Drug Abuse Prevention

Research Findings from September, 2004 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.

Family Attention and Tobacco Smoking Among Adolescents

This study examined the association between family attention and tobacco use among 5549 adolescent students in five Central American countries, Panama, and the Dominican Republic who participated in a survey of drug use in 1994. Drug use and other variables were assessed using an adapted version of the Drug Use Screening Inventory (DUSI) in Spanish. Students with the highest level of family attention had a lower occurrence of tobacco smoking than students with the lowest level of family attention. Country-specific analyses show similar associations. These findings underscore the need to understand tobacco use in Central America and neighboring countries and to test whether interventions aimed at enhancing parentalÑchild attention, communication, and monitoring reduce the incidence of tobacco use among youths. Gosebruch, G., Sanchez, M., Delva, J., Wagner, F., and Anthony, J.C. Family Attention and Tobacco Smoking Among Adolescents in Central America, Panama, and the Dominican Republic. Substance Use Misuse 38(8), pp. 1037-1106, 2003.

Sources of Information about MDMA/Ecstasy

Researchers conducted a cross-sectional study to assess the perceived accuracy and importance of various sources of information about MDMA/ecstasy among young adult users. They used a respondent driven sampling plan to recruit and then interview recent ecstasy users (n = 304), aged 18-30, in Ohio. Information collected included the most common venue of ecstasy use; the total number of occasions ecstasy had been used; behavioral intentions to use ecstasy again; and the perceived accuracy as well as the importance of 16 sources of information about ecstasy, including the Internet. Friends, drug abuse treatment programs, and physicians were identified as the most accurate sources of information about ecstasy by 45.7%, 37.2%, and 30.3% of the sample, respectively. Friends were considered the most important source of information about ecstasy (40.2%), followed by web sites like DanceSafe (16.2%), and MTV/VH1 television specials (6.9%). More than half the sample used the Internet to obtain information about ecstasy, with younger and more educated participants significantly more likely to do so. Educated users were also significantly more likely to consider the Internet to be an important source of information, and visited sites like DanceSafe as many as 4 times more often than government-sponsored web sites. These findings support the development of peer-oriented, network strategies to reach ecstasy users with prevention messages. In particular, efforts should be made to make prevention information web sites more attractive and useful. Falck, R.S., Carlson, R.G., Wang, J. and Siegal, H.A. Sources of Information about MDMA/Ecstasy: Perceived Accuracy, Importance, and Implications for Prevention Among Young Adult Users. Drug and Alcohol Depend, 74, pp. 45-54, 2004.

Revised Project ALERT Modifies Risk Factors in Adolescents

The revised Project ALERT curriculum is designed to help young people resist pro-drug pressures and contains additional lessons on smoking cessation, and alcohol misuse, and a series of new home-learning activities that encourage parental involvement. To test the impact of the revised curriculum, fifty-five middle schools from South Dakota were randomly assigned to the revised ALERT or control condition. Treatment group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4,276 eighth graders were assessed 18 months after baseline. Results indicated that the revised ALERT had statistically significant effects on all targeted risk factors associated with cigarette and marijuana use and more modest gains with pro-alcohol risk factors. The program showed beneficial changes in adolescents at all risk levels (i.e., low, moderate and high) for future use, with the effect sizes typically stronger for the low and moderate risk groups. Gosh-Dastidar, B., Longshore, D., Ellickson, P. and McCaffrey, D. Modifying Pro-Drug Risk Factors in Adolescents: Results from Project ALERT. Health Education & Behavior, 31(3), pp. 318-334, 2004.

Advocacy Interventions Reduce Smoking among Teenagers

The purpose of this study was to determine whether high school students' participation in advocacy activities related to the advertising, availability and use of tobacco in communities would prevent or reduce their own use. Eleventh and 12th grade students in 10 continuation high schools were randomly assigned to advocacy activities (treatment in 5 schools) or to learning about drug and alcohol abuse prevention during a semester-long program (5 control schools). Based on self-reports, students were classified as nonsmokers, light smokers (those who smoked less than a pack per week) or regular smokers (those that smoked one or more packs per week. Three additional measures were assessed: perceived self-efficacy, perceived incentive value, and outcome expectances. There was a significant net change from baseline to the end of the semester (after the intervention) between treatment and control schools for students who were regular smokers but not for students who were nonsmokers or light smokers. Regular smoking decreased 3.8% in treatment schools and increased 1.5% in control schools (P<.001). Regular smoking continued to decrease at 6-months post-intervention in treatment schools, with a total change in prevalence from 25.1% to 20.3%. Measures of community-advocacy involvement and the three social constructs also showed significant net changes between control and treatment schools. Winkelby, M.A., Feighery, E., Dunn, M., Kole, S., Ahn, D. and Killen, J.D. Effects of an Advocacy Intervention to Reduce Smoking Among Teenagers. Archives of Pediatric and Adolescent Medicine 158, pp. 269-275, 2004.

