2nd National Conference on Drug Abuse Prevention: A Progress Update

United States

Introductions

Dear Colleagues:

The National Institute on Drug Abuse (NIDA) is pleased to welcome you this important and timely conference, the 2nd National Conference on Drug Abuse Prevention Research : A Progress Update. I would like to thank the Robert Wood Johnson Foundation (RWJF) for joining us in sponsoring this event.

Five years ago, NIDA sponsored its first national forum on drug abuse prevention research to bring together leaders of the field to establish a dialogue on the effectiveness of prevention research for use in communities. Since then, numerous scientific advances have emerged that have changed how we as a nation approach addiction, especially how we prevent and treat it. This conference is intended to provide participants with focused time to explore current preventive interventions for youngsters that have been shown to be effective in family, school, and community settings. The plenary panels led by leading prevention scientists will provide background in what has been learned and how this knowledge is being used in current prevention programming efforts. The hallmark of this conference is the format of the workshops, which will allow for lively discussion between the researchers, who have created many of our nation's most effective prevention programs, and the practitioners, who are implementing these programs in communities across the country.

We look forward to sharing current knowledge about drug abuse prevention and also to hearing your suggestions for future activities and efforts in the field.

I hope that this conference provides helpful information and strategies that can be applied in families, schools, and communities to prevent drug abuse among our nation's youth.

Sincerely,
Alan I. Leshner, Ph.D., Director

Dear Colleagues:

On behalf of the Robert Wood Johnson Foundation, welcome to the 2nd National Conference on Drug Abuse Prevention Research: A Progress Update. We are especially pleased to be cosponsoring this important event with the National Institute on Drug Abuse (NIDA).

This promises to be an engaging and informative conference. Significant strides have been made in drug prevention research in the past decade. As researchers continue to unravel the overall complexity of drug abuse and addiction, they are also emerging with a clearer understanding of the factors that put children at risk for later drug use. This, in turn, has enabled prevention researchers to develop interventions that are showing some very promising positive outcomes. The science findings that will be showcased over the next two days will provide communities with new tools and ideas to confront and respond to drug abuse and its related health consequences.

Although the science has come quite a distance, much more remains to be done to ensure that evidence-based approaches to drug abuse prevention can be easily and readily adapted by all communities across the country. It is our Foundation's hope that the state-of-the-art knowledge that emerges from this conference will be able to be used in real-life settings. We also hope that this event ignites new and exciting directions for tomorrow's research endeavors that, ultimately, will improve the health and health care of all Americans.

Sincerely,
Steven A. Schroeder, M.D., President and CEO

Abstracts

Plenary Panel I: Using Risk and Protective Factors in Prevention

Why Risk and Protective Factors Matter in the Design of Effective Interventions 
J. David Hawkins, Ph.D.

Preventive interventions that do not address the predictors of drug abuse have little chance of succeeding. Over the past 20 years, knowledge of the predictors of substance abuse and dependence has grown exponentially, as have the number and variety of preventive interventions tested and shown to be effective in reducing risk for and use of substances. These programs have shown that some predictors, identified as risk and protective factors in longitudinal descriptive studies, are modifiable causes of drug abuse that can be changed through preventive interventions. Epidemiologic data show that exposure to multiple risk factors increases substance use prevalence, suggesting that preventive efforts should focus on populations or geographic areas where overall risk levels are high and protective levels low. Furthermore, profiles of risk and protection vary by area. Good epidemiologic data on levels of risk and protection, drug use, and related adolescent health and behavior outcomes are fundamental for matching preventive policies and services to the areas and populations served. These data also can form the baseline for monitoring changes in levels of risk, protection, substance use, and related outcomes over time; increasing accountability; and providing benchmarks for continual, outcome-guided improvement of prevention policies and services based in science.

• Arthur MW, Blitz C. (2000) Bridging the gap between science and practice in drug abuse prevention through needs assessment and strategic community planning. Journal of Community Psychology28(3):241-255.
• Hawkins JD, Catalano RF, Kosterman R, Abbott R, Hill KG. (1999) Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatrics and Adolescent Medicine153(3):226-234.
• Pollard JA, Hawkins JD, Arthur MW. (1999) Risk and protection: Are both necessary to understand diverse behavioral outcomes in adolescence? Social Work Research 23(3):145-158.

