Zili Sloboda, Sc.D., Principal Investigator September 13, 2005 VII Meeting of the Expert Group on

1. The Clash between Science and the Real World: The Experiences of the Adolescent Substance Abuse Prevention Study Zili Sloboda, Sc.D., Principal Investigator September 13, 2005 VII Meeting of the Expert Group on Demand Reduction OAS/CICAD Funded by the Robert Wood Johnson Foundation (Grant#s O39223 and 040371)

2. The Adolescent Substance Abuse Prevention Study • To develop and evaluate an evidence-based substance abuse prevention program with curricula for the 7th grade (when children are ages 12 and 13) and 9th grade (when children are ages 14 and 15) to be delivered by DARE officers • Evaluation consists of following a cohort of students from the 7th through the 11th grades

3. Risk Years for Substance Use • There is an increase of between 150% and 200% in the use of all substances between the 8th (ages 13 and 14) and 10th grades (ages 15 and 16) • 10th graders’ rates of substance use are closer to and parallel to those of 12th graders.

5. Why D.A.R.E.? • D.A.R.E. is a delivery system of officer/instructors and has a presence in 80% of school districts nationwide • D.A.R.E. training and monitoring strengthens implementation fidelity • Officers are trained to be prevention specialists and their coming into the classroom during prescheduled times insures that classroom time is devoted to prevention

6. Overview of Presentation: • Curriculum Design • Research Elements • Measures • Challenges • Current Status

7. CURRICULUM DESIGN SEVENTH and NINTH GRADES

8. ELEMENTS OF EFFECTIVE SCHOOL-BASED PREVENTION PROGRAMMING • CONTENT • Dispel myths about prevalence and expectancies of substance use • Establish anti-substance use norms • Address tobacco and alcohol as well as illicit drug use • Address perceptions of consequences of substance use for adolescents • Skills development: communications, decision making, resistance • DELIVERY • Interactive learning • Practice skills through role play, small group discussion etc.

9. Curriculum Design Criteria • Highly engaging problem-based activities. • Authentic problems as organizers. • Critical thinking skills required. • Spiral sequence of skill development. • In 7th grade-extensive small group deliberations; in 9th grade large group discussions (limited lecturing) . • Culturally and socially sensitive.

10. External Variables Attitudes Intention Behavior Subjective Norms Perceived Behavioral Control Theory of Planned Behavior Theoretical Model Beliefs that behavior leads to certain outcomes Demographics Attitudes Towards Target Evaluation of outcomes Beliefs of specific referents as to performance of behavior Personality Motivation to comply with those referents Relative Importance of attitudinal and normative considerations

11. Three Major Content Emphases(Mediators)—EVIDENCE OF EFFECTIVENESS • Normative beliefs among adolescents • Perceptions of consequences of substance use/abuse for adolescents • Social problem-solving skills • communication skills • decision making skills • resistance/assertiveness skills

12. RESEARCH ELEMENTS

13. ASAPS Research Questions • Are there differences in the subsequent substance use behaviors of children who receive the program compared to those who were in the control schools? • To what extent is the program’s effectiveness a function of the implementation fidelity of the delivered program? • To what extent is the program’s effectiveness a function of the student’s exposure to the program? • What is the relationship between program mediators (normative beliefs, skills, etc.) and subsequent substance use?

14. Refusal Skills Refusal Skills Consequences Consequences Attitudes Attitudes (How much does... (How much does... (I think it's okay (I think it's okay affect how well the affect how well the for students my for students my brain works...) brain works...) age to...) age to...) Intentions Intentions (How likely is it that (How likely is it that 30 Day Use 30 Day Use you will use...in the you will use...in the next 12 months) next 12 months) Normative Beliefs Normative Beliefs Subjective Norms Subjective Norms (How many (How many 10th 10th (Most Students My (Most Students My graders do you graders do you age think it's okay age think it's okay think...) think...) to...) to...) Decision-Making Decision-Making Skills Skills constructs targeted by prevention curricula constructs in the TPB Proposed Extension of TPB for Targeted Mediators Constructs targeted by prevention curricula Constructs in the TPB

15. Methods—Study Population • SITES: DETROIT, HOUSTON, LOS ANGELES, NEWARK (NJ), NEW ORLEANS, ST. LOUIS • Unit of analysis=school clusters made up of a high school and all feeder middle schools • Random assignment of school clusters to two conditions: one where the schools receive the new program and the other, not. • Universe stratified by high and low stress (proportion of district students eligible for free lunch and proportion of minority students)

