Running head: Signature Assignment: Research Proposal

Running head: Signature Assignment: Research Proposal 1Signature Assignment: Research Proposal 2

Research ProposalUniversity of South CarolinaTerrell Gunter, Ali Johnson, Nikki Fiore, Chloe Taylor and Farris Jones

IntroductionPurpose:The purpose of this research project is to determine the most effective intervention for adolescent drug and alcohol abuse in the United States. The research project will provide information including statistics about drug and alcohol consumption among children in rural areas verses the drug and alcohol consumption of children the inner cities of the United States. This research project will determine the effectiveness of various alcohol prevention programs for adolescents, and if there is a correlation between the quality of services that are offered in the inner cities of the United States compared to those that reside in the rural areas of the nation. This study involves children in the United States from the age of twelve through twenty. The benefits of this research is to provide information that proves that the adolescents that live in inner cities across the United States are more likely to abuse drugs and alcohol than adolescents the live in rural areas across the nation. According to Clark, "Wilson and Donnermeyer (2006) found that peer influence was a stronger influence on drug use among urban-located youths but did not find any differences for family factors (Clark, 2011, p. 208)." This implies that there is more drug and alcohol abuse for inner city adolescents.Another purpose for this research is to determine if more drug and alcohol prevention programs are needed in the inner cities of the United States verses the rural areas. Should inner cities receive more funding than rural areas? This research project will also examine different drug and alcohol prevention programs of methods available for adolescents in the United States. We will measure our findings with the CRAFFT screening tool which is used to measure drug and alcohol abuse for those that are 21 and under.Significance:The social work profession seeks to determine vulnerable and/or oppressed populations and help alleviate the symptoms of oppression for all individuals (NASW, 2008). The research question presented in this paper seeks to determine a specific group of people suffering from alcohol and drug abuse in South Carolina in the hopes that they may be better served and understood. It is important to correctly determine a specific population that is at risk in order to provide necessary services to them. This research question is relevant to the social work profession in that it will determine a specific group of individuals, based on their environment, that are potentially in need of an intervention and social services. This topic is significant due to the fact that alcohol and drug abuse is a growing trend among adolescents in America that poses serious health risks to themselves and those around them. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), "more than 190,000 people under the age of 21 visited the emergency room for alcohol related injuries in 2008 alone" and the NIAAA also states that "every year in the United States, about 5,000 young people under the age of 21 die as a result of underage drinking" (NIAAA, 2013, p. 1-2). It is crucial to determine specific areas where alcohol and drug abuse is prevalent among adolescents so that we may better address their environment and potential causes for the abuse of alcohol and drugs. If we can determine specific factors that contribute to the consumption of alcohol and use of drugs among underage citizens then we can possess a better understanding of how to address this issue. The scope of this issue in our nation is very large. For this reason, we have narrowed our research down to findings in South Carolina so that we may better address the issue in our local community. According to data from the Pacific Institute for Research and Evaluation (PIRE) "approximately 169,000 underage customers in South Carolina drink each year" (PIRE, 2011, p. 1-2). It later states in this same data document that this rate of underage drinking in South Carolina "leads to substantial harm due to traffic crashes, violent crime, property crime, unintentional injury and risky sex" (PIRE, 2011, p. 2). The consumption of alcohol and use of drugs among adolescents in South Carolina is a vast issue that affects the adolescents consuming alcohol and using drugs and the people around them. By addressing this issue in South Carolina and determining the environment that contributes to the abuse of alcohol and drugs among adolescents, we may be able to better provide necessary services to the environments at risk that can help to prevent this problem. By answering this research question, we will have a better understanding of where to start when determining who is most at risk for underage drinking and use of illegal substances in our state. Once we know the areas that are most affected by this epidemic, proper social services can be initiated or improved in order to correctly address this issue.

