Development and immediate impact of a self-instruction curriculum for an adolescent indicated drug abuse prevention trial

This article describes the development and immediate impact of a self-instruction indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse to complete their high school education, and is a method of choice among educators at alternative high schools. This article describes the justification for the self-instruction program, keys to good programmed self-learning, and how a 12-session health educator delivered program was converted to a self-instruction format. In addition, the immediate impact of a 3-group experimental trial is presented. Health educator led, self-instruction, and standard care control conditions are compared on knowledge change, and the two program conditions are compared on process ratings. Self-instruction programming can be successfully adapted from a health educator-led format, though the lack of student group interaction in this modality may limit its receptivity among students.     

Implementation and process evaluation of a school-based drug abuse prevention program: Project Towards No Drug Abuse

The present study provides an implementation, process, and immediate outcomes evaluation of the classroom component of Project Towards No Drug Abuse (TND). This project involves development and evaluation of a school-based drug abuse prevention curriculum for continuation high school youth, who are at relatively high risk for drug abuse. Three randomized conditions were evaluated: a standard care, classroom only, and classroom plus school-as-community. The latter condition was an enhanced school-based condition which involved outside-of-classroom meetings and activities. Implementation was high in both program conditions even though this was a higher risk context. Process evaluation data were favorable and did not vary between the two program conditions. Immediate outcomes data (knowledge) was higher in the two program conditions than in the standard care condition. Regarding the classroom program, addition of extra-classroom activities does not appear to alter the quality of delivery of the program.     

The Connections of Mental Health Problems,Violent Life Experiences,and the Social Milieu of the “Stroll” with the HIV Risk Behaviors of Female Street Sex Workers

Abstract

This paper examines the connections of mental health, victimization, and sexual risk behaviors among a sample of 278 street-based female sex workers in Miami. Using targeted sampling strategies, drug-using sex workers were recruited into an HIV prevention research program. Data were collected by trained interviewers, and focused on drug use and sexual risk for HIV, childhood abuse, recent victimization, and mental health. More than half of the participants reported histories of physical (51.1%) or sexual (53.1%) abuse as children, 37.4% were classified with moderate or severe anxiety symptoms, and 52.9% had symptoms of moderate or severe depression. Logistic regression analyses demonstrated significant associations between mental health issues and engagement in recent unprotected vaginal and oral sex. The program development and policy implications of these findings are discussed.     

Drug prevention with high risk families and young children

The effects of a school and home-based drug prevention program on risk factors for subsequent alcohol, tobacco, and other drug (ATOD) use among children were studied. Data on parent and child risk factors for ATOD use were collected from fifty-six low-income parents and their children, ages four to six years, using a pretest-posttest design. The parent-child intervention was conducted over a two-month period. The intervention had no effect on parent or child risk factors. However, the program was favorably received by parents and children. Almost two-thirds of the parents at the experimental school were involved in the program. Almost half of the parents had high depressive symptoms. The high rates of ATOD use and depressive symptoms among these parents are cause for concern.     

Evaluation of a family-based substance abuse prevention program targeted for the middle school years

A family-based substance abuse prevention program was evaluated which emphasizes family cohesion, school and peer attachment, self-esteem, and attitudes about adolescent use of alcohol and tobacco. The program was implemented in rural communities and targeted families with students entering middle or junior high school. Baseline surveys were conducted with students and parents in four schools and were readministered one year later. Because the program was voluntary, a quasi-experimental design was used to compare participants (29 students and 28 parents) and nonparticipants (268 students and 134 parents). Analyses of covariance indicated that student participants, as compared to nonparticipants, had higher family cohesion, less family fighting, greater school attachment, higher self-esteem, and believed that alcohol should be consumed at an older age at the one year follow-up. There were fewer significant results for parent participants. Strategies for involving parents in prevention programs are discussed.     

Pilot Evaluation of a Sexual Abuse Prevention Program for Taiwanese Children

The purpose of the current study was to develop and evaluate the efficacy of a school-based child sexual abuse prevention program for Taiwanese children. Forty-six Taiwanese children age 6 to 13 were divided into one of two groups based on their school grade and then randomly assigned to a skills-based child sexual abuse prevention program who received training immediately or a waiting-list control condition who received the training after a delay. Children's self-protection skills improved regardless of age after participation in the program. The program, however, did not successfully improve children's knowledge of sexuality and safety. Although future studies should modify the program content to better target knowledge of sexuality and safety, these results are promising for a pilot of this skills-based CSA prevention program in Taiwan.     

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.     

