Drug Abuse Prevention

Research Findings from May, 2003 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Positive Impact of Competence Skills and Psychological Wellness in Protecting Inner-city Adolescents from Alcohol Use

Research has shown that competence enhancement prevention programs for substance use are effective in reducing alcohol use and other problem behaviors. However, less is known about the mechanisms by which high competence helps youth avoid negative outcomes. This study explored whether greater competence is associated with increased levels of psychological wellness that in turn deters subsequent alcohol use. Specifically, 1,459 students attending 22 middle and junior high schools in New York City completed surveys that included measures of competence (decision making, self-efficacy), psychological wellness, and alcohol use. Students completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Data collectors administered the questionnaire following a standardized protocol during a regular 40-min class period. On the basis of a longitudinal structural equation model, adolescents who were highly competent reported greater psychological wellness, which was then associated with less drinking. These findings highlight the potential of alcohol prevention programs designed to enhance competence and psychological wellness. Epstein, J.A., Griffin, K.W. and Botvin, G.J. Positive Impact of Competence Skills and Psychological Wellness in Protecting Inner-city Adolescents from Alcohol Use. Prevention Science, 3, pp. 95-104, 2002.

Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing Fathers

This study examines marijuana use among children of male drug abusers. Subjects were 83 African-American and European-American male drug abusers (the majority of whom were injection drug users) and their children. Thirty-one of the fathers were HIV-positive and 52 were HIV-negative. Using logistic regression analyses, the authors explored cross-sectionally the relationship between four psychosocial domains (i.e., paternal attributes, adolescent problem behaviors, father-adolescent relations, and the environment) and adolescent marijuana use. The father's use of illegal drugs and his failure to cope adaptively predicted adolescent marijuana use, while a close father-child bond predicted less adolescent marijuana use. Adolescent problem behaviors predicted an increased likelihood of marijuana use. Furthermore, hierarchical regression analysis demonstrated that the adolescent's problem behavior mediated the associations between the father-adolescent relationship as well as environmental factors with adolescent marijuana use. Reducing the risk factors and enhancing the protective factors within each of the domains could help reduce marijuana use among the adolescent children of drug-abusing fathers. Moreover, if a father is a drug abuser, it is important to help him establish a close bond with his child in order to help attenuate the influence of his drug use on the child's marijuana use. Brook, D.W., Brook, J.S., Richter, L., Whiteman, M. and Arencibia-Mireles, O. Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing Fathers. The American Journal on Addictions, 11, pp. 95-110, 2002.

Risk and Protective Factors of Adolescent Drug Use: Implications for Prevention Programs

The first purpose of this chapter is to identify the risk and protective factors related to adolescent drug use. The framework is derived from the family interactional theory. Operating within a developmental framework, the authors explore the interrelations of risk factors related to drug use. In addition, they elucidate the protective factors that mitigate adolescents' vulnerability to drug use. A second goal of the chapter was to elucidate the implications of etiological research for prevention, treatment, public policy, and research. In so doing, authors build heavily on a number of the major studies that have been conducted in the last decade. Finally, they present several prevention programs that have successfully incorporated the findings of etiological research into their prevention programs. Brook, J.S., Richter, L.and Whiteman, M. In Z. Sloboda and W.J. Bukoski (eds.), Handbook of Drug Abuse Prevention: Theory, Science and Practice, pp. 265-287, New York: Plenum, 2003.

Comprehensiveness of Substance Use Prevention Programs in U.S. Middle Schools

This study assessed how current practice in middle school substance use prevention programs compares to seven recommended guidelines adapted from the Centers for Disease Control and Prevention's guidelines for school-based tobacco use prevention programs. Substance use prevention practice was analyzed using data from a 1999 mailed survey of a nationally representative sample of 1,496 public and private schools with middle school grades that reported having a substance use prevention program. An estimated 64 percent of schools met four or more of the recommendations for school-based substance use prevention practice; 4 percent met all seven recommendations. Of the seven, schools were most likely to report having and enforcing substance use prevention policies (84 percent), and least likely to report training teachers in substance use prevention (18 percent). More recommendations were implemented by schools with the following characteristics than by those without them: they were public, had larger enrollments, greater perceived availability of resources, greater school board and parental support for substance use prevention, and had hired a school substance use prevention coordinator. Additional resources may be needed to increase the prevalence of comprehensive substance use prevention programs in U.S. middle schools. Wenter, D.L., Ennett, S.T., Ribisl, K., Vincus, A.A., Rohrbach, L., Ringwalt, C.L., and Jones, S.M. Journal of Adolescent Health, 30(6), pp. 457-464, 2003.

