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Alphabetical abstracts and references
Allott R, Paxton R, Leonard R (1999)

British Government policy on drugs primary prevention is outlined and principal recommendations are identified. The review is organized under the four main providers: police, teachers, peers and parents. Current methods are reviewed within a British policy framework with a focus on British programmes which have been evaluated. Most programmes use a combination of information, resistance or life skills training and normative education. Evaluative research suggests these methods are generally most effective. The police have achieved a community-wide approach, teachers have managed to integrate drug education into the National Curriculum, peer approaches have considered the needs of their target audience and parent approaches have recruited influential educators. However, more evaluative research is required before we can identify which particular programmes are most effective in reducing drug use.

  • Allott R, Paxton R, Leonard R (1999). Drug education: a review of British Government policy and evidence of effectiveness. Health Education Research Theory and Practice 14 (4): 491-505. 

Ashton M (2003)

A curriculum based on selected US models is to be tested in England's first national evaluation of substance use education. The choice is critical - poor outcomes could undermine support for drug education in Britain. How solid is the US foundation?

  • Ashton M (2003). American STAR comes to England. Drug and alcohol Findings, 8, 21-26.
Black DR, Tobler NS, Sciacca JP (1998)

It is hard not to be daunted after reading this series of papers. The collection certainly succeeds brilliantly in portraying the many difficulties and complexities that need to be faced if prevention of drug-related harm among high-risk groups of young people is to succeed. It does not leave me feeling, however, that we know much about what works and, perhaps, even about what would be the criteria for effectiveness. I do, however, have a sense of an important new agenda emerging on the prevention of drug-related harm which urgently needsan empirical basis. Reading this thought-provoking set of papers, a number of niggling questions came to mind, most of which relate to what we need to know rather than what we already know. I start with the most general of these questions.

  • Black DR, Tobler NS, Sciacca JP (1998). Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco and other drug use among youth?. Journal of School Health, 68(3), 87-93.

Butler GKL, Montgomery AMJ (2004)

The present study investigated characteristics of recreational drug users, especially ecstasy (MDMA) users, in 254 undergraduates. All participants completed a drug history questionnaire (DHQ), the impulsiveness venturesomeness and empathy questionnaire, a novel risk-taking task (Bets16), and 59 also completed the tri-dimensional personality questionnaire (TPQ). DHQresponses allocated participants to five groups: non-drug controls, cannabis users, polydrug (no ecstasy) users, low (< 20 occasions) ecstasy users and high (>20 occasions) ecstasy users.

Eighteen percent of the sample had used ecstasy and of the ecstasy users, only one had not used other substances. A larger proportion of high ecstasy users had also used amphetamines, cocaine and LSD in comparison to the low ecstasy and non-ecstasy polydrug users. High ecstasy users typically took significantly more ecstasy tablets compared with low ecstasy users. Impulsiveness, venturesomeness and novelty seeking behaviour increased from the non-drug users to high ecstasy users. Ecstasy users (low and high) and polydrug (non-ecstasy) users had higher levels of impulsivity, venturesomeness and novelty seeking behaviour compared with non-drug users. Furthermore, high ecstasy users scored higher on the Bets16 risk-taking measure than non-drug users, cannabis users and low ecstasy users. The findings are discussed in relation to:
(i) the possibility that increased impulsivity pre-dated drug use; and (ii) the possible link between impulsivity and the putative serotonergic neurotoxicity of ecstasy.

  • Butler GKL,Montgomery AMJ (2004). Impulsivity, risk taking and recreational ‘ecstasy’ (MDMA) use. Drug and Alcohol Dependence , (76 ),  55-62
Butters JE (2004)

Drug education programs that rely on an abstinence based philosophy neglect, and may even contribute to, the potentially adverse consequences experienced by young people who already engage in this potentially health-compromising behaviour. A predominant focus for drug research during the initial wave of rising cannabis use by young people in the 1960's and 1970's was centred on identifying the factors that contributed to this trend. Less attention has been devoted to uncovering those factors that may inhibit the progression to high-risk levels of use and particularly whether their impact differs for adolescent males and females. In spite of the questionable effectiveness, formal control mechanism (i.e., criminal laws) and a reliance on prevention-based drug education remain primary approaches for combating drug use. This paper identifies a sub-group of adolescents already using cannabis and estimates the effects of peers, social disapproval and perceived health effects on inhibiting the escalation of use to problem levels. The results suggest that the risk for problem cannabis use among adolescents may be attenuated by some of these informal control items. The findings also suggest however, that the effects of these factors may be different for males and females. The implications for drug education initiatives are discussed.

The impact of peers and social disapproval on high-risk cannabis use: Gender differences and implications for drug education.
  • Butters JE (2004). The impact of peers and social disapproval on high-risk cannabis use: Gender differences and implications for drug education. Drugs: education, prevention and policy, 11(5), 381-390.
Canning U, Millward L, Raj T, Warm D (2004)

 /What we know /

Generally, the effectiveness of drug prevention programmes has tended to be assessed in relation to so-called ‘gateway’ drugs, such as alcohol, tobacco and marijuana, rather than specifically illicit drug use. The impact of drug prevention programmes on illicit drug use has not been adequately reviewed (Black et al., 1998). However, a number of points about the effectiveness of interventions can be made, as follows: • Evidence shows that school-based interventions aimed at adolescents can delay for a short time the start of substance misuse by non-users, and temporarily reduce use by some current users, although the effects decrease with time (White and Pitts, 1998) • Universal prevention programmes appear to be more effective for lower-risk adolescents than those at higher risk (Windle and Windle, 1999) • Review evidence suggests that one US life skills training (LST) programme (Botvin et al., 1990, 1995) demonstrated some continuing success five years after the end of the programme (White and Pitts, 1998). Although a recent external evaluation suggests that neither LST nor other primary prevention programmes are likely to have a major impact on drug use and drug problems, LST is one of the few programmes that has been extensively evaluated and for which there is research evidence of a small but positive impact on drug use (Coggans et al., 2003). Delivery • Review evidence suggests that interactive educative programmes using peers are more effective than non-interactive interventions in preventing drug misuse (Black et al., 1998). • Information-based programmes, including project DARE (Drug Abuse Resistance Education), led by police officers have not had much effect on substance misuse behaviour (Ennett et al., 1994a, 1994b in Allott et al., 1999). For British settings see Noble, 1997; Whelan and Culver, 1997, in Allott et al., 1999. • Teacher-led programmes in Britain fall into three groups – curricular programmes, Theatre in Health Education (THE), and resource packs: – Evaluation results of one curricular programme that has been delivered and evaluated in Britain, Project CHARLIE (Chemical Abuse Resolution Lies in Education), reported prevention of drug use in a small sample of young people who received the programme in primary school and who were followed up in secondary school (see Lloyd et al., 2000) – A qualitative assessment of THE delivered in eight British schools (Fine and Durrant, 1996, in Allott et al., 1999) suggests that the programme was more effective in changing attitudes than merely providing information, although more research is needed – An evaluation of the Lambeth Drug Prevention Team’s Drug Studies Resource Pack concluded that the pack was extremely effective in raising awareness, although more research is necessary (Fine and Durrant, 1996, in Allott et al., 1999). • In peer-led interventions, the child or young person delivering the programme tends to benefit most from the experience (Parkin and McKeganey, 2000). • British parent-oriented programmes have not been adequately evaluated, although there is an indication that such programmes are poorly attended. Attendance is even lower among parents who drink and smoke more heavily, suggesting that programmes might stigmatise these parents and so discourage high-risk families from attending (Cohen and Linton, 1995, in Allott et al., 1999). Components of effective programmes Effective programmes include those that modify attitudes and/or normative beliefs and/or impact on behaviour, such as preventing or reducing drug use. • Effective programmes have tended to include booster sessions (White and Pitts, 1998). • Intensive programmes given a large amount of curriculum time (eg 10 or more sessions) have been shown to be effective, although intensity alone does not necessarily ensure effectiveness (White and Pitts, 1998). • The effectiveness of individual elements included in multicomponent programmes have not been sufficiently assessed; evaluations tend to be limited to comparisons of the effects of the whole programme (Allott et al., 1999). /What we don’t know /Interventions • Most British interventions are not properly evaluated in terms of their outcome, making it hard to judge their effectiveness. • There is a lack of good ‘sound’ evidence for targeted interventions not based in schools (White and Pitts, 1998). • There is a lack of evaluated curricular programmes targeting primary schoolage children (Lloyd et al., 2000). • While studies show the impact of programmes on attitudes, knowledge, resistance skills and intentions of preadolescent children (for example, Ambtman et al., 1990; Church et al., 1990, in Lloyd et al., 2000), very few have examined impact on behaviour in the long term (Lloyd et al., 2000). Methodological issues • Weaknesses in evaluations, such as low participation rates and inappropriate choice of outcome measures, mean that there is a limit to the conclusions that can be drawn from them (Allott et al., 1999). More rigorous evaluation, together with development of alternative evaluation strategies, are required. • Because drug taking is illegal, it is often difficult to identify, recruit and retain participants. • Many studies over-rely on selfreporting, and very few use more objective data, such as saliva or blood tests (White and Pitts, 1998).

