Drug Abuse Prevention Research Research Articles

A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study.

BackgroundDespite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care.ObjectivesThe purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”).MethodsA total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis.ResultsA total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app.ConclusionsThere is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.

The HIV and Drug Abuse Prevention Research Ethics Training Institute: Training Early-Career Scientists to Conduct Research on Research Ethics.

The responsible conduct of HIV/drug abuse prevention research requires investigators with both the knowledge of and ability to generate empirical data that can enhance global ethical practices and policies. This article describes a multidisciplinary program offering early-career professionals a 2-year intensive summer curriculum along with funding to conduct a mentored research study on a wide variety of HIV/drug abuse research ethics topics. Now in its fifth year, the program has admitted 29 trainees who have to date demonstrated increased knowledge of research ethics, produced 17 peer-reviewed publications, 46 professional presentations, and submitted or been awarded five related federal grants. The institute also hosts a global information platform providing general and HIV/drug abuse relevant research ethics educational and research resources that have had more than 38,800 unique visitors from more than 150 countries.

Enhancing the Responsible Conduct of Sexual Health Prevention Research Across Global and Local Contexts: Training for Evidence-Based Research Ethics

The HIV/AIDS pandemic has brought global attention to the ethical challenges of conducting research involving socially vulnerable participants. Such challenges require not only ethical deliberation but also an empirical evidentiary basis for research ethics policies and practices. This need has been addressed through the Fordham University HIV and Drug Abuse Prevention Research Ethics Institute, a National Institute on Drug Abuse–funded program that trains and funds early career scientists in conducting research on HIV/drug abuse research ethics. This article describes the ethical framework guiding Institute training and introduces readers to six empirical articles in this special issue that illuminate and help foster the responsible conduct of research.

Short-term impact of cognition-motivation-emotional intelligence-resistance skills program on drug use prevention for school students in Wuhan, China

Drug abuse continues to be a serious public health threat worldwide. Most drug abuse prevention research has been conducted with predominantly American or European adolescent populations. Little is known about approaches that work best to prevent the initiation of Chinese adolescent drug use. For targeting risk factors of drug initiation in Chinese adolescents, a school-based health intervention program named "Cognition-Motivation-Emotional Intelligence-Resistance Skills" (CMER) was developed to enhance cognition upon drug use, to decrease motivation of drug use and to improve emotional adjusting and drug resistance skills in this study. A total of 798 students from 3 senior high schools in Wuhan, a city in central China, were assigned randomly to intervention and control groups. The intervention group received the CMER program in which knowledge, development of positive attitude and motivation towards drugs and training of peer resistance skills were basic elements. The immediate impact was compared by measuring the above mentioned elements prior to and three-month after the training session. Students from both groups were asked to complete a self-administered questionnaire. The questionnaire included demographic items, self-reported drug use behavior, cognition, attitude, and motivation associated with the initiation of drug use and resistance skills. Three months after the intervention, significant effects were found on "illegal substance use at least once" (P<0.05) between the intervention and control groups. Immediate effects of the intervention were also found on knowledge, motivation and peer resistance skills (P<0.05), but there was no clear evidence for any effects on attitude towards substance use (P>0.05). It was concluded that the CMER program, which significantly increased the knowledge of drugs and peer resistance skills, was effective in the drug abuse prevention in a sample of school students in Wuhan, China.

Building Partnerships Between Indigenous Communities and Universities: Lessons Learned in HIV/AIDS and Substance Abuse Prevention Research

Many HIV/AIDS and substance abuse prevention studies in American Indian and Alaska Native communities have been directed by academic researchers with little community input. We examined the challenges in conducting HIV/AIDS-related research in American Indian and Alaska Native communities and the benefits of changing the research paradigm to a community-based participatory model. The lessons we learned illustrate that the research process should be a cyclical one with continual involvement by community members. Steps in the process include (1) building and sustaining collaborative relationships, (2) planning the program together, (3) implementing and evaluating the program in culturally acceptable ways, and (4) disseminating research findings from a tribal perspective. These steps can enhance the long-term capacity of the community to conduct HIV/AIDS and substance abuse prevention research.

