Preventing adolescent drug use: long-term results of a junior high program

High School Follow-Up of the Dating Matters® RCT: Effects on Teen Dating Violence and Relationship Behaviors

Teen dating violence (TDV) is a significant public health problem that can have lifelong consequences. Using a longitudinal, cluster randomized controlled trial (RCT), this study examines whether the Dating Matters comprehensive prevention model, implemented in middle school, prevented TDV and negative relationship behaviors and promoted positive relationship behaviors in high school (9th-11th grades), when compared with a standard of care intervention. Dating Matters includes programs for sixth to eighth grade youth and their parents, training for school staff, a youth communications program, and policy and data activities implemented in the community. Self-report survey data were collected from students in 46 middle schools that were randomly assigned to condition within site. Students completed two surveys (fall and spring) in each middle school grade and a single survey in the spring of each high school grade. This study examined self-reported TDV perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills in the high school follow-up. While varying patterns emerged, latent panel models demonstrated significant program effects for all outcomes. Dating Matters students reported 19% reduced risk for TDV perpetration, 24% reduced risk for TDV victimization, 7% reduced risk for use of negative conflict strategies, and 3% more use of positive relationship skills, on average across time and cohort, than standard of care students. On average, Dating Matters, implemented in middle school, continued to be more effective at reducing TDV perpetration, TDV victimization, and use of negative conflict resolution strategies in high school than an evidence-based comparison program.Trial Registration: clinicaltrials.gov Identifier: NCT01672541.

Primary Substance Use Prevention Programs for Children and Youth: A Systematic Review

CONTEXT

An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers.

OBJECTIVE

To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth.

DATA SOURCES

A systematic review was conducted of studies published up until March 31, 2020.

STUDY SELECTION

Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group.

DATA EXTRACTION

Two reviewers independently evaluated study quality and extracted outcome data.

RESULTS

Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice.

LIMITATIONS

Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness.

CONCLUSIONS

The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.

Pathways to prevention: protocol for the CAP (Climate and Preventure) study to evaluate the long-term effectiveness of school-based universal, selective and combined alcohol misuse prevention into early adulthood

BACKGROUND

Alcohol use and associated harms are among the leading causes of burden of disease among young people, highlighting the need for effective prevention. The Climate and Preventure (CAP) study was the first trial of a combined universal and selective school-based approach to preventing alcohol misuse among adolescents. Initial results indicate that universal, selective and combined prevention were all effective in delaying the uptake of alcohol use and binge drinking for up to 3 years following the interventions. However, little is known about the sustainability of prevention effects across the transition to early adulthood, a period of increased exposure to alcohol and other drug use. This paper describes the protocol for the CAP long-term follow-up study which will determine the effectiveness of universal, selective and combined alcohol misuse prevention up to 7 years post intervention, and across the transition from adolescence into early adulthood.

METHODS

A cluster randomized controlled trial was conducted between 2012 and 2015 with 2190 students (mean age: 13.3 yrs) from 26 Australian high schools. Participants were randomized to receive one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). The positive effect of the interventions on alcohol use at 12-, 24- and 36-month post baseline have previously been reported. This study will follow up the CAP study cohort approximately 5- and 7-years post baseline. The primary outcome will be alcohol use and related harms. Secondary outcomes will be cannabis use, alcohol and other drug harms including violent behavior, and mental health symptomatology. Analyses will be conducted using multi-level, mixed effects models within an intention-to-treat framework.

DISCUSSION

This study will provide the first ever evaluation of the long-term effectiveness of combining universal and selective approaches to alcohol prevention and will examine the durability of intervention effects into the longer-term, over a 7-year period from adolescence to early adulthood.

TRIAL REGISTRATION

This trial was registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12612000026820 ) on January 6th 2012.

Perceived friends' use as a risk factor for marijuana use across young adulthood

Perceived social norms of substance use are commonly identified as a risk factor for use. How the strength of association between perceived friends' use and substance use may change across development has not yet been documented. The current analysis considers how the associations between perceived friends' marijuana use and participants' own use of any marijuana in the past year changes from ages 18 to 30 using longitudinal data from the United States national Monitoring the Future study from 1976 to 2014 (N = 30,794 people). Time-varying effect modeling (TVEM) was used to examine the associations between perceived friends' use of marijuana and participants' own annual marijuana use by age, as well as the extent to which these time-varying associations were moderated by sex, race/ethnicity, and parental education. Associations between perceived friends' use and own marijuana use increased with age. In addition, the association between perceived friends' use and own marijuana use significantly varied by demographic groups, such that it was significantly greater for men from ages 19 to 24 and from ages 27 to 30, compared with women; for Whites, compared with other race/ethnicities, across all ages; and for individuals whose parents attended college, compared with those whose parents had a high school education or less, across all ages. Results suggest that perceived friends' marijuana use becomes an even more important marker for increased marijuana use as people age through young adulthood. Therefore, the role of peers in substance use remains crucial beyond adolescence and should be incorporated into intervention strategies for young adults. (PsycINFO Database Record

Long-Term Effects of the Life Skills Program IPSY on Substance Use: Results of a 4.5-Year Longitudinal Study

This study investigated the long-term effectiveness of a Life Skills program with regard to use and proneness to legal and illicit drug use across a 4.5-year study interval. The universal school-based Life Skills program IPSY (Information + Psychosocial Competence = Protection) against adolescent substance use was implemented over 3 years (basic program in grade 5 and booster sessions in grades 6 and 7). Over the same time period, it was evaluated based on a longitudinal quasi-experimental design with intervention and control group, including two follow-up assessments after program completion [six measurement points; N (T1) = 1657 German students; M age (T1) = 10.5 years]. Applying an HLM approach, results showed that participation in IPSY had a significant effect on the frequency of smoking, and proneness to illicit drug use, across the entire study period. In addition, shorter-term effects were found for the frequency of alcohol use in that intervention effects were evident until the end of program implementation but diminished 2 years later. Thus, IPSY can be deemed an effective intervention against tobacco use and proneness to and use of illicit drugs during adolescence; however, further booster sessions may be necessary in later adolescence to enhance youths' resistance skills when alcohol use becomes highly normative among peers.

