Continuation High Schools Research Articles

An Evaluation of the Fidelity of Implementation of a School-Based Drug Abuse Prevention Program: Project toward No Drug Abuse (TND)

This article provides an implementation fidelity evaluation of the fourth experimental trial of Project Towards No Drug Abuse (TND). Two theoretical content components of the curriculum were examined to increase our understanding of the active ingredients of successful drug abuse prevention programs. A total of 18 senior high schools were randomly assigned by block to receive one of three conditions: cognitive perception information curriculum, cognitive perception information + behavioral skills curriculum, or standard care (control). These curricula were delivered to both regular and continuation high schools students (n=2331) by trained project health educators and regular classroom teachers. Across all program schools, the two different curricula were implemented as intended, were received favorably by students, and showed significant improvements in knowledge specific to the theoretical content being delivered. This pattern of results suggests that the experimental manipulations worked as intended, and thus, permit the attribution of future behavioral outcome differences between conditions to differences in content of Project TND material provided rather than to differences in the fidelity of delivery. Further, our findings indicate that Project TND can be implemented effectively with low and high risk youth in a general environment as well as with high risk youth in a more specialized environment.

Motivation to quit as a mediator of tobacco cessation among at-risk youth

The purpose of this study is twofold: 1) to evaluate the effects of a smoking cessation clinic (Project EX) on changing motivation to quit smoking, and 2) to assess differences in quit rates based on these changes in motivation. Student smokers in 18 continuation high schools in the Los Angeles county area were invited to participate in a tobacco cessation clinic designed to enhance motivation to quit tobacco use. The 18 schools were randomly assigned to one of three conditions. Compared to students in the control group, students who participated in the program conditions were more likely to express higher motivation to quit tobacco use. Higher motivation was also significantly related to higher quit rates. Motivation to quit as defined by constituents of the energy/direction model of motivation appears to be a plausible mediator of cessation program effects.

Explaining the link between violence perpetration, victimization and drug use

This study examined relationships between illegal and legal drug use and violence perpetration and victimization as well as possible mediators of these relationships. Subjects were continuation high school students followed prospectively over 5 years. Results indicated that illegal drug use predicted violence and victimization 5 years later and that earlier victimization was also associated with later illegal drug use. A measure intending to tap a psychopharmacological effects system, consistent with its definition in Goldstein's (1985) [Goldstein, P. J. (1985). The drugs/violence nexus: A tripartite conceptual framework. Journal of Drug Issues, 15(4), 493–506] tripartite model, was found to mediate the relationships between illegal drug use and victimization and violence. Results suggest that violence and victimization prevention efforts may benefit by addressing the psychopharmacological effects of adolescent illegal drug use.

Spirituality as a 1-Year Prospective Predictor of Violence Perpetration and Drug Use Among Youth at Continuation High Schools1

This paper presents the results of a 1-year prospective study of violence perpetration, drug use, and spirituality among continuation high school youth. Spirituality was found to predict later violence perpetration and drug use as a single predictor. However, it failed to predict violence or drug use in models that also entered 6 other variables; particularly, baseline levels of violence and drug use, and morality of drug use. It is possible that current measures of spirituality predict later violence perpetration and drug use as a result of tapping attitudes about morality. Controlling for baseline spirituality, male gender, low morality of drug use, violence perpetration, and drug use predicted later spirituality. Spirituality appears to be affected by drug use and violence, but not the converse. The protective influence of spirituality is not supported, at least as currently measured.

Prospective Prediction of Alternative High School Graduation Status at Emerging Adulthood1

Most studies that examine the prediction of graduation status among teens have examined those who attend regular high schools. The present study reports the prediction of high school graduation status 5 years later among 646 youth who attended alternative (continuation) high schools at baseline. Those youth at baseline who: (a) reported less intention to use soft drugs (cigarettes, alcohol, or marijuana) during the next year; (b) suffered relatively few drug‐related consequences during the last year; (c) were relatively less likely to have carried a weapon (knife or gun) in the last year; (d) reported feeling relatively hopeful about the future; and (e) were older were more likely to self‐report having graduated continuation high school 5 years later. These results suggest that the consequences of drug use, not drug use per se, other illegal behavior, and a sense of well‐being are important predictors of graduation among groups of high‐risk teens. Problem behavior and resiliency theories are offered as potential explanations of these findings.

