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...on Prevention
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www.ProjectCork.org
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Fall 2012
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Revisiting the concepts of risk and protective factors for understanding the etiology and development of substance use and substance use disorders: Implications for prevention.
Sloboda Z; Glantz MD; Tarter RE. Substance Use & Misuse 47(8): 944-962, 2012. (197 refs.)
Over the past 20 years we have accumulated a greater knowledge and understanding of the genetic, neurobiological, and behavioral factors that may be associated with young people initiating the use of drugs and other substances and to progressing from use to abuse and dependence. This knowledge suggests that individuals may be "predisposed" to substance use disorders (SUD) and that the actual engagement in these behaviors depends on their environmental experiences from micro to macro levels. This paper summarizes this knowledge base and supports a developmental framework that examines the interaction of posited genetic, psychological, and neurobiological "predispositions" to SUD and those environmental influences that exacerbate this vulnerability. Copyright 2012, Informa Healthcare.
Short-term effects of a smoking prevention website in American Indian Youth.
Bowen DJ; Henderson PN; Harvill J; Buchwald D. Journal of Medical Internet Research 14(3): 163-170, 2012. (23 refs.)
Background: The rate of smoking commercial tobacco products among American Indian youth is double the rate for white youth. Interventions are needed to reduce this disparity. Objective: To test the feasibility of a Web-based intervention to influence attitudes toward and intentions about smoking cigarettes among American Indian youth who attended a Native summer camp in the Northern Plains. Methods: The study website, the SmokingZine, was originally developed and tested in Canadian youth, then adapted to be appropriate for American Indian youth. We conducted a randomized controlled trial to test the influence of exposure to the adapted SmokingZine website on smoking attitudes and behaviors among American Indian youth 12-18 years of age. Participants assigned to the intervention group were given access to the website for 1 hour per day during their camp experience and asked to sign in to the site and use it. Control group participants were not given access to the site. Results: A total of 52% of intervention youth signed in to the website at least once. Among nonsmokers, intentions to try a cigarette in the intervention group declined from 16% to 0%, and increased from 8% to 25% in the control group (P < .05). Compared with the control group, youth in the intervention group were more likely to help others quit (21 percentage point change in intervention versus no change in control; P < .05) and had less positive attitudes about the drug effects of smoking (-0.19 change in intervention versus 0.67 in control; P < .05). Conclusion: These data indicate that SmokingZine needs more long-term, rigorous investigation as a way to keep American Indian youth from becoming regular smokers. Because the intervention group could use computers only 1 hour per day, increasing access might result in more visits and a greater effect of the website on smoking behaviors. Copyright 2012, JMIR Publications.
A web-based computer-tailored smoking prevention programme for primary school children: Intervention design and study protocol.
Cremers HP; Mercken L; Oenema A; de Vries H. BMC Public Health 12: e-article 277, 2012. (46 refs.)
Background: Although the number of smokers has declined in the last decade, smoking is still a major health problem among youngsters and adolescents. For this reason, there is a need for effective smoking prevention programmes targeting primary school children. A web-based computer-tailored feedback programme may be an effective intervention to stimulate youngsters not to start smoking, and increase their knowledge about the adverse effects of smoking and their attitudes and self-efficacy regarding non-smoking. Methods & design: This paper describes the development and evaluation protocol of a web-based out-of-school smoking prevention programme for primary school children (age 10-13 years) entitled 'Fun without Smokes'. It is a transformation of a postal mailed intervention to a web-based intervention. Besides this transformation the effects of prompts will be examined. This web-based intervention will be evaluated in a 2-year cluster randomised controlled trial (c-RCT) with three study arms. An intervention and intervention + prompt condition will be evaluated for effects on smoking behaviour, compared with a no information control condition. Information about pupils' smoking status and other factors related to smoking will be obtained using a web-based questionnaire. After completing the questionnaire pupils in both intervention conditions will receive three computer-tailored feedback letters in their personal e-mail box. Attitudes, social influences and self-efficacy expectations will be the content of these personalised feedback letters. Pupils in the intervention + prompt condition will - in addition to the personalised feedback letters - receive e-mail and SMS messages prompting them to revisit the 'Fun without Smokes' website. The main outcome measures will be ever smoking and the utilisation of the `Fun without Smokes' website. Measurements will be carried out at baseline, 12 months and 24 months of follow-up. Discussion: The present study protocol describes the purpose, intervention design and study protocol of 'Fun without Smokes'. Expectations are that pupils receiving tailored advice will be less likely to smoke after 24 months in contrast to pupils in the control condition. Furthermore, tailored feedback letters and prompting is expected to be more effective than providing tailored feedback letters only. Copyright 2012, Biomed Central.