Brief Family Intervention Effects 6 Years Past Baseline

This study examines the effects of two brief family-focused interventions on the trajectories of substance initiation over a period of 6 years following a baseline assessment. The interventions, designed for general population families of adolescents, were the 7-session Iowa Strengthening Families Program (ISFP) and the 5-session Preparing for the Drug Free Years Program (PDFY). Thirty-three rural public schools were randomly assigned to the ISFP, the PDFY, or a minimal contact control condition. These interventions have been previously proven to reduce alcohol use at 2.5 years and 4 years past baseline. The curvilinear growth observed in school-level outcome measures of drug initiation was evaluated using a logistic growth curve analysis. Alcohol and tobacco composite use indicesÑas well as lifetime use of alcohol, cigarettes, and marijuanaÑand lifetime drunkenness, were examined in the current analysis, in which study participants are an average of 18.2 years old. Significant intervention-control differences were observed, indicating favorable delays in growth rates of initiation of alcohol use without parental permission, drunkenness, and cigarette use initiation in the intervention groups. Spoth, R.L., Redmond, C., Shin, C. and Azevedo, K. Brief Family Intervention Effects on Adolescent Substance Initiation: School-level Growth Curve Analyses 6 Years Following Baseline. Journal of Consulting and Clinical Psychology, 72(3), pp. 535-542, 2004.

The Role of Parental Risk in the Moderation of Child Intervention Outcomes

Four years of longitudinal data from 373 families participating in a randomized intervention trial were used to examine whether intervention effects on adolescent alcohol and tobacco use trajectories were moderated by family risk, as defined by parental social emotional adjustment. A single parental social emotional maladjustment score was calculated by summing average scores from subscales tapping anxiety, depression, and hostility based on parent report. Consistent with previous studies based on a different analytic technique, the current analyses confirmed that both the Preparing for the Drug Free Years program and the Iowa Strengthening Families Program favorably influenced youth alcohol use index trajectories across the time frame of the study while only the latter program evidenced positive effects on a tobacco use index. With regard to the role of parental risk in moderating these program outcomes, analyses provided no support for family risk moderation of any intervention effect. Guyll, M., Spoth, R.L., Chao, W., Wickrama, K.A.S. and Russell, D. Family-focused Preventive Interventions: Evaluating Parental Risk Moderation of Substance Use Trajectories. Journal of Family Psychology, 18(2), pp. 293-301, 2004.

Violence Prevention among African American Adolescent Males

This study tests whether the efficacious, multi-year Aban Aya intervention has significant effects on the proposed mediating variables and whether the significant preventive effects in reducing violence found in previous analyses are mediated by changes in proposed mediators. Five hundred seventy-one African American adolescent males participated in this randomized trial. Multi-level modeling techniques were used to ascertain both intervention and mediated effects. The intervention significantly reduced the rate of growth of violence and five social and psychological factors in the treatment group relative to the control group. Four of these social and psychological factors, behavioral intentions, attitudes toward violence, estimates of peers' behaviors, and estimates of best friends' behaviors, were found to be complete mediators between the intervention and its preventive effects. Ngwe, J.E., Liu, L.C., Flay, B.R., Segawa, E. and the Aban Aya coinvestigators. Violence Prevention among African American Adolescent Males. American Journal of Health Behavior, 28(Suppl 1), pp. S24-S37, 2004.

Social Assertiveness, Internalizing, and Gender Moderation Effects Of A Preventive Intervention

The current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency and the initiation of substance use as well as the effects of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment. A latent growth curve comparison analysis found that internalizing was inversely related to initial levels of social assertiveness skill among girls. Internalizing was positively related to substance use initiation growth trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance use initiation and a faster increase in social assertiveness. Lillehoj, C.J., Trudeau, L., Spoth, R.and Wickrama, K.A.S. Internalizing, Social Competence, and Substance Initiation: Influence of Gender Moderation and a Preventive Intervention. Substance Use and Misuse, 39(6), pp. 963-991, 2004.

D.A.R.E Plus Is More Effective in Preventing Violence Among Boys Than Girls

Twenty-four middle schools were randomly assigned to: 1) DARE curriculum; 2) DARE Plus multi-component curriculum; or 3) control condition. Outcomes of the three conditions on violence-related behaviors were compared, and mediational analyses were conducted to examine how interventions reduced physical and verbal violence. Generally, boys demonstrated higher rates of violence and victimization than girls. Boys in the DARE Plus condition had a marginally significant lower number of verbally violent acts than boys in the control condition. Boys in the DARE Plus condition had a marginally lower number of physically violent acts than boys in the DARE condition. There were no significant differences between the DARE only and control groups. There were no significant differences between the three groups in victimization. The small behavioral effect that DARE Plus demonstrated on physical and verbal violence among boys was mediated by a decrease of norms that support violence, an increase in outcome expectancies about being violence-free, and an increase in parental consequences for fighting. DARE Plus was not as effective in preventing violence among girls, however, girls in the DARE Plus condition had significantly lower scores on the Victimization Scale than girls in the DARE only condition. Komro, K.A., Perry, C.L., Veblen-Mortenson, S., Stigler, M.H., Bosma, L.M., Munson, K.A. and Farbakhsh, K. Violence-related Outcomes of the DARE Plus Project. Health Education & Behavior, 31(3), pp. 335-354, 2004. Perceptions of Rural Parents Regarding Family-Focused Programs Data collected in the Promoting School-Community-University Partnership to Enhance Resilience (PROSPER) project during telephone interviews with 1,156 parents of sixth graders from 36 rural schools were used in multilevel structural equation modeling. Results of analyses show that: 1) parents considered their children to be at low risk for substance use; 2) parents perceived themselves to be effective in helping their children avoid maladaptive behaviors; 3) mothers perceived themselves to be more efficacious than did fathers; 4) parental efficacy perceptions inversely affected perceptions of child susceptibility; 5) parents' perceptions of child susceptibility positively affected perceived program benefits; and 6) higher perceived program benefits and higher perceived child susceptibility were associated with mothers, male children, single parents, lower household income, and lower parent education. Redmond, C., Spoth, R, Shin, C. and Hill, G. Engaging Rural Parents in Family-Focused Programs to Prevent Youth Substance Abuse. Journal of Primary Prevention, 24(3), Spring, 2004.

