By Lori Whitten, NIDA NOTES Staff Writer
First graders who receive systematic help in learning to concentrate and control their behavior are less likely to begin smoking in the middle-school years than children who receive no special intervention, a NIDA-funded study has found. Investigators at the Center for Prevention and Early Intervention at The Johns Hopkins Bloomberg School of Public Health in Baltimore developed two interventions that are broad-based rather than specific to substance abuse, and have been testing them in schools since the early 1990s.
In 1993, Drs. Sheppard Kellam, Nicholas Ialongo, and colleagues randomly assigned first-grade teachers and 678 of their students in Baltimore public schools to either a classroom-centered or a family-school partnership (FSP) intervention, or to the standard curriculum. During the summer, the investigators gave the teachers who would participate in the classroom-centered intervention 60 hours of training in strategies for managing behavior and helping children overcome academic problems. This training used detailed manuals, checklists, and other standardized materials. Meanwhile, the teachers, school social workers, and psychologists who would participate in the FSP intervention learned how to conduct workshops designed to help parents improve their behavior management and homework-assistance skills and partner with school professionals.
School staff delivered both interventions throughout the students' year in first grade. During this time, the investigators visited the classrooms and conducted regular assessments of the interventions, and met monthly or as often as needed with the participating school staff.
At the end of seventh or eighth grade, when the children were 13 years old on average, the researchers followed up to see whether those who received the interventions had fared any differently from the control group. Overall, 39 percent of the 566 young people they were able to assess at this time had initiated smoking. Of those who participated in the classroom-centered or FSP interventions, however, a significantly lower percentage had begun smoking—34 and 36 percent, respectively—compared with 47 percent of the control group. The classroom-centered intervention was associated with a smaller prevalence of reported cocaine and heroin use in middle school—3 percent compared with 7 percent in the standard curriculum; however, the researchers note that only 29 of 566 participants had tried these drugs, a number of subjects too small to draw definitive conclusions. Although many youths in both the intervention and control groups had tried alcohol, marijuana, or inhalants, the percentage was marginally smaller among those who experienced the interventions.
Dr. Ialongo cites the long-term significance of the findings and advocates extending such efforts throughout children's school careers. "Fewer kids smoking in middle school eventually should produce a measurable clinical and public health impact in the form of reduced smoking-related disease in these children's later lives. These gains probably will be more sizable if teachers present these interventions throughout elementary school and add standard approaches to drug abuse prevention in the middle-school years," he says.
Building the Interventions
The classroom-centered and FSP programs represent the culmination of more than three decades of research on human development and problem behaviors. Evidence from studies in the 1970s and 1980s suggested that certain characteristics evident as early as first grade—poor academic achievement, difficulty with concentration, and aggressive and shy behaviors—are associated with later substance abuse, depression, and antisocial behavior. However, the field lacked randomized, controlled intervention trials showing that a reduction of these characteristics can reduce later problem behaviors in the general population of children. Dr. Kellam, then at the Prevention Intervention Research Center at The Johns Hopkins University, and his colleagues Lisa Ulmer and Hendricks Brown, began in the mid-1980s to develop, refine, and assess interventions that address antecedents of problem behaviors—efforts that eventually produced the classroom-centered and FSP programs.
"Effective prevention programs encompass key elements of raising healthy children—positive child-rearing practices at home, good behavior management at school, and a strong school-family connection. Youths need consistent messages and support at home and school for healthy development. Forging a strong link between the activities, values, and practices across the family, school, and community throughout childhood and adolescence has enduring effects," says Dr. Shakeh Kaftarian of NIDA's Division of Epidemiology, Services and Prevention Research.
Dr. Ialongo and his colleagues have shown other lasting effects of the interventions in previous studies. For example, boys who showed aggressive behavior at the beginning of first grade and received the intervention improved by sixth grade.
"It's common sense that improvements in first-graders' concentration and readiness to learn produce better students and citizens and may delay or prevent tobacco and illegal drug use. But it's not enough to intervene once in first grade to improve academic achievement and classroom behavior—prevention is a long-term commitment," says Dr. Ialongo.
- Furr-Holden, C.D.M., et al. Developmentally inspired drug prevention: Middle school outcomes in a school-based randomized prevention trial. Drug and Alcohol Dependence 73(2):149-158, 2004. [Abstract]
How Much Will it Cost? Is it Feasible?
Researchers at the Center for Prevention and Early Intervention are conducting an economic evaluation of the classroom-centered and family-school partnership (FSP) interventions. To date, investigators have identified the cost of particular program elements, but do not yet have a cost-benefit analysis of the program as a whole. For example, the mathematics and reading enhancements offered in the classroom-centered intervention cost about $1,200 per classroom or $9.60 per student, given that the materials could be used for about 5 years. Adding one senior teacher to help with implementation and tutoring students who have difficulties would cost about $65,000 per year for salary and benefits.
To maximize economies, the investigators worked within the school system's established planning structure and training programs to implement the interventions. In the classroom-centered intervention, for example, the school system incorporated the mathematics and reading enhancements into its scheduled curriculum revision and long-term investment plan. This approach avoided duplication of materials and training effort.
Teachers learned how to implement the interventions during regularly scheduled training sessions. Ongoing supervision of the program, which requires about 10 hours a week per classroom, usually is assumed by a seasoned teacher on staff who is already accustomed to mentoring. This teacher is formally designated to assist other teachers in implementing the classroom-centered intervention and to work with children who need additional help with school assignments or behavior. Even using these cost-saving strategies, a typical elementary school with an 18-teacher staff would need to add at least one senior teacher.
Elements of the FSP intervention—including parent workshops, childcare, and incentives for participation—present costs beyond what is typically allotted in most elementary school budgets. But educators and researchers can mitigate these costs by marshalling resources already in place. Offering parent workshops during scheduled parent-teacher conferences, for example, does not add costs and makes these activities possible for busy parents. Parent-teacher organizations can enhance parental involvement and provide childcare. Schools serving socioeconomically disadvantaged communities are eligible for Federal funds, which they may use to hire a parent liaison who can help mobilize parents' participation.
It is easier to calculate the costs involved in the program than it is to determine the benefit, or the money saved, for example, in reduced special education assessment and services. As the students in the Baltimore study progress through life—they are now in 12th grade—the investigators will follow up and measure how the experience benefited them. Next year the researchers will determine if more children in the intervention groups completed high school, a long-term economic benefit.
Even in a large economically challenged school system such as Baltimore's, Dr. Ialongo believes that "programs such as ours are not outside the realm of possibility. The key point is that prevention requires a sustained and highly organized effort that identifies the necessary resources and uses them in a cost-effective way."
Volume 20, Number 1 (August 2005)