigarettes and all other drugs is strongly emphasized.

NIDA's AIDS-awareness campaign features four print materials that correspond with the messages seen in the television PSAs. Two colorful cartoon posters, entitled "Self-Realization--Jeanine" (AVD66) and "Self-Realization--Barry," (AVD65) humorously provide a palatable and compelling message for young adults, of any ethnic background, that drug and alcohol abuse can lead to deadly HIV infection. A full-color print ad, "Facing Reality" (AVD67) features Jeanine and Barry in a similar cartoon sequence. A pamphlet entitled "How Not to Get High, Get Stupid, Get AIDS: A Guide to Partying" (PHD622) suggests ways that young adults can modify their behavior so that they can still have fun, but avoid irreversible mistakes, such as using drugs and alcohol and having risky sex.

This colorful fold-out leaflet, enlivened with comic-book style drawings, takes a serious look at why getting high on drugs can cause risky behavior and why AIDS is another way drugs can kill. Also available on audiocassette.

Comprehensive and easy to read, this booklet discusses inhalant abuse, including the harmful effects and signs of use. It also explains why some people use inhalants, and what can be done to intervene and where to obtain more information.

This activity booklet conveys information about the dangers of smoking marijuana, why some young people use marijuana, and how to say "no." Activities include crossword puzzles, fill in the blanks, and decoding puzzles.

This booklet provides the reader with information about marijuana and how using it adversely affects development in teenagers. It explains how marijuana negatively affects thought processes, communication, and self-image. The booklet also refutes common misconceptions, such as "lots of people do it," or "it's no worse than cigarettes or alcohol."

Brief and easy-to-read, this pamphlet lists the "dos" and "don'ts" of pregnancy. Tips include a strong no-use message for alcohol, tobacco, and other drugs. It also advises "You can play a major part in helping your baby get a good start in life. Be careful with your body while pregnant, for it is also your baby's home. This will help the baby for the rest of his/her life."

This brief and easy-to read pamphlet explains that fetal alcohol syndrome is permanent, but can be prevented if the mother does not drink while pregnant. Ways an expectant father can support his mate include encouraging her to get frequent medical checkups; avoid all alcohol, tobacco, and other drugs; and practice other healthy habits.

Materials for Prevention Specialists and Community Leaders

This report of a 2-day conference explores practical ways of addressing African-American youth at high risk in a culturally relevant manner. The authors examine the role of culture in AOD use, contemporary values in the African-American community that provide resistance to AOD abuse, and socioeconomic conditions that contribute to AOD abuse.

This publication discusses building an agenda and strategies for preventing HIV infection and AIDS among street and homeless youth. This report shows the connection between HIV and drug use, homelessness, AIDS, and other issues. It addresses the varied origins of these problems and how to best prevent them.

Traffic accidents are the leading cause of death for teenagers, taking 4,000 lives annually. Young males from blue-collar backgrounds are particularly likely to die in alcohol-related crashes. They tend to drink beer and drink to the point of intoxication more often than peers in other demographic groups. This report finds that beer manufacturers are spending up to $50 million per year on motor sports sponsorships. The report documents how American beer companies link beer and fast cars in a carefully crafted effort to promote beer, especially among working class youth and young adults who are part of the "car culture." The report advocates an eventual ban on sponsorship of motor sports by alcohol companies.

Although youth participation is a good idea, it is not necessarily easy to put into practice. This book provides an overview of how to build and maintain effective youth participation programs, including practical tips for program development, how to involve community partners, and a resource list. The author examines how youth participation helps promote healthy adolescent development and helps a community reinforce responsible behavior.

Based on the simple premise that young people trying to appear more mature and independent often start using drugs in response to social influences, Project ALERT is designed to provide the motivation, skills, and practice students need to resist gateway substances (alcohol, tobacco, marijuana, and inhalants). Purchase of the curriculum materials also includes a full day training workshop by Project ALERT staff and other benefits.

This comprehensive resource for FAS information can benefit service providers both within and outside of the IHS system. The book provides resources for meeting the special needs of children with FAS/FAE, as well as parent education programs, cultural resources, and referrals to prevention and treatment services nationwide.

This facilitator's manual provides an outline for a 1- to 2-day workshop to be delivered to professionals and paraprofessionals in the chemical dependency and social service fields. The presentation is also adaptable to an audience of parents. The workshop will familiarize participants with the scope of the inhalants problem, adolescents' development and special needs in relation to substance abuse, and community strategies for prevention, intervention, and treatment. Support materials and overheads are included.

