Drug Prevention Programs Research Articles

Defining and operationalizing ‘research-based’ prevention: a critique (with case studies) of the US Department of Education's Safe, Disciplined and Drug-Free Schools Exemplary Programs

‘Science-based’ and ‘research-based’ are terms that have increasingly been applied to school drug and violence prevention programs over the past 5 years. The US Department of Education recently produced a list of research-based drug and violence prevention programs, which conferred ‘Exemplary’ status on nine programs. According to the criteria used to define Exemplary, there must be at least one evaluation that has demonstrated an effect on a behavioral outcome, and this evidence must come from a methodologically sound evaluation. This paper discusses these criteria through an examination of two evaluations of school-based programs that were conferred Exemplary status—the Second Step curriculum and the Adolescent Training and Learning to Avoid Steroids (ATLAS) program. The preponderance of evidence reported in each evaluation shows that the programs had little or no effect on behavioral outcomes. Also, both evaluations have methodological flaws, especially with regard to recruitment and retention of participants. These findings suggest that the Exemplary criteria were either poorly defined or not well operationalized in the process of program selection.

Effective ingredients of school-based drug prevention programs: A systematic review

Drug prevention in schools is a top priority in most Western countries and several well-designed studies have shown that prevention programs have the potential of reducing drug use in adolescents. However, most prevention programs are not effective and there are no general criteria available for deciding which program is effective and which is not. In this systematic review of the literature, the current scientific knowledge about which characteristics determine the effectiveness of drug prevention programs is examined. Three types of studies are reviewed: meta-analyses (3 studies were included), studies examining mediating variables of interventions (6 studies), and studies directly comparing prevention programs with or without specific characteristics (4 studies on boosters, 12 on peer- versus adult-led programs, and 5 on adding community interventions to school programs). Seven evidence-based quality criteria were formulated: the effects of a program should have been proven; interactive delivery methods are superior; the “social influence model” is the best we have; focus on norms, commitment not to use, and intentions not to use; adding community interventions increases effects; the use of peer leaders is better; and adding life skills to programs may strengthen effects.

Peer-led and adult-led school drug prevention: a meta-analytic comparison.

Several studies have suggested that peer-led drug prevention programs are more effective than adult-led programs, but the evidence is not conclusive. In this article the results are presented of a meta-analysis of studies that compare drug prevention programs led by peers to the same programs led by adults. Twelve studies were identified in a systematic literature search. The quality of these studies was not optimal, and the interventions and target groups differed considerably among studies. Overall, peer-led programs were found to be somewhat more effective than adult-led programs (standardized difference d: 0.24). Large differences between studies were found, with some studies indicating greater effects for peer-led programs and other studies showing greater effects for adult-led programs. It is concluded that the effectiveness of a prevention program is determined by several characteristics of the programs. The leader may constitute one of those characteristics.

Does elementary school alcohol, tobacco, and marijuana use increase middle school risk?

To assess whether alcohol, tobacco, and other drug (ATOD) use in elementary school may have serious implications for continued ATOD use in middle school and beyond. Longitudinal analyses were conducted on questionnaire data from 331 middle school students who had previously provided ATOD-use data during elementary school. Non-school personnel administered questionnaires in three participating school districts in three different states. The sample of students was ethnically and geographically diverse, including students from a range of low socioeconomic status backgrounds living in rural, urban or inner-city environments. Middle school alcohol use was almost three times as likely to occur if alcohol use had occurred in elementary school (OR = 2.94, p <.001). Elementary school use of tobacco and marijuana also greatly increased the likelihood of middle school use (OR = 5.35, p <.001 and OR = 4.25, p <.05, respectively). Early use of ATOD is associated with greatly increased odds of later use, which has important implications for the timing of drug prevention programs. Preventive interventions designed for use in pediatric practice settings should commence no later than elementary school, during the middle childhood years.

Age differences in alcohol and cocaine expectancies and attitudes.

Positive and negative expectancies regarding the behavioral effects of alcohol and cocaine were assessed and used to predict attitudes toward their use across four age groups (5-7, 8-10, 11-14, and 18-25, N = 121). Regardless of gender and minority status, children and early adolescents appeared to overgeneralize their beliefs about alcohol to a less familiar drug, cocaine, perceiving the effects of the two drugs similarly. Only college students differentiated between drugs, perceiving cocaine as less likely than alcohol to produce drunkenness and more likely to have stimulant and elation/empowerment effects. With age and other expectancies controlled, expectancy of drunkenness was the best predictor of disapproval of alcohol use; attitudes toward cocaine use were unrelated to expectancies but became more negative with age. Drug prevention programs should rest on data regarding children's preexisting beliefs about the consequences of drug use and should help them understand that different drugs (for example, stimulants and depressants) pose different dangers.

