Research Findings - Prevention Research
Evaluation of the National Youth Anti-Drug Media Campaign: Fifth Semi-Annual Report of Findings
The National Youth Anti-Drug Media Campaign (NYAMC) was funded by the Congress to reduce and prevent drug use among young people both directly, by addressing youth and indirectly, by encouraging their parents and other adults to take actions known to affect youth drug use. The major intervention components include television, radio, and other advertising, complemented by public relations efforts including community outreach and institutional partnerships.
The goals of the evaluation are to determine: 1) if there is change in the behaviors, attitudes and beliefs targeted by the Campaign and 2) determine if such change can be attributed to the Campaign. The findings summarized below are from the fifth Evaluation report; the first three waves of data collection involved enrolling nationally representative samples of about 8,100 youth from 9 to 18 and 5,600 of their parents. The 4th and 5th waves together include the first (of two) follow-up interviews of the initial samples. The new report covers the period from September 1999 through June 2002 and examines 1) exposure of youth and their parents to anti-drug messages (general exposure and specific exposure to ads run in the 2 months prior to the interview that are played on a computer to respondents); 2) effects on parents in terms of beliefs and behaviors associated with talking about drugs, and beliefs and behaviors regarding monitoring their child, and doing fun activities with their child; and 3) effects on youth cognitions, intentions, and initiation of drug use.
- Exposure to and Recall of Campaign Messages
As in the 4th Report, most parents and youth recalled being exposed to NYAMC anti-drug messages. About 70 percent of both groups report exposure to one or more messages through all media channels every week. The average (median) youth remember seeing one television ad per week. In the first three waves less than 25 percent of parents recalled seeing a TV ad every week; this increased to 40 percent in the second half of 2001 and 50 percent during the first half of 2002. The current report indicates that both parents and youth reported substantial recognition of the Campaign's "anti-drug" brand phrases. The Campaign added Drugs and Terror ads targeted to both parents and youth during this period. The evaluation of these ads by both groups was somewhat less positive than the evaluation of the other ads broadcast during Wave 5.
- Effects on Parents
There continues to be evidence suggesting a favorable Campaign effect on parents. Overall, there are favorable changes in 3 out of 5 parent belief and behavior outcome measures including talking about drugs with and monitoring of children. In addition, those parents who report more exposure to Campaign messages at time 1 measurement, were more likely subsequently to talk with their children and do fun activities with them. However, there is little evidence for Campaign effects on parents' monitoring behavior, the focus of the parent Campaign in the past year and the parent behavior most associated with youth nonuse of marijuana. Likewise, there is no evidence of favorable indirect effects on youth behavior as the result of parent exposure to the Campaign.
- Effects on Youth
There is no evidence of direct favorable Campaign effects on youth. There is no statistically significant decline in marijuana use to date, and some evidence for an increase in use from 2000 to 2001. Nor are there improvements in anti-use beliefs and attitudes about marijuana between 2000 and the first half of 2002. Conversely, there are some unfavorable trends in youth anti-marijuana beliefs. In addition, there is no tendency for those reporting more exposure to Campaign messages to hold more desirable beliefs.
There continues to be evidence for an unfavorable delayed effect of Campaign exposure from September 1999 through June 2001 on subsequent intentions to use marijuana and on other beliefs and these are found for the entire sample. Whereas intentions are strong predictors of subsequent initiation of marijuana use, the evidence for an unfavorable effect on actual initiation was not statistically significant overall or for any subgroup. Thus, the behavioral evidence for some youth subgroups at Wave 4 was not confirmed once the entire sample was considered.
The full evaluation will involve three interviews with respondents over 3 1/2 years.
Effectiveness of a Universal Drug Abuse Prevention Approach For Youth At High Risk For Substance Use Initiation
Griffin and his colleagues examined the impact of universal school-based prevention programs for alcohol, tobacco, and other drug use for youth at high risk for substance use initiation. The effectiveness of a universal drug abuse preventive intervention was examined among youth from 29 inner-city middle schools participating in a randomized, controlled prevention trial. A subsample of youth (21% of full sample) was identified as at high risk for substance use initiation based on exposure to substance-using peers and poor academic performance in school. The prevention program taught drug refusal skills, anti-drug norms, personal self-management skills and general social skills. Findings indicated that youth at high risk who received the program (n = 426) reported less smoking, drinking, inhalant use, and polydrug use at the one-year follow-up assessment compared to youth at high risk in the control condition that did not receive the intervention (n = 332). Results indicate that a universal drug abuse prevention program is effective for minority, economically disadvantaged, inner-city youth who are at higher than average risk for substance use initiation. The findings from this study suggest that universal prevention programs can be effective for a range of youth along a continuum of risk. Griffin, K.W., Botvin, G.J., Nichols, T.R., and Doyle, M.M. Preventive Medicine, 36, pp. 1-7, 2003
Effective Family Intervention Embedded into the Public School Setting
The Adolescent Transitions Program (ATP) promotes student adjustment and reduces risk through a tiered intervention, involving universal, selective, and indicated intervention. The universal intervention places a family resource center in the schools for parenting resources and information supportive of protective parenting practices. The indicated intervention, a motivational interviewing process referred to as the Family Check Up, engages parents in appropriate family centered interventions. The indicated intervention involves a menu of options designed to strengthen effective family management practices. In this trial, 672 multiethnic students and their families were randomly assigned from the entire population of 6th grade students in three middle schools to the ATP intervention or to control. By the 9th grade, youth in the ATP program had a reduced incidence of a composite measure of tobacco or alcohol use compared to youth in the control group. The intervention effect did not differ by risk status or ethnicity. This study provides a successful model for embedding family interventions within the public school ecology. Dishion, T.J., Kavanagh, K., Schneiger, A., Nelson, S., and Kaufman, N. Preventing Early Adolescent Substance Use: A Family Centered Strategy for the Public Middle School. Prevention Science, 3(3), pp. 191-201, 2002.
