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Acknowledgments     NIDA wishes to thank the following individuals for their guidance and comments during the development ...
ContentsAcknowledgments                                                                                               iiPr...
Chapter 4: Examples of Research-Based Drug Abuse Prevention Programs                26         Universal Programs         ...
PrefaceToday’s youth face many risks, including drug abuse,    Researchers are also studying older teens whoviolence, and ...
IntroductionIn 1997, the National Institute on Drug Abuse (NIDA)      This second edition, reflecting NIDA’s expandedpubli...
Prevention Principles    These revised prevention principles have emerged from research studies funded by NIDA on the orig...
Prevention Planning                                     School ProgramsFamily Programs                                    ...
Community Programs                                     Prevention Program Delivery    PRINCIPLE 9    Prevention programs a...
PRINCIPLE 14  Prevention programs should includeteacher training on good classroom managementpractices, such as rewarding ...
Chapter 1: Risk Factors and Protective Factors    This chapter describes how risk and protective factors influence drug ab...
Other risk and protective factors are independent ofeach other, as demonstrated in the table as examples      Chapter 1 Pr...
Gender may also determine how an individual                 In the Family    responds to risk factors. Research on relatio...
Outside the Family                                        Family has an important role in providing protection            ...
Then, when they enter high school, young people face       When and how does drug abuse     additional social, psychologic...
Different patterns of drug initiation have beenidentified based on gender, race or ethnicity, and                         ...
Chapter 2: Planning for Drug Abuse Prevention                in the Community     This chapter presents a process to help ...
based prevention. Consider, for example, Principle 3:“Prevention programs should address the type of            Chapter 2 ...
How can the community assess the                        As an example, the Communities That Care prevention     level of r...
• Ethnographic studies. Ethnographic approaches             Is the community ready for prevention?  use systematic, observ...
ASSESSING READINESS*                                         COMMUNITY ACTION          Readiness Stage                    ...
How can the community assess                               In assessing the impact of individual programs, it isthe effect...
Chapter 3: Applying Prevention Principles to                Drug Abuse Prevention Programs     This chapter describes how ...
academic support, and parent-child relationships.Recognizing that it can be difficult to attract            Chapter 3 Prin...
Chapter 3 Principles                                          Most research-based prevention interventions in             ...
Many programs coordinate prevention efforts                 What are the core elements of effectiveacross settings to comm...
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
Red Book
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Red Book

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  3. 3. Acknowledgments NIDA wishes to thank the following individuals for their guidance and comments during the development and review of this publication: Karen L. Bierman, Ph.D. Hyman Hops, Ph.D. Pennsylvania State University Oregon Research Institute C. Hendricks Brown, Ph.D. Eugene R. Oetting, Ph.D. University of South Florida Colorado State University Richard R. Clayton, Ph.D. Zili Sloboda, Sc.D. University of Kentucky University of Akron Thomas J. Dishion, Ph.D. Richard Spoth, Ph.D. University of Oregon Iowa State University E. Michael Foster, Ph.D. John B. Reid, Ph.D. Pennsylvania State University Oregon Social Learning Center Meyer D. Glantz, Ph.D. Thomas A. Wills, Ph.D. National Institute on Drug Abuse Albert Einstein College of Medicine Mark T. Greenberg, Ph.D. Pennsylvania State University NIDA also would like to thank the Community Anti-Drug Coalitions of America for helping organize a focus group of community leaders in reviewing this publication. This publication was written by Elizabeth B. Robertson, Ph.D., Susan L. David, M.P.H. (retired), and Suman A. Rao, Ph.D., National Institute on Drug Abuse. All materials in this volume are in the public domain and may be used or reproduced without permission from NIDA or the authors. Citation of the source is appreciated. The U.S. government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in the publication are used only because they are considered essential in the context of the studies described here. NIH Publication No. 04-4212(A) Printed 1997 Reprinted 1997, 1999, 2001 Second Edition October 2003ii Preventing Drug Use among Children and Adolescents
  4. 4. ContentsAcknowledgments iiPreface vIntroduction 1Prevention Principles 2Chapter 1: Risk Factors and Protective Factors 6 What are risk factors and protective factors? 6 What are the early signs of risk that may predict later drug abuse? 8 What are the highest risk periods for drug abuse among youth? 9 When and how does drug abuse start and progress? 10Chapter 2: Planning for Drug Abuse Prevention in the Community 12 How can the community develop a plan for research-based prevention? 12 How can the community use the prevention principles in prevention planning? 12 How can the community assess the level of risk for drug abuse? 14 Is the community ready for prevention? 15 How can the community be motivated to implement research-based prevention programs? 16 How can the community assess the effectiveness of current prevention efforts? 17Chapter 3: Applying Prevention Principles to Drug Abuse Prevention Programs 18 How are risk and protective factors addressed in prevention programs? 18 What are the core elements of effective research-based prevention programs? 21 How can the community implement and sustain effective prevention programs? 24 How can the community evaluate the impact of its program on drug abuse? 24 What are the cost-benefits of community prevention programs? 25 National Institute on Drug Abuse iii
  5. 5. Chapter 4: Examples of Research-Based Drug Abuse Prevention Programs 26 Universal Programs 26 Elementary School • Caring School Community Program • Classroom-Centered (CC) and Family-School Partnership (FSP) Intervention • Promoting Alternative Thinking Strategies (PATHS) • Skills, Opportunity, And Recognition (SOAR) Middle School • Guiding Good Choices • Life Skills Training (LST) Program • Lions-Quest Skills for Adolescence (SFA) • Project ALERT • Project STAR • The Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14) High School • Life Skills Training: Booster Program • Lions-Quest Skills for Adolescence • Project ALERT Plus • The Strengthening Families Program: For Parents and Youth 10–14 Selective Programs 31 Elementary School • Focus on Families (FOF) • The Strengthening Families Program (SFP) Middle School • Coping Power High School • Adolescents Training and Learning to Avoid Steroids (ATLAS) Indicated Programs 33 High School • Project Towards No Drug Abuse (Project TND) • Reconnecting Youth Program (RY) Tiered Programs 34 Elementary School • Early Risers “Skills for Success” Risk Prevention Program • Fast Track Prevention Trial for Conduct Problems Middle School • Adolescent Transitions Program (ATP) Chapter 5: Selected Resources and References 36 Selected Resources 36 Selected References 38iv Preventing Drug Use among Children and Adolescents
  6. 6. PrefaceToday’s youth face many risks, including drug abuse, Researchers are also studying older teens whoviolence, and HIV/AIDS. Responding to these risks are already using drugs to find ways to preventbefore they become problems can be difficult. One further abuse or addiction. Practical issues, such asof the goals of the National Institute on Drug Abuse cost-benefit analyses, are being studied. Presenting(NIDA) is to help the public understand the causes these findings to the public is one of NIDA’s mostof drug abuse and to prevent its onset. Drug abuse important responsibilities.has serious consequences in our homes, schools, We are pleased to offer our newest edition of theand communities. From NIDA’s perspective, the publication, Preventing Drug Use among Childrenuse of all illicit drugs and the inappropriate use of and Adolescents: A Research-Based Guide for Parents,licit drugs is considered drug abuse. Educators, and Community Leaders, Second Edition.Prevention science has made great progress in recent This edition includes updated principles, new questionsyears. Many prevention interventions are being tested and answers, new program information, and expandedin “real-world” settings so they can be more easily references and resources. We also invite you toadapted for community use. Scientists are studying visit our Web site at www.drugabuse.gov wherea broader range of populations and topics. They this publication and other materials related to thehave identified, for example, effective interventions consequences, prevention, and treatment of drugwith younger populations to help prevent risk abuse are offered. We hope that you will find thebehaviors before drug abuse occurs. guide useful and helpful to your work. Nora D. Volkow, M.D. Director National Institute on Drug Abuse National Institute on Drug Abuse v
