The Evaluation of a Workplace Program to Prevent Substance Abuse: Challenges and Findings

Workplace consequences of alcohol and drug abuse include poor performance, fighting, insubordination, and occupational injuries. To address the need for workplace substance abuse prevention, the PREVENT program, originally designed for the United States Navy, was adapted to the railroad workforce. This study evaluates the impact of the PREVENT program on alcohol use and smoking among young adults ages 18–29 in the railroad industry. We discuss challenges to study protocol faced by this evaluation in the reality of the workplace. PREVENT is a 2-day health promotion program that includes substance abuse and smoking modules. Using a prospective controlled before–after study design, we compare self-reported alcohol use and smoking pre- versus post-intervention among PREVENT participants versus a comparison group of workers. Comparison and case group non-equivalency at baseline is controlled for using a propensity score. The study sample suffered high losses to follow-up. In the analysis, we included those lost to follow up and applied an intent-to-treat approach that assumed, conservatively, that substance use by non-respondents was identical pre and post. In regression analysis PREVENT participants showed significant declines in drinking levels post-intervention compared to comparison workers, controlling for baseline and demographic factors. Relative to pre-intervention levels PREVENT participants consumed 56 % fewer drinks (relative rate = 0.44, 95 % CI 0.23–0.85) and consumed alcohol on 32 % fewer days (relative rate = 0.68, 95 % CI 0.50–0.93) compared to comparison workers. Changes in smoking behaviors were not significant. We conclude that PREVENT is a promising program for reducing alcohol abuse.     

Condom Use Assessment of Persons in Drug Abuse Treatment

The purpose of this study was to objectively and quantitatively assess individual skill level of male condom use. This study developed a reliable and face valid assessment of correct male condom use based on Centers for Disease Control and Prevention criteria. Participants (N=163) were recruited from persons in treatment for cocaine addiction. Condom use was assessed on the basis of correct completion of eight discrete steps. An overall score of 40 correct condom use indicated the need for training in this sample. Assessment showed training needs especially related to steps involving reduction of ejaculate leakage and steps related to potential hazards of nonoxynol-9 use. Frequency of condom use was also assessed; there was no correlation between frequency of condom use and condom use skill. Drug addiction treatment programs are encouraged to incorporate HIV risk reduction programs that teach condom use skills and use the CUDOS as an empirical measure of condom skill acquisition.     

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.     

Factors associated with adolescents receiving drug treatment: Findings from the National Household Survey on Drug Abuse

This article examines factors associated with adolescents receiving treatment for drug-related problems. Data on adolescents (aged 12–17) from the 1995 and 1996 National Household Survey on Drug Abuse (NHSDA,N=9133) were used. Information was obtained concerning adolescent drug use, smoking, drinking and related problems, as well as sociodemographics. Many adolescents with drug-related problems did not receive treatment. Among predisposing factors, gender and age were associated with drug treatment. Severity of drug problems and comorbid emotional and health problems also predicted seeking treatment. The results call for an improved service delivery system. Screening for drug problems in primary care settings, at school, and in mental health programs will help in the early identification and treatment of drug use disorders in youth.     

Childhood Sexual Abuse and Cannabis Use in Early Adulthood: Findings from an Australian Birth Cohort Study

Childhood sexual abuse (CSA) is associated with a wide range of health problems later in life. The impact of CSA on young adults’ use of cannabis remains under-studied. We examined the extent to which exposure to CSA was associated with increased rates of use of cannabis in early adulthood in a birth cohort of 3,285 Australian children followed-up to the age of 21 years, when retrospective reports of CSA were obtained from sample participants along with information on their use of cannabis at 21 years. Young adult men and women who reported experiencing CSA had significantly higher rates of frequent use of cannabis in early adulthood, defined as use of cannabis at least “every few days.” In multivariate analyses, men who reported a history of CSA had an odds ratio (OR) of 2.1 (95% CI = 1.1–3.9) for frequent use of cannabis at the age of 21 years. For women, there was an OR of 3.9 (95% CI = 2.4–6.3). Family and individual factors measured earlier in the study did not confound these associations. The findings suggest that children experiencing CSA have a substantially greater risk of use of cannabis and, in particular, its frequent use in early adulthood. Further research is required to explore factors that explain the pathway linking CSA and use of cannabis in early adulthood.     

Project Towards No Drug Abuse: generalizability to a general high school sample

OBJECTIVE: We examined the generalizability of a successful classroom-based prevention program developed for youth at alternative high schools (high risk) to youth at general high schools. METHOD: A replication of a previously tested prevention program in a general high school population was conducted with 1-year follow-up data. Classrooms within each of three schools were randomly assigned to two conditions, classroom education or standard care control. RESULTS: Statistically significant effects on alcohol and illicit drug use were achieved in this population through a 1-year period following the program, although effects were not achieved on cigarette smoking and marijuana use. CONCLUSIONS: These results suggest that this program (Project Towards No Drug Abuse) has applicability to a wide range of older teens.     

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.