Prevention Efforts Underlying Decreases in Binge Drinking at Institutions of Higher Education

Analyses of 94 Fund for the Improvement of Post-Secondary Education (FIPSE)-sponsored drug-prevention programs and their outcomes used the Core Survey to identify 34 institutions where college students' binge drinking increased (M = 5.44%) and 60 institutions where it decreased (M = -4.59%) during 2 years of program operation. The authors used an inductively derived taxonomy of prevention program elements, student variables, student substance use, use-related variables, and institutional variables to compare the 2 groups of institutions. Only prevention program elements discriminated between groups. Factor analysis of discriminating elements identified 8 prevention factors that improved base-rate prediction of institutional decrease in binge drinking by 28.1%. Factor synthesis yielded a 3-construct binge-drinking prevention model based on student participation and involvement strategies, educational and informational processes, and campus regulatory and physical change efforts. This model improved base-rate prediction of decreased binge drinking by 33.2%.

Young People's Images of Cigarettes, Alcohol and Drugs

To meet their aim of reducing the acceptability of psychoactive substances to young people, the designers of drug prevention programmes need to have a thorough understanding of the personal views already held by their audience with respect to the object of attitude and behavioural change. However, few studies involving younger adolescents have collated participant-generated impressions of a range of legal and illegal substances. The present study used a word association methodology to explore adolescents' impressions of cigarette smoking, drinking alcohol and taking a range of illegal drugs. In total, 3571 images were generated which were placed into 24 categories on the basis of content analysis. The predominance of negative imagery was of note, particularly for cigarette smoking and drug taking and there was little evidence of a simplistic generic attitude to substance use. Images of alcohol, especially alcopops, were markedly more positive and were much less likely to contain reference to specific health problems than the images of cigarette smoking. However, there was less differentiation between 'hard' and 'soft' illegal drugs than has been found with older adolescents in other studies and many of the images relating to illegal drugs were poorly defined, revealing vague notions of danger and risk. The present methodology is proposed as a useful tool for assessing attitudes both prior to and following prevention programmes and it is suggested, based on the wide variation in images elicited, that successful prevention dialogues with young people may need to vary their message according to the particular substance targeted.

The relative influence of smoking on drinking and drinking on smoking among high school students in a rural tobacco-growing county.

To construct and estimate a model that contains a reciprocal relationship between smoking and drinking and to test whether the gateway drug thesis or the cumulative risk behaviors thesis best fits the data. Data (n = 630) are from a survey of all students (50% female; aged 16.2 years on average; 2.4 grade point average; and 57% residing in homes with both mother and father present) in a rural, tobacco-growing county's two high schools, one public (85%) and one private, in 1993. The survey was conducted by the schools as part of their alcohol and other drugs (AOD) prevention programs and was coordinated by the county AOD Council. Students completed the questionnaires in their homerooms. Endogenous predictors of drinking and smoking include student's perception of adult drug behavior, peer pressure to drink, degree to which their friends' drink, and attitudes toward drinking and smoking. Path coefficients were estimated by using LISREL. The strong correlation between smoking and drinking resulted from shared causes, rather than from the effects of one type of drug use on the other. Approval of drinking had the strongest association with being a drinker (beta =.57) and with being a smoker (beta =.37). Those who found smoking offensive were less likely to be a smoker (beta = -.25). However, attitude toward smoking was not associated with being a drinker. Having drinking friends increased both the likelihood of being a drinker (beta =.29) and of being a smoker (beta =.23). Peer pressure to drink increased the likelihood of being a smoker (beta =.14) and of being a drinker (beta =.12). Students with lower grade point averages, males, older students, students in public school, and students with family structures other than both parents living in the same household were more likely to be a drinker and were more likely to be a smoker. Our results support the cumulative risk behaviors thesis. The link between both high-risk behaviors, smoking and drinking, results from common causes rather than from drinking leading to smoking.

