The efficacy of an education program to teach children a scientific theory of how drugs affect behavior

Marijuana Message Channels, Health Knowledge, Law Knowledge, and Confidence in Knowledge as Risk and Protective Factors of Marijuana Use among College Students

Marijuana use among U.S. college students is the highest since the mid-1980s. Because knowledge about marijuana and confidence in the knowledge are related to changing marijuana laws and marijuana-related messages ubiquitous in college students' information environment, we examined their relationships with use. The Structural Equation Modeling method was used to analyze the relationships using survey responses from 249 college students in an adult-use marijuana legal state. Marijuana health knowledge was related to less use, and law knowledge was related to more use. Both relationships were mediated by perceived risk. Confidence in knowledge was related to more use directly as well as indirectly via lower peer disapproval and lower perceived risk. Among various marijuana message channels, peers were the most influential, contributing to lower health knowledge and higher confidence in knowledge.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

U.S. College Students' Marijuana Information Sources, Confidence in Knowledge, and Objective Knowledge

In recent years, marijuana use on U.S. college campuses reached the highest point while the perceptions of risk and social disapproval registered the lowest since the early 1980s. However, little attention has been paid to the sources of the marijuana-related messages and their relationships with marijuana knowledge and confidence in knowledge, proximate protective/risk factors. To fill this gap, a convenience sample of students (N = 249) on a campus located in a U.S. recreational marijuana legal state were surveyed to identify their marijuana information sources and explore the relationships among the sources, confidence in marijuana knowledge, and objective knowledge. Peers/media were the most important sources and they were used more than other sources. Use of peers/media sources was related to lower health knowledge and higher confidence in knowledge. Although students named parents and education/science sources as important, these were less frequently used than siblings, the sources they named as the least important. This study advanced our understanding of the various sources of marijuana information used by U.S. college students and the relationships between the information sources and confidence in knowledge and objective knowledge, two emerging risk/protective factors in the era of marijuana deregulation.

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 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.

Does Learning About the Effects of Alcohol on the Developing Brain Affect Children's Alcohol Use?

Protecting You/Protecting Me (PY/PM) is a classroom-based, alcohol-use prevention and vehicle safety program for students in grades 1-5 developed by Mothers Against Drunk Driving (MADD). PY/PM is one of the first alcohol prevention programs targeting children that incorporates emerging research on the adverse effects of alcohol on the developing brain. In this study, we surveyed fifth grade students, some of whom were exposed to their fifth consecutive year of PY/PM implementation. Results indicate that, relative to comparison students from matched schools, PY/PM students increased their knowledge of the effects of alcohol on the developing brain, their perception of the potential harm of alcohol use, and their vehicle safety skills. PY/PM students also exhibited increased negative attitudes toward underage drinking, increased their intentions not to use alcohol, and reported decreased riding with an impaired driver. PY/PM did not have an effect on alcohol use per se of these fifth graders. Path modeling revealed that knowledge of the effects of alcohol on the developing brain had both a direct and an indirect effect on alcohol use, the latter by increasing perceptions of the harm of underage alcohol use which, in turn affected intentions to use and use itself. Teaching children about the effects of alcohol on the developing brain appears to be a promising strategy for underage alcohol use prevention.

School-based prevention for illicit drugs' use

BACKGROUND

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

OBJECTIVES

To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention .

SEARCH STRATEGY

MEDLINE , EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drug and Alcohol Group Register, updated to February 2004, were searched. Bibliography of papers was checked and personal contacts were made to identify other relevant studies.

SELECTION CRITERIA

RCTs, CCTs or Controlled Prospective Studies (CPS) evaluating school-based interventions designed to prevent substance use.

DATA COLLECTION AND ANALYSIS

Data were selected and extracted independently by two reviewers. Quality was assessed with the CDAG checklist. Interventions were classified as skills, affective, knowledge-focused and other characteristics were also studied (teaching, follow-up implementation, context activation).

MAIN RESULTS

32 studies (29 RCTs and 3 CPSs) were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. RCTs: (1) Knowledge vs usual curricula: Knowledge focused programs improve drug knowledge (SMD=0.91; 95% CI: 0.42, 1.39).(2) Skills vs usual curricula: Skills based interventions increase drug knowledge (WMD=2.60; 95% CI: 1.17-4.03), decision making skills (SMD=0.78; CI95%: 0.46-1.09), self-esteem (SMD=0.22; CI95%: 0.03-0.40), peer pressure resistance (RR=2.05; CI95%: 1.24-3.42), drug use (RR=0.81; CI95%: 0.64, 1.02), marijuana use (RR=0.82; CI95%: 0.73, 0.92) and hard drug use (RR=0.45; CI95%: 0.24-0.85). (3) Skills vs knowledge: No differences are evident.(4) Skills vs affective: Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; CI95%: 0.25, 3.55). (5) Affective vs usual curricula: Affective interventions improve drug knowledge (SMD=1.88; CI95%: 1.27, 2.50) and decision making skills (SMD=1.35; CI95%: 0.79, 1.9). (6) Affective vs knowledge: Affective interventions improve drug knowledge (SMD=0.60; CI95%: 0.18,1.03), and decision making skills (SMD=1.22; CI95%: 0.33, 2.12). Results from CPSs: No statistically significant results emerge from CPSs.

AUTHORS' CONCLUSIONS

Skills based programs appear to be effective in deterring early-stage drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.