Reflections on 40 Years of Drug Abuse Prevention Research

Over the past twenty-five years, tremendous progress has been made in the area of drug abuse prevention research. The accumulated findings from longitudinal studies of adolescents regarding the factors associated with vulnerability to the substance use and abuse and trends from national surveys of substance use showing their association to societal perceptions of the harmfulness resulting from the use of these substances have informed the development of effective innovative prevention strategies. The 1990s saw a reversal in the perception of the value and importance of drug abuse prevention research with recognition of the field's approach to intervention development and implementation and its scientific rigor in demonstrating intervention impact. This paper reflects on this history anticipating both the positive and negative aspects of the future for the field.

Psychosocial Correlates of the Perceived Stigma of Problem Drinking in the Workplace

The purpose of this study was to evaluate a questionnaire assessment of the perceived stigma of problem drinking that was designed for use in workplace substance abuse prevention research. Municipal employees from a mid-sized city (n = 315) and a large-sized city (n = 535) completed questionnaire measures of perceived coworker stigmatization of problem drinking, drinking levels, substance-use policy attitudes, workgroup stress and interdependence, alcohol-tolerance norms, and demographic variables. Inter-item correlation coefficients showed that the measure of the stigma of problem drinking had good internal consistency reliability (.76) in both samples. Hierarchical regression analyses showed that higher education, abstinence from alcohol, stress, and perceived temperance norms were all uniquely correlated with perceived stigma. Women and men perceived the same level of stigma from coworkers. Editors' Strategic Implications: This brief, validated measure provides organizations with a way to assess the level of stigma attached to alcohol abuse in their workplace culture, thereby enabling the organization to target and promote effective strategies to decrease the stigma attached to seeking help with the goal of reducing alcohol abuse.

Great Minds Don't Always Think Alike: The Challenges of Conducting Substance Abuse Prevention Research in Public Schools

Prevention researchers and school personnel lack a common understanding concerning the opportunities and burdens of school-based drug prevention research. In this article, we review issues related to researching substance abuse prevention programs in school settings, and assess challenges related to recruitment, communication, research design, surveying, and ensuring program fidelity. We conclude that before any school is enrolled, there must be a mutual understanding as to the nature and extent of the study's requirements and what adjustments a school will have to make to support a successful collaboration. Further, researchers must understand that schools' responsibilities for preparing students to perform well on academic and standardized tests will always overshadow the value they place on participating in studies to evaluate the effectiveness of prevention curricula.

Translation in Tobacco and Drug Abuse Prevention Research

The purpose of this article is to describe the translation of research on tobacco and drug abuse prevention from basic science to program development to large-scale program dissemination, and from animal to human studies. Where relevant, continuity of translation is discussed by referring to two variables that have been studied for their potential relationship to drug use risk in both animals and humans: sensation and novelty seeking and low impulse control. Review of the research indicates relatively slow translation until the early 1990s. The authors recommend several mechanisms to promote more rapid translation across types of research that encourage reciprocal rather than unidirectional transmission of knowledge to expedite the development and diffusion of more timely, targeted drug abuse prevention programs.

Prevention science, drug abuse prevention, and Life Skills Training: Comments on the state of the science

There has been tremendous growth in the field of prevention science over the past two decades. The defining features of contemporary prevention science are high quality empirical research using rigorous and well-established scientific methods, careful hyphothesis testing, and the systematic accumulation of knowledge. One area where substantial progress has been made is in our understanding of the etiology and prevention of tobacoo, alcohol, and illicit drug abuse. In this paper, we review the growth in prevention as a scientific enterprise, discuss advances in drug abuse prevention research, and review the effectiveness of one approach to the problem of adolescent drug abuse, the Life Skills Traning (LST) program, and the methodological strengths of the LST evaluation research. In addition, we provide a response to criticism regarding two types of data analysis in evaluation research, and show that these analyses can help address a number of important research questions with implications for theory and practice. First, the analysis of high fidelity subsamples can address research questions about the importance of program implementation fidelity; and second, composite measures of concurrent tobacco, alcohol, and marijuana use (i.e., polydrug use) are useful in testing research questions about program effects on more serious levels of drug involvement. With an increasing number of ramdomized controlled trials underway, the field of prevention science is contributing to a new generation of evidence-based approaches and policies that, if widely utilized, offer the potential of reducing the mortality and morbidity associated with a number of major health and social problems.