Outcomes of the Minnesota DARE PLUS Project

In the past, the Drug Abuse Resistance Education (DARE) has been the most widely used drug use prevention program in elementary schools. Several evaluations have shown the program's lack of effectiveness; other evaluations of the DARE curriculum have reported short-term changes in cigarette smoking that have been modest in size. The Minnesota DARE PLUS Project was designed to capitalize on the successful elements of DARE and also provide additional, complementary components based on state-of-the-art prevention strategies. DARE PLUS curriculum focuses on middle/junior high school level, and is designed to reduce tobacco, alcohol and marijuana use, and violent behavior among 7th and 8th grade students. The evaluation study of DARE PLUS involved 24 middle and junior high schools in Minnesota that were matched on socio-economic measures, drug use, and size, and were randomly assigned to three conditions: 1) DARE; 2) DARE PLUS, and 3) delayed DARE PLUS control. The principal outcomes of the study were measured by self-administered questionnaires. Differences between the three conditions were tested using a three-level, linear, random coefficients model. DARE PLUS was found to significantly improve the DARE middle/junior high curriculum, and was an effective intervention for reducing alcohol, tobacco, and multi-drug use and victimization among adolescent boys. However, DARE PLUS did not demonstrate similar effects among adolescent girls. The gender differences in outcomes need further exploration. Perry, C.L., Komro, K.A., Veblen-Mortenson, S., Bosma, L.M., Farbakhsh, K., Munson, K.A., Stigler, M.H., and Lytle, L.A. A Randomized Controlled Trial of the Junior High DARE and DARE PLUS programs. Archives of Pediatrics and Adolescent Medicine, 157, pp. 178-184, 2003.

Effects of The Coping Power Program

This study evaluates the effects of both a universal and an indicated preventive intervention. Children were identified as being at risk on the basis of 4th-grade teachers' ratings of children's aggressive and disruptive behaviors. Interventions were delivered during the 5th- and 6th-grade years. Children were randomly assigned to the Coping Power (indicated) intervention, the universal intervention, the combined Coping Power plus universal intervention, or a control condition. The Coping Power program included child and parent components. Results indicated that all three intervention conditions produced relatively lower rates of substance use at post-intervention than did the control condition. The interventions also produced effects on three of the four predictor variable domains: children's social competence and self-regulation and parents' parenting skills. Lochman, J.E., and Wells, K.C. The Coping Power Program at the Middle-School Transition: Universal and Indicated Prevention Effects. Psychology of Addictive Behaviors, 16(4), pp. S40-S54, 2002.

Three-Year Outcomes of the Early Risers Longitudinal Prevention Trial

This study evaluated the effects of participation following a 3-year preventive intervention trial targeting elementary school children with early-onset aggressive behavior. The Early Risers intervention model includes two core components: CORE, a coordinated set of school-centered interventions that target key developmental domains underlying risk and protection in young children and FLEX, a risk-adjusted family-focused intervention delivered through home visitation to foster parenting skills. Intent-to-treat analyses revealed that compared with controls, program participants showed greater gains in social skills, academic achievement, and parent discipline, with mean scores in the normative range on the latter two constructs. As-intended participation in the FLEX Family Program, which included separate parent and child education and skills-training groups, was associated with improved parent discipline practices and gains in children's social skills, with level of child aggression moderating gains in academic achievement. Recommended level of FLEX family support contact time was associated with gains in academic achievement, concentration problems, and social skills, with parents of severely aggressive children showing greater reductions in parent distress. August, G.J., Hektner, J.M., Egan, E.A., Realmuto, G.M. and Bloomquist, M.L. The Early Risers Longitudinal Prevention Trial: Examination of 3-Year Outcomes in Aggressive Children with Intent-to-Treat and As-Intended Analyses. Psychology of Addictive Behaviors, 16(4), pp. S27-S39, 2002.

Findings from the Raising Healthy Children Social Development Intervention

This study examined results of a comprehensive, multifaceted longitudinal school-based prevention program called Raising Healthy Children (RHC). RHC focuses on enhancing protective factors with the goal of promoting positive youth development, reducing identified risk factors and preventing adolescent problem behaviors. Participants included 938 first or second graders who were enrolled in 10 area schools in the Pacific Northwest and randomly assigned to the RHC or control condition. Analyses were conducted 18 months after implementation and focused on academic and behavioral outcomes in the school environment. Results using hierarchical linear modeling showed that RHC students, compared to their peers who did not receive the intervention, had significantly higher teacher-reported academic performance and a stronger commitment to school. RHC students showed a significant decrease in antisocial behaviors and an increase in social competency compared to control peers. Regression results from parent-reported outcomes also showed that RHC students had higher academic performance and a stronger commitment to school. Catalano, R.F., Mazza, J.J., Harachi, T.W., Abbott, R.D., Haggerty, K.P. and Fleming, C.B. Raising Healthy Children Through Enhancing Social Development in Elementary School: Results after 1.5 years. Psychology of Addictive Behaviors 16(2), pp. 129-134, 2003.