Personal Competence Skills, Distress, and Well-Being As Determinants of Substance Use In A Predominantly Minority Urban Adolescent Sample
Several previous studies have investigated the relationship between psychological distress and substance use among youth. However, less research has investigated the potentially protective role of psychological well-being on adolescent substance use, and the extent to which personal competence skills may promote well-being. The present study examined personal competence skills, psychological distress and well-being, and adolescent substance use over a three-year period in a predominantly minority sample of urban students (N = 1,184) attending 13 junior high schools in New York City. Structural equation modeling indicated that greater competence skills predicted less distress and greater well-being over time. While psychological well-being was associated with less subsequent substance use, distress did not predict later substance use. Findings indicate that competence skills promote resilience against early stage substance use in part by enhancing psychological well-being, and suggest that school-based prevention programs should include competence enhancement components in order to promote resilience. Griffin, K.W., Botvin, G.J., Scheier, L.M., Epstein, J.A., and Diaz, T. Prevention Science, 3, pp. 23-33, 2002.
Factors Associated With Regular Marijuana Use Among High School Students: A Long-Term Follow-Up Study
The present study investigated whether several behavioral and psychosocial factors measured during early adolescence predicted regular marijuana use 6 years later in a sample of high school students. As part of a school-based survey, 7th-grade students (N=1132) reported levels of alcohol, tobacco, and marijuana use, and were assessed on several domains of psychosocial functioning potentially relevant in the etiology of marijuana use. When students were followed-up in the 12th grade, 14% smoked marijuana on a regular basis (once or more per month). Findings indicated that early cigarette smoking, alcohol use, and alcohol intoxication predicted later regular marijuana use. For boys, early marijuana use increased the odds for later regular marijuana use. Cigarette smoking by friends and siblings during early adolescence also increased the likelihood of later monthly marijuana use. The findings suggest that early prevention programs for adolescent alcohol, tobacco, and/or other drug use may have important preventive effects in terms of potentially more serious levels of marijuana involvement later in adolescence and early adulthood. Griffin, K.W., Botvin, G.J., Scheier, L.M., and Nichols, T.R. Substance Use & Misuse, 37, pp. 225-238, 2002.
Life Skills Training As a Primary Prevention Approach for Adolescent Drug Use and Other Problem Behaviors
Alcohol, tobacco, and other drug use are important problems that typically begin during adolescence. Fortunately, substantial progress has been made in developing effective drug abuse prevention programs for youth over the past two decades. Prevention approaches that focus on the risk and protective factors associated with drug use initiation and those that teach skills related to social resistance are most effective. The Life Skills Training (LST) program is an effective primary prevention program for adolescent drug abuse that focuses on these factors as well as enhancing social and personal competence skills. This paper provides an overview of the theoretical underpinnings of the LST program, along with a description of the program's components, materials, and methods. Findings from over two decades of evaluation research are reviewed and demonstrate that the LST approach consistently produces positive behavioral effects on alcohol, tobacco, and other drug use. The role of competence enhancement-based primary prevention programs in preventing other negative behaviors during adolescence is discussed. Botvin, G.J., and and Griffin, K.W. International Journal of Emergency Mental Health, 4, pp. 41-47, 2002.
Positive Impact of Competence Skills and Psychological Wellness In Protecting Inner-City Adolescents From Alcohol Use
Research has shown that competence enhancement prevention programs for substance use are effective in reducing alcohol use and other problem behaviors. However, less is known about the mechanisms by which high competence helps youth avoid negative outcomes. This study explored whether greater competence is associated with increased levels of psychological wellness that in turn deters subsequent alcohol use. Specifically, 1,459 students attending 22 middle and junior high schools in New York City completed surveys that included measures of competence (decision making, self-efficacy), psychological wellness, and alcohol use. Students completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Data collectors administered the questionnaire following a standardized protocol during a regular 40-min class period. On the basis of a longitudinal structural equation model, adolescents who were highly competent reported greater psychological wellness, which was then associated with less drinking. These findings highlight the potential of alcohol prevention programs designed to enhance competence and psychological wellness. Epstein, J.A., Griffin, K.W., and Botvin, G.J. Prevention Science, 3, pp. 95-104, 2002.
