This report provides a multidimensional framework for understanding the meaning of evidence in prevention science. Six themes comprise the framework, each with impact on the meaning of evidence. (1) There are rigorous prevention scientific strategies now in use; each has shared but also unique requirements for the meaning of evidence. Some are directed at individuals, others at small social contexts, others at larger societal structures. (2) The phases of prevention research have shared but also unique requirements for evidence. These include efficacy, effectiveness, sustainability, going-to-scale, and sustaining programs systemwide. (3) Prevention programs address different segments of the population defined by levels of risk: the total population; a smaller subpopulation at increased risk; or a still smaller subpopulation at very high risk. The levels influence the meaning of evidence. (4) Economic analysis and economic evidence must become a central part of prevention research. These are needed for appropriate policy decision making and for assessing long-term benefits. (5) Collaboration is required for rigor in prevention research: including researchers, but also policy makers, program advocates and leaders, and community and institutional leaders. Broad ownership is critical for implementing rigorous research and for sustaining program fidelity. (6) Acceptance of a multidimensional framework for understanding "evidence" is essential across those agencies and institutions that carry out and/or use prevention science. The more widely the vision of the prevention field is shared, and the more the various qualities and rules of evidence are accepted and implemented, the better the quality will be of prevention research and programs.
The Community Youth Development Study (CYDS) is a community-randomized trial of the Communities That Care (CTC) prevention system. Using data from 2001 and 2004 administrations of the Community Key Informant Survey, this study reports changes in three community-level outcomes 1.5 years after implementing CTC in 12 communities. Respondents consisted of 534 community leaders in 24 communities representing multiple sectors within each community. Results of multilevel analyses controlling for respondent and community characteristics indicated that (a) CTC and control communities had comparable baseline levels of adopting a science-based approach to prevention, collaboration across community sectors, and collaboration regarding specific prevention activities; and (b) CTC communities exhibited significantly greater increases in these outcomes between 2001 and 2004 relative to control communities. These results suggest that CTC was successful in changing proximal system outcomes theorized to lead to more effective prevention services and, ultimately, reduced risk, enhanced protection, and improved adolescent health and behavior outcomes.
A hierarchical linear model was used to estimate the individual and school level effects for marijuana use among a national sample of 12th-grade students. School effects were small in comparison to individual level effects, accounting for 2.9% of the variance in marijuana use. At the individual level, perceived harm, perceived availability, and their interaction were significant predictors, each of which varied randomly across schools. Among two school-level predictors, the normative environment for perceived harm was not significant, but normative perceived availability predicted level of marijuana use. The effect of perceived availability on marijuana use was stronger in larger, compared to smaller communities. Results are discussed in light of the use of random regression methods for identifying school-specific patterns of risk and protection for prevention planning.
The link between adept parental monitoring (PM) and later positive behavioral and health outcomes already has motivated intervention trials, but questions remain about which specific facets and mechanisms of PM make a difference. Our current research questions concern fundamental male-female differences in PM facets as manifest in a US cohort, re-sampled each year at age 12 through 17 years during an interval from 2004 to 2009. We hypothesized emergence, by mid-adolescence, of a specific male-female difference in a "limit time with friends" (LTF) facet of adept PM, with overall PM levels held constant. The data, arranged using a "mutoscope" approach, are from six successive nationally representative independent cross-sectional sample surveys of the cohort, with each adolescent measured only once, via a multi-item PM module nested within the larger survey. Estimates and tests of male-female differences are from a "multiple indicators, multiple causes" latent structure model appropriate for complex survey data. In evidence consistent with the advance hypothesis and with PM level held constant via the model, the LTF facet generally was more relaxed for boys as compared to girls, in a difference that emerged by mid-adolescence, possibly due to greater LTF constraints for girls at mid-adolescence. This research adds to the knowledge base about male-female similarities and differences in facets of PM. As a specific PM facet, LTF might function as a mechanism suitable for deliberate intervention and as a possible specific target in "micro-trials" of new prevention research. We acknowledge limitations such as omitted variables, including social media effects, not measured in this investigation's national surveys, but of potential importance in future research on peer influence as might have more distal parenting determinants.
Prime Time, a youth development intervention, aims to reduce multiple risk behaviors among adolescent girls seeking clinic services who are at high risk for pregnancy. The purpose of the current study was to examine whether Prime Time involvement produced changes in relational aggression, physical violence, and related psychosocial and behavioral outcomes. Qualitative case exemplars illustrated social contexts of intervention participants with differing longitudinal patterns of relational aggression and physical violence. Data were from a randomized efficacy trial with 13-17 year-old girls (n = 253) meeting specified risk criteria. Intervention participants were involved in Prime Time and usual clinic services for 18 months, control participants received usual clinic services. Participants in the current study completed self-report surveys at baseline and 18 months following enrollment. Outcomes analyses revealed significantly lower levels of relational aggression perpetration in the intervention group versus controls. In contrast, Prime Time involvement did not result in significant reductions in physical violence. Exploratory dose-response analyses indicated that reductions in relational aggression may have been most pronounced among girls actively involved in Prime Time case management and peer leadership activities. Qualitative findings suggested that the intervention's emphasis on modeling and building supportive relationships contributed to reductions in relational aggression. This study contributes to what has been a very limited evidence base regarding effective approaches to preventing violence among high-risk adolescent girls. Findings suggest that offering youth development interventions through clinic settings hold promise in reducing violence risk among vulnerable youth.
Recently, adaptive interventions have emerged as a new perspective on prevention and treatment. Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed.
