Wednesday, may 25, 2005 7: 00 am – 5: 00 pm registration



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12:00 PM – 1:30 PM

LUNCH ON YOUR OWN

1:30 PM – 3:00 PM

CONCURRENT SESSIONS 1 - 9

CONCURRENT 1, EFFECTIVENESS TRIALS, Organized symposia

EFFECTS OF TWO UNIVERSAL INTERVENTIONS DIRECTED AT FIRST GRADE CLASSROOM BEHAVIOR AND ACHIEVEMENT ON THE PREVENTION OF YOUNG ADULT MENTAL DISORDERS AND DRUG USE, AND LEVEL OF SERVICE USE

Chair: Sheppard Kellam

  • Regency A

450

EFFECTS OF TWO UNIVERSAL INTERVENTIONS DIRECTED AT FIRST GRADE CLASSROOM BEHAVIOR AND ACHIEVEMENT ON THE PREVENTION OF YOUNG ADULT MENTAL DISORDERS AND DRUG USE, AND LEVEL OF SERVICE USE. Sheppard Kellam1, Jeanne Poduska2, Hendricks Brown3, Nicholas Ialongo4, Amy Windham2, Holly Wilcox5, John Reid6, 1American Institutes of Research and Johns Hopkins University, Washington, DC United States; 2American Institutes for Research, Washington, DC United States; 3University of South Florida, Tampa, FL United States; 4Johns Hopkins University, Baltimore, MD United States; 5George Washington University, Washington, DC United States; 6Oregon Social Learning Center, Eugene, OR United States

This symposium is on the prevention of drug abuse, suicidal behavior and depression, school failure, and the level of service use from first grade through age 19-21 in an epidemiologically defined population in Baltimore public schools. This is the second report on the transition into adulthood from the first generation of preventive trials in the Baltimore City Public School System. This population participated in a field trial of two separate classroom-based universal preventive interventions in a parallel, randomized design. The trial was carried out in 40 first grade classrooms in 18 elementary schools. Schools were matched and randomly assigned to one of the two interventions or to a control condition. Within schools, classrooms and teachers were randomly assigned to the intervention or to a standard program classroom; children were balanced across classrooms. The interventions extended from fall of 1st through 2nd grades. The intervention results examined here are from the Good Behavior Game (GBG) and Mastery Learning (ML). Based on life course/social field theory, GBG and ML were directed at improving social adaptation to two classroom tasks, GBG at improving teachers´ socializing children to be students, and reducing aggressive, disruptive behavior; ML at improving instruction and raising reading scores, both frequently confirmed antecedents of later problem outcomes. The ones we will report here are tobacco, alcohol, and illicit drug use, suicidal ideation and behavior, years of schooling attained, and use of services by age 19-21. The population was first assessed in the fall of 1st grade, followed up annually through 7th grade, and again at the time of transition into adulthood. This allowed mapping the developmental trajectories as antecedents of young adult outcomes, as well as variation in intervention impact over these stages of life. After an overview of theory, design, and a summary of previously reported results the symposium will provide data on GBG and ML impact on: 1) Tobacco, alcohol, illicit drug use; 2) Suicide ideation, attempts, and depression; and 3) Use of educational, behavioral, and mental health services. Significant results were found, but varied by gender and baseline level of risk. The symposium will examine the theoretical and practical implications of the results, and particularly the role of gender.


451

EFFECTS OF TWO UNIVERSAL PREVENTIVE INTERVENTIONS DIRECTED AT FIRST GRADE CLASSROOM BEHAVIOR AND ACHIEVEMENT ON THE CUMULATIVE USE OF SERVICES BY YOUNG ADULTHOOD. Jeanne Poduska1, Sheppard Kellam1, Hendricks Brown2, Nicholas Ialongo3, Amy Windham4, 1American Institutes for Research, Baltimore, MD United States; 2University of South Florida, Tampa, FL United States; 3Johns Hopkins University, Baltimore, MD United States; 4American Institutes for Research, Washington, DC United States

