PCP April 2013 Issue-1

PREVENTION IN
COUNSELING PSYCHOLOGY:
THEORY, RESEARCH, PRACTICE AND TRAINING
A Publication of Prevention Section in Division 17 of American Psychological Association
Volume 6 Issue 1 April 2013
Photo by Erin Sadler, http://www.erinsadler.com

Prevention in Counseling Psychology: Theory, Research, Practice and Training is a publication of the Preven-
tion Section of the Society for Counseling Psychology. The publication is dedicated to the dissemination of information on
prevention theory, research, practice and training in counseling psychology, stimulating prevention scholarship, promoting
collaboration between counseling psychologists engaged in prevention, and encourages student scholars. The publication
focuses on prevention in specific domains (e.g., college campuses) employing specific modalities (e.g., group work), and
reports summaries of epidemiological and preventive intervention research. All submissions to the publication undergo
blind review by an editorial board jury, and those selected for publication are distributed nationally through electronic and
hard copies.
Editorial Board Chair

Michael Waldo
New Mexico State University
Managing Editor
Julie M. Koch
Oklahoma State University
Production Editor
Jonathan P. Schwartz
Associate Editor
Cynthia A. Unger
Members of the Editorial Board

Aimee Arikian, University of Minnesota
Kimberly Burdine, Oklahoma State University
Stephanie Chapman, Baylor College of Medicine
Simon Chung, University at Albany
Michael Gale, University at Albany
Michelle Murray, University at Albany
Submission Guidelines
The Prevention Section of the Society of Counseling Psychology publishes Prevention in Counseling Psychology: Theory, Re-
search, Practice and Training. This is a blind peer-reviewed publication presenting scholarly work in the field of prevention
that is distributed nationally. Contributions can focus on prevention theory, research, practice or training, or a combina-
tion of these topics. We welcome student submissions. As a publication of the Prevention Section of Division 17, presenta-
tions and awards sponsored by the section will be highlighted in these issues. We will also publish condensed reviews of
research or theoretical work pertaining to the field of prevention. All submissions need to clearly articulate the prevention
nature of the work. Submissions to this publication need to conform to APA style. All submissions must be electronically
submitted. Please send your documents prepared for blind review with a cover letter including all identifying information
for our records. Submissions should be emailed to Julie Koch, Managing Editor, at julie.koch@okstate.edu.
2 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2013, Vol. 6, No. 1
Volume 6 April
Issue 1
PREVENTION IN 2013
COUNSELING PSYCHOLOGY
Section News
Message from the Chair 4
LeRoy Reese
Greetings from the Editorial Board 5

Editorial Board
Message from Your Graduate Student Representative 6

Erin Ring
Theory, Research, Practice and Training

Investigating Gender Differences in PTSD, Depression, and
Substance Use Disorders Among OEF/OIF Veterans 7
Kathryn E. Tichy, Laurel A. Copeland, & Jack Y. Tsan
Preventing Attrition of Minority Counseling Psychology Graduate

Students: The Value of Feminist and Relational Cultural Advising 9
Brittan Davis, Tiffany Williams, & Sneha Pitre
Accuracy of Parents Beliefs about Their College Student Childrens

Pre-Existing Substance Use Behaviors and Expectations at the Start of College 12
Jason A. Parcover & Joshua N. Semiatin
Social Responsibility in Psychology Today: Prevention is Imperative 19

Adrienne M. Dugger
The Role of the Family in Enhancing Positive Development in Rural LGB Youth 21
Jennifer Glass, Sarah L. Hastings, Tracy J. Cohn, & Thomas W. Pierce
Prevention Abstracts
Marijuana and College Counseling Center Clients: Risk and
Protective Factors of Marijuana Use Disorders 27
Laura L. Holt & Ellen L. Vaughan
Saving Our Sisters: Effects of a Computer-based Version of SISTA 28

Krystal S. Frieson
Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2013, Vol. 6, No. 1 3
Section News
Message from the Chair

LeRoy Reese
Morehouse School of Medicine
Dear Colleagues,
Thank you for taking time to read the important contributions offered in this issue of Prevention in Counseling Psycholo-
gy: Theory, Research, Practice and Training. As you read these contributions, we ask that you consider submitting your
work to the publication.
In the last issue, I encouraged each of you to review the current federal legislative language regarding the prevention pri-
orities established by the Department of Health and Human Services as it provided instructive guidance about the gov-
ernments direction regarding prevention and health promotion. Since that time, the Affordable Care Act signed into law
by the President has successfully withstood a challenge through the United State Supreme Court establishing its constitu-
tionality albeit with some important caveats. This action by the Court presents a number of important opportunities for
those of us interested and committed to prevention, health equity and a healthy citizenry.
I have come to understand and believe that change often happens first at the local level and there are hundreds of im-
portant examples that support this observation. At the same time, I have seen both the positive and negative impact of
politics on local efforts to change, improve and help. With this in mind, I hope to use opportunities such as the Message
from the Chair to identify opportunities for us to advance our efforts as change agents. As an example, at my institution,
the passing of the Affordable Care Act initiated a series of educational seminars for our faculty, both teaching and those
engaged in clinical practice for the purpose of understanding what the Act might mean for the communities we serve and
the patients under our care. Consistent with our mission there was significant attention given to our work in primary
care settings specifically related to preventive screenings and behavioral health. At the seminar I attended, a colleague
asked whether there was any effort locally or otherwise to educate community members about the provisions of the new
law. No one in the room could answer this question, yet my colleagues resolved to address this by organizing communi-
ty forums for Question and Answer sessions, creating one-pager handouts for distribution at our clinics and through the
health department. The Act provides for fairly robust mental health and preventive services, thus this is also an oppor-
tunity for us to be resources and advocates for our constituents. To that end, I encourage you to ask what it is we can
do to educate ourselves and our communities about the provisions of this Act. In 1899, W.E.B. DuBois offered this
challenge, We must endeavor to eliminate, so far as possible, the problem elements which make a difference in health
among people. Here is another opportunity to move in that direction.
Peace and progress!
Section News
Greetings from the Editorial Board

Welcome to Volume 6 of Prevention in Counseling Psychology: Theory, Research, Practice, and Training, the
publication of the Prevention Section of the Society of Counseling Psychology. The goal of this publication is
to promote prevention theory and research. There are compelling reasons that should lead prevention to the
forefront of our profession. The supply and demand imbalance related to mental health services is prominent.
We believe it is important to think about how to utilize prevention to both prevent unnecessary suffering as
well as to meet ever growing mental health needs.
In this issue Tichy, Copeland and Tsan explore the important issue of gender differences among veterans in
PTSD, depression and substance use disorders. We are also pleased to showcase the work of Davis, Williams,
& Pitre, who reviewed the literature on preventing attrition of minority graduate students through advising,
using a feminist and relational cultural approach.
Next, we feature empirical research by Parcover & Semiatin, who studied the accuracy of parental perception
of college-bound students substance use behaviors during the year before entering college. Their work re-
vealed important discrepancies between parents and students regarding communication about and consequenc-
es of substance use in this population.
Finally, Glass, Hastings, Cohn, & Pierce provide a review of sexual minority youths family influences on the
coming out process.
We continue to accept manuscripts addressing prevention theory, research, practice and training. We encour-
age you to submit your own work for our next issue to Julie Koch, Managing Editor, at Ju-
lie.koch@okstate.edu. The deadline for our Summer 2013 issue is May 15th, 2013.
Section News
Message from Your Graduate Student Representative

Erin Ring
University at Albany
I would like to extend a warm welcome to the students reading this issue of Prevention in Counseling Psychol-
ogy: Theory, Research, Practice, and Training. We appreciate your enthusiasm for the field of prevention, and
hope the articles in this issue speak to your interests as students, researchers, and professionals!
The past several years have been very exciting for professionals in the field of prevention, and we anticipate
more excitement to come. Scholars in the health sciences and social sciences continue to draw attention to is-
sues that are relevant to prevention, as evidenced by initiatives promoting violence prevention, bullying pre-
vention, and obesity prevention in todays youth. As the field continues to grow, it will become increasingly
important to hear from students and new professionals in the field who can contribute their knowledge to pre-
vention in counseling psychology.
If you are currently working on, or have recently finished, prevention research in psychology, we encourage
you to submit an abstract or manuscript to our journal. Prevention is a large and interdisciplinary field, so we
value research on a variety of issues and encourage collaboration with professionals in other fields. Should
you have any questions about potential contributions, please contact the Managing Editor, Julie Koch, who can
provide you with more information (Julie.koch@okstate.edu).
Finally, if you have not yet joined Division 17s Prevention Section and/or are interested in learning some
more about the field, please do not hesitate to contact me (ering@albany.edu), or any of the other officers in
the section. We also encourage you to join the listserv, share resources and information, and participate in
some of the discussions. Our section members and officers have a strong commitment to student involvement,
and we always welcome new perspectives and feedback from students and new members.
Investigating Gender Differences in PTSD, Depression,

