School-based Substance Abuse Prevention Program Research Articles

Neutralization and glorification: Cannabis culture-related beliefs predict cannabis use initiation

Addressing specific pro-cannabis attitudes may be a viable adjunct to school-based substance abuse prevention programs. To study the predictive value of cannabis culture-related beliefs in relation to initiation of cannabis use, a prospective cohort study of 1223 students attending high school or equivalent education programs in Denmark were administered a questionnaire containing demographic information, questions about cannabis use, normative perception and personal beliefs in relation to two dimensions of cannabis culture-related beliefs: (1) beliefs about the negative consequences of cannabis use (neutralization) and (2) beliefs about positive aspects of cannabis use (glorification). Normative perception and glorification were both robustly associated with incidence of cannabis use at the 6- and 12-month follow-up. Neutralization was associated with initiated cannabis use only at the 12-month follow-up. These findings suggest that beliefs about the benefits of cannabis use may be as important in targeted programs to prevent cannabis use as beliefs about whether cannabis use is common or harmful.

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.

Partnership, Knowledge Translation, and Substance Abuse Prevention With a First Nations Community

Partnership, Knowledge Translation, and Substance Abuse Prevention With a First Nations Community Lola Baydala, Fay Fletcher, Stephanie Worrell, Tania Kajner, Sherry Letendre, Liz Letendre, and Carmen Rasmussen What Is the Purpose of This Study? • To understand the benefits of culturally adapting and implementing a 3-year, school-based, drug and alcohol prevention program for First Nation children and youth. What Is the Problem? • Substance abuse is a significant area of concern within Aboriginal communities across Canada. However, effective school-based substance abuse prevention programs are not typically available to the majority of First Nations schools. • Prevention programs that are available often fail to integrate the cultural beliefs and values of individuals outside of the dominant culture. • More research is required on the benefits of culturally appropriate drug and alcohol prevention programs that incorporate the beliefs, values, language, and visual images of the community. What Are the Findings? • Qualitative measures revealed a positive effect of the culturally adapted program on youth. • Elders and community members observed positive changes in student’s cultural knowledge and cited observed behavioral changes as evidence of the adapted program’s success. • The culturally adapted program is seen as surpassing the original in terms of embodying the values of the community. • Positive community developments occurred as a result of the program adaptation process, which followed a community-based participatory research approach. • Results of the quantitative measures were mixed, in part as a result of inconsistent and unpredictable student school attendance. Who Should Care Most? • Educators, school officials, and health care providers working in First Nations communities. • Policymakers in the areas of health and education. • Community members and leaders. • Substance abuse, public health, and youth program providers. [End Page 139] Recommendations for Action • Highly effective, evidence-based substance abuse prevention programs for school-aged children can be successfully adapted to incorporate the cultural beliefs, values, language, and visual images of the community where the program is delivered. • Community Elders are the keepers of the Nation’s oral traditions and knowledge and their input and guidance is an important and necessary part of program adaptation, implementation, and evaluation. • Culture, language, history, and spirituality are the foundations of Aboriginal identity and are essential components of program adaptation. • Cultural adaptations should go beyond surface level cultural markers to include Aboriginal worldviews and ways of knowing, as well as recognition of historical impacts on health and education. • A community-based participatory research approach is a catalyst for community development and an important component of program sustainability. • Attention to both community capacity building and academic capacity building is important to ensure a successful project. [End Page 140] Lola Baydala University of Alberta Fay Fletcher University of Alberta Stephanie Worrell University of Alberta Tania Kajner University of Alberta Sherry Letendre University of Alberta Liz Letendre Alexis Heritage Program, Alexis Nakota Institute Carmen Rasmussen University of Alberta Copyright © 2014 The Johns Hopkins University Press

Advancing school-based interventions through economic analysis.

Commentators interested in school-based prevention programs point to the importance of economic issues for the future of prevention efforts. Many of the processes and aims of prevention science are dependent upon prevention resources. Although economic analysis is an essential tool for assessing resource use, the attention given economic analysis within school-based prevention remains cursory. Largely, economic analyses of school-based prevention efforts are undertaken as secondary research. This limits these efforts to data that have been collected previously as part of epidemiological and outcomes research. Therefore, economic analyses suffer from gaps in the knowledge generated by these studies. This chapter addresses the importance of economic analysis for the future of school-based substance abuse prevention programs and highlights the role of prevention research in the development of knowledge that can be used for economic analysis.

Public commitment, resistance to advertising, and leisure promotion in a school-based drug abuse prevention program: a component dismantling study.

