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PLENARY PANEL I: USING RISK AND PROTECTIVE FACTORS IN PREVENTION
Why Risk and Protective Factors Matter in the Design of Effective Interventions
J. David Hawkins, Ph.D.
Preventive interventions that do not address the predictors of drug abuse have little chance of succeeding. Over the past 20 years, knowledge of the predictors of substance abuse and dependence has grown exponentially, as have the number and variety of preventive interventions tested and shown to be effective in reducing risk for and use of substances. These programs have shown that some predictors, identified as risk and protective factors in longitudinal descriptive studies, are modifiable causes of drug abuse that can be changed through preventive interventions. Epidemiologic data show that exposure to multiple risk factors increases substance use prevalence, suggesting that preventive efforts should focus on populations or geographic areas where overall risk levels are high and protective levels low. Furthermore, profiles of risk and protection vary by area. Good epidemiologic data on levels of risk and protection, drug use, and related adolescent health and behavior outcomes are fundamental for matching preventive policies and services to the areas and populations served. These data also can form the baseline for monitoring changes in levels of risk, protection, substance use, and related outcomes over time; increasing accountability; and providing benchmarks for continual, outcome-guided improvement of prevention policies and services based in science.
Arthur MW, Blitz C. (2000) Bridging the gap between science and practice in drug abuse prevention through needs assessment and strategic community planning. Journal of Community Psychology 28(3):241-255.
Hawkins JD, Catalano RF, Kosterman R, Abbott R, Hill KG. (1999) Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatrics and Adolescent Medicine 153(3):226-234.
Pollard JA, Hawkins JD, Arthur MW. (1999) Risk and protection: Are both necessary to understand diverse behavioral outcomes in adolescence? Social Work Research 23(3):145-158.
What the Family Can Do About Early Risks
John B. Reid, Ph.D.
A strong, broad, and rapidly expanding research base now exists that pinpoints family-level antecedents, risk, and protective factors that are directly involved in the early development of children and can lead to substance use, conduct problems, risky sexual activities, and other related problems in adolescence. The influence of family factors begins at birth or before and continues through early and middle childhood into adolescence. Increasingly, this developmental research base has been used to inform the design of preventive and clinical interventions that are specifically focused on helping families deal with a variety of risk factors that emerge from early childhood through middle adolescence. Many such interventions have been demonstrated to have strong and persistent effects in carefully controlled studies. This presentation will summarize new and relevant findings from basic research, exemplary interventions, and implications for the next generation of family-level interventions.
Capaldi DM, Eddy JM. (2000) Improving children's long-term well-being by preventing antisocial behavior. In: A Buchanan, B Hudson (eds.). Promoting Children's Emotional Well-being. Oxford, United Kingdom: Oxford Press, pp. 209-229.
Chamberlain P, Reid J. (1998) Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology 6:624-633.
Reid JB, Eddy JM. (1997) The prevention of antisocial behavior: Some considerations in the search for effective interventions. In: DM Stoff, J Breiling, JD Maser (eds.). Handbook of Antisocial Behavior. New York: John Wiley and Sons, pp. 343-356.
Webster-Stratton C. (1998) Preventing conduct problems in Head Start children: Strengthening parent competencies. Journal of Consulting and Clinical Psychology 66:715-730.
What the School Can Do With Early Prevention Interventions
Sheppard G. Kellam, M.D.
Schools as communities are core units for prevention research and programs. Over the past three decades, much has been learned about early risk factors related to later drug abuse. A set of four rigorous prevention research strategies has been developed that is directed at these risk factors. These four strategies will be described, and data from the developmental epidemiologic strategy will be used to illustrate the central role of school and the influence of school environment on risk and prevention. The first strategy requires identifying early risk factors, directing interventions at them, and then determining whether the developmental trajectories toward risk of drug abuse have been improved. The second strategy involves intervening at times of more immediate, concurrent risk, just as the child enters middle school, for example, with exposure to drug-taking children. The third strategy involves multiple interventions at the community level, using school-based drug education, media, and parental awareness, for example. The fourth strategy is at the larger societal policy and law levels, using simulation modeling. All of these strategies are complementary, and all will be required in the next stage of prevention research and programming.