Substance misuse prevention and economic analysis: Challenges and opportunities regarding international utility.
Guyll M; Spoth R; Cornish MA. Substance Use & Misuse 47(8): 877-888, 2012. (65 refs.)
Economic analyses of substance misuse prevention assess the intervention cost necessary to achieve a particular outcome, and thereby provide an additional dimension for evaluating prevention programming. This article reviews several types of economic analysis, considers how they can be applied to substance misuse prevention, and discusses challenges to enhancing their international relevance, particularly their usefulness for informing policy decisions. Important first steps taken to address these challenges are presented, including the disease burden concept and the development of generalized cost-effectiveness, advances that facilitate international policy discussions by providing a common framework for evaluating health care needs and program effects. Copyright 2012, Informa Healthcare.
Cannabis abuse and vulnerability to psychosis: Targeting preventive services. (review).
Kolliakou A; Fusar-Poli P; Atakan Z. Current Pharmaceutical Design 18(4): 542-549, 2012. (91 refs.)
Cannabis is the most widely used illicit substance in the world and due to the high levels of use observed among young people with psychosis, most research has focused on the causal relationship between cannabis use and mental health problems. Despite a large interest in developing intervention models to target this group, there are as yet no established and effective methods of prevention and intervention focusing on cannabis use. In this paper we present the available evidence for the effectiveness of substance use treatments in patients with co-morbid severe mental illness, as well as exploring the prevention and early intervention initiatives for substance use in the general population. Copyright 2012, Bentham Science Publishing.
Differential impact of a Dutch alcohol prevention program targeting adolescents and parents separately and simultaneously: Low self-control and lenient parenting at baseline predict effectiveness.
Koning IM; Verdurmen JEE; Engels RCME; van den Eijnden RJJM; Vollebergh WAM. Prevention Science 13(3): 278-287, 2012. (38 refs.)
To test whether baseline levels of the factors accountable for the impact of the Prevention of Alcohol use in Students (PAS) intervention (self-control, perceived rules about alcohol and parental attitudes about alcohol), moderate the effect of the intervention. A cluster randomized trial including 3,490 Dutch early adolescents ( age = 12.66, = 0.49) and their parents randomized over four conditions: 1) parent intervention, 2) student intervention, 3) combined intervention and 4) control group. Moderators at baseline were used to examine the differential effects of the interventions on onset of (heavy) weekly drinking at 34-month follow-up. The combined intervention was only effective in preventing weekly drinking among those adolescents who reported to have lower self-control and more lenient parents at baseline. No differential effect was found for the onset of weekly drinking. No moderating roles of self-control and lenient parenting were found for the student and parent interventions regarding the onset of drinking. The combined intervention is more effective among adolescents with low-self control and lenient parents at baseline, both factors that were a specific target of the intervention. The relevance of targeting self-control in adolescents and restrictive parenting is underlined. Copyright 2012, Springer.
Improving media message interpretation processing skills to promote healthy decision making about substance use: The effects of the middle school media ready curriculum.
Kupersmidt JB; Scull TM; Benson JW. Journal of Health Communication 17(5): 546-563, 2012. (45 refs.)
