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.     

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.     

Critical Issues for Substance Abuse Prevention Targeting American Indian Youth

This paper examines prevention programs targeting alcohol and other drug use among American Indian youth. We start with a review of what is known about substance use by this population. We provide consideration of specific prevention programs for Indian youth within these frameworks: Cognitive/Information Dissemination, Affective Education, Social Influence, and Personal and Social Skills Training. A particular focus is on the manner in which issues of culture are incorporated into prevention programs. A detailed overview of the diversity of the American Indian population is presented and its implications for prevention work with Indian youth are discussed. A major conclusion is that there is not one type of prevention program that is likely to work with American Indian youth since there is no such thing as a typical American Indian.     

Etiology and Prevention of Substance Use Among Asian American Youth

Among populations identified by the U.S. Bureau of the Census, it is anticipated that the Asian/Pacific Islander (API) population will experience the greatest change between 1990 and 2050 (U.S. Bureau of the Census. [1996, February]. Current population reports. Series P25-1130. Washington, DC: U.S. Government printing office). Limited studies focus on APIs as a racial group and still fewer disaggregate samples to specific ethnic Asian subgroupings. This paper begins with definitions of the API communities, then examines rates of adolescent drug use, risk and protective factors, and preventive intervention effectiveness focused on API communities. The limited epidemiological data suggest that in general, APIs are at a relatively lower risk for drug use than youth from most other ethnic groups. However, the available data also suggest that use may not be as low as generally assumed with rates for alcohol use, smoking, and some illicit drugs being equal to or exceeding those of African Americans and European Americans. Despite the paucity of available data on particular Asian subgroups, the available data demonstrate that there are differences among API subgroups, underscoring the importance of identifying Asian subgroups when studying substance use and when planning prevention and treatment. The limited data examining the etiology of drug use across API subgroups suggests that some of the risk and protective factors derived from majority based research may also be predictors for these populations. These data support the utility of examining the generalizability of existing tested prevention approaches among different API communities. Finally, further efforts should be made to encourage and support the evaluation of community-based programs that already target and deliver services to API youth.     

Characteristics of Effective School-Based Substance Abuse Prevention

Prevention Science - This study summarizes, using meta-analytic techniques, results from 94 studies of school-based prevention activities that examined alcohol or other drug use outcomes. It set...     

The Prevention of Substance Abuse Among Construction Workers: A Field Test of a Social-Cognitive Program

A substance abuse prevention program based on social-cognitive principles and cast in a health promotion framework was tested on 374 construction workers from 5 sites. Subjects were randomly assigned to receive the Power Tools program with substance abuse material or without the material. Both self-report and bioassay data were collected before and approximately one year after the program. Data were analyzed mainly by analysis of covariance, analysis of variance, and chi-square analysis. Program effects were not demonstrated on consumption of substances, but were found on stages-of-change measures of smoking and drinking and on the frequency with which parents talk with their children about alcohol and drugs. The results suggest that a program of this type might help construction workers move toward reductions in licit substance use, but not in illicit drug use.     

Program Evaluation Strategies for Substance Abuse Prevention

Substance abuse prevention has grown from a grassroots movement and a topic of marginal academic interest into full-fledged technology. Central to the success of this technology has been the development of evaluation methods for documenting the effectiveness of programs and policies. This paper reviews the state-of-the-art in program evaluation for substance abuse prevention efforts. Included in this review is a discussion of approaches to process, outcome, and impact evaluation. Evaluation designs are reviewed with attention given to topics such as recruitment and retention of sites and participants, defining interventions, data collection, controlling for rival explanations, and data analysis and reporting.     

Advances in Statistical Methods for Substance Abuse Prevention Research

The paper describes advances in statistical methods for prevention research with a particular focus on substance abuse prevention. Standard analysis methods are extended to the typical research designs and characteristics of the data collected in prevention research. Prevention research often includes longitudinal measurement, clustering of data in units such as schools or clinics, missing data, and categorical as well as continuous outcome variables. Statistical methods to handle these features of prevention data are outlined. Developments in mediation, moderation, and implementation analysis allow for the extraction of more detailed information from a prevention study. Advancements in the interpretation of prevention research results include more widespread calculation of effect size and statistical power, the use of confidence intervals as well as hypothesis testing, detailed causal analysis of research findings, and meta-analysis. The increased availability of statistical software has contributed greatly to the use of new methods in prevention research. It is likely that the Internet will continue to stimulate the development and application of new methods.     

