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This group-randomized trial assessed the effects of a universal prevention training curriculum for school administrators and teachers that focused on effective strategies to prevent adolescent substance use and related problems. Twenty-eight schools in three regions of Peru were randomly assigned to either an intervention or control condition (14 schools per condition). Repeated cross-sectional samples of 11 to 19-year-old students participated in four surveys from May 2018 to November 2019 (N = 24,529). School administrators and teachers at intervention schools participated in a universal prevention training curriculum focusing on the development of a positive school climate as well as effective policies related to school substance use. All intervention and control schools were offered Unplugged, a classroom-based substance use prevention curriculum. Outcome measures included: lifetime drug use; past-year and past-month tobacco, alcohol, marijuana, and other drug use; awareness of school tobacco and alcohol use policies; perceived enforcement of school policies; school bonding; perceived friends' use of tobacco, alcohol, marijuana and other drugs; and personal problems in general and problems related to substance use. Multi-level analyses indicated significant reductions in past-year and past-month smoking, friends' substance use, and problems related to substance use and in general at intervention relative to control schools. Significant increases were found in intervention vs. control schools related to students' awareness of school substance use policies, perceived likelihood of getting caught for smoking, and school bonding. These findings suggest that the universal prevention training curriculum and the school policy and climate changes it promoted reduced substance use and related problems in the study population of Peruvian adolescents.

While researchers have developed more effective programs and strategies to prevent the initiation of substance use and increasingly communities are delivering these interventions, determining the degree to which they are delivered as they were designed remains a significant research challenge. In the past several years, more attention has been given to implementation issues during the various stages of program development and diffusion. This paper presents the findings from a substudy of an evaluation of a newly designed middle and high school substance abuse prevention program, Take Charge of Your Life delivered by local Drug Abuse Resistance Education officer instructors. A key aspect of the study was to determine the extent to which implementation fidelity, using the measures of content coverage and appropriate instructional strategy, was associated with improvement in the program mediators of realistic normative beliefs, understanding the harmful effects of substance use and the acquisition of decision-making and resistance skills. Although it was found that higher fidelity was associated with better scores on some of the mediators, this was not a consistent finding. The mixed results are discussed within the context of the lesson activities themselves.

Drawing on the elaboration likelihood model of persuasive communication, the authors examine the impact of the perceptions of the instructor or source on students' receptivity to a new substance abuse prevention curriculum. Using survey data from a cohort of students participating in the Adolescent Substance Abuse Prevention Study, the authors use structural equation modeling to determine the effects of the perceptions students have of their program instructor on measures of the targeted program mediators and the use of cigarettes, alcohol, and marijuana. They test these instructor effects after each component of a two-part curriculum is administered (during the seventh and ninth grades). They find that the perceptions of the instructor significantly affect refusal, communication and decision-making skills, normative beliefs, perceived consequences of use, and substance use. The authors discuss the implications of these findings for school-based prevention programming and indications for further research. (Contains 10 notes and 3 tables.)

Over the past twenty-five years, tremendous progress has been made in the area of drug abuse prevention research. The accumulated findings from longitudinal studies of adolescents regarding the factors associated with vulnerability to the substance use and abuse and trends from national surveys of substance use showing their association to societal perceptions of the harmfulness resulting from the use of these substances have informed the development of effective innovative prevention strategies. The 1990s saw a reversal in the perception of the value and importance of drug abuse prevention research with recognition of the fieldis approach to intervention development and implementation and its scientific rigor in demonstrating intervention impact. This paper reflects on this history anticipating both the positive and negative aspects of the future for the field.

The discipline of epidemiology utilizes the constructs of agent, host, vector, and environment to study the incidence and prevalence (i.e., the nature, extent, distribution, correlates) and the contexts, and consequences of drug abuse in the United States. This paper provides a selected review of the results of 40 years of epidemiological study of drug abuse using surveillance systems, general population surveys, ethnography and qualitative research approaches. It then addresses the challenges in conducting research on drug abuse epidemiology. The paper concludes with some missed opportunities and lessons learned in four decades of a large portfolio of research studies conducted by an impressive array of distinguished scientists.

Sample attrition, a major concern in any longitudinal study, is even more problematic when adolescents are the study population. The need to minimize the loss of participants in order to maintain the integrity of the cohort is vital in substance abuse prevention evaluations. The Adolescent Substance Abuse Prevention Study (ASAPS), a national school based prevention study being conducted in six sites across the country, followed students attending schools randomly assigned to either a treatment or control condition from the seventh through the eleventh grade. The percent of study dropouts after the ninth grade pretest warranted consideration of an attrition study to acquire data from those students who were no longer in a study school. A pilot study conducted with a sample of attrition cases in one site (51 of 495) was undertaken to assess the feasibility and costs of a full study. This paper describes the experiences gained from this pilot study in tracking study subjects. An exhaustive protocol was developed and contacts with parents were initiated through telephone calls and flyers sent by mail. Online public records and telephone directories were used to acquire additional contact information. Contact was established with 56.8% of the parents and resulted in completed surveys from 19.6% of the sample at a cost of $1,949.30 per survey.

We examined the diffusion of the D.A.R.E program to reduce use of illicit drugs among school-aged children and youths and the diffusion of syringe exchange programs to reduce HIV transmission among injection drug users. The D.A.R.E program was diffused widely in the United States despite a lack of evidence for its effectiveness; there has been limited diffusion of syringe exchange in the United States, despite extensive scientific evidence for its effectiveness. Multiple possible associations between diffusion and evidence of effectiveness exist, from widespread diffusion without evidence of effectiveness to limited diffusion with strong evidence of effectiveness. The decision theory concepts of framing and loss aversion may be useful for further research on the diffusion of public health innovations.