  7. 7. IntroductionIn 1997, the National Institute on Drug Abuse (NIDA) This second edition, reflecting NIDA’s expandedpublished the first edition of Preventing Drug Use research program and knowledge base, is more thanamong Children and Adolescents: A Research-Based double the size of the first edition. The preventionGuide to share the latest NIDA-funded prevention principles have been expanded to provide moreresearch findings with parents, educators, and understanding about the latest research, and principlescommunity leaders. The guide introduced the concept relevant to each chapter accompany the discussion.of “research-based prevention” with questions and Additional questions and answers, a new chapteranswers on risk and protective factors, community on community planning, and more informationplanning and implementation, and 14 prevention on the core elements in research-based preventionprinciples derived from effective drug abuse prevention programs have been added. Each chapter ends withresearch. Examples of research-tested prevention a “Community Action Box” for primary readers—programs were also featured. The purpose was to help parents, educators, and community leaders. As in theprevention practitioners use the results of prevention first edition, the descriptions of prevention programsresearch to address drug abuse among children and are presented as examples of research-basedadolescents in communities across the country. programs currently available.Since then, NIDA’s prevention research program has The expanded Selected Resources section offers Webmore than doubled in size and scope to address all sites, sponsored by Federal and private-sector agencies.stages of child development, a mix of audiences and Some feature registries of effective preventionsettings, and the delivery of effective services at the programs with agency-specific selection criteriacommunity level. The Institute now focuses on risks and other resources for community planning. Thefor drug abuse and other problem behaviors that Selected References section includes up-to-date booksoccur throughout a child’s development. Prevention and journal articles that provide more informationinterventions designed and tested to address risks can on prevention research. NIDA hopes that this revisedhelp children at every step along their developmental guide is helpful to drug abuse prevention efforts amongpath. Working more broadly with families, schools, children and adolescents in homes, schools, andand communities, scientists have found effective ways communities nationwide.to help people gain the skills and approaches to stopproblem behaviors before they occur. Research fundedby NIDA and other Federal research organizations—such as the National Institute of Mental Health andthe Centers for Disease Control and Prevention—shows that early intervention can prevent manyadolescent risk behaviors. National Institute on Drug Abuse 1
  8. 8. Prevention Principles These revised prevention principles have emerged from research studies funded by NIDA on the origins of drug abuse behaviors and the common elements found in research on effective prevention programs. Parents, educators, and community leaders can use these principles to help guide their thinking, planning, selection, and delivery of drug abuse prevention programs at the community level. The references following each principle are representative of current research. Risk Factors and Protective Factors • While risk and protective factors can affect people of all groups, these factors can have PRINCIPLE 1 Prevention programs should a different effect depending on a person’s age, enhance protective factors and reverse or reduce gender, ethnicity, culture, and environment risk factors (Hawkins et al. 2002). (Beauvais et al. 1996; Moon et al. 1999). • The risk of becoming a drug abuser involves the PRINCIPLE 2 Prevention programs should address relationship among the number and type of all forms of drug abuse, alone or in combination, risk factors (e.g., deviant attitudes and behaviors) including the underage use of legal drugs (e.g., and protective factors (e.g., parental support) tobacco or alcohol); the use of illegal drugs (e.g., (Wills and McNamara et al. 1996). marijuana or heroin); and the inappropriate use • The potential impact of specific risk and of legally obtained substances (e.g., inhalants), protective factors changes with age. For prescription medications, or over-the-counter example, risk factors within the family have drugs (Johnston et al. 2002). greater impact on a younger child, while PRINCIPLE 3 Prevention programs should association with drug-abusing peers may be a address the type of drug abuse problem in the more significant risk factor for an adolescent local community, target modifiable risk factors, (Gerstein and Green 1993; Kumpfer et al. 1998). and strengthen identified protective factors • Early intervention with risk factors (e.g., (Hawkins et al. 2002). aggressive behavior and poor self-control) PRINCIPLE 4 Prevention programs should be often has a greater impact than later tailored to address risks specific to population intervention by changing a child’s life path or audience characteristics, such as age, gender, (trajectory) away from problems and toward and ethnicity, to improve program effectiveness positive behaviors (Ialongo et al. 2001). (Oetting et al. 1997).2 Preventing Drug Use among Children and Adolescents
  9. 9. Prevention Planning School ProgramsFamily Programs PRINCIPLE 6 Prevention programs can be designed to intervene as early as preschoolPRINCIPLE 5 Family-based prevention programs to address risk factors for drug abuse, suchshould enhance family bonding and relationships as aggressive behavior, poor social skills, andand include parenting skills; practice in developing, academic difficulties (Webster-Stratton 1998;discussing, and enforcing family policies on Webster-Stratton et al. 2001).substance abuse; and training in drug educationand information (Ashery et al. 1998). PRINCIPLE 7 Prevention programs for elementary school children should target improving academicFamily bonding is the bedrock of the relationship and social-emotional learning to address riskbetween parents and children. Bonding can factors for drug abuse, such as early aggression,be strengthened through skills training on academic failure, and school dropout. Educationparent supportiveness of children, parent-child should focus on the following skills (Ialongocommunication, and parental involvement et al. 2001; Conduct Problems Prevention Work(Kosterman et al. 1997). Group 2002b):• Parental monitoring and supervision are • self-control; critical for drug abuse prevention. These skills can be enhanced with training on rule-setting; • emotional awareness; techniques for monitoring activities; praise • communication; for appropriate behavior; and moderate, • social problem-solving; and consistent discipline that enforces defined • academic support, especially in reading. family rules (Kosterman et al. 2001). PRINCIPLE 8 Prevention programs for middle or• Drug education and information for parents junior high and high school students should increase or caregivers reinforces what children academic and social competence with the following are learning about the harmful effects of skills (Botvin et al.1995; Scheier et al. 1999): drugs and opens opportunities for family discussions about the abuse of legal and • study habits and academic support; illegal substances (Bauman et al. 2001). • communication;• Brief, family-focused interventions for the • peer relationships; general population can positively change • self-efficacy and assertiveness; specific parenting behavior that can reduce • drug resistance skills; later risks of drug abuse (Spoth et al. 2002b). • reinforcement of antidrug attitudes; and • strengthening of personal commitments against drug abuse. National Institute on Drug Abuse 3