Research Design Description of the research design:Research Question: Does the duration of adolescents living in an urban community in South Carolina predict substance abuse scores on the T-ASI scale among adolescents? Independent Variable: The duration of adolescents living in an urban community in South Carolina. Meaning the number of adolescents that reside in an urban setting as opposed to a rural setting. We will measure the independent variable by distributing the T-ASI survey to 50 adolescent in each of the 46 counties in South Carolina. The survey will include an indication of the participants geographic environment this will determine whether the fact that they are living in an urban or rural setting has anything to do with the results of the survey. Dependent Variable: The scores that indicate substance abuse on the T-ASI scale. These scores will give s a clearer picture of whether adolescents are using illegal substances. We will determine the dependent variable by the answers that the participants provide on the T-ASI scale, which is an indicator of substance abuse for adolescents. Hypothesis: The duration of urban residential status of adolescents in South Carolina significantly predicts positive substance abuse scores on the T-ASI scale. Sampling Technique: The sampling technique for this research is a stratified random sample of 2,300 adolescents from each of the 46 counties in South Carolina since the population that s to be tested will be separated into different strata and random samples will be taken from each subpopulation. Twenty-five adolescents in a urban community and twenty-five within a rural community will be selected from each county making each county have 50 adolescents as representation. With this sampling method we would randomly select adolescents from urban and rural public schools. Method of Data Analysis: The method for data analysis in this research design is regression since we are trying to identify the relationship between the residential status of adolescents and the scores of adolescents on the ADI scale in order to make predictions. Tool: A survey would be administered to the adolescents and include the question of how long they were a resident of their location at the time of the survey. This survey would also determine whether the adolescents location is urban or rural. To measure the dependent variable of substance abuse the Adolescent Diagnostic Interview would be used. The T-ASI systematically assesses psychoactive substance use disorders in 12- to 18-year-olds. Based on DSM-III-R criteria, this convenient structured interview also evaluates psychosocial stressors, school and interpersonal functioning, and cognitive impairment. In addition, it screens for specific problems commonly associated with substance abuse" (Kaminer, Y., Burkstein, O.G. & Tarter, R.E., 1991).Method of Data Collection: We will distribute this survey to public schools in South Carolina in person. All persons distributing the survey will be IRB certified in order to conduct proper research. The participants and their parents will be informed that everything on the survey will remain completely confidential and only used for the purposes of research. Participants may also choose to stop the survey at any time or keep their results from being used in research if they change their minds. Cultural Sensitivity: We will be distributing this survey to all adolescents (ages 12-20) willing to participate regardless of their race, class, or gender. Being IRB certified, we are fully aware, as researchers, the need to be culturally sensitive and respectful of every participants background in order to obtain unbiased research. Reliability and Validity: The T-ASI scale itself has been tested for reliability and validity. According to Kaminer, Y., Burkstein, O.G. & Tarter, R.E. (1991), the measures of reliability that were used for this scale are test-retest and interrator agreement and internal consistency. The measures of validity of this scale are content and construct. Strengths and weaknesses including threats to internal validity:A threat to the internal validity of this design is the fact that adolescents can be dishonest about the use of drugs and alcohol out of fear of getting in trouble. In an attempt to eliminate this weakness, a strength of this survey is that it will remain confidential and will only taken for the purposes of research. The participants will be informed of their confidentiality when completing this assessment. Another threat to the validity of this scale is that it is dated since it was published in 19931 The reliability of this measure will increase if it is given on a yearly basis so that it may be sensitive to time changes. A strength of this assessment that reduces this threat to validity is that it can be repeated or expanded as necessary. For example, you can test up to as many random participants as necessary between any urban or rural location in South Carolina in order to obtain a better knowledge of the use of illegal substances among adolescents across the whole state. Explain why this research design is the best option:We feel that this research design will be the best option due to the fact that we will be able to proportionately observe the amount of substance abuse that is taking place between two distinct geographic