Preventing Drug Abuse What Do We Know? (1993) / Chapter Skim
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3 Evaluating Prevention Program Effects
3 Evaluating Prevention Program Effects
Pages 76-118
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From page 76... ...
Much of the theoretical foundation for social influence approaches is transferable to mass media, although communications experts view the media fundamentally as a supplemental or amplifying rather than the primary carrier of persuasive communications regarding health-related behavior. The empirical research picture is not as tidy as the theoretical concepts.
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From page 77... ...
The prevention research field is substantial enough, and of long enough standing, that a number of large-scale, meticulously conducted research evaluations of preventive interventions have been completed; numerous research reviews and collections of reviews have been published (see, for example, Goplerud, 1991; Bell and Battjes, 1987; Kumpfer, 19873. Several welldefined prevention programs have been very widely disseminated.
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From page 78... ...
The advantage of the study-effect approach is that it is more selective, excluding studies with serious methodological flaws, and it weights each study equally when average effect sizes are calculated. In a reanalysis, Tobler (1989)
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From page 79... ...
Tobler estimated effect sizes for program success based on outcome variables for drug knowledge; drug attitudes and values; behavioral skills (i.e., decision making, assertiveness, refusal, etc.) , in terms of learning the skills and, separately, reporting instances of using them; and self-reported drug use.
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From page 80... ...
When peer leaders or teachers were used in the peer strategies, their average effect sizes were equivalent (0.31~." As clear as these results appear, direct scrutiny of the top-10 programs yields ambiguities and obstacles to generalization that neither Bangert-Drowns's nor Tobler's reanalysis addresses. One cardinal point is that Tobler's generic use of the term drug includes cigarettes and that 4 of the top-10 peer programs (and an uncertain number of others in the sample)
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From page 81... ...
Just 2 of the 10 studies drew representative samples of students experimentally assigned to treatment and control conditions, and in both of those studies the interventions (and outcomes reported) are specifically on cigarette smoking.
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From page 82... ...
Even more troublesome than the prevailing methodological defects is the fact that these interventions are not, by and large, drug prevention programs as the term is generally understood. Admission to three of the four programs just reviewed required substantial levels of drug-related problems to begin with; even the fourth program was quite selective, excluding two-thirds of students.
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From page 83... ...
Nevertheless, when closely examined, the fruits of Tobler's meta-analysis can be considered imaginative and provocative but hardly persuasive concerning the question of how effective prevention programs may be. Other Meta-Analyses Bangert-Drowns studied a selection of educational programs much more tightly screened than Tobler's.
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From page 84... ...
Since only a handful of the evaluations included knowledge, attitude, and behavior in the same design, conclusions about the relative effect sizes must be viewed with caution. Bangert-Drowns's exclusion of studies with significant pretreatment differences between experimental and control groups does not clarify what constituted significant initial nonequivalence in particular, whether statistical controls over initial conditions were accepted.
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From page 85... ...
The strength of Tobler's meta-analysis is its overview of different program types, but the strongest conclusion is difficult to regard as applicable to prevention programs at all. These results suggest that we need to examine studies of prevention interventions that employ much more tightly defined contents and more careful scientific designs than appear typical among the types of studies that carry so much weight in some of the meta-analyses.
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From page 86... ...
Improvement of nonverbal and verbal communication skills for social encounters including dating, conversation, and assertiveness. The Life Skills Training program was implemented with booster sessions among a predominantly white sample of 7th grade students who were followed up in grades 8 and 9 (Botvin et al., 19901.
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From page 87... ...
In summary, the research findings support short- and long-term efficacy of Life Skills Training with respect to knowledge, attitudes, and cigarette smoking outcomes of youth in different ethnic populations and in schools and community settings. The Cognitive-Behavioral Approach Positive effects on knowledge, attitudes, and behavior have been reported for the cognitive-behavioral approach to drug prevention.
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From page 88... ...
The final strategy was a course in Drug Education. This course taught social competencies and drug information to 7th graders.
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From page 89... ...
It should be noted that the Drug Education curriculum incorporates virtually all of the elements identified as important to the social influence approach (e.g., the Project ALERT lessons; see Chapter 2 and below) , although in a somewhat different sequence.
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From page 90... ...
It is instructive to give detailed attention to two of these programs that have sustained high methodological standards, one focusing strictly on cigarette smoking prevention, the other on all of the gateway drugs: the Waterloo study in east-central Canada and Project ALERT in the western United States. Waterloo In two school districts in Waterloo, Ontario, 22 schools volunteered to participate in a study of an antismoking intervention using social influence.
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From page 91... ...
The researchers caution, however, against an interpretation of the latest findings as evidence that prevention efforts have no effect on results 6 years later, when the proper conclusion should be that results obtained early had disappeared 6 years later in the absence of sustained or repeated efforts. The decay of effects over a 6-year period might not be ineluctable; this process might be counteracted by modest intermediary efforts; for example, brief booster sessions in the early high school years may be sufficient to perpetuate the substantial early effects; this would be in line with advances over the 10 years since the Waterloo study was initiated with respect to understanding essential components of effective prevention programs.
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From page 92... ...
In another 10 schools, trained "teen leaders" assisted the health educators in delivering these lessons. In the remaining 10 schools there was no intervention, although previously instituted information-type drug prevention programs continued during the study period in four of these schools.
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From page 93... ...
for their Life Skills Training curriculum for junior high school or high school sophomore students: although data were generally collected for students who had initiated smoking prior to receiving the intervention, these groups are systematically excluded from Botvin and colleagues' analyses. The published data are not complete enough to reconstruct fully the main (whole-group)
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From page 94... ...