  10. 10. Community Programs Prevention Program Delivery PRINCIPLE 9 Prevention programs aimed at PRINCIPLE 12 When communities adapt programs general populations at key transition points, such to match their needs, community norms, or as the transition to middle school, can produce differing cultural requirements, they should retain beneficial effects even among high-risk families core elements of the original research-based and children. Such interventions do not single intervention (Spoth et al. 2002b), which include: out risk populations and, therefore, reduce labeling and promote bonding to school and community • Structure (how the program is organized (Botvin et al. 1995; Dishion et al. 2002). and constructed); PRINCIPLE 10Community prevention programs • Content (the information, skills, and strategies that combine two or more effective programs, of the program); and such as family-based and school-based • Delivery (how the program is adapted, programs, can be more effective than a single implemented, and evaluated). program alone (Battistich et al. 1997). PRINCIPLE 13 Prevention programs should be PRINCIPLE 11 Community prevention programs long-term with repeated interventions (i.e., reaching populations in multiple settings—for booster programs) to reinforce the original example, schools, clubs, faith-based organizations, prevention goals. Research shows that the and the media—are most effective when they benefits from middle school prevention programs present consistent, community-wide messages diminish without followup programs in high in each setting (Chou et al. 1998). school (Scheier et al. 1999).4 Preventing Drug Use among Children and Adolescents
  11. 11. PRINCIPLE 14 Prevention programs should includeteacher training on good classroom managementpractices, such as rewarding appropriate studentbehavior. Such techniques help to foster students’positive behavior, achievement, academic motivation,and school bonding (Ialongo et al. 2001).PRINCIPLE 15 Prevention programs are mosteffective when they employ interactive techniques,such as peer discussion groups and parentrole-playing, that allow for active involvement inlearning about drug abuse and reinforcing skills(Botvin et al. 1995).PRINCIPLE 16 Research-based prevention programscan be cost-effective. Similar to earlier research,recent research shows that for each dollar investedin prevention, a savings of up to $10 in treatmentfor alcohol or other substance abuse can be seen(Pentz 1998; Hawkins 1999; Aos et al. 2001;Spoth et al. 2002a). National Institute on Drug Abuse 5
  12. 12. Chapter 1: Risk Factors and Protective Factors This chapter describes how risk and protective factors influence drug abuse behaviors, the early signs of risk, transitions as high-risk periods, and general patterns of drug abuse among children and adolescents. A major focus is how prevention programs can strengthen protection or intervene to reduce risks. What are risk factors actions, this behavior can lead to additional risks and protective factors? when the child enters school. Aggressive behavior in school can lead to rejection by peers, punishment Studies over the past two decades have tried to by teachers, and academic failure. Again, if not determine the origins and pathways of drug abuse addressed through preventive interventions, these and addiction—how the problem starts and how it risks can lead to the most immediate behaviors that progresses. Many factors have been identified that put a child at risk for drug abuse, such as skipping help differentiate those more likely to abuse drugs school and associating with peers who abuse drugs. In from those less vulnerable to drug abuse. Factors focusing on the risk path, research-based prevention associated with greater potential for drug abuse are programs can intervene early in a child’s development called “risk” factors, while those associated with to strengthen protective factors and reduce risks long reduced potential for abuse are called “protective” before problem behaviors develop. factors. Please note, however, that most individuals at risk for drug abuse do not start using drugs or The table below provides a framework for become addicted. Also, a risk factor for one person characterizing risk and protective factors in five may not be for another. domains, or settings. These domains can then serve as a focus for prevention. As the first two examples As discussed in the Introduction, risk and protective suggest, some risk and protective factors are mutually factors can affect children in a developmental risk exclusive—the presence of one means the absence trajectory, or path. This path captures how risks of the other. For example, in the Individual domain, become evident at different stages of a child’s life. early aggressive behavior, a risk factor, indicates the For example, early risks, such as out-of-control absence of impulse control, a key protective factor. aggressive behavior, may be seen in a very young Helping a young child learn to control impulsive child. If not addressed through positive parental behavior is a focus of some prevention programs. Risk Factors Domain Protective Factors Early Aggressive Behavior Individual Impulse Control Lack of Parental Supervision Family Parental Monitoring Substance Abuse Peer Academic Competence Drug Availability School Antidrug Use Policies Poverty Community Strong Neighborhood Attachment6 Preventing Drug Use among Children and Adolescents
  13. 13. Other risk and protective factors are independent ofeach other, as demonstrated in the table as examples Chapter 1 Principlesin the peer, school, and community domains. Forexample, in the school domain, drugs may be Risk Factors andavailable, even though the school has “antidrug Protective Factorspolicies.” An intervention may be to strengthen PRINCIPLE 1 Prevention programs should enhanceenforcement so that school policies create the protective factors and reverse or reduce risk factors.intended school environment. • The risk of becoming a drug abuser involves theRisk factors for drug abuse represent challenges relationship among the number and type of risk factorsto an individual’s emotional, social, and academic (e.g., deviant attitudes and behaviors) and protective factors (e.g., parental support).development. These risk factors can produce differenteffects, depending on the individual’s personality • The potential impact of specific risk and protectivetraits, phase of development, and environment. factors changes with age. For example, risk factorsFor instance, many serious risks, such as early within the family have greater impact on a youngeraggressive behavior and poor academic achievement, child, while association with drug-abusing peers may be a more significant risk factor for an adolescent.may indicate that a young child is on a negativedevelopmental path headed toward problem behavior. • Early intervention with risk factors (e.g., aggressiveEarly intervention, however, can help reduce or reverse behavior and poor self-control) often has a greaterthese risks and change that child’s developmental path. impact than later intervention by changing a child’s life path (trajectory) away from problems and towardFor young children already exhibiting positive behaviors.serious risk factors, delaying intervention • While risk and protective factors can affect people ofuntil adolescence will likely make it more all groups, these factors can have a different effectdifficult to overcome risks. By adolescence, depending on a person’s age, gender, ethnicity, culture,children’s attitudes and behaviors are well and environment.established and not easily changed. PRINCIPLE 2 Prevention programs should address all forms of drug abuse, alone or in combination, includingRisk factors can influence drug abuse in several the underage use of legal drugs (e.g., tobacco or alcohol);ways. They may be additive: The more risks a the use of illegal drugs (e.g., marijuana or heroin); and thechild is exposed to, the more likely the child will inappropriate use of legally obtained substances (e.g., inhalants),abuse drugs. Some risk factors are particularly prescription medications, or over-the-counter drugs.potent, yet may not influence drug abuse unless PRINCIPLE 3 Prevention programs should address thecertain conditions prevail. Having a family history type of drug abuse problem in the local community, targetof substance abuse, for example, puts a child at modifiable risk factors, and strengthen identifiedrisk for drug abuse. However, in an environment protective factors.with no drug-abusing peers and strong antidrug PRINCIPLE 4 Prevention programs should be tailorednorms, that child is less likely to become a drug to address risks specific to population or audienceabuser. And the presence of many protective characteristics, such as age, gender, and ethnicity,factors can lessen the impact of a few risk factors. to improve program effectiveness.For example, strong protection—such as parentalsupport and involvement—can reduce the influenceof strong risks, such as having substance-abusingpeers. An important goal of prevention, then,is to change the balance between risk andprotective factors so that protective factorsoutweigh risk factors. National Institute on Drug Abuse 7