This quarterly newsletter contains lesson plans, information on state-of-the-art programs, and topical articles on alcohol and other drug use and prevention. Back issues featured topics such as spit tobacco, steroids, and prenatal drug abuse. To subscribe or order back issues, please contact NCADI.

Urban, Low-Income Communities

During seventh grade, many adolescents initiate alcohol use yet school drop-out rates are still low. Therefore, this is an ideal period of adolescence to examine predictors of alcohol use. The purpose of this study was to elucidate the etiology of alcohol use among an understudied population: disadvantaged inner-city minority youths. The authors attempted to develop as complete a model of predictors of alcohol use as possible from three domains: background characteristics, social influences to drink and individual characteristics. To explore alcohol use of youths who are living in poverty and are members of minority groups, New York City public schools from districts known to have predominantly minority student bodies with low socio-economics status (SES) were identified. Self-reports of alcohol use and data concerning background, social, environmental, and individual characteristics hypothesized to promote drinking alcohol were collected from Black and Hispanic seventh graders (N=757). Logistic regression analyses indicated that social influences from friends, peers, and parents predicted alcohol use. Most interestingly, the drinking status of the person the respondent most admired was related to drunkenness and future alcohol use. Individual characteristics, such as health-related knowledge concerning alcohol use and anti-drinking attitudes, lowered the odds of drinking. These findings imply that effective prevention programs targeting inner-city minority youths should provide students with awareness of the social influences to drink, provide them with positive role models, and correct misperceptions about the prevalence of drinking among friends and peers.

Our understanding of youth involvement with drug trafficking is derived mainly from survey data. Personal narratives present the life choices that low-income, urban African-American youth perceive and the decisions that they make. Narratives provide insight into the complexities inherent in those choices. Twenty youth were interviewed through semiclinical, open-ended interviews. Youths were asked to describe their perceptions of how people their age make choices about becoming involved or refraining from involvement in drug trafficking. Data were analyzed within the context of psychological factors that influence child development, including attributions of personal meaning and identify formation. Youth narratives reflect an awareness of the contradictory messages present within their environments. Youths articulate the importance of family and peer influences on their decisions to encourage in or refrain from the drug trafficking. Their perceptions of themselves as belonging to a racial minority group also influence their views regarding the viable alternatives available to them for achieving success. Youth who are able to identify alternative activities from which they can derive positive experiences are less likely to become involved in drug trafficking. Recommendations for intervention at the familial, community, and institutional levels are discussed.

The authors examined relationships involving three extremely high-risk behaviors (drug use, drug trafficking, and weapon carrying) among low-income, urban, African-American early adolescent boys using both quantitative and qualitative methods. The quantitative phase included 192 African-American boys from 9 through 15 years of age recruited from reaction centers located in low-income communities. Youth completed a survey addressing personal risk practices; intentions to engage in risk practices; risk taking among family, friends and community; and values toward risk practices. They also completed standardized assessments of sensation seeking, perceived peer pressure, and parent-child communication. All questionnaires were self-administered through Macintosh computers programmed to present questions orally and visually. The qualitative phase included 12 African-American youth from low-income, urban families. The youth participated in 60- to 90-minute interviews regarding drug activities and violence. Most boys (73 percent) were not involved in either drug activities or weapon carrying. Boys who were involved in drug activities or weapon carrying were often involved in other high-risk activities (cigarette and alcohol use, school failure and expulsion) and had low rates of adaptive communication with their parents. The boys reported high rates of drug involvement by their family, friends, and community. However, psychological and interpersonal factors were better predictors of individual risk activities than community or family variables. Personal values regarding economics predicted drug trafficking. More than 56 percent of the boys who reported past involvement in drug activities did not anticipate future involvement. Multilevel strategies are necessary to prevent involvement in drug activities and weapon carrying. Intervention programs should begin early and should promote communication between parents and children, adaptive behavior in school, and avoidance of cigarette and alcohol use. Community-level interventions are needed to alter the myth that drug involvement and weapon carrying are normative and to promote images that are less materialistic and more supportive of education and future-oriented activities.