The objective of the present study was to examine the contribution of three intervention components (public commitment, resistance to advertising, and leisure promotion) on alcohol and protective variables in a school-based substance use prevention program. Participants included 480 Spanish students aged from 14 to 16 who received the Saluda prevention program in one of the following five experimental conditions: complete program, program minus public commitment, program minus resistance to advertising, program minus leisure promotion, and a waiting-list control. The students completed self-report surveys at pretest, posttest, and 6-month follow-up assessments. When excluding the healthy leisure promotion component, the Saluda program showed no loss of efficacy neither on alcohol use nor on other substance-related variables, while public commitment and resistance to advertising improved the aforementioned program's efficacy.

Boosting a Teen Substance Use Prevention Program with Motivational Interviewing

A brief motivational interviewing (MI) intervention may be a viable adjunct to school-based substance abuse prevention programs. This article describes the development and implementation of a brief MI intervention with 573 adolescents (mean age 16.8; 40.3% female, 68% Latino) enrolled in eight continuation high schools in Southern California. Study participants were assigned to the MI condition in a randomized controlled trial of Project Toward No Drug Abuse. Data are provided on dosage, topics discussed, and quality of MI determined with the Motivational Interviewing Skill Code (MISC). Results suggest that the protocol was feasible and implemented with adequate fidelity. The study's limitations are noted.

Effects of a School-Based Prevention Program on European Adolescents' Patterns of Alcohol Use

School-based substance abuse prevention programs are widespread but are rarely evaluated in Europe. We aimed to evaluate the effect of a new school-based prevention program against substance use on the frequency of alcohol consumption and alcohol-related problem behaviors among European students. During the school year 2004-2005, a total of 7,079 students aged 12-14 years from 143 schools in seven European countries participated in this cluster randomized controlled trial. Schools were randomly assigned to either control (65 schools, 3,532 students) or to a 12-session standardized program based on the comprehensive social influence model (78 schools, 3,547 students). Alcohol use and frequency of alcohol-related problem behaviors were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. The association between intervention and changes in alcohol-related outcomes was expressed as odds ratio (OR), estimated by multilevel regression model. The preventive program was associated with a decreased risk of reporting alcohol-related problems (OR = .78, 95% confidence intervals [CI] = .63-.98), although this reduction was not statistically significant in the subgroup of 743 current drinkers at baseline. The risk for alcohol consumption was not modified by exposure to the program (OR = .93, 95% CI = .79-1.09). In the intervention group, nondrinkers and occasional drinkers at baseline progressed toward frequent drinking less often than in the control group. School curricula based on the comprehensive social-influence model can delay progression to frequent drinking and reduce occurrence of alcohol-related behavioral problems in European students. These results, albeit moderate, have potentially useful implications at the population level.

School Disrepair and Substance Use Among Regular and Alternative High School Students

The physical environment influences adolescent health behavior and personal development. This article examines the relationship between level of school disrepair and substance use among students attending regular high school (RHS) and alternative high school (AHS). Data were collected from students (N = 7058) participating in 2 randomized controlled trials of a school-based substance abuse prevention program implemented across the United States. Students provided substance use and demographic information on a self-reported survey. Data for the physical disrepair of schools were collected from individual rater observations of each school environment. We hypothesized that school disrepair would be positively associated with substance use controlling for individual characteristics and a socioeconomic status proxy. Multilevel mixed modeling was used to test the hypothesized association and accounted for students nested within schools. Findings indicated that students attending AHS with greater school disrepair were more likely to report the use of marijuana and other illicit drugs (ie, cocaine, heroin). Students attending RHS with greater school disrepair were less likely to report smoking cigarettes. Differences in findings between RHS and AHS students are discussed, and implications for substance use prevention programming are offered. Students attending AHS with greater school disrepair may require more substance abuse prevention programming, particularly to prevent illicit substance use.

The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial

Aim To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial). Materials and methods Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12–14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models. Results Persisting beneficial program effects were found for episodes of drunkenness (any, POR = 0.80; 0.67–0.97; frequent, POR = 0.62; 0.47–0.81) and for frequent cannabis use in the past 30 days (POR = 0.74; 0.53–1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers. Conclusion The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking.