Risk and protective factors associated with adolescent girls' substance use: Data from a nationwide Facebook sample

BACKGROUND

Despite overall reductions in teenage substance use, adolescent girls' rates of substance use remain unacceptably high. This article examines whether girls' substance use is associated with general risk and protective factors (goal setting, problem solving, refusal skills, peer use, and self-efficacy) and gender-specific risk and protective factors (communication style, coping skills, self-esteem, body image, perceived stress, anxiety, and depression).

METHODS

Cross-sectional data were collected in 2013 via online surveys from a nationwide sample of adolescent girls (N = 788), aged 13 and 14 years, who were recruited through Facebook.

RESULTS

In multivariate analyses, controlling for correlates of adolescent substance use, 11 of the 13 general and gender-specific risk and protective factors were consistently associated with past-month alcohol, cigarette, and other drug use in the expected direction; past-month marijuana use was associated with 8 of the 13 factors. Refusal skills, peer use, coping, and depressive mood were most consistently and strongly associated with substance use.

CONCLUSIONS

Substance abuse prevention programs targeting adolescent girls should focus on such general risk and protective factors as problem solving, refusal skills, peer influences, and self-efficacy, as well as such gender-specific risk and protective factors as communication style, coping, self-esteem, body image, perceived stress, and mood management.

Family Matters: A Family-Directed Program Designed to Prevent Adolescent Tobacco and Alcohol Use

This article describes a program for families that is intended to reduce adolescent tobacco and alcohol use. The program, featuring mailed booklets and follow-up telephone contacts by health educators, is directed toward general populations and is being evaluated with a randomized experiment involving families throughout the contiguous states of the United States. Considerations include description of the principles that influenced program features, the conceptual model for the program, the formative research conducted to design the program, the attributes of the final program as implemented nationally for 658 families, parent assessments of the program, program costs, and the evaluation design.

Translation in Tobacco and Drug Abuse Prevention Research

The purpose of this article is to describe the translation of research on tobacco and drug abuse prevention from basic science to program development to large-scale program dissemination, and from animal to human studies. Where relevant, continuity of translation is discussed by referring to two variables that have been studied for their potential relationship to drug use risk in both animals and humans: sensation and novelty seeking and low impulse control. Review of the research indicates relatively slow translation until the early 1990s. The authors recommend several mechanisms to promote more rapid translation across types of research that encourage reciprocal rather than unidirectional transmission of knowledge to expedite the development and diffusion of more timely, targeted drug abuse prevention programs.

Neighborhood × Serotonin Transporter Linked Polymorphic Region (5-HTTLPR) interactions for substance use from ages 10 to 24 years using a harmonized data set of African American children

This study investigated the influences of neighborhood factors (residential stability and neighborhood disadvantage) and variants of the serotonin transporter linked polymorphic region (5-HTTLPR) genotype on the development of substance use among African American children aged 10-24 years. To accomplish this, a harmonized data set of five longitudinal studies was created via pooling overlapping age cohorts to establish a database with 2,689 children and 12,474 data points to span ages 10-24 years. A description of steps used in the development of the harmonized data set is provided, including how issues such as the measurement equivalence of constructs were addressed. A sequence of multilevel models was specified to evaluate Gene × Environment effects on growth of substance use across time. Findings indicated that residential instability was associated with higher levels and a steeper gradient of growth in substance use across time. The inclusion of the 5-HTTLPR genotype provided greater precision to the relationships in that higher residential instability, in conjunction with the risk variant of 5-HTTLPR (i.e., the short allele), was associated with the highest level and steepest gradient of growth in substance use across ages 10-24 years. The findings demonstrated how the creation of a harmonized data set increased statistical power to test Gene × Environment interactions for an under studied sample.

Universal school-based prevention for illicit drug use

BACKGROUND

Drug addiction is a chronic, relapsing disease. Primary interventions should aim to reduce first use or to prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions.

OBJECTIVES

To evaluate the effectiveness of universal school-based interventions in reducing drug use compared to usual curricular activities or no intervention.

SEARCH METHODS

We searched the Cochrane Drugs and Alcohol Group's Trials Register (September 2013), the Cochrane Central Register of Controlled Trials (2013, Issue 9), PubMed (1966 to September 2013), EMBASE (1988 to September 2013) and other databases. We also contacted researchers in the field and checked reference lists of articles.

SELECTION CRITERIA

Randomised controlled trials (RCT) evaluating school-based interventions designed to prevent illicit drugs use.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS

We included 51 studies, with 127,146 participants. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA. Social competence approach versus usual curricula or no intervention Marijuana use at < 12 months follow-up: the results favoured the social competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9456 participants, moderate quality evidence). Seven studies assessed this outcome (no data for meta-analysis): two showed a positive significant effect of intervention, three showed a non-significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.Marijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2678 participants, high quality evidence). Seven studies assessed this outcome (no data for meta-analysis): two showed a significant positive effect of intervention, three showed a non-significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.Hard drug use at < 12 months: we found no difference (RR 0.69; 95% CI 0.40 to 1.18, one study, 2090 participants, moderate quality evidence). Two studies assessed this outcome (no data for meta-analysis): one showed comparable results for the intervention and control group; one found a statistically non-significant trend in favour of the social competence approach.Hard drug use at 12+ months: we found no difference (mean difference (MD) -0.01; 95% CI -0.06 to 0.04), one study, 1075 participants, high quality evidence). One study with no data for meta-analysis showed comparable results for the intervention and control group.Any drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2512 participants, moderate quality evidence). One study with 1566 participants provided continuous data showing no difference (MD 0.02; 95% CI -0.05 to 0.09, moderate quality evidence). Social influence approach versus usual curricula or no intervention Marijuana use at < 12 months: we found a nearly statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716 participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence intervention (MD -0.26; 95% CI -0.48 to -0.04).Marijuana use at 12+ months: we found no difference (RR 0.95; 95% CI 0.81 to 1.13, one study, 5862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed nearly statistically significant results in favour of the social influence intervention (MD -0.22; 95% CI -0.46 to 0.02). Of the four studies not providing data for meta-analysis a statistically significant protective effect was only found by one study.Hard drug use at 12+ months: one study not providing data for meta-analysis found a significant protective effect of the social influence approach.Any drug use: no studies assessed this outcome. Combined approach versus usual curricula or no intervention Marijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD -1.90; 95% CI -5.83 to 2.03).Marijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910 participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD -0.80; 95% CI -4.39 to 2.79). Two studies not providing data for meta-analysis did not find a significant effect.Hard drug use at < 12 months: one study with 693 participants provided both dichotomous and continuous data and showed conflicting results: no difference for dichotomous outcomes (RR 0.85; 95% CI 0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD -3.10; 95% CI -5.90 to -0.30). The quality of evidence was high.Hard drug use at 12+ months: we found no difference (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI -1.36 to 1.96). Two studies not providing data for meta-analysis showed a significant effect of treatment.Any drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6362 participants).Only one study assessed the effect of a knowledge-focused intervention on drug use and found no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesise.

AUTHORS' CONCLUSIONS

School programmes based on a combination of social competence and social influence approaches showed, on average, small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on the social competence approach also showed protective effects for some outcomes.Since the effects of school-based programmes are small, they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.

School-based programmes for preventing smoking

BACKGROUND

Helping young people to avoid starting smoking is a widely endorsed public health goal, and schools provide a route to communicate with nearly all young people. School-based interventions have been delivered for close to 40 years.

OBJECTIVES

The primary aim of this review was to determine whether school smoking interventions prevent youth from starting smoking. Our secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Tobacco Addiction Group's Specialised Register, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Health Star, and Dissertation Abstracts for terms relating to school-based smoking cessation programmes. In addition, we screened the bibliographies of articles and ran individual MEDLINE searches for 133 authors who had undertaken randomised controlled trials in this area. The most recent searches were conducted in October 2012.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) where students, classes, schools, or school districts were randomised to intervention arm(s) versus a control group, and followed for at least six months. Participants had to be youth (aged 5 to 18). Interventions could be any curricula used in a school setting to deter tobacco use, and outcome measures could be never smoking, frequency of smoking, number of cigarettes smoked, or smoking indices.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed studies for inclusion, extracted data and assessed risk of bias. Based on the type of outcome, we placed studies into three groups for analysis: Pure Prevention cohorts (Group 1), Change in Smoking Behaviour over time (Group 2) and Point Prevalence of Smoking (Group 3).

MAIN RESULTS

One hundred and thirty-four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.Pure Prevention cohorts (Group 1) included 49 studies (N = 142,447). Pooled results at follow-up at one year or less found no overall effect of intervention curricula versus control (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow-up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes.Change in Smoking Behaviour over time (Group 2) included 15 studies (N = 45,555). At one year or less there was a small but statistically significant effect favouring controls (standardised mean difference (SMD) 0.04, 95% CI 0.02 to 0.06). For follow-up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI -0.00 to 0.02).Twenty-five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled.We were unable to analyse data for 49 studies (N = 152,544).Subgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow-up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco-only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow-up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow-up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results.

AUTHORS' CONCLUSIONS

Pure Prevention cohorts showed a significant effect at longest follow-up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less. The combined social competence and social influences interventions showed a significant effect at one year and at longest follow-up. Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information-only approach were similarly ineffective.Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions.

A Lifespan Developmental-Stage Approach to Tobacco and Other Drug Abuse Prevention

At least by informal design, tobacco and other drug abuse prevention programs are tailored to human developmental stage. However, few papers have been written to examine how programming has been formulated as a function of developmental stage throughout the lifespan. In this paper, I briefly define lifespan development, how it pertains to etiology of tobacco and other drug use, and how prevention programming might be constructed by five developmental stages: (a) young child, (b) older child, (c) young teen, (d) older teen, and (e) adult (emerging, young-to-middle and older adult substages). A search of the literature on tobacco and other drug abuse prevention by developmental stage was conducted, and multiple examples of programs are provided for each stage. A total of 34 programs are described as examples of each stage (five-young children, 12-older children, eight-young teens, four-older teens, and five-adults). Implications for future program development research are stated. In particular, I suggest that programming continue to be developed for all stages in the lifespan, as opposed to focusing on a single stage and that developmentally appropriate features continues to be pursued to maximize program impact.

Evaluation of a drug prevention program for young high risk students

This article provides results of an evaluation of the effectiveness of a multi-faceted drug prevention program for high-risk elementary and younger junior high school students. Participants were selected for the program by public school teachers and guidance counselors. These students participated in a series of meetings where they practiced skills to help them effectively handle pressures to use drugs. Researchers evaluated changes in participants' levels of knowledge about drugs, attitudes about drug use, and self-concept. Results indicate that young high-risk students will benefit from multifaceted drug prevention programs that teach life skills.

