Mason, W., Kosterman, Rick, Hawkins, J., Haggerty, Kevin P., Spoth, Richard L.

Reducing adolescents' growth in substance use and delinquency: Randomized trial effects of a parent-training prevention intervention

The relationship between growth in adolescent substance use and delinquency was examined in a longitudinal, randomized controlled study of the Preparing for the Drug Free Years Program (PDFY), a universal family-focused prevention intervention. Latent growth curve modeling was used to analyze 5 waves of data collected from 429 rural adolescents. Results showed that adolescents assigned to the PDFY intervention condition had a slower rate of linear increase over time in both substance use and delinquency compared with adolescents assigned to the control condition. Moreover, pretest level of delinquency was a reliable, positive predictor of growth in substance use, whereas pretest level of substance use did not predict growth in delinquency. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract).

Prevention Science, 4(3) : 203- 212

Perry, Cheryl L., Komro, Kelli A., Veblen-Mortenson, Sara, Bosma, Linda M., Farbakhsh, Kian, Munson, Karen A., Stigler, Melissa H., et-al

A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. Plus programs

OBJECTIVE: To evaluate the effect of the middle and junior high school Drug Abuse Resistance Education (D.A.R.E.) and D.A.R.E. Plus programs on drug use and violence. DESIGN: Randomized controlled trial of 24 schools, with 3 conditions: D.A.R.E. only, D.A.R.E. Plus, and delayed program control. SETTING: Schools and neighborhoods, primarily in Minneapolis-St Paul. PARTICIPANTS: All seventh-grade students in 24 schools in the academic year 1999-2000 (N = 6237 at baseline, 67.3% were white, and there was 84.0% retention at final follow-up). INTERVENTIONS: The middle and junior high school D.A.R.E. curriculum in the 16 schools that received D.A.R.E. only and D.A.R.E. Plus. In the 8 schoolts that received D.A.R.E. Plus, additional components included a peer-led parental involvement classroom program called \"On the VERGE,\" youth-led extracurricular activities, community adult action teams, and postcard mailings to parents. The interventions were implemented during 2 school years, when the cohort was in the seventh and eighth grades. MAIN OUTCOME MEASURES: Self-reported tobacco, alcohol, and marijuana use; multidrug use; violence; and victimization, assessed at the beginning and end of seventh grade and at the end of eighth grade. Growth curve analytic methods were used to assess changes over time by condition. RESULTS: There were no significant differences between D.A.R.E. only and the controls; significant differences among boys between D.A.R.E. Plus and controls for tobacco, alcohol, and multidrug use and victimization; significant differences among boys between D.A.R.E. Plus and D.A.R.E. only in tobacco use and violence; and no significant behavioral differences among girls. CONCLUSION: D.A.R.E. Plus significantly enhanced the effectiveness of the D.A.R.E. curriculum among boys and was more effective than the delayed program controls, underscoring the potential for multiyear, multicomponent prevention programs and demonstrating sex differences in response to intervention programs.

Archives of Pediatrics & Adolescent Medicine, 157(2) : 178- 84

Sussman, Steve, Sun, Ping, McCuller, William J., Dent, Clyde W.

Project Towards No Drug Abuse: two-year outcomes of a trial that compares health educator delivery to self-instruction

OBJECTIVES: This paper describes the 2-year follow-up of a 12-session version of an indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse to complete their high school education. However, a health educator-led program is much more interactive. METHODS: The effects of self-instruction versus health educator- led versions of this curriculum were examined. Eighteen schools were randomly assigned by block to one of three conditions--standard care (control), health educator-led classroom program, and self-instruction classroom program. Subjects were followed up 1 and 2 years later. Two-year results are reported here. RESULTS: The self-instruction program produced no behavioral effects relative to the standard care control condition. The 2-year follow-up results indicated maintenance of program effects on cigarette smoking and hard drug use in the health educator-led version. CONCLUSIONS: Project TND shows maintenance of effects on some drugs 2 years after program implementation, when most youth were young adults. More work is needed to learn how to maintain effects across substances. Continued exploration of modalities of implementation may be helpful.

