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

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

Teachers' delivery skills and substance use prevention program outcomes: the moderating role of students' need for cognition and impulse decision making

The purpose of this study was to extend the literature in both substance use implementation and persuasive health communication by examining the extent to which students' need for cognition and impulsive decision-making moderated the relationship between teachers' classroom communication behavior and program outcomes in an evidence-based middle school substance use prevention curriculum. Participants included 48 teachers and their respective 7th grade students who participated in a randomized trial testing the effectiveness of personal coaching as a means to improve the quality with which teachers implemented the All Stars curriculum. Need for cognition and impulse decision-making were both associated with positive changes in lifestyle incongruence and commitments to not use substances for students whose teachers displayed greater interactive teaching. Further, need for cognition was associated with lower alcohol use rates while impulse decision making related to lower rates of marijuana use in classes with interactive teaching.     

Parent training to reduce problem behaviors over the transition to high school: Tests of indirect effects through improved emotion regulation skills

Adolescent problem behaviors are costly for individuals and society. Promoting the self-regulatory functioning of youth may help prevent the development of such behaviors. Parent-training and family intervention programs have been shown to improve child and adolescent self-regulation. This study helps fill gaps in knowledge by testing for indirect effects of the Common Sense Parenting® (CSP) program on reduced substance use, conduct problems, and school suspensions through previously identified short-term improvements in parents' reports of their children's emotion regulation skills. Over two cohorts, 321 low income families of 8th graders were enrolled and randomly assigned to either the standard CSP program, an adapted CSP Plus program, or a minimal-contact control condition. Pretest, posttest, 1-year follow-up, and 2-year follow-up survey assessments were completed by parents and students with 94% retention. Intent-to-treat multivariate path analyses were conducted. Neither intervention had statistically significant total effects on the three targeted adolescent outcomes. CSP, but not CSP Plus, had statistically significant indirect effects on reduced substance use and school suspensions at the 1-year follow-up as well as conduct problems and school suspensions at the 2-year follow-up through increased child emotion regulation skills at posttest. Findings provide some support for emotion regulation as one pathway through which the intervention was associated, indirectly, with reduced substance use, conduct problems, and school suspensions among at-risk students over the high school transition.     

Project success' effects on substance use-related attitudes and behaviors: a randomized controlled trial in alternative high schools

Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets high-risk students. We recruited two groups of alternative high schools in successive academic years, and randomly assigned schools in each group to either receive the intervention (n = 7) or serve as a control (n = 7). Students completed surveys prior to and following the administration of the program, and again 1 year later. Although participation in Project SUCCESS significantly increased students' perceptions of harm resulting from alcohol and marijuana use, students in the control group reported greater increases in peer support. We also found conflicting evidence in two opposing trends related to students' perceptions of the prevalence and acceptability of substance use. Therefore, the effects of Project SUCCESS on substance use-related beliefs and behaviors must be considered mixed.     

Adolescent Pregnancy Prevention in a Rural Native American Community

Nationally, the United States has a higher rate of teen pregnancy than any other industrialized nation. Native American youth have a higher birth rate than the national rate. A full-year healthy relationship program, based on Native American teachings, traditions, and cultural norms, was delivered to all eighth-grade students at a rural tribal school and a new group of eighth graders every year for 5 years, to teach healthy relationships and encourage abstinence. This article summarizes the Discovery Dating curriculum and compares the participants in the healthy relationship program to the comparison group, at the end of 5 years, in regards of the number of pregnancies as well as self-reported sexual behavior. The comparison group comprises students in the same community who attended a public middle school, rather than the tribal middle school, but the same public high school. All students had a similar age, socioeconomic status, culture, and ethnicity. Students who received the healthy relationship program (treatment group) had fewer pregnancies than the students who did not receive the healthy relationship program (comparison group). Of those who reported that they were sexually active, the students who received the healthy relationship program (treatment group) reported higher condom use than the students who did not receive the healthy relationship program (comparison group).     

Effects of the 5th and 7th grade enhanced versions of the keepin' it REAL substance use prevention curriculum

This study assessed the outcomes of adapting the culturally-grounded, middle school, substance-use prevention intervention, keepin ' it REAL (kiR), to target elementary school students and to address acculturation. At the beginning of 5th grade, 29 schools were randomly assigned to conditions obtained by crossing grade of implementation (5th, 7th, 5th + 7th, and control/comparison) by curriculum version [kiR-Plus vs. kiR-Acculturation Enhanced (AE)]. Students (n = 1984) completed 6 assessments through the end of 8th grade. The kiR curricula generally appear no more effective than the comparison schools' programming. Students receiving either version of the kiR intervention in only the 5th grade report greater increases in substance use than did control students. Receiving the kiR-AE version twice (both 5th and 7th grades) has benefits over receiving it once.     

Acculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth

This study examined whether language preference, as an indicator of acculturation, moderated the effects of a culturally grounded substance use prevention intervention for Mexican and Mexican American middle school students (N = 2,146) in Phoenix, Arizona. The main hypothesis was that levels of program effectiveness would vary based on the language preference of the students and the specific culturally grounded version of the intervention they were assigned. Findings show that matching language preference to particular versions of the intervention did not influence substance use related program outcomes, but that overall program effects (intervention versus control) did vary by language preference. English-language dominant participants, the most at risk sub-group, responded more positively to the intervention, while Spanish dominant, who had low substance use rates at baseline, and bilingual participants did not demonstrate significant differences between the intervention and control groups. Implications for school social work prevention interventions and prevention science in general, are discussed.     

Acculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth

SUMMARY

This study examined whether language preference, as an indicator of acculturation, moderated the effects of a culturally grounded substance use prevention intervention for Mexican and Mexican American middle school students (N = 2,146) in Phoenix, Arizona. The main hypothesis was that levels of program effectiveness would vary based on the language preference of the students and the specific culturally grounded version of the intervention they were assigned. Findings show that matching language preference to particular versions of the intervention did not influence substance use related program outcomes, but that overall program effects (intervention versus control) did vary by language preference. English-language dominant participants, the most at risk sub-group, responded more positively to the intervention, while Spanish dominant, who had low substance use rates at baseline, and bilingual participants did not demonstrate significant differences between the intervention and control groups. Implications for school social work prevention interventions and prevention science in general, are discussed.     

Three-year follow-up of Drug Abuse Resistance Education (D.A.R.E.)

The long-term effectiveness of D.A.R.E. was assessed by contrasting 9th-grade students who received the program in the 6th grade with others who did not receive the program. Of 38 elementary schools eligible for D.A.R.E. programs, 21 received the program and 17 did not. A follow-up survey assessed central D.A.R.E. concepts such as self-esteem, resistance to peer pressure, delay of experimentation with drugs, and drug use. Employing latent variables to represent the concepts, no significant differences were found between D.A.R.E. participants and controls. The authors discuss attenuation of effects and the generally antidrug context of schools.     

The effects of Project SUCCESS on student academic performance: a quasi-experimental study

Project SUCCESS (PS) is a substance use prevention program that targets indicated high school students. We used archival data to explore the program's effects on students' academic achievement and disciplinary problems. It is essential to demonstrate such effects, if prevention curricula are to survive in schools that face multiple competing demands for class time. Using a quasi-experimental design that compared students exposed to the program to those not exposed in five schools, we examined the effects of PS on grades, absenteeism, and disciplinary problems. Using longitudinal analyses that linked individual students' program exposure data to their academic performance, we found that PS had a positive impact on both grades and absenteeism for two years following exposure. We note that these findings are particularly fortuitous, as PS was not designed to affect these outcomes. We recommend that future evaluations of school-based prevention curricula routinely include academic performance.     

The prevalence of evidence-based substance use prevention curricula in the nation's elementary schools

Current guidelines for school-based substance use prevention suggest that prevention efforts should begin in elementary grades, before students begin using substances. Previous research suggests, however, that the use of evidence-based curricula in these grades may be low. Using a 2005 survey of public school districts in the United States that include elementary grades (n = 1563), we assessed the prevalence of elementary curricula use, particularly those designated as evidence-based. We found that although 72% of districts administer a substance use prevention curriculum to their elementary students, only about 35% are using one that is evidence-based and only about 14% are using an evidence-based curriculum more so than any other prevention curriculum. We present prevalence estimates for specific evidence-based curricula and conclude by discussing possible reasons for and implications of our findings.     

Long-term impact of Drug Abuse Resistance Education (D.A.R.E.). Results of a 6-year follow-up

The long-term effectiveness of Drug Abuse Resistance Education (D.A.R.E.) was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 twelfth-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although the authors found no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th grade, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample but not in a validation sample. Findings from the two studies suggest a possible sleeper effect for D.A.R.E. in reference to the use of harder drugs, especially among teenage males.     

Effects of a stage-based alcohol preventive intervention for inner-city youth

The purpose of this study was to examine first year outcomes of an alcohol preventive intervention within inner-city middle schools. Subjects consisted of 650 sixth grade students from one neighborhood inner-city school (n = 262) and one bused school (n = 388). At posttest, chi-square analyses showed that significantly fewer neighborhood intervention students initiated alcohol use, used alcohol during the past seven-day and thirty-day periods, drank heavily during the past thirty days, and drank over any period of time, compared to control students (p's < .05). Significant group x prior alcohol consequences interaction effects were found for bused students, showing those with past alcohol consequences who received the intervention had less intentions to use alcohol and less frequent use of alcohol (p's < .05). These results suggest that a brief, stage-based preventive intervention may result in significant reductions in alcohol initiation and consumption among some inner-city youth.     