Strategies for Community/School Collaborations to Prevent Youth Substance Abuse

Within communities across the United States, collaborations have developed between community-based organizations (CBOs) and schools to plan and implement unified approaches to prevent youth substance abuse. This article describes challenges and workable strategies reported by a diverse group of 11 community-based organizations (CBOs) for developing and maintaining collaborative relationships with schools. Strategies recommended by CBOs for effective CBO/school collaborations are described within four categories: (1) establishing the collaboration; (2) maintaining cooperation with schools during program implementation; (3) addressing cultural issues; and (4) institutionalizing the collaborative programs. The need to tailor community prevention efforts to the specific context of each community is emphasized.     

Bridging the Gap Between Family-Focused Research and Substance Abuse Prevention Practice: Preface

This paper introduces the contributions of this special section on connecting family-focused substance abuse prevention research and practice. Other expert reviews and the meta-analyses discussed in this and the following papers have given us a good idea about what works in this area. They have specified a number of family-focused substance abuse prevention approaches and programs effective in decreasing substance abuse in youth. Unfortunately, some practitioners are still primarily implementing untested, ineffective programs. A number of recommendations are made by the authors of this special section to help improve the adoption of evidence-based family programs to prevent substance abuse by youth.     

Family-Based Approaches to Substance Abuse Prevention

In this paper, the prevalence of child and adolescent substance use is briefly presented. The nature of the co-occurrence of multiple antisocial behaviors, including substance use, during adolescence, and the causal factors which contribute to the early onset and maintenance of youth substance use and substance abuse are discussed. Emphasis is placed on parent and family factors, and children's social competence, which are associated with substance use, and which are the potentially mutable targets of family-based preventive interventions. Family-based preventive interventions were classified as either primarily addressing parent and family skills training, or addressing family therapy and in-home family support models. Distinctions were also made between programs that were universal or selective preventive interventions, or that were indicated preventive interventions directed at high risk individuals who were already showing early signs of being on the trajectory to substance abuse. Intervention research conducted within the past 30 years within these topical areas are summarized within tables, and findings indicate consistent intervention effects on children's problem behaviors, and on potential mediating processes such as parenting behaviors and aspects of family functioning. Recent studies with strong designs are described in greater depth. The paper concludes with discussions of the gaps in current intervention research, of barriers encountered in the implementation and evaluation of family-based prevention programs, and of the implications for future preventive intervention research and for social policy related to family-based preventive interventions.     

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.     

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.     

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.     

Preventing Substance Abuse Among African American Children and Youth: Race Differences in Risk Factor Exposure and Vulnerability

The accurate identification of risk factors is central to the development of effective efforts to prevent young people from using alcohol, tobacco and other substances. To date, a key limitation of the prevention literature has been the paucity of research that examines the extent to which substance use risk factors identified in studies of white adolescents generalize to African American (and other non-white) youth. In the absence of research on race differences in risk factor exposure and vulnerability, current preventive interventions are based on the implicit assumptions that 1) the risk factors for African American and white adolescents' substance use are identical; and 2) that African American and white adolescents are equally exposed and equally vulnerable to these risk factors. The purpose of the present study was to begin to examine empirically the equal exposure and vulnerability assumption. Specifically, the paper used Hawkins, Catalano and Millers' widely cited 1992 article on risk and protective factors for adolescent and young adult substance use as a framework within which to review past risk factor research and as a guide to identify risk factors to examine for race differences in exposure and/or vulnerability. Based upon our review of the existing literature and our analysis of data from the University of Michigan's Monitoring the Future study, we conclude that the simple assumption that African American and white youth are equally exposed and vulnerable to the same risk factors is not correct. In fact, we found that African American and white seniors' differed significantly in their exposure to more than half of the 55 risk factors examined. Similarly, nearly one third of the 165 tests for race differences in vulnerability were highly significant (i.e., p < .01). While it is possible that some of the differences we identified resulted from chance, their consistency across variables, within the same risk factor domain, and across drug categories, makes the likelihood that our findings are primarily statistical artifacts unlikely. Based upon the results of this study it is clear that additional theoretically and empirically rigorous race-specific research is needed to better understand the etiology of substance use among African American adolescents. Further research is also needed to identify those risk factors that are most salient for African American adolescents and most amenable to change through well designed, and perhaps, culturally tailored preventive interventions.     

