Effectiveness of School-Based Drug Prevention Programs: A Meta-Analysis of the Research

Effectiveness of different types of drug prevention programs was examined in a meta-analysis of 120 school-based programs (5th-12th) that evaluated success on self-reported drug use measures. Hypothesis tests using Weighted Least Squares regressions were conducted of an a priori classification scheme that was based on program content and its method of delivery. Two major types of programs were identified: Interactive and Non-Interactive. Six factors related to program effectiveness (sample size, targeted drug, type of control group, special populations, type of leader, and attrition) were included as covariates. The superiority of the Interactive programs was both clinically and statistically significant to the Non-Interactive programs for tobacco, alcohol, marijuana and illicit drugs and for all adolescents including minority populations. The larger Interactive programs were less effective, although still significantly superior to the Non-Interactive programs, which suggests implementation failures.     

A Comparison of Current Practice in School-Based Substance Use Prevention Programs with Meta-Analysis Findings

The series of seminal meta-analytic studies of school-based substance use prevention program studies conducted by the late Nancy S. Tobler and colleagues concluded that programs with content focused on social influences' knowledge, drug refusal skills, and generic competency skills and that use participatory or interactive teaching strategies were more effective than programs focused on knowledge and attitudes and favoring traditional didactic instruction. The present study compared current school practice against evidence-based standards for effective content and effective delivery, derived from the Tobler findings. Respondents were the lead staff who taught substance use prevention in the 1998–1999 school year in a national sample of public and private schools that included middle school grades (N = 1,795). Results indicate that most providers (62.25%) taught effective content, but few used effective delivery (17.44%), and fewer still used both effective content and delivery (14.23%). Those who taught an evidence-based program (e.g., Life Skills Training, Project ALERT), however, were more likely to implement both effective content and delivery, as were those teachers who were recently trained in substance use prevention and were comfortable using interactive teaching methods. The findings indicate that the transfer to practice of research knowledge about school-based substance use prevention programming has been limited.     

Applying Cost Analysis Methods to School-Based Prevention Programs

In order to efficiently allocate scarce prevention resources, policymakers need information about the economic costs of school-based substance use prevention programs. The objective of this paper is to outline economic cost analysis methods and demonstrate their applicability to school-based prevention programs. As an example, the paper focuses on estimating the economic cost of ALPHA, an intensive school-based substance use prevention program. The cost of ALPHA is compared to the costs of 3 elementary school programs that were alternatives to ALPHA. We collected cost information for 3 years, using a cost questionnaire that was completed by program and school budget officers and school principals. The program costs obtained from these sources were modified to conform to well-established economic cost analysis principles.     

Drug Abuse Prevention Among Minority Adolescents: Posttest and One-Year Follow-Up of a School-Based Preventive Intervention

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

Long-Term Follow-Up Effects of a School-Based Drug Abuse Prevention Program on Adolescent Risky Driving

This study examined long-term follow-up data from a large-scale randomized trial to determine the extent to which participation in a school-based drug abuse prevention program during junior high school led to less risky driving among high school students. Self-report data collected from students in the 7th, 10th, and 12th grades were matched by name to students' department of motor vehicles (DMV) records at the end of high school. The DMV data included the total number of violations on students' driving records as well as the number of "points" that indicate the frequency and severity of the violations. A series of logistic regression analyses revealed that males were more likely to have violations and points on their driving records than females, and regular alcohol users were more likely to have violations and points than those who did not use alcohol regularly. Controlling for gender and alcohol use, students who received the drug prevention program during junior high school were less likely to have violations and points on their driving records relative to control group participants that did not receive the prevention program. Findings indicated that antidrinking attitudes mediated the effect of the intervention on driving violations, but not points. These results support the hypothesis that the behavioral effects of competence-enhancement prevention programs can extend to risk behaviors beyond the initial focus of intervention, such as risky driving.     

Family-Based Drug Abuse Prevention Programs: A Review

Key elements of promising family-based drug abuse prevention strategies include: (1) program content based on proven prevention theory and research; (2) comprehensive approaches that begin early, extend across the life span, address multiple risk and protective factors, and generalize across settings; (3) developmentally appropriate material; (4) sensitivity to the culture and community; (5) sufficient dosage and follow-up; (6) use of interactive teaching techniques; (7) training for prevention program providers; and (8) evaluation to know that the intervention had the desired effect on behavior. In addition, an issue with major implications for prevention is how to reach the broadest possible audience or those who may most benefit from prevention services.     