Universal school-based substance abuse prevention programs: Modeling targeted mediators and outcomes for adolescent cigarette, alcohol and marijuana use

Objective We examined the relationships among targeted constructs of social influences and competence enhancement prevention curricula and cigarette, alcohol and marijuana use outcomes in a diverse sample of high school students. We tested the causal relationships of normative beliefs, perceptions of harm, attitudes toward use of these substances and refusal, communication, and decision-making skills predicting the self-reported use of each substance. In addition, we modeled the meditation of these constructs through the intentions to use each substance and tested the moderating effects of the skills variables on the relationships between intentions to use and self-reported use of each of these substances. Methods Logistic regression path models were constructed for each of the drug use outcomes. Models were run using the Mplus 5.0 statistical application using the complex sample function to control for the sampling design of students nested within schools; full information maximum likelihood estimates (FIML) were utilized to address missing data. Results Relationships among targeted constructs and outcomes differed for each of the drugs with communication skills having a potentially iatrogenic effect on alcohol use. Program targets were mediated through the intentions to use these substances. Finally, we found evidence of a moderating effect of decision-making skills on perceptions of harm and attitudes toward use, depending upon the outcome. Conclusions Prevention curricula may need to target specific drugs. In addition to normative beliefs, perceptions of harm, and refusal and decision-making skills, programs should directly target constructs proximal to behavioral outcomes such as attitudes and intentions. Finally, more research on the effects of communication skills on adolescent substance use should be examined.

The Adolescent Substance Abuse Prevention Study: A randomized field trial of a universal substance abuse prevention program

Objectives The purpose of the study was to determine whether a universal school-based substance abuse prevention program, Take Charge of Your Life ( TCYL), prevents or reduces the use of tobacco, alcohol, or marijuana. Methods Eighty-three school clusters (representing school districts) from six metropolitan areas were randomized to treatment (41) or control (42) conditions. Using active consenting procedures, 19,529 seventh graders were enrolled in the 5-year study. Self-administered surveys were completed by the students annually. Trained Drug Abuse Resistance Education (D.A.R.E.) police officers presented TCYL in seventh and ninth grades in treatment schools. Analyses were conducted with data from 17,320 students who completed a baseline survey. Intervention outcomes were measured using self-reported past-month and past-year use of tobacco, alcohol, and marijuana when students were in the 11th grade. Results Main effect analyses show a negative program effect for use of alcohol and cigarettes and no effect for marijuana use. Subgroup analyses indicated that the negative effect occurred among nonusers at baseline, and mostly among white students of both genders. A positive program effect was found for students who used marijuana at baseline. Two complementary papers explore the relationship of the targeted program mediators to the use of alcohol, tobacco, and marijuana and specifically for students who were substance-free or who used substances at baseline. Conclusions The negative impact of the program on baseline nonusers of alcohol and tobacco indicate that TCYL should not be delivered as a universal prevention intervention. The finding of a beneficial effect for baseline marijuana users further supports this conclusion. The programmatic and methodological challenges faced by the Adolescent Substance Abuse Prevention Study (ASAPS) and lessons learned offer insights for prevention researchers who will be designing similar randomized field trials in the future.

A Culturally Adapted Drug and Alcohol Abuse Prevention Program for Aboriginal Children and Youth

A Culturally Adapted Drug and Alcohol Abuse Prevention Program for Aboriginal Children and Youth Lola T. Baydala, Betty Sewlal, MSc , Carmen Rasmussen, Kathleen Alexis, Fay Fletcher, PhD , Liz Letendre, Janine Odishaw, PhD , Merle Kennedy, PhD , and Brenda Kootenay What Is the Purpose of the Study? • To review, adapt, and deliver the first year of a 3-year, school-based substance abuse prevention program for Aboriginal children and youth. What Is the Problem? • The National Native Alcohol and Drug Abuse Program has identified substance abuse as a significant area of concern within Aboriginal communities across Canada, yet effective, school-based substance abuse prevention programs are not available to the majority of First Nation schools. • Prevention programs that are available often fail to capture and integrate the cultural beliefs and values of the community where the program is delivered. What Are the Main Findings? • Positive changes in student participants’ drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use. • Ownership of and investment in the program by the community. • Documentation of the relevance, importance, and benefits of employing a culturally adapted substance abuse prevention program with Aboriginal students attending a First Nations school through the inclusion of teaching approaches and activities that fit the learning contexts, worldviews, and relationships of the community. • Participation of Elders to ensure that learning activities reflect traditional ways of knowing. Who Should Care Most? • Health and Education stakeholders of the Alexis Nakota Sioux Nation. • First Nations Communities in Canada that operate band-controlled schools. • First Nations and Inuit Health, Health Canada. Recommendations for Action • Working collaboratively, Aboriginal communities can and should develop school-based, culturally adapted tools for the prevention of substance abuse. • Aboriginal community members can and should deliver culturally appropriate programs. • Build on existing research to adapt, deliver, and evaluate the full 3-year, culturally adapted elementary and middle school programs to students at Alexis Nakota Sioux Nation School. [End Page 7] Lola T. Baydala Department of Pediatrics, University of Alberta Betty Sewlal Alexis Board of Education, Alexis Nakota Sioux Nation Carmen Rasmussen Department of Pediatrics, University of Alberta Kathleen Alexis Alexis Board of Education, Alexis Nakota Sioux Nation Fay Fletcher Center for Health Promotion, School of Public Health and Faculty of Extension Liz Letendre Alexis Board of Education, Alexis Nakota Sioux Nation Janine Odishaw University of Alberta Merle Kennedy Misericordia Hospital Brenda Kootenay Alexis Board of Education, Alexis Nakota Sioux Nation Copyright © 2009 The Johns Hopkins University Press