Community-Level Collaboration for Substance Abuse Prevention

This paper reviews the literature on the roles of community-wide collaboration in substance abuse prevention. Three broad strategies through which collaboration may have its effects are identified (i.e., building community capacity, increasing service integration, and influencing policy change). Alternative theories of effects, means of measurement, and results and conclusions from studies of collaborative interventions for prevention are discussed. The strength of empirical evidence for the impact of collaboration on substance abuse outcomes varies by strategy, with more support for the logic of policy change. Additional conclusions are offered regarding when and how this approach can work, and what might be useful next steps.     

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.     

Project HOPE: Altering Risk and Protective Factors Among High Risk Hispanic Youth and Their Families

Latino youth in urban centers, and more specifically those in families dealing with the challenges of recent immigration to the United States, have special sources of risk for substance abuse and related problems. Project HOPE focused on such a group: Latino seventh and eighth graders in English as a Second Language (ESL) classes at middle school sites with particularly high concentrations of Latino youth. The overriding goals of the project were: (a) to increase protective factors at the individual, family and school level that are likely to lead to reduced abuse of alcohol and other drugs; and (2) to produce actual reductions in rates of use of alcohol, cigarettes, and marijuana. This report describes the results from the third year of this project. With a general risk-protective model as the starting point, several areas of importance were identified for work with this population: (a) the centrality of the family to Latino youth; (b) the importance of cultural identification during times of rapid acculturation; (c) the need to support families in investing in the school institutions influencing their children's lives and (d) increasing the responsiveness of the school institutions to a culturally different population for which they may not be fully prepared. The result was the implementation of a multi-component intervention that addressed change at youth, family and school levels. The youth component engaged youth through three interventions: (a) a school-based prevention curriculum (12 sessions) that focused on substance abuse and on career development; (b) a peer leadership program that focused on building a positive peer culture for Latino youth through a focus on both individual development and team-building in retreats and after-school activities; and (c) a counseling, referral, and advocacy effort that provided counseling and tutoring sessions by bilingual/bicultural Student Relations Specialists (one at each site). These counselors acted as advocates for the students, and mediated with teachers and parents in order to promote school bonding. The parent component engaged the parents of these youth in two ways: (a) a parenting skills workshop (9 sessions) focused on traditional parenting skills content; and (b) an advocacy skills training component that used home visits and workshops to increase parents' ability to be advocates for their children with the school system. A school intervention aimed at increasing teachers' and administrators' sensitivities to Latino needs was planned but not implemented at the time of the report. The design of the evaluation was quasi-experimental, making use of several kinds of comparisons to strengthen causal inferences in a situation where a conventional comparison group was not feasible. Several important results emerged among the 82 youth from whom we were able to collect pre and post data. In terms of the risk/protective factors seen as intermediate outcomes, feelings of Meaninglessness in Life were reduced significantly in the total sample, and perceptions of the school climate became significantly more positive among eighth graders. In terms of ultimate outcomes, 30 day prevalence of alcohol use was reduced by 42% (p < .07). Dose-response analyses indicated that higher levels of program participation were associated with increased levels of cultural pride (p < .02) and greater school attendance (p < .08). Among the 18 Parents for whom we had pre-post data, there were significant increases in self-reported levels of school contact (p < .001), but also significant decreases in perceived parenting skills (p < .04). Project participation may have led parents to a more honest appraisal of their skills. Perhaps more striking is anecdotal evidence that Latino parents have become the most active participants in PTO activities in the two target schools in the HOPE project. In terms of implications, we conclude that a culturally appropriate multi-component intervention can bring about measurable reduction in alcohol use among high risk Latino Youth. Development of culturally appropriate materials and implementation by a culturally sensitive staff (predominantly Latino and from the same origin cultures as the target population) are valuable aspects of interventions for this target group. Building a positive peer culture, addressing cultural identification, and engaging parents to be more invested in and less intimidated by school institutions seem particularly important mediating factors for this population.     

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.