Adolescent Neurocognitive Development, Self-Regulation, and School-Based Drug Use Prevention

Adolescence is marked by several key development-related changes, including neurocognitive changes. Cognitive abilities associated with self-regulation are not fully developed until late adolescence or early adulthood whereas tendencies to take risks and seek thrilling and novel experience seem to increase significantly throughout this phase, resulting in a discrepancy between increased susceptibility to poor regulation and lower ability to exercise self-control. Increased vulnerability to drug use initiation, maintenance, and dependence during adolescence may be explained based on this imbalance in the self-regulation system. In this paper, we highlight the relevance of schools as a setting for delivering adolescent drug use prevention programs that are based on recent findings from neuroscience concerning adolescent brain development. We discuss evidence from school-based as well as laboratory research that suggests that suitable training may improve adolescents’ executive brain functions that underlie self-regulation abilities and, as a result, help prevent drug use and abuse. We note that considerable further research is needed in order (1) to determine that self-regulation training has effects at the neurocognitive level and (2) to effectively incorporate self-regulation training based on neuropsychological models into school-based programming.     

Mediation Analysis of a School-Based Drug Prevention Program: Effects of Project ALERT

This study used mediation analyses, implemented in a longitudinal structural equation modeling framework, to examine the mechanisms by which a social-influence-based school drug use prevention program (Project ALERT) achieved its effects on past month cigarette use and alcohol misuse. Participants were 4,277 South Dakotan middle-school students (2,554 treatment and 1,723 control) measured at baseline and 1 year later on past month cigarette use and alcohol misuse, as well as cigarette- and alcohol-related mediating variables targeted by the Project ALERT curriculum (i.e., resistance self-efficacy, positive and negative beliefs about use, and peer influence). Results for cigarettes showed that all hypothesized mediating variables were significant mediators of ALERTs effect on intentions to smoke and past month cigarette use, with peer influence being the strongest. Results for alcohol point to positive beliefs about the consequences of drinking as an important mediator for alcohol misuse. Taken together, the findings highlight an avenue for program improvement through increased impact on peer influence to use alcohol and drugs.     

Effectiveness of School-Based Intervention Programs in Reducing Prevalence of Overweight

Objectives:

To assess the effectiveness of school-based interventions program in reducing the prevalence of overweight or obesity among schoolchildren.

Data source:

Ovid Medline (1950-December 2012), Embase (1980-2012), CINAHL (1982-2012), secondary references, review articles, and expert in the field.

Study selection:

All published clinical trials were eligible for study if were randomized, methodologically strong-based on a validity assessment, aimed to evaluate a school-based intervention for childhood overweight or obesity, and measured outcome in term of prevalence/incidence difference in overweight and obesity among both groups. Studies involved in cost-effective analysis of school-based intervention have been excluded. Data from eligible studies abstracted and pooled for relative risk.

Results:

Five trials with 3,904 schoolchildren were included. Mean age of the students (boys and girls) ranges 8.6-12.6 years. Meta-analysis showed a statistical significance beneficial effect of school-based intervention programs on obesity status of schoolchildren (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.43-0.78) and suggested 42% reduction in prevalence of obesity among schoolchildren through school-based intervention programs. Individual studies also showed effectiveness of these school-based interventions.

Conclusion:

School-based intervention programs are effective in prevention of childhood overweight and obesity problem and our results quantitatively supported this argument.     

School-Based Prevention Programs for Eating Disorders

Scarce resources are dedicated to research on school-based prevention programs for eating disorders. Despite this, however, recent years have witnessed an abundance of publications on controlled prevention trials. We now have a cumulative body of knowledge available to guide future developments in the prevention of eating disorders.Medline and Psychlnfo were searched for the years 1985–2002 to find relevant publications for this review. Nineteen universal and ten targeted school-based prevention programs were identified and then evaluated.The results obtained by the controlled trials evaluated reassure parents, teachers, and stakeholders in the healthcare sector that school-based eating disorder prevention programs do not have harmful effects on student attitudes and behaviors. Targeted prevention programs have obtained promising results in high-risk individuals. Other positive effects have been obtained using an interactive format. Universal prevention programs have unfortunately been disappointing in their ability to change unhealthy behaviors.Results can be improved by gaining a greater understanding of those risk factors which are most strongly linked to eating disorders and most susceptible to change. A broad range of interventions is needed for further consideration. Promising results from the field of eating disorder prevention and from modern risk factor research could build a new generation of universal prevention trials for eating disorders without the methodological limitations seen in the current literature and with real effectiveness in achieving the goal of reducing the prevalence of eating disorders in the general population.     