This proposed paper is part of a symposium on the developmental course and prevention of mental disorders and drug use, and the use of services from first grade through age 19-21 in an epidemiologically defined population in Baltimore public schools. This paper is concerned with whether the cumulative need and use of services for emotional and behavioral disorders by young adulthood is influenced by either of two universal preventive interventions. Mastery Learning (ML) was directed at improving first grade teachers´ instructional practices and reducing poor achievement, a risk factor for later depression. Good Behavior Game (GBG) was directed at improving first grade teacher´s classroom behavior management, aggressive, disruptive behavior being a risk factor for later drug use and behavioral disorders. The trial was carried out in 5 urban areas; 3 or 4 schools were matched in each area and randomly assigned to one of the two interventions, or to a matched control condition. Within schools, the 40 classrooms and teachers were randomly assigned to the intervention or to a standard program (control) classroom, while children were balanced across classrooms. The interventions extended from fall of 1st through 2nd grades. Based on life course/social field theory, which emphasizes mastery of the social task demands in each main social field at each stage of life, we hypothesize that failure to master the role of student not only leads to more problem outcomes, but more need for and use of services. By young adulthood, 39% of control males reported receiving services for problems with behavior, emotions, or drugs or alcohol; for control girls the prevalence of service use was 20%. For boys aggression was related to service use, and GBG reduced aggression from 1st to 7th grade and impacted service use by young adulthood. However, no effect of earlier aggressive behavior, or of GBG was found for girls. We will report how the need for and use of services are influenced by the course of achievement and ML compared to GBG, as well as covariates such as poor concentration, shy behavior, and depressive symptoms. Gender differences will be a particular focus in these analyses. Theoretical and practical implications will be discussed.



452

EFFECTS OF TWO UNIVERSAL INTERVENTIONS DIRECTED AT FIRST GRADE CLASSROOM BEHAVIOR AND ACHIEVEMENT ON THE PREVENTION OF TOBACCO, ALCOHOL, AND ILLICIT DRUG USE. Sheppard Kellam1, Jeanne Poduska1, Hendricks Brown2, Amy Windham3, Nicholas Ialongo4, 1American Institutes for Research, Baltimore, MD United States; 2University of South Florida, Tampa, FL United States; 3American Institutes for Research, Washington, DC United States; 4Johns Hopkins University, Baltimore, MD United States

This proposal is for a paper to be delivered in a symposium on the developmental course and prevention of drug use and psychopathology from first grade through age 19-21 in an epidemiologically defined population in Baltimore public schools. This paper investigates how the course of aggression relates to drug use by young adulthood. We first will investigate how the course of aggression relates to use of specific drugs, including tobacco, alcohol, marijuana, cocaine, and heroin, as well as the use of multiple drugs. Second, we will examine whether or not two universal interventions, the Good Behavior Game (GBG) and Mastery Learning (ML) impacted the use of these drugs, either alone or in combination. Third, we will investigate how the developmental trajectory of aggression and drug use vary as a function of gender, early classroom environment, and community and individual poverty. Based on life course/social field theory, GBG and ML were directed at improving social adaptation to two classroom tasks, GBG at improving teacher´s socializing children to be students, and reducing aggressive, disruptive behavior; ML at improving instruction and raising reading scores, both frequently confirmed antecedents of later problem outcomes. The trial was carried out in 40 first grade classrooms in 18 elementary schools. Schools were matched and randomly assigned to one of the two interventions, or to a matched control school. Within schools, classrooms and teachers were randomly assigned to the intervention or to a standard program classroom, while children were balanced across classrooms. The interventions extended from fall of 1st through 2nd grades. We found the course of aggression was related to lifetime illicit drug use and there was a reduction in lifetime illicit drug use among the highest risk students. Analyses of specific drug use and multiple drug use are ongoing. We hypothesize that the developmental trajectory of aggression will relate differentially to use of specific types and/or combinations of drugs; that children from the intervention classrooms should have a lower likelihood of drug use and that intervention impact may vary for specific types and combinations of drug use; and that both the profile of drug use and intervention impact will vary by gender, early classroom environment, and community and individual poverty.