environments in order to predict the relationship between environment and substance abuse among adolescents living in the state of South Carolina. Conceptual Model:SEE APPENDIX AThis logic model is the theoretical framework for our research design. Obviously there are many factors that can contribute to the use of alcohol and drugs among adolescents other than geographic location, and it is important to look into the bigger picture of what is happening. This is why we have designed a logic model in order to observe the different factors that contribute to our dependent variable. Once we are able to observe the flow of factors contributing to the problem that we are observing, we can design and observe programs that will better fit the situation and gain a broader and clearer perspective of the use of drugs and alcohol among adolescents living in South Carolina.Literature Review The goal of the literature review is to summarize research findings on adolescent alcohol and drug use in rural and urban communities. Another goal is to apply theories to the research findings to give a frame of reference. The effort to divide the literature into sections will show recognition of the different key concepts that are present and should be acknowledged in a study that focuses both on adolescent substance abuse and the adolescents environment. The independent variable in the research is the duration of time of where the adolescent is residing is defined as being either urban or rural. Theories applied from our research are the social disorganization theory and social learning theory. Social disorganization theory asserts that negative behavior is more likely in environments that lack structure and social control (Nasim, A., Fernander, A., Townsend, T. G., Corona, R., & Belgrave, F. Z., 2011). Social learning theory is the concept of learning a certain behavior by observing others and was created by Albert Bandura. Adolescent Drug and Alcohol Abuse/Dependent Variable In our research the life stage of adolescent is defined as anyone ranging from age twelve to twenty-one. The independent variable of substance abuse is defined by the National Institute on Drug Abuse as any illicit use of a substance as drug abuse. Drug abuse also includes the nonmedical use of prescription drugs. Social risk factors are the most prevalent causes of adolescent substance abuse according to authors Kaylen and Pridemore. Factors such as poverty, economic and residential instability, family disruption, and community violence leave youth vulnerable for engaging in risky behaviors, including substance use and abuse (Kaylen, M. T., & Pridemore, W.,2011). Family conflict and the relationship between the parent and adolescent are key factors resulting in involvement in substance abuse. Family risk factors include inadequate parental supervision, poor communication, family tension and conflicts, inconsistent or unduly severe parental discipline, broken homes, and family history of parental alcohol or drug abuse (Kaylen, 2011). One author stated that families might differ in communication, sanctions, and involvement based on their geographic location. For example families in more rural areas my be more involved with their adolescent children and concerned about staying within the normative bounds of behavior as prescribed by their specific community (Rioux, A. R., & Hollist, D. R. 2010). According to the literature parents do not know how common substance abuse is among adolescents. Family structure, such as a two parents or single parent seem to have strong influences on whether an adolescent engages in substance abuse as well. Those who had two parents were less likely abuse alcohol or drugs according to the research. Individual risk factors are also predominant when determining why adolescents involve themselves in risky behaviors. Some of these factors include history aggressive behavior; history of physical or sexual abuse, emotional, social, or academic difficulties, impulsivity, unstable emotions, and low perception of the dangers inherent in drug use (Ali, S., Mouton, C. P., Jabeen, S., Ofoemezie, E., Bailey, R. K., Shahid, M., & Zeng, Q. 2011). Other important risk factors include low socioeconomic status, living in a high crime and drug-use neighborhood, drug availability, peer pressure, level of education and history of mental illness. Adolescent Substance Abuse and Theory Peer influence was also a predominant factor for adolescent substance abuse within the literature. Social learning theory suggests that the likelihood of substance use will be high in those situations where the perceived rewards associated with the practice are high and the costs associated with substance use are low. Thus, substance use is part of a learning process where youths learn the benefits and punishments both indirectly through observing the reactions to the use of others and directly through their interactions with others and others favorable or unfavorable reactions to their own use (Rioux, 2010). This theory is related back to dependent variable of substance because based on the adolescents community they will learn certain norms including drug use. The literature emphasized how positive adult influences decreased the chances of adolescence being involved in risky behaviors. To relate back to the independent variable of