Superintendents' Intentions toward DARE: Results from a Statewide Survey

This investigation assessed superintendents' beliefs and intentions toward Drug Abuse Resistance Education (DARE) and drug prevention programming, using a modified Theory of Planned Behavior as a framework. The study's primary purpose was to predict intentions toward future reliance on DARE. In June 2000 an anonymous mail survey was sent to all 611 public school superintendents in Ohio. The response rate was 71.5%. DARE was used by 85 to 87% of the state's public school districts. A large majority of the superintendents (88.2%) reported that they intended to rely on the program in the future. Most held either incorrect information about DARE's efficacy (29.0%) or acknowledged that that they were uninformed about DARE outcome research (33.6%). A multiple logistic regression analysis found that intention to use DARE in the future was positively associated with normative beliefs about community support for the program and negatively related with perceptions of their ability to replace drug prevention curricula in their district. The findings suggest that superintendents' positive intentions toward DARE were formed to avert conflict with adults in the school district and community. The dissemination of evidence-based drug prevention strategies will likely require stimulating parental demand for efficacious programming, in addition to educating school officials.

Shiraz University students’ attitude towards drugs: an exploratory study

Using a self-reported questionnaire, 213 Shiraz University students were surveyed about their attitudes towards drug use (cigarettes, alcohol, opium, heroin, cannabis) and their use of drugs (ever or during the 6 months prior to the study). About 52% had smoked cigarettes, 25% had tried alcohol, 21% opium and 12% cannabis; only one student had used heroin. Those who had used drugs obtained them from and used them with friends or acquaintances. The majority of students wanted more information on drugs, and considered television and films the best medium for providing information. Drug use among Shiraz University students is still lower than that reported in the West (except opium). Drug prevention programmes relevant to Iranian culture should be devised.

A Review of the Role of Social Support Systems in the Drug Use Behavior of Hispanics

In this article the authors conducted a critical review of ongoing and recently completed drug abuse studies which have examined the importance of social support systems in the drug-using behavior of Hispanics. Published and unpublished preliminary data from these studies are presented and discussed. This critical review of the research literature supports earlier findings that social support systems play an important role in preventing drug abuse among Hispanics. Specifically, this review found that familial factors, peer influences, involvement with religious institutions, and after-school activities have a powerful impact on the drug-using behaviors of Hispanic child, youth and adult drug users. The authors suggest that drug prevention and treatment programs within Hispanic communities will be more successful if they incorporate social support systems into their programs. In conclusion, the authors identify areas in which the role of social support systems in the drug-using behavior of Hispanics need further investigation.

Safe and drug-free school coordinators' perceived needs to improve violence and drug prevention programs.

A random sample of 380 Ohio safe and drug-free school coordinators was mailed surveys regarding their perceived needs to improve safe and drug-free school programs. Of 298 who responded (78%), most were White (88%), female (71%), older than age 40 (72%), possessed a master's degree (56%), and worked at either a rural (43%) or suburban (40%) school. Training topics perceived as most beneficial in improving safe and drug-free school programs included training on effective techniques that enhance youth success, building school-parent-community partnerships, and providing conflict management/dispute resolution skills. Lack of time, poor parental attitudes, and lack of school personnel support were identified most often as barriers to program improvement. Findings can be used by state health education resource centers and training providers to more effectively meet the needs of safe and drug-free school coordinators.

A Review of School-Based Drug Prevention Program Evaluations in the 1990s

Studies conducted over the past 20 years have found both knowledge models and affective models of drug prevention programs to be ineffective in changing adolescents' drug use. Social-Influence models have dominated school-based drug-prevention programs. This article reviews evaluation studies of programs published in the 1990s to identify significant program features that may influence the success of drug prevention education. Programs employing a social-influence model have not always been found to be effective. The results indicate that such models vary in their effectiveness depending on the substance. Reasons for limited program effectiveness are discussed along with recommendations for future programming and research.

Feedback from participants and leaders in an intervention program: the 1997-1998 opening doors process evaluation.

Parents, students, and program leaders involved in an in-school drug prevention program called Opening Doors were assessed for their perceptions of the efficacy of the program. In general, the feedback indicated a very high program satisfaction level from respondents with parents indicating the highest level satisfaction (92%). Areas for improvement ranged from: parent attendance, invitation process, increased support from schools, and increasing awareness of scheduling and time involvement by leaders and school administration based on program leader feedback as well as invitation process and program duration from the parents (e.g., 37% thought the program was too short). Student satisfaction may be predicted from the perceived impact of the program on significant relationships (e.g., with peers and family) as well as affective reactions to the program (e.g., enjoyment of the program). Finally, a school-level analysis indicated that the application of the Opening Doors Program in different schools was provided uniformly.

From early to late adolescence: alcohol use and anger relationships.