What the Family Can Do About Early Risks
John B. Reid, Ph.D. 

A strong, broad, and rapidly expanding research base now exists that pinpoints family-level antecedents, risk, and protective factors that are directly involved in the early development of children and can lead to substance use, conduct problems, risky sexual activities, and other related problems in adolescence. The influence of family factors begins at birth or before and continues through early and middle childhood into adolescence. Increasingly, this developmental research base has been used to inform the design of preventive and clinical interventions that are specifically focused on helping families deal with a variety of risk factors that emerge from early childhood through middle adolescence. Many such interventions have been demonstrated to have strong and persistent effects in carefully controlled studies. This presentation will summarize new and relevant findings from basic research, exemplary interventions, and implications for the next generation of family-level interventions.

• Capaldi DM, Eddy JM. (2000) Improving children's long-term well-being by preventing antisocial behavior. In: A Buchanan, B Hudson (eds.). Promoting Children's Emotional Well-being. Oxford, United Kingdom: Oxford Press, pp. 209-229.
• Chamberlain P, Reid J. (1998) Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology 6:624-633.
• Reid JB, Eddy JM. (1997) The prevention of antisocial behavior: Some considerations in the search for effective interventions. In: DM Stoff, J Breiling, JD Maser (eds.). Handbook of Antisocial Behavior. New York: John Wiley and Sons, pp. 343-356.
• Webster-Stratton C. (1998) Preventing conduct problems in Head Start children: Strengthening parent competencies. Journal of Consulting and Clinical Psychology 66:715-730.

What the School Can Do With Early Prevention Interventions
Sheppard G. Kellam, M.D.

Schools as communities are core units for prevention research and programs. Over the past three decades, much has been learned about early risk factors related to later drug abuse. A set of four rigorous prevention research strategies has been developed that is directed at these risk factors. These four strategies will be described, and data from the developmental epidemiologic strategy will be used to illustrate the central role of school and the influence of school environment on risk and prevention. The first strategy requires identifying early risk factors, directing interventions at them, and then determining whether the developmental trajectories toward risk of drug abuse have been improved. The second strategy involves intervening at times of more immediate, concurrent risk, just as the child enters middle school, for example, with exposure to drug-taking children. The third strategy involves multiple interventions at the community level, using school-based drug education, media, and parental awareness, for example. The fourth strategy is at the larger societal policy and law levels, using simulation modeling. All of these strategies are complementary, and all will be required in the next stage of prevention research and programming.

How the Community Can Set Positive Norms and Policies
Mary Ann Pentz, Ph.D.

Before the mid-1980s, community-based prevention was associated with social activism and grassroots organizing to achieve environmental change, typically in response to a community crisis. There was little evidence of effects of these approaches on preventing youth drug use. However, reviews of multicomponent, community-based prevention programs after this period have shown that several have been effective in changing youth drug use. The effective, "evidence-based" approaches share several features, including linking two or more of school, parent, mass media, community organization, and policy intervention components and community-wide involvement in and commitment to these interventions. Results have shown sustained effects on youth drug use for up to or exceeding 8 years and additional effects on parent-child communication, the efficiency of how community leaders organize for prevention, and community norms and policies for prevention. Despite the effectiveness of specific community-based programs, communities face several challenges in deciding whether to adopt a multicomponent program. These include greater cost compared with single-component programs, a greater time commitment for implementation, and a required commitment to long-term institutionalization once community leaders organize for prevention. There are also challenges facing researchers trying to evaluate such programs, including measuring community readiness to commit to a sustained multicomponent program. Status quo community norms and policies have shown weak relationships to youth drug use. Relatively little is known yet about whether and how changing the status quo as a result of community-based programs affects subsequent youth drug use and prevention programs. 

How the Media Can Change Behavior
Joseph N. Cappella, Ph.D.

To understand the potential of the media to change behavior, it is necessary to consider both their direct and indirect effects. Direct effects refer to the impact of mass media messages on beliefs, intentions, attitudes, social norms, and efficacy, which in turn affect behavior. Well-designed communication campaigns can have direct effects on behavior, as evidenced by research on smoking and drug use among adolescents. Indirect effects refer to the impact of mass media messages on mental frameworks, social institutions, interpersonal communication, and other processes that can affect targeted behavior "down the line." For example, national media attention to problems such as drunk driving has affected State legislative activity, which in turn resulted in a reduction of fatalities. Media attention can also shape the public's agenda of important problems, redirecting economic resources and highlighting public concerns. 