While these trials, inaugurated some years ago, do not necessarily represent the most advanced work that might be fielded today, they give a good indication of the degree to which school-based prevention programming is operating on the basis of plausibility and good faith rather than research knowledge. To make these points even more emphatically, it is
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From page 95... ...
and thus resembles the social influence curriculum being delivered as STAR in Kansas City and I-STAR in Indianapolis (see Pentz et al., 1989b) (described in a later section)
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From page 96... ...
There were significant differences between treatment and control students in perceived external control, which remained when statistical controls for type of school were implemented. The DARE curriculum did have the desired effect of producing significantly greater scores on peer resistance skills.
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From page 97... ...
Data were collected at pretest, posttest, and annual follow-up periods from students attending experimental and control schools. No statistically significant impact on measured outcomes was
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From page 98... ...
The contradictory results in other respects are not explained, and the great expansion of the size and scope of the program package and its widespread diffusion to schools around the country seems entirely out of proportion to the evidence of its usefulness in preventing drug problems. RESEARCH IN PROGRESS Developmental Interventions The developmental approach to intervention outlined in Chapter 2 involves deep-seated shifts in the organization of the school, designed to produce- far more than simple reductions in drug incidence and prevalence.
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From page 99... ...
Observational data in classrooms show the expected program effects on spontaneous prosocial behavior (Solomon et al., 1988) and capability to resolve hypothetical conflicts (Battistich et al., 1989~; lower loneliness and anxiety, higher peer acceptance, and more democratic beliefs; and higher reading comprehension in tests of higher-order thinking skills.
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From page 100... ...
Pentz and associates (1989a) describe the components as resistance skills training and environmental support of nonsmoking and nondrug use through the use of school, parent, and community organization programs, health policy changes, and mass media programming.
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From page 101... ...
Further 3-year follow-up findings reveal that the prevention programs were effective in reducing tobacco and marijuana use and in reducing the prevalence of drug use in youth identified at high and low risk (Johnson et al., 1990~. The authors conclude that a comprehensive community-based approach to drug abuse prevention is effective in preventing the onset of substance abuse, the benefits of which are accrued by high- and low-risk populations.
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From page 102... ...
The recent shift in research focus from within-classroom interventions to broader school reforms is consistent with the growing recognition of the need to support educational interventions on the drug problem with broader policy and environmental changes and to engage parents, community, and other social forces. MASS MEDIA AND DRUG ABUSE PREVENTION Rogers and Storey (1987:818-821)
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From page 103... ...
As Rogers and Storey (1987:831) indicate: "In the early eras of communication campaigns there was frequent reliance on mass media alone to accomplish campaign objectives.
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From page 104... ...
They conclude (1983:17~: "An overwhelming majority of mass media drug abuse prevention programs have failed to change behavior. One obvious reason for this is that most tpublic service announcements]
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From page 105... ...
EVALUATING PREVENTION PROGRAM EFFECTS 105 involvement and commitment of the advertising industry in developing the messages and the extensive formative research that has provided a foundation for the messages and the campaign. The evaluation of effectiveness of these campaigns involves matched samples of persons interviewed annually for three consecutive years (1987, 1988, 1989~.
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From page 106... ...
For high sensation seeking non-users, a group whose members are particularly at risk to become users, a message which stresses exciting alternatives to drug use and is high in sensation value clearly is more likely to be effective than one which stresses peer resistance skills and is lower in sensation value.... Low sensation seeking non-users, on the other hand, appear to be much more influenced by a message which stresses peer resistance skills and is low in sensation value than by a message which features exciting alternatives to drug use and is high in sensation value." A major strength of this project is that formative evaluation is an integral part of the process.
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From page 107... ...
have identified nine features of effective mass media campaigns against drug abuse: · Widespread exposure to campaign messages is a necessary ingredient in a communication campaign's effectiveness.
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From page 108... ...
These characteristics of effective messages provide an important beginning point for future research on media effects on drug use and abuse and in antidrug prevention campaigns. However, the guiding principle of the entire enterprise has been identified by Roberts and Maccoby (1985:544~: ".
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From page 109... ...
Social Influence Research Much of the work on social influence approaches to interventions completed to date has focused on preventing or delaying onset of use of the gateway drugs. But preventing or delaying onset is only part of the drug using and abusing continuum.
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From page 110... ...
Ethnicity and Gender: The Neglected Dimensions Most school-or~ented drug prevention programs are based on mainstream, one-size-fits-all cultural assumptions. Data on differential effects by ethnicity of recipient students have been notably scarce in evaluations of major schoolbased prevention programs; either no disaggregation by ethnicity is provided by the evaluators, or the sample sizes for which data are available are too small for any differential zero-order or partially controlled effects to be statistically discernible.
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From page 111... ...
An important exception to the rule of not reporting ethnic results is Graham and colleagues (1990) , who evaluated short-term program effects of a social influence program (SMART)
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From page 112... ...
Wills 1985 Personal and social skills training: cognitive-behavioral approaches to substance abuse prevention.
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From page 113... ...
Bukoski, eds., Drug Abuse Prevention Intervention Research: Methodological Issues. Rockville, Md.: National Institute on Drug Abuse.
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From page 114... ...
Sobel 1988 Affective and social influences approaches to the prevention of multiple substance abuse among seventh graders: results from Project SMART. Preventive Med~cine 17(2)
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From page 115... ...
Williams 1982 Longitudinal study of assertion training as a drug abuse prevention strategy. American Educational Research Journal 19(3)
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From page 116... ...
1986 Community-based substance abuse prevention: a multicultural perspective. Journal of School Health 56()
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From page 117... ...
1986 Meta analysis of 143 adolescent drug prevention programs: quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues 16(4)
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