Drug trafficking seems to be both prevalent and associated with considerable morbidity and mortality among inner-city African-American males. Survey data has indicated the possible importance of economic need in the rapid emergence of drug trafficking in this population. In the present study, an historical-cultural approach is used to examine this economic relationship further and to explore the role that drug trafficking plays in a society that has permitted its successful and rapid growth. Data were obtained from interviews of approximately 600 African-Americans residing in inner-city neighborhoods in Washington, DC, and Baltimore during nine drug- and acquired immunodeficiency syndrome-related studies conducted over 4 years. From the perspective of the study participants, the need to provide economic support for one's family as well as to achieve some sense of status, respect, and reputation among one's peers are two core constructs of masculine identity in the United States. The historical and worsening inequities in access to economic resources and power by African-American males are viewed as significantly reducing the opportunity for economic success through more social or legal enterprises. Pursuit of non-mainstream activities (such as drug trafficking) is perceived as offering an opportunity for economic advancement and for establishing a power base for individuals who have been denied access to mainstream opportunities.

This article describes and evaluates the impact of Boys & Girls Clubs recently installed in residential public housing developments. Because most prevention interventions to date have been school-based, this study marks a development in prevention interventions for problem behavior among high-risk youth. The evaluation compares sites without Boys & Girls Clubs to sites with both previously and recently installed Boys & Girls Clubs. The results show that public housing developments with Boys & Girls Clubs have less drug-related activity, measurably fewer damaged and unoccupied units, and increased parental involvement in youth activities.

Homeless, Runaway, and Street Youth

The overall health status of delinquent and homeless youths is of increasing concern. These high-risk youth populations have a variety of health problems, including relatively high levels of substance abuse. This study provides empirical data on the substance use behaviors of a sample of delinquent and homeless youth in San Francisco, CA. The data, secured within the context of medical examinations, indicate that both samples use tobacco, alcohol, and illicit drugs at higher rates than the general adolescent population. The study concludes that drug education and prevention programs must be tailored to fit the needs and lifestyles of these two populations, and that the programs should be provided within the broader context of adolescent health care.

An attempt is made to characterize the population of homeless street youth who are living marginally and to describe aspects of this population's dynamics, motivations, values, and aspirations. Street youth, ranging in age from birth to 21, are on the street for one reason or another — because of dire poverty in the home, which necessitates their working on the street to supplement the family income; because of rejection by parents or guardians; because of violence in the home or drug or alcohol use by family members; or because of lack of a place where they feel they can be "themselves." These conditions make street youths particularly vulnerable to HIV infection, not to mention malnutrition, stress, and drug use. Their violently accelerated emotional maturation, ignorance, alcohol- and drug-induced confusion, together with the exploitation and sexual abuse of which they are often victims, are additional factors that contribute to sexual practices that may lead to HIV infection.

High-risk sex and drug use behaviors are examined among 446 male street youth 14 to 23 years old in Hollywood, CA (the area in Los Angeles County with the highest number of AIDS cases). Comparisons are made based on whether the sex behaviors occurred in situations of "survival sex" ("sex you gotta do") and "recreational sex" ("sex you wanna do"). Ninety-seven percent of the males were sexually active with 27.1 percent involved in prostitution in the last 3 months. Involvement in prostitution is most common among older, gay identified males. The most prevalent risk factors seen among this group include inconsistent condom use (which also varies by social situation), high-risk sexual behaviors during both survival and recreational sex, large numbers of sexual partners, intravenous drug use, and the use of drugs and alcohol during all sex.

Each year, there are approximately 2 million homeless and runaway youths in the United States. On any given night, there are 1,000 homeless youngsters living on the streets of San Diego, CA. Homeless young people are commonly involved in one or more of the following activities that place them at risk for HIV infection — unprotected sexual intercourse, needle-sharing in the use of injectable drugs, sex with someone who injects drugs. The Teen Peer Outreach-Street Work Project trains teen peer educators to work in three existing San Diego youth service programs with street outreach staff members to provide HIV prevention education and referral services to San Diego's homeless youth. Selected teens from the target population also participate in street-based case management that provides skill development to bring about behavioral and attitudinal changes. An HIV outreach program cannot stand alone and is most successful if it is integrated with services that meet the basic needs of its clients. In the three participating youth service programs of the Teen Peer Outreach-Street Work Project, food, clothes, and shelter information are provided. There are shelters in two of the three programs that become places where HIV educational messages, delivered on the street, can be reinforced. Immediate and concrete assistance can be offered to homeless youth.