Five-year prospective prediction of marijuana use cessation of youth at continuation high schools

This paper reports the prediction of marijuana use cessation among young adults who were regular users 5 years earlier. Social, attitude, intrapersonal, violence-related, drug use, and demographic baseline measures served as predictors of whether or not 339 teenage marijuana users reported having quit use 5 years later. Young adult social role variables were included as additional predictors. Quitting was defined as having not used marijuana in the last 30 days (42% of the sample at follow-up). After controlling for covariation among predictors, in a three-step analysis, only baseline level of marijuana use, male gender, young adult marital status, and friends' marijuana use (marginal) remained statistically direct predictors. Implications of these results include the need to reduce psychological dependence on marijuana and increase social unacceptability of marijuana use across genders to help increase prevalence of quit attempts.

Drug abuse prevention program development. Results among Latino and non-Latino white adolescents.

Five program development studies from Project Towards No Drug Abuse (TND) were re-analyzed to discern Latino versus non-Latino Whites similarities and differences in receptivity to a wide variety of high school-based drug abuse prevention activities. In most of the program development studies, these youth attended alternative (continuation) high schools in Southern California. Although there were a total of 46% Latino students in these schools, 99% of the students indicated English as the main language spoken at school and home. Thus, taken together, almost all Latino youth in the various studies analyzed preferred to respond to survey questions in English. Latinos were relatively low in socioeconomic status (SES) and used drugs less frequently. Still, this group of highly acculturated Latinos and non-Latino Whites (37% of the school population) perceived that they were attending alternative schools for the same reasons (e.g., lack of credits, truancy). Very few differences in receptivity ratings of proposed TND activities were found as a function of ethnicity. In other words, the data suggest that the same types of lessons are applicable to older teens in both ethnic groups.

Longitudinal Relations Among Depression, Stress, and Coping in High Risk Youth

The structural relationships among risk and protective factors were examined in a sample of 646 continuation high school students. Although depression predicted more perceived stress, it was not a unique predictor of anger coping, seeking social support, or substance use. Perceived stress increased seeking social support. Seeking social support decreased the utilization of anger coping, which suggests that it may be a means of prevention for adolescents. Anger coping behaviors were implicated as being significant in sustaining depression and perceived stress, and in increasing hard drug use over time. Moderation analysis indicated that although there was no difference in the stress–coping–depression relationship between Latinos and Caucasians, the relationship among perceived stress, anger coping, and depression was stronger for female than for male adolescents. Theoretical and practical implications of the findings are discussed.

Interpersonal conflict tactics and substance use among high-risk adolescents

Adolescents who use aggressive tactics to handle interpersonal conflicts may be at high risk for substance use, while adolescents who possess coping strategies to avoid or manage interpersonal conflict may be at lower risk for substance use. This study examined the association between interpersonal conflict tactics and substance use among 631 continuation high school students. Items from a modified Conflict Tactics Scale formed three factors: Physical Aggression, Nonphysical Aggression, and Nonaggression. Logistic regression analyses revealed that adolescents' ways of responding to interpersonal conflicts were associated with their substance use. Use of physical aggression was associated with a higher risk of cigarette, alcohol, marijuana, and other drug use. Use of nonphysical aggression was associated with a higher risk of cigarette and alcohol use. Use of nonaggressive conflict tactics was associated with a lower risk of cigarette use. Adolescents who respond to interpersonal conflicts in an aggressive manner, whether physical or verbal/psychological, may be at increased risk for substance use, while nonaggressive conflict management skills may be protective. Possibly, teaching adolescents nonaggressive techniques for handling interpersonal conflict may be a useful strategy for preventing both interpersonal violence and substance use.

Predicting regular cigarette use among continuation high school students.

To provide a 1-year prospective examination of social, behavioral, intrapersonal and demographic factors that predict transition from experimental to regular cigarette use among continuation high school students. A cohort of 252 students completed baseline and 1-year follow-up questionnaires on health behaviors. Relatively low smoking prevalence estimates, intention to smoke in the next year, violence perpetration, perceived stress, sensation seeking, and male gender predicted the transition to regular use 1 year later. Intrapersonal variables may be relatively important in predicting the progression from experimental to regular smoking.

The relationship of hope in the future and perceived school climate to school completion.

