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.     

Needs for Youth Substance Abuse and Violence Prevention in Schools and Communities

Substance abuse and violence among today's youth are at an all time high. Numerous prevention programs have been implemented to address these issues. Not all are successful. Research has found that when schools and communities are involved in the planning of prevention programs, youth are more cognizant of risk factors and of behaviors that strengthen risk factors. The purpose of this study was to assess the emerging needs for prevention and health education among youth, and to identify effective approaches for prevention program development and service delivery in schools and communities. This study surveyed 312 youth prevention specialists, school and community health educators and counselors, and parents in a regional sample of ten states. Results indicated that substance abuse and violence are the two most critical and priority issues in need of comprehensive prevention. Multiple prevention service delivery strategies appropriate to youth, including training, technical assistance, conferencing and networking, needs assessment and evaluation, and information requests are discussed in detail. Implications for prevention programming emphasized reducing risk factors and strengthening protective factors, reaching and motivating youth participation.     

Measuring the Effectiveness of the Urban Youth Connection: The Case for Dose-Response Modeling to Demonstrate the Impact of an Adolescent Substance Abuse Prevention Program

Introduction. This paper presents methods and findings from an outcome evaluation of an adolescent drug prevention program serving predominantly Hispanic and African American students in an inner-city public middle school and secondary school in Boston. The program, entitled the Urban Youth Connection, consists of individual, pair and group counseling to high risk students identified by school personnel. The study design and statistical analysis techniques are presented as a model approach to estimating the impact of adolescent drug prevention programs to maximize scientific rigor without compromising the service delivery mission of the program. The objectives of the intervention are to prevent and reduce 30-day use of alcohol, tobacco and other drugs, and to reduce risk and improve resiliency factors associated with healthy behaviors: self-esteem, social coping, depression, interpersonal violence, school involvement and aspirations, school attendance, and academic performance. Methods. A pre-test, post-test comparison group design was used to identify changes over time in behavioral, psychosocial, and academic outcomes. Stratified analysis was used to adjust for baseline differences in outcomes of interest between the treatment and comparison groups. A dose-response relationship was measured between amount of services received and self-reported behavioral outcomes, academic performance, and school attendance, by means of correlational and regression analyses. Self-reported behavioral outcomes were measured through surveys administered in both participating schools in the fall and spring of 1993-1994. Academic performance and school attendance was abstracted from student report cards at the end of the 1993-1994 school year. Service records, self-administered questionnaires, and grade and attendance reports were linked in an integrated computerized management information system. Results. Benefits of increased program exposure were indicated for intermediate outcomes of depression, social coping, school performance, especially for high risk students in the secondary school. Reduction of tobacco, beer and marijuana use among treatment students in the secondary school is suggested from this study. The dose-response model which associated amount of program exposure with self-reported outcomes and academic performance and attendance indicated that the intervention had the greatest effect on academic indicators among high school students who were identified as high risk at baseline. Discussion. The Urban Youth Connection shows promise of having an impact on intermediate outcomes of interest for high risk youth in middle school and high school settings. Behavioral indicators related to substance use or abuse are not impacted by the intervention as measured by a smaller subset of paired pre/post self-reported surveys among treatment and comparison group students. Early findings from the pre-test/post-test comparison are limited by small sample sizes. Trends suggest that program success may be demonstrated with increasing sample size as the program continues. Cohort studies in an action setting can lead to insignificant findings due to lower statistical power as a result of small sample sizes. Dose-response modeling can be a useful technique to make causal inferences to estimate program impact and can have more statistical power since this analytic approach can yield larger sample sizes useful for analysis. Dose-response modeling requires linkage of service information to client outcomes. Either approach requires stratification to adjust for variability within both the treatment group and the comparison group that result from application of quasi-experimental study designs for evaluating outcomes of adolescent drug prevention programs.     

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.     

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.     

Characteristics of Effective Substance Abuse Prevention Programs for High-Risk Youth

The last two decades have witnessed a rapid development of substance abuse prevention programs. Most efforts to evaluate these programs have been limited to single program studies, and nearly all studies involving multiple drug prevention programs have involved school-based programs for general youth populations. In 1995, the Center for Substance Abuse Prevention (CSAP), with the Substance Abuse and Mental Health Administration (SAMHSA), funded the CSAP National Cross-site Evaluation of High Risk Youth Programs, a five-year, multi-site evaluation study involving 46 programs and over 10,500 youth at high risk for substance use (CSAP, 2002(a)). This article reports findings from this evaluation, focusing on program characteristics that help explain reductions in 30-day substance use among program participants. Programs found to be most effective in reducing substance use were those that offered strong behavioral life skills development content, emphasized team-building and interpersonal delivery methods, emphasized introspective learning approaches focusing on self-reflection, were based upon a clearly articulated and coherent program theory, and provided intense contact with youth. Programs utilizing these positive program components produced consistent and lasting reductions in substance use. These findings provide a solid basis for the adoption of positive program characteristics in the development of future prevention programming for high-risk youth.     