The problem of adolescents who run away from home has recently come to national prominence in the United States and Canada. Runaways are at a high risk for becoming street youth. This paper compares student runaways, non-runaways, and street youth on alcohol and other drug use, problems, and psychological depression. Most runaways do not become street youth but leave home for brief periods, often going to neighbors, friends, or relatives' homes because of some temporary crisis. Studies of street youth show that those groups contain youth who have run away from home repeatedly. These youth have high rates of drug use. Few studies have been made of runaways in general samples of youth. No study has shown how similar runaways still in school compare to street youth. The authors expected that runaways in their study would be much higher than non-runaways and close to street youth with regard to drug use and depression.

One-hundred fifty clients of a shelter for homeless youths in New York City were interviewed to obtain information about their backgrounds and the incidence of behavioral and emotional disorder. Most of the respondents came from backgrounds characterized by severe emotional deprivation and physical or sexual abuse. Of the 140 who completed the full interview, 90 percent fulfilled DSM-III-R criteria for an emotional or behavioral disorder. Fifty-nine percent had conduct disorder, three-quarters were depressed, 41 percent had considered suicide, and more than one-quarter had attempted suicide.

The extent of depression and other psychiatric problems among adolescent "street" and homeless populations is largely undocumented. Using a sample of 145 adolescent street youth interviewed in Toronto, Canada, this study attempted to extend the knowledge of street youth by examining the association of depression with alcohol and other drug use and related problems, social supports, self-esteem, family background, and alcohol and other drug use among family members. The results indicated that the best predictors of depression among street youth were self-esteem and length of time spent in a hostel.

More women and children are homeless today than ever before. In the 1980s, growing numbers of women and children transformed the homeless population. Many women were alone on the streets, but others had pre-school age children in tow. The following topics are addressed: (1) housing, poverty, and homelessness; (2) homelessness and prevention research; (3) the impact of homelessness on children; (4) mother and child interactions in high-risk families; (5) family violence and homelessness; (6) impact of substance abuse on homeless families; and (7) public policies, program responses, and evaluation strategies for homeless families.

Rural, Low-Income Youth

This study tested the relevance of a risk factor model for predicting drug use among rural adolescents. A questionnaire battery assessing drug use and the presence/absence of 20 risk factors derived from a previous study of urban adolescents was administered to a sample of seventh graders (N = 235) in the public school system of a rural community. All but one of these risk factors were found to be significantly related to at least one category of drug use. In addition, a risk factor default based on a subset of 10 risk factors was significantly associated with the prevalence and frequency of use for cigarettes, beer and wine, hard liquor, marijuana, and other drugs. These findings support the generalizability of a risk factor approach to predicting drug use, and underscore the need for increased prevention and research efforts directed at rural adolescents.

Based on developmental theory, this article tests the relationships between first and current use of alcohol, marijuana, and other drugs among a sample of 197 rural and small-town youth. Findings indicate that age of first use of alcohol predicts current use of alcohol. The same pattern occurs for marijuana and other drugs. Age of first use of alcohol is also related to first use of marijuana, which in turn is related to first use of other drugs. The order is reversed for current use. Current use of other drugs predicts current use of marijuana, which in turn predicts current use of alcohol.

This study examined differences in rural adolescent male and female drinking patterns, problem drinking behavior, and the factors associated with problem drinking behavior. An anonymous written survey was administered to 2,297 adolescents, ages 12 to 18 years, in a rural Mississippi River Delta county. Potential risk factors for problem drinking behavior examined included demographic, behavioral, peer, and parental characteristics. Drinking patterns were examined separately for male and female adolescent drinkers. Individual factors associated with problem drinking behavior for these rural adolescents were consistent with previous research. However, these factors were gender specific in prevalence. Males were more likely than females to report all of the behavioral and peer risk factors associated with problem drinking, except depressive symptoms, which were more frequently reported by females than males. The interactions of gender with race and gender with peer approval of drinking were significantly associated with problem drinking. The ratio of male to female problem drinkers among African-American adolescents was twice as high as the ratio among Caucasian adolescents. Females were much more strongly influenced by peer disapproval of drinking than were males. Prevention and intervention programs may be more effective for rural females if they target depression and focus on support systems, whereas intensive programs for adolescents with multiple high risk behaviors may be more effective for rural males.

The purposes of this study were (1) to assess the usage of substances by 2,125 youth (grades 4-12) in rural Indiana and (2) to explore the differences between students' reported use of substances and parents' perceptions of students' use. While all parents believed that some students were using substances (i.e., cigarettes, alcohol, and marijuana), they underestimated the percentage of students in their child's grade who reported the use of a variety of substances, especially alcohol. If parents are to be allies in the fight against drugs, it is imperative they be aware of the dimensions of the problem.

