Drug Abuse Prevention

Research Findings from February, 2003 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Evaluation of the National Youth Anti-Drug Media Campaign: Fifth Semi-Annual Report of Findings

The National Youth Anti-Drug Media Campaign (NYAMC) was funded by the Congress to reduce and prevent drug use among young people both directly, by addressing youth and indirectly, by encouraging their parents and other adults to take actions known to affect youth drug use. The major intervention components include television, radio, and other advertising, complemented by public relations efforts including community outreach and institutional partnerships.

The goals of the evaluation are to determine: 1) if there is change in the behaviors, attitudes and beliefs targeted by the Campaign and 2) determine if such change can be attributed to the Campaign. The findings summarized below are from the fifth Evaluation report; the first three waves of data collection involved enrolling nationally representative samples of about 8,100 youth from 9 to 18 and 5,600 of their parents. The 4th and 5th waves together include the first (of two) follow-up interviews of the initial samples. The new report covers the period from September 1999 through June 2002 and examines 1) exposure of youth and their parents to anti-drug messages (general exposure and specific exposure to ads run in the 2 months prior to the interview that are played on a computer to respondents); 2) effects on parents in terms of beliefs and behaviors associated with talking about drugs, and beliefs and behaviors regarding monitoring their child, and doing fun activities with their child; and 3) effects on youth cognitions, intentions, and initiation of drug use.

• Exposure to and Recall of Campaign Messages
  As in the 4th Report, most parents and youth recalled being exposed to NYAMC anti-drug messages. About 70 percent of both groups report exposure to one or more messages through all media channels every week. The average (median) youth remember seeing one television ad per week. In the first three waves less than 25 percent of parents recalled seeing a TV ad every week; this increased to 40 percent in the second half of 2001 and 50 percent during the first half of 2002. The current report indicates that both parents and youth reported substantial recognition of the Campaign's "anti-drug" brand phrases. The Campaign added Drugs and Terror ads targeted to both parents and youth during this period. The evaluation of these ads by both groups was somewhat less positive than the evaluation of the other ads broadcast during Wave 5.


• Effects on Parents
  There continues to be evidence suggesting a favorable Campaign effect on parents. Overall, there are favorable changes in 3 out of 5 parent belief and behavior outcome measures including talking about drugs with and monitoring of children. In addition, those parents who report more exposure to Campaign messages at time 1 measurement, were more likely subsequently to talk with their children and do fun activities with them. However, there is little evidence for Campaign effects on parents' monitoring behavior, the focus of the parent Campaign in the past year and the parent behavior most associated with youth nonuse of marijuana. Likewise, there is no evidence of favorable indirect effects on youth behavior as the result of parent exposure to the Campaign.


• Effects on Youth
  There is no evidence of direct favorable Campaign effects on youth. There is no statistically significant decline in marijuana use to date, and some evidence for an increase in use from 2000 to 2001. Nor are there improvements in anti-use beliefs and attitudes about marijuana between 2000 and the first half of 2002. Conversely, there are some unfavorable trends in youth anti-marijuana beliefs. In addition, there is no tendency for those reporting more exposure to Campaign messages to hold more desirable beliefs.
  
  There continues to be evidence for an unfavorable delayed effect of Campaign exposure from September 1999 through June 2001 on subsequent intentions to use marijuana and on other beliefs and these are found for the entire sample. Whereas intentions are strong predictors of subsequent initiation of marijuana use, the evidence for an unfavorable effect on actual initiation was not statistically significant overall or for any subgroup. Thus, the behavioral evidence for some youth subgroups at Wave 4 was not confirmed once the entire sample was considered.
  
  The full evaluation will involve three interviews with respondents over 3 1/2 years.