Political Science, Public Policy, and Drug Use Prevention

Increasingly, drug use prevention programs and research are being considered in the environmental contexts in which they occur. One context that is rarely considered is the political context. This article examines the reciprocal effects of policy and prevention programs from four perspectives representing different contexts, beginning with political science, and followed by social work and public health administration, psychology, and education. Four specific issues are considered. First is how current national policies on drug use shape our nation's prevention efforts, from a political science perspective. Second is how effective prevention programs can affect and shape policy change. This issue is considered from a social and public health administration perspective. Third is how policy change can act as an intervention to prevent drug use, from the perspective of psychology. The fourth issue is how dissemination of prevention programs and policies can impact drug use prevention. This question considers an educational perspective. The perspectives are integrated into a general conceptual model to improve our understanding of how drug use prevention occurs in a national political context. Finally, examples are given of how this model might inform the other perspectives represented in this special issue on transdisciplinary drug abuse prevention research.

A review of research on fidelity of implementation: implications for drug abuse prevention in school settings.

To help inform drug abuse prevention research in school settings about the issues surrounding implementation, we conducted a review of the fidelity of implementation research literature spanning a 25-year period. Fidelity has been measured in five ways: (1) adherence, (2) dose, (3) quality of program delivery, (4) participant responsiveness and (5) program differentiation. Definitions and measures of fidelity were found not to be consistent across studies, and new definitions are proposed. While there has been limited research on fidelity of implementation in the social sciences, research in drug abuse prevention provides evidence that poor implementation is likely to result in a loss of program effectiveness. Studies indicate that most teachers do not cover everything in a curriculum, they are likely to teach less over time and training alone is not sufficient to ensure fidelity of implementation. Key elements of high fidelity include teacher training, program characteristics, teacher characteristics and organizational characteristics. The review concludes with a discussion of the tension between fidelity and reinvention/adaptation, and ways of resolving this tension. Recommendations are made for developing a consistent methodology for measuring and analyzing fidelity of implementation. Further, researchers and providers should collaborate to develop ways of introducing flexibility into prevention programs.

Advances in statistical methods for substance abuse prevention research.

The paper describes advances in statistical methods for prevention research with a particular focus on substance abuse prevention. Standard analysis methods are extended to the typical research designs and characteristics of the data collected in prevention research. Prevention research often includes longitudinal measurement, clustering of data in units such as schools or clinics, missing data, and categorical as well as continuous outcome variables. Statistical methods to handle these features of prevention data are outlined. Developments in mediation, moderation, and implementation analysis allow for the extraction of more detailed information from a prevention study. Advancements in the interpretation of prevention research results include more widespread calculation of effect size and statistical power, the use of confidence intervals as well as hypothesis testing, detailed causal analysis of research findings, and meta-analysis. The increased availability of statistical software has contributed greatly to the use of new methods in prevention research. It is likely that the Internet will continue to stimulate the development and application of new methods.

The Next Generation of Drug Abuse Prevention Research: DA-01-009

The Next Generation of Drug Abuse Prevention Research: DA-01-009

Drug abuse prevention among minority adolescents: posttest and one-year follow-up of a school-based preventive intervention.

Most drug abuse prevention research has been conducted with predominantly White middle-class adolescent populations. The present study tested a school-based drug abuse preventive intervention in a sample of predominantly minority students (N = 3,621) in 29 New York City schools. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills in an effort to provide students with skills and information for resisting drug offers, to decrease motivations to use drugs, and decrease vulnerability to drug use social influences. Results indicated that those who received the program (n = 2,144) reported less smoking, drinking, drunkenness, inhalant use, and polydrug use relative to controls (n = 1,477). The program also had a direct positive effect on several cognitive, attitudinal, and personality variables believed to play a role in adolescent substance use. Mediational analyses showed that prevention effects on some drug use outcomes were mediated in part by risk-taking, behavioral intentions, and peer normative expectations regarding drug use. The findings from this study show that a drug abuse prevention program originally designed for White middle-class adolescent populations is effective in a sample of minority, economically disadvantaged, inner-city adolescents.