Estimates of Intragroup Dependence for Drug Abuse and Skills Measures Encountered In School-Based Drug Abuse Prevention Trials: An Empirical Study of Three Independent Samples
Group-randomized drug abuse prevention trials customarily designate schools as the unit of assignment to experimental condition; however, students within schools remain the unit of observation. Students nested within schools may show some resemblance based on common (peer) selection or school climate factors (i.e., disciplinary practices, group norms, or rules). Appropriate analyses of any treatment effects must be statistically correct for the magnitude of clustering within these intact social units (i.e., intraclass correlation coefficient [ICC]). There is little reported evidence, however, of variation in ICCs that might occur with studies of racially or geographically diverse populations. The purpose of this study was to generate estimates of intragroup dependence for drug use and psychosocial measures (hypothesized mediators) from three separate drug abuse prevention trials. Clustering for the drug use measures averaged .02 across study and age-groups (range = .002 to .053) and was equivalently small for the psychosocial measures (averaging .03 across studies and age-groups; range = .001 to .149). With few exceptions and across different samples clustering decreased in magnitude over time. Clustering was largest for peer smoking and drinking norms among white, suburban youth and smallest for alcohol expectancies among urban black youth. Findings are discussed with respect to the influence of social climate factors and group norms in the design and analysis of school-based, drug abuse, prevention programs. Scheier, L.M., Griffin, K.W., Doyle, M.M., and Botvin, G.J. Health Education & Behavior, 29, pp. 85-103, 2002.
Culturally Sensitive Adaptation of Prevention Intervention
Very few family interventions have been adapted to be culturally sensitive for specific ethnic groups. This paper examines recruitment/retention and outcome effectiveness in five studies comparing standard and culturally adapted versions of the Strengthening Families Program (SFP). This selective prevention program is a 14-session family skills intervention involving parent, child, and family skills training components. Standard and adapted interventions were compared for African American, Hawaiian, Hispanic, and Native American families. Standard versions of the intervention tended to have slightly better outcomes, but recruitment and retention of families was 41% improved when implementing culturally adapted versions. Kumpfer, K.L., Alvarado, R., Smith, P., and Bellamy, N. Cultural Sensitivity and Adaptation in Family Based Prevention Interventions. Prevention Science, 3(3), pp. 241-246, 2002.
Friendships and Substance Use: Bi-directional Influence
The reciprocal relationship between deviant friendships and substance use was examined from early adolescence to young adulthood. Deviance within friendships was studied using direct observations of videotaped friendship interaction and global reports of deviant interactions with friends as well as time spent with friends. Substance use was assessed through youth self-report at all time points. Multivariate modeling revealed that substance use in young adulthood is a joint outcome of friendship influence and selection processes. In addition, substance use appears to influence the selection of friends in late adolescence. Findings suggest that effective prevention should target peer ecologies conducive to substance use and that treatment should address both the interpersonal underpinnings and addiction processes intrinsic to chronic use, dependence, and abuse. Dishion, T.J. and Owen, L.D. A Longitudinal Analysis of Friendships and Substance Use: Bi-directional Influence from Adolescence to Adulthood. Developmental Psychology, 38(4), pp. 480-491, 2002.
Sibling Collusion and Problem Behavior
Sibling collusion is a process whereby siblings form coalitions that promote deviance and undermine parenting. Collusive sibling processes were identified and measured using macro ratings of videotaped family interactions. Using a multiethnic urban 6th grade sample, investigators examined multiple questions, including whether more sibling collusion occurs in families with a high-risk child that with a normative child and whether sibling collusion can predict problem behavior. High-risk youth were identified by a smoking measure and a 16-item teacher rating of risk. High-risk youth who participated in a family assessment and had a sibling aged 10 or older (n=26) were matched with a normative target child on age, gender, ethnicity, and parental marital status (n=26). Siblings in families with a high-risk target child showed reliably higher rates of collusion than those in families with a normative target child. Sibling collusion also accounted for variance in problem behavior after controlling for involvement with deviant peers. Findings suggest that deviant conduct forms a common ground among siblings, potentially amplifying risk of mutuality in problem behavior during early adolescence. Attention to sibling relationship processes is relevant to family interventions to prevent behavior problems. Bullock, B.M. and Dishion, T.J. Sibling Collusion and Problem Behavior in Early Adolescence: Toward a Process Model for Family Mutuality. Journal of Abnormal Child Psychology, 30(2), pp. 143-153, 2002.
Combining School-based and Family-based Intervention
This study evaluated the substance initiation effects of an intervention combining two empirically supported prevention interventions, one that is family-based and another that is school-based. Strengthening Families Program for Parents and Children 10-14 (SFP 10-14) is a family-based program designed to enhance parental skills in nurturing, limit setting, and communication as well as youth prosocial and peer resistance skills. Life Skills Training Program (LST) is a classroom-based prevention intervention designed to promote skill development in youth for the prevention of substance abuse. Thirty-six rural schools were randomly assigned to one of three conditions: 1) LST and SFP 10-14, 2) LST only, or 3) a control condition. Outcomes were examined one year after the intervention posttest, using a substance initiation index measuring lifetime use of alcohol, cigarettes, and marijuana and rates of use for individual substances. Both the combined and the LST interventions differed significantly (and favorably) from the control condition with regard to the substance initiation index and marijuana use, while the difference between the combined and LST-only programs was not significant for these measures. However, the combined program significantly reduced rates of alcohol initiation as compared to both the LST-only and control groups. Preliminary results suggest that the family-focused component may be particularly important in preventing the initial transition to alcohol use. Spoth, R.L., Redmond, C., Trudeau, L., and Shin, C. Longitudinal Substance Initiation Outcomes for a Universal Preventive Intervention Combining Family and School Programs. Psychology of Addictive Behaviors 16(2), pp. 129-134, 2002.