The impact of a culturally enhanced drug prevention program on drug and alcohol refusal efficacy among urban African American girls

This study examined the utility of the Specific Event Drug and Alcohol Refusal Efficacy scale (SEDARE) as an outcome of a culturally enhanced drug abuse prevention program for urban African-American girls in early adolescence. The SEDARE captures the perceived likelihood that youth will use drugs and alcohol in specific situations. Ninety-two girls participated in the program. Girls in the intervention group had higher drug refusal efficacy as measured by the SEDARE than girls in the comparison group. Girls varied in situations they perceived they could refuse drugs and alcohol. Findings are discussed with implications for drug abuse prevention programs for urban African-American girls.     

Mexican-American families: A psychoeducational approach for addressing chemical dependency and codependency

Chemical dependency and codependency are often referred to as family problems, and the ways in which families frame these problems may be influenced by their ethnic and cultural background. Increased efforts are being made to help families understand the problems that arise from alcohol and other drug abuse by utilizing approaches that take into consideration their unique cultural aspects. This article reviews some of the ways in which Mexican-American families, in particular, may view chemical dependency and codependency. More importantly, it describes the cultural adaptation of a psychoeducational program to help. Mexican-American parents, primarily mothers whose children are drug involved or who are considered to be at risk for drug use, better address these problems.     

Structuring a multi-site evaluation for youth mentoring programs to prevent teen alcohol and drug use

Despite mentoring's rapidly increasing popularity as an intervention for the prevention of teen alcohol and drug abuse and associated problems, there is little research consensus on its overall effectiveness or on the core principles and components that define effective mentoring. To advance knowledge concerning this important prevention intervention, the Center for Substance Abuse Prevention has designed and funded a multi-site cooperative agreement involving seven mentoring programs. The programs are designed to provide a rigorous outcome evaluation that allows comparisons of differing approaches to organizing and delivering mentoring services to adolescents at high risk for substance abuse. The cooperative agreement guidelines set service parameters and options that focus on issues that are grounded in past research on mentoring prevention interventions. The cooperative agreement includes a quasi-experimental, longitudinal multi-site evaluation that provides evidence-based recommendations to advance the effective use of mentoring as a prevention strategy.     

Parenting services for families affected by substance abuse

This article describes the development, implementation, and replication of a group-based parenting program for families affected by substance abuse. The Nurturing Program for Families in Substance Abuse Treatment and Recovery improves parenting, as measured on objective scales; enhances parents' satisfaction and competence, as measured by participant reports; and is based on principles demonstrated to be effective in reducing risk of both child abuse and neglect and substance abuse for both parents and children.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Effective Recruitment for Parenting Programs Within Ethnic Minority Communities

This article describes the results of a demonstration project which focused on exploring recruitment and retention of ethnic minority families to a parent training program aimed to prevent substance abuse among their children. The Parenting for Drug-Free Children project sought to deliver a curriculum to parents from several ethnic groups in an urban setting. The targeted ethnic communities were African American, Latino, Native American, and Samoan. The project successfully recruited diverse groups of families to participate in a drug prevention program, many of whom had never participated before in a parenting program. The identification of key individuals for recruiting and accessing networks of potential participants proved to be an effective means of recruitment.     

The prevention of gambling problems in youth: a conceptual framework

Despite increased awareness of the need to begin educating young children about the potential dangers of gambling, empirical knowledge of the prevention of adolescent problem gambling and its translation into science-based prevention initiatives is scarce. This paper poses the question of whether or not the common elements of tobacco, alcohol, and illicit drug abuse prevention programs can be applied to gambling prevention. Common risk and protective factors across addictions, including gambling, appear to point to the need to develop a general model of primary, secondary, and tertiary prevention. The authors present the need for science-based prevention initiatives and describe a general adolescent risk-taking model as a basis for science-based prevention of adolescent problem gambling and other risk behaviors.     

Therapeutically Managing Reunification After Abuse Allegations

School-based programs have been the central strategy to educate children about the serious nature of child sexual abuse in the hope of prevention or early intervention. Virtually all evaluations have been quantitative, seldom allowing children to directly comment on their experiences. This article presents the results of qualitative research with 116 students (51 boys and 65 girls) ranging from age 6 to 12 who had participated in the Who Do You Tell child sexual abuse education program. Ten focus groups were conducted with students in separate grades, from kindergarten through sixth grade, two to three months after program participation. The core themes that emerged from the focus group interviews are presented, as are implications for child sexual abuse prevention programs.     

Community drug abuse prevention in a Hmong village in Thailand

The goal of this project was to implement a model of drug abuse prevention, drawing on health care, psychosocial and legal principles, in a selected village community in Thailand. Primary, secondary, and tertiary prevention strategies were used within a nursing conceptual framework that included the interactions among the person, drugs, and environment. An initial community survey revealed 112 addicted individuals and identified many atrisk groups, such as children of addicted parents, adolescents, and women. Primary health care and dental health services were provided in the community, as well as drug abuse education and activities for school children and at-risk groups. Treatment camps were also established in the community on two occasions to provide detoxification and rehabilitation services for addicted individuals. At the end of the 3-year program, there were no new addicted individuals, and the number of addicted individuals decreased from 112 to 50 (after first treatment) and 26 (after second treatment). In addition, the villagers were more aware of problems related to using opium and heroin and of modern, approved drugs to treat illnesses. The prevention strategies were beneficial for the community members, as well as the addicted individuals and theirfamilies.     