and Substance Use Disorders Among OEF/OIF Veterans
Kathryn E. Tichy Jack Y. Tsan

Laurel A. Copeland VA Texas Valley Costal Bend Health Care System
Central Texas Veterans Health Care System
Women comprise 14% of the active-duty military force Health Follow Through after Primary Care, were studied via da-
and an increasing proportion of new users in the Veterans Health tabase abstraction and chart review. Clinical mental health diag-
Administration (VA) (Yano et al., 2010). Womens experiences noses were assessed using ICD-9-CM diagnostic codes. Demo-
of trauma and stress correlate with negative mental health out- graphic variables included age, sex, marital status, and combat
comes, most notably PTSD, depression, and substance abuse. exposure. Separate multivariable logistic regression models ex-
There is some evidence that women are more likely to have amined associations between gender and each of the three diag-
comorbid PTSD and depression (Maguen et al., 2012), while men noses, Post-traumatic stress disorder (PTSD, ICD 309.81), major
have a higher prevalence of comorbid PTSD and substance use depressive disorder (MDD, ICD 296.2, 296.3, & 311), and sub-
disorders (Maguen, Ren, Bosch, Marmar, & Seal, 2010). Several stance use disorder (SUD, ICD 303.0-305.8, excluding 305.1),
factors have been identified that play an important role in risk for adjusting for covariates. Bivariate chi-square analyses explored
post-deployment mental health problems. One recent study found PTSD+SUD, PTSD+MDD, and MDD+SUD co-occurring combi-
that among Veterans with psychiatric conditions, women are at nations by gender.
greater risk for depression after experiencing combat exposure Of the 513 participants, 19% (n = 97) were women.
when compared to male counterparts (Luxton, Skopp, & Maguen, Women averaged 36.9 years (SD = 8.6) and men, 35.8 years (SD
2010). Lower levels of relational support (i.e. unmarried) are as- = 8.2; t+ -1.22; p = 0.23). Significantly fewer women were diag-
sociated with heightened symptoms of PTSD and depression nosed with PTSD (X 2=7.2 df=1, p < 0.01). Men were more likely
(Lapierre, Schwegler, & Labauve, 2007). Although no gender to be diagnosed with SUD (X 2=5.2 df=1, p < 0.05). As anticipat-
differences were examined, a similar effect may be found among ed, co-occurring PTSD+SUD was more prevalent among men
women. (X2=5.4 df=1, p=0.02). Other bivariate associations were not sig-
Womens health care is a priority area for VA. Investi- nificant. Relative odds of being diagnosed with SUD decreased
gating potential gender differences, as well as associated demo- with increasing age, by about 3% per year cumulatively
graphic characteristics, for common conditions seen in primary (OR=0.97; 95% CI 0.94-<1.0). After adjusting for combat expo-
care may assist with planning of appropriate mental health treat- sure and demographics, gender was no longer associated with
ment programs (Schnurr et al., 2007). The purpose of this sec- SUD. The variables in the multivariable model were not signifi-
ondary data analysis, as part of an ongoing study, was to examine cantly associated with MDD. Relative odds of PTSD diagnosis
gender differences in post-deployment rates of individual and co- were lower for women by a factor of about 2 (OR=0.50, 95% CI
occurring PTSD, substance use, and depression in a cohort of 0.31-<0.80). Relative odds of diagnosis with PTSD also de-
OEF/OIF Veterans in the Central Texas Health Care System creased by about 3% cumulatively per year older (OR=0.97; 95%
(CTVHCS). CI 0.95-<1.0).
The study identified 513 OEF/OIF Veterans who re- Consistent with existing literature (Maguen, Ren, Bosch,
ceived health services between August 1st, 2006 and September Marmar, & Seal, 2010), male Veterans were more likely to have
2nd, 2009. All patients were referred to mental health treatment co-occurring PTSD+SUD than women. Given that male Veterans
from either a primary or specialty care visit within the study peri- exhibit a high rate of comorbidity, development of early interven-
od. OEF/OIF Veterans enrolled in the project, Specialty Mental tions may be useful. Significantly fewer women were diagnosed
with PTSD or SUD. Although no significant gender differences
were found between PTSD+MDD, or MDD+SUD, the co-
Correspondence concerning this article should be directed
occurrence of PTSD+MDD is similar between men (26%) and
to:
women (25%). Future research should identify risk factors that
mediate the relationship between gender and comorbidity. Gener-
Jack Y. Tsan, Harlingen VA Outpatient Clinic, VA Texas
alizability is limited since this sample includes those receiving
Valley Coastal Bend Health Care System, 2106 Treasure
services in primary care or specialty mental health clinics, and
Hills Blvd., Harlingen, TX 78550. Email:
does not include Veterans who never received VA services.
jacktsan@va.gov
Overall, understanding gender and comorbidities among re-
turning Veterans receiving VA care can inform policy and treat-
Investigating Gender Differences
ment. The need for this information is critical to incorporate a

gender sensitive approach to treatment.
References
Lapierre, C. B., Schwegler, A. F., LaBauve, B. J. (2007). Post-

traumatic stress and depression symptoms in soldiers retur-
ning from combat operations in Iraq and Afghanistan. Jour-
nal of Traumatic Stress, 20, 933-943. doi: 10.10002/
jts.20278
Luxton, D. D., Skopp, N. A., & Maguen, S. (2010). Gender dif-
ferences in depression and PTSD symptoms following com-
bat exposure. Depression & A nxiety, 27, 1027-1033. doi:
10.1002/da.20730
Maguen, S., Cohen, B., Cohen, G., Madden, E., Bertenthal, D., &
Seal, K. (2012). Gender differences in health service utiliza-
tion among Iraq and Afghanistan veterans with posttraumatic
stress disorder. Journal Of W omen's Health, 21, 666-673.
Maguen, S., Ren, L., Bosch, J. O., Marmar, C. R., & Seal, K. H.
(2010) Gender differences in mental health diagnoses among
Iraq and Afghanistan veterans enrolled in Veterans Affairs
health Care. A merican Journal of Public Health, 100, 2450-
2456.
Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E.B., Shea, M.
T., Chow, B. K., et al. (2007) Cognitive behavioral therapy
for posttraumatic stress disorder in women: A randomized
controlled trial. Journal of the A merican Medical A ssocia-
tion, 297, 820-830. doi:10.1001/jama.297.8.820
Yano, E. M., Hayes, P., Wright, S., Schnurr, P.P., Lipson, L.,
Bean-Mayberry, B., et al. (2010). Integration of women vet-
erans into VA quality improvement research efforts: What
researchers need to know. Journal of General Internal Medi-
cine, 25, 56-61.
This work was supported by Department of Veterans Affairs, Ad-

vanced Fellowship Program in Mental Illness Research and
Treatment, VISN 17 New Investigator Award (PI: Jack Y. Tsan;
Site PI: Lianna D. Evans), APA Division 17 Prevention Section
Research Grant (PI: Jack Y. Tsan), VA VISN 17 Center of Excel-
lence for Research on Returning War Veterans, Center for Ap-
plied Health Research, and Central Texas Veterans Health Care
System. Additional support was provided by David Greenawalt
in editing and verifying the analyses during the development of
this article.
Preventing Attrition of Minority Counseling Psychology Graduate

Students: The Value of Feminist and Relational Cultural Advising
Brittan Davis, Tiffany Williams, & Sneha Pitre
Cleveland State University
Preventing Graduate Student Attrition this abstract, we will only briefly discuss three minority student
groups: (a) lesbian, gay, bisexual, transgender, and queer
The most common concerns that contribute to early de- (LGBTQ), (b) African American women, and (c) international
parture from doctoral programs include, but are not limited to, students. Also, we acknowledge that two or all three of these
time management, various dimensions of graduate work (e.g. identities may intersect, but due to the terse nature of this submis-
coursework), dissertation research, financial commitments, man- sion, the unique stressors inherent within each of the aforemen-
agement of work-family-school balance, and difficulty establish- tioned minority groups will be discussed without addressing the
ing relationships with faculty (Schlemper, 2011). The Council of added complexity and stress associated with the embodiment of
Graduate Schools (CGS) has received a grant from the National more than one of the discussed minority identities.
Science Foundation (NSF grant
#1138814) to fund the Doctoral Initiative on Minority Attrition Lesbian, Gay, Bisexual, Transgender, and Queer Students
and Completion in order to assess and assist minority students in LGBTQ students and faculty continue to be an underrepre-
completing doctoral education, which is intended to reduce attri- sented group in academia, which remains rather negative and
tion within the STEM (Science, Technology, Engineering, and sometimes hostile in regards to LGBTQ issues (Bidell, Turner, &
Mathematics) fields (Council of Graduate Schools, 2012). Alt- Casas, 2002). For instance, Pilkington and Cantor (1996) found
hough counseling psychology programs can be housed in either that the majority (97%) of LGB identified psychology trainees
colleges of education or colleges of science (psychology depart- experienced heterosexual bias and discrimination within their
ments), data pertaining to attrition within counseling psychology professional psychology programs and during their supervised
programs is lacking within the literature. practica. Such negative experiences are often exacerbated as
Despite this dearth of literature on attrition rates within LGBTQ students remain the only group of students that are con-
counseling psychology programs, on the whole graduate student fronted with blatant and legal discrimination (Schlosser, Talley-
attrition is a significant problem, as it has been reported to be as rand, Lyons, Kim, & Johnson, 2011). Furthermore, given the in-
high as 40-50%, which far exceeds that of undergraduate pro- visibility of their LGBTQ identity, such students are in the con-
grams at10-20% (Bowen & Rudenstine, 1992; Golde, 2005). As stant state of disclosing or concealing their identity, sometimes
such, minority students face additional stressors related to dis- leading to emotional turmoil and isolation. Such torment and iso-
crimination, stereotypes, microaggressions, and feelings of isola- lation is only made worse in that LGBTQ students often have to
tion, which contribute to high rates of attrition (Baumgartner & work hard to find open LGBTQ faculty member or LGBTQ-
Johnson-Bailey, 2010; Torres, Driscoll, & Burrow, 2010). How- affirmative faculty that are willing to serve as advisors and men-
ever, family support, a positive school environment (e.g., positive tors (Schlosser et al., 2011). LGBTQ-affirmative mentoring and
relationships with advisors, mentors, and peers), and community advising is an essential component in promoting retention of
(e.g., religious groups, peers from country of origin, LGBTQ LGBTQ students, since they are exposed to a great deal of heter-
community, etc.) can foster resiliency in minority graduate stu- osexist and stereotypical remarks made by texts, instructors, su-
dents. Zalaquett (2006) found that having supportive families that pervisors, and peers (Pilkington & Cantor, 1996). Additionally,
value education could promote academic resilience in Latino/a LGBTQ students often experience lack of support within aca-
college students. Furthermore, positive relationships with men- demia and are often discouraged from pursuing LGBTQ research
tors has been shown to increase retention rates for minority grad- interests (Pilkington & Cantor, 1996). Therefore, an LGBTQ-
uate students (Hoskins & Goldberg, 2005; Patton & Harper, affirmative counseling psychology training program that includes
2003). Although there are many groups of minority students that the presence of faculty conducting research on LGBTQ issues, an
are confronted with these additional stressors, due to brevity of integration of LGBTQ issues into courses, and LGBTQ-
affirmative advising and mentoring can better support LGBTQ-
Correspondence concerning this article should be directed identified students, minimize attrition, and further promote the
to: multiculturalism that is central to counseling psychology
(Phillips, 2000).
Brittan Davis, M.Ed., at Cleveland State University: brit-
tanleedavis@gmail.com. African American Female Students
Many minorities report their doctoral education experience
Preventing Attrition of Minority Graduate Students
as oppressive and dehumanizing as they learn to navigate and ne- and mentorship is evident. Advising is a very personal relation-
gotiate the social world of their graduate program (Gildersleeve, ship due to the emphasis on personal and clinical development of
Croom, & Vasquez, 2011). Such minority students, specifically the advisee (Nelson, Gizara, Hope, Phelps, Steward, & Weit-
African Americans, must learn to manage the many cultural and zman, 2006). When racial, gender, and cultural differences exist
structural forces, in addition to the racism and discrimination, in the advisory relationship, it can create a power imbalance,
which are deeply embedded within the institution of the academe which can lead to further oppression and marginalization. This
(Wilson, 2009). Moreover, African American women face addi- influence of power in any social context is central to feminist
tional challenges in higher education, given the necessity to learn scholarship on relationships (Porter & Vazquez, 1997). Tradition-
ways of navigating the privileged world of doctoral education al models of advising, which are directive and hierarchical in na-
while learning to negotiate their intersecting identity of gender, ture, minimize the unique needs that women, people of color, and
race, and being a doctoral student (Collins, 1998). As such, Afri- LGBTQ students may have in comparison to their White male
can American women are more likely to experience discrimina- counterparts (Colley, 2002). However, within feminist multicul-
tion as a result of the multiple oppressed identities they possess tural mentoring, evaluative components of the relationship are
and they often struggle finding companionship due to the small discussed, mutual empathy and empowerment is encouraged,
number of African American females pursing doctoral education shared caretaking with a healthy degree of reciprocity is support-
(Blake, 1999). Therefore, African American women in counsel- ed, and authenticity is promoted (Benishek, Bieschke, Park, &
ing psychology doctoral programs would benefit greatly from re- Slattery, 2004). Additionally, feminist mentoring models empha-
lational-cultural (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991) size the importance of relationship for the mentor and mentee,
and feminist multicultural models of mentoring and advising. while focusing on issues of power and mutual empowerment
Such models of advising put a mutually empowering and com- through a nonhierarchical relationship (Fassinger, 1997).
passionate relationship at the fore, providing a safe space to sup- Furthermore, Relational Cultural Theory (RCT; Miller,
port African American women doctoral students in their ascent 1976), as it would apply to advising or mentoring relationships,
up the rungs of academia. Through the relational quality of femi- stresses the importance of understanding and valuing the contex-
nist multicultural and relational-cultural models of mentoring and tual and relational experiences of marginalized individuals. Core
advising, the open, authentic, and mutually supportive mentoring RCT tenets to incorporate into their relationships with advisees
relationships could help African American women cope with and mentees include: (1) growing toward and through relation-
their experiences of discrimination, empower them to persevere ship, (2) mature functioning through mutuality, (3) psychological
throughout their graduate education, and encourage them to be- growth through engaging in complex relationships, (4) emphasiz-
come successful professionals and leaders post-graduation ing mutual empowerment and empathy, (5) authenticity within
(Blake, 1999). such relationships, (6) growth happens by participating in such
growth-fostering relationships, and (7) the goal is to increase re-
International Students lational competence throughout life (Comstock, Hammer,
With growing attention to the internationalization of counsel- Strentzsch, Cannon, Parsons, & Salazar, 2008). Such feminist
ing psychology in the past decade, discussion on effective train- and relational models of advising and mentoring can provide the
ing of international students is much needed (Park-Saltzman, Wa- needed support for minority counseling psychology students to
da, & Mogami, 2012). International students experience a variety buffer the effects of discrimination, isolation, and grappling with
of challenges including culture shock, isolation and homesick- institutional, structural, and cultural boundaries and barriers.
ness, language related difficulties, acculturative stress, and dis- While all graduate students endure many challenges
crimination. Stress resulting from these challenges puts interna- when pursuing higher education, LGBTQ, African American fe-
tional students at greater risk for academic difficulties as well as males, and international students must endure additional chal-
psychological problems than their U.S. born counterparts (Mori, lenges that can hinder their success in their counseling psycholo-
2000). Thus, mentors and advisors of international students need gy graduate programs. Subsequently, feminist and relational cul-
to be aware of these specific challenges faced by such students tural advising and mentorship can potentially provide these mi-
and the cultural differences that may affect their mentorship rela- nority students with the support and empowerment needed to suc-
tionship (Park-Saltzman et al., 2012). As such, traditional West- cessfully complete their programs. In essence, feminist and rela-
ern mentoring models typically emphasize personal achievement tional cultural advising has the potential to encourage and pro-
and competition. Such mentoring models, emphasizing individu- mote the achievement of minority counseling psychology gradu-
alistic standards, often conflict with the values of many ethnic ate students not only within their programs, but also within their
groups collectivistic cultures, which stress cooperation and profession, which in turn may shape the ways in which these fu-
group cohesion. Keeping these differences in mind, it is essential ture leaders advise, supervise, and mentor new minority students.
for mentoring models to recognize and incorporate diverse racial,
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Accuracy of Parents Beliefs about Their College Student Childrens