  • Canning U, Millward L, Raj T, Warm D (2004). Drug use prevention among young people: a review of reviews.: Health Development Agency.
Coggans N, Watson J (1995)

The key role of educational interventions in the prevention of drug misuse has been reaffirmed in recent expert reports. Nevertheless there is vigorous debate about the value of established approaches to drug education. The purpose of this working paper is to provide an overview of these approaches, examine evidence of effectiveness and draw out implications for delivery in the mass media, communities and schools.

Cohen D, Linton K (1995)

British parent-oriented programmes have not been adequately evaluated, although there is an indication that such programmes are poorly attended. Attendance is even lower among parents who drink and smoke more heavily, suggesting that programmes might stigmatise these parents and so discourage high-risk families from attending

  • Cohen D, Linton K (1995). Parent participation in an adolescent drug abuse prevention program. Journal of Drug Education 25: 159-69.  

Conrad KJ, Randolph FL, Kirby MW, Bebout RR (1999)

The use of logic models in program development, evaluation, and dissemination is becoming more commonly accepted as a means of facilitating communication, replication, quality improvement, and assessment. Each of the following chapters in this book includes a logic model of the program being described. The purpose of this chapter is to describe what logic models are, and to convey to a diverse field the role and functioning of logic models in the conceptualisation, delivery, management, and evaluation of programs. Since this volume is intended fo a wide audience including service providers, program administrators, and researchers, we will attempt to provide information on logic models that is broadly useful. Therefore, this chapter is structured so that each of the four authors presents her/his unique perspective based principally on their own experience using logic models.

 

Conrad KJ, Randolph FL, Kirby MW, Bebout RR (1999). Creating and using logic models: four perspectives. Alcoholism Treatment Quarterly , 17(1/2), 17-31.

Cuijpers P (2002)

Seven evidence-based quality criteria were formulated: the effects of a program should have been proven; interactive delivery methods are superior; the "social influence model" is the best we have; focus on norms, commitment not to use, and intentions not to use; adding community interventions increases effects: the use of peer leaders is better; and adding life skills to programs may strengthen effects.

  • Cuijpers P (2002). Effective ingredients of school-based drug prevention programs: a systematic review. Addictive Behaviors, 27, 1009-1023
Cunningham JA, Wild C, Bondy SJ, Lin E (2001)

OBJECTIVE: As many as one in four adults in North America experiences some problems due to alcohol consumption. Although most of these problem drinkers do not have concerns that are severe enough to merit formal treatment, such drinking has large economic costs and can place the drinker at risk for long-term negative health and social consequences. The present study evaluated a minimal intervention that used normative feedback about population drinking to motivate changes in alcohol use. METHOD: An intervention pamphlet was mailed to over 6,000 households in Toronto, randomized by block from a region containing almost 10,000 households. In the month after the mailing, a general population survey was conducted in the region to assess alcohol use. RESULTS: Respondents from households receiving normative feedback (n = 472) reported significantly lower alcohol use than controls (n = 225), but this effect occurred only among respondents who met an objective criterion for problem drinking and who perceived some risk associated with their drinking. CONCLUSIONS: Viewed from a public health perspective, normative feedback interventions have the potential for a significant payoff because they can be provided at low cost and to problem drinkers who might ordinarily never access any treatment services.

  • Cunningham JA, Wild C, Bondy SJ, Lin E (2001). Impact of normative feedback on problem drinkers: a small-area population study. Journal of Studies an Alcohol, 62, 228-233.

Derzon JH, Sale E, Springer F, Brounstein P (2005)

In a 46-site, 5-year high-risk youth substance abuse prevention evaluation, effect sizes were adjusted using a meta-analytic regression technique to project potential effectiveness under more optimal research and implementation conditions. Adjusting effect size estimates to control for the impact of comparison group prevention exposure, service intensity, and coherent program implementation raised the mean effectiveness estimate from near zero (0.02, SD = 0.21) to 0.24 (SD = 0.18). This finding suggests that adolescent prevention programs can have significant positive effects under optimal, yet obtainable conditions.

  • Derzon JH, Sale E, Springer F, Brounstein P (2005). Estimating intervention effectiveness: synthetic projection of field evaluation results. Journal of Primary Prevention, (26), 321-343.

Dusenbury L, Falco M (1995)

A review of school-based drug abuse prevention programs was conducted for 1989-1994. In addition to a comprehensive literature review, interviews were conducted with a panel of 15 leading experts in prevention research. Key elements of promising prevention curricula were identified. Effective prevention programs were found to be based on a sound theoretical or search foundation. They included developmentally appropriate information about drugs, social resistance skills, training, and normative education. Broader based personal and social skills training appeared to enhance program effects.

Effective programs used interactive teaching techniques and teacher training, and provided adequate coverage and sufficient follow-up.

Cultural sensitivity to the target population was found to be critical to program success. Additional program components were expected to enhance curriculum effectiveness. Finally, experts agreed that adequate evaluation of prevention curricula was critical. Unfortunately, despite information about the types of curricula that are effective, the most promising prevention curricula are not widely disseminated. Reasons for under-utilization are explored, and recommendations made for correcting the situation.

  • Dusenbury L, Falco M (1995). Eleven Components of Effective Drug Abuse Prevention Curricula. Journal of School Health, 65(10), 420-425.
Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL (1994)

OBJECTIVES. Project DARE (Drug Abuse Resistance Education) is the most widely used school-based drug use prevention program in the United States, but the findings of rigorous evaluations of its effectiveness have not been considered collectively. METHODS. We used meta-analytic techniques to review eight methodologically rigorous DARE evaluations. Weighted effect size means for several short-term outcomes also were compared with means reported for other drug use prevention programs. RESULTS. The DARE effect size for drug use behavior ranged from .00 to .11 across the eight studies; the weighted mean for drug use across studies was .06. For all outcomes considered, the DARE effect size means were substantially smaller than those of programs emphasizing social and general competencies and using interactive teaching strategies. CONCLUSIONS. DARE's short-term effectiveness for reducing or preventing drug use behavior is small and is less than for interactive prevention programs.

  • Ennett ST, Tobler NS, Ringwalt CL, Flewelling RL (1994). How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. American Journal of Public Health , (84), 1394-1401.

Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A (2004)

Objective: To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely.

Design and data sources: Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science.

Selection of studies: We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components.

Main outcome measures: Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results.

Results: 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only" arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people.

Conclusions: No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.

http://bmj.bmjjournals.com/cgi/content/full/328/7449/1166

Furr-Holden CDM, Ialongo NS, Anthony JC, Petras H, Kellam SG (2004)

Prior investigations have linked behavioral competencies in primary school to a reduced risk of later drug involvement. In this randomized prevention trial, we sought to quantify the potential early impact of two developmentally inspired universal preventive interventions on the risk of early-onset alcohol, inhalant, tobacco, and illegal drug use through early adolescence. Participants were recruited as they entered first grade within nine schools of an urban public school system. Approximately, 80% of the sample was followed from first to eighth grades. Two theory-based preventive interventions, (1) a family-school partnership (FSP) intervention and (2) a classroom-centered (CC) intervention, were developed to improve early risk behaviors in primary school. Generalized estimating equations (GEE) multivariate response profile regressions were used to estimate the relative profiles of drug involvement for intervention youths versus controls, i.e. youth in the standard educational setting. Relative to control youths, intervention youths were less likely to use tobacco, with modestly stronger evidence of protection associated with the CC intervention (RR = 0.5; P = 0.008) as compared to protection associated with the FSP intervention (RR = 0.6; P = 0.042). Intervention status was not associated with risk of starting alcohol, inhalants, or marijuana use, but assignment to the CC intervention was associated with reduced risk of starting to use other illegal drugs by early adolescence, i.e. heroin, crack, and cocaine powder (RR = 0.32, P = 0.042). This study adds new evidence on intervention-associated reduced risk of starting illegal drug use. In the context of 'gateway' models, the null evidence on marijuana is intriguing and merits attention in future investigations.

