Project DARE: no effects at 10-year follow-up

The Role of Law Enforcement Officers/Police in Drug Prevention within Educational Settings-Study Protocol for the Development of a Guiding Document Based on Experts' Opinions

The United Nations Office on Drugs and Crime—World Health Organization International Standards on Drug Use Prevention—reflects the value of safe, nurturing and supportive social institutions around the lives of youths to benefit from the prevention of risky behavior extending beyond individually-developed resilience for healthy adolescent development. Schools are valuable social institutions to this effect and school safety and adolescent health outcomes can be threatened by drug use and violence. As such, collaborative, multi-level, evidence-based, developmentally sensitive, substance use prevention programs are imperative. The International Standards, in their latest version, did not reflect specific evidence of law enforcement officer-based programs with effect on drug use prevention, including in school settings. Nevertheless, the collaboration between law enforcement agencies and school-based substance use prevention programs continue to be the focus of research and policy. In this project, we aim to explore in more detail the role of law enforcement in preventing substance use in schools. We use mixed methods, including three phases: (i) scoping review on the best practices for effective law enforcement in school-based drug and crime prevention; (ii) interviews with experts, using the Delphi method, in substance use prevention and training law enforcement in school-based drug prevention; and iii) developing guidelines for law enforcement based on the findings. Initially, we identified a total of 17 papers that were categorized in four categories based on their results (negative or null effect n = 11 studies, positive effect n = 1 study, mixed effects n = 4 studies and indefinite conclusion n = 1 study). However, the authors of the studies with negative or null effect did recommend being cautious about these results due to the respective studies’ methodological limitations. The actual and perceived roles of police are largely unclear and/or variable. Therefore, clear outlines regarding law enforcement’s role within schools are crucial as one study showed that an officer’s role influences how they respond to student conduct. A secondary emergent theme from this review indicates that there is potential for positively impacting a youth’s perceptions of police through collaborative and engaging school-based programs. Currently the project is gradually moving to Phase II, where we are identifying the key experts based on scientifically published peer reviewed and grey literature/guidelines to investigate elements that make the role of law enforcement officers in school-based prevention more effective. Given the frequency with which policy makers around the world request information about the role of law enforcement in effective prevention efforts, guidelines on their roles within schools is a gap that needs to be filled. Such efforts would improve drug prevention in schools and better orient law enforcement’s role in drug prevention within educational settings.

Natural Peer Leaders as Substance Use Prevention Agents: the Teens' Life Choice Project

In adolescent social groups, natural peer leaders have been found to engage in more frequent experimentation with substance use and to possess disproportionate power to affect the behavior and social choices of their associated peer followers. In the current exploratory study, we used sociometrics and social cognitive mapping to identify natural leaders of cliques in a seventh grade population and invited the leaders to develop anti-drug presentations for an audience of younger peers. The program employed social-psychological approaches directed at having leaders proceed from extrinsic inducements to intrinsic identification with their persuasive products in the context of the group intervention process. The goals of the intervention were to induce substance resistant self-persuasion in the leaders and to produce a spread of this resistance effect to their peer followers. To test the intervention, we compared the substance use behaviors of the selected leaders and their peers to a control cohort. The study found preliminary support that the intervention produced changes in the substance use behavior among the leaders who participated in the intervention, but did not detect a spread to non-leader peers in the short term. This descriptive study speaks to the plausibility of employing self-persuasion paradigms to bring about change in high-risk behaviors among highly central adolescents. In addition, it highlights the viability of applying social psychological principles to prevention work and calls for more research in this area.

A framework for testing and promoting expanded dissemination of promising preventive interventions that are being implemented in community settings

Many evidence-based preventive interventions have been developed in recent years, but few are widely used. With the current focus on efficacy trials, widespread dissemination and implementation of evidence-based interventions are often afterthoughts. One potential strategy for reversing this trend is to find a promising program with a strong delivery vehicle in place and improve and test the program's efficacy through rigorous evaluation. If the program is supported by evidence, the dissemination vehicle is already in place and potentially can be expanded. This strategy has been used infrequently and has met with limited success to date, in part, because the field lacks a framework for guiding such research. To address this gap, we outline a framework for moving promising preventive interventions that are currently being implemented in community settings through a process of rigorous testing and, if needed, program modification in order to promote expanded dissemination. The framework is guided by RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) (Glasgow et al., Am J Publ Health 89:1322-1327, 1999), which focuses attention on external as well as internal validity in program tests, and is illustrated with examples. Challenges, such as responding to negative and null results, and opportunities inherent in the framework are discussed.