Beyond primary prevention of alcohol use: a culturally specific secondary prevention program for Mexican heritage adolescents

Classroom-based primary prevention programs with adolescents are effective in inhibiting the onset of drug use, but these programs are not designed to directly address the unique needs of adolescents at higher risk of use or already using alcohol and other drugs. This article describes the initial efficacy evaluation of a companion psychosocial small group program which aims at addressing the needs of Mexican heritage students identified by their teachers as being at higher risk for substance use or already experimenting with alcohol and other drugs. The adolescent (7th grade) small group curricula, REAL Groups, is a secondary prevention program which supplements the primary classroom-based substance use prevention program, keepin' it REAL. Following a mutual aid approach, a total of 109 7th grade students were referred by their teachers and participated in the REAL Groups. The remaining 252 7th grade students who did not participate served as the control group. To account for biased selection into REAL Groups, propensity score matching (PSM) was employed. The estimated average treatment effect for participants' use of alcohol was calculated at the end of the 8th grade. Results indicate that alcohol use decreased among students who participated in the REAL Groups relative to matched students who did not participate. These findings suggest that REAL Groups may be an effective secondary prevention program for higher-risk Mexican heritage adolescents.

Voluntary After-School Alcohol and Drug Programs for Middle School Youth : If You Build It Right, They Will Come

Few after-school programs target alcohol and other drug (AOD) use because it is difficult to encourage a diverse group of youth to voluntarily attend. The current study describes attendance at a voluntary after-school program called CHOICE, which targeted AOD use among middle school students. Over 4,000 students across eight schools completed surveys and 15% participated in CHOICE. Analyses indicated that there were some differences between CHOICE participants and non-participants. For example, African American and multiethnic students were more likely to attend. Past month alcohol users were more likely to initially attend, and marijuana users were more likely to continue attendance. Thus, CHOICE reached students of different racial/ethnic groups and attracted higher risk youth who may not typically obtain prevention services.

Peers and Teachers as Facilitators of the Life Skills Program IPSY

Aims: This pilot study investigated the feasibility and effectiveness of the Life Skills program IPSY (Information + Psychosocial Competence = Protection) with regard to alcohol and cigarette consumption, expectations of regular use, and resistance skills in early adolescence. Thereby, we were particularly interested in the usefulness of peer educators and teachers as program facilitators in the German school setting. Methods: The design included a longitudinal assessment of a peer-led and teacher-led condition with a control group (pre- and post-assessment with a 2-year follow up; classroom-wise randomization, N = 105, T1 10 yrs. old). Results: Results of a series of ANOVAs with repeated measurement indicated that although IPSY facilitated by older peers was highly accepted by the recipients, it was ineffective regarding expectations to regular smoking, and resistance skills towards the offer of cigarettes, and it revealed negative effects on some of the students’ outcomes (in particular regarding alcohol use). In contrast, the same program facilitated by teachers had positive effects on substance use and resistance skills. Conclusions: The discussion focuses on peers’ characteristics (e. g., experiences in leading a classroom, or own consumption patterns) that might have caused the unexpected findings. This implies that, for target groups in early adolescence, in order to avoid negative outcomes, peer facilitators for universal prevention programs have to be selected and trained with great care.

Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000-08

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control. A national representative sample of youth 12-17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth. More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000-02, to increased quitting and declined initiation in 2003-05, and to initiation, quitting and relapse in 2005-08. Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review

AIMS

To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people.

METHODS

A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour.

CONCLUSIONS

There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.

Adolescent substance use disorders in the school setting

Adolescent substance use is a major public health problem that concerns parents, schools, clinicians, and policy makers. The authors review school-based prevention programs, school drug policies, clinical signs and symptoms of substance impairment, recommendations for referral and engaging adolescents who are using substances, and treatment interventions for adolescent substance use disorders.

WITHDRAWN: Primary prevention for alcohol misuse in young people

BACKGROUND

Alcohol misuse is a cause of concern for health services, policy makers, prevention workers, the criminal justice system, youth workers, teachers and parents.

OBJECTIVES

1. To identify and summarize rigorous evaluations of psychosocial and educational interventions aimed at the primary prevention of alcohol misuse by young people. 2. To assess the effectiveness of primary prevention interventions over the longer-term (> 3 years).

SEARCH STRATEGY

Databases searched (no time limits): Project CORK, BIDS, PSYCLIT, ERIC, ASSIA, MEDLINE, FAMILY-RESOURCES-DATABASE, HEALTH-PERIODICALS-DATABASE, EMBASE, BIDS, Dissertation-Abstracts, SIGLE, DRUG-INFO, SOMED, Social-Work-Abstracts, National-Clearinghouse-on-Alcohol-and-Drug-Information, Mental-Health-Abstracts, DRUG-database, ETOH (all searched Feb-June 2002).

SELECTION CRITERIA

1. randomised controlled and non-randomised controlled and interrupted time series designs. 2. educational and psychosocial primary prevention interventions for young people up to 25 years old. 3. alcohol-specific or generic (drugs; lifestyle) interventions providing alcohol outcomes reported. 4. alcohol outcomes: alcohol use, age of alcohol initiation, drinking 5+ drinks on any one occasion, drunkeness, alcohol related violence, alcohol related crime, alcohol related risky behaviour.

DATA COLLECTION AND ANALYSIS

Stage 1: All papers screened by one reviewer against inclusion criteria. Stage 2: For those papers that passed Stage 1, key information was extracted from each paper by 2-3 reviewers.

MAIN RESULTS

20 of the 56 studies included showed evidence of ineffectiveness. No firm conclusions about the effectiveness of prevention interventions in the short- and medium-term were possible. Over the longer-term, the Strengthening Families Program (SFP) showed promise as an effective prevention intervention. The Number Needed to Treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkeness) was 9 (for all three behaviours). One study also highlighted the potential value of culturally focused skills training over the longer-term (NNT=17 over three-and-a-half years for 4+ drinks in the last week).