  14. 14. Gender may also determine how an individual In the Family responds to risk factors. Research on relationships Children’s earliest interactions occur within the within the family shows that adolescent girls respond family and can be positive or negative. For this positively to parental support and discipline, while reason, factors that affect early development in the adolescent boys sometimes respond negatively. family are probably the most crucial. Children are Research on early risk behaviors in the school setting more likely to experience risk when there is: shows that aggressive behavior in boys and learning difficulties in girls are the primary causes of poor peer • lack of mutual attachment and nurturing relationships. These poor relationships, in turn, can by parents or caregivers; lead to social rejection, a negative school experience, and problem behaviors including drug abuse. • ineffective parenting; • a chaotic home environment; What are the early signs of risk that • lack of a significant relationship with may predict later drug abuse? a caring adult; and Some signs of risk can be seen as early as infancy. • a caregiver who abuses substances, suffers from Children’s personality traits or temperament can mental illness, or engages in criminal behavior. place them at increased risk for later drug abuse. These experiences, especially the abuse of drugs and Withdrawn and aggressive boys, for example, often other substances by parents and other caregivers, can exhibit problem behaviors in interactions with their impede bonding to the family and threaten feelings of families, peers, and others they encounter in social security that children need for healthy development. settings. If these behaviors continue, they will likely On the other hand, families can serve a protective lead to other risks. These risks can include academic function when there is: failure, early peer rejection, and later affiliation with deviant peers, often the most immediate risk for drug • a strong bond between children and their families; abuse in adolescence. Studies have shown that children with poor academic performance and inappropriate • parental involvement in a child’s life; social behavior at ages 7 to 9 are more likely to be • supportive parenting that meets financial, involved with substance abuse by age 14 or 15. emotional, cognitive, and social needs; and • clear limits and consistent enforcement of discipline. Finally, critical or sensitive periods in development may heighten the importance of risk or protective factors. For example, mutual attachment and bonding between parents and children usually occurs in infancy and early childhood. If it fails to occur during those developmental stages, it is unlikely that a strong positive attachment will develop later in the child’s life.8 Preventing Drug Use among Children and Adolescents
  15. 15. Outside the Family Family has an important role in providing protection for children when they are involved in activitiesOther risk factors relate to the quality of children’s outside the family. When children are outside therelationships in settings outside the family, such as family setting, the most salient protective factors are:in their schools, with their peers, teachers, and inthe community. Difficulties in these settings can be • age-appropriate parental monitoring of socialcrucial to a child’s emotional, cognitive, and social behavior, including establishing curfews, ensuringdevelopment. Some of these risk factors are: adult supervision of activities outside the home, knowing the child’s friends, and enforcing• inappropriate classroom behavior, such household rules; as aggression and impulsivity; • success in academics and involvement• academic failure; in extracurricular activities;• poor social coping skills; • strong bonds with prosocial institutions, such• association with peers with problem behaviors, as school and religious institutions; and including drug abuse; and • acceptance of conventional norms against• misperceptions of the extent and acceptability drug abuse. of drug-abusing behaviors in school, peer, and community environments. What are the highest risk periodsAssociation with drug-abusing peers is often themost immediate risk for exposing adolescents to for drug abuse among youth?drug abuse and delinquent behavior. Research has Research has shown that the key risk periodsshown, however, that addressing such behavior in for drug abuse occur during major transitions ininterventions can be challenging. For example, a children’s lives. These transitions include significantrecent study (Dishion et al. 2002) found that placing changes in physical development (for example,high-risk youth in a peer group intervention resulted puberty) or social situations (such as movingin negative outcomes. Current research is exploring or parents divorcing) when children experiencethe role that adults and positive peers can play in heightened vulnerability for problem behaviors.helping to avoid such outcomes in future interventions. The first big transition for children is when they leaveOther factors—such as drug availability, drug the security of the family and enter school. Later,trafficking patterns, and beliefs that drug abuse is when they advance from elementary school to middlegenerally tolerated—are also risks that can influence or junior high school, they often experience newyoung people to start to abuse drugs. academic and social situations, such as learning to get along with a wider group of peers and having greater expectations for academic performance. It is at this stage—early adolescence—that children are likely to encounter drug abuse for the first time. National Institute on Drug Abuse 9
  16. 16. Then, when they enter high school, young people face When and how does drug abuse additional social, psychological, and educational start and progress? challenges. At the same time, they may be exposed to greater availability of drugs, drug abusers, and Studies such as the National Survey on Drug Use social engagements involving drugs. These challenges and Health, formerly called the National Household can increase the risk that they will abuse alcohol, Survey on Drug Abuse, reported by the Substance tobacco, and other drugs. Abuse and Mental Health Services Administration, indicate that some children are already abusing A particularly challenging situation in late adolescence drugs by age 12 or 13, which likely means that some is moving away from home for the first time without may begin even earlier. Early abuse includes such parental supervision, perhaps to attend college or drugs as tobacco, alcohol, inhalants, marijuana, other schooling. Substance abuse, particularly of and psychotherapeutic drugs. If drug abuse persists alcohol, remains a major public health problem for into later adolescence, abusers typically become college populations. more involved with marijuana and then advance When young adults enter the workforce or marry, to other illegal drugs, while continuing their abuse they again confront new challenges and stressors of tobacco and alcohol. Studies have also shown that may place them at risk for alcohol and other that early initiation of drug abuse is associated drug abuse in their adult environments. But these with greater drug involvement, whether with the challenges can also be protective when they present same or different drugs. Note, however, that both opportunities for young people to grow and pursue one-time and long-term surveys indicate that most future goals and interests. Research has shown that youth do not progress to abusing other drugs. But these new lifestyles can serve as protective factors among those who do progress, their drug abuse as the new roles become more important than being history can vary by neighborhood drug availability, involved with drugs. demographic groups, and other characteristics of the abuser population. In general, the pattern of abuse is Risks appear at every transition from early associated with levels of social disapproval, perceived childhood through young adulthood; therefore, risk, and the availability of drugs in the community. prevention planners need to consider their target audiences and implement programs Scientists have proposed several hypotheses as to that provide support appropriate for each why individuals first become involved with drugs developmental stage. They also need to and then escalate to abuse. One explanation is a consider how the protective factors involved biological cause, such as having a family history in these transitions can be strengthened. of drug or alcohol abuse, which may genetically predispose a person to drug abuse. Another explanation is that starting to abuse a drug may lead to affiliation with more drug-abusing peers which, in turn, exposes the individual to other drugs. Indeed, many factors may be involved.10 Preventing Drug Use among Children and Adolescents