We examined historical change in the association between adolescent deviance proneness and marijuana use using 26 years (from 1979 through 2004) of national 12th grade data from the Monitoring the Future (MTF) study. "Deviance proneness" was measured using a latent factor model of behavioral and personality characteristics that underlie both substance use and antisocial disorders. Marijuana use was measured both in terms of annual frequency of use and degree of involvement with marijuana. Separate within-gender structural equation models were used to determine whether links between deviance proneness and marijuana use were consistently significant and invariant in magnitude across 13 two-year historical cohorts. Overall results affirmed the established association between adolescent deviance proneness and both the frequency of marijuana use as well as regular use. Among male youth, the size of the association between deviance proneness and marijuana use was significantly smaller at the cohort of lowest population prevalence (1991/92) compared to cohorts marking peaks in marijuana use prevalence, thus suggesting a "softening" historical trend. By contrast, the prediction of female marijuana use from deviance proneness was not consistently related to historical shifts in population prevalence of marijuana use. Study findings point to the utility of risk-focused prevention programming that targets early precursors of both antisocial and substance use disorders.
Public health efforts to reduce the harms related to tobacco use currently include a significant emphasis on anti-smoking media campaigns. This paper provides (a) data on the overall extent of exposure to anti-smoking media among American youth from 1997 to 2001, (b) an appraisal of general youth reactions to such advertising, and (c) an examination of how exposure levels and reactions vary by socio-demographic characteristics. Data were obtained from the Monitoring the Future study, an ongoing nationwide study of youth. Data were collected each year from nationally representative separate and nonoverlapping school samples of 8th, 10th, and 12th grade students (N = 29,724; 24,639; and 12,138, respectively). Self-reported levels of recalled exposure to both electronic and print anti-smoking advertising were measured, as well as the judged impact and perceived exaggeration of such advertising. Data indicate that significant increases in overall exposure to anti-smoking advertising occurred over the study time period. These increases were associated with (a) increases in the self-reported likelihood that anti-smoking advertising diminished the probability of individual smoking behaviors, and (b) increases in the perceived level to which anti-smoking advertising exaggerates the risks associated with smoking. Further, these trends were significantly associated with various characteristics-most notably, ethnicity, smoking behaviors, and residence in a state with an ongoing tobacco-control program having a media component.
Although cyberbullying is characterized by worrying prevalence rates and associated with a broad range of detrimental consequences, there is a lack of scientifically based and evaluated preventive strategies. Therefore, the present study introduces a theory-based cyberbullying prevention program (Media Heroes; German original: Medienhelden) and evaluates its effectiveness. In a pretest–posttest design (9-month interval), schools were asked to randomly assign their participating classes to either control or intervention group. Longitudinal data were available from 593 middle school students (M
Age = 13.3 years, 53 % girls) out of 35 classes, who provided information on cyberbullying behavior as well as socio-demographic and psychosocial variables. While the present results revealed worrying prevalence rates of cyberbullying in middle school, multilevel analyses clearly demonstrate the program’s effectiveness in reducing cyberbullying behavior within intervention classes in contrast to classes of the control group. Hence, this study presents a promising program which evidentially prevents cyberbullying in schools.
The No Child Left Behind Act mandates the implementation of evidence-based drug prevention curricula in the nation's schools. The purpose of this paper is to estimate changes in the prevalence of such curricula from 2005 to 2008. We surveyed school staff in a nationally representative sample of schools with middle school grades. Using a web-based approach to data collection that we supplemented by telephone calls, we secured data from 1892 schools for a response rate of 78.2%. We estimate that the prevalence of evidence-based drug prevention curricula rose from 42.6% in 2005 to 46.9% in 2008, and that the prevalence of schools that used these curricula most frequently increased from 22.7% to 25.9% over this period. In addition, the proportion of schools using locally developed curricula also rose, from 17.6% to 28.1%. This study suggests the success of efforts by the Office of Safe and Drug-Free Schools to increase the prevalence of evidence-based curricula, as well as the need to continue to track the prevalence of these curricula in response to any reductions in the Office's fiscal support for evidence-based drug prevention curricula in the nation's schools.
Youth depression is a significant and growing international public health problem. Youth who engage in high levels of delinquency are at particularly high risk for developing problems with depression. The present study examined the impact of a behavioral intervention designed to reduce delinquency (Multidimensional Treatment Foster Care; MTFC) compared to a group care intervention (GC; i.e., services as usual) on trajectories of depressive symptoms among adolescent girls in the juvenile justice system. MTFC has documented effects on preventing girls' recidivism, but its effects on preventing the normative rise in girls' depressive symptoms across adolescence have not been examined. This indicated prevention sample included 166 girls (13-17 years at T1) who had at least one criminal referral in the past 12 months and who were mandated to out-of-home care; girls were randomized to MTFC or GC. Intent-to-treat analyses examined the main effects of MTFC on depression symptoms and clinical cut-offs, and whether benefits were greatest for girls most at risk. Depressive symptom trajectories were specified in hierarchical linear growth models over a 2 year period using five waves of data at 6 month intervals. Depression clinical cut-off scores were specified as nonlinear probability growth models. Results showed significantly greater rates of deceleration for girls in MTFC versus GC for depressive symptoms and for clinical cut-off scores. The MTFC intervention also showed greater benefits for girls with higher levels of initial depressive symptoms. Possible mechanisms of effect are discussed, given MTFC's effectiveness on targeted and nontargeted outcomes.