Implementation Quality and Proximal Intervention Outcomes
The authors describe the results of two longitudinal studies of competency training interventions that involved community-university collaboration to enhance implementation quality. In Study 1, 22 rural schools were randomly assigned to a family-focused intervention or a minimal contact control group. In Study 2, 36 rural schools were randomly assigned to a family-focused preventive intervention combined with a school-based intervention, the school-based intervention alone, or a minimal contact control group. In both studies, observers rated adherence to intervention protocols. Results showed that, on average, high levels of observer-rated adherence were attained in both studies. Analyses of the relationship between observer-rated adherence scores and proximal outcomes showed limited evidence of poorer outcomes associated with lower adherence. Spoth, R., Guyll, M., Trudeau, L., and Goldberg-Lillehoj, C. Two Studies of Proximal Outcomes and Implementation Quality of Universal Preventive Interventions in a Community-University Collaboration Context. Journal of Community Psychology, 30(5), pp. 499-518, 2002.
Family Processes Predict Smoking Initiation
This study examined the relationship between family processes measured when children are in early elementary school and initiation of cigarette smoking in sixth or seventh grade in a sample of 810 suburban school children. Family process measures included both protective factors, such as attachment to parents and parent contact with school, and risk factors such as inconsistent discipline and family conflict. Measures of child attachment to parent and parent involvement with the child's school were significantly and negatively associated with smoking initiation when controlling for household structure and income, parent smoking, and peer and child characteristics. The results of these analyses suggest that enhancing the bonding process between parents and children and encouraging parents to be involved in the child's school may help prevent the initiation of smoking at the end of elementary school and the beginning of middle school. Fleming, C.B., Kim, H., Harachi, T.W., and Catalano, R.F. Family Processes for Children in Early Elementary School as Predictors of Smoking Initiation. Journal of Adolescent Health, 30, pp. 184-189, 2002.
Prevalence of Cigarette Smoking Among Rural Adolescents in the U.S.
Results are reported from a nationwide, U.S. study of cigarette smoking carried out from 1996 to 2000 involving 68,270 adolescents in grades 7 through 12 attending high school or the associated feeder junior high/middle school in a particular community. The sampling design was constructed to include students from a representative sample of rural communities in the United States. Based on responses to cigarette use survey items, students were classified into one of eight user categories, ranging from being a non-user to being a heavy user (i.e., ongoing use of a half a pack or more per day). Hierarchical linear modeling was used to model smoking as a function of grade, gender, region, and community size (rurality). Significant effects were found for rurality, region, grade, and gender. The highest levels of smoking were found for rural adolescents and adolescents living in the South. Males smoked more than females in all regions except the West, where females smoked more. Given that rural adolescents smoke more "heavily" than do their nonrural peers, researchers should devote more attention to understanding the factors that underlie smoking initiation in rural youth. Aloise-Young, P.A., Wayman, J.C., and Edwards, R.W. Substance Use and Misuse, 37(5-7), pp. 613-630, 2002.
Explanations for Exposure Effects in an Anti-Drug Media Campaign
This study examines longitudinal evidence for the impact of exposure to an in-school media campaign on adolescent substance use attitudes and behaviors using data from four middle schools in two school districts. Amount of exposure to the campaign directly impacted perceptions that marijuana use was inconsistent with personal aspirations and intentions to use marijuana. It also was associated with a reduction in maturational decay in anti-drug attitudes. Path analyses suggested effects on behavior change, consistent with the Theory of Reasoned Action, occurred through their impact on intention, and exposure effects on intention, in turn, occurred by affecting aspirations. Reverse causation was tested and rejected, as were possible moderation models that might also qualify exposure effects. Analyses of a foil recognition measure using a treatment and control population suggested that response set artifacts were nominal in size, and that response bias was slight and could be statistically controlled. Slater, M.D. and Kelly, K. Testing Alternative Explanations for Exposure Effects in Media Campaigns: The Case of a Community-based, In-school Media Drug Prevention Project. Communication Research, 29, pp. 367-389, 2002.
