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Director's Report to the National Advisory Council on Drug Abuse - September, 2003

Research Findings - Prevention Research

Limited Transfer of Research to Practice in School-based Substance Use Prevention

This study compared current substance use prevention practices in schools against standards of evidence-based prevention strategies for "effective content" and "effective delivery." Respondents were lead school staff that taught substance use prevention from 1998-1999 in a national sample of public and private schools that included middle school grades (N=1,795). Results indicate that most providers (62.25%) taught effective content, but few used effective delivery (17.44%), and fewer still used both effective content and delivery (14.23%). Those who taught evidence-based programs (e.g., Life Skills Training, Project ALERT), however, were more likely to implement both effective content and delivery, as were those teachers who were recently trained in substance use prevention and were comfortable using interactive teaching methods. These findings indicate that in the past, transfer of research knowledge to practice about school-based substance use prevention programming has been limited. Ennett, S.T., Ringwalt, C.L., Thorne, J., Rohrbach, L.A., Vincus, A., Simons-Rudolph, A., and Jones, S. A Comparison of Current Practice in School-Based Substance Use Prevention Programs with Meta-analytic Findings. Prevention Science, 4(1), pp. 1-14, 2003.

Sampling of High Risk-Related Populations

Adaptive sampling, where the sampling design adapts based on observations made during the survey, is particularly useful to substance use researchers when the population of interest is rare, unevenly distributed, hidden, or hard to reach. Examples of such populations are injection drug users, individuals at high risk for HIV/AIDS, and young adolescents who are nicotine dependent. By contrast, conventional sampling designs are based entirely on a priori information, and are fixed before the study begins. In the present article several adaptive sampling designs are discussed. Link-tracing designs such as snowball sampling, random walk methods, and network sampling are described, along with adaptive allocation and adaptive cluster sampling. It is stressed that special estimation procedures taking the sampling design into account are needed when adaptive sampling has been used. These procedures yield estimates that are considerably better than conventional estimates. For rare and clustered populations adaptive designs can give substantial gains in efficiency over conventional designs, and for hidden populations, link-tracing and other adaptive procedures may provide the only practical way to obtain a sample large enough for study objectives. Thompson, S. K. and Collins, L.M. Adaptive Sampling in Research on Risk-Related Behaviors. Drug and Alcohol Dependence, 68(1), pp. 57-67, 2002.

Sensation-Seeking Moderates Peer Influences on Marijuana and Cigarette Use

The interactions of sensation seeking with peer influence variables on marijuana and cigarette use were examined. Using survey data from 3,127 eighth graders in 20 U.S. middle schools, authors found that peer pressure and perceived peer marijuana use had a relatively small effect on low sensation-seekers and a much greater effect on high sensation seekers. In addition, aspirations inconsistent with marijuana use appeared protective for high sensation-seekers. These findings suggest that moderate and high sensation-seekers should be the primary audience for substance use prevention efforts directed toward younger adolescents. Reinforcing the perceptions that substance use is inconsistent with personal aspirations might counterbalance the vulnerability sensation-seeking youth to peers. Slater, M.D., Sensation-Seeking as a Moderator of the Effects of Peer Influences, Consistency with Personal Aspirations, and Perceived Harm on Marijuana and Cigarette Use Among Younger Adolescents. Substance Use & Misuse 38(7), pp. 865-880, 2003.

Self-Fulfilling Prophecies and Underage Drinking

This research examined whether mothers' expectations about their children's drinking behavior influenced their children's alcohol use through self-fulfilling prophecies and examined factors moderating this influence. The researchers defined self-fulfilling prophecies as expectations that lead to their own fulfillment (Merton, 1948). Longitudinal survey data were used from a study of 505 mother-child dyads living in the rural Midwest who participated in a prevention program. The investigators constructed a measure of the "inaccurate" portion of mothers' expectations by regressing mother's expectation for her child's future alcohol use on a composite score of valid predictors of the child's substance use (such as child's gender, family income, and child's past alcohol use) then creating residuals reflecting the accuracy of the mother's expectation. The investigators found that the inaccurate portion of mother expectations predicted children's future alcohol use after accounting for relevant control variables. Moderation analyses indicated that the self-fulfilling effect of mother expectations was stronger among high self-esteem children and when mother expectations were positive. These findings suggest that mothers have a small but significant self-fulfilling effect on their children's future alcohol use. Madon, S., Guyll, M., Spoth R.L., Cross, S.E., and Hilbert, S.J. The Self-fulfilling Influence of Mother Expectations on Children's Underage Drinking. Journal of Personality and Social Psychology, 84(6), pp. 1188-1205, 2003.

