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CORK Bibliography: Prevention Programs, Evaluations

72 citations. January 2010 to present

Prepared: September 2011

Anderson DM. Does information matter? The effect of the Meth Project on meth use among youths. Journal of Health Economics 29(5): 732-742, 2010. (39 refs.)

Are demand-side interventions effective at curbing drug use? To the extent demand-side programs are successful, their cost effectiveness can be appealing from a policy perspective. Established in 2005, the Montana Meth Project (MMP) employs a graphic advertising campaign to deter meth use among teens. Due to the MMP's apparent success, seven other states have adopted Meth Project campaigns. Using data from the Youth Risk Behavior Surveys (YRBS), this paper investigates whether the MMP reduced methamphetamine use among Montana's youth. When accounting for a preexisting downward trend in meth use, effects on meth use are statistically indistinguishable from zero. These results are robust to using related changes of meth use among individuals without exposure to the campaign as controls in a difference-in-difference framework. A complementary analysis of treatment admissions data from the Treatment Episode Data Set (TEDS) confirms the MMP has had no discernable impact on meth use.

Andreeva TI; Krasovsky KS. Recall of tobacco pack health warnings by the population in Ukraine and its association with the perceived tobacco health hazard. International Journal of Public Health 56(3): 253- 262, 2011. (33 refs.)

After years of prevalence of smoking increase, Ukraine observes its decline. Recent tobacco control measures included smoke-free policies, new textual health warnings (THW) since late 2006, ban of outdoor tobacco advertising since January 2009 and tobacco tax increase since late 2008. The objective was to estimate potential contribution of THW to smoking decline process in Ukraine. The study is based on a nationwide omnibus survey of 2008 Ukrainian adults (18+). Outcome measures: quitting smoking after 2006 and perception of tobacco-related hazards. To measure the exposure to THW respondents were asked to describe the warnings they recall. Multivariate regression analysis was performed in SPSS 15.0. Those who considered health hazard of smoking as serious were significantly more likely to quit. Male smokers were more likely to perceive health hazard if they recalled health warnings 'Smoking is addictive, do not start to smoke!' and 'Smokers die early'. THW reach those groups of the population they are aimed to and may potentially result in consequent quitting smoking in male smokers.

Andrews JA; Gordon JS; Hampson SE; Christiansen SM; Gunn B; Slovic P et al. Short-term efficacy of Click City (R): Tobacco: changing etiological mechanisms related to the onset of tobacco use. Prevention Science 12(1): 89-102, 2011. (51 refs.)

This paper described the short-term results from an ongoing randomized controlled efficacy study of Click City (R): Tobacco, a tobacco prevention program designed for 5th graders, with a booster in sixth grade. Click City (R): Tobacco is an innovative school-based prevention program delivered via an intranet, a series of linked computers with a single server. The components of the program target theoretically based and empirically supported etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was designed to change one or more etiological mechanisms and was empirically evaluated in the laboratory prior to inclusion in the program. Short-term results from 47 elementary schools (24 schools who used Click City (R): Tobacco, and 23 who continued with their usual curriculum) showed change in intentions and willingness to use tobacco from baseline to 1-week following the completion of the 5th grade sessions. The results demonstrate the short-term efficacy of this program and suggest that experimentally evaluating components prior to including them in the program contributed to the efficacy of the program. The program was most efficacious for students who were most at risk.

Brinn MP; Carson KV; Esterman AJ; Chang AB; Smith BJ. Mass media interventions for preventing smoking in young people. (review). Cochrane Database of Systematic Reviews 11: e-article CD001006, 2010. (164 refs.)

Background: The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community. Objectives: To evaluate the effectiveness of mass media interventions to prevent smoking in young people in terms of reduced smoking uptake, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy and perception. Search strategy: We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of MEDLINE and EMBASE in July 2010. Selection criteria Randomized trials, controlled trials without randomization and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. Data collection and analysis: Information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risk of bias was abstracted by two independent reviewers. Studies were combined using qualitative narrative synthesis. Main results: Seven out of a total of 84 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All seven studies used a controlled trial design. Three studies concluded that mass media reduced the smoking behaviour of young people. All of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages, and message broadcast was of reasonable intensity over extensive periods of time. Authors' conclusion: There is some evidence that mass media can prevent the uptake of smoking in young people, however the evidence is not strong and contains a number of methodological flaws.

Chang FC; Chung CH; Yu PT; Chao KY. The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan. Health Education Research 26(2): 179-191, 2011. (43 refs.)

The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.

Clark HK; Ringwalt CL; Hanley S; Shamblen SR. Project ALERT's effects on adolescents' prodrug beliefs: A replication and extension study. Health Education & Behavior 37(3): 357-376, 2010. (52 refs.)

This article represents a replication and extension of previous studies of the effects of Project ALERT, a school-based substance use prevention program, on the prodrug beliefs of adolescents. Specifically, the authors' research examined Project ALERT's effects on adolescents' intentions to use substances in the future, beliefs about substance use consequences, normative beliefs, and resistance self-efficacy. In all, 34 schools with Grades 6 to 8 completed this randomized controlled trial and 71 Project ALERT instructors taught 11 core lessons to 6th graders and 3 booster lessons to 7th graders (one grade level earlier than in previous studies). Students were assessed in 6th grade prior to the onset of the intervention, in 7th grade after the completion of the 2-year curriculum, and again 1 year later in 8th grade. The authors found no evidence to suggest that Project ALERT had a positive impact on any alcohol, cigarette, or marijuana prodrug beliefs. Implications for school-based substance use prevention are discussed.

Colon RM; Deren S; Guarino H; Mino M; Kang SY. Challenges in recruiting and training drug treatment patients as peer outreach workers: A perspective from the field18. Substance Use & Misuse 45(12): 1892-1908, 2010. (18 refs.)

Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.

Comello MLG; Slater MD. The effects of drug-prevention messages on the accessibility of identity-related constructs. Journal of Health Communication 16(5): 458- 469, 2011. (40 refs.)

Recent theoretical work has posited that the self-system guides behavior via currently activated self-concepts. The authors adopted this framework to the study of drug-prevention messages by examining the extent to which messages can alter the accessibility of views of self and of drugs that would support nonuse. Participants were exposed to 1 of 3 print-ad conditions: autonomy-themed prevention messages (treatment), health-information themed prevention messages (comparison), and informational consumer ads (control). Outcomes were reaction times to make dichotomous judgments. Relative to comparison and control ads, treatment ads were more successful at activating a self-view as a nonuser, a view that marijuana use is inconsistent with autonomy, and unwillingness to use marijuana. Post-hoc analysis revealed that the effect of ad condition on unwillingness was partially mediated by the accessibility of self-view as a nonuser.

Cousins K; Connor JL; Kypri K. Reducing alcohol-related harm and social disorder in a university community: A framework for evaluation. Injury Prevention 16(e-article 5), 2010. (38 refs.)

Background: In New Zealand and other middle to high income countries, university student are at high risk of alcohol-related injury and other problems due to their typical pattern of episodic heavy drinking. In 2007, one university implemented Campus Watch, a novel and extensive programme to reduce social disorder, including alcohol-related injury, in the university area. Objectives: To quantify the effects of this complex intervention. Setting: A large public university campus and surrounding community in New Zealand. Design: A health promotion evaluation model was used, examining: (1) how the programme was developed, introduced and received by the community? (process); (2) whether the programme affected behaviour? (impact); and (3) whether the programme reduced social disorder and alcohol-related harm in particular? (outcome). The outcome phase uses a non-equivalent control group design to measure changes occurring in the Campus Watch area compared with other universities, and with a same-city control site. Participants: Programme staff, university students and other community members. Data: Interviews with university administrators and Campus Watch staff; surveys of local residents' views; Campus Watch incident data; national surveys of university students in 2005, 2007 and 2009; police data; fire department data. Outcome Measures: Prevalence of heavy episodic drinking; number of acute alcohol-related harms; incidence of antisocial behaviour, assault and street fires. Regression analyses will be used to examine changes in the intervention site relative to changes in the control areas.

Cowling DW; Modayil MV; Stevens C. Assessing the relationship between ad volume and awareness of a tobacco education media campaign. Tobacco Control 19(Supplement 1): I37-I42, 2010. (59 refs.)

Background:The relation between aided ad recall and level of television ad placement in a public health setting is not well established. We examine this association by looking back at 8 years of the California's Tobacco Control Program's (CTCP) media campaign. Methods: Starting in July 2001, California's campaign was continuously monitored using five telephone series of surveys and six web-based series of surveys immediately following a media flight. We used population-based statewide surveys to measure aided recall for advertisements that were placed in each of these media flights. Targeted rating points (TRPs) were used to measure ad placement intensity throughout the state. Results: Cumulative TRPs exhibited a stronger relation with aided ad recall than flight TRPs or TRP density. This association increased after log-transforming cumulative TRP values. We found that a one-unit increase in log-cumulative TRPs led to a 13.6% increase in aided ad recall using web-based survey data, compared to a 5.3% increase in aided ad recall using telephone survey data. Conclusions: In California, the relation between aided ad recall and cumulative TRPs showed a diminishing return after a large volume of ad placements. These findings may be useful in planning future ad placement for CTCP's media campaign.

Crone MR; Spruijt R; Dijkstra NS; Willemsen MC; Paulussen TGWM. Does a smoking prevention program in elementary schools prepare children for secondary school? Preventive Medicine 52(1): 53-59, 2011. (28 refs.)

Introduction. A smoking prevention program was developed to prepare children in elementary school for secondary school. This study assessed the effects on smoking in secondary school. Methods. In 2002, 121 schools in The Netherlands were randomly assigned to the intervention or control group. The intervention group received 3 lessons in 5th grade of elementary school and a second 3 lessons in 6th grade. The control group received "usual care". Students completed 5 questionnaires: before and after the lessons in 5th and 6th grade and in the first class of secondary school. At baseline, 3173 students completed the questionnaire; 57% completed all questionnaires. Results. The program had limited effect at the end of elementary school. One year later in secondary school significant effects on behavioral determinants and smoking were found. The intervention group had a higher intention not to smoke (beta=0.13, 95% confidence interval = 0.01-0.24) and started to smoke less often than the control group (odds ratio = 0.59,95% confidence interval = 0.35-0.99): smoking increased from 2.5% to 3.6% in the intervention group and from 3.2% to 6.5% in the control group. Girls showed the largest differences in smoking between intervention and control condition. Conclusions. A prevention program in elementary school seems to be effective in preventing smoking.