How the Community Can Set Positive Norms and Policies
Mary Ann Pentz, Ph.D.
Before the mid-1980s, community-based prevention was associated with social activism and grassroots organizing to achieve environmental change, typically in response to a community crisis. There was little evidence of effects of these approaches on preventing youth drug use. However, reviews of multicomponent, community-based prevention programs after this period have shown that several have been effective in changing youth drug use. The effective, "evidence-based" approaches share several features, including linking two or more of school, parent, mass media, community organization, and policy intervention components and community-wide involvement in and commitment to these interventions. Results have shown sustained effects on youth drug use for up to or exceeding 8 years and additional effects on parent-child communication, the efficiency of how community leaders organize for prevention, and community norms and policies for prevention. Despite the effectiveness of specific community-based programs, communities face several challenges in deciding whether to adopt a multicomponent program. These include greater cost compared with single-component programs, a greater time commitment for implementation, and a required commitment to long-term institutionalization once community leaders organize for prevention. There are also challenges facing researchers trying to evaluate such programs, including measuring community readiness to commit to a sustained multicomponent program. Status quo community norms and policies have shown weak relationships to youth drug use. Relatively little is known yet about whether and how changing the status quo as a result of community-based programs affects subsequent youth drug use and prevention programs.
How the Media Can Change Behavior
Joseph N. Cappella, Ph.D.
To understand the potential of the media to change behavior, it is necessary to consider both their direct and indirect effects. Direct effects refer to the impact of mass media messages on beliefs, intentions, attitudes, social norms, and efficacy, which in turn affect behavior. Well-designed communication campaigns can have direct effects on behavior, as evidenced by research on smoking and drug use among adolescents. Indirect effects refer to the impact of mass media messages on mental frameworks, social institutions, interpersonal communication, and other processes that can affect targeted behavior "down the line." For example, national media attention to problems such as drunk driving has affected State legislative activity, which in turn resulted in a reduction of fatalities. Media attention can also shape the public's agenda of important problems, redirecting economic resources and highlighting public concerns.
Palmgreen P, Donohew L, Lorch EP, Hoyle RH, Stephenson MT. (Feb 2001) Television campaigns and adolescent marijuana use: Tests of sensation seeking targeting. American Journal of Public Health 91(2):292-296.
Worden JK, Flynn BS, Solomon LJ, Secker-Walker RH. (Nov 1996) Using mass media to prevent cigarette smoking among adolescent girls. Health Education Quarterly 23(4):453-468.
Yanovitzky I, Bennett C. (Aug 1999) Media attention, institutional response, and health behavior change: The case of drunk driving, 1978-1996. Communication Research 26(4):429-453.
THURSDAY WORKSHOPS
Strengthening Families Program: For Parents and Youth 10-14
Richard L. Spoth, Ph.D.
This presentation will include an overview of the Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14), the risk and protective factors the program addresses, and a summary of the program's core elements and topics. The speakers will review key substance-related outcomes of the SFP 10-14 from a followup assessment 6 years past baseline. Findings concerning the relationship of implementation quality and outcomes also will be presented, along with strategies for high-fidelity implementation. The speakers will describe SFP 10-14 participation research and related procedures for maximizing recruitment and retention and provide information on program materials and training.
School-Based Drug Use Prevention: The Project ALERT Experience
Phyllis L. Ellickson, Ph.D.
Using Project ALERT as an example, this presentation will provide an overview of school-based drug prevention, what works, and why. It will discuss which drugs to target, which risk factors to address, and the principles that underlie effective drug use prevention programs. Concrete examples of how those principles can be translated into classroom lessons and activities will be provided. The presentation will describe Project ALERT's original evaluation and results and provide early information from a followup evaluation. It will conclude with a discussion of lessons learned from evaluation research and from the educators who adopt and implement prevention programs.