  • Furr-Holden CDM, Ialongo NS, Anthony JC, Petras H, Kellam SG (2004). Developmentally inspired drug prevention: Middle school outcomes in a school-based randomized prevention trial. Drug and Alcohol Dependence 73(2): 149-158.
Gardner SE, Brounstein PJ, Stone DB (2001)

Although recent reports show a levelling or decrease in substance use among our nation's youth, drug abuse remains a problem in our country. There were 14.8 million current users of illicit drugs in 1999. This figure represents 6.7 percent of the population 12 years and older. The 1999 National Household Survey also found increases in illicit drug use among adults ages 18-25. Although the rates for those 26-43 years old and 35 years and older have not changed significantly since 1994, overall statistics indicate that there is still work to be done in preventing substance abuse.

The Substance Abuse and Mental Services Health Administration's (SAMHSA) Centre of Substance Abuse Prevention (CSAP) developed this series of products in response to the ongoing substance abuse problems. The three components in this series support CSAP's mission to provide resources that are based on science, with measurable outcomes, and designed to hep community and state leaders formulate targeted programs.

CSAP is committed to sponsoring, accumulating, and integrating knowledge regarding scientifically defensible and effective prevention practices. The primary foci of each document in this series is CSAP grantees, constituent organizations, and the communities these groups serve.

We are pleased to release this guide to CSAP's conceptual framework and methodology for designing and assessing scientifically defensible programs for substance abuse prevention. The results reflect the findings of 10 years of CSAP-funded demonstration programs, as well as other advances in the design and evaluation of successful prevention strategies. These findings together lay the foundation for a new, empirically based approach to prevention programming.

The booklet highlights the risk and protective factors that help determine an individual's vulnerability to substance abuse. It also examines CSAP's qualitative and quantitative strategies for evaluating existing substance abuse prevention programs and developing scientifically defensible best practices.

This booklet is one in a series of products developed to hep key stakeholders structure and assess scientifically defensible programs. It is designed to serve practitioners and others involved in the development, implementation, and evaluation of substance abuse prevention programs as we work together on innovative and effective solutions that respond to the unique needs of individual communities.

  • Gardner SE, Brounstein PJ, Stone DB (2001) Science-Based Substance Abuse Prevention: A Guide. Rockville MD: Division of Knowledge Development and Evaluation, Substance Abuse and Mental Health Services Administration, Centre for Substance Abuse Prevention.
Green LW, Kreuter MW (1991)

Green LW, Kreuter MW (1991). Health Promotion Planning: An Educational and Environmental Approach / (2nd edition).

Hansen WB, Graham JW (1991)

BACKGROUND. Two strategies for preventing the onset of alcohol abuse, and marijuana and cigarette use were tested in junior high schools in Los Angeles and Orange Counties, California. The first strategy taught skills to refuse substance use offers. The second strategy corrected erroneous normative perceptions about prevalence and acceptability of use among peers and established conservative groups norms regarding use. METHODS. Four experimental conditions were created by randomly assigning schools to receive (a) neither of the experimental curricula (placebo comparison), (b) resistance skill training alone, (c) normative education alone, or (d) both resistance skill training and normative education. Students were pretested prior to the program and post-tested 1 year following delivery of the program. RESULTS. There were main effects of normative education for summary measures of alcohol (P = 0.0011), marijuana (P = 0.0096), and cigarette smoking (P = 0.0311). All individual dichotomous measures of alcohol, marijuana, and tobacco use indicated significant reductions in onset attributable to normative education. There were no significant main effects of resistance skill training. CONCLUSION. These results suggest that establishing conservative norms is an effective strategy for preventing substance use.

  • Hansen WB, Graham JW (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms.. Preventive Medicine, (20), 414-430.

Hansen W B (1992)

Substance use prevention studies published between 1980 and 1990 are reviewed for content, methodology and behavioral outcomes. Studies were classified based on the inclusion of 12 content areas: Information, Decision Making, Pledges, Values Clarification, Goal Setting, Stress Management, Self-Esteem, Resistance Skills Training, Life Skills Training, Norm Setting, Assistance and Alternatives. Six groups of programs (Information/Values Clarification, Affective Education, Social Influence, Comprehensive, Alternatives and Incomplete programs) are identified. Reports are analyzed for two major threats to validity, selection bias and statistical power. Program groups generally have similar selection biases but have important differences in statistical power. Comprehensive and Social Influence programs are found to be most successful in preventing the onset of substance use.

  • Hansen W B (1992). School-based substance abuse prevention: a review of the estate of the art in curriculum, 1980 - 1990. Heatlh Education Research. Theory & Practice, 7(3), 403-430.
Hawks D, Scott K, McBride N, Jones P, Stockwell T. (2002)

This review sets out to determine what evidence exists for the efficacy of preventive interventions in five circumscribed areas: regulation of physical and economic availability of alcohol, regulation of physical and economic availability of illicit substances, the use of the mass media, community-based initiatives and the use of school-based education.

  • Hawks D, Scott K, McBride N, Jones P, Stockwell T. (2002). Prevention of Psychoactive Substance Use. A Selected Review of What Works in the Area of Prevention. Geneva: World Health Organization.
Hawkins J D, Catalano R F, Miller J Y (1992)

The authors suggest that the most promising route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies. The authors review risk and protective factors for drug abuse, assess a number of approaches for drug abuse prevention potential with high-risk groups, and make recommendations for research and practice.

  • Hawkins J D, Catalano R F, Miller J Y (1992). Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention. Psychological Bulletin, 112(1), 64-105.
Jones, M (2004)

This paper sets out to make sense of government responses to young people and drug use through an application of some central concepts arising from the work of Ulrich Beck and risk society theory. It is primarily concerned with recent universal and targeted drug prevention initiatives in the UK. With regard to universal educational and health promotion, it is argued that initiatives have struggled to define their communicative rationality in the context of young people's changing social encounter with drugs. Policy-based initiatives have also become increasingly expansive in nature as they seek to contain a complex and contested social risk environment. Yet, in so doing they encounter operational difficulties associated with 'manufactured risks'. Meanwhile, targeted drug prevention has become increasingly driven by the science of risk and vulnerability. However, rather than managing hazards, both 'risk science' associated policy-based interventions encounter definitional problems and system-generated risks associated with their praxis. Government agencies have, in turn, responded through introducing formalized systems for co-ordination and the responsibilisation of an increasing range of actors. Notwithstanding some difficulties, it is suggested therefore that risk society theory elucidates some of the conflicts and instabilities that underlie contemporary young people and drug prevention policy.

  • Jones, M (2004) Anxiety and Containment in the Risk Society: theorising young people’s drugs prevention policy., International Journal of Drug Policy , 15/16, 367-376

Joseph A, Califano Jr (2005)

CASA research has consistently shown that the more often teens have dinner with their families, the less likely they are to smoke, drink or use drugs. This report, The Importance of Family Dinners, which draws from the results of CASA's tenth annual back to school survey, finds that, compared to teens who have five or more family dinners per week, teens who have two or less are:

    • three times likelier to try marijuana;
    • two and a half times likelier to smoke cigarettes; and
    • more than one and a half times likelier to drink alcohol.
  • Joseph A, Califano Jr. "The Importance of Family Dinners II ." The National Center on Addiction and Substance Abuse at Columbia University 2005.

Kumpfer K L, Bluth B (2004)

This article discusses implications of a theoretical model of resilience—the Resilience Framework, including the impact of parent/child transactional processes in moderating or mediating a child’s biological or environmental risks and later substance misuse.

Research is presented on behavioural and emotional precursors of substance abuse disorders in children of substance users. Detrimental processes within dysfunctional family environments are presented followed by a listing of strategies for increasing resilience in youth by improving family dynamics. The value in elucidating these interactive processes is to increase our understanding of ways to reduce the impact of risk factors. Prevention providers should use these strategies as benchmarks for selecting or developing effective family focused prevention programs. Resources are presented for finding effective family interventions as well as an example of a family intervention based on resilience principles, namely the Strengthening Families Program. Recommendations are made for future research and better dissemination of evidence-based family interventions.