AUTHORS' CONCLUSIONS

1. Research into important outcome variables needs to be undertaken. 2. Methodology of evaluations needs to be improved. 3. The Strengthening Families Programme needs to be evaluated on a larger scale and in different settings. 4. Culturally-focused interventions require further development and rigorous evaluation. 5. An international register of alcohol and drug misuse prevention interventions should be established and criteria agreed for rating prevention intervention in terms of safety, efficacy and effectiveness.

When to intervene: elementary school, middle school or both? Effects of keepin' it REAL on substance use trajectories of Mexican heritage youth

This article presents the findings of a study exploring two questions: What age is most efficacious to expose Mexican heritage youth to drug abuse prevention interventions, and what dosage of the prevention intervention is needed? These issues are relevant to Mexican heritage youth-many from immigrant families-in particular ways due to the acculturation process and other contextual factors. The study utilized growth curve modeling to investigate the trajectory of recent substance use (alcohol, cigarettes, marijuana, inhalants) among Mexican heritage students (N = 1,670) participating in the keepin' it REAL drug prevention program at different developmental periods: the elementary school (5th grade), middle school (7th grade), or both. The findings provide no evidence that intervening only in elementary school was effective in altering substance use trajectories from 5th to 8th grade, either for licit nor illicit substances. Implementing keepin' it REAL in middle school alone altered the trajectories of use of all four substances for Mexican heritage youth. A double dose of prevention, in elementary and middle school proved to be equally as effective as intervening in 7th grade only, and only for marijuana and inhalants. The decrease in use of marijuana and inhalants among students in the 7th-grade-only or the 5th- and 7th-grade interventions occurred just after students received the curriculum intervention in 7th grade. These results are interpreted from an ecodevelopmental and culturally specific perspective and recommendations for prevention and future research are discussed.

Universal school-based prevention programs for alcohol misuse in young people

BACKGROUND

Alcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents. This is one of three reviews examining the effectiveness of (1) school-based, (2) family-based, and (3) multi-component prevention programs.

OBJECTIVES

To review evidence on the effectiveness of universal school-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age.

SEARCH STRATEGY

Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO.

SELECTION CRITERIA

Randomized trials evaluating universal school-based prevention programs and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted relevant data independently using an a priori defined extraction form. Risk of bias was assessed.

MAIN RESULTS

53 trials were included, most of which were cluster-randomised. The reporting quality of trials was poor, only 3.8% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in 23% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.Six of the 11 trials evaluating alcohol-specific interventions showed some evidence of effectiveness compared to a standard curriculum. In 14 of the 39 trials evaluating generic interventions, the program interventions demonstrated significantly greater reductions in alcohol use either through a main or subgroup effect. Gender, baseline alcohol use, and ethnicity modified the effects of interventions. Results from the remaining 3 trials with interventions targeting cannabis, alcohol, and/or tobacco were inconsistent.

AUTHORS' CONCLUSIONS

This review identified studies that showed no effects of preventive interventions, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in characteristics that would distinguish trials with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game. A stronger focus of future research on intervention program content and delivery context is warranted. 

Ill Effects of Smoking: Baseline Knowledge among School Children and Implementation of the "AntE Tobacco" Project

Introduction. Cigarette smoking contributes to the deaths of more than 400,000 Americans annually. Each day >3,000 children and adolescents become regular smokers. This paper details a new antitobacco educational program titled “AntE Tobacco” Method. Children in grades 1–3 were administered a 10-item questionnaire to ascertain their baseline knowledge about the ill effects of smoking, shown an educational cartoon video depicting the ill effects of tobacco, and given a story book based on the video. At the end of video, children were administered a questionnaire to determine short-term recall of the antitobacco educational objectives of the program. Four to 6 weeks later, the children were then administered a follow-up survey to determine long-term retention of the anti tobacco educational program. Result. Eighty two percent of the children answered the outcome questions correctly immediately following the video. At follow-up, 4–6 weeks later, 83% of children answered all questions correctly. Conclusion. The anti tobacco education program used in this study effectively conveyed most of the educational objectives. The results of this study indicate that a multimedia (i.e., video and book) educational program can be used to educate and reinforce anti tobacco messages. This program may be very useful as a part of a comprehensive anti tobacco curriculum in school systems.

The effects of Project ALERT one year past curriculum completion

School-based drug prevention curricula constitute the nation's most prevalent strategy to prevent adolescent drug use. We evaluated the effects of one such curriculum, Project ALERT, on adolescent substance use. In particular, we sought to determine if a single effect on 30-day alcohol use, noted shortly following the completion of the 2-year program, could be detected 1 year later. We also looked for delayed effects on other outcomes of interest, namely lifetime alcohol use, and 30-day and lifetime use of cigarettes, marijuana, and inhalants. We employed a randomized controlled trial that used school as the unit of assignment. Thirty-four schools with grades 6-8 from 11 states completed the study. Seventy-one Project ALERT instructors taught 11 core lessons to sixth graders and 3 booster lessons to seventh graders. Students were assessed prior to the onset of the intervention, as sixth graders, after the completion of the 2-year curriculum, as seventh graders, and again 1 year later as eighth graders. This paper examines data from the pretest and final posttest. Using hierarchical nonlinear modeling, we found that our earlier effect on 30-day alcohol use did not persist. Further, we continued to find no effects for lifetime alcohol use and both the lifetime and 30-day use of cigarettes, marijuana, and inhalants. Our findings do not support the long-term effectiveness of Project ALERT, when delivered to sixth graders.