School Predictors of the Intensity of Implementation of School-Based Prevention Programs: Results from a National Study

Research has indicated that the effectiveness of school-based prevention programs is affected by the implementation quality of these programs. As the importance of implementation has become clearer, researchers have begun to examine factors that appear to be related to implementation quality. Data from a nationally representative sample of 544 schools were used to examine structural equation models representing hypothesized relationships among school and program factors and implementation intensity, controlling for exogenous community factors. Significant relationships were found between implementation intensity and several school and program factors, including local program development process, integration into school operations, organizational capacity, principal support, and standardization. Implications of these findings are discussed.     

Essential Elements of School-Based Smoking Prevention Programs

ABSTRACT: The current status of adolescent tobacco use in the United States is discussed in the context of the identification of those elements considered necessary for successful school-based smoking prevention programs. Also described are the conclusions of a National Cancer Institute-convened expert advisory panel charged with the task of addressing: What are the essential elements of a school-based smoking prevention program? The panel focused on nine areas in which sufficient data and experience existed to reach a preliminary conclusion or make a recommendation. The nine areas are: program impact, focus, context, and length; ideal age at intervention; need for peer and parental involvement; teacher training; and program implementation. The panel concluded U.S. school-based smoking prevention programs have had consistently positive effects, though these effects have been modest and often limited to delaying the onset of tobacco use. Though the panel felt many programs are suitable for dissemination, several research recommendations also are described.     

Examining the Effects of School-Based Drug Prevention Programs on Drug Use in Rural Settings: Methodology and Initial Findings

ABSTRACT:  Context: Although there have been substantial advances in knowledge about drug prevention over the last decade, the majority of school-based drug prevention studies have been conducted in urban settings. There is little knowledge about the effectiveness of such programs when they are implemented in rural populations. Purpose: To examine the prevention effects of school-based drug prevention programs implemented in rural populations. Methods: Mixed model or 2-level meta-analysis of trials based on school-based drug prevention programs that included rural populations. A total of 182 trials were coded for urbanicity of schools and 22 separate trials were selected for the analysis conducted in this paper. A total of 435 distinct analyses were examined from these 22 trials. Findings: We found a modest but consistent beneficial impact of drug prevention programs on later use as well as level of use. Regarding later drug use, the largest impact was on those who were not using at baseline and those exposed to an interactive program; the results were much larger for marijuana and other drugs compared to alcohol or tobacco, while inhalant use was less affected than other drug categories. Regarding level of use, the impact was greatest 6 months after the trial ended, with diminishing effects thereafter. Conclusions: Evidence exists for a small but systematic beneficial effect of drug prevention programs in rural settings. It is likely that these programs have produced a mild reduction in new use of substances but have had little impact on those already using substances.     

Developmental Issues in School-Based Aggression Prevention from a Social-Cognitive Perspective

Contemporary research on the development and prevention of aggressive behavior in childhood and adolescence emphasizes the importance of social-cognitive factors such as perceptual biases, problem-solving skills, and social-moral beliefs in the maintenance of aggression. Indeed, school-based social-cognitive intervention approaches have been identified as best practices by the Centers for Disease Control and Prevention. However, because child age is an important covariate of both intervention effectiveness and social-cognitive ability, school-based prevention program designers should keep in mind a number of issues identified through developmental research. In this paper, we review the social-cognitive model of aggressive behavior development as applied to prevention programming. We then discuss some of the ways in which the broader developmental research base can inform the design of aggression prevention programs. Editors' Strategic Implications: Educational administrators and policy makers will find evidence in this review that school-based programs that employ a social-cognitive model represent a strategy that works for preventing violence. Prevention researchers will also benefit from the authors' insights regarding theoretical mediating processes and the importance of a developmental view.     

Does Federal Policy Support the Use of Scientific Evidence in School-Based Prevention Programs?

