Universal School-based Prevention Research Articles

Preventing alcohol use with a universal school-based intervention: results from an effectiveness study.

BackgroundThe effectiveness of the universal school-based alcohol prevention program “Unge & Rus” [Youth & Alcohol] was tested by an independent research group. The program aims to prevent alcohol use and to change adolescents’ alcohol-related attitudes. The main outcome measure was frequency of monthly alcohol use, favorable alcohol attitudes, perceived behavioral control (PBC), positive alcohol expectancy and alcohol-related knowledge.MethodsJunior high school students (N = 2,020) with a mean age of 13.5 years participated in this longitudinal pre, post and one-year follow-up study with a quasi-experimental design, involving an intervention group and a comparison group recruited from 41 junior high schools in Norway. Multilevel analysis was used to account for the repeated observations (level 1) nested within students (level 2) who in turn were clustered within school classes (level 3).ResultsResults showed an increased level of alcohol-related knowledge in the intervention group (p < .005) as compared to the comparison group at one-year follow-up. However, no significant difference in change was found between the intervention group and the comparison group in frequency of monthly alcohol use, alcohol-related attitudes, PBC or alcohol expectancy at one-year follow-up.ConclusionsThis study offers adequate data on the effectiveness of a school-based alcohol prevention program widely implemented in Norway. Under its current method of implementation, use of the program cannot be supported over the use of standard alcohol curriculum within schools.

A qualitative analysis of factors influencing middle school students' use of skills taught by a violence prevention curriculum

This study examined factors that influenced the use of skills taught in a school-based universal violence prevention program. Interviews were conducted with 91 students from two urban schools (83% were African American and 12% multiracial) and 50 students from a nearby county school (52% were White, 32% African American, and 12% multiracial). About half the sample (54%) was male. All had been in sixth grade classrooms where the Second Step (Committee for Children, 1997b) violence prevention curriculum had been implemented earlier in the school year or in the preceding school year. Qualitative analysis of interview transcripts suggested that participants' use of intervention skills was influenced by their beliefs and values, perceived relevance and effectiveness of the skill, issues related to enacting the behavior, and contextual factors. These findings highlight the need for a more intensive and comprehensive effort to address barriers and supports that influence the relevance and impact of school-based violence prevention programs.

Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials.

BackgroundPreventive interventions for adolescents are an important priority within school systems. Several interventions have been developed, but the effectiveness of such interventions varies considerably between studies. The purpose of this study was to assess the effectiveness of universal school-based prevention programs on alcohol use among adolescents by using meta-analytic techniques.MethodA systematic literature search in the databases, PubMed (Medline), PsycINFO (Ovid), EMBASE (Ovid) and WEB of Science (ISI) was conducted to search for empirical articles published in the period January 1990 to August 2014.ResultsIn total, 28 randomized controlled studies with 39,289 participants at baseline were included. Of these 28 articles, 12 studies (N = 16279) reported continuous outcomes (frequency of alcohol use and quantity of alcohol use), and 16 studies (N = 23010) reported categorical data (proportion of students who drank alcohol). The results of the random effects analyses showed that the overall effect size among studies reporting continuous outcomes was small and demonstrated a favorable effect from the preventive interventions (Hedges’ = 0.22, p < .01). The effect size among studies reporting categorical outcomes was not significant ( = 0.94, p = .25). The level of heterogeneity between studies was found to be significant in most analyses. Moderator analyses conducted to explore the heterogeneity showed neither significant difference between the different school levels (junior high schools and high schools), nor between the varied program intensities (low, medium and high intensity programs). The meta-regression analyses examining continuous moderators showed no significant effects for age or gender.ConclusionsThe findings from this meta-analysis showed that, overall, the effects of school-based preventive alcohol interventions on adolescent alcohol use were small but positive among studies reporting the continuous measures, whereas no effect was found among studies reporting the categorical outcomes. Possible population health outcomes, with recommendations for policy and practice, are discussed further in this paper.

Universal school-based prevention for illicit drug use.

Universal school-based prevention for illicit drug use.

Long-Term Effects of the keepin’ it REAL Model Program in Mexico: Substance Use Trajectories of Guadalajara Middle School Students

In the face of rising rates of substance use among Mexican youth and rapidly narrowing gender differences in use, substance use prevention is an increasingly urgent priority for Mexico. Prevention interventions have been implemented in Mexico but few have been rigorously evaluated for effectiveness. This article presents the long term effects of a Mexico-based pilot study to test the feasibility of a linguistically specific (Mexican Spanish) adapted version of keepin' it REAL, a school-based substance abuse prevention model program. University affiliated researchers from Mexico and the US collaborated on the study design, program implementation, data collection, and analysis. Students and their teachers from two middle schools (secundarias) in Guadalajara participated in this field trial of Mantente REAL (translated to Spanish). The schools were randomly assigned to treatment and control conditions. The sample of 431 students reported last 30day substance use at three times (one pretest and two posttests). Changes in substance use behaviors over time were examined using growth curve models. Long term desired intervention effects were found for alcohol and marijuana use but not for cigarettes. The intervention effects were greater for girls than for boys in slowing the typical developmental increase over time in alcohol use. Marijuana effects were based on small numbers of users and indicate a need for larger scale studies. These findings suggest that keepin' it REAL is a promising foundation for cultural program adaptation efforts to create efficacious school-based universal prevention interventions for middle school students in Mexico.