Validating a Perceived Message Sensation Value (PMSV) Scale
Sensation seeking has been linked to drug abuse and risky behaviors, and with preferences for messages high in sensation value (i.e., perceived to be highly novel, arousing, dramatic, or intense). This suggests the value of developing a valid and reliable measure of perceived message sensation value (PMSV) for research on information processing, persuasion, and prevention. This article reports the dimensions and construct validity of a 17-item PMSV scale examined in 2 studies. In the first, 368 high school students' reactions to televised anti-marijuana public service announcements (PSAs) were explored; study 2 assessed 444 college students' responses to televised anti-cocaine PSAs. Exploratory and confirmatory factor analyses indicated 3-dimensional solutions for the PMSV scale were nearly identical for high sensation seeking (HSS) and low sensation seeking (LSS) respondents in Study 1 and HSS respondents in Study 2. Total scale alphas were .87 for Study 1 and .93 for Study 2. The PMSV scale and its three dimensions (i.e., Emotional Arousal, Dramatic Impact, Novelty) were positively correlated with affective response measures in both studies for HSS and LSS. Study 1 also examined cognitive, narrative, and sensory PSA processing. These were positively associated with total PMSV and the Arousal and Dramatic Impact dimensions of PSMV for both HSS and LSS. Palmgreen, P., Stephenson, M.T., Everett M.W., Baseheart J.R., and Francies R. Perceived Message Sensation Value (PMSV) and the Dimensions and Validation of a PMSV Scale. Health Communication 14(4), pp. 403-428, 2002.
Predictors of Exposure from an Anti-Marijuana Media Campaign
Using data from a large-scale anti-marijuana media campaign, this investigation examined the demographic and psychographic variables associated with exposure to public service announcements (PSAs) designed to target high sensation-seeking adolescents. The literature on sensation seeking indicates that adolescents high in this trait are at greater risk for substance abuse. This study assessed the predictive utility of various risk and protective factors, normative influences, demographic variables, and marijuana-related attitudes, intentions, and behaviors on campaign message exposure. The results confirm that the level of sensation seeking was positively associated with greater message exposure. In addition, viewers reporting greater exposure were younger adolescents who indicated that they had poor family relations, pro-marijuana attitudes, and friends and family who used marijuana. Implications for designing future anti-marijuana messages based on these findings are discussed. Stephenson M.T., Morgan S.E., Lorch E.P., Palmgreen P., Donohew L., and Hoyle R.H. Predictors of Exposure from an Anti-marijuana Media Campaign: Outcome Research Assessing Sensation Seeking Targeting. Health Communication, 14(1), pp. 23-43, 2002.
Drug-Moderating Effects of Peer Acceptance and Friendship on Family Adversity
Peer acceptance and friendships were examined as moderators in the link between family adversity and child externalizing behavioral problems. Data on family adversity (i.e., ecological disadvantage, violent marital conflict, and harsh discipline) and child temperament and social information processing were collected during home visits from 585 families with 5-year-old children. Socio-metric methods were used to assess children's peer acceptance, friendship, and friends' aggressiveness in kindergarten and grade one. Teachers rated children on externalizing behavior problems in grade two. Peer acceptance was a moderator for all three measures of family adversity, and friendship was a moderator for harsh discipline. Family adversity was not significantly associated with child externalizing behavior when levels of positive peer relationships were high. These moderating effects generally were not qualified by child gender, ethnicity, or friends' aggressiveness, nor were they accounted for by child temperament or social information-processing patterns. Criss, M.M., Pettit, G.S., Bates, J.E., Dodge, K.A., and Lapp, A.L. Family Adversity, Positive Peer Relationships, and Children's Externalizing Behavior: A Longitudinal Perspective on Risk and Resilience. Child Development, 73(4), pp. 1220-1237, 2002.
Behavioral Judgments and Aggression
Externalizing behavior problems of 124 adolescents were assessed in Grades 7-11. In Grade 9, participants' social-cognitive functioning was assessed following a task in which they imagined themselves to be the object of provocations portrayed in six videotaped vignettes. Participants responded to vignette-based questions representing response decision steps. Phase 1 of the investigation supported a two-factor model of the response decision (response valuation and outcome expectancy). Phase 2, after controlling for externalizing behavior in Grades 7-8, showed significant relations between the response decision processes, and response selection measured in Grade 9, and externalizing behavior in Grade 9, 10 and 11. These findings suggest that behavioral judgments about aggression play a crucial role in the maintenance and growth of aggressive response tendencies in adolescence. Fontaine, R., Salzer Burks, V., and Dodge, K.A. Response Decision Processes and Externalizing Behavior Problems in Adolescents. Development & Psychopathology, 14(1), pp. 107-122, 2002.
Social Information Processing and Aggressive Behavior
Social information processing (SIP) patterns were conceptualized in domains of process and context and measured through responses to hypothetical vignettes in a stratified sample of 387 children (50% boys; 49% minority) from 4 geographical sites followed from kindergarten through 3rd grade. Findings indicated that SIP constructs significantly predicted children's aggressive behavior problems as measured by later teacher reports. The findings support the construct validity of children's social cognitive patterns and the relevance of SIP patterns in children's aggressive behavior problems. Dodge, K.A, Laird, R., Lochman, J.E., and Zelli, A. and Conduct Problems Prevention Research Group. Multidimensional Latent-Construct Analysis of Children's Social Information Processing Patterns: Correlations with Aggressive Behavior Problems. Psychological Assessment, 14(1), pp. 60-73, 2002.