  17. 17. Different patterns of drug initiation have beenidentified based on gender, race or ethnicity, and COMMUNITY ACTION BOXgeographic location. For example, research has found Parents can use information on risk andthat the circumstances in which young people are protection to help them develop positiveoffered drugs can depend on gender. Boys generally preventive actions (e.g. talking about familyreceive more drug offers and at younger ages. Initial rules) before problems occur.drug abuse can also be influenced by where drugsare offered, such as parks, streets, schools, homes, Educators can strengthen learning and bonding toor parties. Additionally, drugs may be offered by school by addressing aggressive behaviors anddifferent people including, for example, siblings, poor concentration—risks associated with laterfriends, or even parents. onset of drug abuse and related problems.While most youth do not progress beyond initial Community Leaders can assess communityuse, a small percentage rapidly escalate their risk and protective factors associated withsubstance abuse. Researchers have found that these drug problems to best target prevention services.youth are the most likely to have experienced acombination of high levels of risk factors with lowlevels of protective factors. These adolescents werecharacterized by high stress, low parental support,and low academic competence.However, there are protective factors that cansuppress the escalation to substance abuse. Thesefactors include self-control, which tends to inhibitproblem behavior and often increases naturally aschildren mature during adolescence. In addition,protective family structure, individual personality,and environmental variables can reduce the impactof serious risks of drug abuse. Preventive interventionscan provide skills and support to high-risk youthto enhance levels of protective factors and preventescalation to drug abuse. National Institute on Drug Abuse 11
  18. 18. Chapter 2: Planning for Drug Abuse Prevention in the Community This chapter presents a process to help communities as they plan to implement research-based prevention programs. It provides guidance on applying the prevention principles, assessing needs and community readiness, motivating the community to take action, and evaluating the impact of the programs implemented. Additional planning resources are highlighted in Selected Resources and References. How can the community develop a plan of the problem and guide the selection of programs for research-based prevention? most relevant to the community’s needs. This is an important process, whether a community is selecting Prevention research suggests that a well-constructed a school-based prevention curriculum or planning community plan incorporates the characteristics multiple interventions that cut across the outlined in the following box. entire community. Next, an assessment of the community’s readiness THE COMMUNITY PLAN for prevention can help determine additional steps • Identifies the specific drugs and other child that are needed to educate the community before and adolescent problems in a community; beginning the prevention effort. Then, a review of existing programs is needed to determine gaps • Builds on existing resources (e.g., current drug abuse in addressing community needs and identifying prevention programs); additional resources. • Develops short-term goals relevant to implementation of research-based prevention programs; Finally, community planning can benefit from contributions of community organizations that • Projects long-term objectives so that plans and provide services to youth. Convening a meeting resources are available for the future; and of leaders of youth-serving organizations can aid in • Incorporates ongoing assessments to evaluate the coordinating ideas, resources, and expertise to help effectiveness of prevention strategies. implement and sustain research-based programs. Planning for implementation and sustainability requires resource development for staffing and management, Planning Process long-term funding commitments, and linkages with Planning usually starts with an assessment of drug existing delivery systems. abuse and other child and adolescent problems, which includes measuring the level of substance How can the community use the abuse in the community as well as examining the prevention principles in level of other community risk factors (e.g., poverty) prevention planning? [see section on “How can the community assess the level of risk for drug abuse?” for more details]. Several prevention principles provide a framework The results of the assessment can be used to raise for effective prevention planning and programming community awareness of the nature and seriousness by presenting key concepts in implementing research-12 Preventing Drug Use among Children and Adolescents
  19. 19. based prevention. Consider, for example, Principle 3:“Prevention programs should address the type of Chapter 2 Principlesdrug abuse problem in the local community, targetmodifiable risk factors, and strengthen identified Principles for Prevention Planningprotective factors.” This principle describes how the PRINCIPLE 2 Prevention programs should address allplan should reflect the reality of the drug problem in forms of drug abuse, alone or in combination, includingthat community and, importantly, what needs to be the underage use of legal drugs (e.g., tobacco or alcohol);done to address it. the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants),Community-wide efforts also can be guided by prescription medications, or over-the-counter drugs.Principle 9: “Prevention programs aimed at general PRINCIPLE 3 Prevention programs should address thepopulations at key transition points . . . can produce type of drug abuse problem in the local community, targetbeneficial effects, even among high-risk families and modifiable risk factors, and strengthen identifiedchildren.” With carefully structured programs, the protective factors.community can provide services to all populations, PRINCIPLE 4 Prevention programs should be tailoredincluding those at high risk, without labeling or to address risks specific to population or audiencestigmatizing them. characteristics, such as age, gender, and ethnicity, to improve program effectiveness.In implementing a more specific program, such asa family program within the educational system, PRINCIPLE 9 Prevention programs aimed at generalthe principles address some of the required content populations at key transition points, such as the transitionareas. For instance, Principle 5 states, “Family-based to middle school, can produce beneficial effects even among high-risk families and children. Such interventionsprevention programs should enhance family bonding do not single out risk populations and, therefore, reduceand relationships and include parenting skills; practice labeling and promote bonding to school and community.in developing, discussing, and enforcing family policies PRINCIPLE 10 Community prevention programs thaton substance abuse; and training in drug education combine two or more effective programs, such as family-and information.” based and school-based programs, can be more effectiveThe principles offer guidance for selecting or adapting than a single program alone.effective programs that meet specific community needs. PRINCIPLE 11 Community prevention programs reachingIt is important to recognize, however, that populations in multiple settings—for example, schools,not every program that seems consistent with clubs, faith-based organizations, and the media—are mostthese research-based prevention principles is effective when they present consistent, community-wide messages in each setting.necessarily effective. To be effective, programsneed to incorporate the core elements identified inresearch (see Chapter 3). These include appropriatestructure and content, adequate resources for trainingand materials, and other implementation requirements.For more information on resources to help communitiesin prevention planning and the research underlyingthe prevention principles, see Selected Resourcesand References. National Institute on Drug Abuse 13