Elek E; Wagstaff DA; Hecht ML. Effects of the 5th and 7th grade enhanced versions of the keepin' it Real substance use prevention curriculum. Journal of Drug Education 40(1, special issue): 61-79, 2010. (39 refs.)

This study assessed the outcomes of adapting the culturally-grounded, middle school, substance-use prevention intervention, keepin' it REAL (kiR), to target elementary school students and to address acculturation. At the beginning of 5th grade, 29 schools were randomly assigned to conditions obtained by crossing grade of implementation (5th, 7th, 5th + 7th, and control/comparison) by curriculum version [kiR-Plus vs. kiR-Acculturation Enhanced (AE)]. Students (n = 1984) completed 6 assessments through the end of 8th grade. The kiR curricula generally appear no more effective than the comparison schools' programming. Students receiving either version of the kiR intervention in only the 5th grade report greater increases in substance use than did control students. Receiving the kiR-AE version twice (both 5th and 7th grades) has benefits over receiving it once.

Faggiano F; Vigna-Taglianti F; Burkhart G; Bohrn K; Cuomo L; Gregori D. The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial. Drug and Alcohol Dependence 108(1-2): 56-64, 2010. (52 refs.)

Aim: To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial). Materials and methods: Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models. Results: Persisting beneficial program effects were found for episodes of drunkenness (any, POR = 0.80; 0.67-0.97; frequent, FOR = 0.62; 0.47-0.81) and for frequent cannabis use in the past 30 days (POR=0.74; 0.53-1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers. Conclusion: The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking.

Flynn BS; Worden JK; Bunn JY; Solomon LJ; Ashikaga T; Connolly SW et al. Mass media interventions to reduce youth smoking prevalence. American Journal of Preventive Medicine 39(1): 53-62, 2010. (33 refs.)

Background: Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported. Design: Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n = 19,966) and in 2005 after (n = 23,246) the interventions were completed. Setting/participants: Grade 7-12 students from public schools in these eight medium-sized metropolitan areas participated in the summative evaluations; Grades 4-12 students were targeted to receive mass media interventions in four of these markets. Intervention: Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years. Main outcome measures: Prevalence of youth smoking and psychosocial mediators of smoking. Results: No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas. Conclusions: Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, probably because of a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign.

Forster J; Chen V; Perry C; Oswald J; Willmorth M. The Minnesota Adolescent Community Cohort Study: Design and baseline results. Prevention Science 12(2): 201-210, 2011. (54 refs.)

The Minnesota Adolescent Community Cohort (MACC) Study is a population-based, longitudinal study that enrolled 3,636 youth from Minnesota and 605 youth from comparison states ages 12 to 16 years in 2000-2001. Participants have been surveyed by telephone semi-annually about their tobacco-related attitudes and behaviors. The goals of the study are to evaluate the effects of the Minnesota Youth Tobacco Prevention Initiative and its shutdown on youth smoking patterns, and to better define the patterns of development of tobacco use in adolescents. A multilevel sample was constructed representing individuals, local jurisdictions and the entire state, and data are collected to characterize each of these levels. This paper presents the details of the multilevel study design. We also provide baseline information about MACC participants including demographics and tobacco-related attitudes and behaviors. This paper describes variability in smoking prevalence and demographic characteristics for local units, and compares MACC participants to the state as a whole.

Goenka S; Tewari A; Arora M; Stigler MH; Perry CL; Arnold JPS et al. Process evaluation of a tobacco prevention program in Indian schools: Methods, results and lessons learnt. Health Education Research 25(6): 917-935, 2010. (46 refs.)

In India, 57% of men between 15 and 54 years and 10.8% of women between 15 and 49 years use tobacco. A wide variety of tobacco gets used and the poor and the underprivileged are the dominant victims of tobacco and its adverse consequences. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a tobacco prevention intervention program, a cluster-randomized trial in 32 Indian schools which aimed to decrease susceptibility to tobacco use among sixth- to ninth-grade students in urban settings in India. This culture-specific intervention, which addressed both smokeless and smoked forms of tobacco, was Indian in content and communication. We qualitatively developed indicators which would help accurately measure the dose of the intervention given, received and reached. A multi-staged process evaluation was done through both subjective and objective measures. Training the teachers critically contributed toward a rigorous implementation and also correlated with the outcomes, as did a higher proportion of students participating in the classroom discussions and better peer-leader-student communication. A sizeable proportion of subjective responses were 'socially desirable', making objective assessment a preferred methodology even for 'dose received'. The peer-led health activism was successful. Teachers' manuals need to be concise.

Guyll M; Spoth R; Crowley DM. Economic analysis of methamphetamine prevention effects and employer costs. Journal of Studies on Alcohol and Drugs 72(4): 577-585, 2011. (31 refs.)

Objective: The goal of this research was to evaluate economically three interventions designed to prevent substance use in general populations of adolescents, specifically focusing on the prevention of methamphetamine use and its subsequent benefits to employers. Method: In a randomized, controlled trial, three preventive interventions were delivered to 6th- or 7th-grade youth in 58 Iowa school districts, with 905 of these youth (449 girls) providing follow-up assessments as 12th graders. Intervention conditions included the family-focused Iowa Strengthening Families Program (ISFP), the school-based Life Skills Training (LST) program, and a combined condition of both the Strengthening Families Program: For Parents and Youth 10-14 (SFP10-14; an ISFP revision) plus LST (LST + SFP10-14). Analyses based on intervention costs, 12th-grade methamphetamine use rates, and methamphetamine-related employer costs yielded estimates of intervention cost, cost-effectiveness, benefit cost ratio, and net benefit. Results: The ISFP lowered methamphetamine use by 3.9%, cost $25,385 to prevent each case, and had a benefit cost ratio of 3.84, yielding a net benefit of $2,813 per youth. The LST program reduced methamphetamine use by 2.5%, required $5,122 per prevented case, and had a benefit cost ratio of 19.04, netting $2,273 per youth. The combined LST + SFP10-14 prevention condition lowered methamphetamine use rates by 1.8%, cost $62,697 to prevent each case, had a benefit cost ratio of 1.56, and netted $620 per youth. Findings were robust after varying a number of key parameters across a range of plausible values. Conclusions: Substance use prevention programming is economically feasible, particularly for effective interventions that have lower per person treatment delivery costs.

Hanewinkel R; Isensee B; Maruska K; Sargent JD; Morgenstern M. Denormalising smoking in the classroom: Does it cause bullying? Journal of Epidemiology and Community Health 64(3): 202-208, 2010. (27 refs.)

Background: The Smokefree Class Competition, the largest school-based smoking prevention programme in Europe, aims to create a class climate that denormalises smoking. An analysis was carried out to assess whether it increases bullying or perception of isolation. Methods: A cluster randomised controlled trial was conducted, with two waves of assessment directly before the start and immediately after the end of the prevention programme. Some 3490 students were recruited from 84 secondary schools in Germany, of whom 3123 students (90%) provided data from both waves. Classes from the intervention group (IG) participated in the Smokefree Class Competition, committing themselves to stay smokefree for a period of 6 months, and self-monitoring their smoking status on a weekly basis. Classes that refrained from smoking were eligible for a prize draw. To test the hypotheses that participation in the competition might foster bullying, we measured students' self report of (1) being victimised, (2) engaging in bullying and (3) being isolated. Results: There was a strong association between daily smoking and higher odds of bullying others at baseline (adjusted proportional OR 4.66; 95% CI 3.38 to 6.43). No significant pre-post differences across treatment assignment groups were found on any bullying measure using generalised linear latent and mixed models. For being isolated, the trends suggested that the programme, if anything, fostered lower levels of isolation at follow-up, especially for those who perceived high levels of isolation at baseline. Conclusion: Participation in the intervention had no effect on bullying or perceptions of isolation.

Hanewinkel R; Isensee B; Sargent JD; Morgenstern M. Effect of an antismoking advertisement on cinema patrons' perception of smoking and intention to smoke: A quasi-experimental study. Addiction 105(7): 1269-1277, 2010. (36 refs.)

Aims: To assess the effect of an antismoking advertisement under real-world conditions. Design: Quasi-experimental study. Setting/participants: Multiplex cinema in Kiel, Germany; 4073 patrons were surveyed after having viewed a movie. Some 4005 patrons were >= 10 years old (28.7% between 10 and 17 years). A total of 654 subjects (16.3%) were smokers. Intervention: In the intervention condition (weeks 1 and 3), a 30-second antismoking advertisement-accentuating long-term health consequences of smoking and promoting cessation-was shown prior to all movies; in the control condition (weeks 2 and 4) no such spot was shown. Main outcome measures: (i) Awareness of smoking in the movie, (ii) approval of smoking in the movie, (iii) attitude towards smoking, (iv) intention to smoke in the future and (v) desire to smoke among smokers. Findings: Patrons who were exposed to the antismoking advertisement were more likely to be female, but did not differ with respect to smoking status. After controlling for gender differences, patrons exposed to the antismoking advertisement had (i) higher awareness of smoking in the movies, (ii) lower levels of approval of smoking in the movies, and (iii) a more negative attitude towards smoking in general compared with those not exposed. Among smokers, smoking in the movies increased urge to smoke, but there was no interaction between smoking in the movies and experimental condition. Conclusions: Study results suggest that placing an antismoking advertisement before movies can affect attitudes towards smoking, bolstering evidence in support of such policies.