• Palmgreen P, Donohew L, Lorch EP, Hoyle RH, Stephenson MT. (Feb 2001) Television campaigns and adolescent marijuana use: Tests of sensation seeking targeting. American Journal of Public Health91(2):292-296.
• Worden JK, Flynn BS, Solomon LJ, Secker-Walker RH. (Nov 1996) Using mass media to prevent cigarette smoking among adolescent girls. Health Education Quarterly 23(4):453-468.
• Yanovitzky I, Bennett C. (Aug 1999) Media attention, institutional response, and health behavior change: The case of drunk driving, 1978-1996. Communication Research 26(4):429-453.

Thursday Workshops

Strengthening Families Program: For Parents and Youth 10-14
Richard L. Spoth, Ph.D.

This presentation will include an overview of the Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14), the risk and protective factors the program addresses, and a summary of the program's core elements and topics. The speakers will review key substance-related outcomes of the SFP 10-14 from a followup assessment 6 years past baseline. Findings concerning the relationship of implementation quality and outcomes also will be presented, along with strategies for high-fidelity implementation. The speakers will describe SFP 10-14 participation research and related procedures for maximizing recruitment and retention and provide information on program materials and training.

School-Based Drug Use Prevention: The Project ALERT Experience
Phyllis L. Ellickson, Ph.D.

Using Project ALERT as an example, this presentation will provide an overview of school-based drug prevention, what works, and why. It will discuss which drugs to target, which risk factors to address, and the principles that underlie effective drug use prevention programs. Concrete examples of how those principles can be translated into classroom lessons and activities will be provided. The presentation will describe Project ALERT's original evaluation and results and provide early information from a followup evaluation. It will conclude with a discussion of lessons learned from evaluation research and from the educators who adopt and implement prevention programs.

Reconnecting Youth
Jerald R. Herting, Ph.D.

Reconnecting Youth (RY) is an indicated substance use prevention program targeting youth at risk of school failure. Many of these youth have co-occurring problems of drug involvement, depression, anger/aggression, and suicide-risk behaviors. RY addresses this constellation of behavioral outcomes. The speakers will describe the semester-long, school-based RY program and detail its skills development content, peer and mentor support intervention strategy, small-group classroom framework within the schools, and evaluation with respect to changing substance use and other behaviors. They will then present current continued testing of the RY program and its expansion to include a year-round curriculum and a parent component. The speakers will also discuss strategies for process and outcome evaluation of RY and tools and procedures for evaluation. Finally, they will discuss general implementation strategies and provide current information on program dissemination.

ATLAS/ATHENA
Linn Goldberg, M.D., FACSM, and Diane Elliot, M.D., FACP, FACSM

Adolescents who participate in sports in the United States represent 50 percent of all students. Although participation in athletics can be beneficial, sports do not protect youth from alcohol and other drug use. This interactive workshop will demonstrate major aspects of the adolescent male health promotion and drug use prevention program, ATLAS, and its counterpart, ATHENA, designed to reduce drug use and disordered eating among adolescent female athletes. Both programs use a team-centered, coach-facilitated, and gender-specific approach. The speakers will describe how ATLAS and ATHENA work and how young athletes can develop resistance to the use of alcohol and illicit drugs and practice healthy lifestyles. 

Drug Abuse Prevention Campaigns and Sensation Seeking
Philip Palmgreen, Ph.D.

This presentation will describe the findings of a 15-year series of studies aimed at developing more effective antidrug messages for use in prevention campaigns and other interventions. The research has revolved around sensation seeking - a widely recognized risk factor for drug use. High-sensation seekers not only are much more likely to use a variety of substances but also require much more novel, stimulating, and dramatic messages to attract their attention and persuade them. A targeting approach utilizing sensation seeking, known as SENTAR, will be illustrated with two campaign studies, the second of which demonstrated via a controlled time-series that SENTAR-based television campaigns can substantially reduce marijuana use among high-sensation-seeking adolescents. 