Effectiveness of a Universal Drug Abuse Prevention Approach For Youth At High Risk For Substance Use Initiation

Griffin and his colleagues examined the impact of universal school-based prevention programs for alcohol, tobacco, and other drug use for youth at high risk for substance use initiation. The effectiveness of a universal drug abuse preventive intervention was examined among youth from 29 inner-city middle schools participating in a randomized, controlled prevention trial. A subsample of youth (21% of full sample) was identified as at high risk for substance use initiation based on exposure to substance-using peers and poor academic performance in school. The prevention program taught drug refusal skills, anti-drug norms, personal self-management skills and general social skills. Findings indicated that youth at high risk who received the program (n = 426) reported less smoking, drinking, inhalant use, and polydrug use at the one-year follow-up assessment compared to youth at high risk in the control condition that did not receive the intervention (n = 332). Results indicate that a universal drug abuse prevention program is effective for minority, economically disadvantaged, inner-city youth who are at higher than average risk for substance use initiation. The findings from this study suggest that universal prevention programs can be effective for a range of youth along a continuum of risk. Griffin, K.W., Botvin, G.J., Nichols, T.R., and Doyle, M.M. Preventive Medicine, 36, pp. 1-7, 2003

Effective Family Intervention Embedded into the Public School Setting

The Adolescent Transitions Program (ATP) promotes student adjustment and reduces risk through a tiered intervention, involving universal, selective, and indicated intervention. The universal intervention places a family resource center in the schools for parenting resources and information supportive of protective parenting practices. The indicated intervention, a motivational interviewing process referred to as the Family Check Up, engages parents in appropriate family centered interventions. The indicated intervention involves a menu of options designed to strengthen effective family management practices. In this trial, 672 multiethnic students and their families were randomly assigned from the entire population of 6th grade students in three middle schools to the ATP intervention or to control. By the 9th grade, youth in the ATP program had a reduced incidence of a composite measure of tobacco or alcohol use compared to youth in the control group. The intervention effect did not differ by risk status or ethnicity. This study provides a successful model for embedding family interventions within the public school ecology. Dishion, T.J., Kavanagh, K., Schneiger, A., Nelson, S., and Kaufman, N. Preventing Early Adolescent Substance Use: A Family Centered Strategy for the Public Middle School. Prevention Science, 3(3), pp. 191-201, 2002.

Life Skills Training As a Primary Prevention Approach for Adolescent Drug Use and Other Problem Behaviors

Alcohol, tobacco, and other drug use are important problems that typically begin during adolescence. Fortunately, substantial progress has been made in developing effective drug abuse prevention programs for youth over the past two decades. Prevention approaches that focus on the risk and protective factors associated with drug use initiation and those that teach skills related to social resistance are most effective. The Life Skills Training (LST) program is an effective primary prevention program for adolescent drug abuse that focuses on these factors as well as enhancing social and personal competence skills. This paper provides an overview of the theoretical underpinnings of the LST program, along with a description of the program's components, materials, and methods. Findings from over two decades of evaluation research are reviewed and demonstrate that the LST approach consistently produces positive behavioral effects on alcohol, tobacco, and other drug use. The role of competence enhancement-based primary prevention programs in preventing other negative behaviors during adolescence is discussed. Botvin, G.J., and and Griffin, K.W. International Journal of Emergency Mental Health, 4, pp. 41-47, 2002.

Positive Impact of Competence Skills and Psychological Wellness In Protecting Inner-City Adolescents From Alcohol Use

Research has shown that competence enhancement prevention programs for substance use are effective in reducing alcohol use and other problem behaviors. However, less is known about the mechanisms by which high competence helps youth avoid negative outcomes. This study explored whether greater competence is associated with increased levels of psychological wellness that in turn deters subsequent alcohol use. Specifically, 1,459 students attending 22 middle and junior high schools in New York City completed surveys that included measures of competence (decision making, self-efficacy), psychological wellness, and alcohol use. Students completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Data collectors administered the questionnaire following a standardized protocol during a regular 40-min class period. On the basis of a longitudinal structural equation model, adolescents who were highly competent reported greater psychological wellness, which was then associated with less drinking. These findings highlight the potential of alcohol prevention programs designed to enhance competence and psychological wellness. Epstein, J.A., Griffin, K.W., and Botvin, G.J. Prevention Science, 3, pp. 95-104, 2002.