A substantial challenge in improving public health is how to facilitate the local adoption of evidence-based interventions (EBIs). To do so, an important step is to build local stakeholders' knowledge and decision-making skills regarding the adoption and implementation of EBIs. One EBI delivery system, called PROSPER (PROmoting School-community-university Partnerships to Enhance Resilience), has effectively mobilized community prevention efforts, implemented prevention programming with quality, and consequently decreased youth substance abuse. While these results are encouraging, another objective is to increase local stakeholder knowledge of best practices for adoption, implementation and evaluation of EBIs. Using a mixed methods approach, we assessed local stakeholder knowledge of these best practices over 5 years, in 28 intervention and control communities. Results indicated that the PROSPER partnership model led to significant increases in expert knowledge regarding the selection, implementation, and evaluation of evidence-based interventions. Findings illustrate the limited programming knowledge possessed by members of local prevention efforts, the difficulty of complete knowledge transfer, and highlight one method for cultivating that knowledge.
Reducing youth access to commercial sources of alcohol is recognized as a necessary component of a comprehensive strategy to reduce underage drinking and alcohol-related problems. However, research on policy-relevant factors that may influence the commercial availability of alcohol to youth is limited. The present study examines characteristics of off-premise alcohol outlets that may affect alcohol sales to youth. Random alcohol purchase surveys (N = 385) were conducted in 45 Oregon communities in 2005. Underage-looking decoys who were 21 years old but did not carry IDs were able to purchase alcohol at 34% of the outlets approached. Purchase rates were highest at convenience (38%) and grocery (36%) stores but were relatively low (14%) at other types of outlets (e.g., liquor and drug stores). Alcohol purchases were less likely at stores that were participating in the Oregon Liquor Control Commission's Responsible Vendor Program (RVP), when sales clerks asked the decoys for their IDs, and at stores with a posted underage alcohol sale warning sign. Alcohol purchases were also inversely related to the number of sales clerks present in a store, but were not related to sales clerks' age and gender. Findings of this study suggest that more frequent compliance checks by law enforcement agents should target convenience and grocery stores, and owners of off-premise outlets should require training of all sales clerks to ensure reliable checks of young-looking patron IDs, and should post underage alcohol sales warning signs in clear view of patrons.
This study illustrates a method to evaluate mediational mechanisms in a longitudinal prevention trial, the Aban Aya Youth Project (AAYP). In previous studies, interventions of AAYP were found to be effective in reducing the growth of violence, substance use and unsafe sex among African American adolescents. In this article, we hypothesized that the effects of the interventions in reducing the growth of substance use behavior were achieved through their effects in changing intermediate processes such as behavioral intentions, attitudes toward the behavior, estimates of peers' behaviors, best friends' behaviors, and peer group pressure. In evaluating these mediational mechanisms, difficulties arise because the growth trajectories of the substance use outcome variable and some of the mediating variables were curvilinear. In addition, all of the multivariate mediational measures had planned missing data so that a score from the multiple items for a mediator could not be formed easily. In this article, we introduce a latent growth modeling (LGM) approach; namely, a two-domain LGM mediation model, in which the growth curves of the outcome and the mediator are simultaneously modeled and the mediation effects are evaluated. Results showed that the AAYP intervention effects on adolescent drug use were mediated by normative beliefs of prevalence estimates, friends' drug use behavior, perceived friends' encouragement to use, and attitudes toward the behavior.
While injuries are a leading health concern for Aboriginal populations, injury rates and types vary substantially across bands. The uniqueness of Aboriginal communities highlights the importance of collecting community-level injury surveillance data to assist with identifying local injury patterns, setting priorities for action and evaluating programs. Secwepemc First Nations communities in British Columbia, Canada, implemented the Injury Surveillance Project using the Aboriginal Community-Centered Injury Surveillance System. This paper presents findings from a community-based participatory process evaluation of the Injury Surveillance Project. Qualitative data collection methods were informed by OCAP (Ownership, Control, Access, and Possession) principles and included focus groups, interviews and document review. Results focused on lessons learned through the planning, implementation and management of the Injury Surveillance Project identifying lessons related to: project leadership and staff, training, project funding, initial project outcomes, and community readiness. Key findings included the central importance of a community-based and paced approach guided by OCAP principles, the key role of leadership and project champions, and the strongly collaborative relationships between the project communities. Findings may assist with successful implementation of community-based health surveillance in other settings and with other health issues and illustrate another path to self-determination for Aboriginal communities. The evaluation methods represent an example of a collaborative community-driven approach guided by OCAP principles necessary for work with Aboriginal communities.
Two media-based interventions designed to reduce adolescent marijuana use ran concurrently from 2005 to 2009. Both interventions used similar message strategies, emphasizing marijuana's inconsistency with personal aspirations and autonomy. "Be Under Your Own Influence" was a randomized community and school trial replicating and extending a successful earlier intervention of the same name (Slater et al. Health Education Research 21:157-167, 2006). "Above the Influence" is a continuing national television, radio, and print campaign sponsored by the Office of National Drug Control Policy (ONDCP). This study assessed the simultaneous impact of the interventions in the 20 U.S. communities. Results indicate that earlier effects of the "Be Under Your Own Influence" intervention replicated only in part and that the most plausible explanation of the weaker effects is high exposure to the similar but more extensive ONDCP "Above the Influence" national campaign. Self-reported exposure to the ONDCP campaign predicted reduced marijuana use, and analyses partially support indirect effects of the two campaigns via aspirations and autonomy.