Data assessing the extent of drug and alcohol use among 4-H members were collected in the fall of 1990 from 255 youth in a three-county area of rural northeastern Nevada. The results were compared to a similar survey conducted in local schools by the Nevada State Department of Education. No statistically significant differences were found between the 4-H members' drug and alcohol use and students in the school survey. Seventy percent of the 4-H members indicated that 4-H had made a difference in their attitudes about drug and alcohol use. Yet, school was the most reported source of their current information about drugs and alcohol. Recommendations for 4-H programs wanting to implement contemporary programs are included.

Native-American, Low-Income Youth

Trends in overall drug use among Indian and non-Indian youth have followed similar patterns, increasing from 1975 to the early 1980s and, for the most-used drugs, declining since then. At every point in time more reservation Indian youth are involved with drugs than are non-Indian youth. Rates for cocaine and hallucinogen use by Indian youth increased until 1990. The decline in overall drug use has occurred because a considerable number of moderate users have shifted to non-use. There has been no decrease in the proportion of high-risk users; since 1980, it has stayed between 17 percent and 20 percent. Societal changes and prevention programs are reaching casual drug users but not those susceptible to heavy drug involvement.

Rates of drug use and involvement were compared for three groups: Indian youth living on reservations, Indian youth living off reservations, and Anglo youth. A consistent pattern emerged, showing the lowest rates of use among Anglo youth, higher rates among non-reservation Indian youth, and the highest rates among Indian youth on reservations. Rates of tobacco use, both smoked and smokeless, and marijuana use are especially high for Indian youth. Indian youth also show a pattern of earlier initiation to drug use. Gender differences reveal slightly higher rates of use for males, although the differences are not great enough to suggest that prevention efforts for males should have a higher priority.

American Indian and Alaska Native communities illustrate the great diversity found among the rural populations of the United States. These communities are marked by cultural, socioeconomic, and historical patterns that differ from other rural groups, causing a distinctive set of social problems. American Indian and Alaska Native youth show exceptionally high levels of drug use compared to the national average for youth. Because Native groups share a number of similar cultural characteristics, it could be hypothesized that the rates of drug use among them are related to cultural traits. However, non-Native Alaskan youth also have high rates of drug use, indicating factors in the social environment other than culture that account for drug use. Possible explanatory factors include uncertain economic conditions, family instability, and lack of access to cultural values. Although rural living in itself is not necessarily a contributing factor to drug use, it does place some constraints on intervention efforts. Geographic isolation and lack of adequate health and social service resources make it difficult to develop adequate prevention and treatment services.

Questionnaires on smokeless tobacco use were completed by 781 sixth grade students in 15 schools at six locations in the United States. The students were both American Indian-Alaskan Native and non-American Indian-Alaskan Native. The Indian and Alaskan Native school children were experimenting with and regularly using smokeless tobacco at higher rates than non-Indian school children. At Indian Health Service sites, 28.1 percent of the children reported current use of smokeless tobacco, compared with 3.3 percent of the children elsewhere. For girls reporting smokeless tobacco experimentation, the comparison was 68.9 percent at Indian Health Service sites and 8.7 percent at non-Indian sites; for boys, it was 79.1 percent from the Indian sites and 35.4 percent from the non-Indian sites. For those students who had tried smokeless tobacco, more than half also reported having tried cigarettes. The majority of all sixth grade students surveyed were aware of the health risks of smokeless tobacco use in that it is an increased risk for cancer.

Two promising theoretical models for predicting substance abuse were examined. The life stress and social support theory identified life stress as a significant influence on levels of family support and drug use but for unknown reasons it did not predict levels of alcohol use. Family support moderates rates of alcohol use and is itself also influenced by life stress factors. Overall, life stress appears to be a major influence on factors related to substance use. The peer cluster theory also identified factors significant to substance use. Family strength or parental expectations were found to influence levels of friend support, family support, and school adjustment. Adolescents who received greater friend support and had better school adjustment chose same-age peers to drink with.

References and abstracts of articles on drug and alcohol use by American Indian youth that have been published by staff of the Tri-Ethnic Center for Prevention Research are provided. Publications begin in 1978, noting high rates of use, particularly of inhalants. Subsequent papers are concerned with epidemiology, psychosocial correlates of use, prevention, and treatment. The number preceding each entry refers to the reprint filing system of the Tri-Ethnic Center.