Reconnecting Youth
Jerald R. Herting, Ph.D.
Reconnecting Youth (RY) is an indicated substance use prevention program targeting youth at risk of school failure. Many of these youth have co-occurring problems of drug involvement, depression, anger/aggression, and suicide-risk behaviors. RY addresses this constellation of behavioral outcomes. The speakers will describe the semester-long, school-based RY program and detail its skills development content, peer and mentor support intervention strategy, small-group classroom framework within the schools, and evaluation with respect to changing substance use and other behaviors. They will then present current continued testing of the RY program and its expansion to include a year-round curriculum and a parent component. The speakers will also discuss strategies for process and outcome evaluation of RY and tools and procedures for evaluation. Finally, they will discuss general implementation strategies and provide current information on program dissemination.
ATLAS/ATHENA
Linn Goldberg, M.D., FACSM, and Diane Elliot, M.D., FACP, FACSM
Adolescents who participate in sports in the United States represent 50 percent of all students. Although participation in athletics can be beneficial, sports do not protect youth from alcohol and other drug use. This interactive workshop will demonstrate major aspects of the adolescent male health promotion and drug use prevention program, ATLAS, and its counterpart, ATHENA, designed to reduce drug use and disordered eating among adolescent female athletes. Both programs use a team-centered, coach-facilitated, and gender-specific approach. The speakers will describe how ATLAS and ATHENA work and how young athletes can develop resistance to the use of alcohol and illicit drugs and practice healthy lifestyles.
Drug Abuse Prevention Campaigns and Sensation Seeking
Philip Palmgreen, Ph.D.
This presentation will describe the findings of a 15-year series of studies aimed at developing more effective antidrug messages for use in prevention campaigns and other interventions. The research has revolved around sensation seekingÑa widely recognized risk factor for drug use. High-sensation seekers not only are much more likely to use a variety of substances but also require much more novel, stimulating, and dramatic messages to attract their attention and persuade them. A targeting approach utilizing sensation seeking, known as SENTAR, will be illustrated with two campaign studies, the second of which demonstrated via a controlled time-series that SENTAR-based television campaigns can substantially reduce marijuana use among high-sensation-seeking adolescents.
Message Development for Latino Audiences
William D. Crano, Ph.D., and Eusebio M. Alvaro, M.P.H., Ph.D.
Recent research suggests large differences in health-relevant (prevention) knowledge between Hispanic and Anglo youth and their parents. These differences occur despite intense media efforts mounted to help prevent the consequences of unsafe sex and drug abuse. We believe that mass-media prevention messages may place minority groups at a disadvantage if messages are not specifically tailored to address their cultures and concerns. The speakers will describe research on new approaches to presenting information that have been found to be effective for adolescent Hispanic audiences. They will report findings from research on drug use prevention among Anglo and Hispanic youth that involved an intensive, interactive, multimedia, computer-based approach that has proved effective in past research on HIV prevention. The speakers will review this research, detail recent findings that made use of antidrug messages, and discuss possible ways in which the approach may be extended and generalized in the efforts against drug abuse.
Project QUEST Evaluation and Followup
Marvin Eisen, Ph.D.
The Skills for Adolescence (SFA), a widely used comprehensive life skills training curriculum with a dedicated drug education unit, was evaluated in a randomized study of 34 middle schools. Two years after baseline (1 year after intervention), data were collected from 5,691 eighth graders (77 percent student retention). Lifetime use and past 30-day use of alcohol, cigarettes, marijuana, and other drugs were measured. There were two significant treatment main effects at the end of the eighth grade: Lifetime use (p=.05) and recent (p<.03) marijuana use were lower in SFA than in control ("usual" programming) schools. There was one treatment by baseline binge drinking interaction, with baseline bingers reporting less binge drinking in SFA schools (p<.01) but no SFA effect among baseline nonbingers. This study supports SFA's life skills prevention approach and, because of its commercial availability, provides an additional step in bridging a major gap in the research-to-practice literature: identifying popular programs that work.
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