453

EFFECTS OF TWO UNIVERSAL INTERVENTIONS DIRECTED AT FIRST GRADE CLASSROOM BEHAVIOR AND ACHIEVEMENT ON THE PREVENTION OF DEPRESSION AND SUICIDE-RELATED BEHAVIORS. Holly Wilcox1, Sheppard Kellam2, C. Hendricks Brown3, Jeanne Poduska2, Nicholas Ialongo4, James Anthony5, 1George Washington University, Washington, DC United States; 2American Institutes for Research, Baltimore, MD United States; 3University of South Florida, Tampa, FL United States; 4Johns Hopkins University, Baltimore, MD United States; 5Michigan State University, East Lansing, MI United States

This proposed paper is to be delivered in a symposium on the developmental course and prevention of psychopathology from first grade through age 19-22 in an epidemiologically defined population in Baltimore public schools. This paper is concerned with variation in the impact of two universal preventive interventions, the Good Behavior Game (GBG) and Mastery Learning (ML) on the risk for depression, suicide ideation and suicide attempt by young adulthood. Based on life course/social field theory, GBG and ML were directed at improving social adaptation to two classroom tasks, GBG at improving teacher´s socializing children to be students, and reducing aggressive, disruptive behavior; ML at improving instruction and raising reading scores, both frequently confirmed antecedents of later problem outcomes. Consisting of two consecutive cohorts of first graders, this population participated in a field trial of the two separate classroom-based universal preventive interventions in a parallel, randomized design. The trial was carried out in 40 first grade classrooms in 18 elementary schools. Schools were matched and randomly assigned to one of the two interventions, or to a matched control school. Within schools, classrooms and teachers were randomly assigned to the intervention or to a standard program classroom, while children were balanced across classrooms. The interventions extended from fall of 1st through 2nd grades. This paper, like the others in this symposium, is focused on the developmental trajectories of children in the standard classrooms and in intervention classrooms. We hypothesized that children from the GBG and ML classrooms should have a lower likelihood of depression, suicide ideation or attempt. We found that the risk of suicide ideation was lower for youths randomly assigned to the GBG intervention, as compared to youths in standard setting classrooms, with and without adjustment for multiple covariates (unadjusted Relative Risk, RR=0.54, 95% Confidence Interval 0.3, 0.9; p=0.012); there was no intervention-associated reduced risk for suicide attempt. We are currently in the process of examining the impact of the interventions on depression. In regard to these findings, we will discuss the role of antecedent developmental trajectories of aggression, academic achievement and depression in relation to intervention impact on suicide ideation. Mediating and moderating influences as well as gender differences will be a particular focus in these analyses.



CONCURRENT 2, DISSEMINATION, Organized symposia

META-ANALYSIS OF MODEL PROGRAMS IN THE SAMHSA NATIONAL REGISTRY

Chair: William Hansen

  • Ticonderoga

454

META-ANALYSIS OF MODEL PROGRAMS IN THE SAMHSA NATIONAL REGISTRY. William Hansen1, Kevin Hennessy2, Nancy Jacobs3, 1Tanglewood Research, Inc., Greensboro, NC United States; 2US Department of Health and Human Services, Rockville, MD United States; 3John Jay College of Criminal Justice, CUNY, New York, NY United States

The goal of SAMHSA's National Registry of Effective Programs (NREP) is to identify drug abuse prevention programs with proven effectiveness that can be disseminated broadly to schools and community service organizations. During the past several years, over 900 programs have been nominated for inclusion in the list of proven programs. To date, fewer than 180 have been reviewed and found to have sufficiently rigorous evaluations and positive outcomes to have been included. This symposium will present methods, findings and implications of a meta-analytic study conducted on model and effective programs in the registry. This meta-analysis was conducted to identify the core components of effective substance abuse prevention programs. Thus, this analysis was limited to 48 programs that specifically addressed substance abuse prevention from among those on the effective or model program lists and that had manuals. Programs manuals were examined and coded for: (1) Program content, (2) developmental appropriateness, (3) cultural appropriateness, (4) ease of implementation, (5) potential of the program to engage participants, (6) dosage, (7) integration across settings, and (8) IOM classification. Of the 48 programs for which manuals were coded, 25 provided data that could be coded as effect sizes. Three programs provided sufficient numbers of outcomes to examine implementation variables. This symposium will discuss findings and implications of this meta-analysis.