  20. 20. How can the community assess the As an example, the Communities That Care prevention level of risk for drug abuse? operating system, developed by Hawkins and colleagues at the University of Washington (Hawkins et al. 2002), To assess the level of risk of youth engaging in drug is based on epidemiological methods. An assessment abuse, it is important to: is conducted to collect data on the distribution of risk and protective factors at the community level. This • measure the nature and extent of drug abuse approach helps local planners identify geographic patterns and trends; areas with the highest levels of risk and the lowest • collect data on the risk and protective factors levels of protective resources. This analysis tool throughout the community; assists planners in selecting the most effective prevention interventions to address the specific • understand the community’s culture and how that risks of neighborhoods. culture affects and is affected by drug abuse; Other data sources and measurement instruments • consult with community leaders working in drug (such as questionnaires) that can help in community abuse prevention, treatment, law enforcement, planning include the following resources. mental health, and related areas; • Public access data. Several large national • assess community awareness of the problem; and surveys provide data to help local communities understand how their drug problems relate to • identify existing prevention efforts already under the national picture. These include the National way to address the problem. Survey on Drug Use and Health, Monitoring the Researchers have developed many tools to assess Future Study, and Youth Behavior Risk Study. the extent of a community’s drug problem. Most of Information on accessing these data is provided these tools assess the nature of the problem—what in Selected Resources and References. drugs are available and who is abusing them. Some • Public access questionnaires. The studies listed of them assess the extent of abuse by estimating above and many other federally sponsored data sets how many people are abusing drugs. Others assess make the data collection instruments available for factors associated with abuse, such as juvenile adaptation and use by the public. Communities delinquency, school absenteeism, and school dropout can conduct local studies using these instruments rates. Researchers have also developed instruments to collect uniform data that can often be compared that assess individual risk status. It is important with national findings. when beginning the assessment process to collect sufficient information to help local planners target • Archival data. Data from public access files the intervention by population and geographic area. from school systems, health departments, hospital emergency rooms, law enforcement agencies, and drug abuse treatment facilities can be analyzed to identify the nature of the local drug problem and other youth problems.14 Preventing Drug Use among Children and Adolescents
  21. 21. • Ethnographic studies. Ethnographic approaches Is the community ready for prevention? use systematic, observational processes to describe behaviors in natural settings, such as studying the Identifying a serious level of risk in a community abuse of drugs by youth gangs, and documenting does not always translate into community readiness the individual perspectives of those under observation. to take action. Based on studies of many small communities, researchers have identified nine stages• Other qualitative methods. Other qualitative of readiness that can guide prevention planning methods, such as convening focus groups of (Plested et al. 1999). Applying measures to assess representatives of drug-abusing subpopulations readiness, prevention planners can then identify the or key interviews with community officials, can critical steps needed to implement programs (see be used to gain a greater understanding of the table on page 20). Although much of the research local drug abuse problem. on the stages of community readiness has examined small communities, large communities find thatAs each of these methods has advantages and these stages provide a structure to describe levelsdisadvantages, it is advisable, permitting resources, of awareness of drug issues in their communityto use multiple strategies to assess community risk and readiness to embrace a prevention program.to provide the best information possible. Awareness is assessed at two levels: that of the publicThe Community Epidemiology Work Group (CEWG), (by examining the nature and level of drug coverageanother data source pioneered in the early 1970s by in the news) and that of officials (by determiningNIDA and communities nationwide, is composed if they have taken a position on drug abuseof researchers from 21 U.S. cities who collect or use in the community).archival data to characterize the nature of the drug Community leaders can begin assessing theirproblem in their locations. CEWG representatives community’s readiness by interviewing keymeet with NIDA biannually to inform the Institute informants in their community. Additionaland fellow CEWG members of changing drug trends planning and program sources can be found inin their cities. The work group has developed a Selected Resources and References. Web sites,Guide for Community Epidemiology Surveillance contact information, and publications offer furtherNetworks on Drug Abuse to help other communities information to guide community efforts.use this approach to provide up-to-date informationon local drug abuse problems.Using information obtained through these manysources can help community leaders make sounddecisions about programs and policies. Analyzingthese data before implementing new programs canalso help establish a baseline for evaluating results.To be most informative, periodic assessments needto be made routinely.For more information on how communities canassess the level or risk of drug abuse in theircommunity, see Selected Resources and References. National Institute on Drug Abuse 15
  22. 22. ASSESSING READINESS* COMMUNITY ACTION Readiness Stage Community Response Ideas 1. No awareness Relative tolerance of drug abuse Create motivation. Meet with community leaders involved with drug abuse prevention; 2. Denial Not happening here, can’t do use the media to identify and talk about the anything about it problem; encourage the community to see 3. Vague awareness how it relates to community issues; begin Awareness, but no motivation preplanning. 4. Preplanning Leaders aware, some motivation 5. Preparation Active energetic leadership Work together. Develop plans for prevention and decisionmaking programming through coalitions and other community groups. 6. Initiation Data used to support Identify and implement research-based programs. prevention actions 7. Stabilization Community generally supports Evaluate and improve ongoing programs. existing program 8. Confirmation/ Decisionmakers support improving Institutionalize and expand programs to reach Expansion or expanding programs more populations. 9. Professionalization Knowledgeable of community drug Put multicomponent programs in place for problem; expect effective solutions all audiences. * Plested et al. 1999. How can the community be motivated But care is needed in organizing a community-level to implement research-based coalition to ensure that its programming incorporates prevention programs? research-tested strategies and programs—at the individual, school, and community levels. Having a The methods needed to motivate a community to supportive infrastructure that includes representatives act depend on the particular community’s stage of across the community can reinforce prevention readiness. At lower stages of readiness, individual messages, provide resources, and sustain prevention and small group meetings may be needed to attract programming. Introducing a school-based curriculum, support from those with great influence in the however, requires less community involvement, but is community. At higher levels of readiness, it may be still a focused preventive effort. possible to establish a community board or coalition of key leaders from public- and private-sector Research has shown that prevention programs organizations. This can provide the impetus for action. can use the media to raise public awareness of the seriousness of a community’s drug Community coalitions can and do hold community- problem and prevent drug abuse among wide meetings, develop public education campaigns, specific populations. Using local data and speakers present data that support the need for research-based from the community demonstrates that the drug prevention programming, and attract sponsors for problem is real and that action is needed. Providing comprehensive drug abuse prevention strategies. some of the examples of research-based programs described in Chapter 4 can help mobilize the community for change.16 Preventing Drug Use among Children and Adolescents