This study reports findings from a systematic review and meta-analysis of literature examining the effects of school dropout prevention and intervention programs on students' school absenteeism outcomes. The meta-analysis synthesized 74 effect sizes measuring posttest differences in school absenteeism outcomes for youth enrolled in dropout prevention programs relative to a comparison group. Although results from randomized controlled trials indicated significant beneficial program effects, findings from quasi-experimental studies indicated no significant beneficial or detrimental effects. Examination of study characteristics suggested that dropout programs may have beneficial effects on school absenteeism among primarily male samples, and younger samples. Although no single type of intervention program was consistently more effective than others, vocational oriented and supplemental academic training programs showed some promise. However, the inconsistency in results and the possibility of small study bias mean the quality of evidence in this literature is low; at this time there is not enough evidence to conclude that dropout prevention programs have a universal impact on youth's school absenteeism outcomes.
This paper describes the empirical and theoretical development of a workplace training program to help reduce/prevent employee alcohol and drug abuse and enhance aspects of the work group environment that support ongoing prevention. The paper (1) examines the changing social context of the workplace (e.g., teamwork, privacy issues) as relevant for prevention, (2) reviews studies that assess risks and protective factors in employee substance abuse (work environment, group processes, and employee attitudes), (3) provides a conceptual model that focuses on work group processes (enabling, neutralization of deviance) as the locus of prevention efforts, (4) describes an enhanced team-oriented training that was derived from previous research and the conceptual model, and (5) describes potential applications of the program. It is suggested that the research and conceptual model may help prevention scientists to assess the organizational context of any workplace prevention strategy. The need for this team-oriented approach may be greater among employees who experience psychosocial risks such as workplace drinking climates, social alienation, and policies that emphasize deterrence (drug testing) over educative prevention. Limitations of the model are also discussed.
Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.
This study examined long-term follow-up data from a large-scale randomized trial to determine the extent to which participation in a school-based drug abuse prevention program during junior high school led to less risky driving among high school students. Self-report data collected from students in the 7th, 10th, and 12th grades were matched by name to students' department of motor vehicles (DMV) records at the end of high school. The DMV data included the total number of violations on students' driving records as well as the number of "points" that indicate the frequency and severity of the violations. A series of logistic regression analyses revealed that males were more likely to have violations and points on their driving records than females, and regular alcohol users were more likely to have violations and points than those who did not use alcohol regularly. Controlling for gender and alcohol use, students who received the drug prevention program during junior high school were less likely to have violations and points on their driving records relative to control group participants that did not receive the prevention program. Findings indicated that antidrinking attitudes mediated the effect of the intervention on driving violations, but not points. These results support the hypothesis that the behavioral effects of competence-enhancement prevention programs can extend to risk behaviors beyond the initial focus of intervention, such as risky driving.
In this study we estimate the proportion of the nation's middle school teachers who have adapted substance abuse curricula in response to their students' special problems or needs. We also explore a variety of characteristics associated with schools, teachers, and the curricula implemented that are associated with adaptations made in response to the most prevalent of these student problems or needs. Study data were collected in 1999 from a representative sample of lead substance abuse prevention teachers in the nation's public and private schools. We found that 79.8% of respondents report adapting their prevention curricula in response to at least one of the dozen student problems and needs specified. The problems cited most frequently, by slightly more than half of all respondents, relate to the needs of students who are sexually active or have discipline problems. Associated most strongly with adaptations for these two reasons were teachers who were recently trained in their curricula, and substance abuse prevention lessons that could readily be integrated into the school's overall curriculum. We discuss the need for curriculum developers to recognize the frequency with which, and reasons for which, teachers are adapting their curricula, and to include appropriate optional content that addresses students' needs.
This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which we compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students' posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects.
This study developed and tested an Internet-based gender-specific drug abuse prevention program for adolescent girls. A sample of seventh, eighth, and ninth grade girls (N = 236) from 42 states and 4 Canadian provinces were randomly assigned to an intervention or control group. All girls completed an online pretest battery. Following pretest, intervention girls interacted with a 12-session, Internet-based gender-specific drug prevention program. Girls in both groups completed the measurement battery at posttest and 6-month follow-up. Analysis of posttest scores revealed no differences between groups for 30-day reports of alcohol, marijuana, poly drug use, or total substance use (alcohol and drugs). At 6-month follow-up, between-group effects were found on measures of 30-day alcohol use, marijuana use, poly drug use, and total substance use. Relative to girls in the control group, girls exposed to the Internet-based intervention reported lower rates of use for these substances. Moreover, girls receiving the intervention achieved gains over girls in the control group on normative beliefs and self-efficacy at posttest and 6-month follow-up, respectively.
This bulletin describes state-of-the-art universal and selective prevention programs designed to promote parent and teacher competencies and to prevent conduct problems. In addition, it describes indicated interventions designed for children who already have been diagnosed with oppositional defiant disorder and/or conduct disorder. Emphasis is placed on empirically supported programs that have identified key malleable risk factors in children, families, and schools, which have been shown in longitudinal research to be related to later development of substance abuse, delinquency, and violence. We have targeted preschool and primary grade children, ages 0-8 years, in this review because research suggests that the most effective interventions can nip in the bud risk behaviors in the early years, before antisocial behaviors become crystallized. Guidelines for selecting effective interventions are provided.