Hanley SM; Ringwalt C; Ennett ST; Vincus AA; Bowling JM; Haws SW; Rohrbach LA. The prevalence of evidence-based substance use prevention curricula in the nation's elementary schools. Journal of Drug Education 40(1, special issue): 51-60, 2010. (21 refs.)

Current guidelines for school-based substance use prevention suggest that prevention efforts should begin in elementary grades, before students begin using substances. Previous research suggests, however, that the use of evidence-based curricula in these grades may be low. Using a 2005 survey of public school districts in the United States that include elementary grades (n = 1563), we assessed the prevalence of elementary curricula use, particularly those designated as evidence-based. We found that although 72% of districts administer a substance use prevention curriculum to their elementary students, only about 35% are using one that is evidence-based and only about 14% are using an evidence-based curriculum more so than any other prevention curriculum. We present prevalence estimates for specific evidence-based curricula and conclude by discussing possible reasons for and implications of our findings.

Hansen WB. Current and future directions in elementary school drug prevention. (editorial). Journal of Drug Education 40(1, special issue): 91-98, 2010. (16 refs.)

Hansen WB; Bishop DC; Jackson-Newsom J. Impact of a classroom behavior management intervention on teacher risk ratings for student behavior. Journal of Drug Education 40(1, special issue): 81-90, 2010. (20 refs.)

Classroom behavior management interventions have been used successfully with drug prevention programs to prevent subsequent antisocial behavior and substance use among youth. This article presents results from implementation of the All Stars Challenge, a classroom-based behavior management component to a drug prevention program for fifth graders. Risk ratings for shyness and lack of awareness of social norms among high-risk students who received the All Stars Challenge were reduced compared with fifth graders who did not receive the intervention. In contrast, physical and social aggressivity among low-risk students who received the program increased when compared to similar control students.

Hatzis CM; Papandreou C; Kafatos AG. School health education programs in Crete: Evaluation of behavioural and health indices a decade after initiation. Preventive Medicine 51(3-4): 262-267, 2010, 2010. (32 refs.)

Objective. To assess the long-term effectiveness of a school-based health education intervention program 10 years after its initiation. Method. In 1992 the total population of first grade students from three counties of Crete participated in the study. Over 1000 students were randomly selected for initial and periodic evaluation. Biochemical and behavioural parameters (anthropometric, lipoproteins, blood pressure, physical activity, dietary record and health habits) were measured. Re-evaluation of the program was performed at 3, 6 and 10 years after its initiation. Results. Ten years after the initiation of the program, the results showed that BMI had increased significantly less (p<0.001) and performance in the shuttle run test was significantly better (p<0.001) in the intervention group as compared to the control group. The reduction in total cholesterol noted in both groups was significantly greater in the intervention group than in the control group (p<0.001). The incidence of smoking was also significantly lower in the intervention group (intervention group 7%, control group 13%, p<0.005). Conclusion. This program appears to improve children's health and decrease risk factors for chronic diseases. If these positive effects are maintained in the forthcoming decades, the risk of chronic diseases may well be reduced.

Hedman E; Riis U; Gabre P. The impact of behavioural interventions on young people's attitudes toward tobacco use. Oral Health & Preventive Dentistry 8(1): 23-32, 2010. (26 refs.)

Purpose: The objective of the present study was to study the ability to influence young at-risk patients attitudes toward tobacco use through two intervention methods that were performed by dental health professionals. Materials and Methods: Two inteiventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group. Before and after interventions, a questionnaire was used. Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included. Results: Both before and after interventions, the results showed a generally negative attitude towards tobacco use. A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%) Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends. The older participants believed to a greater extent that they would try smoking as adults. No change in tobacco use was registered after intervention, although the participants reported an increased use among friends. Conclusions: The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent. However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models.

Hill LG; Goates SG; Rosenman R. Detecting selection effects in community implementations of family-based substance abuse prevention programs. American Journal of Public Health 100(4): 623-630, 2010. (29 refs.)

To calculate valid estimates of the costs and benefits of substance abuse prevention programs, selection effects must be identified and corrected. A supplemental comparison sample is typically used for this purpose, but in community-based program implementations, such a sample is often not available. We present an evaluation design and analytic approach that can be used in program evaluations of real-world implementations to identify selection effects, which in turn can help inform recruitment strategies, pinpoint possible selection influences on measured program outcomes, and refine estimates of program costs and benefits. We illustrate our approach with data from a multisite implementation of a popular substance abuse prevention program. Our results indicate that the program's participants differed significantly from the population at large.

Hopfer S; Davis D; Kam JA; Shin Y; Elek E; Hecht ML. A review of elementary school-based substance use prevention programs: Identifying program attributes. (review). Journal of Drug Education Journal of Drug Education(1, special issue): 11-36, 2010. (67 refs.)

This article takes a systematic approach to reviewing substance use prevention programs introduced in elementary school (K-6th grade). Previous studies evaluating such programs among elementary school students showed mixed effects on subsequent substance use and related psychosocial factors. Thirty published evaluation studies of 24 elementary school-based substance use prevention programs were reviewed. The study selection criteria included searching for program evaluations from 1980 to 2008. Among 27 evaluation studies that examined program effects on substance use, 56% (n = 15) found significant decreases. In addition, programs most often demonstrated effects on increasing negative substance use attitudes, increasing knowledge, decreasing perceptions of prevalence rates (i.e., descriptive norms), and improving resistance skills. These results have implications for the appropriateness and value of introducing substance use prevention programs to youth in elementary school.

Horyniak D; Higgs P; Lewis J; Winter R; Dietze P; Aitken C. An evaluation of a heroin overdose prevention and education campaign. Drug and Alcohol Review 29(1): 5-11, 2010. (18 refs.)

Introduction and Aims. Following detection of an upward trend in the frequency of fatal heroin overdoses in Victoria between 2001 and 2003, Victoria's Department of Human Services planned a campaign aimed at increasing injecting drug users' (IDU) awareness of overdose risks and prevention strategies. Stickers, wallet cards and posters featuring five key messages were distributed via needle and syringe programs (NSP) and other drug and alcohol services between November 2005 and April 2006. An evaluation of the campaign was commissioned to be conducted in late 2006. Design and Methods. The evaluation consisted of analysis of three independent data sets--quantitative data collected from IDU during the campaign period (n = 855 at baseline; and a range of 146-656 at follow up); qualitative interviews with IDU who were NSP clients during the campaign period (n = 16) and qualitative interviews with NSP staff and other key stakeholders (n = 9). Results. While key experts felt that the campaign messages had engendered lasting impact for at least some IDU, these positive impressions were not borne out by the NSP client data, with less than one quarter of all campaign messages being mentioned by a significantly higher proportion of clients during the post-campaign period compared with baseline. Key experts perceived the greatest weakness of the campaign to be the delay between issue identification and the introduction of campaign materials. Discussion and Conclusions. While IDU are generally responsive to health promotion campaigns, future initiatives in this domain should be designed and implemented rapidly and in ways that are sufficiently flexible to cope with shifts in drug markets which could influence the reception of key messages.

Hustad JTP; Barnett NP; Borsari B; Jackson KM. Web-based alcohol prevention for incoming college students: A randomized controlled trial. Addictive Behaviors 35(3): 183-189, 2010. (36 refs.)

College students are an at-risk population based on their heavy alcohol consumption and associated consequences. First-year students are at particular risk due to greater freedom and access to alcohol on campus. Web-based (electronic) interventions (e-interventions) are being rapidly adopted as a universal approach to prevent high-risk drinking, but have not been well evaluated. The objective of this study was to investigate the effectiveness of the two most widely adopted EIs, AlcoholEdu and The Alcohol eCHECKUP TO GO (e-Chug), in reducing both alcohol use and alcohol-related consequences in incoming college students. To do so, we conducted a 3-group randomized trial (N=82) comparing AlcoholEdu and e-Chug to an assessment-only control group. Compared to the assessment-only control group, participants in the AlcoholEdu and e-Chug groups reported lower levels of alcohol use across multiple measures at 1-month follow-up. Participants who received AlcoholEdu showed significantly fewer lower alcohol-related consequences than assessment-only controls, while there was a trend for reduced consequences in participants who received e-Chug versus assessment-only. Findings indicate that e-intervention is a promising prevention approach to address the problem of college student alcohol consumption, especially for campuses that have limited resources.

Johnson MB; Clapp JD. Impact of providing drinkers with "Know Your Limit" information on drinking and driving: A field experiment. Journal of Studies on Alcohol and Drugs 72(1): 79-85, 2011. (16 refs.)

Objective: Given that most effective alcohol harm-reduction laws specify the blood alcohol concentration (BAC) that constitutes illegal behavior (e.g., the .08% breath alcohol concentration legal limit), interventions that allow drinkers to accurately estimate their BACs, and thus better assess their risk, have potential importance to long-term driving-under-the-influence prevention efforts. This study describes a field experiment designed to test the impact on drinking of providing "Know Your Limit" (KYL) BAC estimation cards to individuals in a natural drinking environment. Method: We randomly sampled 1,215 U.S. residents as they entered Mexico for a night of drinking, interviewed them, and randomly assigned them to one of six experimental conditions. Participants were reinterviewed and breath-tested when they returned to the United States. The experimental conditions included providing generic warnings about drinking and driving, giving out gender-specific BAC calculator cards (KYL cards), and providing incentives to moderate their drinking. Results: Cueing participants about the risks of drunk driving resulted in significantly lower BACs (relative to control) for participants who indicated that they would drive home. Providing KYL matrixes did not reduce BACs, and, in fact, some evidence suggests that KYL cards undermined the effect of the warning. Conclusions: KYL information does not appear to be an effective tool for reducing drinking and driving. Implications for prevention and future research are discussed.

Koning IM; van den Eijnden RJJM; Engels RCME; Verdurmen JEE; Vollebergh WAM. Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use. Addiction 106(3): 538-546, 2011. (43 refs.)

