Study 1
Eisen, Zellman, and Murray (2003) conducted a longitudinal randomized controlled trial of Lions Quest Skills for Adolescence (SFA) for the National Institute on Drug Abuse to assess the program’s effectiveness in deterring and delaying students’ substance use through middle school in comparison to usual drug education programming. Thirty-four middle schools were selected for the study during the fall and winter of 1997–1998, including schools in Baltimore, Md.; Detroit, Mich.; Los Angeles, Calif.; and Washington, D.C. The sample population totaled 7,426 sixth graders, and a baseline survey was conducted with all actively consented sixth graders in each school in the spring of 1998. Based on the survey’s results, schools were pair-matched within each district, based on reported prevalence of any recent (within the previous 30 days) substance use (tobacco, alcohol, or other illicit drugs). Accordingly, schools were divided into a treatment group and a control group, each comprising 17 schools. The study cohort in the 17 treatment schools received only SFA as their seventh-grade drug education during the 1998–1999 school year, while their counterparts in the 17 control schools received their usual drug education programming. The comparison programs, which were generally left to the discretion of teachers in each school, ranged from school assemblies, to local teacher–devised classroom curricula, to Drug Abuse Resistance Education (D.A.R.E.) exposure.
To monitor the program’s progress, 1-year posttest data (baseline to end of the intervention school year) was collected from 6,239 seventh graders in May and June of 1999. One-year follow-up data (i.e., 1 year post-intervention) were collected at the end of eighth grade, in May and June of 2000. To assess evidence of the program’s effectiveness, 1-year follow-up data was used to compare drug use outcomes between SFA and control schools from spring of 1998 through spring of 2000. Initiation of “ever” and “recent” use of alcohol, tobacco, marijuana, and other illegal substances (“any other” drugs, including inhalants and cocaine or crack) for baseline nonusers and changes in recent use for baseline were compared using mixed-model regressions to control for school clustering. “Ever” was defined as having ever used the substance in one’s lifetime, while “recent” was defined as use within 30 days prior to data collection. In addition to these measures, alcohol use rates were measured by the occurrence of recent binge drinking (three or more drinks at one time in the previous 30 days). Alcohol, tobacco, and illegal drug use prevalence rates were assessed through a set of standard items that was modified, when necessary, following pretesting with the target population. Use of each substance was measured, with items having five- to seven-point ordinal response categories (e.g., “never” or “none” to “more than 100 cigarettes [more than 5 packs]”). These ordinal indicators of lifetime and recent substance use were then recoded to 0=no/1=yes response categories.
The study also measured potential changes in behavioral and refusal skills by assessing students’ behavioral intentions to use drugs, social influences and interpersonal perceptions, perception of harmful drug effects, and communication skills and self-efficacy regarding drug use refusal. Behavioral intentions to use tobacco, alcohol, marijuana, and cocaine in the following 3 months were assessed using several items regarding such intentions (1=definitely yes to 4=definitely no). Social influence and interpersonal perceptions were assessed using standard questions on students’ normative beliefs about the prevalence of substance use by a best friend (yes/no/I don’t know), friends in general, and same-grade peers (1=all to 5=none), as well as a three-item scale on whether using alcohol, cigarettes, and marijuana makes it easier to ‘‘fit in’’ (1=strongly agree to 5=strongly disagree). Perceptions of the harmful or helpful effects of alcohol, binge drinking, smoking, marijuana, and cocaine were assessed with three-item scales focusing on whether each substance helps or harms one’s health, ability to relax, and popularity (1=very helpful to 4=very harmful). Students’ sense of self-efficacy in refusing alcohol, cigarettes, marijuana, and cocaine in various situations (e.g., “ … how easy or hard would it be to say ‘no’ to marijuana if you are at party with friends/at close friend’s house—no parents home/hanging out with friends after school—not at someone’s house?”) was measured using separate three-item scales. These items were developed after careful review and content analysis of the SFA communication and resistance skills classroom curriculum and role-play exercises used in the eight key sessions. Subgroup analyses were conducted to examine the impact of the program on baseline binge drinkers.