A qualitative investigation of adolescents' perceived mechanisms of change from a universal school-based depression prevention program.

A recent meta-analysis provides evidence supporting the universal application of school-based prevention programs for adolescent depression. The mechanisms underlying such successful interventions, however, are largely unknown. We report on a qualitative analysis of 109 Grade 9 students’ beliefs about what they gained from an evidence-based depression prevention intervention, the Resourceful Adolescent Program (RAP-A). Fifty-four percent of interviewees articulated at least one specific example of program benefit. A thematic analysis of responses revealed two major themes, improved interpersonal relationships and improved self-regulation, both stronger than originally assumed. A more minor theme also emerged—more helpful cognitions. It is postulated that both improved interpersonal relationships and improved self-regulation are likely to enhance one another, and more helpful cognitions may express its contribution through enhanced self-regulation. These findings broaden our understanding of the impact of depression prevention programs, beginning to illuminate how such programs benefit participants.

Teachers or psychologists: who should facilitate depression prevention programs in schools?

The current study evaluates a depression prevention program for adolescents led by psychologists vs. teachers in comparison to a control. The universal school-based prevention program has shown its efficacy in several studies when implemented by psychologists. The current study compares the effects of the program as implemented by teachers versus that implemented by psychologists under real-life conditions. A total of 646 vocational track 8th grade students from Germany participated either in a universal prevention program, led by teachers (n = 207) or psychologists (n = 213), or a teaching-as-usual control condition (n = 226). The design includes baseline, post-intervention, and follow-up (at 6 and 12 months post-intervention). The cognitive-behavioral program includes 10 sessions held in a regular school setting in same-gender groups and is based on the social information-processing model of social competence. Positive intervention effects were found on the change in girls’ depressive symptoms up to 12 months after program delivery when the program was implemented by psychologists. No such effects were found on boys or when program was delivered by teachers. The prevention program can successfully be implemented for girls by psychologists. Further research is needed for explanations of these effects.

O4 * FREE ORAL COMMUNICATIONS 4: ALCOHOL INTERVENTIONS IN DIFFERENT SETTINGS

O4 * FREE ORAL COMMUNICATIONS 4: ALCOHOL INTERVENTIONS IN DIFFERENT SETTINGS

Exploring the promise of mandatory random student drug testing by comparing it to other school drug prevention strategies

Exploring the promise of mandatory random student drug testing by comparing it to other school drug prevention strategies

For Whom Does It Work? Subgroup Differences in the Effects of a School-Based Universal Prevention Program

This study examined subgroup differences in the effectiveness of a universal classroom-based preventive intervention. The Good Behavior Game (GBG) was delivered in Grade 1 and 2 in a randomized controlled trial including 759 students. Changes in externalizing and internalizing problems were modeled from Kindergarten through Grade 2. Unlike previous research, a person-centered approach was employed to examine critical combinations of child, peer, family, and demographic characteristics at baseline as moderators of intervention impact. Six subgroups were identified that differed both in baseline risk profiles and intervention responsiveness. The GBG prevented the development of externalizing and internalizing behavior among low-risk children, children with emotional problems, and victimized children. No positive intervention effects were found for children from dysfunctional families and children with combinations of behavioral and social risks. The study presented a novel approach to study subgroup differences in universal preventive interventions and provides first evidence that universal school-based programs may not be effective for children with more severe risks and risks at multiple levels.

Preventing depression and promoting resilience: feasibility study of a school-based cognitive-behavioural intervention

The limited reach and effectiveness of psychological treatments for adolescent depression have fuelled interest in alternative approaches designed to promote resilience. Schools offer a convenient location for the widespread delivery of depression prevention programmes, although little research has evaluated the feasibility of delivering interventions in this setting. To investigate the feasibility of delivering and evaluating a universal school-based depression prevention programme for children aged 12-16 years. A three-arm pilot study was conducted in one UK secondary school (n = 834). Interventions had good reach (96%), with high rates of consent (89%) and reasonable retention (78%). The majority of intervention sessions were delivered as intended, with 85% of students attending seven or more sessions. The programme was acceptable to students and teachers, with the specific content of the active intervention being rated differently from the control programmes. Delivering and undertaking methodologically robust evaluations of universal school-based depression programmes is feasible.