Since 1998, federal policy has explicitly required the use of “evidence-based” prevention programs in schools. We review how this policy has been implemented through state recipients of the Safe and Drug Free Schools (SDFS) Program, and how other federal and private agencies have supported the policy by providing guidance about the scientific evidence for specific programs’ effectiveness. We report data from a survey of SDFS state office directors, and we compare and contrast the most popular lists of effective programs. State offices supply the infrastructure for administering the SDFS Program, providing technical assistance to local school districts, monitoring the implementation of federal policy at the local level, and determining funding eligibility based on compliance. We found that states rely heavily on federal lists to determine whether school districts are meeting federal policy requirements, particularly the National Registry of Effective Programs and Practices (NREPP). Both SDFS and NREPP are changing, however, and the changes do not bode well for the transfer of prevention science to schools. Conclusions and recommendations are presented.     

Cultural Considerations in Family-Based Primary Prevention Programs in Drug Abuse

America has been seen as a place where people from distinct ethnic and cultural groups are synthesized into one composite American culture that both includes and reflects the values, norms and mores of everyone. However, the evolution of a consensus model of ethnic and cultural fusion has failed to materialize; with many groups tenaciously adhering to their value, belief, and behavior systems of origin. Because of the degree of tenacity to which these differences have been retained, it is imperative that sufficient effort be exerted toward a clarification and an appreciation of the function of race, ethnicity, and culture in problem occurrence, prevention, and treatment. However, this clarification has not proven itself to be an easy task. Too often, the concepts of race, culture, and ethnicity are not treated as distinct in the literature, which can be confusing and problematic in determining the most appropriate methodological and analytical approach to the research. This article will discuss some of the etiological and methodological issues associated with planning, conducting, and the dissemination of family-based, drug abuse prevention programs with ethnic minorities.     

Spreading a Warm Blanket of Prevention over All Children: Guidelines for Selecting Substance Abuse and Related Prevention Curricula for Use in the Schools

There is a need for a set of clear, practical, empirically and theoretically grounded guidelines to select substance abuse and related prevention and competence promotion programs based in schools. This report provides such a framework in the form of recommended key elements of effective school-based prevention programs derived from an extensive literature search. In addition, major programs are summarized and compared in relation to their coverage of these key elements.     

Economic Evaluation of Adolescent Addiction Programs: Methodologic Challenges and Recommendations

This article identifies and describes several methodologic challenges encountered in economic evaluations of substance abuse interventions for adolescents. Topics include study design, the choice of perspective, the estimation of costs and outcomes, and the generalizability of results. Recommendations are offered for confronting these challenges using examples from research on adolescent substance abuse and dependency/addiction.     

Effectiveness and Content Analysis of Interventions to Enhance Oral Antidiabetic Drug Adherence in Adults with Type 2 Diabetes: Systematic Review and Meta-Analysis

ObjectivesTo estimate the pooled effect size of oral antidiabetic drug (OAD) adherence-enhancing interventions and to explore which of the behavior change techniques (BCTs) applied in the intervention groups modified this pooled intervention effect size.MethodsWe searched relevant studies published until September 3, 2013, on MEDLINE, Embase, PsycInfo, the Cochrane Library, CINAHL, Current Contents Connect, and Web of Science. Selected studies were qualitatively synthesized, and those of at least medium quality were included in the meta-analysis. A random-effects model was used to pool effectiveness (Hedges’s g) and to examine heterogeneity (Higgins I²). We also explored the influence on the pooled effectiveness of unique intervention BCTs (those delivered to the intervention groups but not control groups in a trial) by estimating their modifying effects.ResultsFourteen studies were selected for the qualitative synthesis and 10 were included in the meta-analysis. The pooled effectiveness of the interventions was 0.21 (95% confidence interval −0.05 to 0.47; I² = 82%). Eight unique BCTs were analyzed. “Cope with side effects” (P = 0.003) and “general intention formation” (P = 0.006) had a modifying effect on the pooled effectiveness. The pooled effectiveness of the interventions in which “cope with side effects” was applied was moderate (0.64; 95% confidence interval 0.31–0.96; I² = 56%).ConclusionsThe overall effectiveness of OAD adherence-enhancing interventions that have been tested is small. Helping patients cope with side effects or formulate desired treatment outcomes could have an impact on the effectiveness of OAD adherence-enhancing interventions. Only those interventions that include helping patients to cope with side effects appear to be particularly effective in improving OAD adherence.