  • Kumpfer K L, Bluth B (2004). Parent/child transactional processes predictive of resilience or vulnerability to ‘‘Substance abuse disorders’’. Substance Use & Misuse, 39(5), 671-698.
Lillehoj CJ, Trudeau L, Spoth R, Wickrama KAS (2004)

Using latent growth curve modeling, the current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency (i.e., social assertiveness) and the initiation of substance use (i.e., tobacco, alcohol, marijuana), as well as the effect of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment conducted in 1998. A latent growth curve comparison analysis found that internalizing was related inversely to initial levels of social assertiveness skill among girls; further, internalizing was related positively to substance initiation growth-trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance initiation. Gender moderation of the impact of internalizing and social assertiveness on substance initiation and response to the intervention, as well as the utility of latent growth curve modeling in the study of longitudinal change, are discussed.

  • Lillehoj CJ, Trudeau L, Spoth R, Wickrama KAS (2004). Internalizing, social competence, and substance initiation: Influence of gender moderation and a preventive intervention. Substance Use and Misuse, 39(6), 963-991.
Lindström P, Svensson R (1998)

Lindström P, Svensson R (1998). Skolungdomars attityder til droger. En utvärdering av VÅGA-programmet . Nordisk Alkohol & Narkotikatidskrift , 15(1), 5-21.

 

Martínez-Lorca M, Alonso-Sanz C (2003)

The purpose of the present work is to analyse if there is a relationship between certain personality variables (sensation-seeking, self-concept and assertiveness) and tobacco, alcohol and cannabis use. The sample consisted of 243, 12 year old students of 4 schools in Toledo. The results indicated the strong relationship between sensation-seeking and drug use. As far as the self-concept, the results indicated that, although general self-concept has little relation with behaviour, the family and academic self-concept do seem to have a protector effect in drug-use. This underlines the preventive importance of the family environment and the necessity of working to improve academic self-concept, rather than the purely academic performance, as the latter has shown little relation with drug-use. As far as the social-concept is concerned, there is also little relation with substances use, which seems to advise against basing prevention programmes on the development of general social skills, and is consistent with the weak relationship found between assertiveness and drug-use. Emotional self-concept, contrary to what we expected, indicates a direct relation with the use of the substances studied. 

  • Martínez-Lorca M, Alonso-Sanz C (2003). Búsqueda de sensaciones, autoconcepto, asertividad y consumo de drogas ¿Existe relación?. Adicciones, 15(2), 145-158.
McCambridge J, Strang J (2004)

Abstract: To test whether a single session of motivational interviewing (discussing alcohol, tobacco and illicit drug use) would lead successfully to reduction in use of these drugs or in perceptions of drug-related risk and harm among young people. Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either motivational interviewing (n=105) or non-intervention education-as-usual control condition (n=95). Ten further education colleges across inner London.

Two hundred young people (age range 16–20 years) currently using illegal drugs, with whom contact was established through peers trained for the project. The intervention was adapted from the literature on motivational interviewing in the form of a 1-hour single-session face-to-face interview structured by a series of topics. Changes in self-reported cigarette, alcohol, cannabis and other drug use and in a range of drug-specific perceptions and other indicators of risk and harm. Measurement at recruitment and follow-up interview 3 months later. A good follow-up rate (89.5%; 179 of 200) was achieved. In comparison to the control group, those randomized to motivational interviewing reduced their use of cigarettes, alcohol and cannabis, mainly through moderation of ongoing drug use rather than cessation. Effect sizes were 0.37 (0.15–0.6), 0.34 (0.09–0.59) and 0.75 (0.45–1.0) for reductions in the use of cigarettes, alcohol and cannabis, respectively. For both alcohol and cannabis, the effect was greater among heavier users of these drugs and among heavier cigarette smokers. The reduced cannabis use effect was also greater among youth usually considered vulnerable or high-risk according to other criteria. Change was also evident in various indicators of risk and harm, but not as widely as the changes in drug consumption. This study provides the first substantial evidence of non-treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing. The targeting of multiple drug use in a generic fashion among young people has also been supported.

  • McCambridge J, Strang J (2004). The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial. Addiction, Volume 99, Number 1, pp. 39-52.
McGovern TF (1998)

McGovern TF (1998). Vulnerability: Reflection on Its Ethical Implications for the Protection of Participants in SAMHSA Programs. Ethics & Behavior, Vol. 8 (4), 293-304.

Morgan M (2001)

This publication provides an overview and analysis of all available research, in Ireland and abroad, relating to the prevention of drug misuse.

Morral A R, McCaffrey D F, Paddock S M (2002)

Aims: Strong associations between marijuana use and initiation of hard drugs are cited in support of the claim that marijuana use per se increases youths' risk of initiating hard drugs (the 'marijuana gateway' effect). This report examines whether these associations could instead be explained as the result of a common factor -drug use propensity- influencing the probability of both marijuana and other drug use.

Design: A Model of adolescent drug use initiation in the United States is constructed using parameter estimates derived from US household surveys of drug use conducted between 1982 and 1994. Model assumptions include: (1) individuals have a non-specific random propensity to use drugs that is normally distributed in the population; (2) this propensity is correlated with the risk of having an opportunity to use drugs and with the probability of using them given an opportunity, and (3) neither use nor opportunity to use marijuana is associated with hard drug initiation after conditioning on drug use propensity.

Findings: Each of the phenomena used to support claims of a 'marijuana gateway effect' are reproduced by the model, even though marijuana use has no causal influence over hard drug initiation in the model.

Conclusions: Marijuana gateway effects may exist. However, our results demonstrate that the phenomena used to motivate belief in such an effect are consistent with an alternative simple, plausible common-factor model. No gateway affect is required to explain them. The common-factor model has implications for evaluating marijuana control policies that differ significantly from those supported by the gateway model.

  • Morral A R, McCaffrey D F, Paddock S M (2002). Reassessing the marijuana gateway effect. Addiction, 97, 1493-1504.
Newcomb MD, Maddahian E, Bentler PM (1986)

This study points to the importance of drug use among peers (and adults) as some of the most important risk factors, but more important is the point that the actual number of riskfactors is crucial for the development of problem use/or not.

  • Newcomb MD, Maddahian E, Bentler PM (1986). Risk Factors for Drug Use among Adolescents: Concurrent and Longitudinal Analyses. American Journal of Public Health;76:525-31.
Ogilvie D, Gruer L, Haw S (2005)

Young people in the United Kingdom can easily obtain cigarettes and alcoholic drinks from a range of social and illicit commercial sources before they reach the legal minimum age for such purchases; many also report having access to
illicit drugs.
Prices of alcoholic drinks and most illicit drugs, but not cigarettes, have been falling in real terms.
Increasing the price of tobacco and alcohol is,likely to reduce young people’s demand for,them.
Enforcing the minimum age for purchase of tobacco can reduce sales to people under the
legal age limit, and raising the minimum age for purchase of alcohol has been shown to reduce young people’s consumption.
Unenforced voluntary agreements with retailers and intervening in illicit distribution systems have not been shown to influence young people’s use of tobacco, alcohol, or other drugs

  • Ogilvie D, Gruer L, Haw S. "Young peoples access to tobacco, alcohol and other drugs." BMJ Journals 2005.

Orlando M, Tucker J S, Ellickson P L, Klein D J (2005)

Concurrent use of alcohol and tobacco is common among adolescents, yet little is known about the developmental patterns of concurrent use, or the consequences associated with such patterns during young adulthood. Using data collected at six time points during 1985–1995 as part of an evaluation of a school-based substance abuse prevention
program in California and Oregon, this study used latent growth mixture modeling to identify five distinct developmental trajectories of concurrent use of alcohol and tobacco from ages 13–23 in a cohort of 5873 individuals and compared these distinct groups with respect to demographic characteristics and young adult outcomes (at age 23 and age 29).
Results suggest that while it is common during adolescence to drink but not smoke, it is very unusual to smoke and not drink. Compared to young people who smoked and drank consistently throughout their teens and early twenties, those who drank consistently but smoked only occasionally or dramatically decreased their smoking over time had lower rates of deviant behavior and predatory violence at age 23 and were less likely to have a history of arrest and substance use problems by age 29. This close examination of concurrent use of alcohol and cigarette use from ages 13–23 further accentuates the importance of curbing smoking behavior among adolescents before it becomes habitual.