Creating School and Community Partnerships for Substance Abuse Prevention Programs

The article reviews the scope and scale of the problem, explores a transactional view of etiology, and summarizes the prevailing approaches to prevention, exemplary and promising approaches, and standards for research and practice. The authors stress the importance of addressing the complexity of the problem through creation of comprehensive, multifaceted approaches to reduce substance abuse. Effective intervention frameworks are presented that weave together the resources of school, home, and community.     

Students′ Special Needs and Problems as Reasons for the Adaptation of Substance Abuse Prevention Curricula in the Nation's Middle Schools

In this study we estimate the proportion of the nation's middle school teachers who have adapted substance abuse curricula in response to their students' special problems or needs. We also explore a variety of characteristics associated with schools, teachers, and the curricula implemented that are associated with adaptations made in response to the most prevalent of these student problems or needs. Study data were collected in 1999 from a representative sample of lead substance abuse prevention teachers in the nation's public and private schools. We found that 79.8% of respondents report adapting their prevention curricula in response to at least one of the dozen student problems and needs specified. The problems cited most frequently, by slightly more than half of all respondents, relate to the needs of students who are sexually active or have discipline problems. Associated most strongly with adaptations for these two reasons were teachers who were recently trained in their curricula, and substance abuse prevention lessons that could readily be integrated into the school's overall curriculum. We discuss the need for curriculum developers to recognize the frequency with which, and reasons for which, teachers are adapting their curricula, and to include appropriate optional content that addresses students' needs.     

Implementation and Impact of a Family-Based Substance Abuse Prevention Program in Rural Communities

A family-based alcohol, tobacco, and other drug abuse prevention program was evaluated. The program targeted families with students entering middle or junior high school. The goals of the program were to increase resiliency and protective factors including family cohesion, communication skills, school attachment, peer attachment, and appropriate attitudes about alcohol and tobacco use by adolescents. The Families In Action program is a structured program which includes six 2 1/2 hour sessions, offered once a week for six consecutive weeks to parents and youth. The program was offered to all eligible families in eight rural school districts. Families who chose to participate began the program with lower scores on several protective factors as compared to nonparticipating families. Analysis of covariance controlling for initial differences found several positive effects of program participation at the one year follow-up. The results were strongest for boys. These findings suggest that providing parents and youth with similar communication skills can be an effective approach to substance abuse prevention.     

Managed Care and Prevention of Mental Health and Substance Abuse Problems: Opportunities for Growth Through Collaboration in the New Millennium

Mental health and substance abuse problems impose significant direct and indirect costs on society, yet an increasing number of effective preventive interventions have been identified in the field of behavioral health. Using the Institute of Medicine's Continuum of Care model of prevention, we examine the evolution and future prospects of prevention in the managed care environment. Specific barriers and opportunities for expanding prevention efforts are discussed.     

Strategies for Ensuring Use of Needs Assessment Findings: Experiences of a Community Substance Abuse Prevention Program

This article offers specific strategies for ensuring utilization of needs assessment findings. It is designed to help prevention specialists, community planners, program evaluators, and involved citizens maximize their efforts in developing community services by tying those services closely to community needs. Program evaluators who completed a broad-based community needs assessment commissioned by their organization, found that the organization had gone ahead in developing programs and saw the needs assessment findings as unrelated to their ongoing activities. Far from being unique, this situation is common in organizations where participants feel an urgency to get programs under way to address widespread community problems.     

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.     