location in our research we used the social disorganization theory. In a study with social disorganization theory it stated that more affluent areas, neighborhoods with high rates of poverty are likely to have higher rates of violence, more unemployed residents, more visible displays of crime, cultural norms more favorable to deviance and more commercial access to alcohol and tobacco. Social disorganization theories emphasize that youth delinquency is not equally distributed across communities but rather is clustered in more disadvantaged areas (Pinchevsky, G. M., Fagan, A., & Wright, E., 2010). Environmental Influences: Rural vs. Urban/ Independent Variable The most widely debated factor in the literature was whether living in a rural community or urban community influenced adolescents to engage in substance abuse. According to the National Center on Addiction and Substance Abuse, the rate of drug, alcohol and nicotine use among teens in rural America is now higher than in the nations larger centers. Adjacency of rural to urban areas is important because of the influence that urban areas may have on rural areas in terms of increasing the supply of drugs, providing educational and economic opportunities, and promoting cultural influences (Lambert, D., Gale, J. A., & Hartley, D. 2008).Discussion:Program Description:The proposed program preceding our study will be a drug and alcohol educational program for South Carolinas public schools.The services provided in the proposed program are to include alcohol and substance abuse prevention programming for adolescents in the communities found to be most at risk in South Carolina. This will take the form of classes/seminars provided for grade schools and in local community centers, and maybe even a designated alcohol and drug type counselor/social worker placed in each school in at-risk areas that are accessible for children living in at-risk environments. A primary factor of the use of alcohol and drugs among adolescents is a lack of substance abuse education or support in certain areas of South Carolina. By eliminating this factor, we will be able to, hopefully, greatly decrease the effects of this issue. The characteristics of clients served will include the characteristics of the population addressed in the research question: between the ages of 12 and 20, living in South Carolina, and residing in the environment which proves to promote a higher use of alcohol and drug abuse (either rural or inner-city areas. Basically, this means that programming will be promoted in the area that turns out to need it the most for adolescents in South Carolina who are both abusing alcohol and drugs or at risk for abusing alcohol and drugs. Ideally, these services will be provided through government funding. The funding will be a part of public education funding. If this is not substantial funding then more money can be obtained through grants. The services will be free for students who are attending public schools, it will be worked in as a part of their school curriculum or education.There is a program similar to the one laid out in our program description called "D.A.R.E". Ideally, our program proposal would be similar to this program, but mandated for all schools in South Carolina. The long-term goal for this program will be to increase awareness and education about the use of drugs and alcohol for all of South Carolina's youth in the hopes of the prevention of drug and alcohol abuse and relief from the use of drugs and alcohol use. Sampling Design:As mentioned in the research design, we will sample 2,300 random participants who meet the criteria of our target population; ages 12-20 and residents of South Carolina. They will be both male and female, and between the ages 12 and 20. The reason we have chosen these ages is that they must be at least 12 years old but not older than 21 to be considered an adolescent. We will be using the stratified random sampling method. Stratification is the process of grouping members of the population into relatively homogeneous subgroups before sampling. (Princeton University) This just means that since were are sampling from different geographical locations such as urban and rural areas, that we are dividing them into subgroups to make the process more reliable. One of the strengths of stratified sampling is its organization. Keeping the different groups separated will help everything stay organized and easy to understand, which will ultimately lead to less mistakes on our part. Also, since it will be randomly distributed, it will be unbiased. Another strength is representativeness, because it will be easy to determine whether or not the participants represent a certain population as long as we know their residence. However, there are some weaknesses that come along with this sampling method. Probably the greatest weakness is validity. As also stated in the research design portion, we cannot guarantee that all the participants will take our survey seriously and answer the questions honestly. They may also be hesitant to answer the questions because they will be asked about certain illegal behaviors concerning alcohol and drug use, and they may be afraid of getting into legal trouble. Protection of Research Subjects:For the protection of our research subjects, we will emphasize the voluntary participation