Preventive Medicine, 37(2) : 155- 62

Hecht, Michael L., Marsiglia, Flavio Francisco, Elek, Elvira, Wagstaff, David A., Kulis, Stephen, Dustman, Patricia, Miller-Day, Michelle

Culturally grounded substance use prevention: an evaluation of the keepin' it R.E.A.L. curriculum

This paper reports on the evaluation of a culturally grounded prevention intervention targeting substance use among urban middle-school students. The curriculum consists of 10 lessons promoting antidrug norms and teaching resistance and other social skills, reinforced by booster activities and a media campaign. Three versions were delivered: Mexican American, combined African American and European American, and Multicultural. Thirty-five middle schools were randomly assigned to 1 of the 3 versions or the control. Students completed baseline and follow-up questionnaires over a 2-year period (total 6,035 respondents). Analyses utilizing a generalized estimating equations approach assessed the overall effectiveness of cultural grounding and the cultural matching hypothesis. Support was found for the intervention's overall effectiveness, with statistically significant effects on gateway drug use as well as norms, attitudes, and resistance strategies but with little support for the cultural matching hypothesis. Specific contrasts found the Mexican American and Multicultural versions impacted the most outcomes.

Prevention Science, 4(4) : 233-48

Griffin, Kenneth W., Botvin, Gilbert J., Nichols, Tracy R., Doyle, Margaret M.

Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation

BACKGROUND: Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at high risk for substance use initiation. METHOD: 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 being 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, antidrug norms, personal self-management skills, and general social skills. RESULTS: 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. CONCLUSIONS: Findings suggest that universal prevention programs can be effective for a range of youth along a continuum of risk.

Preventive Medicine, 36(1) : 1-7

Gottfredson, Denise C., Wilson, David B.

Characteristics of effective school-based substance abuse prevention

This study summarizes, using meta-analytic techniques, results from 94 studies of school-based prevention activities that examined alcohol or other drug use outcomes. It set out to determine what features of school-based substance abuse prevention programs are related to variability in the size of program effects, It asked (1) Which populations (e.g., high risk vs. general population) should be targeted for prevention services? (2) What is the best age or developmental stage for prevention programming? (3) Does program duration matter? and (4) Does the role of the person delivering the service (e.g., teacher, law enforcement officer, peer) matter? The results suggest that targeting middle school aged children and designing programs that can be delivered primarily by peer leaders will increase the effectiveness of school-based substance use prevention programs. The results also imply that such programs need not be lengthy. The evidence related to the targeting issue is sparse, but suggests that, at least for programs teaching social competency skills, targeting higher risk youths may yield stronger effects than targeting the general population. Suggestions for future research are offered.

Prevention Science, 4(1) : 27-38

Ellickson, Phyllis L., McCaffrey, Daniel F., Ghosh-Dastidar, Bonnie, Longshore, Douglas L.

New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools.[see comment]

OBJECTIVES: We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. METHODS: Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. RESULTS: The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. CONCLUSIONS: School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

American Journal of Public Health, 93(11) : 1830-6

Eisen, Marvin, Zellman, Gail L., Murray, David M.

Evaluating the Lions-Quest \"Skills for Adolescence\" drug education program. Second- year behavior outcomes

Thirty-four schools (n=7426 consented sixth graders, 71% of the eligible population) were randomized to conditions to test the hypothesis that Skills for Adolescence (SFA), a widely used comprehensive life skills training curriculum with a dedicated drug education unit, is more effective than standard care in deterring and delaying substance use through middle school. Two-year posttest (1-year post-intervention) data were collected from 5691 eighth graders (77% of those who completed the sixth-grade survey and 87% of those who completed the seventh-grade survey). Lifetime and recent (last 30 days) use of five substances or combinations of substances was compared using mixed-model regression to control for school clustering. There were two significant treatment main effects at the end of the eighth grade: lifetime (P=.05) and recent (P<.03) marijuana use were lower in SFA than control schools with pretest usage and salient demographic and psychosocial variables controlled. There was also one significant Treatment x Pretest Usage interaction around binge drinking. Baseline binge drinkers in SFA schools were less likely to report recent binge drinking than students in control schools (P<.01); there were no treatment differences among baseline nonbinge drinkers. Analyses of potential mediators of SFA treatment effects on eighth-grade binge drinking and marijuana use suggested that SFA increased self-efficacy around drug refusal skills, but did not affect behavioral intentions, perceptions of harm, or perceived peer norms. These 2-year (1-year post-intervention) outcomes offer some additional support for SFA effectiveness and the general thrust of school-based, life skills-based prevention programs. The promising sixth- through eighth-grade findings for SFA, a commercially available program, provide a further step in bridging a major gap in the \"research to practice\" literature: theory-based interventions that have documented behavioral effects have not enjoyed large-scale implementation, while intuition-based programs that have no documented effects still enjoy wide exposure.

