School-based drug prevention programs: a review of what works.

• Jurisdiction: Australia
• Author: Soole, David W.
• Date: 01 August 2008

This article examines the effectiveness of school-based drug prevention programs in preventing illicit drug use. Our article reports the results of a systematic review of the evaluation literature to answer three fundamental questions: (I) do school-based drug prevention programs reduce rates of illicit drug use? (2) what features are characteristic of effective programs? and (3) do these effective program characteristics differ from those identified as effective in reviews of school-based drug prevention of licit substance use (such as alcohol and tobacco)? Using systematic review and mere-analytic techniques, we identify the characteristics of school-based drug prevention programs that have a significant and beneficial impact on ameliorating illicit substance use (i.e., narcotics) among young people. Successful intervention programs typically involve high levels of interactivity, time-intensity, and universal approaches that are delivered in the middle school years. These program characteristics aligned with many of the effective program elements found in previous reviews exploring the impact of school-based drug prevention on licit drug use. Contrary to these past reviews, however, our analysis suggests that the inclusion of booster sessions and multifaceted drug prevention programs have little impact on preventing illicit drug use among school-aged children. Limitations of the current review and policy implications are discussed.

Keywords: drug prevention, meta-analysis, illicit drug use

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Schools are a popular starting point for the delivery of many social education and prevention efforts, addressing a variety of social phenomena such as drug use, crime and delinquency, teenage sexual activity and pregnancy, and various health issues such as nutrition, exercise, and sexually transmitted disease (Botvin & Griffin, 2003). School-based drug prevention (SBDP) programs are especially popular, with evidence suggesting their benefits to be twice that of costs (Caulkins, Pacula, Paddock, & Chiesa, 2002). Schools are thus an appropriate and convenient 'platform' from which to launch drug prevention efforts. Schools have the ability to reach large numbers of school-aged children, and programs delivered during school hours are relatively easy to implement compared to other types of noninstitutionally-based programs (such as family or community-based programs). Petrosino (2003) laments, however, that the large number of highly variable school-based programs creates confusion among policymakers as to which strategies to implement.

A plethora of studies have assessed the effectiveness of SBDP efforts, most of which focus on the impact of these programs on reducing or preventing licit drug use' (Allott, Paxton, & Leonard, 1999; Belcher & Shinitzky, 1998; Black, Tobler, & Sciacca, 1998; Botvin & Griffin, 2003, 2004; Coggans, Cheyne, & McKellar, 2003; Cuijpers, 2002; Dusenbury, Mathea, & Lake, 1997; Ennett, Tobler, Ringwalt, & Flewelling, 1994; Flay, 2000; Gottfredson & Wilson, 2003; McBride, 2003; Midford, 2000; Skara & Sussman, 2003; Tobler et al., 2000). The focus in the literature on licit drug consumption, such as alcohol and tobacco, makes intuitive sense given that most SBDP programs are implemented at a developmental stage when illicit drug use rates among adolescents are low.

We know, however, that illicit substance use among school-aged children is a major and growing concern. In 2004, 28.5% of Australian adolescents aged 12 to 17 years had used an illicit drug during their life. More than one in five 12- to 17-year-olds reported having tried marijuana (23.2%), 3.7% reported having tried amphetamines, 3.4% ecstasy, 1.0% cocaine, and 0.5% opiates (Australian Institute of Health and Welfare [AIHW], 2005). In the United States (US) 36.8% of 8th through 12th graders reported having used an illicit substance during their lifetime (Johnston, O'Malley, Bachman, & Schulenberg, 2005). To our knowledge there have been just two systematic reviews that have examined the impact of SBDP programs on illicit drug outcomes (Tobler, Lessard, Marshall, Ochshorn, & Roona, 1999; White & Pitts, 1998). Our research extends the body of literature around SBDP in two ways: first, we update these two past systematic reviews by accessing studies conducted after the late 1990s to assess the effectiveness of SBDP programs in reducing or preventing illicit substance use. Second, we compare and contrast our results with reviews of licit drug use outcomes.