Message Development for Latino Audiences
William D. Crano, Ph.D., and Eusebio M. Alvaro, M.P.H., Ph.D.

Recent research suggests large differences in health-relevant (prevention) knowledge between Hispanic and Anglo youth and their parents. These differences occur despite intense media efforts mounted to help prevent the consequences of unsafe sex and drug abuse. We believe that mass-media prevention messages may place minority groups at a disadvantage if messages are not specifically tailored to address their cultures and concerns. The speakers will describe research on new approaches to presenting information that have been found to be effective for adolescent Hispanic audiences. They will report findings from research on drug use prevention among Anglo and Hispanic youth that involved an intensive, interactive, multimedia, computer-based approach that has proved effective in past research on HIV prevention. The speakers will review this research, detail recent findings that made use of antidrug messages, and discuss possible ways in which the approach may be extended and generalized in the efforts against drug abuse.

Project QUEST Evaluation and Followup
Marvin Eisen, Ph.D.

The Skills for Adolescence (SFA), a widely used comprehensive life skills training curriculum with a dedicated drug education unit, was evaluated in a randomized study of 34 middle schools. Two years after baseline (1 year after intervention), data were collected from 5,691 eighth graders (77 percent student retention). Lifetime use and past 30-day use of alcohol, cigarettes, marijuana, and other drugs were measured. There were two significant treatment main effects at the end of the eighth grade: Lifetime use (p=.05) and recent (p<.03) marijuana use were lower in SFA than in control ("usual" programming) schools. There was one treatment by baseline binge drinking interaction, with baseline bingers reporting less binge drinking in SFA schools (p<.01) but no SFA effect among baseline nonbingers. This study supports SFA's life skills prevention approach and, because of its commercial availability, provides an additional step in bridging a major gap in the research-to-practice literature: identifying popular programs that work.

Plenary Panel II: Identifying Effective Features in Prevention Interventions

The Prevalence of Effective Middle-School-Based Curricula, Substantive Content, and Teaching Strategies
Christopher Ringwalt, Dr.P.H.

Many of the Nation's middle schools continue to implement strategies that are either untested or ineffective and to use ineffective teaching strategies to do so. This presentation will report on the prevalence of the use of effective content and teaching strategies in U.S. middle schools and the prevalence of the use of evidence-based curricula in schools. Respondents were lead staff members who taught substance use prevention in a representative sample of 1,905 of the Nation's public and private middle schools. Data were collected in 1999 by a self-administered survey. Respondents were more likely to report giving primary emphasis to knowledge content (46.1 percent) and generic skills (29.9 percent) than to affective content (17.3 percent) and refusal skills (6.8 percent). Respondents were also more likely to use didactic (79.5 percent) than interactive (46.8 percent) teaching methods. Furthermore, only 26.8 percent of all schools, including 34.6 percent of public schools and 12.6 percent of private schools, used at least 1 of the 10 curricula deemed effective by NIDA and/or other institutions. These results demonstrate the considerable gap between current school prevention practices and the understanding of effective curricula and their components. Additional research is needed on the processes by which schools consider, adopt, implement, and institutionalize effective curricula and teaching practices.

Evaluation of Community-Based Interventions
Denise Hallfors, Ph.D.

This presentation will review an evaluation of demand-reduction activities initiated by communities, primarily from the Fighting Back Project. Fighting Back brought local community members together to reduce the demand for substances. This approach relied on an inclusive participation process and local knowledge to identify problems and to devise strategies related to the continuum of care, such as public awareness, prevention, early identification, treatment, relapse prevention, and environmental improvement. Through interviews, local recordkeeping, and evaluator site visits, specific strategies were identified and compared across sites. Findings indicate that most planned strategies were not fully implemented. It was particularly difficult for institutions, such as health care organizations, schools, and churches, to sustain prevention interventions. Nevertheless, each site had a small number of strategies that it was able to deliver consistently. Outcome data from both the national survey and a meta-analysis of school surveys were linked to these strategies to examine effects. 

• Saxe L, Reber E, Hallfors D, Kadushin C, Jones D, Rindskopf D, et al. (1997) Think globally, act locally: Assessing the impact of community-based substance abuse prevention. Evaluation and Program Planning20(3):357-366.