Reports of Substance Abuse Prevention Programming Available in Schools

Evaluations of school-based substance abuse prevention programs with schools or school districts randomly assigned to either the treatment or control condition have demonstrated effective strategies over the past 30 years. Although control schools were never considered "pure" (i.e., no other interventions were being offered), school-based programming in the 1980s did not include evidence-based interventions. Since the late 1990s, funding agencies have required schools either to select programming from approved lists of prevention strategies or to demonstrate the efficacy of the strategies that would be used. This has increased the number of schools delivering evidence-based programs to their students. As a result, "treatment as usual" is more challenging to researchers. This paper describes exposure to prevention programming as reported by 204 school administrators from 83 districts and their 19,200 students who are participating in the Adolescent Substance Abuse Prevention Study, a national randomized evaluation trial of the program, Take Charge of Your Life. In order to determine the extent of student exposure to prevention programming in both the control and treatment schools, data were collected in each of the 5 years of the study from two sources: principals and prevention coordinators and from students. The data provided by the principals and prevention coordinators indicate that the vast majority of schools assigned to the control condition offered students drug prevention programming. This finding has implications for the evaluation of Take Charge of Your Life but also for other evaluation studies. The students were asked questions regarding participation in drug education posed on annual surveys. When their responses were compared to the reports from their school principals and prevention coordinators, it was found that the students underreported exposure to drug education. A follow-up qualitative study of a sample of students suggests the need for rewording of the questions for students in future studies. The implications of our findings for evaluation studies are discussed.

The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial

Objective To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test. Methods Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12–14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model. Results Program effects were found for daily cigarette smoking (POR = 0.70; 0.52–0.94) and episodes of drunkenness in the past 30 days (POR = 0.72; 0.58–0.90 for at least one episode, POR = 0.69; 0.48–0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR = 0.77; 0.60–1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking. Conclusion School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness.

Do adolescents perceive police officers as credible instructors of substance abuse prevention programs?

Although program recipients' attitudes toward instructors are crucial to program outcomes, they have not been adequately examined in the substance abuse prevention literature. This study uses survey data to explore attitudes toward instructors of prevention programming held by students from a national longitudinal evaluation of a school-based substance abuse prevention program delivered by Drug Abuse Resistance Education (D.A.R.E.) officers. Our analyses indicated that students who had police officers as instructors evaluated program instructors significantly higher than students who had non-police officers as instructors. The evaluation of police instructors varied according to students' sociodemographic characteristics. Implications for future research and practice are considered.

The Efficacy of a Systematic Substance Abuse Program for Adolescent Females

A school-based substance abuse prevention program based on the assumptions of the ASCA National Model® was designed to change adolescent females’ drug-using behaviors. The program was designed to reduce substance abuse, increase negative attitudes toward drug use, and reduce negative behaviors while increasing positive behaviors, knowledge of the physical symptoms of drug use, student achievement, and self-esteem. Group sessions were based on solution-focused brief therapy and action learning theory and were supplemented by mentorship from community members and peers. Positive outcomes were found on five dependent variables.

The Efficacy of a Systematic Substance Abuse Program for Adolescent Females

A school-based substance abuse prevention program based on the assumptions of the ASCA National Model® was designed to change adolescent females' drug-using behaviors. The program was designed to reduce substance abuse, increase negative attitudes toward drug use, and reduce negative behaviors while increasing positive behaviors, knowledge of the physical symptoms of drug use, student achievement, and selfesteem. Group sessions were based on solution-focused brief therapy and action learning theory and were supplemented by mentorship from community members and peers. Positive outcomes were found on five dependent variables.

Type II Translation

This article summarizes research on Type II translation of prevention interventions aimed at enhancing the adoption of effective programs and practices in communities. The primary goal of Type II translation is to institutionalize evidence-based programs, products, and services. First, the authors describe theoretical frameworks that are useful to guide Type II translation research. Second, research on prevention program implementation, including fidelity of implementation and factors that are associated with successful program implementation, is summarized. The authors describe interventions designed to enhance the dissemination of preventive interventions in community and public health settings. Third, they describe strategies used by prevention program developers who have taken programs to scale. Fourth, they present a case example of Project Towards No Drug Abuse (TND), an empirically validated high school-based substance abuse prevention program. They describe ongoing research on the dissemination of Project TND. Finally, they provide suggestions for future Type II translation research.

Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.

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.