principle. In other words, well will explain to our subjects that they are not required or mandated to participate and have the choice to refuse to in this research project. Our participants will be aware of the fact that the nine-item questionnaire given will be administered to them on their approval. As far as informed consent, we will make sure that our subjects are aware of the actions that will be conducted during the process of which they participate. We will ensure that our subjects realize that the information that we gain from the data collected will be used solely for the purpose of measuring the level of substance abuse in rural Orangeburg County vs. urban Richland County. This involves educating our subjects on the likely risks that could very well occur given the fact that they participate. Benefits that may result from protecting our research subjects are that the subjects may be more likely to give accurate data. If our participants feel as though we are not going to protect them and keep the data confidential, then they may not answer the questions honestly in fear of some form of penalty for using alcohol or illegal drugs, especially since all participants are under the age of 21. Confidentiality is very important when regarding human subjects because if they feel as though the data you are recording will be shared with an outside party, their choice to give false information/answers can sabotage the results of your study. Further Research in the Future:This research design is ideal because it can be redistributed on a regular basis. The survey can be administered every year in order to compare results across time and see if the proposed program design has had any affect on the dependent variable. This research design could also be applicable in any state that one is wishing to study the correlation of an urban setting and adolescents scores on the T-ASI scale. Ideas for further research would include redistributing this research design every year to a different pool of random participants in order to increase the reliability of the study across time. This survey can also be administered in a different state and work just as effectively.ReferencesAli, S., Mouton, C. P., Jabeen, S., Ofoemezie, E., Bailey, R. K., Shahid, M., & Zeng, Q. (2011). Early detection of illicit drug use in teenagers. Innovations In Clinical Neuroscience, 8(12), 24-28.Kaminer, Y., Burkstein, O.G. & Tarter, R.E. (1991). The Teen Addiction Severity Index: Rationale and reliability. The International Journal of the Addictions,26, 219-226. Kaylen, M. T., & Pridemore, W. (2011). A Reassessment of the Association Between Social Disorganization and Youth Violence in Rural Areas. Social Science Quarterly (Wiley-Blackwell), 92(4), 978-1001. doi:10.1111/j.1540-6237.2011.00808.xLambert, D., Gale, J. A., & Hartley, D. (2008). Substance abuse by youth and young adults in rural America. The Journal Of Rural Health, 24(3), 221-228. doi:10.1111/j.1748-0361.2008.00162.xNasim, A., Fernander, A., Townsend, T. G., Corona, R., & Belgrave, F. Z. (2011). Cultural protective factors for community risks and substance use among rural African American adolescents. Journal Of Ethnicity In Substance Abuse, 10(4), 316-336. doi:10.1080/15332640.2011.623510Pinchevsky, G. M., Fagan, A., & Wright, E. (2010). Racial/Ethnic Differences in the Relationship Between Neighborhood Disadvantage and Adolescent Substance Use.Journal of Drug Issues, 69-84.Rioux, A. R., & Hollist, D. R. (2010). Community, family, and peer influences on alcohol, marijuana, and illicit drug use among a sample of Native American youth: An analysis of predictive factors. Journal Of Ethnicity In Substance Abuse, 9(4), 260-283.Children's Hospital Boston. 2009. The CRAFFT Screening Interview. Retrieved from www.caesar-boston.org/CRAFFT/pdf/CRAFFT_English.pdf National Institute on Alcohol Abuse and Alcoholism. July (2013). Underage Drinking [Data file]. Retrieved from pubs.niaaa.nih.gov/publications/UnderageDrinking/Underage_Fact.pdf Pacific Institute for Research and Evaluation. September (2011). Underage Drinking in South Carolina: The Facts [Data file]. Retrieved from www.udetc.org/factsheets/SC.pdf STORY:. (n.d.). Princeton University. Retrieved April 29, 2014, from http://www.princeton.eduWinters, K. & Henly, G. Adolescent Diagnostic Interview (ADI) Manual. Los Angeles, CA: Western Psychological Services, 1993. Workers, N. A. (2008). NASW Code of Ethics (Guide to the Everyday Professional Conduct of Social Workers). Washington, DC: NASW. Clark, Trenette T.; Nguyen, Anh B.; Faye Z (2011). Journal of Child & Adolescent Substance Abuse. Risk and Protective Factors for Alcohol and Marijuana Use Among African-American Rural and Urban Adolescents. Vol. 20 Issue 3, P 205-220. 4 Charts.

Appendices:Appendix A: Conceptual Model Single Parent vs two parent household Education on preventative resources School Systems Community in which adolescent lives Family history with addiction and substance abuses Access to drugs and alcohol Peer Pressure Gang Involvement Parental influence on teens development and decisions Substance abuse among adolescents in rural and urban communities in South Carolina

Appendix BSCALE USED FOR MEASUREMENTA copy of the T-ASI can be accessed at this link: http://www.emcdda.europa.eu/attachements.cfm/att_4008_EN_tt-asi.pdf