Aims: To examine the effects of a parent and student intervention offered separately and simultaneously (PAS) on onset of weekly drinking via its putative mediators. Design: A randomized trial with four conditions; (1) parent intervention, (2) student intervention, (3) combined parent-student intervention and (4) control group. Setting: High schools selected randomly, located in different areas. Participants: A total of 2937 early adolescents (mean age = 12.6, standard deviation = 0.49) and their parents. Measurements: Mediation effects were analysed using pretest data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated (Mplus) to examine the effect of the interventions on adolescent-reported mediators (self-control, perceived parental rules and attitudes about alcohol) and parent-reported mediators (parental rules and attitudes about alcohol). Outcome was onset of weekly drinking. Findings: The parent intervention modified rules and attitudes about alcohol as reported by parents. An indirect effect of the parent intervention via parental rules was found. The combined intervention affected both adolescent-reported and parent-reported rules and attitudes about alcohol and adolescents' perceived self-control, yet only perceived rules and self-efficacy, as reported by adolescents, and parental attitudes mediated the association between the combined intervention and onset of weekly drinking. No significant effects were found of the separate student intervention on the mediating factors. Conclusions: The PAS programme proved to be effective as predicted by the theoretical assumptions underlying the interventions. Interventions with parents and adolescents to prevent adolescent alcohol consumption may usefully target parental rules about alcohol and adolescents' self-confidence.

Krebs P; Prochaska JO; Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. (review). Preventive Medicine 51(3-4): 214-221, 2010, 2010. (44 refs.)

Objective. Computer-tailored interventions have become increasingly common for facilitating improvement in behaviors related to chronic disease and health promotion. A sufficient number of outcome studies from these interventions are now available to facilitate the quantitative analysis of effect sizes, permitting moderator analyses that were not possible with previous systematic reviews. Method. The present study employs meta-analytic techniques to assess the mean effect for 88 computer-tailored interventions published between 1988 and 2009 focusing on four health behaviors: smoking cessation, physical activity, eating a healthy diet, and receiving regular mammography screening. Effect sizes were calculated using Hedges g. Study, tailoring, and demographic moderators were examined by analyzing between-group variance and meta-regression. Results. Clinically and statistically significant overall effect sizes were found across each of the four behaviors. While effect sizes decreased after intervention completion, dynamically tailored interventions were found to have increased efficacy over time as compared with tailored interventions based on one assessment only. Study effects did not differ across communication channels nor decline when up to three behaviors were identified for intervention simultaneously. Conclusion. This study demonstrates that computer-tailored interventions have the potential to improve health behaviors and suggests strategies that may lead to greater effectiveness of these techniques.

Kristjansson AL; James JE; Allegrante JP; Sigfusdottir ID; Helgason AR. Adolescent substance use, parental monitoring, and leisure-time activities: 12-year outcomes of primary prevention in Iceland. Preventive Medicine 51(2): 168-171, 2010. (13 refs.)

Objective. To examine 12-year changes in alcohol use and cigarette smoking in response to community-based prevention activities among Icelandic adolescents. Methods. This study used a quasi-experimental, non-randomized control group design to compare outcomes in 4 Icelandic communities (n=3117) that participated in community-based substance use prevention activities designed to increase levels of parental monitoring and adolescent engagement in healthy leisure-time activities and a matched group of 7 comparison communities (n = 1,907). Annual, nationwide, population-based cross-sectional surveys of the prevalence of adolescent substance use were conducted among cohorts of Icelandic adolescents, aged 14-15 years (N = 5,024), in all communities from 1997 to 2009. Results. Parental monitoring and adolescent participation in organized sports increased in communities that adopted the intervention program compared to communities that did not, whereas unmonitored idle hours and attendance at unsupervised parties decreased. Over time, alcohol use (OR = 0.89,95% CI 0.82, 0.98, p = 0.012) and being intoxicated during the last 30 days (OR = 0.86, 95% CI 0.78, 0.96, p = 0.004) decreased more in the intervention than control communities. Conclusion. Community-based prevention designed to strengthen parental monitoring and participation in organized sports may confer some protection against adolescent substance use.

Lammers J; Goossens F; Lokman S; Monshouwer K; Lemmers L; Conrod P et al. Evaluating a selective prevention programme for binge drinking among young adolescents: Study protocol of a randomized controlled trial. BMC Public Health 11: article 126, 2011. (60 refs.)

Background: In comparison to other Europe countries, Dutch adolescents are at the top in drinking frequency and binge drinking. A total of 75% of the Dutch 12 to 16 year olds who drink alcohol also engage in binge drinking. A prevention programme called Preventure was developed in Canada to prevent adolescents from binge drinking. This article describes a study that aims to assess the effects of this selective school-based prevention programme in the Netherlands. Methods: A randomized controlled trial is being conducted among 13 to 15-year-old adolescents in secondary schools. Schools were randomly assigned to the intervention and control conditions. The intervention condition consisted of two 90 minute group sessions, carried out at the participants' schools and provided by a qualified counsellor and a co-facilitator. The intervention targeted young adolescents who demonstrated personality risk for alcohol abuse. The group sessions were adapted to four personality profiles. The control condition received no further intervention above the standard substance use education sessions provided in the Dutch national curriculum. The primary outcomes will be the percentage reduction in binge drinking, weekly drinking and drinking-related problems after three specified time periods. A screening survey collected data by means of an Internet questionnaire. Students have completed, or will complete, a post-treatment survey after 2, 6, and 12 months, also by means of an online questionnaire. Discussion: This study protocol presents the design and current implementation of a randomized controlled trial to evaluate the effectiveness of a selective alcohol prevention programme. We expect that a significantly lower number of adolescents will binge drink, drink weekly, and have drinking-related problems in the intervention condition compared to the control condition, as a result of this intervention.

Lemstra M; Bennett N; Nannapaneni U; Neudorf C; Warren L; Kershaw T et al. A systematic review of school-based marijuana and alcohol prevention programs targeting adolescents aged 10-15. Addiction Research & Theory 18(1): 84-96, 2010. (35 refs.)

Aims: The purpose of this systematic review was to determine if school-based marijuana and alcohol prevention programs are effective in preventing marijuana and alcohol use in adolescents between the ages of 10-15 years. In particular, we examined knowledge versus comprehensive type prevention programs in order to better understand the inconsistency of results in school-based marijuana and alcohol prevention programs found in the literature. Methods: We performed a systematic literature review to identify published or unpublished papers between January 01, 1980 and December 02, 2007 that reviewed the long-term effectiveness (I year or longer) of school-based marijuana and alcohol primary prevention programs targeting adolescents aged 10-15 years. Results: Long-term marijuana and alcohol prevention programs that utilized a "comprehensive" program content resulted in: (a) a mean absolute reduction of 12 days of alcohol usage per month and (b) a mean absolute reduction of 7 days of marijuana usage per month among adolescents aged 10-15 years old. In comparison, school-based marijuana and alcohol prevention programs that utilized "knowledge only" program content resulted in a mean absolute decrease of 2 days of alcohol usage per month among adolescents aged 10-15 years old. Only one study used knowledge-based content and marijuana use as an outcome measure and as such statistical pooling was not possible. Conclusions: The most effective primary prevention programs for reducing marijuana and alcohol use among adolescents aged 10-15 years in the long-term were comprehensive programs that included anti-drug information combined with refusal skills, self-management skills and social-skills training.

Loneck B; Corrigan MJ; Videka L; Newman LJ; Reed JC; Moonan KE. Prevention counseling and student assistance programs: A review of the literature. (review). Journal of Child & Adolescent Substance Abuse 19(4): 279-299, 2010. (43 refs.)

Substance abuse prevention counseling can be found in two venues: school counseling and student assistance programs (SAPs). School prevention counseling is based on school psychology and guidance counseling. The authors of this article did not find any empirical studies of prevention counseling. Six criteria were used to assess the published research on SAPs: research designs, sampling methods, measures, procedures, analyses, and peer review of results. SAP studies reviewed were placed in one of three levels: Rigorous (N=3; met all inclusion criteria), Informative (N=2; met all criteria except peer review), and Evaluative (N=5; weak design, but explicit in describing methods). The Rigorous Studies found a decrease in substance use or risk factors. The two Informative Studies found a decrease in substance use. The Evaluative Studies demonstrated the prevention of increases in substance use.

Lotrean LM; Dijk F; Mesters I; Ionut C; De Vries H. Evaluation of a peer-led smoking prevention programme for Romanian adolescents. Health Education Research 25(5): 803-814, 2010. (54 refs.)

The goal of this study was to assess the effects of a school-based smoking prevention programme that used both a video and peer-led discussion groups among Romanian junior high school students aged 13-14 years. The programme embraced the social influence approach and concentrated on enhancing self-efficacy and the acquisition of cigarette refusal skills. Twenty schools were randomly assigned to the control and experimental conditions, resulting in 55 participating classes from the seventh grade (28 in the control group and 27 in the experimental group). Pretest and 9 months follow-up data on weekly smoking initiation and psychosocial variables were collected from 1071 students. Multilevel logistic regression analyses demonstrated a significant effect of the programme on adolescents' smoking behaviour after 9 months. At post-test, weekly smoking onset was 4.5% in the experimental group versus 9.5% in the control group. Furthermore, the programme had significant effects on smoking-related beliefs. In the experimental group, this resulted in a more negative attitude towards smoking, increased social self-efficacy levels and a more negative intention towards smoking. These findings show that short-term effects of the smoking prevention programme can be realized in Romania. More studies are needed to analyse how to maintain these effects over time.

Lowe JB; Baxter L; Hirokawa R; Pearce E; Peterson JJ. Description of a media campaign about alcohol use during pregnancy. Journal of Studies on Alcohol and Drugs 71(5): 739-741, 2010. (6 refs.)