Project ALERT’s Effects on Adolescents’ Prodrug Beliefs: A Replication and Extension Study

This article represents a replication and extension of previous studies of the effects of Project ALERT, a school-based substance use prevention program, on the prodrug beliefs of adolescents. Specifically, the authors’ research examined Project ALERT’s effects on adolescents’ intentions to use substances in the future, beliefs about substance use consequences, normative beliefs, and resistance self-efficacy. In all, 34 schools with Grades 6 to 8 completed this randomized controlled trial and 71 Project ALERT instructors taught 11 core lessons to 6th graders and 3 booster lessons to 7th graders (one grade level earlier than in previous studies). Students were assessed in 6th grade prior to the onset of the intervention, in 7th grade after the completion of the 2-year curriculum, and again 1 year later in 8th grade. The authors found no evidence to suggest that Project ALERT had a positive impact on any alcohol, cigarette, or marijuana prodrug beliefs. Implications for school-based substance use prevention are discussed.

Familienbasierte Prävention bei Kindern und Jugendlichen

Fragestellung: Wie evidenzbasiert sind familienbasierte Programme zur selektiven Suchtprävention? Lässt sich ein vorbildhaftes Programm identifizieren? Methodik: Überblick über entsprechende Ansätze und Programm-Merkmale als Ergebnis einer systematischen Literaturrecherche in verschiedenen Datenbanken. Ergebnisse: Das Strengthening Families Program 10–14 aus Iowa/USA (SFP 10–14) ist das wohl zurzeit best evaluierte familienbasierte universelle Präventionsprogramm; so ließen sich nachhaltige Effekte auch im 6-Jahres-Follow-up nachweisen. Schlussfolgerungen: Die kultursensitive Adaptation und Evaluation von SFP 10–14 für die Bundesrepublik kann die Prävention von Suchtstörungen wirkungsvoll ergänzen. Eine Adaptation für den deutschen Sprachraum hat verschiedene kultursensitive Aspekte zu berücksichtigen sowie den Umstand, dass SFP 10–14 aufwändig durchzuführen ist.

The Making of Evidence-based Practice: The Case of Project ALERT

Evidence-based practice has been enthusiastically embraced within the field of drug prevention during the past decade. Project ALERT, a school-based universal prevention program, is among the most widely advocated evidence-based interventions. We examined the results of three large-scale evaluations of Project ALERT, and concluded that assessment of data from the total samples shows that the program has little effect on drug use. Despite this, Project ALERT is included on evidence-based drug prevention lists because the criteria for inclusion are extremely weak. We discuss the implications of this for drug prevention evaluation research and the creation of evidence-based practice lists.

A review of elementary school-based substance use prevention programs: identifying program attributes

This article takes a systematic approach to reviewing substance use prevention programs introduced in elementary school (K-6th grade). Previous studies evaluating such programs among elementary school students showed mixed effects on subsequent substance use and related psychosocial factors. Thirty published evaluation studies of 24 elementary school-based substance use prevention programs were reviewed. The study selection criteria included searching for program evaluations from 1980 to 2008. Among 27 evaluation studies that examined program effects on substance use, 56% (n = 15) found significant decreases. In addition, programs most often demonstrated effects on increasing negative substance use attitudes, increasing knowledge, decreasing perceptions of prevalence rates (i.e., descriptive norms), and improving resistance skills. These results have implications for the appropriateness and value of introducing substance use prevention programs to youth in elementary school.

Establishing the predictive validity of intentions to smoke among preadolescents and adolescents surviving cancer

PURPOSE

A significant proportion of adults surviving childhood cancer are smokers. Although these estimated rates of smoking are slightly lower than those in the US population, they remain alarmingly high for this high-risk group. The purpose of this study was to examine the predictive validity of adolescent self-reported smoking intentions for later smoking among childhood cancer survivors.

PATIENTS AND METHODS

Baseline tobacco intentions were collected from 119 nonsmoking cancer survivors, age 10 to 18 years, who participated in a tobacco-based clinical trial during the late 1990s. Follow-up smoking status was systematically collected annually up to 10 years postintervention (median follow-up, 6.0 years; interquartile range, 3.0 to 6.9 years) as part of clinical survivorship care.

RESULTS

Twenty-seven participants (22.7%) subsequently initiated tobacco use within 5 years of study enrollment. The 5-year cumulative incidence was 29.8% +/- 6.0% for those who were susceptible to smoking compared with 12.8% +/- 5.4% for those who were committed never smokers (P = .022). Past use (P < .001) and having friends who smoked (P = .038) were also associated (univariate model) with tobacco initiation, and there was a trend for an association for older adolescents (P = .073). Every unit increase on the intentions scale was associated with a 17% increase in the risk for tobacco initiation (P = .002) after adjusting for age group and past tobacco use in a multivariable model.

CONCLUSION

Because early intentions to smoke are predictive of later tobacco use, survivors as young as 10 years of age who waver in their commitment to remain tobacco abstinent should be targeted for tobacco prevention interventions.

A comparison of tobacco-related risk factors between preadolescents with and without cancer

INTRODUCTION

To compare preadolescents with and without cancer on current smoking status, future intentions to smoke, and tobacco-related risk factors, as well as to explore the relationship between cancer status and tobacco-related variables with intentions.

PROCEDURE

Ninety-four preadolescents undergoing treatment for cancer and a matched comparison sample of 190 participants without cancer, ages 8 to 11 years, completed questionnaires about their smoking habits, intentions to smoke and tobacco-related psychosocial risk factors.