Life Skills Training Program Outcomes in a Rural, Midwest Youth Population

The purpose of this study is to extend earlier research by evaluating the effect of the Life Skills Training (LST) school-based preventive intervention on substance initiation and two related constructs, expectancies and refusal intentions, in a rural, Midwestern sample. The 15-session LST program (which is based on social cognitive/learning theory and problem behavior theory) was implemented during classroom periods by trained teachers using interactive teaching techniques. All seventh-grade students in 24 participating schools were recruited for participation in the study, and a total of 847 students were included in the growth curve analysis. The pretest, posttest, and follow-up assessments were conducted during the fall of the seventh grade, the spring of seventh grade, and the spring of eighth grade, respectively. The intervention significantly slowed the rate of increase in substance initiation and significantly slowed the rate of decrease in refusal intentions in both males and females. Notably, a stronger intervention effect was detected for females with regard to the rate of decrease in refusal intentions. Trudeau, L., Spoth, R., Lillehoj, C., Redmond, C., and Wickrama, K.A.S. Effects of a Preventive Intervention on Adolescent Substance Initiation, Expectancies, and Refusal Intentions. Prevention Science, 4(2), pp. 109-122, 2003.

Mixture Models for Nonignorable Dropout in Longitudinal Data

Random-coefficient pattern-mixture models (RCPMM's) have been proposed for longitudinal data when dropout is thought to be nonignorable. An RCPMM is a random-effects model with summaries of dropout time included among the regressors. The basis of every RCPMM is extrapolation. This article reviews RCPMM's, describes various extrapolation strategies, and shows how analyses may be simplified through multiple imputation. Using simulated and real data, it shows that alternative RCPMM's that fit equally well may lead to very different estimates for parameters of interest. The authors also show that minor model misspecification can introduce biases that are quite large relative to standard error, even in fairly small samples. For many scientific applications, where the form of the population model and nature of the dropout are unknown, interval estimates from any single RCPMM may suffer from undercoverage because uncertainty about model specification is not taken into account. Demirtas, H. and Schafer, J.L. On the Performance of Random-Coefficient Pattern-Mixture Models for Nonignorable Dropout. Statistics in Medicine, 21, pp. 1-23, 2003.

Communication of Prevention Program Requirements to School Program Implementers

The Department of Education promulgated the "Principles of Effectiveness" and required school districts that received support from the Safe and Drug-Free Schools and Community initiative to: 1) base drug and violence prevention programming on needs assessment data; 2) develop measurable program goals and objectives; 3) implement programs for which there is research evidence of effectiveness, and 4) periodically evaluate programs relative to their goals and objectives. This paper reports on the extent of national awareness of these Principles of Effectiveness, and plans for their implementation among public school districts and schools in the year following their announcement. Results of a mail survey of a national sample of public and private schools' lead staff who taught substance use prevention in the 1998-1999 school year (n=1,795) showed that baseline levels of awareness for these requirements were low in both school districts and schools. Results also suggest the need for greater communication about the principles to school districts and, in turn, the need for greater communication between district and school-levels substance use prevention staff to produce better adherence to these principles. Simons-Rudolph, A.P., Ennett, S.T., Ringwalt, C.L., Rohrbach, L.A., and Vincus, A.A. The Principles of Effectiveness: Early Awareness and Plans for Implementation in a National Sample of Public Schools and Their Districts. Journal of School Health, 73, pp. 181-185, 2003.

Outcomes from the Child Development Project

The Child Development Project is a longitudinal, multisite study that examines the development of aggressive behavior disorders in children and adolescents. Families were recruited in two cohorts in 1987 and 1988 at three sites: Nashville, TN, Knoxville, TN, and Bloomington, IN. The original sample included 585 youths and their families. Results from several recent secondary data analyses are presented:

Neighborhood Structure, Parenting Processes, and Externalizing Behaviors

Associations among neighborhood structure, parenting processes, and the development of externalizing behavior problems were examined among youth age 11 to 13. Hierarchical linear modeling revealed that less parental monitoring was associated with more externalizing behavior problems at age 11, and more unsupervised time spent out in the community and less positive parental involvement were associated with increases in externalizing behavior at ages 12 and 13. The decrease in externalizing levels associated with more parental monitoring was significantly more pronounced when youths lived in neighborhoods with more residential instability. Beyers, J.M., Bates, J.E., Pettit, G.S. and Dodge, K.A. Neighborhood Structure, Parenting Processes, and the Development of Youths' Externalizing Behaviors: A Multilevel Analysis. American Journal of Community Psychology, 31, pp. 35-53, 2003.