To evaluate the longitudinal relationship of alcohol use in early adolescence to anger in late adolescence. Data were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Fifty percent of the 1201 students were female, 75%, white, and 69%, low socioeconomic status, who were surveyed in grades 6/7, 9/10, and 11/12. Subjects were asked four anger-related questions: "When I have a problem, I get mad at people," "When I have a problem, I do bad things or cause trouble," "When I have a problem, I say or do nasty things," and "I am a hotheaded person." Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios (OR) were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence. Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grade 6/7 increased the odds in grade 11/12 of saying or doing nasty things (OR = 8.23, p < .01), self-reported hotheadedness (OR = 9.72, p < .01), and high anger on a composite anger scale (OR = 4.84, p < .05). Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness (OR = 6.17, p <.05) and high anger on the anger scale (OR = 3.20, p < .05) in grade 9/10 and doing something bad to cause trouble in grade 11/12 (OR = 24.97, p < .01). For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble (OR = 2.79, p < .05), saying or doing nasty things (OR = 2.02, p < .05), and self-reported hotheadedness (OR = 2.51, p < .05). The present study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. The findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior.

Implementation of an Empirically Based Drug and Violence Prevention and Intervention Program in Public School Settings

Describes the implementation of a collaborative preventive intervention project (Healthy Schools) designed to reduce levels of bullying and related antisocial behaviors in children attending two urban middle schools serving primarily African American students. These schools have high rates of juvenile violence, as reflected by suspensions and expulsions for behavioral problems. Using a quasi-experimental design, empirically based drug and violence prevention programs, Bullying Prevention and Project ALERT, are being implemented at each middle school. In addition, an intensive evidence-based intervention, multisystemic therapy, is being used to target students at high risk of expulsion and court referral. Hence, the proposed project integrates both universal approaches to prevention and a model that focuses on indicated cases. Targeted outcomes, by which the effectiveness of this comprehensive school-based program will be measured, are reduced youth violence, reduced drug use, and improved psychosocial functioning of participating youth.

Assessing program impact using latent growth modeling: a primer for the evaluator

Latent growth modeling (LGM) has emerged as a flexible analytic technique for modeling change over time because it can describe developmental processes at both the inter- and intra-individual levels. The LGM method can also provide a means for testing the contribution of other variables in order to explain variability in growth trajectories. This paper didactically illustrates the use of LGM as an analytical tool in program evaluation. Specifically, a hypothetical evaluation of a high school drug prevention program was used to demonstrate: (a) how LGM can be used to assess the longitudinal impact of a prevention program by comparing treatment and control populations with respect to individual differences in initial status and in rate of change; and (b) how predictors of initial status (post-intervention) and growth selected on the basis of a particular program theory can be incorporated in the model to explain program impact. Some advantages and limitations of using LGM in program evaluation are highlighted.

Evaluating an In-School Drug Prevention Program for At-Risk Youth

This study assessed an in-school program aimed at preventing or reducing drug use and other deviant behavior in a sample of 167 at-risk youth in their transition years. Over 10 weeks, 17 one-hour sessions were offered to youth who were identified using a self-report questionnaire (at 9 schools with 12 control sites in Ontario, Canada). Repeated measures analysis of covariance was used to assess program impact at posttest and six-month followup. Program participants, compared with the control group, reported less frequent drinking,

Evaluating an In-School Drug Prevention Program for At-Risk Youth

This study assessed an in-school program aimed at preventing or reducing drug use and other deviant behavior in a sample of 167 at-risk youth in their transition years. Over 10 weeks, 17 one-hour sessions were offered to youth who were identified using a self-report questionnaire (at 9 schools with 12 control sites in Ontario, Canada). Repeated measures analysis of covariance was used to assess program impact at posttest and six-month followup. Program participants, compared with the control group, reported less frequent drinking,

School-based adolescent drug prevention programs: 1998 meta-analysis.

This paper reports on a meta-analysis of 207 universal school-based drug prevention programs that compared the self-reported drug use of treatment to control or comparison youth. Programs are classified into Interactive and Non-Interactive groups based on a combination of content and delivery method. Weighted categorical and weighted regression methods have been used to determine the attributes that most effectively reduce, delay, or prevent drug use, including program size, type of control group and leader, attrition, target drug, intensity, grade, special population and level of drug use. Program type and size are found to be significant predictors of effectiveness. Non-interactive lecture-oriented prevention programs that stress drug knowledge or affective development show small effects. Interactive programs that foster development of interpersonal skills show significantly greater effects that decrease with large-scale implementations.