  • Orlando M, Tucker J S, Ellickson P L, Klein D J. "Concurrent Use of Alcohol and Cigarettes from Adolescence to Young Adulthood: An Examination of Developmental Trajectories and Outcomes." Substance Use & Misuse.40 (2005): 1051-1069.

Oxford M L, Harachi T W, Catalano R F, Abbott R D (2000)
A review of the literature suggests that early substance initiation is related to a variety of negative outcomes, including substance misuse or abuse in adolescence and adulthood. This study examines potentially modifiable predictors of early substance initiation, including both family and peer factors known to influence early initiation. A theoretically derived model of substance initiation was tested using structural equation modelling. Results indicate  that both family and peer factors have an impact on early sub-stance initiation when children in this sample were 11 and 12 years old. The model explained 60% of the variance in substance initiation. Prosocial family processes (rules, monitoring, and attachment) had a significant impact on child peer association, decreasing involvement with antisocial peers. These prosocial family processes had a significant negative effect on substance initiation even while modelling the influence of antisocial peers. Implications for drug use prevention practice are discussed.
  • Oxford M L, Harachi T W, Catalano R F, Abbott R D (2000). Preadolescent predictors of substance initiation: a test of both the direct and mediated effect of family social control factors on deviant peer associations and substance initiation. Am. J. Drug alcohol abuse, 27(4), 599-616.
Page RM, Roland M (2004)

Page RM, Roland M (2004). Misperceptions of the prevalence of marijuana use among college students: athletes and non-athletes. . Journal of Child and Adolescent Substance Abuse, 14, 61-75.

Paglia A, Room R (1999)

This paper critically reviews the evaluative literature on programs and other interventions designed to prevent substance-use problems among youth. We start from a description and discussion of patterns and trends in youthful drug use, and evidence on types of harm. We then describe and assess the literature evaluating programs and initiatives to prevent youthful drug problems. The following headings were used: Education & Persuasion, Community-Based, Legal and Regulatory Policies, and Harm Reduction. Lastly, in the light of this review, we offer some commentary and analysis concerning the reality of program goals, theoretical underpinnings, and cost-effectiveness. We conclude with recommendations for future prevention strategies.

  • Paglia A, Room R (1999). Preventing substance use problems among youth: a literature review and recommendations. Journal of Primary Prevention, 20(1), 3-50
Petraitis J, Flay BR, Miller TQ, Torpy EJ, Greiner B (1998)

This paper reviews findings from 58 prospective studies of illicit substance use (ISU) among adolescents. It arranges 384 findings according to three types of influence (viz., social, attitudinal, and intrapersonal) and four levels of influence (viz., ultimate, distal, proximal, and immediate). The bulk of evidence reconfirms the importance of several predictors of ISU (e.g., intentions and prior substance-related behaviour, friendship patterns and peer behaviours, absence of supportive parents, psychological temperament), reveals that a few variables thought to be well-established predictors may not be (e.g., parental behaviours, parental permissiveness, depression, low self-esteem), and uncovers several variables where findings were either sparse or inconsistent (e.g., the role of public policies concerning ISU, mass media depictions of ISU, certain parenting styles, affective states, perceptions of parental disapproval for ISU, and substance-specific refusal skills). Directions for future research are discussed.

  • Petraitis J, Flay BR, Miller TQ, Torpy EJ, Greiner B (1998). Illicit Substance Use among Adolescents: A Matrix of Prospective Predictors. Substance Use & Misuse, 33(13), 2561-2604.
Reis J, Riley W, Lokman L, Baer J (2000)

This article summarizes the process of implementation and short-term impact on knowledge and attitudes of an interactive multimedia software program on preventive alcohol education for young adults. The three factors related to behavioral change addressed in the software are self-efficacy in maintaining personal control and safety while using alcohol, attitudes and related expectations regarding the physiological and behavioral consequences of alcohol consumption, and peer norms regarding alcohol consumption. As compared to alternative alcohol education and a no-alcohol education groups, students using the interactive computer lesson reported learning more about dose-response and ways to intervene with friends in peril. The article concludes with consideration of the import of this technology for informing students about the consequences of alcohol use, and the utility to higher education institutions of using this technology in an era when pressures increase for due diligence around student safety but with few additional institutional resources.

  • Reis J, Riley W, Lokman L, Baer J (2000). Interactive multimedia preventive alcohol education: a technology application in higher education. Journal of Drug Education, 30(4), 399-421.

Repetti RL, Taylor SE, Seeman TS (2002)

Repetti RL, Taylor SE, Seeman TS (2002). Risky Families: Family Social Environments and the Mental and Physical Health of the Offspring. Psychological Bulletin, vol.128, No.2, 330-366.

Rhodes T, Lilly R, Fernández C, Giorgino E, Kemmesis UE, Ossebaard HC, Lalam N, Faasen I, Spannow KE (2003)

This paper discusses research findings on non-biological risk factors associated with illicit drug use. There is an established body of North American research in this field, and a growing European literature. We find that there is an interplay of individual and environmental factors associated with drug use, with the permeation of their interactions potentially limitless. Within the behavioural science literature, we identify three main

analytical dimensions for understanding ‘risk factors’. These are: ‘intrapersonal’; ‘microenvironmental’; and ‘macro-environmental’. We note that it is not new to emphasize

drug use as a social activity, involving social interactions within particular social environments, but that, despite this, the balance of focus in research tends towards ‘extra-environmental’ or ‘individualistic’ interpretations. We emphasize that future research is best oriented towards generating data of practical value for the development of interventions rather than attempting to delineate causative factors. The failure of most risk factors research rests in its incapacity to capture the variety of social and environmental influences on drug use, and the relevance of these for developing socially appropriate interventions. In addition to recognizing the importance of targeting interventions towards ‘high risk’ populations and ‘high risk’ forms of drug use, we emphasize throughout the importance of the ‘risk environment’ in mediating patterns of drug use.

  • Rhodes T, Lilly R, Fernández C, Giorgino E, Kemmesis U E, Ossebaard H C, Lalam N, Faasen I, Spannow K E (2003). Risk factors associated with drug use: the importance of 'risk environment'. Drugs: education, prevention and policy, 10(4), 303-329.
Roe E, Becker J (2005)

The aim of this study was to carry out a comprehensive and systematic review of the literature on drug-use prevention with vulnerable young people. A search of electronic databases was conducted to find evaluations of prevention programmes targeted at high-risk young people and including illegal drug use as an outcome measure. Sixteen relevant studies were found that used a suitable quality of research design, involving at least a comparison group. The most common setting for these evaluations was in schools, where life-skills training interventions showed positive results in reducing drug use (at least in the short term). In the community an intensive multi-component intervention (the Children at Risk program) was the most effective. Across different settings the 11-13 age range appeared to be a crucial period for intervention with vulnerable young people. All of the sixteen studies included in the review were from North America and therefore there is a need for outcome evaluations of targeted drug prevention initiatives in the UK.

  • Roe E, Becker J (2005) Drug prevention with vulnerable young people: a review. Drugs: education, prevention and policy 12 (2), pp. 85-99.

Rooney B L, Murray D M (1996)

This article presents the results of a meta-analysis designed to test the prevailing view that we largely understand why adolescents star to smoke and how to delay it. This view has developed even though none of the major reviews of the last 12 years has adjusted for the important methodological problems that all of those reviews identified as common in the published literature. School-based smoking prevention programs based on peer or social-type programs, published between 1974 and 1991, were included in this meta-analysis. Treatment characteristics were used to predict an effect size after adjustment for study design and population characteristics, and in particular, after a post hoc correction for errors in the original unit of analysis. The results suggest that the average effect for peer or social-type programs is likely to be quite limited in magnitude, and that the reduction in smoking may be only 0.10 standard deviation units, or perhaps 5%. Even under optimal conditions, the reduction in smoking may be only 0.50 to 0.75 standard deviation units, or perhaps 20%-30%.

  • Rooney B L, Murray D M (1996). A Meta-Analysis of Smoking Prevention Programs After Adjustment for Errors in the Unit of Analysis. Health Education Quarterly, 23(1), 48-64.

Saxena S, Hawks D, Scott K, McBride N, Nkowanw M.