Our article addresses three fundamental research questions: (1) do school-based drug prevention programs reduce rates of illicit drug use? (2) what features are characteristic of effective programs? and (3) are these effective program characteristics similar to those identified as effective in reviews of school-based drug prevention of licit substance use? To answer these research questions our approach proceeds in three stages: first, we identify the key elements of program success found in past reviews of SBDP programs that target licit drug use. Second, we update the two past reviews of SBDP that report results pertaining to illicit drug use outcomes using systematic and meta-analytic approaches to synthesise relevant recent literature. We then compare and contrast the elements that we find to be components of successful SBDP programs that target illicit drug use with the successful elements found in the majority of the literature on the impact of SBDP programs on licit drug use outcomes. We conclude our article with a discussion of the policy implications of our research findings.

School-Based Programs: What We Know So Far

School-based prevention programs encompass a very wide range of interventions. Some are structured and use peer learning as a way to engage young people in an interactive manner (e.g., Black et al., 1998). Some seek to build highly-specific resilience skills (e.g., Hurry, Lloyd, & McGurk, 2000), while others are more passive and merely seek to provide young people with educational information (e.g., Forman, Linney, & Brondino, 1990). School-based prevention programs also vary by the grade at which the program is delivered, the level of intensity and interactivity, and the type of attitude or behaviour that the program seeks to change.

The first stage of our review sought to produce a synopsis of the range of systematic reviews already present in the literature to determine the key components of successful school-based programs that target licit and illicit substance use. As such, the following section identifies the main components of school-based prevention programs and highlights the key findings from past reviews in two key areas: licit drug outcomes and illicit drug outcomes.

TheValue of Interactivity on Licit Drug Outcomes

According to Tobler et al. (2000), '[I]nteractive programs provide contact and communication opportunities for the exchange of ideas among participants and encourage learning drug refusal skills' (p. 287). The use of interactivity in school-based prevention programs is an important feature across a range of different types of programs that address a variety of social issues, such as anti-bullying (Bouhours, 2001) and life education (Eisen, Zellman, & Murray, 2003; Botvin, Baker Dusenbury, Tortu, & Botvin, 1990). For drug prevention, research finds that the more interactivity in a SBDP program (i.e., the more that communication among teachers, students and peers is maximised), the more likely it is that a student will be prevented from using a licit substance. Tobler et al. (2000) report that student involvement in the delivery of a program is associated with improved efficacy of drug prevention programs. They (Tobler et al., 2000, 1999) also reported significant positive effects on self-reported licit and illicit drug use for approaches involving interactive teaching methods, such as social influence and competency enhancement.

Conversely, variants of noninteractive programs, such as knowledge dissemination (providing educational material on the harmful effects of drugs) and affective education (teaching students about the relationship between emotions and drug use and what strategies may help to keep emotions in check) were not found to have significant impacts on drug use. A multitude of reviews have since corroborated these findings (Allott et al., 1999; Black et al., 1998; Botvin & Griffin, 2003; Cuijpers, 2002; McBride, 2003).

The Importance of Program Intensity on Licit Drug Outcomes

From a logical perspective, one would expect that more 'intense' SBDP programs would generate more prosocial behavioural change among school-aged children than the less intense programs. Evidence suggests that there is indeed value in developing drug prevention programs that involve multiple sessions, with more intensive programs associated with greater effectiveness (Botvin & Griffin, 2003; Gottfredson & Wilson, 2003; McBride, 2003; Tobler et al., 2000, 1999; White & Pitts, 1998).

The Impact of Booster Sessions on Licit Drug Outcomes

Similarly, the inclusion of booster sessions that are designed to reiterate and build upon original program content has been found to enhance the effectiveness of SBDP programs (Botvin & Griffin, 2003; Gottfredson & Wilson, 2003; McBride, 2003; Skara & Sussman, 2003; Tobler et al., 1999; White & Pitts, 1998). However, past reviews have found that the additional effectiveness of booster sessions may be contingent on other factors of the program, such as program interactivity (Cuijpers, 2002; Tobler et al., 1999).

The Role of Program Providers in Reducing Licit Drug Use

A number of past reviews have also investigated the differential impact of various program providers on program effectiveness and have found mixed evidence. While some reviews report that drug prevention programs led by peers can be as effective as adult-led programs (Allott et al., 1999; Black et al., 1998; Cuijpers, 2002; Gottfredson &amp...