Social Rejection and Antisocial Behavior

With a series of ANOVA models and path analysis, this paper examined the relationship between social rejection and growth in antisocial behavior over time. Several findings of note were reported. First, early peer rejection predicted growth in aggression over time. Second, early aggression moderated the effect of rejection, such that rejection exacerbated antisocial development only among children initially disposed toward aggression. Third, social information processing patterns were found to mediate partially the effect of early rejection on later aggression. Dodge, K.A., Lansford, J.E., Salzer Burks, V., Bates, J.E., Pettit, G.S., Fontaine, R. and Price, J.M. Peer Rejection and Social Information-Processing Factors in the Development of Aggressive Behavior Problems in Children. Child Development, 74, pp. 374-393, 2003.

Father Absence and Risk for Early Sexual Activity and Teenage Pregnancy

The impact of father absence on early sexual activity and teenage pregnancy was investigated in longitudinal studies in the United States and New Zealand. In both studies girls were studied prospectively from age 5 until age 18. Results from both datasets revealed that greater exposure to father absence was strongly associated with elevated risk for early sexual activity and adolescent pregnancy. After controlling for important covariates, there was a stronger and more consistent relationship between father absence and early sexual activity and teenage pregnancy than on other behavioral and mental health problems or academic achievement. Ellis, B.J., Bates, J.E., Dodge, K.A., Fergusson, D.M., Horwood, L.J., Pettit, G.S. and Woodward, L. Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy? Child Development, 74, pp. 801-821, 2003.

Parents' Monitoring-Relevant Knowledge and Adolescents' Delinquent Behavior

This study examined relationships between parental knowledge and adolescent delinquent behavior over a period of 4 years beginning at age 14. Results showed that parental monitoring-relevant knowledge was negatively correlated with delinquent behaviors at baseline and increases over time in such knowledge were negatively correlated with increases in parent-reported delinquent behavior. Reciprocal correlations may indicate that low levels of parental knowledge predict increases in delinquent behavior and that high levels of delinquent behavior predict decreases in knowledge. Laird, R.D., Pettit, G.S., Bates, J.E. and Dodge, K.A. Parents' Monitoring-Relevant Knowledge and Adolescents' Delinquent Behavior: Evidence of Correlated Developmental Changes and Reciprocal Influences. Child Development, 74, pp. 752-768, 2003.

Effects, Message Sensation and Cognition Value

An experimental study was designed to investigate the influence of message strategies on cognitive processing and changes in attitudes, behavioral intentions, and behavior in relation to marijuana use. Researchers created a measure of message cognition value (MCV) and evaluated anti-marijuana messages designed to vary on cognition value as well as sensation value. Three hundred and thirty eight 18-20 year old college students viewed four anti-marijuana public service announcements four times over a four-week period in a lab setting. They completed instruments measuring the need for sensation (NFS) and need for cognition (NFC), cognitive processing attitudes toward marijuana use, intention to use marijuana, and self-reported marijuana use. There was partial support for a main effect of message sensation value (MSV) on changes in attitude, intention and behavior but limited support for an interaction of MSV with NFS on attitude change. Additionally, a significant main effect for message cognition value (MCV) indicates that high cognition value messages led to greater recall than low cognition messages but there was no interaction effect of MCV with NFC. Cognitive processing and message cognition value did not affect attitude, behavioral intentions or behavior regarding marijuana use. Based on these findings, designing messages high in both sensation value and cognition value should be the goal of prevention campaigns. Harrington, N.G., Lane, D.R, Donohew, L., Zimmerman, R.S., Norling, G.R., An, J.H., Cheah, W.H., McClure, L., Buckingham, T., Garofalo, E., and Bevins, C.C. Persuasive Strategies for Effective Anti-Drug Messages, Communication Monographs 70(1), pp.16-38, 2003.

Theory in the Design of Effective Communication

The usefulness of two integrating theories for the development of effective health campaigns is illustrated. The integrative model of behavioral prediction focuses on changing beliefs about the consequences (costs and benefits), perceived norms, and self-efficacy regarding a particular behavior. These, in turn, shape intentions to perform the behavior that underlies action. The model can help explain why some members of a target population are performing the behavior and others are not and this understanding points to the beliefs that need to be addressed in a theory-based communication. For example, if people have not formed the desired intention, an intervention should be directed at changing attitudes, norms or self- efficacy. However, if people have the desired intention but are not acting on it, the intervention should be directed at skill building or removing environmental constraints. Media priming theory focuses on strengthening the association between a belief and its outcomes, such as attitude and intention toward performing the behavior. An effective communication campaign increases the association between beliefs that are consonant with recommended behavior and the more proximal determinants of that behavior. The message strategy should be to identify and target attitudes, norms or beliefs consonant with the desired behavior. The theories are complementary and the article shows how together they provide guidance for selecting beliefs to target in an intervention, namely those that both change beliefs and strengthen the association between the belief and attitude and/or intention. Fishbein, M. and Yzer, M. Using Theory to Design Effective Health Behavior Interventions. Communication Theory 13(2), pp. 64-183, 2003.