The Media Ready Program was designed as a middle school, media literacy education, preventive intervention program to improve adolescents' media literacy skills and reduce their intention to use alcohol or tobacco products. In a short-term efficacy trial, schools in North Carolina were randomly assigned to conditions (Media Ready: n = 214; control: n = 198). Boys in the Media Ready group reported significantly less intention to use alcohol in the future than did boys in the control group. Also, students in the Media Ready group who had used tobacco in the past reported significantly less intention to use tobacco in the future than did students in the control group who had previously used tobacco. Multilevel multiple mediation analyses suggest that the set of logical analysis Message Interpretation Processing variables mediated the program's effect on students' intentions to use alcohol or tobacco in the future. Copyright 2012, Taylor & Francis.
An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: Project Towards no Drug Abuse (TND).
Lisha NE; Sun P; Rohrbach LA; Spruijt-Metz D; Unger JB; Sussman S. Journal of Drug Education 42(1): 33-57, 2012. (75 refs.)
The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n = 1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended. Copyright 2012, Baywood Publishing.
A review of multicomponent interventions to prevent and control tobacco use among college students. (review).
Rodgers KC. Journal of American College Health 60(3): 257-261, 2012. (18 refs.)
Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components. Copyright 2012, Taylor & Francis.
Preventing youthful substance use and harm: Between effectiveness and political wishfulness.
Room R. Substance Use & Misuse 47(8): 936-943, 2012. (42 refs.)
Drinking, smoking, and drug use are symbolic behaviors for young people, often involving a claim for adult status, and set against a "social clock" of expectations about appropriate behavior for a given age. Use is set in a social world of youth sociability, which young people strive to control themselves. Hence, it is difficult to prevent or delay use through adult-run institutions such as schools. Youth-oriented prevention initiatives succeed best when in tune with general social trends, so that youth cannot so easily feel hypocritically singled out. Regulatory approaches that apply to all have had some success in limiting and shaping youthful use and problems. Well-evaluated trials of efforts to insulate youthful use from harm are needed. Copyright 2012, Informa Healthcare.
Graphic warning labels in cigarette advertisements: Recall and viewing patterns.
Strasser AA; Tang KZ; Romer D; Jepson C; Cappella JN. American Journal of Preventive Medicine 43(1): 41-47, 2012. (30 refs.)
Background: The Family Smoking Prevention and Control Act gave the U. S. Food and Drug Administration (FDA) legal authority to mandate graphic warning labels on cigarette advertising and packaging. The FDA requires that these graphic warning labels be embedded into cigarette advertising and packaging by September 2012. Purpose: The aim of this study was to examine differences in recall and viewing patterns of text-only versus graphic cigarette warning labels and the association between viewing patterns and recall. Methods: Participants (current daily smokers; N = 200) were randomized to view a cigarette advertisement with either text-only or graphic warning labels. Viewing patterns were measured using eye-tracking, and recall was later assessed. Sessions were conducted between November 2008 and November 2009. Data analysis was conducted between March 2011 and July 2011. Results: There was a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50% vs 83% (chi(2) = 23.74, p = 0.0001). Time to first viewing of the graphic warning label text and dwell time duration (i.e., time spent looking) on the graphic image were significantly associated with correct recall. Warning labels that drew attention more quickly and resulted in longer dwell times were associated with better recall. Conclusions: Graphic warning labels improve smokers' recall of warning and health risks; these labels do so by drawing and holding attention. Copyright 2012, Elsevier Science.
One-year outcomes of a drug abuse prevention program for older teens and emerging adults: Evaluating a motivational interviewing booster component.
Sussman S; Sun P; Rohrbach LA; Spruijt-Metz D. Health Psychology 31(4): 476-485, 2012. (53 refs.)
Objective: The present study tested the efficacy of motivational interviewing-based booster sessions for Project Toward No Drug Abuse (TND), a 12-session school-based curriculum targeting youth at risk for drug abuse. In addition, generalization of effects to risky sexual behavior was assessed. The 1-year outcomes evaluation of the project is presented. Method: A total of 24 schools were randomized to one of three conditions: standard care control (SCC), TND classroom program only (TND-only), and TND plus motivational interviewing booster (TND + MI). A total of 1186 participants completed baseline and 1-year follow-up surveys. Following the classroom program, youth in the TND + MI condition received up to 3 sessions of MI in person or by telephone. Effects were examined on 30-day cigarette, alcohol, marijuana, and hard drug use, as well as measures of risky sexual behavior (number of sex partners, condom use, having sex while using drugs or alcohol). Results: Collapsed across the 2 program conditions, results showed significant reductions in alcohol use, hard drug use, and cigarette smoking relative to controls. These effects held for an overall substance use index. The MI booster component failed to achieve significant incremental effects above and beyond the TND classroom program. No effects were found on risky sexual behavior. Conclusions: While the program effects of previous studies were replicated, the study failed to demonstrate that an adequately implemented MI booster was of incremental value at 1-year follow-up. Copyright 2012, American Psychological Association.