The results of an international literature search on the prevention of psychoactive substance use and related harms are presented in relation to five main areas: regulation of the physical and economic availability of alcohol, regulation of the physical and economic availability of illicit substances, community based programmes, mass media campaigns and school based programmes. It is concluded that: (i) the enforcement of regulations relating to the sale of alcohol and increasing the cost of alcohol through taxation generally lower local rates of serious alcohol-related harm; (ii) the regulation of illicit psychoactive substances poses unique challenges and that limitations on the supply of one substance may precipitate increased use of another, sometimes more dangerous substance; (iii) community initiatives have been more successful in influencing public perceptions of problems and policy responses than in changing individual behaviour, and should be tailored to a population group by using local prevalence data; (iv) increased marketing of alcohol in developing countries is posing a significant risk to health and welfare, and the use of the mass media in isolation is a relatively ineffective means of reducing different types of psychoactive substance use; (v) the normative component of social influences approaches to school drug education is more effective than resistance skills training while complementary general health and life skills programmes are more effective than other skill-based programs. It was also concluded that drug education is best integrated in a comprehensive school health curriculum. These conclusions need to be contexualized to the local situation before they form the basis for policy and intervention development.

  • Saxena S, Hawks D, Scott K, McBride N, Nkowanw M. A selective review of what works in the area of prevention.
Scheier L (2001)

Scheier L (2001). Perceived Neighborhood Risk as a Predictor of Drug Use Among Urban Ethnic Minority Adolescents: Moderating Influences of Psychosocial Functioning. Journal of Child & Adolescent Substance Abuse, 11(2), 67-105.

Smyth N J, Kost K A (1998)

Smyth N J, Kost K A (1998). Exploring the Nature of the Relationship Between Poverty and Substance Abuse: Knowns and Unknowns. Journal of Human Behavior in the Social Environment. Vol. 1 (1), 67-82.

Springer et al (2004)

The last two decades have witnessed a rapid development of substance abuse prevention programs. Most efforts to evaluate these programs have been limited to single program studies, and nearly all studies involving multiple drug prevention programs have involved school-based programs for general youth populations. In 1995, the Center for Substance Abuse Prevention (CSAP), with the Substance Abuse and Mental Health Administration (SAMHSA), funded the CSAP National Cross-site Evaluation of High Risk Youth Programs, a five-year, multi-site evaluation study involving 46 programs and over 10,500 youth at high risk for substance use (CSAP, 2002(a)). This article reports findings from this evaluation, focusing on program characteristics that help explain reductions in 30-day substance use among program participants. Programs found to be most effective in reducing substance use were *those that offered strong behavioral life skills development content, emphasized team-building and interpersonal delivery methods, emphasized introspective learning approaches focusing on self-reflection, were based upon a clearly articulated and coherent program theory, and provided intense contact with youth.* Programs utilizing these positive program components produced consistent and lasting reductions in substance use. These findings provide a solid basis for the adoption of positive program characteristics in the development of future prevention programming for high-risk youth.

  • Springer J F , Sale E, Hermann J , Sambrano S , Kasim R , Nistler M. "Characteristics of Effective Substance Abuse Prevention Programs for High-Risk Youth." The Journal of Primary Prevention 25.2 (2004): 171-219.

Stockwell T (1999)

It is hard not to be daunted after reading this series of papers. The collection certainly succeeds brilliantly in portraying the many difficulties and complexities that need to be faced if prevention of drug-related harm among high-risk groups of young people is to succeed. It does not leave me feeling, however, that we know much about what works and, perhaps, even about what would be the criteria for effectiveness. I do, however, have a sense of an important new agenda emerging on the prevention of drug-related harm which urgently needs
an empirical basis. Reading this thought-provoking set of papers, a number of niggling questions came to mind, most of which relate to what we need to know rather than what we already know. I start with the most general of these questions.

  • Stockwell T (1999). A New Agenda for Harm Minimization?. Drugs: education, prevent ion and policy, 6(2), 205-208.

Sussman S, Earleywine M, Wills T, Cody C, Biglan T, Dent C W, Newcomb M D (2004)

This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. We explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high- risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. We present key aspects of these three components and link them to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, we describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behaviour of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and other problem behaviour prevention.

  • Sussman S, Earleywine M, Wills T, Cody C, Biglan T, Dent C W, Newcomb M D (2004). The Motivation, Skills and Decision-Making Model of ''Drug Abuse '' Prevention. Substance Use & Misuse, 39(10-12), 1971-2016.
Taylor B J (2000)

Normative information with feedback on how the individual compares with those norms has been found to be a restraining influence in other settings and populations. Particularly relevant are campaigns to tackle excessive drinking among students, some of which have reported positive results. In the general adult population, a mailed pamphlet encouraging recipients to compare their alcohol intake with national norms led to reduced drinking among concerned problem drinkers. Earlier reports had established that adding normative education reduced cannabis, tobacco and alcohol use relative to information-only lessons, while adding refusal skills created no extra reductions. The pupils' refusal skills and normative beliefs both improved, but only normative beliefs were related to drug use reductions.

  • Taylor B J (2000). Modeling prevention program effects on growth in substance use: analysis of five years of data from the Adolescent Alcohol Prevention Trial. Prevention Science, 1(4), 183-197.

Tobler N S, MS, MSW, CSW (1992)

This paper reports findings of a subset of 91 programs, which included drug use measures, from the data base previously reported in the author's meta-analysis of 143 adolescent drug prevention programs. Treatment components of strategies successful in decreasing drug use by adolescents are discussed with regard to both the developmental stages of adolescents and the current etiology of drug abuse. Meta-analysis is briefly discussed. The focus is on issues rather than the actual research. Questions for future programming address theoretical assumptions and practical issues. Is attitude changing a prerequisite for decreased drug use? This meta-analysis questions the validity of using knowledge and attitude measures as the only outcome measures. Successful program strategies require innovative planning and close attention to implementation factors. Answers to implementation questions require continued quality research. Implications for future planning may lie in the public policy arena.

  • Tobler N S,  MS, MSW, CSW (1992). Drug Prevention Programs Can Work: Research Findings. Journal of Addictive Diseases, 11(3), 1-28.

Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV, Stackpole KM (2000)

This paper reports on a meta-analysis of 207 universal school-based drug prevention programs that compared the self-reported drug use of tratment to control or comparison youth. Programs are classified into Interactive and Non-Interactive groups based on a combination of content and delibery method. Weighted categorical and weighted regression methods haver been used to determine the attributes that most effectively reduce, delay, or prevent drug use including program siza, type of control group and leader, attrition, target drug, intensity, grade, special population and level of drug use. Program type ande size are found to be significant predictors of effectiveness. Non-interactive lecture-oriented prevention programs that stress drug knowledge or affective development show small effects. Interactive programs that foster development of interpersonal skills show significantly greater effects that decrease with large-scale implementations.

  • Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV, Stackpole KM (2000). School-Based Adolescent Drug Prevention Programs: 1998 Meta-Analysis. The Journal of Primary Prevention, 20(4), 275-336.
Tobler N (2001)

Substance use prevention studies published between 1980 and 1990 are reviewed for content, methodology and behavioural outcomes. Studies were classified based on the inclusion of 12 content areas: Information, Decision Making, Pledges, Values Clarification, Goal Setting, Stress Management, Self-Esteem, Resistance Skills Training, Life Skills Training, Norm Setting, Assistance and Alternatives. Six groups of programs (Information/Values Clarification, Affective Education, Social Influence, Comprehensive, Alternatives and Incomplete programs) are identified. Reports are analyzed for two major threats to validity, selection bias and statistical power. Program groups generally have similar selection biases but have important differences in statistical power. Comprehensive and  Social Influence programs are found to be most successful in preventing the onset of substance use.

This review sets out to determine what evidence exists for the efficacy of preventive interventions in five circumscribed areas; (i) regulation of physical and economic availability of alcohol (ii) regulation of physical and economic availability of illicit psychoactive substances (iii) the use of the mass media (iv) community-based initiatives and (v) the use of school based education.

  • Tobler N (2001). Prevention is a two-way process. Drug and alcohol Findings, 5, 25-27.
Wallace JM, Muroff JR (2002)

Wallace JM, Muroff JR (2002). Preventing Substance Abuse among African American Children and Youth: Race Differences in Risk Factor Exposure and Vulnerability. Journal of Primary Prevention, (22), 235-261.

White D, Pitts M (1998)

Evidence shows that school-based interventions aimed at adolescents can delay for a short time the start of substance misuse by non-users, and temporarily reduce use by some current users, although the effects decrease with time.