Objective: This study describes the development and testing of a multicomponent media campaign aimed at increasing discussions of alcohol use during pregnancy. Method: Women, Infants, and Children (WIC) programs in Iowa were paired and, within each pair, were randomly assigned to a usual-care group (advice not to consume alcohol while pregnant and the opportunity to watch a 30-second television commercial about the effects of drinking during pregnancy) or intervention group (usual care plus a 10-minute videotape/DVD and a printed pamphlet. Among the 700 research participants in those out-reach programs, interpersonal communication about alcohol use during pregnancy was assessed both before and after intervention, and participants were surveyed for knowledge of the effects of alcohol use during pregnancy. Results: More women in the intervention group than in the usual-care group talked to friends about alcohol use during pregnancy. Also, only women in the intervention group demonstrated an increase in relative knowledge about the effects of drinking during pregnancy. Conclusions: A multimedia campaign may be an effective way to increase interpersonal discussions and awareness of the dangers of alcohol use during pregnancy.

Mahabee-Gittens EM; Vaughn L; Gordon JS. Youths' and parents' views on the acceptability and design of a video-based tobacco prevention intervention. Journal of Child & Adolescent Substance Abuse 19(5): 391-405, 2010. (55 refs.)

The purpose of this study was to evaluate the acceptability of a brief, video-based parental intervention that modeled parent-child communication about tobacco, delivered within an emergency department (ED) setting. While waiting to be seen by a physician in the ED, 20 parent-youth dyads watched the video together and then private, semi-structured focused interviews were conducted around the take-home message and views on the settings, actors, and content of the videos. Dyads agreed that the design, delivery, and content of the video intervention were acceptable, realistic, and useful in providing parental reinforcements about the importance of parent-youth tobacco communication, and the ED was considered to be a good setting for watching the video. Findings support the development and delivery of such an ED intervention and aids in determining content and scenarios for future intervention development.

Malmberg M; Overbeek G; Kleinjan M; Vermulst A; Monshouwer K; Lammers J et al. Effectiveness of the universal prevention program 'Healthy School and Drugs': Study protocol of a randomized clustered trial. BMC Public Health 10: 541, 2010. (45 refs.)

Background: Substance use is highly prevalent among Dutch adolescents. The Healthy School and Drugs program is a nationally implemented school-based prevention program aimed at reducing early and excessive substance use among adolescents. Although the program's effectiveness was tested in a quasi-experimental design before, many program changes were made afterwards. The present study, therefore, aims to test the effects of this widely used, renewed universal prevention program. Methods/Design: A randomized clustered trial will be conducted among 3,784 adolescents of 23 secondary schools in The Netherlands. The trial has three conditions; two intervention conditions (i.e., e-learning and integral) and a control condition. The e-learning condition consists of three digital learning modules (i.e., about alcohol, tobacco, and marijuana) that are sequentially offered over the course of three school years (i.e., grade 1, grade 2, and grade 3). The integral condition consists of parental participation in a parental meeting on substance use, regulation of substance use, and monitoring and counseling of students' substance use at school, over and above the three digital modules. The control condition is characterized as business as usual. Participating schools were randomly assigned to either an intervention or control condition. Participants filled out a digital questionnaire at baseline and will fill out the same questionnaire three more times at follow-up measurements (8, 20, and 32 months after baseline). Outcome variables included in the questionnaire are the percentage of binge drinking (more than five drinks per occasion), the average weekly number of drinks, and the percentage of adolescents who ever drunk a glass of alcohol and the percentage of adolescents who ever smoked a cigarette or a joint respectively for tobacco and marijuana. Discussion: This study protocol describes the design of a randomized clustered trial that evaluates the effectiveness of a school-based prevention program. We expect that significantly fewer adolescents will engage in early or excessive substance use behaviors in the intervention conditions compared to the control condition as a direct result of the intervention. We expect that the integral condition will yield most positive results, compared with the e-learning condition and control condition.

McCambridge J; Hunt C; Jenkins RJ; Strang J. Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention. Drug and Alcohol Dependence 114(2-3): 177- 184, 2011. (27 refs.)

Background: The prevention of initiation of tobacco, alcohol and drug use is a major societal challenge, for which the existing research literature is generally disappointing. This study aimed to test the effectiveness of adaptation of Motivational Interviewing (MI) for universal prevention purposes, i.e. to prevent initiation of new substance use among non-users, and to reduce risks among existing users. Methods: Cluster randomised trial with 416 students aged 16-19 years old recruited in 12 London Further Education colleges without regard to substance use status. Individualised MI was compared with standard practice classroom-delivered Drug Awareness intervention, both delivered over the course of one lesson. Prevalence, initiation and cessation rates for the 3 target behaviours of cigarette smoking, alcohol consumption and cannabis use, along with reductions in use and harm indicators after both 3 and 12 months were assessed. Results: This adaptation of MI was not demonstrated to be effective in either intention-to-treat or subgroup analyses for any outcome. Unexpected lower levels of cannabis initiation and prevalence were found in the Drug Awareness control condition. Conclusions: This particular adaptation of MI is ineffective as a universal drug prevention intervention and does not merit further study.

Minugh PA; Lomuto N; Janke S. Projecting adolescent prevention and treatment need: A novel application utilizing the Communities that Care data in the state of Kansas. Journal of Drug Issues 40(3): 627-651, 2010. (45 refs.)

This study projects substance abuse and dependence prevalence rates based on the number of early problem behaviors (tobacco alcohol and marijuana use and arrests prior to age 15) reported by youth who have taken part in eleven administrations of the annual Kansas Communities That Care survey following a model developed by McGue and Iacono (2005) The probability of males and females developing a substance abuse or dependence disorder at age 17 and 20 was assigned to each respondent Projections were mapped to show county and statewide dispersions for planning purposes. Projected numbers were much higher than expected In addition to young adult treatment need, the implications for prevention service planning became readily apparent. The findings highlight missed opportunities for indicated prevention and early intervention services and are further discussed in the context of how early intervention might alleviate demand on the treatment system as adolescents progress into young adulthood

Modayil MV; Cowling DW; Tang H; Roeseler A. An evaluation of the California community intervention. Tobacco Control 19(Supplement 1): I30-I36, 2010. (29 refs.)

Aim We conducted this study to determine key community-level factors associated with higher tobacco control programme performance. Methods: A combination of surveys, administrative and fiscal data were collected to measure local county-level health department performance over a 7-year period. Longitudinal analyses were performed using generalised estimating equations to examine whether counties that exerted higher effort were successful in creating more tobacco retail licensing (TRL) and secondhand smoke policies. Several social, political and contextual factors were examined as confounders. Results: Local county health departments (CHDs) that demonstrated high effort on their work plans increased the proportion of residents covered by TRL policies (7.2%; 95% CI - 1.7 to 16.1%) compared to CHDs with lower levels of effort. Having legislators who voted in favour of tobacco control bills was found to significantly increase the passage of local TRL policies. CHDs demonstrating higher efforts also increased the proportion of residents covered by secondhand smoke policies (9.2%; 95% CI - 3.5 to 21.9%). Conclusion: There was strong evidence that higher county-level efforts predicted an increasing number of local tobacco control policies. Evaluations using integrated designs are recommended as effective strategies to provide a more accurate assessment of how well community-level interventions catalyse community-wide change.

Newton NC; Teesson M; Vogl LE; Andrews G. Internet-based prevention for alcohol and cannabis use: Final results of the Climate Schools course. Addiction 105(4): 749-759, 2010. (45 refs.)

Aims: To establish the long-term efficacy of a universal internet-based alcohol and cannabis prevention programme in schools. Methods: A cluster-randomized controlled trial was conducted to assess the effectiveness of the Climate Schools: Alcohol and Cannabis Course. The evidence-based course, aimed at reducing alcohol and cannabis use, is facilitated by the internet and consists of 12 novel and curriculum consistent lessons delivered over 6 months. Participants: A total of 764 year 8 students (13 years) from 10 Australian secondary schools were allocated randomly to the internet-based prevention programme (n = 397, five schools), or to their usual health classes (n = 367, five schools). Measures: Participants were assessed at baseline, immediately post, and 6 and 12 months following completion of the intervention, on measures of alcohol and cannabis knowledge, attitudes, use and related harms. Results: This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12-month follow-up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol- and cannabis-related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools. Conclusions: Internet-based prevention programs for school-age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.

O'Neill JM; Clark JK; Jones JA. Promoting mental health and preventing substance abuse and violence in elementary students: A randomized control study of the Michigan Model for Health. Journal of School Health 81(6): 320-330, 2011. (57 refs.)

BACKGROUND: In elementary grades, comprehensive health education curricula mostly have demonstrated effectiveness in addressing singular health issues. The Michigan Model for Health (MMH) was implemented and evaluated to determine its impact on multiple health issues, including social and emotional skills, prosocial behavior, and drug use and aggression. METHODS: Schools (N = 52) were randomly assigned to intervention and control conditions. Participants received 24 lessons in grade 4 (over 12 weeks) and 28 more lessons in grade 5 (over 14 weeks), including material focusing on social and emotional health, interpersonal communication, social pressure resistance skills, drug use prevention, and conflict resolution skills. The 40-minute lessons were taught by the classroom or health teacher who received curriculum training and provided feedback on implementation fidelity. Self-report survey data were collected from the fourth-grade students (n = 2512) prior to the intervention, immediately after the intervention, and 6 weeks after the intervention, with the same data collection schedule repeated in fifth grade. RESULTS: Students who received the curriculum had better interpersonal communication skills, social and emotional skills, and drug refusal skills than the control group students. Intervention students also reported lower intentions to use alcohol and tobacco, less alcohol and tobacco use initiated during the study and in the past 30 days, and reduced levels of aggression. CONCLUSION: The effectiveness of the MMH in promoting mental health and preventing drug use and aggression supports the call for integrated strategies that begin in elementary grades, target multiple risk behaviors, and result in practical and financial benefits to schools.

Paschall MJ; Antin T; Ringwalt CL; Saltz RF. Effects of AlcoholEdu for college on alcohol-related problems among freshmen: A randomized multicampus trial. Journal of Studies on Alcohol and Drugs 72(4): 642-650, 2011. (13 refs.)