Pre-Existing Substance Use Behaviors and Expectations at the Start
of College
Jason A. Parcover Joshua N. Semiatin
Loyola University Maryland VA Maryland Healthcare System
Colleges are increasingly recognizing that the transition between high school and college provides an important context for sub-
stance use intervention; however, efforts that focus only on students may be inadequate. For multi-domain prevention efforts that
involve the individual, family, and school to be effective, parents/guardians must realistically understand their childrens pre-
collegiate drinking behavior. The current study examined the accuracy of parental perception of their college-bound childrens
substance use behaviors in the year prior to entering college. These data also revealed important parent-student discrepancies
regarding consequences of and conversations regarding alcohol use. Implications for data-informed intervention with parents/
guardians and students are discussed.
Introduction that college drinking has on the college institution itself. These
consequences relate to student safety, student attrition, legal
It is widely recognized that the social, health, and eco- costs, poor college-community relations, and risky driving behav-
nomic consequences of underage drinking pose a problem of iors, including those that result in traffic crashes, the greatest
great magnitude on college campuses (Spoth, Greenberg, & Tur- mortality risk of underage drinking (Hingson & Kenkel, 2004).
risi, 2008). Research has consistently found that high levels of Perkins also reported that there is only modest correlation be-
alcohol misuse tend to occur between the ages of 17 and 25 tween a students perception of having a drinking problem and
(O'Malley and Johnston, 2002). Four out of five college students the multitude of negative consequences reported.
drink (National Institute on Alcohol Abuse and Alcoholism
[NIAAA], 2002) and it has been estimated that 44% of college The Impact of the Transition to College on Drinking
students are classified as binge drinkers (Wechsler & Nelson, Behaviors
2008). The negative repercussions of student drinking include in- While preventative science that addresses underage
creased rates of depression and suicide (Windle, Miller-Tutzauer, drinking behaviors has shown significant progress in recent years
& Domenico, 1992), poorer academic performance and higher (Spoth et al., 2006), research on the impact of the transition to
rates of dropout (Spoth, Shin, Guyll, Redmond, & Azevedo, college on drinking behaviors is minimal (Sher & Rutledge,
2006), increased vandalism, sexual assaults, and other acts of vio- 2007). According to Sher and Rutledge, intervention typically
lence (NIAAA, 2002; Hingson, Heeren, Zakocs, Kopstein, & occurs after students arrive on campus; however, such an ap-
Wechsler, 2002), the development of physical health problems proach may be inadequate if delivered only upon college entry.
(NIAAA, 2003), and increased likelihood of unprotected sexual In addressing the efficacy of institutional intervention, it is criti-
activity (Hingson, Heeren, Winter & Wechsler, 2005). Tapert cal to understand the nature of pre-college drinking behaviors and
and Schweinsburg (2006) provided evidence that heavy drinking the impact that the transition to college has on these behaviors.
may have significant and lasting effects on brain structure and LaBrie et al. (2007) reported that high school drinking
functioning and that, as a result, early use of alcohol is associated significantly predicted drinking in college. OMalley and John-
with problematic substance use later in adulthood. It has been es- ston (2002) found that dramatic increases in drinking behaviors
tablished that there is potential for harm among more moderate begin after high school graduation, before students move away to
drinkers as well (Weitzman & Nelson, 2004). college. Heavy drinking in the first semester of college, although
Perkins (2002) noted the wide array of consequences higher than at the end of high school, is strongly predicted by pre
-college heavy drinking, with pre-college heavy drinking ac-
counting for 46% of the variance in first semester heavy drinking
Correspondence concerning this article should be directed (Sher & Rutledge, 2007). Hence, drinking during the first semes-
to: ter "represents a systematic escalation of an ongoing behavior es-
tablished prior to college as opposed to chaotic, unpredictable
Jason A. Parcover, Ph.D., Counseling Center, 150 Hu- change precipitated by the transition to college." Sher and
manities Center, 4501 N. Charles St., Loyola University Rutledge recommended viewing college drinking as occurring in
Maryland, Baltimore, MD 21210. Phone: 410-617-2273. the context of adolescent development. As such, prevention pro-
Fax: 410-617-2001. E-mail: jparcover@loyola.edu. grams may require a new range of interventions that focus on de-
College Student Drinking
velopmental and social factors that are relevant to the transition Behaviors
period. Parents who are concerned for the welfare and growth of
Important variables in predicting heavy drinking at the their college-age children may experience confusion about their
start of college include continuity from pre-college heavy drink- role during this phase of their childrens lives. Many may believe
ing, pre-college peer drinking norms, pre-college other substance that a students peers at college will have far more influence over
use, and pre-college party motivation for attending college (Sher their behavior. However, parental communication and influence
& Rutledge, 2007). Many students have already begun engaging do shape student choices and perceptions of drinking behavior.
in drinking behaviors before making the college transition and Adolescent drinking behaviors are impacted by parental attitudes
may make college selections, in part, based on perceptions of the (Hawkins, Catalano, & Miller, 1992), parental awareness of un-
party atmosphere a prospective school will provide. Such find- derage drinking behavior (Beck, Summons, & Matthews, 1991),
ings confirm that understanding pre-collegiate drinking behav- parental monitoring of underage drinking behavior (Reifman,
iors, perceptions, and attitudes can inform institutional efforts de- Barnes, Dintcheff, Farrell, & Uhteg, 1998), and parent-teen com-
signed to address college drinking behaviors. munication effectiveness (Kafka & London, 1991). Parent-child
discussions about responsible alcohol consumption have been
Multi-Domain Intervention shown to have an effect on college student behavior. For exam-
Intervening with students prior to college may disrupt ple, parental disapproval of student alcohol use relates to students
the momentum of previously established drinking behavior (Sher selecting friendship groups that drink less (Nash, McQueen, &
& Rutledge, 2007). Theories of preventative science have con- Bray, 2005). Booth-Butterfield and Sidelinger (1998) found that
sistently emphasized multi-systemic, multi-domain perspectives while parental attitudes towards drinking and sexual behavior did
for understanding and altering health behaviors. Bronfenbren- not necessarily predict similar behavior in their college-age chil-
ners (1977) widely-utilized Ecological Systems Theory, for ex- dren, children from families that discuss sex and alcohol more
ample, identifies multiple systems that impinge on an individu- frequently and openly were more likely to act safely. Turrisi,
als developmental and health behavior trajectory, from people Wiersma, and Hughes (2000) found that open communication be-
and institutions in close proximity to an individual (e.g., parents, tween mothers and college-age children resulted in the children
school) to broader sociocultural contexts such as ethnic group having a less positive view of binge drinking and greater concern
identity. Similarly, the Health Belief Model (Glanz, Rimer, & about consequences. Students with a less positive view of binge
Lewis, 2002) posits that individuals are more likely to engage in drinking were less likely to engage in the behavior. Wood, Read,
health behaviors when they perceive themselves as susceptible to Mitchell, and Brand (2004) found that higher perceived levels of
experiencing problems and that the problems will be pronounced, parental involvement weakened the link between peer relations
as well as when they hold positive expectations regarding the and alcohol use. Birch, O'Toole, and Kanu (1997) found that
benefits of health behaviors and their own self-efficacy for ac- more than half of college students report that discussions with
complishing such behaviors. This theory further suggests that their parents were either important or very important in promot-
these predictors of health behaviors can be modified through edu- ing their health in domains that include sexuality, substance
cation from sources both proximal to the individual (e.g., parents) abuse, and relationships. Parents are in a position to support their
and those that are more distal (e.g., mass media). children's positive health behaviors and seek change in risky
Consistent with these theories of prevention science, pre health behaviors and parents that know and care about students
-matriculation interventions may be most effective when family alcohol-related behavior may be particularly influential before
members of the college-bound student are involved. In a com- students start college (Wetherill & Fromme, 2007).
prehensive review, family-focused interventions in childhood
have been shown to be highly effective in positively impacting Impact of Parental Perception of Health Behaviors on
drinking outcomes (Spoth et al., 2008). Spoth and colleagues Effective Intervention
(2008) advocated for multi-domain interventions, having hypoth- Given parental influence on student attitudes about alco-
esized that the impact of preventive approaches are maximized hol and drinking behaviors, campus alcohol and drug intervention
when intervention involves the individual, family, and school. efforts may benefit from partnering with parents. Such efforts
Such models are already effectively utilized with elementary are likely to be most effective when parents have an accurate un-
school students. Stigler, Perry, Komro, Cudeck, and Williams derstanding of their children's health-related behaviors (Bylund,
(2006) have found that a parent program component yields the Imes, & Baxter, 2005). However, research has shown that par-
relatively strongest effects on minimizing the tendency toward al- ents tend to underestimate high-risk behaviors that their children
cohol use when multi-domain interventions are implemented. engage in. According to Deffenbaugh, Hutchinson, and
Jaccard and Turrisi (1999) concluded that parent-based interven- Blankschen (1993), who studied youth between the 4 th and 12th
tion for college students is a promising approach to preventing grades in rural Indiana, parents vastly underestimate how many
college drinking problems. Their specific recommendations in- youth engage in smoking, drug use, and drinking. Young and
cluded that programs should focus on variables that are amenable Zimmerman (1998), using a sample of middle school students
to change, including parental cognitions and attitudes, and use and their parents, found that parents are accurate in their percep-
strategies that acknowledge the numerous demands in a parents tions of certain adolescent health behaviors, including seatbelt
life. and bicycle helmet use, diet, and exercise. In contrast, they
found that parents significantly underestimate other health risk
Parental Influence on HealthRelated Attitudes and behaviors, such as carrying a weapon to school, using cocaine,
suicide attempts, sexual intercourse, tobacco, alcohol, and mari- drug use, exercise behaviors, help-seeking behavior, understand-
juana use. Bylund et al. (2005) found that parents significantly ing of academic ethics, community service motivation, spirituali-
underestimated their college student children's reported frequen- ty, sexual identity, and expectations about college. The alcohol
cy of drinking alcohol, binge drinking, smoking cigarettes, hav- and drug questions were developed to correspond with nationally
ing sex, and using marijuana. The authors concluded that paren- normed surveys (e.g., CORE Alcohol & Drug Survey; Presley,
tal misperceptions might have an impact on the effectiveness of Meilman, & Lyerla, 1994) and were modified to fit the needs of
any conversations they have with their children about such high- the universitys student population. The internal consistency
risk behaviors. (Cronbachs alpha) of the four CORE substance use items
Developing effective interventions to modify drinking (alcohol use frequency, alcohol use amount, tobacco use frequen-
attitudes and behaviors continues to be an important goal. Data cy, and marijuana use frequency) was found to be acceptable
suggest that understanding pre-collegiate drinking behaviors and within the current studys sample (alpha = .77).
attitudes can inform institutional efforts. Recent efforts highlight Each questionnaire item consisted of a short question
the potential of multi-domain interventions. Specifically, ap- (e.g., When you drink, how many drinks do you typically
proaches that are timed to have impact during the transition to have?) followed by response options, one of which the respond-
college and that involve the student, parents, and the college in- ent selected. See Table 1 for response options to questions used
stitution have promise in improving prevention efforts. If such in the current study. The substance use items asked students to
partnering is to be effective, parents must have a realistic under- report how often they used alcohol, tobacco, and marijuana in the
standing of their childrens pre-collegiate drinking behavior. Yet, past academic year, as well as the typical number of alcoholic
little is known about parents' perceptions of their college students' drinks that they consumed per drinking episode. Students were
health behaviors, particularly during the transition between high also asked to report how often blackouts and relationship tensions
school and college. related to alcohol use occurred in the past academic year. The
This study represents an effort to expand on previous parent version of the questionnaire included each of the above
work by examining the accuracy of parental perception of their questions, yet asked that parents answer by rating their percep-
childrens pre-existing substance use behaviors specifically dur- tions about their incoming college-bound childs behavior. Par-
ing the pivotal twelve month period that precedes the actual start ents were also asked to indicate the gender of their college-bound
of college. Currently, little is known about the accuracy of pa- child. In addition, students and parents were asked to estimate the
rental perception of their childrens substance use behaviors dur- degree to which they discussed with one another the incoming
ing the months leading up to the start of college, a critical transi- students use of alcohol.
tion period for the development of substance use patterns in early
adulthood. Additionally, this study extends previous work by in- Procedure
vestigating agreement in parent and student perception of the The incoming student questionnaire was administered to
consequences of alcohol use and the nature of parent-student con- all incoming students and one parent for each student at summer
versations about alcohol use in the college setting. orientation. Parents were asked to decide between themselves
who would complete the parent version of the questionnaire if
Method both parents were present. The completion rate for both students
and parents was very high, approaching 100% and data were col-
Participants lected anonymously.
The current studys data were obtained from a recent in-
coming freshman class and their parents at a Middle Atlantic Analyses
comprehensive research university during two incoming student This study used a between-subjects design, comparing
orientation weekends. Nine hundred twenty one students re- the self-reported attitudes and behaviors of students with the atti-
sponded to the questionnaire. Eight hundred forty four parents re- tudes and behaviors that parents reported as being characteristic
sponded. Female students (61%) outnumbered males, which re- of their college-bound child. As student and parent responses
flected the gender distribution of this incoming cohort. The ma- were collected anonymously, it was impossible to match the re-
jority of incoming students identified themselves as Caucasian sponses of students with their parent. Instead, mean-level differ-
(86%), followed by 4% non-White Hispanic/Latino, 3% African ences between parent and student reports of substance-use behav-
American, and 2% Asian, with the remaining students identifying ior and blackouts were evaluated using independent subjects t-
as Native American or other. The students averaged 18 years of tests. The presence of alcohol use-related relationship tensions
age (SD = 0.4 years). were recorded dichotomously (yes/no), and were evaluated using
2, with odds ratios (ORs) reported as effect sizes. Cohens d sta-
Measure tistic (Cohen, 1988) was also estimated as an effect size where
The incoming student questionnaire, administered in appropriate. Cohens d of .3 or less is typically considered a
both student and parent versions, was developed primarily to un- small effect, while differences closer to .5 would be a medium ef-
derstand the behaviors that students exhibit before entering col- fect, and those .8 or greater a large effect.
lege and their parents awareness of these behaviors, and to edu- We conducted separate statistical analyses for male and
cate parents so they can use their influence to partner with the female college-bound children and their parents. Specifically, we
college in shaping the choices that their children make. The con- compared male student reports with estimates of child behavior
structs measured included frequency and quantity of alcohol and by parents of male students. Separately, we compared the reports
of female children with behavior estimates from parents of fe- children (Table 2) revealed a similar pattern, in that they underes-
male students. The Bonferroni correction was employed for each timated how often female children reported using tobacco, mari-
t-test in order to mitigate the effects of alpha inflation when con- juana, and alcohol in the year prior, as well as the quantity of al-
ducting multiple tests with the same dependent variable. cohol consumed.
Effect size estimates suggesting large parent-child dis-
Results crepancies regarding the quantity of alcohol consumed per sitting
were found. Differences regarding alcohol use frequency were
The majority of the outcome frequency distributions moderately strong for both genders. Marijuana-related differ-
were found to be positively skewed, indicating that a large per- ences were in the small to moderate range, and discrepancies for
centage of students did not report substance use or suffer black- tobacco use were relatively smaller.
outs related to alcohol use. Although the t-test is robust to devia-
tions from the assumption of normality, non-parametric Mann- Table 2. Means, standar d deviations, t-test results, and effect
Whitney U tests were performed for each t-test reported below. size estimates for substance-related self-reports by female stu-
All significant raw mean differences (p < .05) found using t-tests dents (n = 562) and behavior estimates of students by parents of
were also found to be significant using Mann-Whitney U tests, female children (n = 529).
suggesting that the t-test results are valid for interpretation. The t-
test results have therefore been reported.
Table 1. Means, standar d deviations, t-test results, and effect