  • White, D. and Pitts, M. (1998). Educating young people about drugs: a systematic review. Addiction 93 (10): 1475-87.
Wilhelmsen BU, Laberg JC, Klepp KI

Value of peer led prevention for peer educators/facilitators

Key Finding

Interactive programmes more effective than non-interactive interventions. However, more effective at changing knowledge and beliefs and may have greater impact on peer educators than participants.

Source Title

The rise and rise of peer education approaches

Source Reference

Drugs: Education, Prevention, and Policy 7(3): 293-310 (2000)

Authors

Parkin S, McKeganey N

Strength

Neither weak nor strong

Certainty Comments

Limited study of the effectiveness of such programmes, despite their widespread use. Need to clarify aims of peer education projects, so that they can be subject to rigorous assessment. In an effective peer group, members may be compelled to provide socially acceptable rather than personally validating responses.

Validity - Generalisability

Generalisable w/concerns

Generalisability - Comments

Great diversity in project format. Peer-led approaches are a model of intervention, rather than a protocol. Is knowledge to be imparted by peers, expressing their opinions, or are peers conduits for adult opinion?

Validity - Transferability

Non-transferable

Transferability - Comments

Need to distinguish knowledge and attitudinal from behavioural change, and community norms vs. those of the individual. Need rigorous evaluation process which does not compromise the nature of the project

Confounding Effects

Insufficient longitudinal analysis; uncertain whether attitudinal and behavioural change is due to participation or extraneous influences.

Realistic

Fairly realistic

Realistic - Comments

Social/peer groups modulate drug discourse and the adoption of rituals and behaviours designed to alter patterns of drug use, expectations of the effects of drug use (e.g. benefits/disadvantages) and related harm (also see Zinberg). In development, peers important influence in shaping expectations, beliefs, and knowledge. Extent of affiliation to peer group vs. personal independence will adjust effectiveness of this approach.

Burden of Mortality/morbidity

No evidence reviewed

Change in burden

Amenable

Change - Comments

Suggestion of evidence for change in drug use exists in informal peer educators. Results from other fields (e.g. sexual health) suggest peer education is an effective health promoting approach.

Duration of Improvement

Short term

Comments regarding duration

No adequate long-term of prospective analysis, so not possible to comment upon duration

Factors involved in shifting burden

Appropriate educators selected by the target group

Cost Effectiveness Info

1

Cost-Effectiveness Rating

Fairly cost effective

Cost-Effectiveness Comments

Minimal, indirect cost effectiveness information. Peer-led approaches are a relatively inexpensive mode of service provision. May result in reduction in professional spending

Health Inequalities Implications

Somewhat Reduce Inequalities

HI Implications – Comments

Recruitment of marginal and disenfranchised groups as peer leaders

Concluding Comments

Peer-led facilitators should have credibility of person, experience, and message, and should be egalitarian without clear authority figures. (Formal peer group vs. informal peer group). May be appropriate to use the term 'peer support' in order to avoid allusions to authority

Though this intervention study is small (N=955 pupils, 12 schools) and with only quasi-experimental design, it has a very interesting conclusion: that the peer-led sessions only had a better impact (than teacher-led) if well-structured and precisely trained - which points to the very different interventions made under the label  "peer-intervention"

  • Wilhelmsen BU, Laberg JC, Klepp KI. Evaluation of two student and teacher involved alcohol prevention programmes. Addiction 1994; 89(9): 1157-65.
Windle M, Windle RC (1999)

In addition to describing the prevalence of substance abuse among adolescents, the authors describe risk and protective factors in looking at approaches to prevention. Possibilities for future prevention programs, along with present limitations, are also discussed.

  • Windle M, Windle RC (1999). Adolescent tobacco, alcohol, and drug use: current findings. Adolescent Medicine: State of the Art Reviews, 10(1), 153-163.
World Health Organization (1993)

World Health Organization (1993). Increasing the Relevance of Education for Health Professionals.

Griffin KW, Nichols TR, Birnbaum AS, Botvin GJ (2006)

Social competence is increasingly multidimensional during adolescence as young people encounter a variety of new social situations and can respond with a broad range of appropriate behaviors. However, research on social competence has focused more on children than adolescents. The present study examined the relationships between components of social competence (e.g., assertiveness and social confidence) and adolescent problem behaviors including alcohol use and antisocial behaviors (e.g., aggression and delinquency). A survey was administered to 6th grade students (N=2411) entering 20 New York City public and parochial middle schools and again a year later in the 7th grade. Findings indicated that verbal aggression was reported most frequently among students (93%), followed by physical aggression (69%), delinquent behaviors (53%), and alcohol use (16%). Structural equation modeling indicated that while assertiveness was protective in terms of adolescent problem behaviors, social confidence--the level of confidence that students had in initiating social interactions including dating--was associated with greater alcohol use and antisocial behavior both cross-sectionally and longitudinally. Additional analyses revealed that social confidence related to the initiation of dating (e.g., asking someone out for a date or having a conversation with a member of the opposite sex) was most strongly correlated with each problem behavior outcome. These findings suggest that social confidence, particularly as it relates to precocious dating behavior during early adolescence, is a risk factor for the early initiation of alcohol use and antisocial behavior.

Griffin KW, Nichols TR, Birnbaum AS, Botvin GJ (2006). Social competence among urban minority youth entering middle school: relationships with alcohol use and antisocial behaviors. Int J Adolesc Med Health, 18(1): 97-106.

Epstein JA, Bang Hand and Botvin GJ (2007)

Past etiology of adolescent substance use research concentrated on the main effects of various risk factors. The purpose of this study was to also longitudinally predict interactions on poly-drug use intensity and future smoking among inner-city adolescents. A panel sample of baseline, 1-year and 2-year follow-ups (N=1459) from the control group of a longitudinal smoking prevention trial participated. We focused on the main effects, as well as, interaction effects between psychosocial protective factors and various risk factors, including perceived norms of friends, peers and adults to use drugs. Significant effectswere identified for intensity of poly-drug use and future smoking. The analysis of the poly-drug use outcome indicated that refusal assertiveness undermined perceived friends' drug use and siblings' smoking, and that low risk-taking undermined perceived friends' drug use. There was a main effect for low psychological wellness. The significant interactions between perceived friends' drug use with refusal assertiveness and decision-making skillswere observed for future smoking.Moreover, perceived peer smoking norms, siblings' smoking, and high risk-taking also showed significant main effects for increasing future smoking.

Epstein JA, Bang Hand and Botvin GJ (2007). Which psychosocial factors moderate or directly affect substance use among inner-city adolescents?. Addictive Behaviors, 32, 700-713.

Lillehoj CJ, Trudeau L, Spoth R, Wickrama KAS (2004)


Using latent growth curve modeling, the current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency (i.e., social assertiveness) and the initiation of substance use (i.e., tobacco, alcohol, marijuana), as well as the effect of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment conducted in 1998. A latent growth curve comparison analysis found that internalizing was related inversely to initial levels of social assertiveness skill among girls; further, internalizing was related positively to substance initiation growth-trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance initiation. Gender moderation of the impact of internalizing and social assertiveness on substance initiation and response to the intervention, as well as the utility of latent growth curve modeling in the study of longitudinal change, are discussed.

Lillehoj CJ, Trudeau L, Spoth R, Wickrama KAS (2004). Internalizing, social competence, and substance initiation: Influence of gender moderation and a preventive intervention. Substance Use and Misuse, 39, 963-991.

Conrod PJ, Stewart SH, Pihl RO, Côté S, Fontaine V, Dongier M (2000)


Female substance abusers recruited from the community were randomly assigned to receive 1 of 3 brief interventions that differentially targeted their personality and reasons for drug use. The 90-min interventions were: (a) a motivation-matched intervention involving personality-specific motivational and coping skills training, (b) a motivational control intervention involving a motivational film and a supportive discussion with a therapist, and (c) a motivation-mismatched intervention targeting a theoretically different personality profile. Assessment 6 months later (N = 198) indicated that only the matched intervention proved to be more effective than the motivational control intervention in reducing frequency and severity of problematic alcohol and drug use and preventing use of multiple medical services. These findings indicate promise for a client-treatment matching strategy that focuses on personality-specific motives for substance abuse.