Not everyone exposed to an efficacious human immunodeficiency virus (HIV) intervention will reduce sexual risk behaviors, yet little is known about factors associated with "failure to change" high-risk sexual behaviors post-intervention. History of abuse and polymorphisms in the serotonin transporter gene (5-HTT) may be associated with non-change. The current study sought to identify genetic, life history, and psychosocial factors associated with adolescents' failure to change condom use behaviors post-participation in an HIV prevention intervention. A sub-set of participants from a clinic-based sample of adolescent African-American females (N = 254) enrolled in a randomized trial of an HIV-prevention was utilized for the current study. Forty-four percent did not increase their condom use from baseline levels 6 months after participating in the sexually transmitted infection (STI)/HIV prevention intervention. In multivariable logistic regression analysis, an interaction between abuse and 5-HTTLPR group was significantly associated with non-change status, along with partner communication frequency scores at follow-up. Follow-up tests found that having a history of abuse was significantly associated with greater odds of non-change in condom use post-intervention for only those with the s allele. For those with ll allele, participants with higher partner communication frequency scores were at decreased odds of non-change in condom use post-intervention. Thus, STI/HIV interventions for adolescent females may consider providing a more in-depth discussion and instruction on how to manage and overcome fear or anxiety related to being assertive in sexual decisions or sexual situations. Doing so may improve the efficacy of STI/HIV prevention programs for adolescent women who have experienced abuse in their lifetime.
Evaluations of school-based substance abuse prevention programs with schools or school districts randomly assigned to either the treatment or control condition have demonstrated effective strategies over the past 30 years. Although control schools were never considered "pure" (i.e., no other interventions were being offered), school-based programming in the 1980s did not include evidence-based interventions. Since the late 1990s, funding agencies have required schools either to select programming from approved lists of prevention strategies or to demonstrate the efficacy of the strategies that would be used. This has increased the number of schools delivering evidence-based programs to their students. As a result, "treatment as usual" is more challenging to researchers. This paper describes exposure to prevention programming as reported by 204 school administrators from 83 districts and their 19,200 students who are participating in the Adolescent Substance Abuse Prevention Study, a national randomized evaluation trial of the program, Take Charge of Your Life. In order to determine the extent of student exposure to prevention programming in both the control and treatment schools, data were collected in each of the 5 years of the study from two sources: principals and prevention coordinators and from students. The data provided by the principals and prevention coordinators indicate that the vast majority of schools assigned to the control condition offered students drug prevention programming. This finding has implications for the evaluation of Take Charge of Your Life but also for other evaluation studies. The students were asked questions regarding participation in drug education posed on annual surveys. When their responses were compared to the reports from their school principals and prevention coordinators, it was found that the students underreported exposure to drug education. A follow-up qualitative study of a sample of students suggests the need for rewording of the questions for students in future studies. The implications of our findings for evaluation studies are discussed.
In response to recent calls for programs that can prevent multiple types of youth violence, the current study examined whether Safe Dates, an evidence-based dating violence prevention program, was effective in preventing other forms of youth violence. Using data from the original Safe Dates randomized controlled trial, this study examined (1) the effectiveness of Safe Dates in preventing peer violence victimization and perpetration and school weapon carrying 1 year after the intervention phase was completed and (2) moderation of program effects by the sex or race/ethnicity of the adolescent. Ninety percent (n = 1,690) of the eighth and ninth graders who completed baseline questionnaires completed the 1-year follow-up assessment. The sample was 51 % female and 26 % minority (of whom 69 % was black and 31 % was of another minority race/ethnicity). There were no baseline treatment group differences in violence outcomes. Treatment condition was significantly associated with peer violence victimization and school weapon carrying at follow-up; there was 12 % less victimization and 31 % less weapon carrying among those exposed to Safe Dates than those among controls. Treatment condition was significantly associated with perpetration among the minority but not among white adolescents; there was 23 % less violence perpetration among minority adolescents exposed to Safe Dates than that among controls. The observed effect sizes were comparable with those of other universal school-based youth violence prevention programs. Implementing Safe Dates may be an efficient way of preventing multiple types of youth violence.
Most drug abuse prevention research has been conducted with predominantly White middle-class adolescent populations. The present study tested a school-based drug abuse preventive intervention in a sample of predominantly minority students (N = 3,621) in 29 New York City schools. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills in an effort to provide students with skills and information for resisting drug offers, to decrease motivations to use drugs, and decrease vulnerability to drug use social influences. Results indicated that those who received the program (n = 2,144) reported less smoking, drinking, drunkenness, inhalant use, and polydrug use relative to controls (n = 1,477). The program also had a direct positive effect on several cognitive, attitudinal, and personality variables believed to play a role in adolescent substance use. Mediational analyses showed that prevention effects on some drug use outcomes were mediated in part by risk-taking, behavioral intentions, and peer normative expectations regarding drug use. The findings from this study show that a drug abuse prevention program originally designed for White middle-class adolescent populations is effective in a sample of minority, economically disadvantaged, inner-city adolescents.
The paper describes advances in statistical methods for prevention research with a particular focus on substance abuse prevention. Standard analysis methods are extended to the typical research designs and characteristics of the data collected in prevention research. Prevention research often includes longitudinal measurement, clustering of data in units such as schools or clinics, missing data, and categorical as well as continuous outcome variables. Statistical methods to handle these features of prevention data are outlined. Developments in mediation, moderation, and implementation analysis allow for the extraction of more detailed information from a prevention study. Advancements in the interpretation of prevention research results include more widespread calculation of effect size and statistical power, the use of confidence intervals as well as hypothesis testing, detailed causal analysis of research findings, and meta-analysis. The increased availability of statistical software has contributed greatly to the use of new methods in prevention research. It is likely that the Internet will continue to stimulate the development and application of new methods.