size estimates for substance-related self-reports by male students
(n = 359) and behavior estimates of students by parents of male
children (n = 315).
Notes:
n's differed between questions due to missing data.
* p < .001
1
Interpreted as the difference between students and parents in standard deviation
units.
2
coded 1 = Never, 2 = Monthly, 3 = Weekly, 4 = Daily
3
coded 1 = Didnt drink, 2 = Less than once / week, 3 = 1 times / week, 4 = 2
times / week, 5 = 3 or more times / week
4
coded 1 = Dont drink, 2 = 1-3 drinks, 3 = 4-6 drinks, 4 = 7 or more drinks
5
coded as 1 = No, 2 = Yes, briefly, 3 = Yes, many times
6
coded 1 = Never/dont drink, 2 = A few times per year, 3 = A few times per
Notes: month, 4 = A few times per week
7
n's differed between questions due to missing data. coded 1 = Didnt use, 2 = A few times per year, 3 = A few times per month, 4 = 1
*p < .001 -2 times per week, 5 = 3 or more times per week
1
Interpreted as the difference between students and parents in standard deviation
units. Regarding the frequency of alcohol-related discussions,
2
coded 1 = Never, 2 = Monthly, 3 = Weekly, 4 = Daily
3 parents of male and female children both consistently reported
coded 1 = Didnt drink, 2 = Less than once / week, 3 = 1 times / week, 4 = 2
times / week, 5 = 3 or more times / week higher ratings than their children. Discrepancies for both genders
4
were medium sized. Further, no significant correlations were
coded 1 = Dont drink, 2 = 1-3 drinks, 3 = 4-6 drinks, 4 = 7 or more drinks
5
coded as 1 = No, 2 = Yes, briefly, 3 = Yes, many times found between the reported frequency of alcohol-related conver-
6
coded 1 = Never/dont drink, 2 = A few times per year, 3 = A few times per
sations and past year alcohol use frequency or quantity among
month, 4 = A few times per week
7 male (frequency: r = .09; quantity: r = .06) or female students
coded 1 = Didnt use, 2 = A few times per year, 3 = A few times per month, 4 = 1
-2 times per week, 5 = 3 or more times per week (frequency: r = .06; quantity: r = .07). In contrast, data indicate
that positive associations exist between such conversations and
The means, standard deviations, and t-test results com- parental perception of past year alcohol frequency (r = .12, p
paring male students with parents of male children are displayed = .04) and quantity (r = .13, p = .03) for parents of male students,
in Table 1. Results revealed that parents of male children under- while for parents of female students, positive associations were
estimated male child reports of tobacco and marijuana use within found only for alcohol frequency (r = .11, p = .02), but not quan-
the past academic year. Parents of males also underestimated tity (r = .09, ns).
male child reports of the frequency and amount of alcohol con- Finally, regarding the consequences of alcohol con-
sumed in the past academic year. Reports from parents of female sumption, male and female students reported similar, medium-
sized discrepancies from the lower estimates made by their par- interventions that can be designed in educating parents on the im-
ents regarding the frequency of blackouts (males: d = 0.61; fe- pact they can have on their students health-related behaviors. In
males: d = 0.56). In contrast, parents of males overestimated this case, one possibility is that parents could benefit from having
(14.7%) male student reports (6.4%) of alcohol-related relation- a better understanding that the assumptions they make about their
ship tensions in the past academic year, 2(1, n = 485) = 9.13, p < .01, sons need for parental involvement may be even more inaccurate
OR = 2.52; parents of females did not differ in estimating than the perceived needs of their daughters. It is also possible
(12.6%) the reports of female students in this regard (9.2%), 2(1, n that parents are more hesitant to discuss risky behaviors with sons
= 756) = 2.30, ns, OR = 1.43. than daughters or that parents are more likely to have a boys will
be boys attitude.
Discussion The positive correlation between parental perception of
their childrens drinking and the nature of conversations regard-
Given our growing understanding that alcohol use typi- ing the use of alcohol is somewhat surprising. One may be natu-
cally predates the start of college, and that almost all current early rally inclined to assume that students who have more frequent
-college preventative approaches are based on interventions that conversations with their parents would exhibit healthier drinking
occur after students arrive at college (Turrisi, Jaccard, Taki, Dun- habits. This does not necessarily appear to be the case, leaving
nam, & Grimes, 2001), it seems important for institutions of additional questions for future research about the content, con-
higher education to examine potential interventions that might text, and effectiveness of these communications. Parents could
have impact before and during the transition to college. Bylund be frequently communicating with students about alcohol be-
and colleagues (2005) believed that college health educators cause they are open and permissive toward drinking, or, con-
should view the parent-student relationship as an opportunity for versely, highly critical of drinking, potentially undermining the
improving health risk behaviors. Turrisi et al. (2001) found that purpose of intervention. Alternatively, parents could be having
parents tend to be quite enthusiastic about participating in inter- more frequent discussions with their child only after discovering
ventions aimed at minimizing college-age substance use and that that the student is already drinking heavily. Turrisi, Mastroleo,
they had a strong desire to obtain information that would be help- Mallett, Larimer, and Kilmer (2007) found that parent communi-
ful in effectively communicating with their teens. They conclud- cation with their student-athletes about the negative health effects
ed that parent-based intervention shows great promise and that of substance use reduced reported student drinking, while in con-
such approaches should be further developed and researched. trast, discussions about legal and social consequences of alcohol
Our findings indicate that parents underestimate the frequency use corresponded with increases in heavy drinking. It can safely
and quantity of alcohol use, the frequency of marijuana use, and be concluded that the content of such interventions is crucial.
the consequences of alcohol use, including the frequency of black This conclusion is strengthened by the lack of relationship be-
outs, of their students, regardless of gender, when assessed during tween the nature of conversation and substance use when as-
the summer before the beginning of college. The medium to large sessed from the student perspective. A more detailed investiga-
effect sizes found (Cohen, 1988) suggest that the statistical sig- tion of the impact that communication style and content has on
nificance of these discrepancies is indeed meaningful, and not adolescent substance use, as well as the interaction between these
merely a function of sample size. An underestimation of high-risk and other salient factors, such as relationship quality, is warrant-
behavior may decrease parental motivation to engage their col- ed to inform future interventions.
lege-bound children in conversations regarding substance use.
College professionals should educate parents about their possible Application
underestimation with the goal of increasing parental motivation Spoth et al. (2008) have argued that greater attention to
to engage in effective prevention efforts (Bylund et al., 2005). evidence-based preventive interventions that address underage
Research has shown that parental discussion can impact health drinking is needed. One potential model involves the participa-
behaviors and that such discussion can have an effect on college tion of incoming students and their parents in new student orien-
student drinking tendencies (Wetherill & Fromme, 2007; Wood tation programs. Data from the current study were collected at
et al., 2004; Turrisi et al., 2001; Turrisi, Wiersma, and Hughes, the start of summer orientation sessions, and were quickly com-
2000). The current finding that parents and college-bound stu- piled and analyzed, a relatively easy task with the technology and
dents disagree on the extensiveness of the conversations that they staff available. This approach allows for the provision of same
have previously had about substance use becomes notable in this day feedback to parents. The data can be used to inform parents
context. Our findings indicate that parents tend to perceive previ- about the substance use and other health-related behaviors of the
ous discussions as more extensive and thorough. Informing par- cohort of the incoming class. In pilot sessions, parents have
ents of this discrepancy can empower them to be more active in shown clear investment and better understanding of the data and
their efforts to discuss these important issues with their college- have asked meaningful questions of the university administrators
bound children. who facilitate the program. Specific strategies designed to help
Our findings also reveal that the parental tendency to parents meaningfully partner with college staff to address pat-
underestimate substance use behaviors and the frequency of terns and consequences of student alcohol use can be shared and
blackouts, and to overestimate the frequency of alcohol-related discussed. Anecdotally, feedback from parents and other univer-
conversations is consistently more pronounced with sons com- sity administrators on such a data-based approach has been posi-
pared to daughters. A greater understanding of this gender-based tive and enthusiastic.
difference is important because it has clear implications for the Armed with data regarding parental misperceptions of
student drinking behaviors, parents can be educated on the cur- tend to be accurate when there are no clear consequences associ-
rent realities of student drinking, as well as how to effectively ated with under- or overreporting (Del Boca & Darkes, 2003),
communicate with their children before and during the transition our data may be subject to self-report bias. However, as such bi-
to college. Of the reported misperceptions, our findings suggest as is likely to be in the direction of under-reporting substance use
that parents are most likely to underestimate the number of drinks behaviors, the effect size strengths found in the current study may
their children consume per episode and the number of blackouts well be larger in the population.
that their children have experienced. It is particularly important Future research could examine other student-based vari-
to inform parents of these realities and explore the implications of ables such as racial/ethnic background, age, high school sub-
high-risk drinking. Parents may feel powerless to affect deci- stance use and GPA, and parental variables, such as parent drink-
sions after children leave home. Learning that parents continue ing behaviors, to determine if such factors relate to discrepancies
to exert considerable influence even after the college transition regarding substance use and parental perceptions thereof. Such
(Amerikaner, Monks, Wolfe, & Thomas, 1994) can be empower- investigations would further our understanding of parent/college-
ing. When college personnel can provide the parent with accu- bound child dyads that may benefit most from expanded pre-
rate and timely knowledge about college drinking and their college substance use prevention efforts. Future research could
childs specific cohort, the parent can shape their communica- also help to clarify how the transition to college impacts student
tions in such a way so that they are best received by their child. drinking and other risky health-related behaviors. The Task
As the results of this study indicate that parents tend to overesti- Force of the National Advisory Council on Alcohol Abuse and
mate the extent of such dialog when compared with their chil- Alcoholism (2002) called for the development of college-based
drens perceptions, parents can be advised to take the time to ful- prevention programs that include a range of interventions that
ly understand how their children are experiencing the conversa- consider the developmental context that students experience as
tions that they have together. they transition from high school into college. Finally, the field
This type of partnership between college, student, and would benefit from further exploration into the frequency and na-
parent exemplifies a multi-domain approach (Stigler et al., 2006; ture of discussions about health-related behaviors between col-
Turrisi et al. 2001; Jaccard & Turrisi, 1999) that is evidence- lege students and their parents.
based (Spoth et al., 2008) and occurs contextually during the In conclusion, we believe that this study has shown that meaning-
transition to college (Sher & Rutledge, 2007). Such interventions ful discrepancies exist between parent knowledge of their college
are founded on widely-utilized and accepted theories of health -bound childs substance use, its consequences and the frequency
behavior change within prevention science, such as Bronfenbren- of use-related conversations, and the reports of their children, re-
ners (1977) Ecological Systems Theory and the Health Belief gardless of his/her gender. Although unanswered questions re-
Model (Glanz, Rimer, & Lewis, 2002). These theories empha- main regarding best practices to ameliorate these differences,
size that efforts to acknowledge and include multiple systems that several promising research avenues are converging to suggest
modulate an individuals experiences and decisions (e.g., family, that evidence-based endeavors by college student personnel to
peers, schools, media) are essential to designing effective preven- partner with parents can empower them to take active roles in the
tion and intervention strategies. However, Turrisi and colleagues health of their college-bound children. We want to particularly
(2001) suggested that such approaches are not utilized in college encourage these integration efforts, as such partnerships would
settings because of the assumption that children are grown up and likely enhance the effectiveness of existing substance prevention/
minimally influenced by their parents at this point in their lives. reduction efforts in college, and thus contribute cost and health
They note that research has demonstrated that parents maintain benefits to campuses nationwide.
influence on their children even after they have moved to college.
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Social Responsibility in Psychology Today: Prevention is Imperative