Conrod PJ, Stewart SH, Pihl RO, Côté S, Fontaine V, Dongier M (2000). Efficacy of Brief Coping Skills Interventions That Match Different Personality Profiles of Female Substance Abusers. Psychol Addict Behav., 14(3):231-42.

Roger D, Jarvis G and Najarian B (1993)

Present study describes the construction and validation of a new scale for measuring coping strategies entitled the Coping Styles Questionnaire (CSQ). Earlier studies had suggested that there were three primary coping components: task, emotion, and avoidance. In part, the validation of the CSQ confirmed these results, extracting factors concerned with problem-solving (Rational Coping, RATCOP), emotion (Emotional Coping, EMCOP) and avoidance (Avoidance Coping, AVCOP). However, a new factor was uncovered which tapped distancing or detachment (Detached Coping, DETCOP). Subsequent analyses suggested a grouping of two adaptive (RATCOP and DETCOP) and two maladaptive (EMCOP and AVCOP) coping styles, which was confirmed by the concurrent validation of the scale using the Emotion Control Questionnaire

Roger D, Jarvis G and Najarian B (1993). Detachment and coping: the construction and validation of a new scale for measuring coping strategies. Personality and individual difference, 15, 619-626.
Neighbors C, Dillard AJ, Lewis MA, Bergstrom RL and Nei TA (2006)


Previous research has shown that students overestimate the drinking of their peers, and that perceived norms are strongly associated with drinking behavior. Explanations for these findings have been based largely on cross-sectional data, precluding the ability to evaluate the stability of normative misperceptions or to disentangle the direction of influence between perceived norms and drinking. The present research was designed to evaluate (1) the stability of normative misperceptions and (2) temporal precedence of perceived norms and drinking. METHOD: Participants were college students (N = 164; 94 women) who completed assessments of perceived norms and reported behavior for drinking frequency and weekly quantity. Most participants (68\%) completed the same measures again two months later. RESULTS: Results indicated large and stable overestimations of peer drinking for frequency and weekly quantity. Results also showed that for weekly quantity, perceived norms predicted later drinking, but drinking also predicted later perceived norms. Results for frequency revealed perceived norms predicted later drinking, but drinking did not predict later perceived norms. CONCLUSIONS: These findings underscore the importance of longitudinal designs in evaluating normative influences on drinking. The present findings suggest that normative misperceptions are stable, at least over a relatively short time period. Findings support a mutual influence model of the relationship between perceived norms and drinking quantity but are more strongly associated with conformity explanations for the relationship between perceived norms and drinking frequency. Results are discussed in terms of implications for prevention interventions.

Neighbors C, Dillard AJ, Lewis MA, Bergstrom RL and Nei TA (2006). Normative misperceptions and temporal precedence of perceived norms and drinking. J Stud Alcohol, 67: 290-299.

Cunningham JA and Selby PL (2007)


We used a random-digit-dialed survey of 434 smokers to demonstrate that approximately three quarters of young adult (aged 19-24 years) smokers overestimated by 20% or more the proportion of their peers who smoked. The effect of this normative fallacy was significantly greater in young adult smokers than in smokers aged 25 years or older. Because of the strength of this false consensus effect in young adult smokers, normative feedback interventions might be especially effective in this age group.

Cunningham JA and Selby PL (2007). Implications of the Normative Fallacy in Young Adult Smokers Aged 19–24 Years. “American Journal of Public Health, 97 (8): 1399-1400.

Donaldson SI, Graham JW, Hansen WB (1994)


Outcome research has shown that drug prevention programs based on theories of social influence often prevent the onset of adolescent drug use. However, little is known empirically about the processes through which they have their effects. The purpose of the present study was to evaluate intervening mechanism theories of two program models for preventing the onset of adolescent drug use. Analyses based on a total of 3077 fifth graders participating in the Adolescent Alcohol Prevention Trial revealed that both normative education and resistance training activated the causal processes they targeted. While beliefs about prevalence and acceptability significantly mediated the effects of normative education on subsequent adolescent drug use, resistance skills did not significantly predict subsequent drug use. More impressively, this pattern of results was virtually the same across sex, ethnicity, context (public versus private school students), drugs (alcohol, cigarettes, and marijuana) and levels of risk and was durable across time. These findings strongly suggest that successful social influence-based prevention programs may be driven primarily by their ability to foster social norms that reduce an adolescent's social motivation to begin using alcohol, cigarettes, and marijuana.


Donaldson SI, Graham JW, Hansen WB (1994). Testing the generalizability of intervening mechanism theories: understanding the effects of adolescent drug use prevention interventions. Journal of Behavioral Medicine, 17(2): 195-216.

Alamar B, Glantz SA (2007)


The tobacco industry has claimed that smoke-free bar laws caused bar revenues to decline by 30%. After we controlled for economic variables, we found that bars located in areas with smoke-free laws sold for prices that were comparable to prices for similar bars in areas with no smoking restrictions. Other studies have reported that sales did not decline, and we also found that neither price nor sales declined. Therefore, bar owners' concerns that smoke-free laws will reduce the value of their bars are unfounded.

Alamar B, Glantz SA (2007). Effect of smoke-free laws on bar value and profits. The American Journal of Public Health, 97, 8: 1400-1402.

Franks P. et al (2007)


We examined the relationship between smoking participation and cigarette pack price by income group and time period to determine role of cigarette prices in income-related disparities in smoking in the United States. METHODS: We used data from the 1984-2004 Behavioral Risk Factor Surveillance System surveys linked to information on cigarette prices to examine the adjusted prevalence of smoking participation and smoking participation-cigarette pack price elasticity (change in percentage of persons smoking relative to a 1% change in cigarette price) by income group (lowest income quartile [lower] vs all other quartiles [higher]) and time period (before vs after the Master Settlement Agreement [MSA]). RESULTS: Increased real cigarette-pack price over time was associated with a marked decline in smoking among higher-income but not among lower-income persons. Although the pre-MSA association between cigarette pack price and smoking revealed a larger elasticity in the lower- versus higher-income persons (-0.45 vs -0.22), the post-MSA association was not statistically significant (P>.2) for either income group. CONCLUSIONS: Despite cigarette price increases after the MSA, income-related smoking disparities have increased. Increasing cigarette prices may no longer be an effective policy tool and may impose a disproportionate burden on poor smokers.

Franks P. et al (2007). Cigarette prices, smoking, and the poor: implications of recent trends. The American Journal of Public Health, 97: 1873-1877.

Holmila M, Warpenius K (2007)


To an increasing degree, alcohol policy and prevention in the Nordic countries is expected to be carried out on the local level as the free-trade agreements and international harmonization of alcohol taxes and regulations are limiting the scope of traditional national alcohol policies. In recent reviews on the effectiveness of alcohol political interventions the recommended strategy for local communities is to combine community mobilization with various types of environmental strategies focused on the supply of alcoholic beverages. The PAKKA project continues the international tradition of research on community-based prevention of alcohol-related harms. In this paper we discuss the challenges and solutions of evaluating community-based prevention projects, using the recently started 'PAKKA' (Local Alcohol Policy) project as a concrete example. The PAKKA project relies on a mixed-intervention strategy attempting to change the local social, economic and physical environment related to risky and under-age drinking. In measuring the project's effectiveness a quasi-experimental research design is used. In our research design we have had to tackle three interconnected problems: the problems of causality in a multi-component population level study, the problem of generalizability and the complex role of the researcher.

Holmila M, Warpenius K (2007). A study on effectiveness of local alcohol policy: Challenges and solutions in the PAKKA project. Drugs: Education, Prevention & Policy, 14: 529-541.

Livingston M, Chikritzhs T, Room R (2007)


Increasingly, it seems, legal and political debates regarding the granting of new liquor licences are turning to the issue of whether the number and density of alcohol outlets makes a difference in rates of alcohol consumption and alcohol-related harm. But what is the state of the evidence on this question? In this Harm Reduction Digest Livingston, Chikritzhs and Room review the research literature on the effects of density of alcohol sales outlets on alcohol consumption and alcohol-related problems; suggest a new way of conceptualising the relationships; and discuss the implications for reducing alcohol-related harm.Kyp KypriGuest Editor, Harm Reduction Digest.

Livingston M, Chikritzhs T, Room R (2007). Changing the density of alcohol outlets to reduce alcohol-related problems. Drug and Alcohol Review, 26: 557-566.

Booklet - DHHS / SAMHSA - 2001 - US
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