The study assessed the impact of an intensive retreat for American-Indian youth in high-risk environments. It found that the experience greatly reduced excessive drinking among the targeted adolescents. The evaluation design was unique in assessing attitudes that were and were not expected to change. Those variables not expected to change because they were to related to the goals of the retreat served as a control for the attitudes that were expected to change. The results were consistent with these expectations and the model for evaluation was appropriate for demonstration programs.

This report is part of a current awareness service. It summarizes recent research on adolescent drug use and its prevention. Each issue abstracts and reviews the prevention implications of new research dealing with a major topic of concern in the field; in this case the problem of substance abuse among Native American youth. The report includes the nature and extent of the problem, use correlates and risk factors, prevention strategies, and a conclusion of the research. AOD use and abuse in the Native American population have long been at a crisis level. Since the 1986 Indian Health Service launching of an intensive, community-based prevention initiative there has been a rapid increase in research. The body of research has increased so markedly that this update report became warranted. In this overview, the findings of studies in regard to the nature and extent of AOD use is reviewed on a drug-by-drug basis. This is followed by a summary of the research on use correlates, especially the risk factors that account for the high levels of use among this population, as well as the protective factors that promote resiliency. The final section discusses the prevention implications of these findings and reviews published program evaluations. Taken as a whole, the evidence indicates that Native American youth generally still exhibit greater use of psychoactive substances than youth in any other U.S. ethnic group.

Low-Income Pregnant Women and Teenagers

The problems associated with adolescent pregnancy are well documented and continue to challenge health care providers, community workers, social service personnel, educators, policy makers, and especially the young men and women and their families whose lives are so intimately affected. Problems such as poor educational achievement, poverty, family instability, homelessness, lack of prenatal care, low birthweight infants, and compromised child development persist for adolescent parents and their children. A resource guide provides information concerning adolescent pregnancy, prevention, and care. A substantial number of resources deal with the prevention of adolescent pregnancy because interventions that address the underlying issues and lower the incidence of pregnancy, especially among younger adolescents, are critical to improving the overall health of adolescents. Resources also are included dealing with pregnancy care and parenting education to help assure optimal outcomes for both the adolescent and his or her child. The resource listing is divided into three sections: (1) publications and resource materials; (2) organizations; and (3) commercial educational resources.

Rural youth have unique disadvantages as a result of their isolation and attendant transportation barriers. A program was funded to provide outreach to pregnant teenagers, only half of whom were in school. AOD use was found to be extensive among the girls, particularly in the last 3 months of pregnancy.

Prenatal alcohol education for low-income expectant mothers is discussed, with a focus on an interactive multimedia program called "The Healthy Touch." The program was created using Hypercard (TM) software for the Macintosh SE computer with a touch-sensitive screen. The program is designed for women of low literacy levels and uses simple terms and provides narration throughout. The welfare of the women's babies is the focal point for changing behaviors. The program went through two cycles of field-testing and revision to determine the appropriateness of the content and the acceptability of the computer format, and to evaluate the interactive functions of the program. The program provides health education via photographic, graphic, spoken narrative, and musical modes, with limited on-screen text. It is concluded that the program offers valuable information in a desirable format. The article includes a brief review of the literature addressing the effects of alcohol consumption during pregnancy, intervention strategies, and interactive multimedia as an educational tool.

This chapter describes the Diagnostic and Rehabilitation Center's (DRC) approach to closing the gap in services for women and their children in Philadelphia, PA. The approach included the provision of a safe, supportive, and drug-free residential facility for mothers and their young children and pregnant women. In combination with this residence, it provided outpatient substance abuse treatment, not in the residential facility, but at DRC's main treatment facility. The women in this project are young, minority, urban mothers who are actively struggling with intergenerational cycles of substance abuse, child abuse, disorganized families, and few environmental resources. They are homeless, polydrug-addicted mothers in treatment for alcohol and other drug problems. The service intervention of this project is described, as is the program concept, policy, staffing, criteria for admission, intake information, protocol for clients, initial plan, progress notes, client tracks, resident plan, and aftercare plan.