Social networks and smoking: exploring the effects of peer influence and smoker popularity through simulations

Adolescent smoking and friendship networks are related in many ways that can amplify smoking prevalence. Understanding and developing interventions within such a complex system requires new analytic approaches. We draw on recent advances in dynamic network modeling to develop a technique that explores the implications of various intervention strategies targeted toward micro-level processes. Our approach begins by estimating a stochastic actor-based model using data from one school in the National Longitudinal Study of Adolescent Health. The model provides estimates of several factors predicting friendship ties and smoking behavior. We then use estimated model parameters to simulate the coevolution of friendship and smoking behavior under potential intervention scenarios. Namely, we manipulate the strength of peer influence on smoking and the popularity of smokers relative to nonsmokers. We measure how these manipulations affect smoking prevalence, smoking initiation, and smoking cessation. Results indicate that both peer influence and smoking-based popularity affect smoking behavior and that their joint effects are nonlinear. This study demonstrates how a simulation-based approach can be used to explore alternative scenarios that may be achievable through intervention efforts and offers new hypotheses about the association between friendship and smoking.

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

BACKGROUND

Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme--Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes.

METHODS

Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation.

RESULTS

KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours.

CONCLUSIONS

KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery.

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

BACKGROUND

Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme--Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes.

METHODS

Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation.

RESULTS

KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours.

CONCLUSIONS

KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery.

Joint modeling of longitudinal data in multiple behavioral change

Multiple behavioral change is an exciting and evolving research area, albeit one that presents analytic challenges to investigators. This manuscript considers the problem of modeling jointly trajectories for two or more possibly non-normally distributed dependent variables, such as marijuana smoking and risky sexual activity, collected longitudinally. Of particular scientific interest is applying such modeling to elucidate the nature of the interaction, if any, between an intervention and personal characteristics, such as sensation seeking and impulsivity. The authors describe three analytic approaches: generalized linear mixed modeling, group-based trajectory modeling, and latent growth curve modeling. In particular, the authors identify identify the strengths and weaknesses of these analytic approaches and assess their impact (or lack thereof) on the psychological and behavioral science literature. The authors also compare what investigators have been doing analytically versus what they might want to be doing in the future and discuss the implications for basic and translational research.

Adolescents' media-related cognitions and substance use in the context of parental and peer influences

Two cross-sectional studies investigated media influences on adolescents' substance use and intentions to use substances in the context of exposure to parental and peer risk and protective factors. A total of 729 middle school students (n = 351, 59% female in Study 1; n = 378, 43% female in Study 2) completed self-report questionnaires. The sample in Study 1 was primarily African-American (52%) and the sample in Study 2 was primarily Caucasian (63%). Across the two studies, blocks of media-related cognitions made unique contributions to the prediction of adolescents' current substance use and intentions to use substances in the future above and beyond self-reported peer and parental influences. Specifically, identification with and perceived similarity to media messages were positively associated with adolescents' current substance use and intentions to use substances in the future, and critical thinking about media messages and media message deconstruction skills were negatively associated with adolescents' intention to use substances in the future. Further, peer influence variables (e.g., peer pressure, social norms, peer substance use) acted as risk factors, and for the most part, parental influence variables (e.g., parental pressure to not use, perceived parental reaction) acted as protective factors. These findings highlight the importance of developing an increased understanding of the role of media messages and media literacy education in the prevention of substance use behaviors in adolescence.

Performance and subjective effects of diazepam and d-amphetamine in high and low sensation seekers

Although sensation-seeking status is associated with age of initiation and amount of drug use among adolescents, and sensitivity to the behavioral and reinforcing effects of drugs among young adults, it is unclear whether sensation-seeking status among adolescents is predictive of sensitivity to the pharmacological effects of drugs (i.e. abuse potential) as adults. This study examined the acute behavioral effects of oral diazepam and d-amphetamine in young adults, ages 18-21 years, who had consistently scored in the highest or lowest third of their grade-based cohort on a modified Sensation Seeking Scale that was completed annually between ages 10 and 14 years. Healthy participants completed 16 7.5-h test days, with test days separated by a minimum of 48 h. Each day, assessments consisting of computer task performance, verbal report of drug effects, and cardiovascular measures were completed 0, 50, 110, 170, 230, and 290 min after drug administration. Placebo and three active doses of diazepam and d-amphetamine (2.5, 5.0 and 10.0 mg/70 kg) were tested under double-blind conditions according to a randomized-block design. Typical stimulant and sedative effects were obtained with d-amphetamine and diazepam, respectively. Drug effects varied as a function of sensation-seeking status, with magnitude of effects on cardiovascular function, task performance, and report of positive drug effects being greater among high sensation seekers, and report of negative drug effects being greater among low sensation seekers. Adolescents who report high levels of sensation seeking on a consistent basis are more sensitive to pharmacological effects of stimulant and sedative drugs that are associated with abuse potential as young adults.