Drink refusal training as part of a combined behavioral intervention: Effectiveness and mechanisms of change.
Witkiewitz K; Donovan DM; Hartzler B. Journal of Consulting and Clinical Psychology 80(3): 440-449, 2012. (56 refs.)
Objective: Many trials have demonstrated the effectiveness of cognitive behavioral interventions for alcohol dependence, yet few studies have examined why particular treatments are effective. This study was designed to evaluate whether drink refusal training was an effective component of a combined behavioral intervention (CBI) and whether change in self-efficacy was a mechanism of change following drink refusal training for individuals with alcohol dependence. Method: The present study is a secondary analysis of data from the COMBINE study (COMBINE Study Research Group, 2003), a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. The goal of the present study was to examine whether a drink refusal skills training module, administered as part of a 16-week CBI (n = 776; 31% female, 23% non-White, average age = 44) predicted changes in drinking frequency and self-efficacy during and following the CBI, and whether changes in self-efficacy following drink refusal training predicted changes in drinking frequency up to 1 year following treatment. Results: Participants (n = 302) who received drink refusal skills training had significantly fewer drinking days during treatment (d = 0.50) and up to 1 year following treatment (d = 0.23). In addition, the effect of the drink refusal skills training module on drinking outcomes following treatment was significantly mediated by changes in self-efficacy, even after controlling for changes in drinking outcomes during treatment (proportion mediated = 0.47). Conclusions: Drink refusal training is an effective component of CBI, and some of the effectiveness may be attributed to changes in client self-efficacy. Copyright 2012, American Psychological Association.
Structuring a college alcohol prevention program on the low level of response to alcohol model: A pilot study.
Schuckit MA; Kalmijn JA; Smith TL; Saunders G; Fromme K. Alcoholism: Clinical and Experimental Research 36(7): 1244-1252, 2012. (62 refs.)
Background: New approaches are needed to bolster the modest effects of campus drinking prevention programs. However, more definitive research on new paradigms is very expensive, and in the current economic climate, progress can be made by evaluating smaller pilot studies. This study describes one such approach. Methods A sample of 18-year-old or older, healthy, drinking freshmen at our university was assigned to 2 groups stratified to be similar on demography, drinking histories, and their level of response (LR) to alcohol. In the spring quarter of the school year, the 32 subjects in each of 2 groups viewed four 45-minute Internet-based videotapes as part of 4 prevention sessions. All 8 modules were based on the same techniques and general content, but the 4 videos for the first group were structured around the validated model of how a low LR affects heavy drinking (the low level of response-based [LRB] Group), with partial mediation by heavier drinking peers, positive alcohol expectancies, and drinking to cope with stress. Videos for the state-of-the-art (SOTA) comparison group did not place the similar prevention messages into the low LR framework. Changes in drinking were evaluated at 3 times: before Module 1, before Module 4, and 1 month after Module 4. Results: Usual and maximum drinks per occasion decreased over time for both high and low LR subjects in both LRB and SOTA groups. As predicted, the low LR students showed greater decreases in the LRB Group, while high LR students showed greater decreases in the more generic SOTA Group. Conclusions: The results support the hypothesis that tailoring prevention efforts to address specific predisposing factors, such as a low LR, may be associated with beneficial effects on drinking quantity. We hope that these data will encourage additional efforts to validate the low LR-based prevention paradigm and test other interventions that are targeted toward predisposing phenotypes such as impulsivity and negative affect. Copyright 2012, Research Society on Alcoholism.
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