16. Research Design 2001-2002 (7TH) 2002-2003 (8TH) 2003-2004 (9TH) 2004-2005 (10TH) 2005-2006 (11TH) O1XO2O3O4XO5O6O7 EXPERIMENTAL CONTROL O1 O2 O3 O4 O5 O6 O7 ON=STUDENT SURVEY X=NEW CURRICULUM

17. Consenting Procedures for Student Surveys • CONSENT PACKAGE • ACTIVE PARENTAL CONSENT FORM • ACTIVE STUDENT ASSENT FORM • TRACKING INFORMATION FOR FOLLOWUP • COVERLETTER WITH BULLETS SUMMARIZING KEY CONSENT ITEMS • TELEPHONE NUMBER FOR INFORMATION • WORKED WITH SCHOOLS AND TEACHERS TO HAND OUT AND COLLECT • INCENTIVES TO STUDENTS AND TEACHERS

18. Consent Procedure And Survey Completion

19. Measures • MEDIATORS • NORMATIVE BELIEFS (MONITORING THE FUTURE ETC.) • PERCEPTIONS OF CONSEQUENCES OF SUBSTANCE USE IN ADOLESCENCE (MONITORING THE FUTURE ETC) • COMMUNICATION, DECISION MAKING AND RESISTANCE SKILLS (OTHER SOURCES AND MODELS) • MODERATORS • DEMOGRAPHICS • RISK STATUS (MONITORING THE FUTURE ETC) • OUTCOMES • SUBSTANCE USE—TOBACCO, ALCOHOL, INHALANTS, MARIJUANA, OTHER ILLICITDRUGS, AND ABUSE OF PRESCRIPTION DRUGS (MONITORING THE FUTURE)

20. Survey Administration • Self-administered within a class • 40 minutes to complete • Supervised by University of Akron staff (no DARE officer) • Confidential (sealed envelope in box)

21. Confidentiality • Hold a National Institute of Health Certificate of Confidentiality • Student data are identified by a numeric code • All survey data will be stored in a secure environment at the University of Akron

22. Sample Characteristics

23. 30-day Prevalence Of Substance Use At Pretest (Baseline)

24. MONITORING FINDINGS • YEAR 1-4 • MEDIATORS • Normative beliefs—all 3 years ASAPS better* scores • Consequences—Ceiling effects, changed measurements for 8th grade, ASAPS better scores at 9th grade • Skills • Decision making—ASAPS better scores immediately after intervention and at 8th grade (changed our measure at 9th grade survey) • Communication—No differences • Resistance—ASAPS better scores immediately after interventions • *Statistically significant at .05 level

25. REAL WORLD CHANGES 1 RECRUITMENT: SUPERINTENDENT PRINCIPALS (HIGH AND MIDDLE OFFERED PREVENTION PROGRAM LETTERS OF AGREEMENT TO PARTICIPATE IN STUDY CONTROL REMAINED CONTROLS RANDOMLY SELECT A REPLACEMENT EXPERIMENTAL LO FIDELITY HI FIDELITY HI ATTENDANCE LO ATTENDANCE HI ATTENDANCE LO ATTENDANCE

26. Other “Real World” Issues • 9/11 • School Riots • Burned down school • Hurricane Katrina • No Child Left Behind Law; allowing students to select high schools outside of their neighborhoods

28. Lost to follow-up by Year 3Control Schools= 34.2%Treatment Schools= 39.6%Estimated Loss to follow-up by Year 5= 50%

29. Examination of Attrition at 9th Grade Post-Survey • Number of students without 9th grade post-survey=6,927 • Comparison of attrition by condition showed no significant difference (design-based chi square test) • Logistic regression models run to predict substance use (use/no use) at baseline also showed no significant differences using a multiplicative interaction term between attrition status and treatment status (although for both groups those who are attritors are more likely to have used substances at baseline) • Examination of gender and ethnicity using logistic regression models find that males in the treatment condition are more likely to be attritors as were American Indians in the control condition

30. Implementation Fidelity Content Coverage Officer Behavior Time on Activity Officer Characteristics Student Assessments

31. Current Status • Cleaning up 10th grade survey data • Running analyses • Administration of 11th grade surveys