A Response to Kodet (2012)
Adrienne M. Dugger
Baylor University
In his article Social Responsibility and Prevention in strated in the literature by identifying those at higher risk (early
the APA Ethical Principles, author Jonathan Kodet (2012) cites detection) and taking steps to ensure they have access to needed
a discussion from Charles R. Clark as the definitional model of care (Compass, 2010; Seligman 2007). According to Cicchetti
social responsibility. He defines social responsibility as the duty and Toth (1992), early detection has the ability to reduce the de-
to reduce human suffering and further human rights by improving gree to which individuals suffer from symptoms and experience
society at large, extending beyond ethical obligations owed to in- functioning limits that can develop as a result of going untreat-
dividuals who are participants in professional relationships (as ed (as cited in Hage et al., 2007, pg. 494). A look at statistics re-
cited in Kodet, 2012, p.5). The duty to reduce human suffering ported by Hage et al., (2007) shows 75%-80% of the 20% of
is largely what the profession of psychology is concerned with youth who suffer from mental health problems do not receive the
accomplishing. Psychologists spend the majority of their academ- care they need (U.S. Department of Health and Human Services,
ic careers studying how the mind-body connection works in order 1999; Ringel & Sturm, 2001). These youth, if left untreated, may
to help individuals function effectively and lead emotionally develop into adults with more severe and debilitating symptoms;
healthier lives. The second half of Clarks description of social consequently, making the process of recovery more difficult. Re-
responsibility, extending beyond ethical obligations owed to in- moving the phrase, to mitigate the causes of human suffering
dividuals who are participants in professional relationships (as leads one to believe that prevention intervention is no longer a
cited in Kodet, 2012, pg. 5), describes what it truly means to re- priority for psychologists. The second important phrase omitted
duce human suffering. Reducing human suffering requires a will- from the Ethics Code, to advance human welfare (Kodet, 2012,
ingness on the part of the mental health professional to go beyond pg. 7; APA, 1992, pg. 1600), embodies the heart of the profession
what is expected or considered obligation by peers and col- of psychology. Psychologists and mental health care providers
leagues to reach those who are often difficult to reach. work together to help individuals who are suffering from mental
Kodet (2012) is most concerned with the removal of the illness function better through evidence-based treatment. Psy-
General Principle of Social Responsibility from the 2002 revision chologists have been known to donate their services, pro bono
of the Ethical Principles of Psychologists and Code of Conduct, (Good, Simon, & Coursey, 1981), to help those who cannot af-
hereafter referred to as the APA Ethics Code (Kodet, 2012; ford or obtain care on their own and often work after hours re-
APA, 2002). Comparing the 1992 revision of the APA Ethics searching the best treatments for their patients. Pro bono work is
Code with the 2002 revision shows that most of the ideas repre- included in Principle B: Fidelity and Responsibility, of the 2002
sented in General Principle F: Social Responsibility can be found APA Ethics Code (APA, 2002), which demonstrates the APAs
elsewhere in the 2002 revision (APA, 1992; APA, 2002). Howev- desire that psychologists go above and beyond what is considered
er, there are two ideas that cannot be found elsewhere in the doc- fare practice. In addition to pro bono work, psychologists also
ument represented in the omitted phrases to mitigate the causes often participate in education campaigns aimed at reaching un-
of human suffering and to advance human welfare (Kodet, derserved, marginalized and disparate populations. This is anoth-
2012, pg. 7; APA, 1992, pg. 1600). These phrases, while insignif- er form of prevention - seeking out those who need but have not
icant in size, represent ideas crucial to the advancement of psy- been able to obtain treatment. Prevention is imperative to the
chology and human welfare. field of Psychology and cannot be emphasized enough. It has
Within the phrase to mitigate the causes of human suf- been implemented in programs targeting numerous populations
fering, is the idea of prevention (Kodet, 2012, pg. 7; APA, including children, teenagers, college students and veterans to
1992, pg. 1600). According to the prevention literature, there are name a few (Compass, 2010; Seligman, 2007; Johnston, 2009).
three levels of prevention, primary, secondary, and tertiary, all of In a field whose primary objective is to treat mental illness and
which aim to stop or reduce problems/illnesses before they fully promote mental health, prevention should not be ignored. While
develop (Williams, 2002; Dooley, 2000). Prevention is demon- some psychologists who are over loaded with patients might be
reluctant to take on patients with less severe symptoms in an ef-
Correspondence concerning this article should be directed fort to practice prevention, they need to remember that reaching
to: at-risk populations before their symptoms become debilitating
could mean they will require less treatment over time. This
Adreanne M. Dugger, Adreanne_Dugger@Baylor.edu would, in turn, free up psychologists to treat more patients, creat-
ing a healthier population overall. Another benefit of prevention
Social Responsibility in Psychology Today
is that it saves money (Herman, Reinke, Stormont, Puri, & Counseling Psychology, 5(1), 7-9.
Agarwal, 2010). This money can then be used to improve mental Neville, H. A. (2012). Rosie Phillips Bingham: On becoming.
health care by creating treatment programs and freeing up money The Counseling Psychologist, (40)3, 443-472. doi:
for schools, hospitals, etc., to hire more mental health practition- 10.1177/0011000011414212
ers and reach a larger population. Ringel, J. & Sturm, R. (2001). National estimates of mental
Aside from the obvious benefits of incorporating pre- health utilization and expenditure for children in 1998. Jour-
vention into mental health care, the importance of including pre- nal of Behavioral Health Services and Research, 28, 319-
vention in mental health care is demonstrated by a shift in the 332.
profession as a whole towards prevention. Within the APA, lead- Seligman, M. P., Schulman, P., & Tryon, A. M. (2007). Group
ing figures such Charles Kiesler, former APA Chief Executive prevention of depression and anxiety symptoms. Behaviour
Officer and Rosie Philips Bingham, former APA Division 17 Research And Therapy, 45(6), 1111-1126. doi:10.1016/
President, Member of the APA Council of Representatives, APA j.brat.2006.09.010
Presidential Candidate, Member of the APA Board of Education- Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2008). Brief
al Affairs, and Member of the APA Board of Directors have cognitive-behavioral depression prevention program for high
helped spur the APA towards action on public policy (Vasquez, -risk adolescents outperforms two alternative interventions:
2012; Neville, 2012). In an address to the APA, Kiesler spoke out A randomized efficacy trial. Journal Of Consulting A nd
about the need for psychology to be involved in social policy Clinical Psychology, 76(4), 595-606. doi:10.1037/a0012645
(Vasquez, 2012, pg. 340). Rosie Philips Bingham has shown her U. S. Department of Health and Human Services. (1999). Mental
dedication to social policy through her participation in the devel- Health: A Report of the Surgeon General-Older Adults and
opment of organizations and conferences such as the National Mental Health. Rockville, MD: Author.
Multicultural Conference Summit, that strive to shed light on the Williams, P. G., Holmbeck, G. N., & Greenley, R. (2002). Ado-
needs of marginalized populations in the U.S. (Neville, 2012). lescent health psychology. Journal of Consulting and Clini-
The APA should heed the example of these notable figures to go cal Psychology, 70(3), 828-842. doi:10.1037/0022-
beyond what is required by the profession and strive to reach the 006X.70.3.828
marginalized and underserved. The APA should include the
standard of Social Responsibility in its next revision of the APA Special thanks to Dr. Jack Tsan, Staff Psychologist (Primary Care
Ethics Code. Mental Health), VA Texas Valley Coastal Bend Health Care Sys-
tem for his supervision and critiquing of this paper.
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The Role of the Family in Enhancing Positive Development in