Addictive Behaviors, 28(5) : 883-97

A culturally responsive, family- enhanced intervention model

he Multicultural Interventions for Adolescent Substance Use, referred to as The Shadow Project, was a 3-year, NIAAA-funded pilot study involving 60 American Indian families who had a youth entering alcohol and drug inpatient treatment. Participation was voluntary and involved comparison of two different treatment modalities: treatment as usual and a brief family-enhanced intervention. In adapting this family-based intervention specifically for American Indian families, a cultural approach to assessment and intervention was integrated into the process, with the intervention focusing on building support around the youth to attain abstinence and assuring the youth that their family, community, and substance abuse counselor were motivating influences. Five areas were assessed in the family observation tasks: relationship building, positive reinforcement, limit setting, monitoring, problem solving, and communication. Cultural adaptation was made for two of the five tasks. Two legends were used to assess the families' skill level in relationship building, problem solving, and communication as a family unit. By incorporating Indian stories, families were encouraged to respond in a culturally appropriate manner. Preliminary findings show that these stories were linked to child prosocial behavior and the percentage of days abstinent from individual drug use. This pilot project also adapted culturally responsive instruments, tasks, and validity to this population. The first year required adaptation of recruitment methods, tribal and treatment center agreements, referral contacts, and implementation of intervention and follow-up with adolescents and their families. The second year was composed of intervention implementation and follow-up assessments. To determine the intervention program's long-term effect on reducing adolescent alcohol and other drug use, all families were followed up and assessed 11 months after they left treatment. The third and final year of the study included follow-up, data entry, and data analysis.

Alcoholism: Clinical & Experimental Research, 27(8) : 1356- 1360

Tait, Robert J., Hulse, Gary K.

A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drug

The aim of this paper is to evaluate the effectiveness of brief interventions (BI) with adolescents (mean age <20) in reducing alcohol, tobacco or other drug (ATOD) use by means of a systematic review of BI for adolescent substance use in the English language literature up to 2002. We identified 11 studies involving 3734 adolescents. Follow-up ranged from 6 weeks to 24 months. Motivational interviewing was the predominant approach, underpinning eight studies: the remaining three provided personalized health information. Seven papers reported outcomes for alcohol interventions and four involved other substances (including one with separate alcohol outcomes). The overall effect size was d=0.126 with borderline homogeneity (Q=14.9, df=9, p=0.09). The effect size from the eight alcohol interventions (n=1,075) was classified as significant but \"small\" (d=0.275). The remaining non-alcohol studies were considered separately as interventions involving tobacco or multiple substance use. The two interventions with tobacco involved a substantial sample (n=2,626) but had a very small effect (d=0.037), while the two interventions addressing multiple substances involved few participants (n=110) but had a medium-large effect (d=0.78). Across a diverse range of settings (dental clinic, schools, universities, substance treatment centres) and, therefore, probably diverse clients, BI conferred benefits to adolescent substance users. BI had a small effect on alcohol consumption and related measures. The data for tobacco interventions suggested a very small reduction, particularly with general community interventions. The effect of BI with multiple substances appears substantial but the small sample cautions against expansive generalization. [References: 59]

Drug & Alcohol Review, 22(3) : 337- 46

Skara, Silvana, Sussman, Steve

A review of 25 long-term adolescent tobacco and other drug use prevention program evaluations

BACKGROUND: Although the initial effectiveness of psychosocial strategies programming in preventing smoking and other drug abuse among adolescents has been well established through literature reviews and meta-analyses, much less evidence exists for the long-term follow-up success of these interventions. The primary goal of this paper, therefore, is to summarize the effectiveness of published program evaluation studies that have followed adolescents across the transitional period between junior high and high school for a period of at least 2 years. METHODS: Studies for inclusion in this review were accessed primarily through a computerized search of Medline, Healthstar, and PsychINFO databases. Intervention studies that met five core criteria were retained for review. Two authors independently abstracted data on study characteristics, methodology, and program outcomes. RESULTS: Search results yielded 25 studies suitable for examination. The majority of these studies reported significant program effects for long-term smoking, alcohol, and marijuana outcomes, while indicating a fairly consistent magnitude of program effects. CONCLUSIONS: This review provides long-term empirical evidence of the effectiveness of social influences programs in preventing or reducing substance use for up to 15 years after completion of programming. However, this conclusion is still somewhat tenuous given the lack of significant program effects reported in several studies and the great variability that existed in the level of internal and external validity across all studies. [References: 68]

Preventive Medicine, 37(5) : 451-74

Santisteban, Daniel A., Coatsworth, J. Douglas, Perez-Vidal, Angel, Kurtines, William M., Schwartz, Seth J., LaPerriere, Arthur, Szapocznik, Jose

Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use

This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample.

Journal of Family Psychology, 17(1) : 121-33