Objective: AlcoholEdu for College is a 2- to 3-hour online course for incoming college freshmen. This study was the first multicampus trial to examine effects of AlcoholEdu for College on alcohol-related problems among freshmen. Method: Thirty universities participated in the study. Fifteen were randomly assigned to receive AlcoholEdu, and the other 15 were assigned to the control condition. AlcoholEdu was implemented by intervention schools during the summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university beginning before the intervention in spring 2008/2009; post-intervention surveys were administered in fall 2008/2009 and spring 2009/2010. The surveys included questions about the past-30-day frequency of 28 alcohol-related problems, from which we created indices for the total number of problems and problems in seven domains: physiological, academic, social, driving under the influence/riding with drinking drivers, aggression, sexual risk taking, and victimization. Multilevel Poisson regression analyses were conducted to examine intent-to-treat and dosage effects of AlcoholEdu for College on these outcomes. Results: Multilevel intent-to-treat analyses indicated significant reductions in the risk for past-30-day alcohol problems in general and problems in the physiological, social, and victimization domains during the fall semester immediately after completion of the course. However, these effects did not persist in the spring semester. Additional analyses suggested stronger AlcoholEdu effects on these outcomes at colleges with higher rates of student course completion. No AlcoholEdu effects were observed for alcohol-related problems in the other four domains. Conclusions: AlcoholEdu for College appears to have beneficial short-term effects on victimization and the most common types of alcohol-related problems among freshmen. Universities may benefit the most by mandating AlcoholEdu for College for all incoming freshmen and by implementing this online course along with environmental prevention strategies.

Porath-Waller AJ; Beasley E; Beirness DJ. A meta-analytic review of school-based prevention for cannabis use. (review). Health Education & Behavior 37(5): 709-723, 2010. (44 refs.)

This investigation used meta-analytic techniques to evaluate the effectiveness of school-based prevention programming in reducing cannabis use among youth aged 12 to 19. It summarized the results from 15 studies published in peer-reviewed journals since 1999 and identified features that influenced program effectiveness. The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students' cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions. Findings revealed that programs incorporating elements of several prevention models were significantly more effective than were those based on only a social influence model. Programs that were longer in duration (>= 15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students. Implications for school-based prevention programming are discussed.

Qin Y; Wu M; Pan XQ; Xiang QY; Huang JP; Gu ZH et al. Reactions of Chinese adults to warning labels on cigarette packages: A survey in Jiangsu Province. BMC Public Health 11: article 133, 2011. (21 refs.)

Background: To compare reactions to warning labels presented on cigarette packages with a specific focus on whether the new Chinese warning labels are better than the old labels and international labels. Methods: Participants aged 18 and over were recruited in two cities of Jiangsu Province in 2008, and 876 face-to-face interviews were completed. Participants were shown six types of warning labels found on cigarette packages. They comprised one old Chinese label, one new label used within the Chinese market, and one Chinese overseas label and three foreign brand labels. Participants were asked about the impact of the warning labels on: their knowledge of harm from smoking, giving cigarettes as a gift, and quitting smoking. Results: Compared with the old Chinese label, a higher proportion of participants said the new label provided clear information on harm caused by smoking (31.2% vs 18.3%). Participants were less likely to give cigarettes with the new label on the package compared with the old label (25.2% vs 20.8%). These proportions were higher when compared to the international labels. Overall, 26.8% of participants would quit smoking based on information from the old label and 31.5% from the new label. When comparing the Chinese overseas label and other foreign labels to the new Chinese label with regard to providing knowledge of harm warning, impact of quitting smoking and giving cigarettes as a gift, the overseas labels were more effective. Conclusion: Both the old and the new Chinese warning label are not effective in this target population.

Quick BL; Bates BR. The use of gain- or loss-frame messages and efficacy appeals to dissuade excessive alcohol consumption among college students: A test of psychological reactance theory. Journal of Health Communication 15(6): 603-628, 2010. (72 refs.)

The present study applies psychological reactance theory (PRT) to examine the effectiveness of a 2 (frame: gain, loss)x2 (efficacy: present, not present) experiment to determine best practices in dissuading excessive alcohol consumption among college students. Results from the structural model revealed no association between a perceived threat to choose and message frame or efficacy appeals. As anticipated, a perceived threat to freedom was positively associated with state reactance, which in turn was positively associated with a boomerang effect and negatively associated with favorable source appraisal. State reactance was not associated with favorable attitudes toward preventing the overconsumption of alcohol. In addition to main effects, interactions between message frame and efficacy appeal with four person factors (participant age, trait reactance, perceived health risk, and alcohol consumption) were examined. Individuals perceiving health risk to be low would benefit from gain-frame messages, whereas loss-frame messages would be most effective for heavy drinkers. Finally, when communicating to underage drinkers, our results support using efficacy appeals when accompanied by a loss-frame message.

Ringwalt C; Hecht ML; Hopfer S. Drug prevention in elementary schools: An introduction to the special issue. (editorial). Journal of Drug Education 40(1, special issue): 1-9, 2010. (36 refs.)

Ringwalt CL; Clark HK; Hanley S; Shamblen SR; Flewelling RL. The effects of Project ALERT one year past curriculum completion. Prevention Science 11(2): 172-184, 2010. (42 refs.)

School-based drug prevention curricula constitute the nation's most prevalent strategy to prevent adolescent drug use. We evaluated the effects of one such curriculum, Project ALERT, on adolescent substance use. In particular, we sought to determine if a single effect on 30-day alcohol use, noted shortly following the completion of the 2-year program, could be detected 1 year later. We also looked for delayed effects on other outcomes of interest, namely lifetime alcohol use, and 30-day and lifetime use of cigarettes, marijuana, and inhalants. We employed a randomized controlled trial that used school as the unit of assignment. Thirty-four schools with grades 6-8 from 11 states completed the study. Seventy-one Project ALERT instructors taught 11 core lessons to sixth graders and 3 booster lessons to seventh graders. Students were assessed prior to the onset of the intervention, as sixth graders, after the completion of the 2-year curriculum, as seventh graders, and again 1 year later as eighth graders. This paper examines data from the pretest and final posttest. Using hierarchical nonlinear modeling, we found that our earlier effect on 30-day alcohol use did not persist. Further, we continued to find no effects for lifetime alcohol use and both the lifetime and 30-day use of cigarettes, marijuana, and inhalants. Our findings do not support the long-term effectiveness of Project ALERT, when delivered to sixth graders.

Rohrbach LA; Gunning M; Sun P; Sussman S. The project Towards No Drug Abuse (TND) dissemination trial: Implementation fidelity and immediate outcomes. Prevention Science 11(1): 77-88, 2010. (75 refs.)

One of the important research issues in the emerging area of research on dissemination of prevention programs relates to the type and extent of training needed by program providers to prepare them to implement effective programs with fidelity. The present paper describes the immediate outcomes of a dissemination and implementation trial of Project Toward No Drug Abuse, an evidence-based prevention program for high school students. A total of 65 high schools in 14 school districts across the USA were recruited and randomly assigned to one of three experimental conditions: comprehensive implementation support for teachers, regular workshop training only, or standard care control. The comprehensive intervention was comprised of on-site coaching, web-based support, and technical assistance, in addition to the regular workshop. Students (n = 2,983) completed self-report surveys before and immediately after program implementation. Fidelity of implementation was assessed with a classroom observation procedure that focused on program process. Results indicated that relative to the controls, both intervention conditions produced effects on hypothesized program mediators, including greater gains in program-related knowledge; greater reductions in cigarette, marijuana and hard drug use intentions; and more positive changes in drug-related beliefs. There were stronger effects on implementation fidelity in the comprehensive, relative to the regular, training condition. However, seven of the ten immediate student outcome measures showed no significant differences between the two training conditions. The implications of these findings for dissemination research and practice are discussed.

Rohrbach LA; Sun P; Sussman S. One-year follow-up evaluation of the Project Towards No Drug Abuse (TND) dissemination trial. Preventive Medicine 51(3-4): 313-319, 2010. (55 refs.)

Objective. The aims of this trial, conducted 2004-2008, were to examine (1) the effectiveness of Project Towards No Drug Abuse (TND) at the one-year follow-up when implemented on a large scale; and (2) the relative effectiveness of two training approaches for program implementers. Method. A total of 65 high schools from 14 school districts across the United States were randomized to one of three conditions: regular workshop training, comprehensive implementation support, or standard care control. Physical education and health teachers delivered the program to students (n = 2538). Program effectiveness was assessed with dichotomous measures of 30-day substance use at baseline and one-year follow-up. Results. When the program conditions were considered in aggregate and compared to controls, the program showed a marginally significant effect in lowering marijuana use from baseline to the one-year follow-up. Significant program effects on hard drug use were achieved for baseline non-users only. There were no differences in the effects of the two program conditions. Conclusion. Positive outcomes may be achieved by trained teachers when they implement Project TND in real-world high school environments; however, program effects are likely to be weaker than those achieved in efficacy trials. Training workshops may be adequate to build capacity for successful program implementation.

Sanders-Jackson AN; Cappella JN; Linebarger DL; Piotrowski JT; O'Keeffe M; Strasser AA. Visual attention to antismoking PSAs: Smoking cues versus other attention-grabbing features. Human Communication Research 37(2): 275-+, 2011. (59 refs.)

This study examines how addicted smokers attend visually to smoking-related public service announcements (PSAs) in adults smokers. Smokers' onscreen visual fixation is an indicator of cognitive resources allocated to visual attention. Characteristic of individuals with addictive tendencies, smokers are expected to be appetitively activated by images of their addiction-specifically smoking cues. At the same time, these cues are embedded in messages that associate avoidance responses with these appetitive cues, potentially inducing avoidance of PSA processing. Findings suggest that segments of PSAs that contain smoking cues are processed similarly to segments that contain complex stimuli (operationalized in this case as high in information introduced) and that visual attention is aligned with smoking cues on the screen.

Satterlund TD; Cassady D; Treiber J; Lemp C. Barriers to adopting and implementing local-level tobacco control policies. Journal of Community Health 36(4): 616-623, 2011. (18 refs.)