This study examined the impact of hope in the future and school climate as protective factors in school dropouts and graduates. Participants consisted of 97 students at risk for not completing school in an urban area. At-risk status was determined by student assignment to a continuation high school, a special placement for students who had had numerous infractions at regular high schools. Retrospectively, dropouts rated perceived school climate significantly lower than graduates, and graduates rated the importance of attending college significantly higher than dropouts. Dropouts and graduates who left school after the study was conducted did not report differences on the risk factors measured, nor did they differ on perceived school climate or the importance of attending college. However, hope in the future significantly predicted dropout versus graduate status for these participants. Results are discussed as describing differences in retrospective versus prospective reports, and as evidence of the utility of the risk/resilience paradigm in school completion research.

Concurrent prediction of drug use among high-risk youth.

Correlates of drug use were examined in a continuation high school sample (n = 1.315), using canonical correlation analysis. Fourteen demographic, attitudes/belief, and psychosocial pressure/ anxiety-type variables were included as concurrent predictors. Eight drug-use-related measures were also placed into the analysis as outcome variables. Two factors were revealed. White ethnicity, not being Latino, all attitude/belief measures, and family conflict and depression showed relatively high loadings on the first predictor factor, and were associated with all drug-use measures. Latino ethnicity and being relatively unacculturated (i.e., tending to speak Spanish), most of the attitude/belief measures (but not sensation seeking or spirituality), and perceived peer approval to use drugs, trait anxiety, and depression showed relatively high loadings on the second predictor factor, and were associated with the hard-drug-use measures. These results suggest that there is a subgroup of unacculturated Latino youth who are anxious, who perceive they will achieve peer approval by using drugs, and who tend to use hard drugs. Indicated drug abuse prevention strategies may need to be tailored to this subgroup when developing and implementing programming.

The one-year prospective prediction of substance abuse and dependence among high-risk adolescents.

The present study examined 1-year prospective predictors of self-reported substance abuse and dependence among a sample of 702 youths at high risk for drug abuse from 21 southern California continuation high schools. Triadic influence theory was used as a theoretical guide. Predictors were selected as measures of triadic influence theory. Among 13 predictors, a drug use and intention index, and concern that one is or will become an addict or alcoholic, were consistently predictive of self-reported substance abuse or substance dependence 1 year later, controlling for baseline abuse or dependence status. In addition, baseline substance abuse, White ethnicity, and relatively poor prosocial coping predicted later substance dependence. Apparently, adolescents can predict their future use, and abuse or dependence status. Also, instruction in prosocial coping (e.g., seeking social support) may help inhibit the transition from substance abuse to substance dependence.

Perceived invulnerability and cigarette smoking among adolescents

Adolescent perceptions of invulnerability toward smoking and nonsmoking–related health risks were examined among 442 continuation high school students. Smokers were less likely than nonsmokers to report feeling invulnerable to both smoking and nonsmoking–related health risks. Among the smokers, those who reported feeling invulnerable to smoking-related health risks, compared to those who reported feeling vulnerable, smoked fewer cigarettes, were less addicted, were less likely to intend to smoke more in the future, attempted to quit fewer times in the past, valued their health more, and reported higher public body awareness. In a multiple logistic regression model, only high public body awareness, fewer previous attempts to quit, and being in the action stage of change (compared to being in the precontemplation stage of change) remained significant independent concurrent predictors of being in the invulnerable group. These results suggest, contrary to some previous work, that perceived invulnerability may be predictive of quitting tobacco use and may reflect relative invulnerability; that is, lighter use of tobacco.

Factors in marijuana cessation among high-risk youth.

The rise in marijuana use among high school students has generated considerable concern. The apparent failure of current marijuana control efforts may be due in part to ignorance about why students use marijuana and what influences them to consider quitting. This article utilized both open-ended and multiple-choice surveys as well as health educator-led focus groups to assess issues related to marijuana use and cessation among a population of high-risk youth. A total of 842 students participated, assessed as two separate samples from eleven continuation high schools in southern California. Approximately 70 percent of the students are current marijuana users. Interpreting results across both samples, it is apparent that interest in quitting marijuana use among continuation high school students is high. Over half of the marijuana users surveyed have tried to quit and failed. Still, several social images associated with marijuana smokers are positive and subjects express a lack of confidence in the efficacy of marijuana cessation clinic programs. Subjects believe that either self-help or punitive methods are the most effective types of marijuana cessation activities. A reportedly high rate of failed quit attempts suggests that effective marijuana cessation programs are needed in this population. Future programs must address both reasons users resist change, including use of marijuana as a stress reliever, and the particular motivations that subjects report regarding why they desire to quit using marijuana, including legal, vocational, and health consequences.