Using Beliefs About Consequences in Message Design

Improving health communications campaigns through message design is illustrated with findings on messages targeted at adolescent marijuana use. The Integrated Model of Behavior holds that a primary determinant of behavior is the person's intention to perform it; intention, in turn, is a function of the person's attitude, normative pressure and self-efficacy to perform the behavior. These are functions of underlying beliefs about the outcomes of performing the behavior. Based on a sample of 1,175 adolescents from middle and high schools around Philadelphia, the researchers explored 36 behavioral beliefs (i.e., positive and negative consequences that a person thinks will happen to him or her) related to regular marijuana use, and compared the responses of high and low risk youth. They found substantial differences between the groups with respect to the likelihood of an effect but far less difference between the risk groups in the value they place on a behavioral belief related to use. For example, high-risk youth do not believe that marijuana use leads to stronger drugs but low risk youth do; both groups agree that that is a negative outcome. The findings suggest campaign designers use the IM to test for the acceptability of behavioral beliefs; test a comprehensive group of beliefs; focus on the beliefs of the high risk subgroup; select beliefs that are already accepted to change. Capella, J.N., Yzer, M. and Fishbein, M. Using Beliefs about Positive and Negative Consequences as the Basis for Designing Message Interventions for Lowering Risky Behavior. pp. 210-219 in Romer, D. (Ed.) Reducing Adolescent Risk. Thousand Oaks, CA: Sage, 2003.

Lessons From a Successful Participatory Action Research Model

This article describes the use of Participatory Action Research (PAR) in the development of the Drug Resistance Strategies Project. PAR requires the direct participation of the community under study and emphasizes social change to solve problems. Through the use of focus groups with teachers and students and the field-testing of products, investigators learned valuable lessons that were translated directly into programmatic design features. Student feedback led to an emphasis on grade 7, the selection of core strategies for drug resistance, the program specific graphic material, and video production (which was undertaken by students). Feedback from teachers was directly used for development of learning objectives and materials as well as practical implementation concerns. Teachers were included in the research team and given ownership of the lessons. The success of this model is inferred in part from positive program outcomes such as a favorable shift in social norms and reduced alcohol and/or drug use among program participants. Gosin, M.N., Dustman, P.A., Drapeau, A.E., and Harthun, M.L. Participatory Action Research: Creating an Effective Prevention Curriculum for Adolescents in the Southwestern US. Health Education Research, 18(3), pp. 363-379, 2003.

Stimulating Adoption of Empirically Supported Treatments in Clinical Settings

Drawing on their experiences implementing the Incredible Years Parent-Training Program and several other empirically supported treatments in a children's mental health center, recommendations and guidelines for future program adoption were developed based on suggestions about effective methods for adopting empirically supported treatment programs in mental health centers. Data were collected through surveys and qualitative interviews with the clinicians and administrators following their implementation of the Incredible Years Program. Successful program implementation hinges on the representation, support, and joint involvement of clinicians, administrators, and an "innovator" who acts as a champion and advocate for the program adoption process. Adoption is fostered by: developing a collaborative working group, making the decision process clear, pilot testing, and garnering organizational commitment for the use of empirically supported treatments. A detailed list of role specific recommendations is offered for each of the three collaborative workgroup participants: the innovator, the clinician, and the administrator. Schmidt, F. and Taylor, T.K. Putting Empirically Supported Treatments Into Practice: Lessons Learned in a Children's Mental Health Center. Professional Psychology, 33, pp. 483-489, 2002.