  23. 23. How can the community assess In assessing the impact of individual programs, it isthe effectiveness of current important for communities to document how wellprevention efforts? the program is delivered and the level of intervention participants receive. For example, in assessing aAssessing prevention efforts can be challenging for school-based prevention program, key questionsa community, given limited resources and limited to be asked include:access to expertise in program evaluation. Manycommunities begin the process with a structured a Have the teachers mastered the content andreview of current prevention programs to determine: interactive teaching strategies needed for the selected curriculum?a What programs are currently in place in the community? a How much exposure have the students had to each content area?a Were strict scientific standards used to test the programs during their development? a Is there an assessment component?a Do the programs match community needs? The community plan should guide actions for prevention over time. Once communities are mobilized, programa Are the programs being carried out as designed? implementation and sustainability require clear, measurable goals, long-term resources, sustaineda What percentage of at-risk youth is being leadership, and community support to maintain reached by the program? momentum for preventive change. ContinuingAnother evaluation approach is to track existing evaluations keep the community informed anddata over time on drug abuse among students in allow for periodic reassessment of needs and goals.school, rates of truancy, school suspensions, drug-abuse arrests, and drug-related emergency roomadmissions. The use of the information obtained in COMMUNITY ACTION BOXthe initial community drug abuse assessment can Parents can work with others in their communityserve as a baseline for measuring change in long- to increase awareness about the local drugterm trends. Because the nature and extent of drug abuse problem and the need for research-basedabuse problems can change with time, it is wise to prevention programs.periodically assess community risk and protectivefactors to help ensure that the programs in place Educators can work with others in their schoolappropriately address current community needs. and school system to review current programs, and identify research-based preventionCommunities may wish to consult with State and interventions appropriate for students.county prevention authorities for assistance in planningand implementation efforts. Also, federally supported Community Leaders can organize a communitypublications and other resources are available, group to develop a community prevention plan,as noted in Selected Resources and References. coordinate resources and activities, and support research-based prevention in all sectors of the community. National Institute on Drug Abuse 17
  24. 24. Chapter 3: Applying Prevention Principles to Drug Abuse Prevention Programs This chapter describes how the prevention principles have been applied to create effective family, school, and community programs. It offers information on working with risk and protective factors, adapting programs while maintaining fidelity to core elements, implementing and evaluating programs, and understanding the cost-benefits of research-based prevention. The goal is to help communities implement research-based prevention programs. How are risk and protective factors Tiered programs, such as the Adolescent Transitions addressed in prevention programs? Program, incorporate all three levels of intervention. Others, such as Early Risers “Skills for Success” Risk and protective factors are the primary targets Prevention Program, may have only two levels of effective prevention programs used in the family, of intervention. school, and community settings. Prevention programs are usually designed to reach specific populations Details of the programs used as examples in the in their primary settings, such as reaching children following sections are provided in Chapter 4. at school or through recreational or after-school In the Family programs. However, in recent years it has become more common to find programs for any given target Prevention programs can strengthen protective factors group in a variety of settings, such as holding a among young children by teaching parents better family-based program in a school or a church. The family communication skills, developmentally goal of these programs is to build new and strengthen appropriate discipline styles, firm and consistent rule existing protective factors and reverse or reduce enforcement, and other family management skills. modifiable risk factors in youth. Parents also can be taught how to increase their emotional, social, cognitive, and material support, Prevention programs can be described by the audience which includes, for example, meeting their children’s or intervention level for which they are designed: financial, transportation, health care, and homework needs. Research confirms the benefit of parents taking • Universal programs are designed for the general a more active role in their children’s lives, by talking population, such as all students in a school. with them about drugs, monitoring their activities, • Selective programs target groups at risk, or subsets getting to know their friends, understanding their of the general population such as children of drug problems and concerns, providing consistent rules abusers or poor school achievers. and discipline, and being involved in their learning and education. The importance of the parent-child • Indicated programs are designed for people who relationship continues through adolescence and beyond. are already experimenting with drugs. An example of a universal family-based program is the Strengthening Families Program For Parents and Youth, 10–14, which provides rural parents guidance on family management skills, communication,18 Preventing Drug Use among Children and Adolescents
  25. 25. academic support, and parent-child relationships.Recognizing that it can be difficult to attract Chapter 3 Principlesparents to this program, the researchers encourageparticipation through flexibility in scheduling and Principles for Programslocation. Offering conveniences such as babysitting, PRINCIPLE 5 Family-based prevention programs shouldtransportation, and meals make participation more enhance family bonding and relationships and includepractical for many rural parents, while enhancing parenting skills; practice in developing, discussing, andthe program’s success in reaching its goals. enforcing family policies on substance abuse; and training in drug education and information.Another type of family program operates within a PRINCIPLE 6 Prevention programs can be designed toschool setting. The Adolescent Transitions Program, intervene as early as preschool to address risk factorsfor example, is a tiered intervention family program. for drug abuse, such as aggressive behavior, poor socialAll families can get involved with the universal skills, and academic difficulties.intervention, which makes available a Family Resource PRINCIPLE 7 Prevention programs for elementary schoolRoom where information on parenting is provided. children should target improving academic and social-The Family Check-Up, the selective level of this emotional learning to address risk factors for drug abuse,program, is an assessment process to identify and such as early aggression, academic failure, andhelp families at greater risk by providing them with school dropout.information and interventions specific to