Child sexual abuse (CSA) is a serious public health issue. Current after-the-fact approaches to treating victims and punishing offenders are not adequate to address a problem of this magnitude; development and rigorous evaluation of CSA prevention strategies are critical. We propose that CSA prevention efforts should target parents of young children. Parents have been neglected as a focus of CSA prevention; they merit attention given their potential to improve children's safety via effective communication and monitoring. This paper provides an overview of current strategies for reducing CSA prevalence and their limitations, presents a rationale for parent-focused CSA prevention, and discusses considerations pertinent to development of an effective parent-focused approach. Parent-focused CSA prevention offers potential as a public health approach to prevention of CSA, and it is time that we devote resources toward developing and studying this important area.
This study summarizes, using meta-analytic techniques, results from 94 studies of school-based prevention activities that examined alcohol or other drug use outcomes. It set out to determine what features of school-based substance abuse prevention programs are related to variability in the size of program effects, It asked (1) Which populations (e.g., high risk vs. general population) should be targeted for prevention services? (2) What is the best age or developmental stage for prevention programming? (3) Does program duration matter? and (4) Does the role of the person delivering the service (e.g., teacher, law enforcement officer, peer) matter? The results suggest that targeting middle school aged children and designing programs that can be delivered primarily by peer leaders will increase the effectiveness of school-based substance use prevention programs. The results also imply that such programs need not be lengthy. The evidence related to the targeting issue is sparse, but suggests that, at least for programs teaching social competency skills, targeting higher risk youths may yield stronger effects than targeting the general population. Suggestions for future research are offered.
In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers' childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants' target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.
The Good Behavior Game (GBG), a method of teacher classroom behavior management, was tested in first- and second-grade classrooms in 19 Baltimore City Public Schools beginning in the 1985-1986 school year. The intervention was directed at the classroom as a whole to socialize children to the student role and reduce aggressive, disruptive behaviors, confirmed antecedents of a profile of externalizing problem outcomes. This article reports on the GBG impact on the courses and interrelationships among aggressive, disruptive behavior through middle school, risky sexual behaviors, and drug abuse and dependence disorders through ages 19-21. In five poor to lower-middle class, mainly African American urban areas, classrooms within matched schools were assigned randomly to either the GBG intervention or the control condition. Balanced assignment of children to classrooms was made, and teachers were randomly assigned to intervention or control. Analyses involved multilevel growth mixture modeling. By young adulthood, significant GBG impact was found in terms of reduced high-risk sexual behaviors and drug abuse and dependence disorders among males who in first grade and through middle school were more aggressive, disruptive. A replication with the next cohort of first-grade children with the same teachers occurred during the following school year, but with minimal teacher mentoring and monitoring. Findings were not significant but generally in the predicted direction. A universal classroom-based prevention intervention in first- and second-grade classrooms can reduce drug abuse and dependence disorders and risky sexual behaviors.
Family and youth violence are increasingly recognized as key public health issues in developing countries. Parenting interventions form an important evidence-based strategy for preventing violence, both against and by children, yet most rigorous trials of parenting interventions have been conducted in high-income countries, with far fewer in low- and middle-income countries (LMICs). This systematic review, conducted in line with Cochrane Handbook guidelines, investigated the effectiveness of parenting interventions for reducing harsh/abusive parenting, increasing positive parenting practices, and improving parent-child relationships in LMICs. Attitudes and knowledge were examined as secondary outcomes. A range of databases were systematically searched, and randomized trials included. High heterogeneity precluded meta-analysis, but characteristics of included studies were described according to type of delivery mode and outcome. Twelve studies with 1580 parents in nine countries reported results favoring intervention on a range of parenting measures. The validity of results for most studies is unclear due to substantial or unclear risks of bias. However, findings from the two largest, highest-quality trials suggest parenting interventions may be feasible and effective in improving parent-child interaction and parental knowledge in relation to child development in LMICs, and therefore may be instrumental in addressing prevention of child maltreatment in these settings. Given the well-established evidence base for parenting interventions in high-income countries, and increasingly good evidence for their applicability across cultures and countries, there is now an urgent need for more rigorously evaluated and reported studies, focusing on youth outcomes as well as parenting, adapted for contexts of considerable resource constraints.
This study examined the impact of an adaptive approach to family intervention in public schools on academic outcomes from age 11 to 17. Students were randomly assigned to the three-session Family Check-Up (FCU), which is designed to motivate change in parenting practices by using an assessment-driven approach and strengths-based feedback. All services were voluntary, and approximately 25% of the families engaged in the FCU. Compared with matched controls, adolescents whose parents received the FCU maintained a satisfactory GPA into high school, and intervention engagement was associated with improved attendance. The highest-risk families were the most likely to engage in the family-centered intervention, suggesting the efficacy of integrating supportive services to families in the context of other schoolwide approaches to promote the success and achievement of vulnerable students.
Despite the evidence supporting parenting programmes as a pathway to reduce and prevent childhood emotional and behavioural problems, these programmes still have low rates of uptake by families in the community. One way of increasing the participation rates of families in parenting programmes is to adopt a consumer's perspective to programme design and development. This study sought to examine whether grandparents providing regular care to their grandchildren viewed the strategies advocated in a parenting programme developed specifically for them as being acceptable and useful, and whether there were barriers to programme use. Forty-five grandparents, with an average age of 61.4 years (SD = 5.0), participated in the study. Grandparents provided between 11 and 20 h of care per week to their grandchildren, who were on average 4.5 years old (SD = 2.4), with the majority being boys (60 %). Results revealed that grandparents found the strategies promoted in the parenting programme highly acceptable and useful and were likely to use the strategies. Barriers to using specific strategies included time demands and belief that a specific strategy would not work. The implications of these findings are discussed within the context of consumer involvement in programme design and development.
Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions.
Behavioral parent training (BPT) has been shown to be efficacious to improve parenting skills for problematic interactions with adolescents displaying oppositional and antisocial behaviors. Some research suggests that support group curricula might be transferred to the Internet, and some studies suggest that other curriculum designs might also be effective. In this research, a BPT program for parents of at-risk adolescents was tested on the Internet in a randomized trial (N = 307) from computer labs at six community technology centers in or near large metropolitan areas. The instructional design was based on asynchronous scenario-based e-learning, rather than a traditional parent training model where presentation of course material builds content sequentially over multiple class sessions. Pretest to 30-day follow-up analyses indicated significant treatment effects on parent-reported discipline style (Parenting Scale, Adolescent version), child behavior (Eyberg Child Behavior Inventory), and on social cognitive theory constructs of intentions and self-efficacy. The effect sizes were small to medium. These findings suggest the potential to provide effective parent training programs on the Internet.
Students with poor mental health are at increased risk for problematic alcohol use. These students also tend to underutilize alcohol-related protective behavioral strategies (PBS). Cross-sectional studies indicate that PBS use may be particularly useful for students with mental health challenges; however, it is unclear whether training these students to use PBS is an effective approach for reducing alcohol use and consequences. The current study evaluated the efficacy of a standalone PBS skills training and personalized feedback (PBS-STPF) intervention among students accessing mental health services. Participants (N = 251) were randomly assigned to either an individual facilitator-led PBS-STPF intervention or a health-related control condition. Participants completed online follow-up surveys 1 and 6 months post-intervention which included measures of alcohol use, negative consequences, and a composite measure of PBS use. Relative to control participants, students in the PBS-STPF condition reported significantly greater PBS use but no differences in alcohol use or consequences. Participants in both conditions reported decreases in drinking outcomes over time. Tests of mediation indicated that the intervention indirectly led to reduction in drinking outcomes at 6 months through increased PBS use. Although the intervention resulted in changes in PBS use that were maintained for up to 6 months post-intervention, the effects of the intervention on drinking and consequences were limited. A brief standalone PBS training may need augmentation in order to promote effective use of PBS for substantial decreases in alcohol consequences.
Individuals not fully complying with their assigned treatments is a common problem encountered in randomized evaluations of behavioral interventions. Treatment group members rarely attend all sessions or do all "required" activities; control group members sometimes find ways to participate in aspects of the intervention. As a result, there is often interest in estimating both the effect of being assigned to participate in the intervention, as well as the impact of actually participating and doing all of the required activities. Methods known broadly as "complier average causal effects" (CACE) or "instrumental variables" (IV) methods have been developed to estimate this latter effect, but they are more commonly applied in medical and treatment research. Since the use of these statistical techniques in prevention trials has been less widespread, many prevention scientists may not be familiar with the underlying assumptions and limitations of CACE and IV approaches. This paper provides an introduction to these methods, described in the context of randomized controlled trials of two preventive interventions: one for perinatal depression among at-risk women and the other for aggressive disruptive behavior in children. Through these case studies, the underlying assumptions and limitations of these methods are highlighted.
This paper investigates the role that acculturation, income, and education play in safety belt nonuse among Californian drivers involved in fatal Motor Vehicle Crashes (MVCs). To achieve this goal, measures of acculturation, income, and education were stochastically incorporated into the Fatality Analysis Reporting System (FARS). Using the 1990 California Tobacco Survey and U.S. Census data, we estimated the combination of zip-code-based measures that most accurately predicts an individual, language-based acculturation index for Hispanics and Asians. Logistic regression was used to investigate the role of these variables in safety belt nonuse in fatal MVCs. We found that acculturation has a positive direct effect on safety belt use among Hispanics. We hypothesize that this positive direct effect is caused by Hispanic immigrants learning the benefits of wearing safety belts. However, our study also suggests an indirect negative effect of acculturation on safety belt use through drinking and driving. Prevention programs aimed at increasing the safety of Hispanic drivers not only need to take acculturation differences into account, but also need to be comprehensive in their message, simultaneously targeting both seat belt nonuse and drinking-and-driving problems.
As little research has examined factors influencing increased and heavy drinking behavior among American sojourners abroad, this study was designed to examine how acculturation orientations (i.e., separation versus assimilation), host country per capita drinking rates, and perceptions about the drinking behavior among other sojourners and natives in the host country predicted alcohol risk abroad. A sample of 216 American college students completing study abroad programs completed a pre-abroad questionnaire to document their pre-abroad drinking levels, followed by a post-return questionnaire to assess drinking while abroad, acculturation orientations and perceived norms of drinking behavior within the foreign environment. A dichotomous variable was created to compare United States (U.S.) per capita drinking rates with those of the host country. Hierarchical repeated-measures ANOVAs examined the changes in drinking from pre-abroad to abroad levels. Participants studying in countries with higher drinking rates than the U.S. and those with higher perceptions about the drinking behavior in the country increased their drinking to a greater extent. Those with higher separation acculturation orientations and greater perceptions drank at heavier levels while abroad. Participants with a greater assimilation orientation and higher perceptions about native drinking, as well as those with a greater separation orientation and higher perceptions about other students' alcohol use drank the heaviest while abroad. These findings have implications for future preventive work with American students and other sojourning groups to promote pre-abroad knowledge of more accurate drinking norms and greater engagement in the culture to potentially prevent increased and heavier drinking.