Team Awareness for Workplace Substance Abuse Prevention: The Empirical and Conceptual Development of a Training Program

This paper describes the empirical and theoretical development of a workplace training program to help reduce/prevent employee alcohol and drug abuse and enhance aspects of the work group environment that support ongoing prevention. The paper (1) examines the changing social context of the workplace (e.g., teamwork, privacy issues) as relevant for prevention, (2) reviews studies that assess risks and protective factors in employee substance abuse (work environment, group processes, and employee attitudes), (3) provides a conceptual model that focuses on work group processes (enabling, neutralization of deviance) as the locus of prevention efforts, (4) describes an enhanced team-oriented training that was derived from previous research and the conceptual model, and (5) describes potential applications of the program. It is suggested that the research and conceptual model may help prevention scientists to assess the organizational context of any workplace prevention strategy. The need for this team-oriented approach may be greater among employees who experience psychosocial risks such as workplace drinking climates, social alienation, and policies that emphasize deterrence (drug testing) over educative prevention. Limitations of the model are also discussed.     

Etiologic Studies of Adolescent Drug Use: A Compendium of Data Resources and Their Implications for Prevention

Etiological studies canvassing five major domains of risk are reviewed. The five domains reflect unique facets of risk that are central to many current prevention approaches and include: peer social influences, family (parenting) processes, expectancies (cognitive motivations), social skills and personal self-management strategies, and personality factors. Each domain is discussed with regard to major theoretical issues, important studies that help to clarify risk mechanisms, and major findings. A sixth area covering studies of multi-ethnic youth and ethnic-specific risk mechanisms also is reviewed in the context of augmenting previous empirical findings. A final section addresses two important concerns: (1) the need for a comprehensive model of developmental vulnerability; and (2) utilization of information stemming from a long tradition of developmental etiology to enhance the efficacy of drug abuse prevention.     

Context of Risk for HIV and Sexually Transmitted Infections Among Incarcerated Women in the South: Individual,Interpersonal, and Societal Factors

Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.     

Strengthening Sugar-Sweetened Beverage Taxation for Non-Communicable Disease Prevention: A Comparative Political Economy Analysis Case Study of Fiji and Tonga

Diet-related fiscal policy is an effective NCD prevention strategy. However, current sugar-sweetened beverage (SSB) taxes in Fiji and Tonga have not had the desired effect; SSB consumption in Fiji, for example, contributes to mortality more than double the global rates and is highest in the WHO Western Pacific Region. We therefore aimed to better understand the perceived underlying political economy drivers that have and continue to affect change in each country. Our study design utilised a comparative case study that triangulated documentary policy and stakeholder analysis with semi-structured stakeholder interviews in both countries and an in-depth corporate political activity analysis in Fiji. We drew on theoretical frameworks relevant to political economy to collect and analyse policy and stakeholder data, and utilised established corporate political activity frameworks to analyse industry activity. Common findings to both Fiji and Tonga suggested that the SSB tax impact could be increased through multisectoral engagement, embracing a whole-of-society approach, strengthened institutional structures and leveraging off competing priorities across sectors towards more common goals. These findings provide opportunities and lessons for Fiji and Tonga as well as other similar settings seeking to strengthen or upscale the impact of diet-related fiscal policy.     

Rationale for two influenza B lineages in seasonal vaccines: A meta-regression study on immunogenicity and controlled field trials

B lineage mismatch prompted introduction of quadri-valent influenza vaccines (QIV) with two influenza B viruses representing distinct antigenic lineages. To explore the impact on antibody induction and vaccine effectiveness predicted from antibody (VEab), we performed a systematic literature search on immunogenicity studies conducted to assess antibody superiority of QIV over trivalent influenza vaccine (TIV). Thirteen relevant articles described 31 trials from 2007 and 2013. Log-transformed GMT trial estimates and their variances were converted to clinical protection rates predicted from antibody (PRab). VEab estimates were calculated from pre- and post-vaccination PRab. Without specific pre-vaccination immunity, average VEab was 69% for match, and −4% for lineage mismatch. With increasing pre-vaccination seropositivity, mismatch impact declined to 2%. We also performed an umbrella literature search for randomised controlled trials and test-negative case-control trials with TIV, and estimated vaccine effectiveness against laboratory-confirmed influenza B (VEf). Sixty-eight eligible clinical articles described 110 season-trials from 1965 to 2012, covering seasons with B lineage match (n = 52), lineage drift (n = 15) and lineage mismatch (n = 43). With no pre-vaccination antibody levels determined, we used chance of previous exposure to influenza B (Ppe) as pre-seasonal immunity measure. When Ppe was 0%, average VEf for matched seasons was 67%, and for mismatched seasons 35%, indicating a moderate, yet significant mismatch impact on VEf. With increasing Ppe, mismatch impact declined to 3%. Thus serological and field trials indicate that B lineage mismatch impact is negatively related to pre-seasonal immunity and that the gain of QIV over TIV most benefits infants and children not yet exposed to influenza B.