An example of international drug politics--the development and distribution of substance prevention programs directed at adolescents

Many substance use prevention programs directed at adolescents exist that have been developed by researchers in the United States and are intended to be used in school settings. Some of the problems associated with such programs are reviewed, including their accessibility, ease of use, copyright status, evaluation options, program scales, and ratings, together with an overall consideration of the factors and processes posited to be associated with substance use and non-use (posited "at-risk" and "protective" mechanisms). The authors contend that there is a great need to: (a) develop substance use prevention programs which are commercially available but are not protected by copyright, (b) assess empirically each component in a program separately, and (c) encourage funding bodies to be more active in supporting the production of manuals and evaluation instruments for substance use prevention programs directed at adolescents. We need more and better process evaluations that are also sensitive to both endogenous and exogenous forces in order to know the processes by which a successful prevention program achieves its effects, is prevented from doing so and which processes are irrelevant. A social competence framework might be used as both a goal and as a theoretical base to achieve a better understanding of the processes by which substance use prevention programs reach their effects.     

Results of prevention programs with adolescents

Programs for preventing smoking and alcohol and drug abuse have radically changed in the past decade. Instead of being regarded as a health or discipline problem that involves only a few deviant adolescents, drug use has begun to be viewed as social behavior that is functional for adolescents, not capricious, and is normative for that population. The most successful prevention programs have sought to delay the onset of tobacco use. Based on theoretical and etiological research, these programs target factors that have repeatedly been predictive of adolescent smoking, alcohol and drug use. The programs teach adolescents (1) why people their age smoke tobacco or use alcohol and drugs; (2) how these meanings get established by peers, older role models and advertising; (3) how to resist these influences to smoke or to use alcohol and drugs; and (4) life skills and competencies to counterbalance the functions that drug use serves. Because of the association with the onset of smoking and the onset of using other drugs, these strategies are being studied for alcohol use and other drugs. In addition, elected peer leaders are trained to conduct these activities with their classmates and act as new role models for non-use. Evaluations of these approaches are optimistic. Studies in northern California and Minnesota reveal 50-70% reductions in the onset of smoking. Botvin's 'Life Skills Training' program demonstrates success in delaying heavy alcohol and marijuana use.     

Iatrogenic effects of alcohol and drug prevention programs

OBJECTIVE: Understanding prevention program risks and the contextual factors associated with negative program outcomes is critical to assisting the development of public policy that is aimed at avoiding future prevention-related harm while maximizing prevention success. The purpose of this review was to systematically analyze published studies evaluating substance use prevention programs, to determine whether iatrogenic effects have occurred, and if so, what types of harmful effects resulted and under what circumstances. METHOD: A search of electronic bibliographic databases in allied health, education, medicine, psychology and general literature was conducted, spanning the years from 1980 to the present. RESULTS: Evidence of negative program effects was found in 17 evaluation studies for which 43 negative outcomes were documented. The most common type of negative outcome resulting from prevention programs was behavioral effects consisting primarily of increases in consumption, especially alcohol use. Drug prevention programs resulted in greater increases in alcohol use, cigarette use, marijuana use and multiple drug use than did alcohol prevention programs. Negative program outcomes appear to exist as three possible scenarios, described in this article. CONCLUSIONS: Researchers, publishers and practitioners should pay special attention to measuring, monitoring and reporting negative outcomes of prevention programs in the future, so that we might learn more about which program elements interact with which contextual factors to cause harm to which groups of youth.     

Efficacy of a drug prevention CD-ROM intervention for adolescents

The purpose of the present study was to examine the efficacy of a substance abuse-preventive intervention using CD-ROM technology among adolescents in the sixth and seventh grades (12- to 13-years-old). The CD-ROM program used interactive audio and video content to teach social resistance skills, general personal and social competence skills, and normative education. Rates of substance-use behavior attitudes, knowledge, normative expectations, and related variables were examined. From approximately 23 schools, students (n = 123) were randomly assigned to either receive the CD-ROM preventive intervention (n = 61) or to serve as a control group (n = 62). Study participants were 50% male, predominantly white (75%), and 94% came from two-parent families. Self-report data were collected using a self-administered web-based survey. Findings indicated that there were significant intervention effects on pro-drug attitudes, normative expectations for peer and adult substance use, anxiety reduction skills, and relaxation skills knowledge, with intervention students reporting improved scores on these outcomes at the posttest relative to control students. Findings indicate that a substance abuse-preventive intervention derived from an effective, school-based prevention approach is efficacious when delivered using CD-ROM technology. Research is needed to determine potential differences in the efficacy of CD-ROM prevention tools delivered in schools compared to home settings.     