455

PROGRAM CLASSIFICATION: METHODOLOGY FOR DEFINING INDEPENDENT VARIABLES. William Hansen1, Linda Dusenbury2, Dana Bishop3, 1Tanglewood Research, Inc., Greensboro, NC United States; 2Tanglewood Research, Southern Pines, NC United States; 3Tanglewood Research, Greensboro, NC United States

NREP currently does not request or require programs to submit copies of intervention manuals or protocols as part of review. We included an analysis of manuals for the following reasons: (1) Only by examining the manual or the protocol can the essential elements of a program be understood. It is crucial to understand the structure, content, and process by which an intervention is delivered. (2) Research papers and manuscripts are summaries and are typically cryptic in their portrayal of an intervention. Brief summaries often give an incomplete description of an intervention. (3) Program developers´ brief descriptions, even when accurate, are often couched in idiosyncratic language and are uneven in what is presented. These descriptions cannot be relied on to classify a program´s components and strategies. We collected program manuals for 48 programs from program developers. Manuals were systematically evaluated and rated for the following: (1) program content, (2) dosage, (3) developmental appropriateness, (4) cultural appropriateness, (5) ease of implementation, (6) appeal of the program, (7) the potential of the program to engage participants, (8) integration across settings, (9) targeted age group, (10) format and structure of the program, (11) targeted behaviors, and (11) IOM classification. Program content refers to the topics addressed in an intervention and can be thought of as the risk and protective factors targeted for change. Our goal in reviewing manuals was to identify which content was and was not addressed by each program. The list of content included was based on an emerging categorization scheme that began with earlier reviews of research on program components (Hansen, 1992; Hawkins, Catalano & Miller, 1992). This list has been refined through the examination of measures used for evaluating programs as part of CSAP's Core Measures Initiative and through our examination of what program developers designed programs to do. Overall, 23 definable and distinct content areas were identified. We grouped content areas into four dimensions that focused on (1) motivational intervention components, (2) intervention components that focused on promoting the development of personal competence, (3) intervention components designed to develop interpersonal or social skills, and (4) interventions designed to change social and environmental characteristics.



456

META-ANALYSIS AND THE DEVELOPMENT OF PREVENTION SCIENCE. Jim Derzon1, William Hansen2, Linda Dusenbury3, 1Pacific Institute for Research and Evaluation, Calverton, MD United States; 2Tanglewood Research, Inc., Greensboro, NC United States; 3Tanglewood Research, Florence, SC United States

Meta-analysis systematically abstracts information from studies in a form that can be statistically managed. Here we examine the effectiveness of 48 programs which were judged NREP effective or model programs. Of these, 25 provided substance use findings that could be standardized. Twenty-four of these provided manuals from which program content, characteristics, and procedures could be coded.

Overall, NREP model and effective programs were effective, with effects for tobacco and marijuana being strongest (d=.140) and effects for alcohol being weakest (d=.084). These effectiveness estimates from research were tested against program manual content. That is, we correlated effectiveness estimates with ratings of the program as intended and not, necessarily as delivered in the intervention study(s) submitted in support of the program.

Variation in program effectiveness was positively correlated with eight program characteristics (i.e., (a) promoting anti-drug attitudes, (b) increasing support and engagement in positive activities, (c) promoting academic skills, (d) classroom management, (e) developing positive peer affiliations, (f) providing positive alternatives, (g) promoting commitments to avoid substance use, (h) developing and achieve personal goals), and negatively correlated with six content areas (i.e., (a) resistance skills training, (b) promoting media literacy, (c) reducing access and increasing enforcement, (d) decision making skills training, (e) increasing incongruence between personally-held values and substance use and (f) promoting family rules, discipline, and management) although a smaller effect delivered to a wider audience may produce a larger net impact than a larger effect delivered narrowly. Program effectiveness was also associated with frequency of delivery, participant characteristics (older and indicated youth show stronger effects), and setting characteristics (comprehensive school-based programs were more effective than family- or community-focused programs).