Peer Influence and Prevention of Problem Behavior

Research shows that deviant peer influence is related to the escalation of various problem behaviors such as substance use, delinquent behavior and violence. The goal of this research was to examine the effects of a family-centered prevention strategy on deviant peer affiliation. The investigators hypothesized that the Adolescent Transitions Program (ATP) would significantly reduce growth in deviant peer affiliation from the beginning of sixth grade to the beginning of ninth grade and that the reduced growth in deviant peer involvement would be correlated with the intensity of the parents' contact with the intervention. The Adolescent Transitions Program involves a 6-week classroom curriculum for all intervention youth, a Family Check-Up component to improve the family management in families identified by a teacher as potentially at-risk, and additional preventive strategies, such as family therapy and brief consultations, for families with motivation and need for assistance. This intervention was administered through a "Family Resource Center" at the school. Six hundred seventy-one youth and their families were recruited to participate from a diverse metropolitan community. Using latent growth analysis, the growth in deviant peer involvement for intervention youth was reliably less than that of the control group. In addition, the results showed that the extent to which parents accessed the family resource center mediated growth in deviant peer affiliation. Dishion, T.J., Bullock, B.M., and Granic, I. Pragmatism in Modeling Peer Influence: Dynamics, Outcomes, and Change Processes. Development and Psychopathology, 14, pp. 969-981, 2002.

Test of the Early-Starter Model of the Development of Serious Conduct Problems

The Fast Track prevention trial was used to test hypotheses from the Early-Starter Model of the development of chronic conduct problems. The researchers randomly assigned 891 high-risk first-grade boys and girls (51 percent African American) to receive or not receive the long-term Fast Track preventive intervention. After four years, outcomes were assessed through teacher ratings, parent ratings, peer nominations, and child self-report. The positive effects of assignment to intervention were evident in teacher and parent ratings of conduct problems, peer social preference scores, and association with deviant peers. Assessments of proximal goals of intervention (e.g., reduced hostile attributional bias, harsh parental discipline, and aggressive behavior at home and school; improved problem-solving skills and pro-social behavior), collected after third grade were found to partially mediate these effects. The findings are interpreted as consistent with developmental theory. Bierman, K.L., Coie, J.D., Dodge, K.A., Greenberg, M.T., Lochman, J.E., McMahon, R.J., and Pinderhughes, E.E. Using the Fast Track Randomized Prevention Trial to Test the Early-Starter Model of the Development of Serious Conduct Problems. Development and Psychopathology, 14, pp. 925-943, 2002.

Leisure Time Motivation Scale for Adolescents

Understanding and measuring motivation can be important in developing and testing prevention interventions for youth. A new self- report measure of adolescent free-time motivation based on self-determination theory (Ryan & Deci, 2000) has been developed. The scale measures five forms of motivation (amotivation, external, introjected, identified, and intrinsic motivation), and is appropriate for use with young adolescents (ages 12-15). Using confirmatory factor analysis, examination of each of the motivation subscales indicated minimally acceptable levels of fit. The test of the overall model without modification was also minimally acceptable. The deletion of two items improved the fit and provided preliminary evidence of the validity of the overall scale. However, future replication of this finding is needed. Baldwin, C.K., and Caldwell, L.L. Leisure Time Motivation Scale for Adolescents. Journal of Leisure Research, 35, pp. 129-151, 2003.

Preventive Intervention Implementation in Rural Schools

Interactive prevention programs (i.e., characterized by dynamic instructional processes such as engaging students in classroom discussions, role-plays, and games) have been proven to be more effective in decreasing student problem behaviors than didactic practices. While almost all rural schools provide some programming to address student behavior problems, minimal attention has been paid to the unique features of rural schools that are particularly relevant to training teachers in the delivery of interactive preventive interventions. This paper describes teacher evaluation of a training based on a model proposed by Tortu and Botvin (1989) and the process of implementing the interactive intervention components of the Capable Families and Youth Prevention Project. This study involves the recruitment of thirty-six schools from communities in a rural Midwestern state for a test of the efficacy of school-based and school-based plus family-based substance abuse prevention programs. Teachers who participated in a two-day training completed an evaluation immediately after the training and upon completion of the classroom implementation. Results showed that teachers were confident about their ability to deliver the program following both training and classroom implementation. Lillehoj, C.J., Spoth, R., and Trudeau, L. Rural Teacher Training. Rural Educator, 24(1), pp. 3-12, 2002.