RESULTS

No preadolescents with cancer and only two preadolescents without cancer reported current smoking. Compared to healthy nonsmoking preadolescents, nonsmokers with cancer were approximately one-half as likely to report future intentions to smoke. Intention to smoke was better predicted by variables most proximal to smoking including older age, being male, not having cancer, having close friends who smoke, parental smoking, and lower perceived vulnerability for tobacco-related illnesses. In the model examining distal variables, preadolescents who were more rebellious, older, and without cancer were more likely to report future smoking intentions.

DISCUSSION/CONCLUSIONS

Although future intentions to smoke differed according to cancer status, the relationship between tobacco-related risk factors and future smoking intentions appeared to be similar among preadolescents with and without cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Smoking prevention and tobacco-related health risk education should begin during the elementary years, a time prior to smoking initiation and the development of solidified smoking attitudes. The diagnosis and treatment of pediatric cancer may provide an excellent opportunity for health care providers to begin communicating anti-smoking messages and health risk counseling to their young patients and families.

Adolescents' impressions of antismoking media literacy education: qualitative results from a randomized controlled trial

Although media literacy represents an innovative venue for school-based antismoking programming, studies have not systematically compared student impressions of these and traditional programs. This study utilized data from a randomized trial comparing these two types of programs. After each program, students responded to three open-ended questions related to their assigned curriculum. Two coders, blinded to student assignments, independently coded these data. Coders had strong inter-rater agreement (kappa = 0.77). Our primary measures were spontaneously noted overall assessment, enjoyment/interest and the likelihood of changing smoking behavior. Of the 531 participants, 255 (48.0%) were randomized to the intervention (media literacy) group. Intervention participants had more net positive responses [rate ratio (RR) = 1.27, 95% confidence interval (CI) = 1.05, 1.54], more responses rating the program as compelling (RR = 1.63, 95% CI = 1.16, 2.29) and fewer responses rating the program as non-compelling (RR = 0.62, 95% CI = 0.39, 0.97). However, the intervention group was not more likely to suggest that the curriculum was likely to change behavior positively (RR = 0.57, 95% CI = 0.30, 1.06). Findings suggest that although media literacy provides a compelling format for the delivery of anti-tobacco programming, integration of components of traditional programming may help media literacy programs achieve maximal efficacy.

The social construction of "evidence-based'' drug prevention programs: a reanalysis of data from the Drug Abuse Resistance Education (DARE) program

This study explores the possibility that any drug prevention program might be considered ;;evidence-based'' given the use of data analysis procedures that optimize the chance of producing statistically significant results by reanalyzing data from a Drug Abuse Resistance Education (DARE) program evaluation. The analysis produced a number of statistically significant differences between the DARE and control conditions on alcohol and marijuana use measures. Many of these differences occurred at cutoff points on the assessment scales for which post hoc meaningful labels were created. Our results are compared to those from evaluations of programs that appear on evidence-based drug prevention lists.

What we can-and cannot-expect from school-based drug prevention

School-based drug prevention is a central component of drug control strategies. This paper assesses quantitatively its contributions in the United States from a social policy perspective. The social benefits per participant stemming from reduced drug use ( approximately $840 from tobacco, alcohol, cocaine and marijuana) appear to exceed the economic costs of running the programs ( approximately $150 per participant); while the benefits associated with reduced cocaine use alone ( approximately $300) exceed the costs, the corresponding figure for marijuana ( approximately $20) is small. Even if prevention reduced the use of other illicit drugs (e.g. heroin) by as much as it reduced use of cocaine, the majority of benefits would still stem from reductions in use of tobacco and alcohol, which has implications for how school-based drug prevention is funded and whether it is perceived more as a weapon in the war on illicit drugs or as a public health measure. Specific numeric results are subject to considerable uncertainty, but the basic character of the conclusions appears to be robust with respect to parameter uncertainty. The greatest uncertainties concern the permanence of prevention's effects and how to value instances of initiation being deferred but not completely prevented.

The promise of long-term effectiveness of school-based smoking prevention programs: a critical review of reviews

I provide a review and critique of meta-analyses and systematic reviews of school-based smoking prevention programs that focus on long-term effects. Several of these reviews conclude that the effects of school-based smoking prevention programs are small and find no evidence that they have significant long-term effects. I find that these reviews all have methodological problems limiting their conclusions. These include severe limiting of the studies included because of performance bias, student attrition, non-reporting of ICCs, inappropriate classification of intervention approach, and inclusion of programs that had no short-term effects. The more-inclusive meta-analyses suggest that school-based smoking prevention programs can have significant and practical effects in both the short- and the long-term. Findings suggest that school-based smoking prevention programs can have significant long-term effects if they: 1) are interactive social influences or social skills programs; that 2) involve 15 or more sessions, including some up to at least ninth grade; that 3) produce substantial short-term effects. The effects do decay over time if the interventions are stopped or withdrawn, but this is true of any kind of intervention.

School-based smoking prevention programs with the promise of long-term effects

I provide a systematic review of trials of school-based smoking prevention programs that had at least 15 sessions, preferably with some in high school, that reported significant short-term effects, and that included long-term follow-up. This is supplemented with a description of some other programs that produce short-term effects that portend large long-term effects. I conclude that school-based programs can have long-term effects of practical importance it they: include 15 or more sessions over multiple years, including some in high school; use the social influence model and interactive delivery methods; include components on norms, commitment not to use, intentions not to use, and training and practice in the use of refusal and other life skills; and use peer leaders in some role. School-based programs of this type can reduce smoking onset by 25-30%, and school plus community programs can reduce smoking onset by 35-40% by the end of high school. Some early childhood programs that do not have smoking prevention as their main aim, including home nursing, the Good Behavior Game, the Positive Action program and others, seem to change the developmental trajectories of children so that they are less likely to engage in multiple problem behaviors, including smoking, as adolescents. This review makes it clear that effective school-based smoking prevention programs exist and can be adopted, adapted and deployed with success - and should be.