Rural LGB Youth
Jennifer Glass, Sarah L. Hastings, Tracy J. Cohn, & Thomas W. Pierce
Radford University
This manuscript examines the process of identity development among rural sexual minority youth, especially within the context
of coming out within their families of origin. Youth in less populated areas encounter unique risk factors associated with their
rural status. Because positive family support can serve as a powerful protective factor for LGB youth, it is important to include
families in prevention efforts. Little research has focused on LGB youth in rural areas, but even less has examined the role of
families in supporting or impeding positive development. The authors will describe the role of families in sexual minority youths
identity development and examine the particular challenges rural youth face when navigating the coming out process within their
families of origin. Directions for future research are suggested.
The frequency of suicide by lesbian, gay, and bisexual challenges rural youth face when navigating the coming out pro-
(LGB) youths has captured national media attention and has cess within their families of origin. Conclusions will include rec-
highlighted the rejection, discrimination, and oppression this pop- ommendations for future research designed to promote well-
ulation frequently endures (Hilton & Szymanski, 2011). Often being and prevent maladjustment among rural adolescent youth
this rejection is expressed by the LGBs family and community and their families.
(Green, 2002). Despite the increased focus on LGB individuals,
research on sexual minorities is still conducted mostly with met- The Rural Context
ropolitan samples (Cohn & Hastings, 2011; McCarthy, 2000;
Poon & Saewyc, 2009). Rural communities, however, provide a The defining characteristics of rural areas have been var-
special set of circumstances for sexual minority youth given that iably described in the literature (McCarthy, 2000; Schank &
heterosexism is more pronounced (Mathy, Carol, & Schillace, Skovholt, 2006). In general, the common elements included in
2003) and geographic isolation limits opportunities for youth to the definition use standards set forth by the United States Census
identify with an LGB peer group. Rural families, as well, have Bureau, which involve numerical population, population density,
limited access to support and information (DAugelli & Hart, geography, and distance from urban centers (McCarthy, 2000;
1987; McCarthy, 2000) to help them navigate their adolescents Schank & Skovholt, 2006). In 2010, 19.3% of Americans lived in
coming out process. Expanding health promotion approaches for areas considered rural by the U.S. Census Bureau.
LGB youth to include attention to geographic settings may enable Rural communities are characterized by conservative
prevention efforts to be informed by rural communities unique and traditional values, religious fundamentalism, resistance to
characteristics and priorities (Poon & Saewyc, 2009). change, high visibility among residents, and limited privacy
The aim of the current work is to examine the process of (Hastings & Cohn, in press; Moses & Buchner, 1980). Neighbors
identity development among rural sexual minority youth, espe- tend to recognize one anothers vehicles and become accustomed
cially in the context of coming out within their families of origin. to one anothers routines. Rural regions are thought to be autono-
Youth in less populated areas encounter unique risk factors asso- mous, cohesive, and highly integrated (McCarthy, 2000). There is
ciated with their rural status. Because positive family support can less tolerance for people who violate community norms (Leedy &
serve as a powerful protective factor for LGB youth, it is im- Connolly, 2007). However, residents generally report they are
portant to include families in prevention efforts. Little research satisfied with their community, and enjoy the quality of life, so-
has focused on LGB youth in rural areas, but even less has exam- cial atmosphere, low crime rates, and sense of community
ined the role of families in supporting or impeding positive devel- (Hastings & Cohn, in press; McCarthy, 2000).
opment. The authors describe the role of families in sexual mi- Notably, the literature has consistently demonstrated
nority youths identity development and examine the particular that rural gays and lesbians face specific challenges (Boulden,
2001; DAugelli & Hart, 1987; McCarthy, 2000). Socialization
Correspondence concerning this article should be directed with other gays and lesbians is often difficult in rural areas for a
to: number of reasons. Gay communities are notoriously invisible
and underground in rural areas, due to justifiable fears of safety
Sarah L. Hastings, Ph.D., Associate Professor, Radford (Boulden, 2001; DAugelli & Hart; McCarthy, 2000). McCarthy,
University, Department of Psychology, at slhast- in examining a group of rural lesbians, reflected this notion, re-
vealing that gay communities in rural areas are often maintained
ing@radford.edu.
secretively, leading to their invisibility. In fact, the participants of
The Role of the Family
this study mentioned that when a lesbian came out in their small Many different models of gay and lesbian identity devel-
town, she was often perceived as the first gay or lesbian person opment exist, and no model is universal to all sexual minorities;
many people had met. however, all models describe similar stages and events that gays
Lack of privacy and anonymity are also well- and lesbians experience when developing identity as a sexual mi-
documented issues with which rural gays and lesbians must con- nority (Liddle, 2007a). Summarizing the main theories of identity
tend (APA, 2004; McCarthy, 2000). DAugelli, Collins, and Hart development, Liddle notes that most models describe the begin-
(1987) pointed out that managing who has knowledge of ones ning stages of sexual identity development with the assumption
sexual orientation and who does not can be an exhausting task. of heterosexuality. Over time however, the young person begins
Those living in urban areas often have some control over who to consider that socially sanctioned practices and rituals (e.g. het-
knows their sexual orientation and who does not; however, dis- erosexual dating or marriage) have less relevance and attraction
closure to one person in a rural area may mean disclosure to the toward same-sex peers becomes more salient. Some, but not all,
entire community, so some people may decide to remain closeted sexual minority youth progress from negative to positive feelings
(Cohn & Hastings, 2011; McCarthy, 2000). LGB individuals liv- about their sexual orientation and may identify as a lesbian or gay
ing in metropolitan areas also have the opportunity to explore man or use another applicable term. All models emphasize the
their sexuality and socialize with others with relative anonymity, importance of finding like-others for support in order to reduce
whereas rural gays and lesbians may avoid contact or social isolation and loneliness and to connect with positive role models
events with openly gay people for fear that community members who can help the young person develop his or her own affirma-
will make assumptions of their sexuality (DAugelli & Hart, tive identity (Liddle, 2007a).
1987; McCarthy, 2000). Many LGB must contend with negative messages about
Rural gays and lesbians have frequently described their their identity from their family of origin. Identity Development
living environments as reflecting a dont ask, dont Theory posits that family members reactions and coping also in-
tell (Boulden, 2001, pg. 71) mentality. Interviewing eight gay fluences the lesbian or gay mans sense of self (Willoughby, Ma-
men from Wyoming on their current experiences of living in a ru- lik, & Lindahl, 2006). Identity Development Theory also asserts
ral area, Boulden found that his participants reported that alt- that sexual minorities seek validation from significant others and
hough some family, friends, and community members may be- internalize this feedback. Before realizing they are gay, young
come supportive of their sexual orientation, it was often under the people are often aware of family members views on homosexu-
unstated condition that the individual become publicly asexual, ality, which can influence the LGB persons beliefs about what it
not appear too gay, and expect heterosexuals to refuse to means to be gay (Waldner & Magruder, 1999). Positive and neg-
acknowledge or encourage their status as a sexual minority. De- ative reactions and beliefs of family members may be incorpo-
spite the challenges Bouldens participants faced, they felt largely rated into the individuals sense of self (Willoughby, Malik, &
satisfied with their living environment and enjoyed the slower Lindahl, 2006), thus it is unsurprising that family support is im-
pace of rural life. perative to the development of an affirmative identity (Hilton &
Szymanski, 2011).
Sexual Minority Development Disclosure of sexual orientation (sexual minority status)
to others and self is an essential component in most of the sexual
Rural adolescents who are sexual minorities have report- identity models. Coming out describes the act of revealing
ed higher levels of distress than their rural heterosexual peers ones sexual orientation to others, but can also include develop-
(Cohn & Leake, 2012). Adolescence can be an especially critical ing awareness of same-sex attraction and identification with the
time for LGB youth, because it is generally during this period LGB community (APA, 2008; APA, 2011). The decision to come
that they identify same-sex-sexual-attraction and begin to identify out warrants consideration of numerous factors, including poten-
sexual orientation (Rosario, Schrimshaw, Hunter & Braun, 1996). tial reactions from others and perceptions of ones personal safety
In general, boys identify two to three years before girls, with girls (Valentine, Skelton, Butler, 2003). Disclosure practices are com-
identifying between the ages of 14 to 16. With this self- plex and most lesbians and gay men do not reveal their sexual
identification, rural youth may face physical and psychological orientation to everyone in their lives at the same time (Carnelley,
risks. Poon and Saewyc (2009) found that rural sexual minority Hepper, Hicks, & Turner, 2011; Green, 2002). Some may choose
adolescent boys were more likely than their urban counterparts to to remain in the closet and keep their sexual orientation private,
report suicidal behaviors. Compared with their urban peers, rural others may come out to certain individuals, and some may come
LGB youth have higher rates of marijuana use. Rural lesbians are out to everyone (APA, 2008; APA, 2011).
more likely to experiment with other drugs, such as cocaine, hal- Lesbian and gay youth typically come out to peers first,
lucinogenics, or heroin (Saewyc et al., 2007), than urban samples. followed by siblings, mothers, and fathers last (Greene, 2002;
Moreover, media attention has increasingly documented bullying Savin-Williams & Ream, 2003). Revealing ones sexual orienta-
directed at gay and lesbian youth. Poon and Saewyc found more tion to parents is often difficult (Hilton & Szymanski, 2006) and
than half of rural LGB students reported sexual harassment and is frequently the last step in the coming out process (Willoughby,
ridicule at school and nearly half described being intentionally Malik, & Lindahl, 2006). Coming out to parents involves consid-
excluded by peers. With the myriad challenges facing rural sexu- eration of a number of factors, including: a) the importance of
al minority youth, advocates have increasingly called for inter- parents as a source of social support, social identity, and econom-
vention efforts to help youth navigate this critical period of their ic support (although this may be less relevant for adult offspring);
development. b) the availability of nonfamily social and economic support; and
c) the individuals perception of the advantages and disad- older parents, being a member of an ethnic minority, lack of edu-
vantages to themselves, the family members, and their relation- cation, and authoritarian parenting styles (Willoughby, Malik, &
ship (Green, 2002). Lindahl, 2006; Waldner & Magruder, 1999). Negative reactions
Coming out can be a potentially risky decision. Howev- from family members lead gays and lesbians to face an increased
er, disclosing sexual orientation can have significant advantages risk of alienation, depression, suicidal ideation, suicide attempts,
to the individual. Being open about sexual orientation increases and substance abuse (Hilton & Szymanski, 2011).
the opportunity to seek social support from other gays and lesbi- Coming out is a developmental milestone, both for gays
ans, a crucial component of positive identity formation and lesbians, as well as their family members (Willoughby, Ma-
(DAugelli & Hart, 1987; Liddle, 2007a) DAugelli & Hart, lik, & Lindahl, 2006). Like the lesbian or gay individual, family
1987). Gays and lesbians with an affirmative identity demon- members often move through a similar coming out process
strate higher self-esteem and better psychological adjustment (Matthews & Lease, 2000), needing time to adapt, emerge, and
(APA, 2008; Carnelly, et al., 2011). Another possible advantage understand the disclosure (Connolly, 2006). Even if parents sus-
is that it is no longer necessary to allocate the significant cogni- pected their child is gay, they can still feel caught off-guard by
tive resources required to maintain the current sets of people who the revelation (Connolly, 2006). On the other hand, parents who
know and do not know the persons true sexual orientation. did not suspect their child was LGB, may have a harder time ad-
justing to the disclosure (Heatherington & Lavner, 2008). Parents
Family Relationships and Coming Out and siblings may experience feelings of grief and shock (Hilton
& Szymanski, 2011). Parents grieve the loss of the child they
LGB individuals face the possibility of being rejected thought they had and the loss of dreams for their child (Matthews
from their family after coming out, not because of something & Lease, 2000). Expectations of a traditional marriage, having
they have done, but because of their identity (Connolly, 2006; children, and carrying on the family legacy are challenged
Green, 2002). Unlike ethnic minorities, lesbian and gay individu- (Willoughby, Malik, & Lindahl, 2006). Family members may al-
als do not usually share the same sexual minority status with par- so feel isolated from their community and fear rejection from oth-
ents (Connolly, 2006; Green, 2002). In groups that face discrimi- er family members (Matthews & Lease, 2000).
nation parents are often able to educate and prepare their children A few characteristics that differentiate accepting and re-
to deal with oppression because they share the same vulnerability jecting families from one another have been identified in the liter-
to prejudice (Green, 2002); furthermore, parents are able to ature. Cohesion is the overall connectedness within the family
demonstrate means of coping with discrimination (Connolly, system and the emotional bonding that family members have to-
2006). Lesbian and gay youth are at a disadvantage though, be- ward one another, while adaptability is the extent to which a fam-
cause their parents are often unable to prepare them for dealing ily is able to change when confronted with novel situations
with prejudice (Green, 2002). Additionally, in minority families, (Willoughby, Malik, & Lindahl, 2006). Families with high cohe-
parents can take on an additional protective role, but parents of sion, adaptability, and warmth are in a better position to accept
lesbian and gay youth often do not experience the same oppres- the lesbian or gay child, because rejection is a violation of the
sive forces. Rather than becoming allies, parents and children can rules of a cohesive, adaptable, and warm family (Green, 2002;
end up on opposing teams, with parents taking sides against their Willoughby, Malik, & Lindahl, 2006). Another framework within
child (Green, 2002). This predicament leads gays and lesbians to which to consider the coming out process, Family Stress Theory,
be at particularly high risk of being rejected by the family (Hilton posits that families with strong psychological resources in place
& Szymanski, 2011). prior to disclosure are in a better position to respond to stressful
