Preventing Tobacco, Alcohol, and Illicit Drug Use through Life Skills Training

Transcription

1 Preventing Tobacco, Alcohol, and Illicit Drug Use through Life Skills Training Gilbert J. Botvin, Ph.D. Professor of Public Health Professor of Psychiatry Weill Medical College of Cornell University

2 Prevention Delivery Channels Families Schools Your Ad Here! Community Organizations Media

3 Substance Use Progression Alcohol Tobacco Marijuana Other Illicit Drugs

4 Prevention Approaches Health Information Scare Tactics Social Influences (Evans, Ellickson, Murray, Pentz,, Perry) Competence Enhancement (Botvin, Schinke, Sussman)

5 Evidence-Based Approaches Extensively Tested Using Rigorous Research Methods Proven Effective Published in Peer-Reviewed Journal

6 Social Influence Approach Psychological Inoculation Normative Education Public Commitment Refusal/Resistance Skills Major Components

7 Social Influence Approach Summary of Evaluation Results Tobacco, Alcohol and Marijuana Initial Reductions 30 to 45% Effects Last 2 to 5 Years Strongest Effects with Peer Leaders Some Evidence with Minority Youth ALERT (Ellickson( Ellickson), STAR (Pentz( Pentz)

8 Figure 1. Hypothesized Etiologic Model of Adolescent Drug Use and Targets of Life Skills Training Program Socio- Cultural Personal Competence Skills Family Social Competence Skills Psychological Factors Drug Use Social Environment Drug Resistance Skills/ Cognitions Life Skills Training

9 Life Skills Training Drug Resistance Skills and Norms Self-Management Skills General Social Skills Major Components

10 Drug Resistance Skills/Norms Awareness of Influences to Use Drugs Anti-Drug Use Norms Prevention-Related Health Knowledge Resistance/Refusal Skills

11 Self-Management Skills Problem-Solving and Decision-Making Personal Behavior Change Skills Stress and Anxiety Management

12 General Social Skills Effective Communication Skills Greetings and Brief Social Exchanges Meeting New People Conversational Skills Complimenting Skills Assertive Skills

13 Middle School Program 15 Class Periods (6th or 7th Grade) 10 Class Periods (7th or 8th Grade) 5 Class Periods (8th or 9th Grade)

14 Program Providers Health Professionals Graduate Students Peer Leaders Teachers

15 Teaching Methods Facilitate Group Discussion Teach Skills Provide Reinforcement Provide Opportunities for Practice

16 Skills Training Methods Instruction Demonstration Behavior Rehearsal Feedback Reinforcement Extended Practice

17 Life Skills Training Short-Term Effects LST Control Percent Using Monthly Tobacco* Alcohol** Marijuana*** Source: *Botvin et al. (1982), ** Botvin, Baker et al. (1984), *** Botvin, Baker, Renick et al.(1984).

18 Life Skills Training Booster Effects 20 LST + Booster LST Control Percent Using Weekly Tobacco* Marijuana** Source: *Botvin et al. (1983), ** Botvin et al. (1990)

19 Life Skills Training Long-Term Effects: Smoking 30 28% Reduction LST Control Percent Using % Reduction 29% Reduction 21% Reduction Weekly Smoking* (White Sample) Weekly Smoking** (Minority Sample) Daily Smoking* (White Sample) Daily Smoking** (Minority Sample) Source: *Botvin et al. (1995), ** Botvin et al. (2004)

20 Life Skills Training Long-Term Effects: Gateway Poly-drug Use & Illicit Drug Use 30 LST Control 25% Reduction 25 38% Reduction Percent Using % Reduction 56% Reduction 5 0 Polydrug Use* (Weekly) Narcotics** (Lifetime) Hallucinogens** (Lifetime) Illicit Drug Use** (Lifetime) Source: *Botvin et al. (1995), ** Botvin et al. (2000)

21 Life Skills Training Binge Drinking (Botvin et al., 2001) 10 LST 8 Control % Using yr follow-up (8th grade) 2 yr follow-up (9th grade)

22 Prevention of Methamphetamine Use: Results from Two Independent Studies Lifetime and Past-Year Meth Use at 4½-6½ Years Past Baseline 8 7 a Past Year Use Lifetime Use--Past Year Plus Prior Use % ISFP b PDFY Control Study 1 (12th Grade).53 b SFP+LST LST Control Study 2 (11th Grade) 2.63 b b SFP+LST LST Control Study 2 (12th Grade) a No lifetime use data were available from Study 1; in Study 2 at 11th grade, lifetime use is equal to past-year use for both intervention conditions. b p<.05 Note: For Study 2, the 12th grade sample size differs from 11th grade, due to attrition. Source: Spoth, R., Clair, S., Shin, C., & Redmond, C. (2006). Archives of Pediatrics and Adolescent Medicine.

23 Violence and Delinquency Prevention: Fidelity Sample Any Level of Outcome Behavior Aggression In Past Month 28% Physical Aggression In Past Month 50% Fighting in Past Year 48% Delinquency in Past Year 46% High Frequency of Outcome Behavior (top quartile) Verbal Aggression In Past Month (> 5 Events) 50% Physical Aggression In Past Month (> 3 Events) 39% Fighting in Past Year (> 3 Events) 44% Delinquency In Past Year (> 3 Events) 46%

24 Summary Reduces Substance Use by 50% to 87% Tobacco, Alcohol, Marijuana Effects Last for at Least 6 Years Inhalants, Narcotics, Hallucinogens Reduces Polydrug Use Reduces Violence and Delinquency White, African-American, American, Hispanic

25 Additional Findings Works with High Risk Youth Peer Drug Use and Poor Academic Performance Reduced Smoking, Drinking, Inhalants, Poly-drugs Reduces Risky Driving New York DMV Data Fewer Driving Convictions (Points) Reduces HIV/AIDS Risk Among Young Adults Risky Sexual Behavior

26 Additional Findings (cont d) Ten-Year Follow-up Study Received LST in Grade 7 (Ages 12-13) 13) Followed Up 10 years Later (Ages 22-23) 23) Reduced Tobacco, Alcohol, and Illicit Drug Use Parent Program Positive Role Model Family Communication Monitoring Discipline Elementary School Program (Grades 3-5) 3 Reduces Cigarette Smoking Reduces Alcohol Use

27 Challenges of Going to Scale User-Friendly Materials Prevention Infrastructure Effective Training Models Adequate Training Capacity Quality of Training Planning and Scheduling Issues Maintain Implementation Fidelity Technical Assistance Stable Funding

28 Summary and Conclusions School-based prevention works! The LST approach produces strong and long-lasting lasting prevention effects Approaches targeting school, family, and community offer greatest potential Promote use of proven approaches Increase funding for prevention

29 Thank You!

30 Gilbert J. Botvin, Ph.D. Professor and Director Institute for Prevention Research Weill Medical College of Cornell University