Culturally Sensitive Adaptation of Prevention Intervention

Very few family interventions have been adapted to be culturally sensitive for specific ethnic groups. This paper examines recruitment/retention and outcome effectiveness in five studies comparing standard and culturally adapted versions of the Strengthening Families Program (SFP). This selective prevention program is a 14-session family skills intervention involving parent, child, and family skills training components. Standard and adapted interventions were compared for African American, Hawaiian, Hispanic, and Native American families. Standard versions of the intervention tended to have slightly better outcomes, but recruitment and retention of families was 41% improved when implementing culturally adapted versions. Kumpfer, K.L., Alvarado, R., Smith, P., and Bellamy, N. Cultural Sensitivity and Adaptation in Family Based Prevention Interventions. Prevention Science, 3(3), pp. 241-246, 2002.

Combining School-based and Family-based Intervention

This study evaluated the substance initiation effects of an intervention combining two empirically supported prevention interventions, one that is family-based and another that is school-based. Strengthening Families Program for Parents and Children 10-14 (SFP 10-14) is a family-based program designed to enhance parental skills in nurturing, limit setting, and communication as well as youth prosocial and peer resistance skills. Life Skills Training Program (LST) is a classroom-based prevention intervention designed to promote skill development in youth for the prevention of substance abuse. Thirty-six rural schools were randomly assigned to one of three conditions: 1) LST and SFP 10-14, 2) LST only, or 3) a control condition. Outcomes were examined one year after the intervention posttest, using a substance initiation index measuring lifetime use of alcohol, cigarettes, and marijuana and rates of use for individual substances. Both the combined and the LST interventions differed significantly (and favorably) from the control condition with regard to the substance initiation index and marijuana use, while the difference between the combined and LST-only programs was not significant for these measures. However, the combined program significantly reduced rates of alcohol initiation as compared to both the LST-only and control groups. Preliminary results suggest that the family-focused component may be particularly important in preventing the initial transition to alcohol use. Spoth, R.L., Redmond, C., Trudeau, L., and Shin, C. Longitudinal Substance Initiation Outcomes for a Universal Preventive Intervention Combining Family and School Programs. Psychology of Addictive Behaviors 16(2), pp. 129-134, 2002.

Many U.S. Middle Schools Continue to Implement Untested or Ineffective Prevention Curricula

School-based curricula constitute the nation's primary means of addressing the prevention of youth substance abuse. Despite an abundance of positive evaluative evidence concerning the effectiveness of a number of school-based substance use prevention curricula, many of the nation's middle schools continue to implement curricula that are either untested or ineffective. Respondents comprised the lead staff who implemented substance use prevention in a representative sample of 1,905 of U.S. public and private middle school schools. A self-administered survey indicated that only 26.8% of all schools used at least 1 of 10 effective curricula. However, few school or respondent characteristics were related to program implementation. Results demonstrate a considerable gap between our understanding of effective curricula and current school practice. Ringwalt, C., Ennett, S, Vincus, A, Thorne, J, Rohrback, L.A., and Simons-Rudolph, A. The Prevalence of Effective Substance Use Prevention Curricula in U.S. Middle Schools. Prevention Science, 3(4), pp. 257-265, 2002.

Early Elementary School Intervention to Reduce Conduct Problems

Children's aggressive behavior and reading difficulties during the early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. Drawing from 3 communities, 116 European American and 168 Hispanic kindergarten through 3rd grade children who were identified for aggressiveness or reading difficulties were randomly assigned to a multicomponent intervention or no-intervention control condition. Intervention families received parent training, and children received social behavior interventions and supplementary reading instruction over a 2-year period. Post-intervention playground observations showed that the intervention children displayed less negative social behavior than controls. At 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. Barrera, M.J.R., Biglan, A., Taylor, T.K., Gunn, B. K., Smolkowski, K., Black, C., Ary, D.V., and Fowler, R.C. Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial with Hispanic and Non-Hispanic Children. Prevention Science, 3(2), pp. 83-94, 2002.