Substance Abuse Communications Interventions
Mark W. Lipsey, Ph.D.

Meta-analytic techniques were used to synthesize the findings from 72 studies of the effects of a media intervention designed to prevent or reduce youth substance use. The overall effects on substance use knowledge, attitudes, and behavior were positive, of modest magnitude, and highly variable. The magnitude of the effects varied according to the source (radio, TV, print), the substance addressed (illicit drugs, alcohol, tobacco), the characteristics of the recipients (age, gender, risk level), and the characteristics of the message (thematic, repetition, targeting). Outcome research in this area is beset with methodological problems, which make assessment of the effects of media campaigns problematic and add uncertainty to conclusions.

Effective Implementation of Interventions
Linda Dusenbury, Ph.D.

Prior research has identified key elements of effective prevention programs. It is clear that the success of theoretically valid prevention approaches depends, in part, on high-quality implementation. Effectiveness depends on dosage (how much of a program is delivered) as well as quality (how well a program is delivered), and training and technical assistance are important in promoting fidelity. Technologies such as the Internet and videotape also provide tools for standardizing and protecting essential content. However, organizations may be less inclined to maintain or institutionalize programs that cannot be modified, and program developers and program providers need to work together to develop strategies that promote high-quality implementation at the same time they allow programs to adapt to the needs of particular organizations or communities; this might extend to a reconsideration of the structure and design of programs. Prevention researchers, policymakers, and practitioners need to collaborate to overcome barriers to effective implementation.

Plenary Panel III: Assessing Substance Abuse in the Communityr for Prevention Planning

Measuring the Level of Substance Abuse in the Community
Zili Sloboda, Sc.D.

The key to planning and implementing a prevention program in a community lies in understanding the special needs of that community. It is clear from comparisons of substance abuse problems across communities that, although there are many common practices, there are sufficient differences warranting special attention in service delivery. Measuring substance abuse patterns and practices within a community is complex; thus, the use of multiple methods and multiple measurement systems is recommended. Various measurement methods will be discussed, with emphasis on their advantages and disadvantages. Adapting these approaches for prevention programming will be explored by addressing how to set prevention priorities and how to match programming to community needs.

Understanding Community Risk and Protective Factors
Richard F. Catalano, Ph.D.

Researchers have identified risk and protective factors for adolescent health and behavior problems, including substance abuse, mental health disorders, delinquency, violence, teenage pregnancy, and school dropout. Strategies that reduce or counter risk by enhancing protective factors are promising approaches to prevention, suggesting that prevention strategies need to be community-based, collaborative, and specific to each community's unique risk and protective profile. They also need to use prevention programs with demonstrated effectiveness. Thus, community-wide approaches need to (1) mobilize the appropriate leadership in communities, (2) assess the communities' unique risk and protective factor profile so that prevention programming addresses the most prevalent predictors of problem behavior, (3) inventory existing program resources to identify programming strengths and gaps, and (4) utilize programs that have demonstrated effectiveness in strengthening protective factors and reducing risk and problem behaviors.

• Hawkins JD, Catalano RF, Kosterman R, Abbott R, Hill KG. (1999) Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatrics and Adolescent Medicine153(3):226-234.
• Hawkins JD, Catalano RF, Miller JL. (1992) Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin112(1):64-105.

Assessing Community Readiness for Prevention
Ruth W. Edwards, M.B.A., Ph.D., and Pamela Jumper-Thurman, Ph.D.

Communities are at many different stages of readiness for addressing community issues. This readiness is a major factor in determining whether local prevention efforts can be effectively implemented and supported by the community. The speakers will describe the Community Readiness Model, which was developed to provide a practical tool to help communities mobilize to address a specific issue. Nine stages of community readiness are defined, ranging from "no awareness" of the problem to "professionalization." Assessment of the stage of readiness is accomplished using key informant interviews, with questions covering six different dimensions. Strategies for successful implementation have been developed for each stage of readiness. Once a sufficient level of readiness is achieved, community teams can be trained in use of the model. These teams then can develop specific, culturally appropriate strategies using local resources to guide their communities to more advanced levels of readiness, eventually leading to long-term sustainability of local community drug abuse prevention activities. 

Evaluating Community Strategies and Programs
David P. MacKinnon, Ph.D.

This presentation will describe general guidelines for thinking about how prevention programs achieve or fail to achieve reductions in drug abuse. There are three major aspects of this approach to prevention. First, what are the risk and protective factors associated with drug abuse? For example, social norms and beliefs are related to drug abuse. Second, how does a prevention program change these risk and protective factors? For example, enforcement of laws on alcohol sales to minors may reduce alcohol use by reducing the availability of alcohol. Third, does the change in risk and protective factors explain the change in drug abuse? Methods to answer these questions are described in the context of the evaluation of community drug abuse prevention programs. The importance of a substantial sample of communities and the assignment of communities to research conditions will be discussed and illustrated with several examples. 

• MacKinnon DP. (1994) Analysis of mediating variables in prevention and intervention research. In: A Cazares and LA Beatty. Scientific Methods in Prevention Research. NIDA Research Monograph 139. U.S. Department of Health and Human Services Pub. No. 94-3631. Washington, DC: U.S. Government Printing Office, pp. 127-153. 
• MacKinnon DP, Johnson CA, Pentz MA, Dwyer JH, Hansen WB, Flay BR, Wang EY. (1991) Mediating mechanisms in a school-based drug prevention program: First-year effects of the Midwestern Prevention Project. Health Psychology 10(3):164-172.
• Murray DM. (1998) Design and Analysis of Group-Randomized Trials. New York: Oxford University Press.

Friday Workshops

Bii-Zin-Da-De-Dah: The Listening to One Another Prevention Program
Leslie B. Whitbeck, Ph.D.

Bii-Zin-Da-De-Dah is a culturally specific, family intervention that targets alcohol and other drug use among American Indian early adolescents. This session will provide an overview of the prevention program, with particular emphasis on the importance of culturally specific program components in work with American Indians. The process and ethics of building research partnerships with American Indian communities will be covered. Research findings from the project baseline survey and the prevention trials will be used to support the efficacy of traditional culture as a resiliency factor for American Indian adolescents and adults. Specific cultural risks also will be addressed. Prevention trials indicated that cultural content was more likely to be retained and used by mothers and children than generic content. 

Focus on Families
Kevin P. Haggerty, M.S.W. 

The Focus on Families (FOF) preventive intervention was developed for parents receiving methadone treatment and their children. The primary goals of the project were to reduce parents' use of illegal drugs and reduce risk factors for their children's future drug use while enhancing protective factors. The intervention employs group training and home-based services to achieve the research goals. This presentation summarizes the lessons learned from the intervention research and the additional dissemination of FOF. Results find a pattern of significant differences favoring the experimental group at 12-month followup and a less stable pattern of reduced parent and child problem behaviors at 24-month followup. Results will be presented in consideration of conducting parenting interventions in treatment settings. Lessons learned from dissemination efforts and principles for effective dissemination will be offered. 

Project Towards No Drug Abuse
Steven Sussman, Ph.D.

Very few evidence-based, high school drug abuse prevention programs exist. The Project Towards No Drug Abuse (Project TND) is evidence-based, as indicated by the 1-year postprogram followup results of three experimental field trials. Summed across conditions and trials, 2,468 senior high school youth from 42 alternative and regular southern California high schools were surveyed. Twelve interactive class sessions provide motivation-skills-decisionmaking prevention material. The sessions are active listening, stereotyping, myths and denial, chemical dependency, talk show, marijuana panel, tobacco use cessation, stress/health and goals, self-control, positive and negative thought and behavior loops, perspectives, and decisionmaking and commitment. Relative to a standard-care comparison group, a year after receiving the program, participants experienced a 27 percent 30-day prevalence reduction in cigarette use, a 9 percent 30-day prevalence reduction in alcohol use among baseline drinkers, a 22 percent 30-day prevalence reduction in marijuana use, a 26 percent 30-day prevalence reduction in hard drug use, and a 25 percent 1-year prevalence reduction in weapons carrying among males.

School-Based Drug Abuse Prevention With Multiethnic Youth Through Life Skills Training
Gilbert J. Botvin, Ph.D.

Advances in understanding the etiology and prevention of adolescent drug use have led to the identification of effective prevention approaches. One extensively used research approach to drug abuse prevention is a multiyear, multicomponent, school-based approach called Life Skills Training (LST). LST is designed to target a broad array of etiologic factors through components that teach drug resistance skills, norm-setting, self-management skills, and general social skills. Studies testing this approach show that it can cut tobacco, alcohol, and marijuana use among junior high school students by half. The LST approach not only reduces onset and early experimental drug use but also decreases escalation to more serious levels of drug involvement in terms of both the frequency and amount of a particular form of drug use, as well as with respect to the use of other classes of drugs. Moreover, research shows that this approach is effective when taught by different program providers and with different populations. A major challenge concerns how to take evidence-based programs such as LST to scale while maintaining their integrity and effectiveness. Findings supporting the effectiveness of the LST approach will be summarized, and initial efforts to move from research to practice will be discussed.

Youth-Focused Media To Prevent Substance Use
John K. Worden, Ph.D. 

The purpose of this research project is to develop and test a program of mass media messages designed to reduce regular cigarette and marijuana use among adolescents. The target population is a diverse sample of young people maturing from grades 4 to 5 to grades 7 to 8 during the intervention. Television and radio messages are developed in a variety of formats using diagnostic and formative research with youth in the target group. The 4-year campaign is placed as paid advertising in a media market representing both urban and nonurban youth. School surveys of cigarette and marijuana beliefs and behaviors are conducted in this area and in a comparison area before and after the campaign. This presentation will give an overview of the study and highlight the unique method of message development that involves target audience research, participation by experts in substance use prevention, and media design and production by creative advertising people.

Good Behavior Game/Mastery Learning
Nicholas S. Ialongo, Ph.D.

The speakers will examine the immediate and longer term impacts of the second-generation Johns Hopkins Prevention Intervention Center field trial. There will be a particular focus on the effects of a universal, first-grade, classroom-based, preventive intervention designed to reduce the risk of antisocial behavior and drug use. This intervention featured two primary components: The first sought to reduce the risk for later antisocial behavior and drug use by enhancing teachers' behavior management skills; the second sought to enhance achievement by targeting the teachers' reading and mathematics instructional practices. The basis for the classroom behavior management component was the Good Behavior Game (Barrish, Saunders, and Wolfe, 1969). The principles underlying the reading and mathematics instructional component were derived from Mastery Learning (Bloom, 1982). At age 12, relative to controls, children who received the classroom intervention had significantly lower ratings from their teachers in terms of conduct problems. They were also significantly less likely than control children to meet diagnostic criteria for conduct disorder and to have been suspended from school in the past year. In addition, children who received the classroom intervention were less likely to have experimented with smoking. These results, although incomplete and in need of replication, lend support for targeting the early risk behaviors for antisocial behavior and substance use in the first-grade classroom. 

Palo Alto Summit on Improving the Prevalence of Successful Adolescence
Anthony Biglan, Ph.D.

The speaker will provide an overview of a year-long effort to forge a future research and practice agenda on the prevention of substance abuse and other problem behaviors, known as the Palo Alto Summit. The presentation will summarize evidence gathered through the project showing that a small proportion of youth engage in numerous problem behaviors, which account for a large proportion of these problems and of many problematic health outcomes. Evidence of the substantial costs to society associated with these behaviors and outcomes, as well as interventions that have been found to be effective in targeting young people who have developed multiple problem behaviors, will be presented. The implications of this analysis for the prevention of drug abuse will be discussed.

Plenary Panel IV: Building Multicomponent Community Programs

The Adolescent Transitions Program: A Multilevel, Family-Centered Preventive Intervention in Schools
Kathryn Kavanagh, Ph.D.

The speaker will present information about the implementation of a tiered strategy of preventive interventions, the Adolescent Transitions Program, in a population of diverse families within a school setting and the results of the research so far. The utility of the Family Check-Up as a motivational tool and mechanism for collaboration with parents will be highlighted. The benefits of family work within schools will be discussed in terms of improved assessment/screening capabilities and intervention opportunities. The speaker also will address some of the problems in becoming a part of a school and working both within and outside its boundaries, which offers many challenges to collaboration and the ability to ensure family confidentiality. Strategies to meet these challenges will be presented. Ideas for future directions for preventive interventions in schools and for increasing the numbers of parents participating in these preventive intervention opportunities will be shared.