Evaluation of drug use practices at primary healthcare centers of Kuwait

Purpose  

The aim of this study was to investigate current prescribing and dispensing practices at primary healthcare centers in Kuwait and compare them with those reported in other countries.     

How cultural factors influence school-based substance use prevention programs

This article analyzes school-based substance use prevention programs, comparing programs in the United States and Nordic countries, explores how cultural factors influence the ways in which prevention programs are designed and implemented, and how evaluation is affected by design and implementation.     

Assessing the effectiveness of Malaysia''s drug prevention education and rehabilitation programs

The multifaceted drug prevention education and rehabilitation system of Malaysia appears to have contributed to the steady decrease of the number of identified drug abusers in the country. In this article, those components of the Malaysian system that would be most applicable to the American effort were examined. In the same manner, because the fastest growing minority group in the United States are Asian Americans, in which a significant proportion involve persons from Southeast Asia, those components in the Malaysian system that are applicable to Southeast Asian Americans were examined.     

Evaluation of six computerized drug interaction screening programs.

Six widely used computerized drug interaction screening programs were evaluated according to criteria developed by a panel of pharmacists. A panel of six pharmacists from various practice settings developed criteria that were used to evaluate six computerized drug interaction screening programs: Medicom Micro Plus, Medical Letter, S-O-A-P, Drug Interactions by Hansten, Drug Therapy Screening Systems (DTSS), and RxTriage. The criteria were that the programs be user friendly and efficient, provide guidance, and be relevant to the user's practice setting. Also, they should detect interactions, quickly alert the user, and guide the user to the appropriate action. The user should be able to set the level of clinical significance, screen only current drugs in a patient profile, and print out summaries. The panel selected nine known drug interactions to test the programs' knowledge bases. Only Medicom Micro Plus and DTSS detected all nine drug interactions; Medical Letter missed three. RxTriage and Drug Interactions received the highest ratings in user friendliness and efficiency, but both missed two interactions. RxTriage was rated most relevant to their practice by hospital and community pharmacists, and Drug Interactions was rated most relevant by faculty practitioners. S-O-A-P received low ratings overall. Of the six drug interaction screening programs evaluated, none was considered by the panel of pharmacists to be ideal.     

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

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

At-Risk Students: drug prevention through afterschool/latchkey programs?

The importance of after school latchkey programs as a major deterrent to the onset of drug use among elementary and secondary school students is reviewed. Most of the data in this study support the need for after school latchkey programs, especially at the elementary school level. Elementary school students indicated gains in all diagnostic categories. The elementary school students showed positive gain scores in family, school, self-esteem, substance use, and personal abuse categories. Elementary school students showed positive gain scores in the substance use category while secondary school students showed negative gain in this area. There is a need to reassert the role of after school latchkey programs in the development of socially desirable behaviors in elementary school students, with a particular need to reassert the role of increasing positive self-esteem in relation to drug use and peer influences. Some implications for educational interventions and drug prevention programs are discussed.     

Acculturation and drug use among dually diagnosed Hispanic adolescents

With drug abuse among Hispanic youth on the rise, examining cultural factors such as acculturation may provide insight into understanding and addressing this problem. This study examined the relationship between acculturation and severity of drug use among a sample of severely impaired Hispanic adolescents referred for residential substance abuse treatment. As recent studies with clinical samples have found, it was hypothesized that lower levels of acculturation would be associated with higher levels of substance use. Results indicated that youth born outside the United States reported greater frequency of drug use at intake into treatment than those born in the United States, supporting the hypothesis.     