Although California communities have been relatively successful in adopting and implementing a wide range of local tobacco control policies, the process has not been without its setbacks and barriers. Little is known about local policy adoption, and this paper examines these processes related to adopting and implementing outdoor smoke-free policies, focusing on the major barriers faced by local-level tobacco control organizations in this process. Ninety-six projects funded by the California Tobacco Control Program submitted final evaluation reports pertaining to an outdoor smoking objective, and the reports from these projects were analyzed. The barriers were grouped in three primary areas: politically polarizing barriers, organizational barriers, and local political orientation. The barriers identified in this study underscore the need for an organized action plan in adopting local tobacco policy. The authors also suggest potential strategies to offset the barriers, including: (1) having a "champion" who helps to carry an objective forward; (2) tapping into a pool of youth volunteers; (3) collecting and using local data as a persuasive tool; (4) educating the community in smoke-free policy efforts; (5) working strategically within the local political climate; and (6) demonstrating to policymakers the constituent support for proposed policy.

Schinke SP; Schwinn TM; Fang L. Longitudinal outcomes of an alcohol abuse prevention program for urban adolescents. Journal of Adolescent Health 46(5): 451-457, 2010. (38 refs.)

Purpose: This randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths. Methods: Study participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CDP), and control. Once all youths completed baseline measures, those in CD and CDP arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CDP arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD-and CDP-arm participants received annual booster intervention sessions. Results: Seven years following postintervention testing and relative to control-arm youths, youths in CD and CDP arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CDP arms. Conclusions: Study findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking.

Schwinn TM; Schinke SP; Di Noia J. Preventing drug abuse among adolescent girls: Outcome data from an Internet-based Intervention. Prevention Science 11(1): 24-32, 2010. (40 refs.)

This study developed and tested an Internet-based gender-specific drug abuse prevention program for adolescent girls. A sample of seventh, eighth, and ninth grade girls (N = 236) from 42 states and 4 Canadian provinces were randomly assigned to an intervention or control group. All girls completed an online pretest battery. Following pretest, intervention girls interacted with a 12-session, Internet-based gender-specific drug prevention program. Girls in both groups completed the measurement battery at posttest and 6-month follow-up. Analysis of posttest scores revealed no differences between groups for 30-day reports of alcohol, marijuana, poly drug use, or total substance use (alcohol and drugs). At 6-month follow-up, between-group effects were found on measures of 30-day alcohol use, marijuana use, poly drug use, and total substance use. Relative to girls in the control group, girls exposed to the Internet-based intervention reported lower rates of use for these substances. Moreover, girls receiving the intervention achieved gains over girls in the control group on normative beliefs and self-efficacy at posttest and 6-month follow-up, respectively.

Shandley K; Austin D; Klein B; Kyrios M. An evaluation of 'Reach Out Central': an online gaming program for supporting the mental health of young people. Health Education Research 25(4): 563-574, 2010. (46 refs.)

The objective of this study was to conduct an evaluation of Reach Out Central (ROC), an online gaming program designed to support the mental health of people aged 16-25. The evaluation sought to determine the benefit of playing ROC on alcohol use, use of coping strategies, psychological distress, resilience and satisfaction with life. Changes in mental health literacy, mental health stigma and willingness to seek help and program satisfaction were also investigated. A single group (N = 266) quasi-experimental repeated measures (pre-, post-program, 2-month follow-up) design was employed. The results demonstrated positive improvements across all outcome measures for females; however, a non-significant worsening effect was observed for males on seeking support, avoidance and resilience. Improvements for both genders were observed on mental health literacy and help-seeking. However, literacy levels and help-seeking were significantly higher, and stigma significantly lower for females. Program satisfaction ratings were high irrespective of gender. Although some inconsistencies between genders were noted, ROC appears to enhance protective factors for the prevention or early intervention of mental health disorders. The results of this study need to be viewed with its limitations in mind, specifically, the use of an open trial methodology and the small number of male participants.

Sobani Z; Nizami S; Raza E; Baloch NU; Khan JA. Graphic tobacco health warnings: Which genre to choose? International Journal of Tuberculosis and Lung Disease 14(3): 356-361, 2010. (24 refs.)

BACKGROUND: Tobacco prevention studies show that graphic health warnings are more effective than text warnings, but there are no data on the effectiveness of different types of graphic health warnings in a Pakistani population. Even marginal differences in the effectiveness of genres can be of potential significance for public health. OBJECTIVE: To study the effectiveness of different types of graphic tobacco warnings In a Pakistani population. STUDY DESIGN: We presented ten anti-smoking warnings to randomly selected volunteers (n = 170) and recorded their opinion on the effectiveness of each warning. The warnings were based on a range of images aimed at the diverse population interviewed. A grading scale based on appeal, application, educational potential and motivation towards cessation was used to produce a composite grade of perceived effectiveness of the warning. RESULTS: Our results indicate that graphic warnings reach a greater proportion of the population than text warnings. Those appealing to logic, and those inculcating a sense of fear by showing a deleterious outcome of smoking, were judged likely to be most effective in motivating smokers to quit and preventing experimental smokers from forming a habit.

Stead M; Stradling R; MacNeil M; MacKintosh AM; Minty S; McDermott L et al. Bridging the gap between evidence and practice: A multi-perspective examination of real-world drug education. Drugs: Education, Prevention, and Policy 17(1): 1-20, 2010. (41 refs.)

Methods: Current guidance in Scotland was compared with systematic review evidence on drug-education effectiveness; a survey was mailed to primary, secondary and special schools (928 questionnaires returned); and 100 drug-education lessons were systematically observed across 40 schools. Findings: Nearly all schools provided drug education but modes of delivery and learning approaches did not always reflect the evidence base. There was a strong reliance on information provision and more limited use of social influences, resistance and normative approaches. Teaching was reasonably interactive, particularly with teachers who had been trained. Although drug education was provided across all school years, there was limited linkage and some duplication of content for different age groups. The rationale for resource use was not always clear, and some resources were inappropriate for pupils. Conclusions: Recommendations for closing the gap between evidence and practice include: guidance that emphasizes more strongly the weight of evidence behind recommendations; training in effective approaches; greater continuity and integration of drug education across the whole curriculum; a review of resources; and better guidance on using external visitors.

Steentoft A; Simonsen KW; Linnet K. The frequency of drugs among Danish drivers before and after the introduction of fixed concentration limits. Traffic Injury Prevention 11(4): 329-333, 2010. (15 refs.)

Objective: Until July 2007, the driving under the influence of drugs (DUID) legislation in Denmark was based on impairment, evaluated on the basis of a clinical investigation and toxicological analyses, but in 2007 fixed concentration limits were introduced into the Danish traffic legislation. The objective for this study was to investigate the prevalence of medication and illicit drugs among Danish drivers before and after 2007. Methods: Blood samples from drivers suspected of being under the influence of medication and/or illicit drugs were investigated as requested by the police. The results for a 10-year period before and for one year after the introduction of fixed concentration limits are presented. Results: A total of 2340 blood samples were analyzed for the presence of medications and/or illicit drugs for the period 1997-2006. The average number of cases per year was 234 (213-283), and on average 87 percent of the investigated cases were positive for one or more drugs. For 2008 the number of investigated traffic cases was increased to 1176. Seventy-three percent of the cases from 2008 were positive for one or more drugs. Benzodiazepines, cannabis (THC), amphetamine, heroin/morphine, methadone, cocaine, and ecstasy were the most frequently detected drugs for the period 1997-2006 and also in 2008. The number of these cases in which an ethanol level was detected above 0.5 mg/g (the Danish legal limit) was on average 18 percent (9-26%) for the period 1997-2006 and 19 percent for 2008. The average age of the drivers ranged from 31 to 34 years for the period 1997-2006 and was 31 years for 2008. The percentage of females per year ranged from 3 to 20 percent. Conclusion: The number of traffic cases investigated for substances other than ethanol were consistently low, in the range of 200 to 300 per year during the period from 1997 to 2006, but after the introduction of fixed concentration limits in 2007 a 5-fold increase was seen already in 2008.

Terry-McElrath YM; Emery S; Szczypka G; Johnston LD. Potential exposure to anti-drug advertising and drug-related attitudes, beliefs, and behaviors among United States youth, 1995-2006. Addictive Behaviors 36(1-2): 116-124, 2011. (32 refs.)

Using nationally representative data from the Monitoring the Future Study on United States middle and high school students, we related exposure to anti-drug television advertising as measured by Nielsen Media Research ratings points, to student self reported drug-related outcomes from 1995 to 2006. Multivariate analyses controlling for key socio-demographics and accounting for the complex survey design included 337,918 cases. Results indicated that attitudes beliefs and behaviors regarding substance use were significantly related to such advertising exposure over the six months prior to the date the youth were surveyed. However the observed relationships varied by grade level over time and by advertising tagline and marijuana focus. Findings differed markedly between middle and high school students across the study. Interval One factor that may partially explain observed differences may be variation in the degree to which the ads focused on marijuana. Putting a concerted effort into increasing anti-drug advertising will likely increase the exposure to and recall of such ads among youth. However the likelihood that such advertising will result in youth being less likely to use drugs seems to depend heavily on the type of advertising utilized and how it relates to different ages and characteristics of targeted youth.

Testa M; Hoffman JH; Livingston JA; Turrisi R. Preventing college women's sexual victimization through parent based intervention: A randomized controlled trial. Prevention Science 11(3): 308-318, 2010. (47 refs.)

A randomized controlled trial, using parent-based intervention (PBI) was designed to reduce the incidence of alcohol-involved sexual victimization among first-year college students. The PBI, adapted from Turrisi et al. (2001), was designed to increase alcohol-specific and general communication between mother and daughter. Female graduating high school seniors and their mothers were recruited from the community and randomly assigned to one of four conditions: Alcohol PBI (n = 305), Enhanced Alcohol + Sex PBI (n = 218), Control (n = 288) or Unmeasured Control (n = 167). Mothers in the intervention conditions were provided an informational handbook and encouraged to discuss its contents with their daughters prior to college matriculation. Consistent with hypotheses, PBI, either standard or enhanced, was associated with lower incidence of incapacitated rape in the first year of college relative to controls. Path analysis revealed support for a hypothesized indirect effects model, by which intervention increased mother-daughter communication, which predicted lower frequency of first semester heavy episodic drinking, resulting in lower rates of alcohol-involved sexual victimization in the first year of college.