Commentary on: ‘Universal school‐based prevention programmes for alcohol misuse in young people’

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Foxcroft DR, Tsertsvadze A. Universal school‐based prevention programmes for alcohol misuse in young people. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD009113. DOI: 10.1002/14651858.CD009113.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Cochrane Review: Universal school‐based prevention programs for alcohol misuse in young people

AbstractBackgroundAlcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents. This is one of three reviews examining the effectiveness of (1) school‐based, (2) family‐based, and (3) multi‐component prevention programs.ObjectivesTo review evidence on the effectiveness of universal school‐based prevention programs in preventing alcohol misuse in school‐aged children up to 18 years of age.Search methodsRelevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO.Selection criteriaRandomized trials evaluating universal school‐based prevention programs and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records.Data collection and analysisTwo reviewers extracted relevant data independently using an a priori defined extraction form. Risk of bias was assessed.Main results53 trials were included, most of which were cluster‐randomised. The reporting quality of trials was poor, only 3.8% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in 23% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.Six of the 11 trials evaluating alcohol‐specific interventions showed some evidence of effectiveness compared to a standard curriculum. In 14 of the 39 trials evaluating generic interventions, the program interventions demonstrated significantly greater reductions in alcohol use either through a main or subgroup effect. Gender, baseline alcohol use, and ethnicity modified the effects of interventions. Results from the remaining 3 trials with interventions targeting cannabis, alcohol, and/or tobacco were inconsistent.Authors' conclusionsThis review identified studies that showed no effects of preventive interventions, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in characteristics that would distinguish trials with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game. A stronger focus of future research on intervention program content and delivery context is warranted.Plain Language SummaryPsychosocial and Developmental Alcohol Misuse Prevention in Schools can be effectiveWe conducted a Cochrane systematic review of 53 well‐designed experimental studies that examined the effectiveness of school‐based universal programs for the prevention of alcohol misuse in young people. The studies were divided into two major groups based on the nature of the prevention program: 1) programs targeting specifically prevention or reduction of alcohol misuse and 2) generic programs with wider focus for prevention (e.g., other drug use/abuse, antisocial behavior). In the review we found studies that showed no effects of the preventive program, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in program characteristics that would distinguish studies with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. In conclusion, current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game.

FRIENDS parent project : effectiveness of parent training in reducing parent anxiety in a universal prevention program for anxiety symptoms in school children

Anxiety is the most pervasive childhood mental health disorder today. This study examined the parent component of a school-based universal prevention and early intervention program. Participating parents (N = 122) completed four measures on anxiety, the Anxiety Sensitivity Index, the Center for Epidemiological Studies-Depression, the Penn State Worry Questionnaire, and the Screen for Child Anxiety Related Emotional Disorders, before and after the parent program. The effectiveness of the program was investigated by analysing mean scores of the parent self-reported anxiety symptoms and parent reports of child anxiety symptoms. The main analyses conducted were 2 x 2 between-within ANOVAs for each measure. The hypothesis that parents who participated in the program (n = 20) would report reduced anxiety symptoms for themselves and for their children when compared to parents who did not attend (n = 120) was not confirmed. The parent's satisfaction level with the program was also studied, with high acceptability ratings providing strong social validity for this program. Implications of the findings, strengths, limitations and suggestions for further research are discussed.

A randomized controlled trial testing the effectiveness of a universal school-based depression prevention program 'Op Volle Kracht' in the Netherlands.

BackgroundThe incidence of depressive symptoms increases during adolescence, from 10.0% to 24.5% at age 11 to 15, respectively. Experiencing elevated levels of depressive symptoms increases the risk of a depressive disorder in adulthood. A universal school-based depression prevention program Op Volle Kracht (OVK) was developed, based on the Penn Resiliency Program, aimed at preventing the increase of depressive symptoms during adolescence and enhancing positive development. In this study the effectiveness of OVK will be tested and possible mediators of program effects will be focus of study as well.MethodThe effectiveness of OVK will be tested in a randomized controlled trial with two conditions, intervention (OVK) and control condition (care as usual). Schools are randomly assigned to research conditions. OVK will be incorporated in the school curriculum, maximizing program attendance. OVK consists of 16 lessons of 50 min, given by trained psychologists to groups of 11-15 students. OVK contains Cognitive Behavioral Therapy, social skills training, problem solving and decision making. Outcomes are measured at 6, 12, 18 and 24 months follow up, to monitor long term program effects. Primary outcome is level of depressive symptoms, secondary outcomes are: anxiety, hopelessness, cognitive bias, substance use, truancy, life satisfaction, coping, self-efficacy, optimism, happiness, friendship, school performance and school attitude. The questionnaires for students will be administered in the school setting. Parents will complete a questionnaire at baseline only.DiscussionIn this paper the study into the effectiveness of the depression prevention program OVK was described. It is expected that OVK will prevent the increase in depressive symptoms during adolescence and enhance positive development in the intervention condition, compared to the control condition. If OVK will be effective, it can be implemented in the school context by which numerous adolescents can be reached.Trial registrationNetherlands Trial Register (NTR): NTR2879