Peer Rejection and Early Conduct Problems
Peer rejection and aggression in the early school years were examined for relevance to early conduct problems. A sample of 657 children from 4 geographical locations was followed from 1st through 4th grades. Peer rejection in 1st grade added incrementally, over and above the effects of aggression, to the prediction of early conduct problems in grades 3 and 4. Peer rejection and aggression in 1st grade were also associated with the impulsive and emotionally reactive behaviors found in older samples. Being rejected by peers after grade 1 marginally added to the prediction of early conduct problems in 3rd and 4th grades, after controlling for 1st-grade attention deficit hyperactivity disorder (ADHD) symptoms and aggression. Peer rejection partially mediated the predictive relation between early ADHD symptoms and subsequent conduct problems. These results support the hypothesis that the experience of peer rejection in the early school years adds to the risk for early conduct problems. Miller-Johnson, S., Coie, J.D., Maumary-Gremaud, A., Bierman, K., and Conduct Problems Prevention Research Group. Peer Rejection and Aggression and Early Starter Models of Conduct Disorder. Journal of Abnormal Child Psychology, 30(3), pp. 217-230, 2002.
The Development of Aggressive-Withdrawn Behavior Profiles
From a sample of 754 first-grade children, those who exhibited 4 behavior problem profiles were identified: aggressive-withdrawn (n = 63, 8%) aggressive only (n = 165, 22%), withdrawn only (n = 94, 12%), and no-problem (n = 432, 57%). Group comparisons revealed that children who became aggressive-withdrawn in first grade exhibited deficits in attention and social skills in kindergarten. Furthermore, these kindergarten deficits contributed to the emergence of aggressive-withdrawn behavior problems in first grade, after accounting for kindergarten levels of aggressive and withdrawn behaviors. In later grades, children who were aggressive-withdrawn in first-grade were more likely than children in any other group to demonstrate poor peer relations and poor academic performance. In addition, kindergarten skill deficits, added to first-grade aggressive and withdrawn behavior problems predicted third-grade social and academic adjustment difficulties. These results document the key role of early inattention and social skill deficits in the prediction of aggressive-withdrawn problem profiles; validate the significance of this problem profile at school entry; and identify potential developmental mechanisms that have implications for preventive interventions. Farmer, A.D., Bierman, K.L., and Conduct Problems Prevention Research Group. Predictors and Consequences of Aggressive-Withdrawn Problem Profiles in Early Grade School. Journal of Clinical Child & Adolescent Psychology, 31(3), pp. 299-311, 2002.
Childcare and School Readiness
The roles of exposure to childcare and quality of parent-child interaction on the development of school readiness and social skills among a low-income, minority sample of kindergarten children (aged 4.8-5.9 yrs) were examined. Findings provide mixed evidence on exposure to childcare, with earlier entry into childcare predicting higher levels of social skills and increased time per week in childcare predicting lower levels of social skills development. Childcare exposure had positive relationships with other readiness-related outcomes after accounting for demographic characteristics of children and their families. Parent-child interactions that were structured and responsive to the child's needs and emotions were positively related to the development of school readiness, social skills, and receptive communication skills development after accounting for demographic characteristics and childcare exposure. Connell, C. M. and Prinz, R. J. The Impact of Childcare and Parent-child Interactions on School Readiness and Social Skills Development for Low-income African American Children, Journal of School Psychology, 40(2), pp. 177-193, 2002.
Elementary School Alcohol, Tobacco and Marijuana Use Increases Middle School Use
Most drug-use data come from cross-sectional surveys that do not allow assessment of the seriousness of early experimentation on later use. This study utilized longitudinal data to assess whether ATOD use in elementary school has serious implications for continued ATOD use in middle school and beyond. Longitudinal analyses were conducted on questionnaire data from 331 middle school students who had previously provided ATOD-use data during elementary school. The sample of students was ethnically and geographically diverse, including students from a range of low socioeconomic status backgrounds living in rural, urban or inner-city environments. Middle school alcohol use was almost three times as likely to occur if alcohol use occurred in elementary school (OR = 2.94, p < .001). Elementary school use of tobacco and marijuana also greatly increased the likelihood of middle school use of these substances (OR = 5.35, p < .001 and OR = 4.25, p < .05, respectively). This study indicates that early use of ATOD is associated with greatly increased odds of later use, pointing to the importance of drug prevention programs; preventive interventions designed for use in pediatric practice settings should commence no later than elementary school. Wilson, N., Battistich,V., Syme, L., and Boyce, W.T. Does Elementary School Alcohol, Tobacco, and Marijuana Use Increase Middle School Risk? Journal of Adolescent Health, 30, pp. 442-447, 2002.
Many U.S. Middle Schools Continue to Implement Untested or Ineffective Prevention Curricula
School-based curricula constitute the nation's primary means of addressing the prevention of youth substance abuse. Despite an abundance of positive evaluative evidence concerning the effectiveness of a number of school-based substance use prevention curricula, many of the nation's middle schools continue to implement curricula that are either untested or ineffective. Respondents comprised the lead staff who implemented substance use prevention in a representative sample of 1,905 of U.S. public and private middle school schools. A self-administered survey indicated that only 26.8% of all schools used at least 1 of 10 effective curricula. However, few school or respondent characteristics were related to program implementation. Results demonstrate a considerable gap between our understanding of effective curricula and current school practice. Ringwalt, C., Ennett, S, Vincus, A, Thorne, J, Rohrback, L.A., and Simons-Rudolph, A. The Prevalence of Effective Substance Use Prevention Curricula in U.S. Middle Schools. Prevention Science, 3(4), pp. 257-265, 2002.