The Timing and Spacing of Observations in Longitudinal Studies

The impact of the temporal design (i.e., the sampling of times of measurement), can affect the statistical and substantive conclusions drawn from longitudinal biomedical and social science research. For a study of a given duration, if observations are spaced too far apart the resulting data can support misleading conclusions, whereas if observations are spaced relatively close together, a much more veridical picture of the process of interest is provided. These ideas are applied to several types of analyses including correlation and regression analyses, where a variable measured at one time is used to predict a variable measured at a later time; growth curve analyses; and analyses involving stage-sequential processes. The authors argue that longitudinal designs should relate the choice of timing and spacing of observations in longitudinal studies to characteristics of the processes being measured. In addition, consideration of the possible effects of measurement design on results of statistical analyses may aid in their interpretation. New approaches involving intensive data collection with much shorter measurement interval, such as Ecological Momentary Assessment, are promising but costly and are not suitable for every research question. Collins, L.M. and Graham, J.W. The Effect of the Timing and Spacing of Observations in Longitudinal Studies of Tobacco and Other Drug Use: Temporal Design Considerations. Drug and Alcohol Dependence, 68(1), pp. 85-96, 2002.

Review of the Communities That Care Youth Survey

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This paper describes the development, reliability and validity of a self-report survey designed for adolescents 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. This instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive interventions. Arthur, M.W., Hawkins, J.D., Pollard, J.A., Catalano, R.F., and Baglioni, A.J. Measuring Risk and Protective Factors for Substance Use, Delinquency, and Other Adolescent Problem Behaviors: The Communities That Care Youth Survey. Evaluation Review, 26(6), pp. 575-601, 2002.

Cost Analysis of Prevention Programs

Fast Track is a multiyear, multicomponent intervention targeted to children at risk for emotional and behavioral problems. This article does not show a definitive cost analysis of the program, but it presents various ways of conceptualizing this analytic approach. The components of the Fast Track intervention include a universal prevention within schools, selective prevention provided to families of children identified as high risk during kindergarten screening, and individualized selective support provided to high-risk children and families based on criterion-referenced assessments over time. The cost analysis process involves identifying the resources involved, measuring their use, and valuing the resources used in dollar terms. The resulting cost estimates include both the direct and morbidity-related costs of the intervention, such as the costs of services provided to children with emotional and behavioral problems. In many cases, such costs are actually reduced by a prevention program, and if so, this provides an opportunity for a cost offset. This type of economic analysis generally results in a range of estimates calculated for each competing assumption or set of figures. Supplemental analysis can be used to examine variation in the impact of the intervention for children with different problem severity levels. The key question to be answered by such cost analysis is whether the direct costs of a prevention program are offset by reductions in the other, morbidity-related costs, such as the subsequent use of expensive services. Foster, E.M., Dodge, K.A. and Jones, D. Issues in the Economic Evaluation of Prevention Programs. Applied Developmental Science, 7, pp. 76-86, 2003.

Assessing Reliability of Substance Use Measures

Latent class models can be used to identify classes of individuals and to assess the psychometric reliability of categorical items. The latent class model is a categorical latent variable model used to identify homogeneous classes of respondents such that class membership accounts for item responses. The assessment of measurement reliability comes directly from the estimates of the model. Although not based on classical test theory, the reliability assessment procedures described answer the same question--that is, how consistent or dependable is measurement? The goal is to identify reliable indicators of a characteristic by examining measurement error and the inter-relatedness of the items. Methods for estimating the reliability of individual items as well as sets of items are presented. These methods are illustrated with data on cigarette smoking from a national sample of adolescents. By using the procedures described, researchers are able to determine: (1) which classes of people are measured well and which are not; (2) which items perform well and which do not; and (3) whether items need to be altered or added in order to measure and identify particular classes better. Flaherty, B.P. Assessing Reliability of Categorical Substance Use Measures with Latent Class Analysis. Drug and Alcohol Dependence, 68(1), pp. 7-20, 2002.

Using Theory to Design Evaluations of Communication Campaigns

A general theory about media campaign effects is presented to illustrate the use of theory in the evaluation of communication campaigns, highlight a theory of campaign effects, and demonstrate its implications for evaluation design using the National Youth Anti-Drug Media Campaign (NYAMC). Campaign exposure effects may operate through individual, social or institutional paths. Such effects also may require substantial levels of exposure through multiple channels over long periods of time in order to accumulate measurable changes. Thus, the design of responsive evaluations depends on selecting appropriate units of analysis and comparison groups, measuring lagged effects, selecting samples able to detect subgroup effects, and analytic strategies consistent with both the underlying theoretical model and the theory of effects. The ongoing evaluation of the NYAMC illustrates such an evaluation strategy and the need for complex evaluation design to detect its effects. Hornik, R and Yanovitzky, I. Using Theory to Design Evaluations of Communication Campaigns: The Case of the National Youth Anti-Drug Media Campaign. Communication Theory, 13(2), pp. 204-224, 2003.


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