Identifying Potential Mediators and Moderators of the Association Between Child Maltreatment and Bullying Perpetration and Victimization in School

A growing body of literature is demonstrating associations between childhood maltreatment and bullying involvement at school. In this literature review, four potential mediators (explanatory) and three potential moderators (mitigates or exacerbates) of the association between childhood maltreatment and school bullying are proposed. Mediators include emotional dysregulation, depression, anger, and social skills deficits. Moderators reviewed include quality of parent–child relationships, peer relationships, and teacher relationships. Although there might be insurmountable challenges to addressing child maltreatment in primary or universal school-based prevention programs, it is possible to intervene to improve these potentially mediating and moderating factors.

Universal school-based prevention programmes for alcohol misuse in young people

Universal school-based prevention programmes for alcohol misuse in young people

Understanding How Programs Work to Prevent Overt Aggressive Behaviors: A Meta-analysis of Mediators of Elementary School–Based Programs

Several recent meta-analyses of universal school-based violence prevention studies indicate the overall positive impacts of these approaches on aggression. These studies, however, assess impacts on broadly defined measures of aggression. Furthermore, little research has analyzed the mechanisms through which these programs attempt to reduce overt aggressive behavior. The current study analyzed overall impacts on a more narrowly defined outcome—overt aggressive behavior—and identified associated mediators in 36 universal prevention studies conducted with kindergarten through fifth-grade students. Programs were associated with a significant, although small, reduction in overt aggression behavior. Three types of mediators were identified: measures of skill acquisition, social-cognitive processes, and classroom characteristics. Using MacKinnon's joint significance test to test for mediation, four measures of skill acquisition, two measures of social cognitive, and one measure of classroom characteristics were identified as significant mediating variables. Implications for the design of effective violence prevention programs and mediators to assess in future research are discussed.

Developing the Climate Schools: Alcohol and Cannabis Module: A Harm-Minimization, Universal Drug Prevention Program Facilitated by the Internet

The Climate Schools: Alcohol and Cannabis Module is a universal harm-minimization school-based prevention program for adolescents aged 13–15 years. The core content of the program is delivered over the Internet using cartoon storylines to engage students, and teacher-driven activities reinforce the core information. The program is embedded within the school health curriculum and is easy to implement with minimal teacher training required. The program was developed in 2007 through extensive collaboration with teachers, students, and health professionals (N = 24) in Sydney, Australia and has since been evaluated (N = 764). This article describes the formative research and process of planning that formed the development of the program and the evidence base underpinning the approach. The study's limitations are noted.

Impact of a universal school-based violence prevention program on violent delinquency: Distinctive benefits for youth with maltreatment histories

Objective Child maltreatment constitutes a strong risk factor for violent delinquency in adolescence, with cumulative experiences of maltreatment creating increasingly greater risk. Our previous work demonstrated that a universal school-based violence prevention program could provide a protective impact for youth at risk for violent delinquency due to child maltreatment history. In this study we conducted a follow-up to determine if participation in a school-based violence prevention program in grade 9 continued to provide a buffering effect on engaging in acts of violent delinquency for maltreated youth, 2 years post-intervention. Methods Secondary analyses were conducted using data from a cluster randomized controlled trial of a comprehensive school-based violence prevention program. Students ( N = 1,722; 52.8% female) from 20 schools participated in 21 75-min lessons in grade 9 health classes. Individual data (i.e., gender, child maltreatment experiences, and violent delinquency in grade 9) and school-level data (i.e., student perception of safety averaged across students in each school) were entered in a multilevel model to predict violent delinquency at the end of grade 11. Results Individual- and school-level factors predicting violent delinquency in grade 11 replicated previous findings from grade 9: being male, experiencing child maltreatment, being violent in grade 9, and attending a school with a lower perceived sense of safety among the entire student body increased violent delinquency. The cross-level interaction of individual maltreatment history and school-level intervention was also replicated: in non-intervention schools, youth with more maltreatment in their background were increasingly likely to engage in violent delinquency. The strength of this relationship was significantly attenuated in intervention schools. Conclusions Follow-up findings are consistent with the buffering effect of the prevention program previously found post-intervention for the subsample of youth with maltreatment histories. Practice implications A relative inexpensive school-based violence prevention program that has been shown to reduce dating violence among the whole student body also creates a protective effect for maltreated youth with respect to lowering their likelihood of engaging in violent delinquency.