Effects of Active Parental Consent on Sample Bias
This article reports the effect of active parental consent on sample bias among rural 7th graders participating in a drug abuse prevention trial. Students obtaining active consent from their parents to complete the survey were of higher academic standing, missed fewer days of school, and were less likely to participate in the special education school programs compared to students that did not return a parental consent form. However, students with consent were not significantly different from students whose parents actively declined. The sample obtained under active parental consent represents students less at-risk for problem behaviors than would be obtained under passive consent procedures. Henry, K.L., Smith, E., and Hopkins, A. The Effects of Active Parental Consent on the Ability to Generalize the Results of an ATOD Prevention Trial to Rural Adolescents. Evaluation Review, 26(6), pp. 425-435, 2002.
Optimal Dynamic Treatment Regimes
A dynamic treatment regime is a list of decision rules, one per time interval, for how the level of treatment will be tailored through time to an individual's changing status. That is, dynamic treatment regimes are individually tailored treatments that are designed to provide treatment to individuals only when and if they need the treatment, explicitly incorporating the heterogeneity in need for treatment across individuals and the heterogeneity in need for treatment across time within an individual. In a dynamic treatment regime, decision rules for how the dosage level and type would vary with time are specified before the beginning of treatment; these rules are based on time-varying measurements of subject-specific need. Dynamic treatment regimes are attractive to public policy makers because they treat only subjects who show a need for treatment, freeing funds for more intensive treatment of the needy, and promise lower non-compliance by subjects due to over treatment. This mathematical paper provides a method for estimating optimal decision rules; rules that when implemented over a time period will produce the highest mean response at the end of the time period. The methodology uses experimental or observational longitudinal data to construct estimators of the optimal decision rules. Murphy, S.A. Optimal Dynamic Treatment Regimes. Journal of the Royal Statistical Society, 65(2), pp. 1-25, 2003.
Early Elementary School Intervention to Reduce Conduct Problems
Children's aggressive behavior and reading difficulties during the early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. Drawing from 3 communities, 116 European American and 168 Hispanic kindergarten through 3rd grade children who were identified for aggressiveness or reading difficulties were randomly assigned to a multicomponent intervention or no-intervention control condition. Intervention families received parent training, and children received social behavior interventions and supplementary reading instruction over a 2-year period. Post-intervention playground observations showed that the intervention children displayed less negative social behavior than controls. At 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. Barrera, M.J.R., Biglan, A., Taylor, T.K., Gunn, B. K., Smolkowski, K., Black, C., Ary, D.V., and Fowler, R.C. Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial with Hispanic and Non-Hispanic Children. Prevention Science, 3(2), pp. 83-94, 2002.
Will the 'Principles of Effectiveness' Improve Prevention Practice? Early Findings From a Diffusion Study
This study examines adoption and implementation of the U.S. Department of Education's new policy, the "Principles of Effectiveness," from a diffusion of innovations theoretical framework focusing on the requirement to select research-based programs. Results from a sample of 104 school districts in 12 states indicate that many districts appear to be selecting research-based curricula, but that the quality of implementation was low. Only 19% of the responding district coordinators indicated that schools were implementing a research-based curriculum with fidelity. Common problems included lack of teacher training, lack of requisite materials, use of some but not all of the required lessons or teaching strategies, and failure to deliver lessons to age-appropriate student groups. This study represents the first attempt to assess the quality of implementation of research-based programs as required by the SDFS Principles of Effectiveness. The authors conclude that low levels of funding, inadequate infrastructure, decentralized decision making and lack of program guidance contribute to slow progress in improving school-based prevention. Hallfors, D. and Godette, D. Health Education Research, 17(4), pp. 461-470, 2002.
The Quality and Inaccessibility of Local and State School-Based Substance Use Surveys Limits their Usefulness
School-based substance use surveys are an important data source for prevention and evaluation researchers, but access to students has become progressively restricted by schools. Because almost all states and many districts conduct their own regular surveys, archival data are a potential resource for informed policy and practice decisions. This study successfully collected substance use survey data from 69 of 105 targeted school districts located in 12 states. Results indicate that the availability, and quality of extant data currently limit their usefulness. Hallfors, D. and Iritani, B. Local and State School-Based Substance Use Surveys - Availability, Content, and Quality. Evaluation Review, 26(4), pp. 418-437, 2002.
How are Community Coalitions 'Fighting Back' against Substance Abuse, and are they Winning?