Trends in marijuana and other illicit drug use among college students: results from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001

The authors examined changes in college students' illicit drug use, patterns of polydrug use, and the relationship between students' ages of initiation of substance use and later use of marijuana and other illicit drugs between 1993 and 2001. Data from 119 US colleges and universities in the Harvard School of Public Health College Alcohol Study were used in the study. They found significant increases in percentages of students' use of marijuana in the past 30 days (from 13% to 17%), past year (from 23% to 30%), and lifetime (from 41% to 47%) between 1993 and 2001, with most of the increase occurring between 1993 and 1997. Past 30-day use of other illicit drugs increased from 4% to 7% and past year use increased from 11% to 14%. More than 98% of marijuana and other illicit drug users used another substance. They also either smoked, were binge drinkers, and/or were users of another illicit drug. Drug prevention programs should emphasize heavy alcohol use and smoking and should start when students are in high school or earlier.     

A norm changing approach to drug prevention

This article describes the implementation of an innovative curriculum called Drugs-At-Work (DAW), which was evaluated in three phases. In phase-one, data collected after the third year of the study suggested that the curriculum had a significant impact on the fifth-grade participants, who in turn influenced their sixth-grade classmates the following year. In comparison to their sixth-grade baseline counterparts, the DAW participants and their classmates were significantly less likely to have used tobacco, alcohol or other illicit drugs (ATOD) and less likely to know other elementary students who did so. In phase-two, data were examined on a year-by-year basis using a modified A-B-A design. These data revealed a drop from baseline in ATOD use during the intervention years and a return-to-baseline after the program ended. In phase-three, comparisons were made among participants in the Combined Baseline Group, the Combined DAW Group and the Transition Group (those exposed to DAW but not surveyed until a year after the grant closed). These analyses revealed that the DAW significantly reduced ATOD use for the total sample and for the Mexican-American, the Anglo, and the African-American students examined separately.     

‘No‐one respects them anyway’: secondary school students’ perceptions of human rights education in Turkey

The incorporation of compulsory courses on human rights into the secondary school curriculum in 1998 has been an important first step in developing respect for human rights and responsibilities among the younger generation in Turkey. Yet, these courses have many shortcomings in terms of materials, pedagogy and teacher attitudes. This paper explores Grades 7 and 8 (ages 13 and 14) students’ experiences in Citizenship and Human Rights Education courses on the basis of qualitative data collected through focus group discussions in Ankara and Istanbul in the 2006–2007 academic year. The responses of the students indicate that these courses have had little impact in empowering students or in facilitating them to consider their own or others’ human rights as an integral part of their lives. Rather, the students perceive the national and the global arena as characterized by mass human rights violations against which they feel powerless. The paper draws attention to the importance of a revised human rights education for students along with a global focus and appropriate methodology.     

An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: project towards no drug abuse (TND)

The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n=1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended.     

Adolescent attitudes toward random drug testing in schools

The current research examined students' perceptions of random drug testing for students participating in after-school activities. Results found students were more likely to endorse drug testing at their school if they are already engaged in after-school activities and not currently using drugs and/or alcohol. While middle and high school students' scores fell within the median, most reported if drug testing were implemented in their school they believed it would not deter continued participation in after-school activities. However, if drug testing were a prerequisite for participating in after-school activities, high school students were more apprehensive about getting tested than middle school students. Student respondents were more likely to endorse drug testing, if all members of the school system (i.e., teachers, coaches and staff) participated in drug testing. High school students' believed they had enough knowledge about drug abuse and were less likely to endorse drug testing because they believed it would violate their personal privacy compared to grade school students. Results also differed as a function of gender and self-reported drug and alcohol use.     

Parents' perceptions of a school-based prevention education program

There are few studies of parents' views about prevention education in general, or about specific prevention education activities. Yet, their perceptions are important because families are a primary socialization source, and because parents' opinions can either reinforce or countermand the message of prevention education programs. This article is an analysis of parents' views of the Drug Abuse Resistance Education (D.A.R.E.) program based on a statewide survey of adults from rural, suburban, and urban communities who had a child participate in the program within the past year. Parent involvement and knowledge of D.A.R.E. was high. Generally, parents were very positive about D.A.R.E., especially when they viewed the D.A.R.E. officer as an effective educator. This article suggests that much more research on parents' views and support of prevention education program needs to be conducted, especially within the context of how their perceptions may mediate the influence of the prevention effort on young people's attitudes and behaviors about substance use.