Bridging the gap between science and practice in drug abuse prevention through needs assessment and strategic community planning

Despite advances in knowledge about factors that predict substance abuse and interventions that have been effective at preventing alcohol, tobacco, and other drug use among adolescents, the prevalence of drug use and abuse among American adolescents and young adults remains alarmingly high. The U.S. government spent $2.45 billion in 1999 on drug abuse prevention services and research, yet there is little evidence these expenditures are achieving meaningful reductions in the prevalence of drug abuse. It is estimated that drug abuse costs American society more than $250 billion per year, and these cost are increasing. Translating the expanding scientific knowledge base for effective preventive interventions into widespread practice that can achieve reductions in the prevalence of drug abuse in this country is a pressing policy issue. This article examines recent advances in prevention science and discusses how this knowledge base can be applied to the development of strategic, science-based community prevention systems. Methods for assessing the need for drug abuse prevention services among populations of children and adolescents are reviewed, and the utility of these methods for guiding strategic community prevention planning is examined. It is argued that strategic community prevention systems focusing science-based interventions on predictors of drug use and abuse that are prevalent among youth in the community hold promise for reducing the prevalence of drug abuse and related problems. Strategies for supporting strategic community prevention planning utilizing science-based preventive interventions are discussed. © 2000 John Wiley & Sons, Inc.

Methodological issues in workplace substance abuse prevention research.

Substance abuse among working adults represents billions of dollars in preventable health care costs and industry financial loss. Therefore, it is imperative to develop and test effective substance abuse prevention programs for the workplace. However, applied workplace substance abuse prevention research is fraught with numerous methodological challenges. This article highlights a number of these challenges, which include (1) reaching a broad audience with prevention messages, (2) handling the concerns of the employer, (3) collecting substance use data in the workplace, (4) accessing and using records-based data, and (5) linking survey and records-based data. Using examples from the authors' ongoing research assessing a workplace health promotion and substance abuse prevention program, funded by the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention, the authors address these challenges.

Bridging the gap between science and practice in drug abuse prevention through needs assessment and strategic community planning

Despite advances in knowledge about factors that predict substance abuse and interventions that have been effective at preventing alcohol, tobacco, and other drug use among adolescents, the prevalence of drug use and abuse among American adolescents and young adults remains alarmingly high. The U.S. government spent $2.45 billion in 1999 on drug abuse prevention services and research, yet there is little evidence these expenditures are achieving meaningful reductions in the prevalence of drug abuse. It is estimated that drug abuse costs American society more than $250 billion per year, and these cost are increasing. Translating the expanding scientific knowledge base for effective preventive interventions into widespread practice that can achieve reductions in the prevalence of drug abuse in this country is a pressing policy issue. This article examines recent advances in prevention science and discusses how this knowledge base can be applied to the development of strategic, science-based community prevention systems. Methods for assessing the need for drug abuse prevention services among populations of children and adolescents are reviewed, and the utility of these methods for guiding strategic community prevention planning is examined. It is argued that strategic community prevention systems focusing science-based interventions on predictors of drug use and abuse that are prevalent among youth in the community hold promise for reducing the prevalence of drug abuse and related problems. Strategies for supporting strategic community prevention planning utilizing science-based preventive interventions are discussed. © 2000 John Wiley & Sons, Inc.

Bridging the Gap Between Family-Focused Research and Substance Abuse Prevention Practice: Preface

This paper introduces the contributions of this special section on connecting family-focused substance abuse prevention research and practice. Other expert reviews and the meta-analyses discussed in this and the following papers have given us a good idea about what works in this area. They have specified a number of family-focused substance abuse prevention approaches and programs effective in decreasing substance abuse in youth. Unfortunately, some practitioners are still primarily implementing untested, ineffective programs. A number of recommendations are made by the authors of this special section to help improve the adoption of evidence-based family programs to prevent substance abuse by youth.

Conducting Drug Abuse Prevention Research in Partnership with Native American Communities: Meeting Challenges Through Collaborative Approaches

SUMMARY Many prior drug abuse studies conducted in Native American communities have been almost exclusively directed by researchers with little community input. This paper focuses on the challenges in conducting research in Native American communities and provides a multi-step model for developing, implementing, and evaluating drug abuse prevention programs in partnership with Native American communities. Key steps in the model include: building collaborative relationships with community members, developing interventions to fit local culture and norms, training indigenous staff to implement the program(s), and obtaining on-going feedback from participants using both qualitative and quantitative methods. A case study, the Native American Prevention Project Against AIDS and Substance Abuse (NAPPASA), serves to illustrate how integrating cultural and community input into the project can lead to empowerment of community members and successful program outcomes.