This paper examines the strategies that coalitions in a large national demonstration program (Fighting Back) chose to develop, the degree to which they implemented these strategies, and evidence regarding their effectiveness. Coalition strategy implementation was coded and ranked for 12 Fighting Back sites. Effect sizes (intervention over time) for outcomes related to substance use, alcohol and other drug treatment, and community/prevention indicators were ranked by site. Based on rank order correlations to test three directional hypotheses, the article compares strategy dose to outcomes. None of the hypotheses was supported. Strategies aimed at youth or community/prevention outcomes showed no effects; while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes. The authors conclude that comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered, and that efforts to evaluate implementation processes and strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research. Hallfors, D., Hyunsan, C., Livert, D., and Kadushin, C. American Journal of Preventive Medicine, 23(4), pp. 237-245, 2002.
An Early Community-Based Intervention for the Prevention of Substance Abuse and Other Delinquent Behavior
The results of a risk-reduction intervention strategy versus a standard intervention approach in the treatment of inner-city youth at high risk of adopting a deviant lifestyle were examined at baseline and 1-year follow-up using information provided by 408 youth (males and females, aged 9-17 years at interview) admitted to 2 community-based Baltimore City "Youth Bureaus." Bureaus offered counseling services for neighborhood youth referred for delinquent and other problematic behavior. One bureau served as the experimental intervention clinic and another as the control, or standard intervention clinic. Outcome measures involved substance abuse, sexual activity, contact with juvenile authorities, and delinquent activity, including violence-related activity. Regression analyses of outcome measures revealed significant differential results for delinquent activity, favoring the intervention condition. Hanlon, T.E., Bateman, R.W., Simon, B.D., O'Grady, K.E., and Carswell, S.B. Journal of Youth & Adolescence, 31(6), pp. 458-471, 2002.
A Self-Instructed Curriculum for Indicated Adolescent Drug Abuse
Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse in completing their high school education, and is a method of choice among educators at alternative high schools. The justification, development and impact of one self-instruction program, Project Towards No Drug Abuse (TND) is described. Keys to effective programmed self-learning are examined. Health-educator led, self-instruction, and standard care control conditions were compared on knowledge change, and the 2 program conditions were compared on process ratings; 572 students completed surveys. A sample of high-school students attended an average of 66% of the sessions in the health educator-led condition, whereas students completed an average of 83% of the self-instruction sessions. The self-instruction condition was easy to implement, provided better implementation, and resulted in learning as great as the health educator condition. However, students rated the health educator condition more positively. Sussman, S., Dent, C.W., Craig, S., Ritt-Olsen, A., and McCuller, W.J. Development and Immediate Impact of a Self-instructed Curriculum for an Adolescent Indicated Drug Abuse Prevention Trial. Journal of Drug Education, 32(2), pp. 121-137, 2002.
Project Towards No Drug Abuse: A Review of the Findings and Future Directions
This paper provides a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior-high-school-based drug abuse prevention program. Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 male and female high school youth from 42 schools in southern California were surveyed. The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization compared to controls. Most of these results were replicated across the 3 trials examined. Project TND is an effective drug and violence prevention program for older teens, at least for one-year follow-up. Sussman, S., Dent, C.W., and Stacy, A.W. American Journal of Health Behavior, 26(5), pp. 354-364, 2002.
Influence of a Substance-Abuse-Prevention Curriculum on Violence-Related Behavior
This study tested the impact of a school-based substance-abuse prevention program, Project Towards No Drug Abuse (TND), on risk for violence. Logistic regression analyses tested whether victimization, perpetration, or weapon carrying differed for intervention students relative to control students in a sample of 850 continuation (high-risk) high school students (aged 14-19 years) who were followed over 12 months. Results showed a higher risk for victimization among male control students. No intervention effect was observed for female students or for perpetration among males. The findings provide limited support for a generalization of TND's preventive effect. Simon, T.R., Sussman, S., Dahlberg, L.L., and Dent, C.W. American Journal of Health Behavior, 26(2), pp. 103-110, 2002.
Modeling Behavior Problems in Elementary-Grade Children
Youth problem behaviors such as drug use, delinquency, poor academic achievement and truancy are related, and often co-occur. Problem behavior theory (Jessor & Jessor, 1977) suggests that these disparate norm-violating behaviors reflect an underlying problem behavior syndrome. This study uses data from an ongoing longitudinal study to explore the application of a general theory of problem behavior among adolescents in fifth and sixth grades (N=1040). Confirmatory factor analysis including hierarchical latent factor models was used to examine the structure of problem behaviors that include school problems, aggression, delinquency, and substance use. Five measurement models of problem behaviors were tested, ranging from a single-factor model to a four-factor model and a second-order model. Results support the model that includes specific factors related to school problems, aggression, delinquency and substance use, and a higher order problem behavior factor. These results have implications for how predictors of problem behaviors are modeled at this age. The unique aspects of the higher order model suggest that there may be slightly different pathways to specific problems. It would therefore be useful to include both specific and general paths when examining predictors of problem behaviors at this age. For example, school bonding may have a general effect on deviance, as well as a specific effect on school problems. Modeling both general and specific effects is possible given the good fit of a second-order model as a measure of problem behaviors. Kim, S., Harachi, T.W., and Catalano, R.F., The Structure of Aggression, Delinquent Behaviors, Substance Use and School Problems in Elemenatry-grade Children. Korean Journal of Social Welfare Studies, 19, pp. 51-70, 2002.