The impact of national smoking prevention campaigns on tobacco-related beliefs, intentions to smoke and smoking initiation: results from a longitudinal survey of youth in the United States

The national truth campaign has exposed U.S. youth to antismoking messages since 2000. Tobacco industry-sponsored campaigns, such as "Think. Don't Smoke" (TDS), have also aired nationally. We examine the effects of recall of the truth and TDS campaigns on changes in tobacco-related beliefs, intentions, and smoking initiation in a longitudinal survey of U.S. youth. Recall of truth(R) was associated with increased agreement with antismoking beliefs, decreased smoking intentions, and lower rates of smoking initiation. Recall of TDS was associated with increased intentions to smoke soon but was not significantly associated with tobacco beliefs or smoking initiation among youth overall.

Strengthening resistance self-efficacy: influence of teaching approaches and gender on different consumption groups

Our study focused on strengthening the individual self-efficacy of low achieving 8th graders reducing drug-specific peer pressure through theoretical and practical training. The subject of the intervention was based on a substance-specific life skills program offering both teacher-centered and student-centered teaching approaches. A cluster analysis identified four consumption groups in our pre-test setting: (1) A "potentially curious" sample; (2) an "actually curious" sample; (3) an "experimenter" sample; and (4) a "consumer" sample. Self-efficacy was measured three times in a pre-, post-, and retention-test design. Only the "potentially curious" sub-sample showed higher resistance self-efficacy, boys and girls revealed no differences. Altogether, a short- and middle-term consistent increase was detected in both teaching methods. Consequences to increase the efficiency of drug prevention measurements are being discussed.

School-Based Drug Prevention Programs: A Review of What Works

This article examines the effectiveness of school-based drug prevention programs in preventing illicit drug use. Our article reports the results of a systematic review of the evaluation literature to answer three fundamental questions: (1) do school-based drug prevention programs reduce rates of illicit drug use? (2) what features are characteristic of effective programs? and (3) do these effective program characteristics differ from those identified as effective in reviews of school-based drug prevention of licit substance use (such as alcohol and tobacco)? Using systematic review and meta-analytic techniques, we identify the characteristics of school-based drug prevention programs that have a significant and beneficial impact on ameliorating illicit substance use (i.e., narcotics) among young people. Successful intervention programs typically involve high levels of interactivity, time-intensity, and universal approaches that are delivered in the middle school years. These program characteristics aligned with many of the effective program elements found in previous reviews exploring the impact of school-based drug prevention on licit drug use. Contrary to these past reviews, however, our analysis suggests that the inclusion of booster sessions and multifaceted drug prevention programs have little impact on preventing illicit drug use among school-aged children. Limitations of the current review and policy implications are discussed.

Long-term Outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) Program for Female High School Athletes

Adolescence and emerging adulthood are critical windows for establishing life-long behaviors. We assessed long-term outcomes of a prospective randomized harm reduction/health promotion program for female high school athletes. The intervention's immediate beneficial effects on diet pill use and unhealthy eating behaviors have been reported; however, tobacco, alcohol and marijuana use were not immediately altered (Elliot et al, 2004). One to three years following graduation, positive benefits in those domains became evident, and intervention students reported significantly less lifetime use of cigarettes, marijuana, and alcohol. Sport teams may be effective vehicles for gender-specific interventions to promote competency skills and deter harmful actions, and those benefits may manifest when acquired abilities are applied in new environments following high school graduation.

School-based prevention for illicit drugs use: a systematic review

OBJECTIVE

To evaluate the effectiveness of school-based interventions in preventing or reducing drug use.

METHODS

The search strategy was conducted according to the Cochrane Collaboration method, and applied to MEDLINE, EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drugs and Alcohol Group Register. RCTs and CCTs evaluating school-based interventions designed to prevent substance use were reviewed. Data were extracted independently by two reviewers. Quality was assessed. Interventions were classified as skills, affective, and knowledge focused.

RESULTS

29 RCTs were included; 28 were conducted in the USA; most were focused on 6th-7th grade students. Compared with usual curricula, skills-based interventions significantly reduce marijuana use (RR=0.82; 95% CI: 0.73, 0.92) and hard drug use (RR=0.45; 95% CI: 0.24, 0.85), and improve decision-making skills, self-esteem, peer pressure resistance (RR=2.05; 95% CI: 1.24, 3.42) and drug knowledge. Compared with usual curricula, affective interventions improve decision-making skills and drug knowledge, and knowledge-focused programs improve drug knowledge. Skills-based interventions are better than affective ones in improved self-efficacy. No differences are evident for skills vs. knowledge-focused programs on drug knowledge. Affective interventions improve decision-making skills and drug knowledge to a higher degree than knowledge-focused programs.

CONCLUSION

Skills-based programs help to deter drug use. Well designed, long-term randomised trials, and evaluation of intervention components are required.

A developmental perspective on alcohol and youths 16 to 20 years of age

Late adolescence (ie, 16-20 years of age) is a period characterized by escalation of drinking and alcohol use problems for many and by the onset of an alcohol use disorder for some. This heightened period of vulnerability is a joint consequence of the continuity of risk from earlier developmental stages and the unique neurologic, cognitive, and social changes that occur in late adolescence. We review the normative neurologic, cognitive, and social changes that typically occur in late adolescence, and we discuss the evidence for the impact of these transitions on individual drinking trajectories. We also describe evidence linking alcohol abuse in late adolescence with neurologic damage and social impairments, and we discuss whether these are the bases for the association of adolescent drinking with increased risks of mental health, substance abuse, and social problems in adulthood. Finally, we discuss both the challenges and successes in the treatment and prevention of adolescent drinking problems.