Refusal and Resistance Skills for Children and Adolescents: A Selected Review

Preadolescent drug use resistance skill profiles, substance use, and substance use prevention

The aims of the current study were threefold: (1) specify the skills component of social influence prevention interventions for preadolescents, (2) examine the relationship between resistance skill profiles and substance use among preadolescents, and (3) evaluate whether subgroups of preadolescents based on their resistance skills and refusal confidence may be differentially impacted by the kiR prevention program. Latent class analysis showed a four-class model of 5th grader resistance skill profiles. Approximately half of preadolescents (53%) were familiar with four prototypical resistance skills and showed confidence to apply these skills in real-world settings (highly competent profile); 15% were familiar with resistance skills but had little confidence (skillful profile); 18% were confident yet had little knowledge (confident profile); while 15% had low knowledge and confidence (low competence profile). These skill profiles significantly predicted 8th grade recent substance use (2LL = -2,262.21, df = 3, p = .0005). As predicted by theory, the highly competent skill profile reported lower mean recent substance use than the population sample mean use. Latent transition analysis showed that although patterns of transiting into the highly competent skill profile over time were observed in the expected direction, this pattern was not significant when comparing treatment and control. Identifying skill profiles that predict recent substance use is theoretically consistent and has important implications for healthy and substance-free development.

Effective elements of school health promotion across behavioral domains: a systematic review of reviews

BACKGROUND

Most school health education programs focus on a single behavioral domain. Integrative programs that address multiple behaviors may be more efficient, but only if the elements of change are similar for these behaviors. The objective of this study was to examine which effective elements of school health education are similar across three particular behavioral domains.

METHODS

A systematic review of reviews of the effectiveness of school-based health promotion programs was conducted for the domains of substance abuse, sexual behavior, and nutrition. The literature search spanned the time period between 1995 and October 2006 and included three databases, websites of review centers and backward search. Fifty-five reviews and meta-analyses met predetermined relevance and publication criteria and were included. Data was extracted by one reviewer and checked by a second reviewer. A standardized data extraction form was used, with detailed attention to effective elements pertaining to program goals, development, content, methods, facilitator, components and intensity. Two assessors rated the quality of reviews as strong, moderate or weak. We included only strong and moderate reviews in two types of analysis: one based on interpretation of conflicting results, the other on a specific vote-counting rule.

RESULTS

Thirty six reviews were rated strong, 6 moderate, and 13 weak. A multitude of effective elements was identified in the included reviews and many elements were similar for two or more domains. In both types of analysis, five elements with evidence from strong reviews were found to be similar for all three domains: use of theory; addressing social influences, especially social norms; addressing cognitive-behavioral skills; training of facilitators; and multiple components. Two additional elements had positive results in all domains with the rule-based method of analysis, but had inconclusive results in at least one domain with the interpretation-based method of analysis: parent involvement and a larger number of sessions.

CONCLUSION

Five effective elements of school health promotion were found to be similar across the three behavioral domains examined (substance abuse, sexual behavior, nutrition). An integrative program that addresses the three domains seems feasible. The five elements are primary candidates to include in programs targeting these behaviors.

Substance use, resistance skills, decision making, and refusal efficacy among Mexican and Mexican American preadolescents

This article examines the relationships among resistance skills, refusal efficacy, decision-making skills, and substance use for a sample of Mexican and Mexican American 5th grade students who were attending public schools in Phoenix, Arizona. An analysis of self-report questionnaire data indicated that the likelihood that male students reported ever having used one or more substances increased as they reported a greater willingness to use passive decision-making (e.g., going along) and decreased as they reported greater refusal efficacy and a greater willingness to utilize active decision making (e.g., thoughtful processing). No significant relationships emerged between the 4 predictors and lifetime substance use among the girls. These findings support the role of social skills in substance use prevention, shed light on an understudied group, and suggest the importance of continuing to examine gender differences in skills-based interventions.

Habilidades sociais e abuso de drogas em adolescentes

O presente estudo propõe uma revisão bibliográfica sobre habilidades sociais e abuso de substâncias. Este artigo foi elaborado a partir de pesquisa nas Bases de Dados Pschynfo, Web of Science, Cochrane Library, Proquest, Medline e Lilacs, entre 1996 e 2006. Os descritores foram: social skills, social skills training, social competence, assertiveness, adolescents, teeenagers, substance abuse, drug abuse, cannabis e marijuana. Nas bases de língua portuguesa, foram: habilidades sociais, treinamento em habilidades sociais, assertividade, adolescentes, abuso de substâncias, drogas e maconha. Os estudos, a maioria de língua inglesa, apontaram a existência de déficits, principalmente a dificuldade em resistir às drogas e dizer não. Conclui-se que a construção de habilidades de resistência ao oferecimento de drogas, a auto-eficácia e o estímulo à capacidade de tomada de decisões pode reduzir o uso de substâncias. Poucos estudos brasileiros foram encontrados abordando esta temática.

The Strong African American Families program: longitudinal pathways to sexual risk reduction

PURPOSE

To identify the mechanisms by which intervention-induced increases in adaptive parenting were associated with a reduction in sexual risk behavior among rural African American adolescents across a 29-month period.

