Manoj Sharma, MBBS, MCHES, Ph.D., FAAHB Paul Branscum, RD, Ph.D. Review of school-based drug abuse prevention programs in high school students Manoj Sharma, MBBS, MCHES, Ph.D., FAAHB Paul Branscum, RD, Ph.D.

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 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 that were used included “substance abuse” or “drug abuse” and “high schools” and “intervention” or “program.” The search was done for the time period 2005 to November 2012 as a Cochrane Review was done in 2005 Inclusion criteria for including studies in this review were: (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 Of the 18 evaluations that were done, 12 evaluations were randomized controlled trials, three were group randomized controlled trials, two were quasi experimental and one used single group pre-test post-test follow-up design In terms of duration, three interventions were brief (less than 1 hour), two were between three and ten hours, three were between four to ten weeks, two were one semester long, and two lasted an entire academic school year. In terms of use of theory, seven interventions used theory while five provided no theoretical basis for the intervention.

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 were (1) Project Toward No Drug Abuse (TND), (2) Project SPORT, (3) Teen Intervention Project – Cherokee (TIP-C), (4) Motivational Interviewing, (5) NARCONONTM drug education curriculum, (6) Cognition-Motivation-Emotional Intelligence Resistance Skills (CMER), and (7) Adventure trial. Of these successful interventions four were based upon theoretical underpinnings, and overall theory was been used by seven interventions. The theories that have been used are: (1) cognitive perception information and behavioral skills, (2) social learning (n=2), (3) behavior image model, (4) PRECEDE-PROCEED model, (5) theory of reasoned action, and (6) 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.