Will the 'Principles of Effectiveness' Improve Prevention Practice? Early Findings From a Diffusion Study

This study examines adoption and implementation of the U.S. Department of Education's new policy, the "Principles of Effectiveness," from a diffusion of innovations theoretical framework focusing on the requirement to select research-based programs. Results from a sample of 104 school districts in 12 states indicate that many districts appear to be selecting research-based curricula, but that the quality of implementation was low. Only 19% of the responding district coordinators indicated that schools were implementing a research-based curriculum with fidelity. Common problems included lack of teacher training, lack of requisite materials, use of some but not all of the required lessons or teaching strategies, and failure to deliver lessons to age-appropriate student groups. This study represents the first attempt to assess the quality of implementation of research-based programs as required by the SDFS Principles of Effectiveness. The authors conclude that low levels of funding, inadequate infrastructure, decentralized decision making and lack of program guidance contribute to slow progress in improving school-based prevention. Hallfors, D. and Godette, D. Health Education Research, 17(4), pp. 461-470, 2002.

How are Community Coalitions 'Fighting Back' against Substance Abuse, and are they Winning?

This paper examines the strategies that coalitions in a large national demonstration program (Fighting Back) chose to develop, the degree to which they implemented these strategies, and evidence regarding their effectiveness. Coalition strategy implementation was coded and ranked for 12 Fighting Back sites. Effect sizes (intervention over time) for outcomes related to substance use, alcohol and other drug treatment, and community/prevention indicators were ranked by site. Based on rank order correlations to test three directional hypotheses, the article compares strategy dose to outcomes. None of the hypotheses was supported. Strategies aimed at youth or community/prevention outcomes showed no effects; while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes. The authors conclude that comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered, and that efforts to evaluate implementation processes and strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research. Hallfors, D., Hyunsan, C., Livert, D., and Kadushin, C. American Journal of Preventive Medicine, 23(4), pp. 237-245, 2002.

An Early Community-Based Intervention for the Prevention of Substance Abuse and Other Delinquent Behavior

The results of a risk-reduction intervention strategy versus a standard intervention approach in the treatment of inner-city youth at high risk of adopting a deviant lifestyle were examined at baseline and 1-year follow-up using information provided by 408 youth (males and females, aged 9-17 years at interview) admitted to 2 community-based Baltimore City "Youth Bureaus." Bureaus offered counseling services for neighborhood youth referred for delinquent and other problematic behavior. One bureau served as the experimental intervention clinic and another as the control, or standard intervention clinic. Outcome measures involved substance abuse, sexual activity, contact with juvenile authorities, and delinquent activity, including violence-related activity. Regression analyses of outcome measures revealed significant differential results for delinquent activity, favoring the intervention condition. Hanlon, T.E., Bateman, R.W., Simon, B.D., O'Grady, K.E., and Carswell, S.B. Journal of Youth & Adolescence, 31(6), pp. 458-471, 2002.

A Self-Instructed Curriculum for Indicated Adolescent Drug Abuse

Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse in completing their high school education, and is a method of choice among educators at alternative high schools. The justification, development and impact of one self-instruction program, Project Towards No Drug Abuse (TND) is described. Keys to effective programmed self-learning are examined. Health-educator led, self-instruction, and standard care control conditions were compared on knowledge change, and the 2 program conditions were compared on process ratings; 572 students completed surveys. A sample of high-school students attended an average of 66% of the sessions in the health educator-led condition, whereas students completed an average of 83% of the self-instruction sessions. The self-instruction condition was easy to implement, provided better implementation, and resulted in learning as great as the health educator condition. However, students rated the health educator condition more positively. Sussman, S., Dent, C.W., Craig, S., Ritt-Olsen, A., and McCuller, W.J. Development and Immediate Impact of a Self-instructed Curriculum for an Adolescent Indicated Drug Abuse Prevention Trial. Journal of Drug Education, 32(2), pp. 121-137, 2002.

Influence of a Substance-Abuse-Prevention Curriculum on Violence-Related Behavior

This study tested the impact of a school-based substance-abuse prevention program, Project Towards No Drug Abuse (TND), on risk for violence. Logistic regression analyses tested whether victimization, perpetration, or weapon carrying differed for intervention students relative to control students in a sample of 850 continuation (high-risk) high school students (aged 14-19 years) who were followed over 12 months. Results showed a higher risk for victimization among male control students. No intervention effect was observed for female students or for perpetration among males. The findings provide limited support for a generalization of TND's preventive effect. Simon, T.R., Sussman, S., Dahlberg, L.L., and Dent, C.W. American Journal of Health Behavior, 26(2), pp. 103-110, 2002.