Disclosure forces family members to reevaluate what events, while those with fewer resources may accept negative ste-
they have believed about homosexuality (Green, 2002; Matthews reotypes and myths about gays and lesbians (Willoughby, Malik,
& Lease, 2000). Parents and siblings reexamine previously held & Lindahl, 2006). Despite cohesion and psychological resources,
beliefs about gender, sex, sexuality, and religion (Green, 2002; the relationship between parent and child prior to coming out
Matthews & Lease, 2000). Family members are often nave to is- may be the best predictor of parents reactions and adjustment.
sues faced by lesbians and gay men, or believe inaccurate as- Secure attachments between parent and child tend to remain even
sumptions or stereotypes (Green, 2002). In turn, these false or in- though boundaries, roles, and beliefs are challenged (Willoughby,
accurate beliefs are then applied to their LGB youth (Matthews & Malik, & Lindahl, 2006).
Lease, 2000). Gays and lesbians are usually aware of their fami-
lys attitude on gender roles, sexual behavior, homosexuality, Rural LGB Youth and Family Relationships
nonconformity, and religion, long before coming out; thus, fears
of parental rejection or abuse often contribute to keeping ones Integrating new family roles after coming out is not
identity secret. Coming out can disrupt the familys homeostasis unique to sexual minorities, but these issues are intensified in ru-
and equilibrium is quickly restored by rejecting the individual ral areas (DAugelli & Hart, 1987) because gays and lesbians
(Matthews & Lease, 2000). face specific challenges their metropolitan counterparts do not,
Parental rejection is often spurred by homophobia, fear such as extreme isolation, unsupportive social environments, ab-
of AIDS, lack of accurate information, and infrequent exposure sent or limited public places to socialize, and little or no organi-
to gays and lesbians (Waldner & Magruder, 1999). Additionally, zational and structural supports (Cohn & Leake, 2012; McCarthy,
characteristics commonly associated with negative parental reac- 2000). To compound the existing obstacles, lack of economic re-
tions include conservative political ideologies, religiosity, having sources and isolated location may prevent many from even ac-
cessing the Internet, a potential source of support and normative lizing genograms to depict family relationships, the researchers
information (McCarthy, 2000). found that partnered lesbian couples must navigate relationships
Coming out represents a significant moment for the fam- both within their family and their partners family. For example,
ily unit; however, most families lack a guide for coping with the some lesbians were accepted by their families, but their partner
situation (Valentine, Skelton, & Butler, 2003). Some people are was not, so the partner was excluded from family gatherings and
naturally more close or distant with other family members, and events. The experiences of these couples also reflected the chang-
gay or lesbian individuals can use knowledge of their family to ing nature of relationships with family members. Participants
decide how to reveal sexual orientation and then navigate the sit- documented how extended family relationships evolved after the
uation (Valentine, Skelton, & Butler, 2003). Coming out and de- birth of children and with the onset of serious illness. The study
veloping a gay or lesbian identity does not solely involve the in- is significant because it demonstrated that family relationships
dividual, but rather includes family members in the process are complex and that changes can occur throughout the lifespan.
(Valentine, Skelton, & Butler, 2003). In rural areas, characterized
by conservative values, religious fundamentalism, and lack of Conclusions and Recommendations for Future Research
visible gays and lesbians in the community (DAugelli & Hart,
1987; McCarthy, 2000; Williams, Williams, Pellegrino, & War- The research described has implications for prevention
ren, 2012), the difficulties associated with integrating a new iden- efforts and suggests directions for further investigation. The envi-
tity within the family can be magnified (DAugelli & Hart, 1987). ronment in which the LGB individual lives can have a dramatic
The literature base addressing rural LGB youth is scarce impact on ones psychological health. A study by Cohn and
(McCarthy, 2000; Williams, Williams, Pellegrino, & Warren, Leake (2012) found that having a supportive family was predic-
2012). Wang (2011) conducted a case study of a rural lesbian sur- tive of lower levels of psychological distress including anxiety
vivor of sexual violence to gain insight into her unique experi- and depression. Thus it is believed that families may serve a pro-
ence. Judy reported specific challenges because of the rural tective role in mitigating stressors associated with the coming out
context in which she lives, such as conservative culture, religious process among rural youth. However, it is important to note that
fundamentalism, discrimination of sexual minorities, feeling iso- the study by Cohn and Leake is one of the few studies available
lated and lonely due to living in a rural context, low levels of an- that looks at the difference between rural and urban LGB. More
onymity, a small LGB community, and poor access to resources. research is needed to explore both the qualitative lived experi-
Echoing Wangs findings, McCarthy (2000) found similar results ence of LGB youth as well as quantitative measures of these in-
when she conducted a focus group with 10 rural lesbians, ages 18 dividuals in rural areas. Specifically, it is important to expand re-
-52. The lesbians in this study reported feeling isolated and invis- search efforts to investigate how youth manage family relation-
ible in their communities, relying on word of mouth to find other ships during and after coming out, and how families can effec-
lesbians to find support. The women reported receiving support tively support their sexual minority children. Although we have a
from both heterosexual and homosexual peers and expressed the sense that supportive families are important, we do not know the
importance of lesbian communities within their region. Addition- components that are most essential for families to be helpful to
ally, these women reported that other lesbians coming out were the LGB youth during the coming out process. Answering ques-
often perceived as the first lesbian in the community, pointing to tions such as (a) what is the relationship between emotional and
the underground nature of support networks. financial support; (b) do children who leave families in conflict
Coming out is not a singular event and new family dy- fare better psychologically than those who stay in the family
namics can develop after someone comes out (DAugelli & Hart, home; and (c) what role do community members and allies such
1987). Oswald (2000) conducted a unique study investigating as teachers, counselors, and gay affirmative religious leaders play
what happened when young women come out as bisexual or les- in the lives of LGB youth will help us tailor interventions to as-
bian. One common theme across the 25 participants was change sist both families and youth as they go through the process of self
in relationship structure, which the authors describe as the - and other-disclosure.
internal and external boundaries of each network (pg. 74). It is essential that we continue to advocate for culturally
Most participants reported that after coming out they were no competent prevention efforts. These efforts should not only target
longer interested in keeping relationships with people who were LGB youth, but include families, as data reflect that identity de-
discriminatory to the LGB community. One participant described velopment as a gay or lesbian individual does not occur in isola-
an experience in which she listened to her family tell homophobic tion from social factors. Because families move through a period
jokes and the resulting distance she enacted after that event. Oth- of adjustment in coming to terms with their sexual minority
er participants experienced strengthened relationships when their youths identity, and because rural families may have less access
support networks took a stand against homophobia. Overall, this to support networks than their rural counterparts, research should
study found that coming out encouraged the social network, and examine ways to support family members in their journeys as
focal participants, to reevaluate their beliefs about homosexuali- well. Although the coming out process has generally been applied
ty, causing some relationships to be restructured to include sup- to the LGB individual, data suggest that families go through a
port for the lesbian or bisexual individuals sexual orientation and coming out process. However, to date, researchers have yet to
other relationships to become characterized by the creation of fully understand what that process is or to develop a model to ex-
distance from people displaying bigotry and homophobia. plain it.
Additionally, a study by Swainson and Tasker (2006) in- Characteristics such as nationality, religion, ethnic
vestigated lesbian couples experiences with their families. Uti- group, class, disability, and a myriad of other variables can also
shape the lives of LGB and their families (Liddle, 2007b). For chology handbook of multicultural education, research, in-
example, Caucasian gays and lesbians in the United States report- tervention, and training (pp. 277-284). San Francisco, CA:
ed receiving most of their social support from sexual minority Jossey-Bass.
friends, rather than blood relatives or family; whereas African Hastings, S. L., & Cohn, T. J. (in press). Challenges and Oppor-
American lesbians reported receiving most social support from tunities Associated with Rural Mental Health Practice, Jour-
other members of the African American community, rather than nal of Rural Mental Health.
their Caucasian, lesbian counterparts. Experiences are so varied Heatherington, L., & Lavner, J. (2008). Coming to terms with
that it may be difficult to generalize findings across an entire na- coming out: Review and recommendations for family sys-
tion, thus future research on LGB persons should likely focus on tems-focused research. Journal of Family Psychology, 22(3),
a smaller subgroup within the population. Investigation of the 329-343. doi: 10.1037/0893-3200.22.3.329.
lives of a particular group within the LGB population, particular- Hilton, A., & Szymanski, D. (2011). Family dynamics and
ly through qualitative methods and utilizing researchers who are changes in sibling of origin relationship after lesbian and
familiar with the groups characteristics, are more likely to gener- gay sexual orientation disclosure. Contemporary Family
ate results that truly reflect lived experience (Liddle, 2007b). Therapy, 33, 291-309, doi: 10.1007/s10591-011-9157-3.
We have examined the process of identity development Liddle, B. J. (2007a). Mutual bonds: Lesbian womens lives and
among rural sexual minority youth, particularly in the context of communities. In K. Biescheke, R. Perez, & K. DeBord,
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Saving Our Sisters: Effects of a Computer- ulation-level effects of HIV and AIDS. Future research should
contribute to expanding the knowledge base regarding research
based Version of SISTA on African Americans as well as HIV research. It should provide
insight into the social ecological underpinnings that influence the
Krystal S. Frieson current state of the HIV/AIDS epidemic. Additionally future re-
University of Kentucky search should contribute to the immerging literature regarding the
adoption of computer-based, evidence-based interventions (EBI)
within HIV prevention research.
Human Immunodeficiency Virus (HIV) and Acquired
Immunodeficiency Syndrome (AIDS) are infectious diseases References
wreaking irreparable havoc on the lives of millions all around the AIDS Community Demonstration Projects. (1999). Community-
world. Of those infected and affected by HIV in the United level HIV intervention in 5 cities: Final outcome data
States, African Americans disproportionately bear the burden of from the CDC AIDS community demonstration projects.
this disease, which has resulted in a major crisis within the Afri- American Journal of Public Health, 89(3), 336-345.
can American community. In 2006, HIV was regarded as one of Centers for Disease Control and Prevention. (2008). WISQARS
the major leading causes of death for African Americans (Centers leading causes of death reports, 1999-2007. National
for Disease Control and Prevention [CDC], 2010). These statis- Center for Injury and Prevention Control. Retrieved on
tics become even more dismal when both race and gender enter September 1, 2010 from http://webappa.cdc.gov/sasweb/
the equation. In 2004, the CDC reported HIV/AIDS was the ncipc/leadcaus10.html
leading cause of death for Black women worldwide (CDC, 2008). Centers for Disease Control and Prevention. (2010). HIV among
It is essential to address this crisis through prevention research as African Americans. Retrieved February 18, 2011, from
well as through the process of delving deeper into the complex http://www.cdc.gov/hiv/topics/aa/
web of factors related to the incidence and prevalence of HIV/ DiClemente, R. J., & Wingood, G. M. (1995). A randomized
AIDS. Behavioral interventions created to address HIV-related controlled trial of an HIV sexual risk reduction interven-
behavioral risks demonstrate the ability to dramatically reduce tion for young African American women. The Journal
this behavior and promote healthier alternatives amongst a varie- of American Medical Association, 274, 1271-1276.
ty of targeted high-risk populations (AIDS Community Demon- Kalichman, S. C., Rompa, D., Cage, M., DiFonzo, K., Simpson,
stration Project [ACDP], 1999; DiClemente & Wingood, 1995; D., Graham, J. (2001). Effectiveness of an interven-
Kalichman et al., 2001). tion to reduce HIV transmission of risk in HIV-positive
The SAHARA program is a computer-based, culturally people. A merican Journal of Public Health, 21(2), 84-
cognizant and appropriate HIV behavioral intervention program 92.
created by African American women for African American wom- Wingood, G. M., Card, J. J., Er, D., Solomon, J., Braxton, N.,
en. Although SAHARA demonstrated preliminary efficacy re- & DiClemente, R.J. (2011). Preliminary efficacy of a
sults for African American women during its initial randomized computer-based HIV intervention for African American
control trial experiment, the study population consisted of a women. Psychology and Health, 26(2), 223-234.
group of African American women located in the urban city of
Atlanta, Georgia (Wingood et al., 2011). Future research with a This research was supported in part by the Prevention Research
population of African American women within a different geo- Award from the Prevention Section of the Division of Counseling
graphical region and clinical setting may provide evidence-based Psychology (17) of the American Psychological Association.
data regarding the validity and appropriateness for the increased
dissemination of this computer-based intervention created from a Correspondence concerning this abstract should be directed to:
CDC approved behavioral intervention. Krystal S. Frieson, Department of Educational, School, and
Until the creation of an effective HIV/AIDS vaccine is Counseling Psychology, The University of Kentucky, 237 Dickey
manufactured, behavioral interventions are both critical and cru- Hall, Lexington, KY 40506-0017. Email: krys-
cial to reducing HIV infection rates. Current research directions tal.frieson@uky.edu .
are underscoring the importance of disseminating and utilizing
effective behavioral interventions, particularly those that are cul-
turally tailored for oppressed and marginalized population such
as African American women. Culturally relevant interventions
aim to acknowledging and address the multiple levels of social
and contextual factors that contribute to the detrimental health
behaviors and poor health outcomes experienced by these under-
served groups. An essential component involved in curbing the
spread of and the eventual elimination of HIV and its deleterious
consequences within communities of color will involve address-
ing the macro-level sociopolitical factors that perpetuate the pop-
Marijuana and College Counseling Center