their needs. PRINCIPLE 8 Prevention programs for middle or juniorFamilies already engaged in problem behaviors and high and high school students should increase academicidentified as needing an indicated intervention are and social competence.provided more intense assistance and information PRINCIPLE 9 Prevention programs aimed at generaltailored to their problem. Such assistance mightinclude, for example, individual or family therapy, populations at key transition points, such as the transition to middle school, can produce beneficial effects evenintensive parent coaching, therapeutic foster care, or among high-risk families and children. Such interventionsother family-specific interventions. The uniqueness do not single out risk populations and, therefore, reduceof the tiered approach is that the whole school labeling and promote bonding to school and community.participates in the program and all individuals or PRINCIPLE 10 Community prevention programs thatfamilies receive the appropriate level of help without combine two or more effective programs, such as family-being labeled in the process. based and school-based programs, can be more effective than a single program alone.In School PRINCIPLE 11 Community prevention programs reachingPrevention programs in schools focus on children’s populations in multiple settings—for example, schools,social and academic skills, including enhancing clubs, faith-based organizations, and the media—are mostpeer relationships, self-control, coping skills, social effective when they present consistent, community-widebehaviors, and drug offer refusal skills. School-based messages in each setting.prevention programs should be integrated withinthe school’s own goal of enhanced academicperformance. Evidence is emerging that a major riskfor school failure is a child’s inability to read by thethird and fourth grades (Barrera et al. 2002), andschool failure is strongly associated with drug abuse.Integrated programs strengthen students’ bondingto school and reduce their likelihood of droppingout. Most prevention curricula include a normativeeducation component designed to correct themisperception that many students are abusing drugs. National Institute on Drug Abuse 19
  26. 26. Chapter 3 Principles Most research-based prevention interventions in schools include curricula that teach many of the behavioral and social skills described above. ThePrinciples for Program Delivery Life Skills Training Program exemplifies universalPRINCIPLE 12 When communities adapt programs to classroom programs that are provided to middle-match their needs, community norms, or differing cultural schoolers. The program teaches drug resistance,requirements, they should retain core elements of the self-management, and general social skills in aoriginal research-based intervention. 3-year curriculum, with the third year a boosterPRINCIPLE 13 session offered when students enter high school. Prevention programs should be long-termwith repeated interventions (i.e., booster programs) to The Caring School Community Program is anotherreinforce the original prevention goals. Research showsthat the benefits from middle school prevention programs type of school-based intervention. This universaldiminish without followup programs in high school. elementary school program focuses on establishing a “sense of community” among the classroom, school,PRINCIPLE 14 Prevention programs should include and family settings. The community support thatteacher training in good classroom management practices, results helps children succeed in school and copesuch as rewarding appropriate student behavior. Suchtechniques help to foster student’s positive behavior, with stress and other problems when they occur.achievement, academic motivation, and school bonding. An indicated intervention that reaches high schoolPRINCIPLE 15 Prevention programs are most effective students, Project Towards No Drug Abuse focuses onwhen they employ interactive techniques, such as peer students who have failed to succeed in school and arediscussion groups and parent role-playing, that allow engaged in drug abuse and other problem behaviors.for active involvement in learning about drug abuse and The program seeks to rebuild students’ interest inreinforcing skills. school and their future, correct their misperceptionsPRINCIPLE 16 Research-based prevention programs about drug abuse, and strengthen protective factors,can be cost-effective. Similar to earlier research, recent including positive decisionmaking and commitment.research shows that for each dollar invested in prevention,a savings of up to $10 in treatment for alcohol or other Recent research suggests caution whensubstance abuse can be seen. grouping high-risk teens in peer group interventions for drug abuse prevention. Such groups have been shown to produce negative effects, as participants appear to reinforce substance abuse behaviors over time (Dishion et al. 2002). Research is examining how to prevent such effects, with a particular focus on the role of adults and positive peers. In the Community Prevention programs work at the community level with civic, religious, law enforcement, and other government organizations to enhance antidrug norms and prosocial behaviors. Strategies to change key aspects of the environment are often employed at the community level. These can involve instituting new policies, such as the drug-free school concept, or strengthening community practices, such as asking for proof of age to buy cigarettes.20 Preventing Drug Use among Children and Adolescents
  27. 27. Many programs coordinate prevention efforts What are the core elements of effectiveacross settings to communicate consistent messages research-based prevention programs?through school, work, religious institutions, and themedia. Research has shown that programs that reach In recent years, many research-based preventionyouth through multiple sources can strongly impact programs have proven effective. These programscommunity norms (Chou et al. 1998). Community- were tested with rigorous designs in diversebased programs also typically include development communities in a wide variety of settings, and withof policies or enforcement of regulations, mass media a variety of populations. The most rigorous designefforts, and community-wide awareness programs. tests the program’s effects on a group that receivesExamples include establishing youth curfew, having the intervention (i.e., “experimental group”) andadvertising restrictions, reducing the density of alcohol compares results to a second group that did notoutlets in the community, raising cigarette prices, receive the intervention (i.e., “control group”).and creating drug-free school zones. Some carefully As communities review prevention programs tostructured and targeted media interventions have determine which best fit their needs, the followingproven to be very effective in reducing drug abuse. core elements of effective research-based programsFor example, a mass media campaign targeting should be considered.sensation-seeking youth reduced marijuana abuseby 27 percent among high sensation-seeking youth • Structure—how each program is organized(Palmgreen et al. 2001). and constructed;Project STAR is an example of a multicomponent • Content—how the information, skills, anddrug abuse prevention program for the community. strategies are presented; andThis project tested whether a coordinated effortthat encompassed schools, parents, community • Delivery—how the program is selected or adaptedorganizations, health policies, and the media could and implemented, as well as how it is evaluatedmake a difference in preventing drug abuse among in a specific community.youth. Project STAR reached all children and When adapting programs to match communityfamilies in the community. The middle school characteristics, it is important to retain these corecurriculum was the core of the program and was elements to ensure that the most effective aspects ofreinforced by homework and other activities of the the program remain intact. Core elements help buildparent component. Health policies and mass media effective research-based prevention programs.components were incorporated as well. Long-termfollowup studies have shown significant impacts in Each core element contains descriptive features, whichreducing substance abuse, with benefits lasting well are presented in the following sections. Tables areinto participants’ adult years. included in each section to provide examples of how these features fit together in programs. National Institute on Drug Abuse 21

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