Alcohol and drug use among "street" adolescents

Studies of adolescent alcohol use typically sample intact high school populations. This study assessed "street" adolescents alienated from the mainstream educational system. Despite recent optimism regarding adolescent substance use, these respondents showed considerable alcohol consumption, drinking to get drunk, and problems. The major correlates of substance abuse were "personal" drinking motives, expectancies of alcohol effects and peer behavior. Thus, adolescents who would not appear in typical studies showed much stronger alcohol involvement than the general population, with individual differences best accounted for by attitude variables relevant to a "stress-vulnerability" approach to substance abuse.     

Profiles of drug use behavior change for adolescents in treatment

This study was designed to replicate and extend previous research on post-treatment responding by identifying trajectories of change on the basis of an empirical classification strategy and to examine predictors of those change trajectories identified. Treatment response was examined for 232 adolescents with substance use disorders who participated in one of two randomized controlled trials evaluating family and cognitive behavioral interventions in an outpatient treatment setting. Cluster analysis was used to identify, empirically, homogeneous groups of individuals who display common internally consistent patterns of change over the course of treatment.     

A videogame intervention for tobacco product use prevention in adolescents

PurposeThis pilot study evaluated the short-term effects of an interactive videogame on changing adolescent knowledge, beliefs and risk perceptions, and intentions to use e-cigarettes, cigarettes, and other tobacco products. A secondary aim was to evaluate players' game experience.MethodsParticipants (N = 80 11–14 year olds) were recruited from 7 community-based afterschool programs in New Haven, Connecticut and Los Angeles, California. The design was a single group pre-post design with replication. A pre-test survey was administered that included demographic variables and knowledge, risk perceptions, beliefs, and intentions to use e-cigarettes, cigarettes, and other tobacco products. An interactive videogame focusing on risky tobacco use situations was subsequently played in four 60-min sessions over a four-week period, followed by a post-test survey. Analyses included paired t-tests of pre-post videogame change, regression analyses, and path analyses testing mediational effects of beliefs and risk perceptions on the relationship between knowledge and intentions.ResultsThe videogame changed knowledge of e-cigarettes and other tobacco products (p's < 0.001), risk perceptions of cigarettes and e-cigarettes (p < .01 and p < .001, respectively), and beliefs about e-cigarettes and other tobacco products (p's < 0.05), but not intentions. Older adolescents reported greater e-cigarette knowledge and risk perceptions (p's < 0.05), and females reported greater risk perception of cigarettes (p < .05). Beliefs mediated the relationship between knowledge and intentions to use e-cigarettes (indirect effect p < .05).ConclusionResults suggest that brief exposure (4 h over 4 weeks) to a videogame focused on changing knowledge and attitudes towards tobacco products may have a promising effect on preventing risk for early adolescent tobacco product use, particularly for e-cigarettes.     

Demographic characteristics and illegal drug use patterns among attendees of drug cessation programs in China

Demographic characteristics and patterns of illegal drug use were assessed among 833 Chinese drug addicts in 1996 at six drug cessation programs in Yunnan and Guangxi, People's Republic of China. The majority of addicts were male, young, single, and with little education. About half were unemployed when they entered the programs. Heroin was the predominant drug. The two most common routes of drug administration were intravenous injection and sniffing or snorting. Two-thirds of the addicts reported at least daily use. Although they were only a small proportion of drug addicts in this sample, females reported earlier onset and a longer history of drug use than males.     

A synthesis review of exemplary drug abuse prevention programs in the United States

In the United States, there has been a concerted emphasis during the past 30 years toward identifying and implementing evidence-based drug prevention programs. The wealth of prevention efficacy research has contributed to the publication of several recent reports on promising, model, and effective programs. We identified five such recent reports, four from the federal government and one from a private foundation, that had nominated and described 100 exemplary prevention programs. Of these 100 programs, 70 reported on evidence of effectiveness. We conducted a qualitative analysis on these 70 exemplary programs. Based on a systematic review process, we identified 10 elements that were characteristic of most (at least 75%) of the programs. These 10 elements are described and discussed in light of public policy issues.