The Aftercare project, which is in the beginning stages, focuses on 200 formerly homeless recovering women with children. The target population will be randomized into two groups. One group will receive peer support and case management and the other will receive case management alone. Subjects will be followed for 18 months. The case load will consist of one case manager to 15 families. The case management model incorporates a philosophy of empowerment. Several barriers in working with the target population are identified, including the need for life and parenting skills, manipulative coping behaviors, transportation, and the potential for relapse. Roles also are identified for the case manager, including advocate, treatment coordinator, educator, and therapist. Major gaps in services, such as the lack of affordable housing, affordable child care, and material goods, will require advocacy by the case manager.

Other Publications about Poverty and Substance Abuse

Urban poverty and rural development literatures are used to identify the determinants of poverty, resulting in the hypothesis that controlling for household and contextual-level variables would reduce metropolitan (metro) core versus rural differences in the likelihood of poverty. Modeling data from the 1985 wave of the Panel Study of Income Dynamics, rural households have the highest probability of poverty followed by the metro core. Both household and contextual factors were important determinants of the chances of household poverty. However, controlling for these determinants failed to eliminate the greater likelihood of rural versus metro-core poverty. Findings indicate the need for new directions in future poverty research and a reconsideration of the importance of space in sociological theory.

Involving the family in assessing and making decisions about the care and treatment of the troubled adolescent is essential to diminish the estrangement and incursions on sense of competence and confidence that inevitably accompany problems with alcohol and other drug abuse and emotional disturbance. Highly involved and competent families that have the resources to devote to the care of their youngsters may be able to be the major context of treatment, providing supervision for the suicidal, attention to the withdrawn, and limits for the antisocial. On the other hand, families that are seriously impaired by other stresses, such as poverty, mental illness, relocations, job loss, or abuse of alcohol and other drugs, may not be able to care for their youngsters; however, they can be involved in thoughtful decisions about how the youth should be cared for and can maintain meaningful connections with their children throughout treatment. This can be done, however, only if the family is the center of the assessment and treatment plan.

Concerns about family economic insecurity dominated much of the Nation's public discourse during the past year. Stubbornly high levels of joblessness and widespread layoffs have kept millions of parents anxious about their own ability to support their children. Fears of possible job loss have been powerful themes in the push for national health reform and the recent debate on the North American Free Trade Agreement (NAFTA). At the same time, the announcement in 1993 of yet another increase in child poverty during the previous year reaffirmed suspicions that the current economic recovery is not reaching many of America's most vulnerable families. As reports of child abuse and neglect continued to climb, Congress passed significant child protection and family support reforms in the form of a new Family Preservation and Support Services Program and increased funding for preventive community-based mental health services for children. Child care has become a basic necessity for millions of American families. In 1993, 54 percent of mothers with children younger than three years of age, and 64 percent of those with children ages three to five, were in the civilian labor force. And many parents, regardless of whether they require child care because of employment, now want their children to have some kind of preschool experience to help them prepare them for school. Rising teen birth rates, steadily increasing youth violence, and persistent employment and education problems for teens and young adults provided powerful warnings in 1993 that American society cannot afford to allow so many children to drift into unproductive or destructive dead-end paths during their adolescence. The degree to which anxiety about violence permeates children's lives was documented powerfully during the year by several nationwide polls, including one released by the Children's Defense Fund (CDF) and Newsweek magazine in which nearly three-quarters of the surveyed parents and more than half of the children said their top worry is that a loved one would become a victim of a violent crime.

This article focuses on facing the problems confronting children living in the inner cities today. The viewpoints of several speakers at an American Academy of Pediatrics meeting are cited. Creativity, cooperation, and long-term vision will be key in solving the problems, especially those that are preventable or treatable such as low birth weight, injuries, measles, and tuberculosis. One physician argues that in addition to health care financing reform, proven public health measures must be made available and more focused treatment and prevention programs targeted to children and families are needed. Key to such public health measures will be convenient access to medical care. For children and adolescents, the school is a logical location. The primary source of health care for many poor children is the emergency department. Barbara Barlow, MD, chief of pediatric surgery, Harlem Hospital, reported that 1 in 100 children in her community were being admitted with major injuries. With the help of the community, the Harlem Hospital Injury Prevention Program was created. Education about safety was a critical component of the program as were various programs aimed at getting children off of the streets. According to George Foltin, director of the Bellevue Hospital Pediatric Emergency Department, the continued escalation in violence, substance abuse, and poverty cannot be remedied by individual programs or short-term solutions. The only real solutions will be long-term; he called for the implementation of the recommendation of the National Commission on Children.

Federal Resources:

Other Resources: