Drug Abuse Prevention

Research Findings from February, 2004 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Prevalence and Development of Psychiatric and Substance Use Disorders in Childhood and Adolescence

The authors used longitudinal data from a representative community sample of 1420 nine through sixteen year olds, to describe the prevalence and continuity of psychiatric disorders over time. Several significant findings were reported. By age 16, over a third (36.7%) of subjects met DSM-IV criteria for one or more disorders, and those with one disorder were 3 times more likely to have the same or another diagnosis at later waves. Rates of comorbidity were high, with one quarter (25.5%) diagnosed with 2 or more disorders at one time. Almost all disorders showed significant rates of continuity over time. Continuity from one diagnosis to another was significant between anxiety and depressive disorders, and from anxiety and conduct disorder to substance abuse, in girls. Substance use disorders increased with age and were more prevalent in boys than girls. The sample, while representative, does not represent the American population, but prevalence rates were comparable to those in several other studies. The notable points from this study relate particularly to the findings regarding continuity: that in a representative sample, only anxiety and conduct disorders predicted substance use disorders, and only in girls. This has important implications for improving our understanding of the etiology of adolescent drug abuse, for identifying those children at particular risk, and for developing and testing effective childhood interventions to prevent later drug abuse. Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., and Angold, A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch Gen Psychiatry, 60, pp. 837-844, 2003.

Children's Proactive and Reactive Aggressive Behaviors Can be Manipulated

Reactive aggression includes hostile, "hot-blooded" and defensive behavior, generally directed at someone or something perceived as a threat. Proactive aggression is generally goal related, involves unemotional and "cold-blooded" behavior that is oriented toward power or dominance, and involves little physiological arousal. This study assessed the effectiveness of two behavior manipulations for the purpose of differentially lowering reactive and proactive aggression in children. Fifty males between the ages of 10 and 12 were selected to play pinball in competition for points against an unknown peer whose responses were actually controlled by the experimenter. Participants could exhibit different levels of aggression towards the unknown peer by : 1) sending an annoying noise; 2) interfering with the opponent's game; or 3) offering a pro-social behavior. After playing five rounds, participants were randomly assigned to two groups: 1) reactive anger manipulation group, where trained instructors helped participants to practice distraction and relaxation techniques and alternative behaviors to aggression; or 2) positive instrumental manipulation group, where trained instructors provided rewards and reinforcement for not using proactive aggression, emphasizing the importance of team-work, taking turns, and noninterference. Then the participants played pinball for another five rounds. Results indicate that positive instrumental manipulation significantly lowered aggressive responses for both reactive and proactive behavior in children. Reactive anger manipulation did not produce similar effects. Phillips, N.C., and Lochman, J.E. Experimentally Manipulated Change in Children's Proactive and Reactive Aggressive Behavior. Aggressive Behavior, 29, pp. 215-227, 2003.

Large-Scale Trial of Revised Project ALERT

Project ALERT was originally designed to use interactive teaching methods to motivate middle-school students against using drugs, and to give them the skills they need to translate that motivation into effective resistance behavior. The initial evaluation of Project ALERT found that the program effectively prevented or reduced both cigarette and marijuana use among eighth-grade students, although committed cigarette smokers did not reduce or stop smoking. Project ALERT also had a modest initial impact on alcohol use, but this disappeared by 8th grade. In an effort to improve the program's effectiveness and generalizability, Project ALERT was revised to focus primarily on smoking cessation and alcohol use, and involve parents in substance-use prevention. The revised version of this program was tested in a randomized trial including a wide variety of schools in urban, small-town, and rural Midwestern communities. The revised version of the curriculum produced the following effects: 1) significant reductions in cigarette initiation (ever use), current use (use in past month), and regular use (weekly use); 2) significant reduction in marijuana initiation, and moderate but nonsignificant reductions in current and regular marijuana use; and 3) nonsignificant reductions on alcohol initiation and current use. Ellickson, P. L., Daniel F., McCaffrey, Ghosh-Dastidar, B. and Longshore, D.L. New Inroads in Preventing Adolescent Drug Use: Results from a Large-Scale Trial of Project ALERT in Middle Schools. American Journal of Public Health, 93(11), pp. 1830-1836, 2003.

Extent of National Awareness for Principles of School Prevention Effectiveness

The U.S. Department of Education's Principles of Effectiveness require recipients of Safe and Drug-Free Schools and Community Act funds 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. A survey of school personnel showed that levels of awareness of these principles were relatively low at both school district (59.6% or 95% CI = 56.7%-62.5%) and individual school (22.3% or 95% CI = 20.2% - 24.4%) levels. Therefore greater communication about these principles to school districts is needed, and in turn, this should increase communication between school districts and school-level substance use and prevention staff. Simmons-Rudolph, A.P., Ennett, S.T., Ringwalt, C.L., Rohrback, 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.

Factors Associated with Teachers' Adherence to Prevention Curricula

Teachers' fidelity in implementing substance use prevention curricula is widely considered desirable, and is linked empirically to prevention effectiveness. Factors pertinent to teachers' adherence to curriculum guides were explored using data from a nationally representative sample of 1905 substance use prevention teachers in the nation's public and private schools. Results suggest that about one-fifth of the teachers did not use a curriculum guide at all; while only 15% reported that they followed one very closely. Adherence was positively associated with: 1) teachers' discretion in their coverage of prevention lessons; 2) beliefs concerning the effectiveness of the most recent training they received and the curricula they taught; and 3) their principal's level of support for substance use prevention. The authors conclude that some degree of curriculum adaptation is inevitable, but adherence to curriculum guides may be improved through teacher training. Ringwalt, C.L., Ennett, S.T., Johnson, R., Rohrbach, L.A., Simons-Rudolph, A. P., Vincus, A.A. and Thorne, J. Factors Associated with Fidelity to Substance Use Prevention Curriculum Guides. Health Education and Behavior, 30, pp. 375-391, 2003.

Relevant Biological Background Knowledge Enables Children to Learn About the Mechanisms of Drug Action

To prevent early drug and alcohol experimentation, experts suggest that prevention efforts should be initiated in elementary school. However, there has been little systematic assessment of the knowledge that elementary school-aged children need in order to understand the risks associated with substance abuse. This study sought to determine whether children are better able to learn about the physiological mechanisms of drug action if they have relevant biological background knowledge than if they do not. The participants were 363 third- to sixth-grade students from 24 classrooms in four Catholic schools in an ethnically diverse metropolitan area who were enrolled in a study of the efficacy of a drug-education curriculum designed to teach a causally coherent explanation of how alcohol and cocaine effect behavior. All children took pre- and posttests designed to measure knowledge about alcohol and cocaine, attitudes and intentions toward their use, and knowledge of the brain and circulatory system. The children were randomly assigned to four small groups within same-grade groupings, and one researcher was randomly assigned to oversee each group. The groups received one of four curricula: (1) basic theory of drug action, (2) biologically enhanced version of the theory, (3) version confronting smoking myths, or (4) control group. Results indicated that biological knowledge was greater among older students, but on the whole, elementary school-aged children may not have sufficient grasp of general biological information to apply it to a specific case like the circulation of drugs. Nevertheless, biological knowledge, especially knowledge of the brain's controlling functions, was positively associated with greater endorsement of central theories of drug action. Most importantly, the hypothesis that relevant biological knowledge would be associated with both concurrent drug knowledge and gains in drug knowledge following exposure to a drug and alcohol education curriculum was supported. Sigelman, C.K., Bridges, L.J., Sorongon, A.G., Rinehart, C.S., Brewster, A.B., and Wirtz, P. Biological Background Knowledge and Learning From a Drug and Alcohol Education Program. The Journal of Genetic Psychology, 164(2), pp. 133-152, 2003.

Curriculum Found To Be Effective, Culturally Grounded Approach to Prevention

The authors present findings from an effectiveness study of a school-base drug abuse prevention intervention developed for culturally diverse, urban middle school students. The 'keepin' it R.E.A.L.' curriculum consists of 10 lessons promoting antidrug norms and teaching resistance skills and other social skills, reinforced by booster activities and a media campaign. Three versions of the intervention were delivered: Mexican American, combined African American and European American, and Multicultural. The investigators hypothesized that: 1) the three culturally-grounded interventions would influence anti-drug attitudes and reduce drug use compared to the standard or existing intervention and 2) the greater the cultural matching between student background and intervention condition, the stronger the effect of the program (cultural matching hypothesis). Thirty-five middle schools were randomly assigned to 1 of the 3 versions or to the control group. A total of 6,035 students completed baseline and follow-up interviews over a two-year period. Analyses utilizing a generalized estimating equations approach suggest that the intervention was effective, with significant effects on gateway drug use as well as norms, attitudes, and resistance strategies. There was little support for the cultural matching hypothesis. Contrasts suggested that the Mexican American and Multicultural versions impacted the most outcomes. Hecht, M.L., Marsiglia, F.F., Elek, E., Wagstaff, D.A., Kulis, S., Dustman, P., and Miller-Day, M. Culturally Grounded Substance Use Prevention: An Evaluation of the keepin' it R.E.A.L. Curriculum. Prevention Science, 4(4), pp. 233-248, 2003.

Gateway Communications are Ineffective in Anti-Marijuana Campaigns

Successful anti-marijuana messages can be hypothesized to have two types of effects: persuasion effects that result in change in people's beliefs about using marijuana, and priming effects, that strengthen the correlation between beliefs and associated variables such as attitude toward and intention to use a drug. This study examined different sets of anti-drug advertisements for persuasion and priming effects focusing on the effectiveness of the gateway argument in anti-marijuana interventions. The belief that marijuana is a gateway to other drugs was selected since it often is endorsed by campaign planning officials and health educators. A sample of 418 middle and high school students was randomly assigned to a control video or one of three intervention conditions two of which included the gateway message in either an explicit or implicit way. Results did not support the use of the gateway belief in anti-marijuana interventions. No clear persuasion or priming effects were found for any of the ad sequences. In fact, in comparison to the control condition, adolescents in the explicit gateway condition tended to agree less with the gateway message and displayed weaker correlations between anti-marijuana beliefs and their attitude toward marijuana use. For most youth there was no room for the ads to lower intentions to use marijuana since they did not intend to use. For higher risk youth many of whom presumably had used marijuana but had not gone on to use other drugs, the gateway message runs counter to their experience and is rejected. These results suggest that the gateway message should not be used in anti-drug interventions. Yzer, M.C., Cappella, J.N, Fishbein, M., Hornik R. and Ahern, R.K. The Effectiveness of Gateway Communications in Anti-Marijuana Campaigns. Journal of Health Communication, 8(2), pp. 129-143, 2003.

Predictors of Smoking Among Rural Adolescents

This study investigated a model of social and cognitive cross-sectional predictors of smoking, with a focus on rural adolescents. Gender-specific differences in etiology were examined by testing the same model separately for boys and girls. Seventh graders (N=1,673) residing in northeastern Iowa self-reported smoking, peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, life skills, prosmoking attitudes, risk-taking tendency, and family management practices. Data were collected during a class period in 36 junior high schools. Peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, prosmoking attitudes, and risk-taking tendency were associated with smoking. Notably, family management skills and life skills were associated with current smoking for girls only. Based on the results of the present study and on previous research, smoking prevention programs for rural adolescents should incorporate normative education, drug refusal training, parent skills training, and competence enhancement skills training, strategies that have been successful with urban and suburban populations. Epstein, J.A., Botvin, G.J., and Spoth, R. Predicting Smoking among Rural Adolescents: Social and Cognitive Processes. Nicotine and Tobacco Research, 5, pp. 485-491, 2003.

Project Towards No Drug Abuse: Two-Year Outcomes of a Trial That Compares Health Educator Delivery To Self-Instruction

This paper describes the 2-year follow-up of a 12-session version of an indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth who are at high risk for dropout and drug abuse to complete their high school education. However, a health educator-led program is much more interactive. In this study the effects of self-instruction versus health educator-led versions of this curriculum were examined. Eighteen schools were randomly assigned by block to one of three conditions-standard care (control), health educator-led classroom program, and self-instruction classroom program. Subjects were followed up 1 and 2 years later. Two-year results are reported here. Results showed that the self-instruction program produced no behavioral effects relative to the standard care control condition. The 2-year follow-up results indicated maintenance of program effects on cigarette smoking and hard drug use in the health educator-led version. It was concluded that Project TND shows maintenance of effects on some drugs 2 years after program implementation, when most youth were young adults. More work is needed to learn how to maintain effects across substances. Continued exploration of modalities of implementation may be helpful. Sussman, S., Sun, P., McCuller, W.J., and Dent, C.W. Preventive Medicine, 37(2), pp. 155-162, 2003.

Prevention Program Slows Increases in Drug Use and Delinquency

This is a study of outcomes of the Preparing for the Drug Free Years Program (PDFY), a universal family-based prevention intervention proven to be effective in previous studies. This study extends prior research on the program, which has predominantly addressed process outcomes and intervention efficacy with regard to specific substances, by examining growth over time in polysubstance use and non-drug delinquency. Latent growth curve modeling was used to analyze 5 waves of data collected from 429 rural adolescents. Results showed that adolescents assigned to the PDFY condition had a slower rate of linear increase over time in both substance use and delinquency compared with adolescents assigned to the control condition. Moreover, pretest level of delinquency was a reliable, positive predictor of growth in substance use, whereas pretest level of substance use did not predict growth in delinquency. Mason, W.A., Kosterman, R., Hawkins, J.D., Haggerty, K.P., and Spoth, R.L. Reducing Adolescents' Growth in Substance Use and Delinquency: Randomized Trial Effects of a Parent-Training Prevention Intervention. Prevention Science, 4(3), pp. 203-212, 2003.

Cognitive Predictors of Children's Attitudes Toward Alcohol and Cocaine

Using a multi-ethnic sample of 217 elementary school children, this study looked at age-related differences in attitudes and intentions regarding alcohol and cocaine use. It also examined possible cognitive underpinnings of these attitudes and intentions, such as basic familiarity with each substance, expectancies about short-term psychological and behavioral effects, beliefs about long-term health effects, and causal understanding of drug action. Findings revealed that as they get older, children increasingly report familiarity with alcohol and cocaine and they understand that their effects are in large part brain-mediated rather than due to a drug's direct effects on peripheral parts of the body. Although older children were more likely than younger children to endorse positive expectancy statements about alcohol and cocaine, negative expectancies prevailed at all ages and did not weaken with age. The knowledge, belief, and understanding variables examined in this study were associated with attitudes toward cocaine use, but not alcohol. Structural equation modeling involving these variables revealed that cognitive predictors had no significant indirect associations with cocaine use intentions through attitudes. Instead, cognitions predicted attitudes and attitudes, in turn, predicted intentions of cocaine use. Whereas most studies have emphasized associations between expectancies and attitudes toward drug use, this study suggests that other sorts of cognitions deserve further exploration. The findings also suggest that it may be beneficial to supplement drug prevention efforts with an approach that targets general knowledge about drugs, knowledge of drugs' long-term effects, and causal understanding of how drugs alter brain functioning. Bridges, L.J., Sigelman, C.K., Brewster, A.B., Leach, D.B., Mack, K.L., Rinehart, C.S., and Sorongon, A.G. Cognitive Predictors of Children's Attitudes Toward Alcohol and Cocaine. Journal of Child and Adolescent Substance Abuse, 12(3), pp. 19-44, 2003.

Project Towards No Drug Abuse: Two-Year Outcomes of a Trial That Compares Health Educator Delivery To Self-Instruction

This paper describes the 2-year follow-up of a 12-session version of an indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth who are at high risk for dropout and drug abuse to complete their high school education. However, a health educator-led program is much more interactive. In this study the effects of self-instruction versus health educator-led versions of this curriculum were examined. Eighteen schools were randomly assigned by block to one of three conditions-standard care (control), health educator-led classroom program, and self-instruction classroom program. Subjects were followed up 1 and 2 years later. Two-year results are reported here. Results showed that the self-instruction program produced no behavioral effects relative to the standard care control condition. The 2-year follow-up results indicated maintenance of program effects on cigarette smoking and hard drug use in the health educator-led version. It was concluded that Project TND shows maintenance of effects on some drugs 2 years after program implementation, when most youth were young adults. More work is needed to learn how to maintain effects across substances. Continued exploration of modalities of implementation may be helpful. Sussman, S., Sun, P., McCuller, W.J., and Dent, C.W. Preventive Medicine, 37(2), pp. 155-162, 2003.

Family-Based Interventions for Substance Use and Misuse Prevention

Because "substance abuse" is a "family disease" of lifestyle, including both genetic and family environmental causes, effective family strengthening prevention programs should be included in all comprehensive substance abuse prevention activities. This article presents reviews of causal models of substance use and evidence-based practices. National searches by the authors suggest that there is sufficient research evidence to support broad dissemination of five highly effective family strengthening approaches (e.g. behavioral parent training, family skills training, in-home family support, brief family therapy, and family education). Additionally, family approaches have average effect sizes two to nine times larger than child-only prevention approaches. Comprehensive prevention programs combining both approaches produced much larger effect sizes. Kumpfer, K.L., Alvarado, R., and Whiteside, H.O. Family-based Interventions for Substance Use and Misuse Prevention. Substance Abuse and Misuse, 38(11-13), pp. 1759-1787, 2003.

Pilot Study Findings of a Preventive Intervention with African American Families

The authors report the results of a pilot of the Strengthening Families Program: For Parents and Youth 10-14 with a sample of African American families with young adolescents (n=110). This study was undertaken to address the gap in knowledge regarding the efficacy of substance use prevention programs with African American populations. Participants were randomized to an intervention and a waitlist control group. Outcome data were collected from all participants by telephone survey before and after the six weekly 2-hour intervention sessions, then once more after the program was offered to the waitlist control group. Implementation feasibility clearly was demonstrated and observer ratings showed high adherence to the intervention protocol. Trial findings showed positive results for intervention-targeted child behaviors, such as setting goals and managing stress. The intervention did not have effects on targeted parenting skills expected to mediate child skill-building. Spoth, R., Guyll, M., Chao, W., and Molgaard, V. Exploratory Study of a Preventive Intervention with General Population African American Families. Journal of Early Adolescence, 23(4), pp. 435-468, 2003.

Development of A Culturally Grounded Prevention Approach

Research has shown that students respond more favorably to drug prevention programs when they see their culture and themselves represented in the prevention message. Additionally, studies highlight important ethnic differences in drug behaviors and attitudes, indicating that students' ethnic culture should be considered in the creation of prevention programs. Still there are few effective, culturally grounded programs like the 'keepin' it R.E.A.L.' curriculum, designed for ethnically diverse seventh grade students residing in a large southwestern city. This curriculum was developed by incorporating several theoretical perspectives such as Communication Competence Theory, Narrative Theory, and the Focus Theory of Norms and culturally grounding through the use of youths narratives that reflect their local, youth, and ethnic cultures. This descriptive paper illustrates the process of curriculum design, focusing on the methods used to ensure cultural grounding. Gosin, M., Marsiglia, F.F., and Hecht, M.L. Keepin' it R.E.A.L.: A Drug Resistance Curriculum Tailored to the Strengths and Needs of Pre-Adolescents of the Southwest. Journal of Drug Education, 33(2), pp. 119-142, 2003.

School-based Programs for Social, Emotional and Academic Development

A comprehensive mission for schools is to educate students to be informed, responsible, socially skilled, healthy, caring, and contributing citizens. To support this mission a growing number of school-based prevention and youth development programs have been developed. However, the impact of these programs is limited because of insufficient coordination with other components of school operations and inattention to implementation and evaluation factors necessary for strong program impact and sustainability. Widespread implementation of beneficial prevention programming requires development of research-based, comprehensive school reform models that improve social, health, and academic outcomes; educational policies that demand accountability for fostering children's full development; professional development that prepares and supports educators to implement programs effectively; and systematic monitoring and evaluation to guide school improvement. Greenberg, M. T., Weissberg, R.P., O'Brien, M.U., Zins, J.E., Fredericks, L., Resnik, H., and Elias M.J. Enhancing School-Based Prevention and Youth Development Through Coordinated Social, Emotional, and Academic Learning. American Psychologist, 58(6-7), pp. 466-474, 2003.

Best Characteristics of Adolescent Gateway Drug Prevention Programs Identified

This paper identifies the best characteristics of gateway prevention programs that prevent or reduce adolescents' use of alcohol, tobacco, and marijuana. A comprehensive literature review of the performance of school-, family-, and community-based drug prevention programs covering the last 20 years was conducted to identify the best characteristics of successful drug prevention programs: involving parents; teaching life and resistance skills and normative education; enacting laws and policies against adolescent drug use; encouraging peer participation; conducting a media campaign; and retaining program participants. School administrators, parents, and community leaders can use the knowledge in this paper to design drug prevention programs that accommodate specific risk factors and types of gateway drug use by adolescents. Montoya, I.D., Atkinson, J., and McFaden, W.C. Best Characteristics of Adolescent Gateway Drug Prevention Programs. Journal of Addictions Nursing, 14, pp. 75-83, 2003.