• Dishion TJ, Kavanagh K. (2000) A multilevel approach to family-centered prevention in schools: Process and outcome. Addictive Behaviors 25(6):899-911.
• Dishion TJ, McCord J, Poulin F. (1999) When interventions harm; peer groups and problem behavior. American Psychologist 54(9):735-764.

The Community Action for Successful Youth Project: Community Builders and the Prevention of Problem Behaviors Among Middle Schoolers
Carol W. Metzler, Ph.D.

Research shows that monitoring the activities of early adolescents, setting and enforcing clear rules, and reinforcing prosocial behavior are essential for ensuring young people's academic and social success. The Community Action for Successful Youth (CASY) Project developed and tested a comprehensive approach to assisting parents, schools, and communities in improving the monitoring and guidance of middle-school youth. Dubbed "Community Builders," the CASY Project intervention involved multiple components in the community, school, and family: (1) community-level strategic planning, community organizing, and assistance with obtaining funding for programs; (2) assistance to schools in improving their behavior management practices; (3) development of free, supervised after-school programs on school grounds; (4) direct mail and parent-child homework activities to promote effective parenting; and (5) establishment of a parent training program and referral system for at-risk families. In this presentation, the components of the intervention, their effects, challenges to implementation, and lessons learned will be described.

• Metzler CW, Biglan A, Ary DV, Li F. (1998) The stability and validity of early adolescents' reports of parenting practices constructs. Journal of Family Psychology 12(4):600-619.
• Metzler CW, Taylor TK, Gunn B, Fowler RC, Biglan A, Ary DV. (1998) A comprehensive approach to the prevention of behavior problems: Integrating effective practices to strengthen behavior management programs in schools. Effective School Practices 17(2):8-24.

Community Readiness, Media, and Schools
Michael D. Slater, Ph.D.

Community Action for Drug Prevention is a multilevel intervention trial incorporating community readiness training workshops, community- and school-level media, and an in-school drug abuse prevention program. The media effort provides community prevention leaders with media training and materials that support community action efforts and help ensure that the community reinforces the messages received by youth in schools. By the conclusion of the intervention (in fall 2003), this multilevel intervention will have been fielded in eight treatment communities around the United States, with comparison data being collected in eight control communities. In addition, in each intervention and control community, one middle school receives the All-Stars in-school prevention curriculum, and one does not. This design permits examination of community readiness/media intervention effects in increasing the effect of an in-school prevention curriculum as well as in influencing youth in the absence of an in-school curriculum. Lessons learned to date will be discussed.

• Edwards RW, Thurman PJ, Plested B, Oetting ER, Swanson L. (2000) Community readiness: Research to practice. Journal of Community Psychology 28:291-307.
• Slater MD, Kelly K, Edwards RW. (2000) Integrating social marketing, community readiness, and media advocacy in community-based prevention efforts. Social Marketing Quarterly 6:125-137.

Families and Schools Together
Lynn McDonald, M.S.W., Ph.D.

Families and Schools Together (FAST) involves outreach to and the engagement of whole families in multifamily groups to build relationships important at several levels of the youth's social ecology. Rather than delivering treatment or instruction, local teams of parents, youth, and professionals, who are culturally representative and collaborative, are trained to plan and facilitate family evenings at schools with meals, songs, and communication games. The FAST team structures repetitive, positive interactions sequenced in dyads (parent to youth, parent to parent) and in small groups (the youth's family, peer groups for parents, peer groups for youth). FAST activities apply theory and research from family stress, family systems, and community development in age-appropriate formats attractive to difficult-to-reach parents of at-risk youth. Participation in six weekly sessions has predictable results in systematically strengthening the social capital of youth from low-income communities. Of families who attend one FAST session, 80 percent complete six of the eight sessions. These retention rates hold across the inner city, rural Indian Nations, and suburban environments. Recently completed experimental studies with 1- and 2-year followups with schoolteachers blinded to condition indicate that the positive effects of FAST hold over time on academic competence, academic performance, social skills, and maladaptive behaviors (CBCL). FAST has an infrastructure for program replication, using trainers who conduct multiple site visits of new programs. The trainers conduct process and outcome evaluations of each new pilot. FAST has replications in more than 600 sites in 38 States and five countries, including six statewide initiatives.