Tobler AL; Komro KA; Dabroski A; Aveyard P; Markham WA. Preventing the link between SES and high-risk behaviors: "Value-added" education, drug use and delinquency in high-risk, urban schools. Prevention Science 12(2): 211-221, 2011. (38 refs.)

We examined whether schools achieving better than expected educational outcomes for their students influence the risk of drug use and delinquency among urban, racial/ethnic minority youth. Adolescents (n = 2,621), who were primarily African American and Hispanic and enrolled in Chicago public schools (n = 61), completed surveys in 6th (aged 12) and 8th (aged 14) grades. Value-added education was derived from standardized residuals of regression equations predicting school-level academic achievement and attendance from students' sociodemographic profiles and defined as having higher academic achievement and attendance than that expected given the sociodemographic profile of the schools' student composition. Multilevel logistic regression estimated the effects of value-added education on students' drug use and delinquency. After considering initial risk behavior, value-added education was associated with lower incidence of alcohol, cigarette and marijuana use; stealing; and participating in a group-against-group fight. Significant beneficial effects of value-added education remained for cigarette and marijuana use, stealing and participating in a group-against-group fight after adjustment for individual- and school-level covariates. Alcohol use (past month and heavy episodic) showed marginally significant trends in the hypothesized direction after these adjustments. Inner-city schools may break the links between social disadvantage, drug use and delinquency. Identifying the processes related to value-added education in order to improve school environments is warranted given the high costs associated with individual-level interventions.

Vallone DM; Duke JC; Cullen J; McCausland KL; Allen JA. Evaluation of EX: A national mass media smoking cessation campaign. American Journal of Public Health 101(2): 302-309, 2011. (28 refs.)

Objectives. We used longitudinal data to examine the relationship between confirmed awareness of a national, branded, mass media smoking cessation campaign and cessation outcomes. Methods. We surveyed adult smokers (n=4067) in 8 designated market areas ("media markets") at baseline and again approximately 6 months later. We used multivariable models to examine campaign effects on cognitions about quitting, quit attempts, and 30-day abstinence. Results. Respondents who demonstrated confirmed awareness of the EX campaign were significantly more likely to increase their level of agreement. on a cessation-related cognitions index from baseline to follow-up (odds ratio [OR]=1.6; P=.046). Individuals with confirmed campaign awareness had a 24% greater chance than did those who were not aware of the campaign of making a quit attempt between baseline and follow-up (OR=1.24; P=.048). Conclusions. A national, branded, mass media smoking cessation campaign can change smokers' cognitions about quitting and increase quit attempts. We strongly recommend that federal and state governments provide funding for media campaigns to increase smoking cessation, particularly for campaigns that have been shown to impact quit attempts and abstinence.

Vallone DM; Niederdeppe J; Richardson AK; Patwardhan P; Niaura R; Cullen J. A national mass media smoking cessation campaign: Effects by race/ethnicity and education. American Journal of Health Promotion 25(5, Supplement S): S38-S50, 2011. (44 refs.)

Purpose. To assess the effectiveness of a large-scale, national smoking cessation media campaign., the EX campaign, across racial/ethnic and educational subgroups. Design. A longitudinal random-digit-dial panel study conducted prior to and 6 months following the national launch of the campaign. Setting. The sample was drawn from eight designated media markets in the United States. Subjects. The baseline survey was conducted on 5616 current smokers, aged 18 to 49 years, and 4067 (73% follow-up response rate) were resurveyed at the 6-month follow-up. Measures. The primary independent variable is confirmed awareness of the campaign advertising, and the outcome variables are follow-up cessation-related cognitions index score and quit attempts. Analysis. Multivariable logistic and linear regression analyses were conducted within racial/ethnic and educational strata to assess the strength of association between confirmed awareness of campaign advertising and cessation-related outcomes. Results. Confirmed awareness of campaign advertising increased favorable cessation-related cognitions among Hispanics and quit attempts among non-Hispanic blacks, and increased favorable cessation-related cognitions and quit attempts among smokers with less than a high school education. Conclusions. These results suggest that the EX campaign may be effective in promoting cessation-related cognitions and behaviors among minority and disadvantaged smokers who experience a disproportionate burden of tobacco-related illness and mortality.

Van De Luitgaarden J; Knibbe RA; Wiers RW. Adolescents binge drinking when on holiday: An evaluation of a community intervention based on self-regulation. Substance Use & Misuse 45(1/2): 190-203, 2010. (25 refs.)

This paper presents a case study of a community intervention aimed at reducing excessive drinking in young men on holiday in seaside camping resorts in the Netherlands. The self-regulated voluntary covenant of parties concerned was evaluated on the basis of several types of data (all collected in 2004): questionnaires administered to young men (N = 191), observations carried out by trained "peers", nuisance questionnaires among city center residents (N = 121), and interviews with local actors. Compliance with measures as well as the effects of measures are discussed. Limitations are noted and recommendations for optimizing the potential of community interventions are made.

Vincus AA; Ringwalt C; Harris MS; Shamblen SR. A short-term, quasi-experimental evaluation of D.A.R.E.'s revised elementary school curriculum. Journal of Drug Education 40(1, special issue): 37-49, 2010. (37 refs.)

We present the short-term results of a quasi-experimental evaluation of the revised DARE. (Drug Abuse Resistance Education) curriculum. Study outcomes examined were D.A.R.E.'s effects on three substances, namely students' lifetime and 30-day use of tobacco, alcohol, and marijuana, as well as their school attendance and academic performance. The study comprised students in 17 urban schools, each of which served as its own control; 5th graders in the 2006-2007 school year constituted the comparison group (n = 1490), and those enrolled as 5th graders in the 2007-2008 school year constituted the intervention group (n = 1450). We found no intervention effect on students' substance use for any of the substance use outcomes assessed. We did find that students were more likely to attend school on days they received DARE. lessons and that students in the intervention group were more likely to have been suspended. Study findings provide little support for the implementation and dissemination of the revised D.A.R.E. curriculum.

Werch CE; Bian H; DiClemente CC; Moore MJ; Thombs D; Ames SC et al. A brief image-based prevention intervention for adolescents. Psychology of Addictive Behaviors 24(1): 170-175, 2010. (26 refs.)

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Wolfson M; Champion H; Rogers T; Neiberg RH; Barker DC; Talton JW et al. Evaluation of Free to Grow: Head Start partnerships to promote substance-free communities. Evaluation Review 35(2): 153- 188, 2011. (41 refs.)

Free to Grow: Head Start Partnerships to Promote Substance-free Communities (FTG) was a national initiative in which local Head Start (HS) agencies, in partnership with other community organizations, implemented a mix of evidence-based family-strengthening and community-strengthening strategies. The evaluation of FTG used a quasi-experimental design to compare 14 communities that participated in the FTG intervention with 14 matched comparison communities. Telephone surveys were conducted with two cohorts of the primary caregivers of children in HS at baseline and then annually for 2 years. The survey was also administered to repeated cross-sectional samples of primary caregivers of young children who were not enrolled in HS. No consistent evidence was found in changes in family functioning or neighborhood conditions when the 14 FTG sites were compared to 14 matched sites. However, caregivers of young children who were not in HS in three high-implementing FTG sites showed evidence of improvements in neighborhood organization, neighborhood norms against substance abuse, and child disciplinary practices. Results provide highly limited support for the concept that family and neighborhood conditions that are likely to affect child development and well-being can be changed through organized efforts implemented by local HS programs.

Wood DM; Who S; Alldus G; Huggett D; Nicolaou M; Chapman K et al. The development of the recreational drug outreach educational concept 'Drug Idle'. Journal of Substance Use 15(4): 237-245, 2010. (11 refs.)

Background: Recreational drug use in common, particularly in those attending nightclubs. Their knowledge about the potential toxicity of drugs and how to manage this is variable. Methods: We therefore established a multidisciplinary local network of key stakeholders interested in the prevention and management of recreational drug toxicity. Through this network we designed a unique outreach educational concept, 'Drug Idle', for recreational drug users and their friends. This was run within nightclub environments in a user-friendly, non-judgemental forum. We describe here the development of this educational concept and how it was evaluated and adapted on the basis of feedback from attendees. Results: 149 attended the three Drug Idle events as part of this study. All of those trialling the finalized concept thought all three components of the concept were useful, 96.0% that it was of appropriate duration and 98.8% that they would recommend future events to a friend. Conclusions: We believe that wider use of this outreach educational concept will help to improve the knowledge of those using recreational drugs, especially concerning management of drug toxicity. Additionally, it will provide them with information that will enable them to make informed decisions about the risk of continuing use of recreational drugs.

Zaidi SMA; Bikak AL; Shaheryar A; Imam SH; Khan JA. Perceptions of anti-smoking messages amongst high school students in Pakistan. BMC Public Health 11: article 117, 2011. (20 refs.)

Background: Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages. Methods: This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers. Results: Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers. Conclusion: Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.

Zhang JY; Borland R; Coghill K; Petrovic-Lazarevic S; Young D; Yeh CH et al. Evaluating the effect of health warnings in influencing Australian smokers' psychosocial and quitting behaviours using fuzzy causal network. Expert Systems with Applications 38(6): 6430-6438, 2011. (13 refs.)

This paper explores the application of fuzzy causal networks (FCNs) to evaluating effect of health warnings in influencing Australian smokers' psychosocial and quitting behaviour. The sample data used in this study are selected from the International Tobacco Control Policy Evaluation Survey project. Our research findings have demonstrated that new health warnings implemented in Australia have obvious impacts on smokers' psychosocial and quitting behaviours. FCN is a useful framework to investigate such impacts that overcome the limitation of using traditional statistical techniques, such as linear regression and logistics regression, to analyse non-linear data.