Clients: Risk and Protective Factors of Mariju-
ana Use Disorders
Laura L. Holt & Ellen L. Vaughan

Indiana University
Marijuana use disorders among college students are an important

target for prevention. Marijuana is the most commonly used illicit
substance in the United States, and is prevalent among college
students (Gledhill-Hoyt et al, 2000, SAMHSA, 2010). Given the
potential dangers associated with long-term marijuana abuse, it is
important to explore potential risk or protective factors for such
marijuana use disorders in order to plan successful prevention in-
terventions. The current study tests the relationship between gen-
der, race/ethnicity, mental health, school year classification, en-
rollment status, campus residency, drinking status, and parental
alcohol abuse and the lifetime presence of a marijuana use disor-
der in a sample of college students who participated in the Na-
tional Epidemiologic Study of Alcohol and Related Conditions
(NESARC). Results found that Hispanic, African-American, or
Asian students had lower odds of a marijuana use disorder. Hav-
ing an anxiety or mood disorder, drinking alcohol, and having a
parent with an alcohol problem increased the odds of having a
marijuana use disorder. Selective and indicated prevention pro-
grams might target those students with who are drinking and have
anxiety or mood disorder diagnoses.
The project results presented in this study were secondary data

analysis of the National Epidemiologic Survey on Alcohol and
Related Conditions.
Correspondence concerning this abstract should be directed to:

Ellen L. Vaughan, Department of Counseling and Educational
Psychology, 201 N. Rose Avenue, Bloomington, Indiana 47405-
1006. Email: elvaugha@indiana.edu.

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PREVENTION IN

Photo by Erin Sadler, http://www.erinsadler.com

Editorial Board Chair

Members of the Editorial Board

Greetings from the Editorial Board 5

Message from Your Graduate Student Representative 6

Theory, Research, Practice and Training

Preventing Attrition of Minority Counseling Psychology Graduate

Accuracy of Parents Beliefs about Their College Student Childrens

Social Responsibility in Psychology Today: Prevention is Imperative 19

Saving Our Sisters: Effects of a Computer-based Version of SISTA 28

Message from the Chair

Greetings from the Editorial Board

Message from Your Graduate Student Representative

Investigating Gender Differences in PTSD, Depression,

Kathryn E. Tichy Jack Y. Tsan

ment. The need for this information is critical to incorporate a

Lapierre, C. B., Schwegler, A. F., LaBauve, B. J. (2007). Post-

This work was supported by Department of Veterans Affairs, Ad-

Preventing Attrition of Minority Counseling Psychology Graduate

Accuracy of Parents Beliefs about Their College Student Childrens

Table 1. Means, standar d deviations, t-test results, and effect

ents perceptions of their college student childrens health www.niaaa.nih.gov/Publications/AlcoholAlerts/.

Social Responsibility in Psychology Today: Prevention is Imperative

American Psychological Association. (1992). Ethical principles

The Role of the Family in Enhancing Positive Development in

closure to parents of same-sex attraction. Journal of

Marijuana and College Counseling Center

Laura L. Holt & Ellen L. Vaughan

Marijuana use disorders among college students are an important

The project results presented in this study were secondary data

Correspondence concerning this abstract should be directed to:

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