Enhancing the effectiveness of school-based drug abuse prevention programs in high school students Paul Branscum Ph.D., RD Assistant Professor – University of Oklahoma Manoj Sharma, MBBS, MCHES, Ph.D., FAAHB Professor – University of Cincinnati

Introduction Drug abuse or substance abuse is a major problem in the United States and the world particularly among young people. Substance use disorders have been shown to a lifetime prevalence of 11.4% in the age group 13 to 18 years. Alcohol, marijuana, and tobacco are the most widely used substances among high school students

Introduction & Purpose There is a very thin line between experimental use and getting dependent on the use of drugs. Therefore both primary and secondary prevention programs are of utmost importance. In 2001 the federal government directed the use of evidence-based programs for substance abuse prevention in schools through the passage of the No Child Left Behind legislation. Purpose of this poster is to review school-based programs implemented in high schools for substance abuse prevention and suggest recommendations for future interventions.

Methods An extensive literature search was conducted to collect studies for inclusion in this article using the databases PubMed, ERIC, and CINAHL. Keywords: “Substance Abuse” or “Drug Abuse” and “High Schools” and “Intervention” or “Program.” Time period: 2005 to November 2012 Inclusion criteria (1) publication in English language; (2) inclusion in one of the three databases listed above; (3) time period 2005 to November 2012; (4) done in high school setting; (5) focused on prevention of alcohol, tobacco, or other drugs; (6) conducted an evaluation and used a quantitative design for evaluation A total of 18 studies were identified with 12 different interventions

Results Research Design Duration Theory 12 Randomized Controlled Trials 3 Group Randomized Controlled Trials 2 Quasi Experimental design 1 Single group pre-test post-test follow-up design Duration Very Brief - 1 Hour or Less (n=3 studies) Brief – 3 to 10 hours (n=2) Medium – 4 to 16 weeks (n=5) Long – Academic School Year (n=2) Theory 7 used theory/5 not reported

Conclusion/Discussion…1 With regards to experimental design, it was noteworthy to find that a majority of the evaluations (15 out of 18) used either a randomized controlled trial or group randomized controlled trial design. These designs are considered the gold standard in establishing the association between an intervention and reported outcomes. Of the 18 evaluations, 12 evaluations measured substance use behavior. Of these 12 studies seven were able to demonstrate statistically significant change from before to after the intervention

Conclusion/Discussion ...2 The names of the successful interventions: Project Toward No Drug Abuse (TND) Project SPORT Teen Intervention Project – Cherokee (TIP-C) Motivational Interviewing NARCONONTM drug education curriculum Cognition-Motivation-Emotional Intelligence Resistance Skills (CMER) Adventure trial. Of these successful interventions four were based upon theoretical underpinnings, and overall theory was been used by seven interventions. Cognitive perception information and behavioral skills Social learning (n=2) Behavior image model PRECEDE-PROCEED model Theory of reasoned action Motivational enhancement therapy. Process evaluations were rarely used in the studies reviewed in this poster

Recommendations…1 High schools are an important venue for designing and implementing substance abuse prevention programs Some of the theories such as social cognitive theory, theory of planned behavior and integrative model of behavior prediction offer promising approaches. Brief interventions have shown lot of promise. If based on theory, interventions can also be very effective and efficient. Benefits for implementing shorter duration interventions is that they are easier to coordinate, require less resources, and are likely more attractive to primary (students) and secondary (teachers and educators) audiences.

Recommendations…2 The interventions must use randomized controlled trials for evaluation. In cases when this is not possible, then group randomized controlled trials should be implemented. Sample size calculation must be done in each evaluation, to assure researchers have sufficient statistical power when analyzing results. Small sample sizes serve very little purpose, and are not useful when determining impact. Process evaluation must also be collected with every intervention.