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.

A multivariate approach to a meta-analytic review of the effectiveness of the D.A.R.E. program

The Drug Abuse Resistance Education (D.A.R.E.) program is a widespread but controversial school-based drug prevention program in the United States as well as in many other countries. The present multivariate meta-analysis reviewed 20 studies that assessed the effectiveness of the D.A.R.E. program in the United States. The results showed that the effects of the D.A.R.E. program on drug use did not vary across the studies with a less than small overall effect while the effects on psychosocial behavior varied with still a less than small overall effect. In addition, the characteristics of the studies significantly explained the variation of the heterogeneous effects on psychosocial behavior, which provides empirical evidence for improving the school-based drug prevention program.

Adolescent neurological development and its implications for adolescent substance use prevention

Recent technological advancements have facilitated the study of adolescent neurological development and its implications for adolescent decision-making and behavior. This article reviews findings from the adolescent neurodevelopment and substance use prevention literatures. It also discusses how findings from these two distinct areas of adolescent development can complement each other and be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, a combination of child-centered and family-based strategies is advocated based on extant neurological and prevention literature. EDITORS' STRATEGIC IMPLICATIONS: Researchers are encouraged to take up the authors' challenge and study the links between adolescent neurological development/decision making ability and the long term efficacy of comprehensive interventions for preventing adolescent substance use.

Ten good reasons to consider biological processes in prevention and intervention research

Most contemporary accounts of psychopathology acknowledge the importance of both biological and environmental influences on behavior. In developmental psychopathology, multiple etiological mechanisms for psychiatric disturbance are well recognized, including those operating at genetic, neurobiological, and environmental levels of analysis. However, neuroscientific principles are rarely considered in current approaches to prevention or intervention. In this article, we explain why a deeper understanding of the genetic and neural substrates of behavior is essential for the next generation of preventive interventions, and we outline 10 specific reasons why considering biological processes can improve treatment efficacy. Among these, we discuss (a) the role of biomarkers and endophenotypes in identifying those most in need of prevention; (b) implications for treatment of genetic and neural mechanisms of homotypic comorbidity, heterotypic comorbidity, and heterotypic continuity; (c) ways in which biological vulnerabilities moderate the effects of environmental experience; (d) situations in which Biology x Environment interactions account for more variance in key outcomes than main effects; and (e) sensitivity of neural systems, via epigenesis, programming, and neural plasticity, to environmental moderation across the life span. For each of the 10 reasons outlined we present an example from current literature and discuss critical implications for prevention.

Examining the effects of fatal vision goggles on changing attitudes and behaviors related to drinking and driving

This study investigated the effectiveness of the Fatal Vision goggles. College students (N = 251) were randomly assigned to one of four groups including two control groups, a group wearing the goggles, and a group watching those wearing the goggles. Attitudes and behaviors toward drinking and driving were assessed immediately prior to and after the intervention, and then again at a four-week follow up. The group wearing the goggles reported significantly greater declines in accepting attitudes toward drinking and driving compared to the other groups at the immediate post-test. However, these differences disappeared after four weeks. Also, the change in attitude was not accompanied by a similar decrease in drunk driving behaviors. Editors Strategic Implications: School and agency administrators, seeking to reduce unacceptably high rates of drinking and driving, will benefit from this well-designed longitudinal experiment. Replication will be necessary, but the authors present strong evidence that this is a prevention strategy that does not result in behavioral change.

Harm reduction and individually focused alcohol prevention

This paper provides a brief overview of harm reduction and individually focused alcohol prevention strategies. Universal, selective, and indicated prevention strategies are described for several populations including elementary and secondary schools, colleges, and medical settings. This paper primarily reviews individually focused alcohol prevention efforts in the United States (US), where harm reduction has been less well received in comparison to many European countries, Canada, and Australia. Zero-tolerance approaches continue to be the norm in individually focused prevention efforts in the US, especially amongst adolescents, despite research suggesting that harm reduction approaches can be effective. Moreover, existing evidence supports that harm reduction approaches show considerable promise in universal prevention and have become best practices in selective and indicated prevention contexts.