*Alcohol and Marijuana Use in Early and Late Adolescence

This study examined alcohol and marijuana use over a 9-year period between ages 11-12 and ages 19-21 using a community based dataset collected prospectively as part of the evaluation of Project DARE. Because the DARE intervention was found to have no effects on any program targets, this dataset provides an appropriate community sample for investigating developmental changes in drug use over time. 481 participants (50.17% male, 79.2% Caucasian) were interviewed once a year in the sixth through tenth grades and again at age 20. A growth mixture model approach was used to analyze interview data from 6 time points in an attempt to empirically identify subgroups of alcohol and marijuana users over time. Three subgroups were identified for both alcohol use and marijuana use: a group that initiated substance use in early adolescence (age 11-12), a group that initiated use in late adolescence/early adulthood (age 15-16), and an abstainer group. Several variables measured in early adolescence including school and church involvement, self-esteem, peer pressure resistance, sensation seeking, expectancies, and conduct problems significantly differentiated the alcohol and marijuana subgroups. The subgroups also differed significantly on young adult outcomes, including alcohol and marijuana dependence, antisocial personality disorder symptoms, and number of arrests. For alcohol use, the early-onset group was more dysfunctional in terms of early psychosocial risk factors and later deleterious outcomes whereas the late-onset and nonuser groups were better adjusted. In contrast, for marijuana, the early- and late-onset groups were both more dysfunctional than the nonuser group. Flory, K., Lynam, D., Milich, R., Leukefeld, C. and Clayton, R. Early Adolescent through Young Adult Alcohol and Marijuana Use Trajectories: Early Predictors, Young Adult Outcomes, and Predictive Utility. Development and Psychopathology, 16, pp. 93-213, 2004. Spirituality and "Health-As-A-Value" Are Protective Against Teen Substance Use This study investigated the influence of two potentially protective factors, Health-as-a-Value (HAV) and spirituality, on monthly alcohol, cigarette, and marijuana use in two multiethnic groups of adolescents varying in risk. Survey respondents included 382 students from continuation/alternative high school, a population considered at risk for drug use, and 260 students drawn from a medical magnet high school, and considered to be at lower risk. The data indicated that spirituality was protective against monthly alcohol use and marijuana use in the lower risk sample. In the higher risk sample, spirituality was protective against all monthly use. HAV was protective against monthly alcohol use in the low risk sample, and protective against all monthly use in the higher risk sample. When both constructs were entered into the same model, spirituality and HAV were independently protective of all monthly use for the higher risk sample and of monthly alcohol use in the lower risk sample, supporting the earlier finding that both are independently protective values. Thus, HAV and spirituality may be protective in various environments, independent of the level of use in the environment. Ritt-Olson, A., Milam, J., Unger, J.B., Trinidad, D., Teran, L., Dent, C.W., and Sussman, S. The Protective Influence Of Spirituality And "Health-As-A-Value" Against Monthly Substance Use Among Adolescents Varying In Risk. Journal Of Adolescent Health, 34 (3), pp. 192-199, 2004.

Agreement of Program Provider and Observer Ratings of School-Based Preventive Intervention Implementation & Relation to Youth Outcomes

Few prevention studies have examined the degree to which different measures of program implementation adherence predict youth outcomes. The current study was conducted with rural middle school youth participating in a longitudinal school-based preventive intervention program. Study participants' average age at the pretest assessment was 12.3 years. The association between program implementation ratings supplied by provider self-reports and trained independent observer reports were evaluated. In addition, the relationship between measures of implementation and youth outcomes were examined. Results indicated that although program providers tended to report higher implementation than independent observers, most ratings were correlated significantly across raters. Moreover, observer-reported implementation ratings significantly predicted several youth substance-related outcomes, while provider reported self-ratings did not. Findings suggest that there might be a social desirability bias in provider self-reported ratings of implementation and that caution must be used when interpreting self-reported ratings of implementation. Lillehoj, C.J., Griffin, K.W. and Spoth, R. Program Provider and Observer Ratings of School-based Preventive Intervention Implementation: Agreement and Relation to Youth Outcomes. Health Education and Behavior, 31(2), pp. 242-257, 2004.