Pro-drug-use myths and competing constructs in the prediction of substance use among youth at continuation high schools: a one-year prospective study

Experimentation with drugs among adolescents often is preceded by faulty beliefs (myths) regarding drug effects. The present study provides empirical demonstration of the utility of a drug use myths index in the prediction of subsequent drug use in a prospective study of substance use among high-risk adolescents. Drug use was measured as an index of recent cigarette, alcohol and marijuana use. A belief-type drug use myths index was compared as a predictor of drug use with four other frequently researched correlates of drug use. The other measures were of social influence, outcome expectancies, attitudes toward wrongness of drug use and sensation seeking. The belief-type drug use myths, attitudes toward wrongness and sensation seeking indices were found to be significant predictors of drug use among our sample of 1074 youth when controlling for gender, ethnicity and prior drug use. These findings have implications for understanding factors contributing to individual differences in drug use behaviors and could benefit the development of drug education programs for high-risk individuals.

Brief report one-year prospective prediction of marijuana use cessation among youth at continuation high schools

This article reports a large-scale study of the prediction of marijuana use cessation among adolescents who were regular users at baseline. Social, attitude, intrapersonal, violence-related, drug-use-related, and demographic baseline measures served as predictors of whether or not 566 current marijuana users reported having quit use 1 year later. Quitting was defined as having not used marijuana in the last 30 days and having no intention to use marijuana in the future (31% of the baseline users). Those who were slightly older, who reported receiving relatively less approval for using drugs, who held relatively unfavorable attitudes about the acceptability of drug use, and who reported relatively less victimization in the last year were relatively likely to quit. Implications of these results include the need to increase unacceptability of marijuana use to help increase efforts at self-initiated quitting.

One-Year Outcomes of Project Towards No Drug Abuse

Objectives. This paper presents the 1-year outcomes evaluation of Project Towards No Drug Abuse (Project TND), a large-scale indicated drug abuse prevention program in southern California applied to continuation high school youth, who are at high risk for drug abuse.Methods. The efficacy of a nine-lesson health motivation-social skills-decision-making curriculum was evaluated in a three-condition experimental design. Twenty-one schools were randomly assigned by block to one of three conditions—standard care (control), classroom program, and classroom program plus a semester-long school-as-community component. A pretest was followed by a 3-week-long drug abuse prevention program and then a posttest at 14 continuation high schools. The 7 standard care schools received only the pretest followed by the posttest (same time duration). Subjects were followed up 1 year later.Results. Changes in use of cigarettes, alcohol, marijuana, and hard drugs were assessed in a pretest-1-year follow-up time interval. The follow-up rate was 67% (analysisn= 1,074). Indicated preventive effects were found on alcohol and hard drug use. No differences were found across the two program conditions.Conclusions. Project TND is the first program to demonstrate 1-year self-reported behavioral effects on alcohol use and hard drug use among older, high-risk youth by using a school-based, limited-session model.

Depression, Suicidal Ideation, and Substance Use Among Continuation High School Students

This study examines the structural relationships among depression, suicidal ideation, “gateway” substance use (including cigarettes, alcohol, and marijuana), and “hard” substance use (including cocaine, stimulants, and inhalants) in a sample of continuation high school students at high risk for drug abuse. When the model was examined separately by ethnic group (Latino and Caucasian) and gender, significant differences among the factor correlations emerged. Compared to Latinos and females, Caucasians and males, respectively, demonstrated a greater number of significant relationships among the factors. For Latinos and females, only the depression and suicidal ideation factors were significantly correlated with each other, as were the gateway and hard substance use factors. For Caucasians and males, four of the six factors were significantly intercorrelated. One implication is that mood enhancement may be a particularly important reason for hard substance use among Caucasian and male adolescents.

Self-reported high-risk locations of adolescent drug use

The present study provides a detailed multiple-choice self-report analysis of home, school, and other public locations where youth report using drugs. In addition, these settings were examined as a function of gender, ethnicity, type of drug used, and drug abuse status. The participants for the present study are 413 continuation high school youth, who are at relatively high risk for substance abuse. The single most frequent location of use was the participants’ bedroom with a small group of friends. However, heavier users used different drugs across a greater variety of locations. Not surprisingly, drugs were used least at school. Interestingly, the prototypical party drug use situation is not a popular situation for drug use, at least among these high-risk youth.