Preventing risk for obesity by promoting self-regulation and decision-making skills: pilot results from the PATHWAYS to health program (PATHWAYS)

The overall aim of the two school-based pilot studies was to evaluate whether an approach to prevention that focused on changing child impulse control, decision making, and social competence can be effective in changing attitudes toward food intake and physical activity as risk factors for obesity. The strategy used was to translate specific components of one evidence-based program for violence prevention (Promoting Alternative Thinking Strategies: PATHS) into an elementary school curriculum program for obesity prevention. Both studies demonstrated significant changes in positive attitudes toward self-regulation of appetitive behavior. In addition, Study 2 demonstrated positive changes in actual food choices and television viewing patterns. Implications are that comprehensive efforts to prevent youth risk for obesity should include as one component school-based curricula that target self-regulation and decision-making skills.     

Preventing child sexual abuse (CSA) in ethnic minority communities: A literature review and suggestions for practice in Australia

A systematic literature review was conducted to address the immense national gap in knowledge on child sexual abuse (CSA) and ethnic minority communities in Australia, which necessarily borrowed from overseas. One theme explored within the review was that of prevention, and it was found that school-based programs are the most common type of prevention effort. The literature also calls for ‘culturally tailored’ programs to avoid homogenising victims' needs, however in Western multicultural countries like Australia there is a risk that such school-based programs heighten racism for ethnic minority children. Thus, program elements that are culturally sensitive could be incorporated into universal programs instead. Universal programs are also beneficial because they help reach many children regardless of their cultural background, help send the message that all children are equally valued and protected, help create unity and support among diverse victims, and can be further justified by three relatively stable cross-cultural findings: (i) that the prevalence of CSA is high worldwide, (ii) all children require protection irrespective of gender, and (iii) perpetrators are usually known to the victim. To help mobilise their role, service providers could co-deliver school-based programs especially to address institutional CSA within schools. They could also provide training to other health professionals to improve their identification of CSA and confidence to probe; a form of early intervention and therefore ‘secondary prevention’. Overall, this review argues that the importance of family reputation in collectivist cultures needs to be taken into account when designing and evaluating prevention programs so that delays in disclosure and help-seeking due to cultural pressure are not mistaken as evidence for their ineffectiveness. The findings are significant because they help progress the ‘prevention’ field in Australia where literature is essentially absent, particularly in the school and service system arenas.     

Preventing child abuse: a review of community-based projects II: Issues arising from reviews and future directions

Detailed examination of evaluated community programmes for the prevention of physical child abuse and neglect shows that success depends on matching the skills of the staff to the needs of the families. The relative inefficiency of risk screening and attrition from prevention programmes argues for comprehensive as well as focused aspects of programmes and variation in which is available. Sexual abuse prevention programmes have usually been implemented in schools but are more successful when the focus includes bullying and when children and parents are also actively involved. This is also true of bullying programmes. In establishing risk for abuse, more effective methods are required to assess aspects of family life that are not readily observable, including involved but non-resident adult males. It is important not only to approach abuse prevention by intervening in different ways and at different points in the network of processes within and around the family, but also to find cost-effective ways of sustaining preventative efforts. © 1998 John Wiley & Sons, Ltd.     

Sexual Abuse Prevention Concept Knowledge: Low Income Children Are Learning but Still Lagging

School-based child sexual abuse (CSA) prevention programs have proliferated since beginning over 30 years ago. Research on program effectiveness has emphasized summative outcomes while under-reporting implementation and process fidelity, limiting reliable comparisons across programs and populations. External validity is further limited by racially and economically homogenous samples, or a failure to report such demographics. This article presents data from a CSA prevention program delivered to 2nd and 3rd grade public school children. A formative concept and item level analysis on the Children’s Knowledge of Abuse Questionnaire at baseline and four week follow-up, as well as fidelity and implementation data, are reported. Results show that children learn and retain certain concepts, but vary widely in knowledge across items. This sample of low-income, minority children also show lower baseline and “learned” abuse prevention knowledge compared to published norms, which is not attributed to implementation variability. These data give critical insight into workshop effectiveness that is masked in summative reporting, yet essential to adapting and strengthening school-based CSA programs. Knowing the long-term consequences of adverse childhood experiences and disparate health outcomes linked to race and socioeconomic status, it is imperative to adequately assess CSA prevention program impact across diverse populations.