METHODS

African American families (N = 284) with 11-year-old children in nine rural Georgian counties participated in the 7-week Strong African American Families (SAAF) project. Counties were randomly assigned to intervention or control conditions. The program was evaluated via pretest, posttest, and long-term follow-up interview data collected in the families' homes. The current paper tests a hypothetical model of program efficacy, positing that intervention-induced changes in parenting behaviors would enhance in youth self-pride, which in turn would forecast changes in sexual behaviors measured 29 months after pretest.

RESULTS

Compared with controls, parents who participated in SAAF reported increased adaptive universal and racially specific parenting. Furthermore, intervention-induced changes in these parenting behaviors were associated indirectly with sexual risk behavior through adolescent self-pride, peer orientation, and sexual intent.

CONCLUSIONS

Culturally competent programs, developed through empirical and theoretical research within affected communities, can foster adaptive universal and racially specific parenting, which can have a long-term effect on adolescent sexual risk behavior. Effective strategies for designing and implementing culturally competent programs are discussed.

The Role of Psychosocial Factors in the Transition to Substance Use: Are They Protective Among Urban Minority Adolescents?

Changes in psychosocial risk and protective factors associated with the onset of substance use were examined in a sample of 556 urban public school sixth graders. General linear modeling analyses indicated that students who did not use substances by the end of sixth grade consistently had higher scores on protective factors than did students who were already using substances at the beginning of sixth grade. Students who began to use during the school year were in flux with scores similar to nonusers at Time 1 and scores closer to early users by Time 2. These findings suggest that interventions which focus on skill enhancement during the transition to middle school may be effective at delaying the onset of substance use. Editors' Strategic Implications: The authors find the same protective factors in this urban, primarily African American sample that are typical in suburban, White samples. Developmentalists and school officials will find interesting the changing effects of protective factors against early substance use during the transitional sixth grade year.

Substance use and young people: the potential of technology

There is widespread concern about alcohol and drug use and abuse among young people in the United Kingdom, Europe and the United States. Evaluations of current drug and alcohol education approaches have mixed findings and some methodological difficulties. This paper reports on exploratory research to explore the potential of technology to provide information and support to young people regarding substance use and abuse. Eight focus groups were conducted with young people (n = 78) and three with key informants (n = 22). The findings revealed that technology has potential to provide information on this topic, and that young people are critical of some of the more traditional methods of provision. The young people were prepared to experiment with technology, felt competent to do so, and made suggestions of information they would like. These findings are discussed and recommendations made for future research in the area.

A cognitive model of binge drinking: the influence of alcohol expectancies and drinking refusal self-efficacy

While binge drinking-episodic or irregular consumption of excessive amounts of alcohol-is recognised as a serious problem affecting our youth, to date there has been a lack of psychological theory and thus theoretically driven research into this problem. The current paper develops a cognitive model using the key constructs of alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE) to explain the acquisition and maintenance of binge drinking. It is suggested that the four combinations of the AE and DRSE can explain the four drinking styles. These are normal/social drinkers, binge drinkers, regular heavy drinkers, and problem drinkers or alcoholics. Since AE and DRSE are cognitive constructs and therefore modifiable, the cognitive model can thus facilitate the design of intervention and prevention strategies for binge drinking.

Keepin' it R.E.A.L.: a drug resistance curriculum tailored to the strengths and needs of pre-adolescents of the southwest

Research has shown that students respond more favorably to drug prevention programs when they see their culture and themselves represented in the prevention message. Additionally, studies highlight important ethnic differences in drug behaviors and attitudes, indicating that students' ethnic culture should be considered in the creation of prevention programs. Because there are few effective, culturally grounded programs, new approaches are needed, particularly among Mexican American youth. This need inspired the Drug Resistance Strategies Project (DRS) to develop and test the keepin' it R.E.A.L curriculum serving ethnically diverse seventh grade students residing in a large southwestern city. This article describes development of the keepin' it R.E.A.L. curriculum, focusing on the methods used to ensure cultural grounding. The article also reviews literature on cultural approaches in prevention, presents a theoretical framework, summarizes key outcomes of the curriculum evaluation, and concludes with recommendations for the development of prevention programs for ethnically diverse youth.

Predicting early adolescent substance use: do risk factors differ depending on age of onset?

This study was designed to identify different risk models associated with non-use, first use, and prior substance use among a group of early adolescents. A total of 582 students completed a self-report questionnaire at the beginning and end of sixth grade. Nine predictor variables were used in discriminant function analysis to classify adolescents into three groups. Five variables distinguished non-users (never used by the end of sixth grade) and new users (first used during sixth grade) from prior users (first used before sixth grade). Prior users were found to have weaker decision making skills, more susceptibility to peer pressure, more negative perceptions of school, less confidence in their skills, and an increased likelihood of being male. A second function indicated that new users were similar to prior users in that they had less positive peer relations, were more likely to come from single parent families, and had less knowledge about alcohol and drugs than did non-users. The similarities and differences between new and prior users have implications for future research and prevention programming.