This approach to disentangling the seeds of effectiveness suffers from lack of control of the program-as-delivered, testing only the effects of the program-as-intended. It nonetheless highlights a critical moment in the development of prevention science. From a meta-analytic perspective, focusing on whether unique intersections of program-as-delivered with setting and sample and outcome demonstrate effectiveness is a bit like case study research at the individual level; important, interesting, and useful and limited. Shifting attention from the effectiveness of programs as black boxes and to unpacking the activities, practices, and components associated with effectiveness is central to the development of a prevention science. Anything less may be description.

457

STRENGTH, FIDELITY AND ADAPTATION OF PREVENTION PROGRAMS. David Cordray1, Nancy Jacobs2, 1Vanderbilt University, Nashville, TN United States; 2John Jay College of Criminal Justice, CUNY, New York, NY United States

NREP has identified model programs for preventing misuse of alcohol, tobacco and other drugs among teens. In addition to providing evidence about the manner in which these programs produce their effects and in investigating the essential elements of these programs, there is considerable interest in adapting these model programs to local conditions and constraints. To assure us that the resulting adaptations are capable of producing positive effects on teens, it is necessary to know the range (if any) of tolerable adaptation of model programs. This presentation summarizes evidence from several programs of research on model programs (e.g., Life Skills Training), highlighting what is known and not known about the strength, fidelity and range of tolerable adaptation of model programs. Issues to be discussed include: (1) Given the generally small effects sizes that have been reported, how does the magnitude of the effect (i.e, relative strength) affect the extent to which model programs can be adapted? (2) What do implementation fidelity studies tell us about adaptability of model programs? (3) What can be learned about adaptability from program variations (over their developmental course and across developers)? and (4) What can and cannot be learned about the importance of program components from meta-analyses of outcome studies and mediational models? Answers to these questions reveal a need to enhance the breadth and depth of research on model programs.



CONCURRENT 3, METHODS, Poster Forum

PREVENTION INTERVENTIONS

Chair: Irene Hantman

  • Yorktown

458

OLD THEMES IN THE FACE OF INNOVATION- IMPLICATIONS FOR FUTURE PREVENTION EFFORTS. Jeffrey Knudsen1, Judy Cushing2, Kathy Laws1, Max Margolis2, 1RMC Research Corporation, Portland, OR United States; 2Oregon Partnership, Portland, OR United States

Oregon Partnership´s innovative Methamphetamine Awareness Project (MAP) combines substance abuse prevention theory with the creative energy and abilities of young people to create prevention messages through film that convey the consequences of methamphetamine use. Participating youth learn from and work with prevention and treatment specialists, law enforcement officials, their peers, and professional filmmakers to create a prevention intervention tool intended to reduce teen methamphetamine use and raise community awareness about the dangers of methamphetamine.

MAP´s overarching program theory is based on the Hawkins and Catalano´s Social Development Model (SDM), which describes processes in the community that strengthen social bonding among children and adults, creates healthy beliefs, and creates clear standards for behaviors across developmental periods. Interventions that strengthen these processes of opportunities, skills, and recognition are likely to promote positive social bonding and the adoption of healthy beliefs and clear standards of behavior. MAP provides participants with an opportunity to acquire and utilize film skills in a context where they are reinforced by adults and peers.

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP) awarded a 3-year grant to Oregon Partnership to implement MAP in three Oregon high schools in the same county. Implementation includes a longitudinal evaluation with a randomly assigned control group at each school. Data from Year 1 has been processed and results have potentially major implications for the program and prevention policy. Results indicate no use of methamphetamines at pre or post for both the treatment and control group, with all study participants indicating extremely high anti-drug attitudes towards methamphetamine. Conversely, study participants reveal high levels of alcohol and marijuana use, and increasingly positive pro-drug attitudes toward both substances from pre to post. Results from subsequent regression analysis indicate that perceived parental attitudes towards substance use and peer use are significant predictors of alcohol and marijuana use. Individual protective factors, central to the SDM, were not major predictors of substance use. While MAP´s innovative approach is focused on knowledge acquisition, skill development, and adult bonding, results indicate that other more traditional variables may be exerting stronger influence in substance use attitudes and behavior.

Prevention policy makers and program developers may need to reconsider: (1) the value of targeting specific substances, and (2) the exclusion of programming that targets traditional variables such as peer and parental influence.

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