Guided by Kraemer et al.'s (Psychological Methods, 3:257-271, 1999) framework for measuring the potency of risk factors, we sought to improve on the classification accuracy reported in Petras et al. (Journal of the American Academy of Child and Adolescent Psychiatry 43:88-96, 2004a) and Petras et al. (Journal of the American Academy of Child and Adolescent Psychiatry 44:790-797, 2005) by using multiple as opposed to single point in time assessments of early aggressive and disruptive behavior in the classification of youth who would likely benefit from targeted preventive interventions. Different from Petras et al. (2004a, 2005), the outcome used in this study included serious antisocial behavior in young adulthood as well as in adolescence. Among males, the use of multiple time points did not yield greater classification accuracy than the highest single time points, that is, third and fifth grades. For females, although fifth grade represented the best single time point in terms of classification accuracy, no significant association was found between earlier time points and the later outcome, rendering a test of the multiple time points hypothesis moot. The findings presented in this study have strong implications for the design of targeted intervention for violence prevention, indicating that the screening quality based on aggression ratings during the elementary years is rather modest, particularly for females.
The objective of this study was to compare the accuracy of self-reported skin cancer risk outcome measures proposed as standards by prevention experts to aggregated estimates of behavior from weekly diaries. Weekly electronic diaries of ultraviolet radiation (UVR) behaviors, initially validated by comparison with daily electronic diaries, were used to assess the accuracy of commonly used end-of-summer self-reported measures among 250 adults. Results revealed low biases, and good correspondence between simple open-ended self-reported estimates of days outside, hours outside, sunbathing days and hours, and days outside when not protected by either sunscreen, long-sleeved shirts, hats, or shade. Rating scale measures commonly used in the current literature and those recently recommended as standards by a workshop of experts showed evidence of being non-interval and lacking precision for more frequent behavior (e.g., >1 h sun exposure daily). These data indicated that open-ended frequency self-reports of skin cancer risk behaviors that follow procedures designed to increase accuracy were reliable over a summer-long period.
I am grateful for the opportunity to reflect and respond to the commentaries of Drs. Burkhart and Biglan. I am in agreement with most of what they say, particularly, the point that environment is a key determinant of health risk behavior and as such, should be a main focus for prevention action.Dr. Burkhart makes a number of points (Burkhart 2013), and I’d like to respond to the two that I find the most significant and challenging to the ideas in my article (Foxcroft 2013).In his insightful and detailed commentary, Dr Burkhart makes a number of helpful suggestions for attributes that could possibly have been considered within the scope of the new taxonomy. Many of these have indeed been thought about, but were not included in the paper for the sake of brevity and clarity. In this response, I have not written about these sins of omission, but instead I have focused on the possible sins of commission pointed out by Gregor, i.e., more fundamental challenges to the proposed form and functi ...
This study examined a non-school program aimed at enhancing the educational performance of economically disadvantaged early adolescents who live in public housing. The educational enhancement program included discussions with adults, writing activities, leisure reading, homework, helping others, and games using cognitive skills. A three-arm research design juxtaposed program youth who received educational enhancements with comparison youth in affiliated facilities who did not receive the program and with control youth in other community programs without educational enhancements. From youths, follow-up data collected 2 1/2 years after baseline revealed uniformly positive outcomes for program youth on measures of reading, verbal skills, writing, and tutoring. Teacher reports at final follow-up favored program and comparison youth over controls on measures of reading, writing, games, overall school performance, and interest in class material. School grades were higher for program youth than for comparison and control youth for reading, spelling, history, science, and social studies. Overall grade averages were higher for program youth versus comparisons and controls, as was school attendance. Study data lend empirical support to the provision of educational enhancements in non-school settings for at-risk youths.
This paper reports on the effectiveness of an integrated comprehensive school model for character development, problem behavior prevention, and academic achievement enhancement. The Positive Action program consists of a school curriculum, together with schoolwide climate, family, and community components. As evaluated here, the yearly K-6 curriculum consists of over 140 fifteen-to-twenty-minute lessons per year delivered in school classrooms on an almost daily basis. The program is based on theories of self-concept, learning, behavior, and school ecology. We use a matched control design and school-level achievement and disciplinary data to evaluate program effects on student performance and behavior in two separate school districts. The program improved achievement by 16% in one district and 52% in another, and reduced disciplinary referrals by 78% in one district and 85% in the other. We discuss implications of these replicated findings for the prevention of substance abuse and violence, the improvement of school performance, and the reform of American schools.
Substance use outcomes were examined for 351 youth participating in a randomized controlled trial designed to assess the efficacy of a school-based multimodal universal preventive intervention, Linking the Interests of Families and Teachers (LIFT). Frequency of any use of tobacco, alcohol, and other drugs was assessed via self-report from grades 5 through 12. Latent variable growth models specified average level, linear growth and accelerated growth. The LIFT intervention had a significant effect on reducing the rate of growth in use of tobacco and illicit drugs, particularly for girls, and had an overall impact on average levels of use of tobacco, alcohol, and illicit drugs. Average tobacco use reductions were mediated by increases in family problem solving. The intervention had significant indirect effects on growth in substance use through intervention effects on reduced playground aggression and increased family problem solving. The intervention was also associated with roughly a 10% reduced risk in initiating tobacco and alcohol use. Implications for future studies of multimodal preventive interventions are discussed.