Alcohol, Tobacco, and Other Drug Use Prevention Programs in U.S. Schools: A Descriptive Summary

Abstract

This report identifies the relative prevalence and trends in state, local, and commercially developed substance abuse prevention programs in middle and high schools from 2001 to 2007, using survey data from nationally representative samples of 1,206 schools. Based on school administrators’ reports, schools and school districts offer students, on average 1.62 prevention programs during their school years from elementary through high school. Bivariate and multivariate regression analyses were conducted with school demographic characteristics (public versus private, size, population density, region of the country, school race/ethnic composition and socioeconomic status of the student body) as predictors of total number of weighted programs students received and of the relative use of local, state, and commercial programs. Schools in the West had significantly fewer prevention programs than those in all other regions of the country. Students in predominantly White and in more affluent schools received significantly more prevention programs than students in majority African American, majority Hispanic, or in less affluent schools. The most frequently reported programs that students received were locally developed. Of all the prevention programs, D.A.R.E. was the most widely adopted. Findings from this study suggest that schools often develop their own curriculum to suit their students’ needs, and students are exposed to multiple prevention programs through their school years, making it difficult to examine the effectiveness of any single program in preventing and reducing substance use among students.

Substance use is a chronic problem that continues to impact U.S. youth. Trend data from the Monitoring the Future (MTF) study from 1975 to 2008 indicate that the variety of substances used has proliferated over the years and substance use remains a major concern for parents, teachers, health professionals, youth workers, law enforcement, and policy makers (Johnston, O’Malley, Bachman, & Schulenberg, 2009). Several governmental and nongovernmental agencies, including the Center for Substance Abuse Prevention (CSAP) in the Substance Abuse and Mental Health Services Administration (SAMHSA), support health education designed to include tobacco and drug prevention education. The Office of Safe and Drug-Free Schools, U.S. Department of Education, has funded drug and violence prevention programs that are executed through state and local educational agencies, as well as public and private nonprofit organizations (Office of Safe and Drug-Free Schools Web site). Universities and other research organizations supported by agencies such as the Centers for Disease Control and Prevention (CDC), the National Institute of Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH) also develop prevention programs for dissemination in schools. Finally, a number of states, school districts, and schools have developed their own drug prevention curricula. Consequently, there has been a proliferation of drug prevention programs resulting in tremendous variability in drug prevention curricula taught in U.S. schools. This has resulted in an increasing demand for accountability by legislators as well as researchers in the field. The Principles of Effectiveness stated in the Safe and Drug-Free Schools and Communities Act of 2002 (U.S. Department of Education, 2002) requires school districts to implement evidence-based prevention programs. An important goal of Healthy People 2010 (National Institutes of Health, 2000) was the prevention of youth substance abuse by providing evidenced-based “research-proven programs for diverse racial and ethnic populations.”

Despite the call for effective substance use prevention, many U.S. middle schools (Ringwalt, Ennett, Vincus, Thorne, Rohrbach, 2002) and high schools (Gottfredson & Gottfredson, 2001) do not provide evidence-based curricula. While a majority of the school districts offer prevention education, most target elementary and middle schools, and less than half of the prevention programs offered delivered evidence-based instruction (Rohrbach, Ringwalt, Ennett, & Vincus, 2005). More recently, Ringwalt et al. (2009) reported an 8% increase from 1999 to 2005 in the proportion of middle schools nationally that implemented a tested and effective drug prevention program. Further, based on data collected from high schools in 2005, Ringwalt and colleagues (2008) reported that a relatively modest proportion of these schools delivered evidence-based substance prevention curriculum. Based on 2004-2005 data from state educational agencies, Cho and colleagues (Cho, Hallfors, Iritani, & Hartman, 2009) reported that only a third of the middle and junior high schools across the nation used evidenced-based prevention curricula.

A task force appointed by the Society for Prevention Research Board of Directors has outlined detailed and comprehensive standards for prevention programs to be judged efficacious, effective, and ready for dissemination (Society for Prevention Research, 2004). Elaborating on these standards, Flay et al. (2005) emphasize the importance of accounting for the “real world conditions” in which programs are implemented, which are often not considered when the efficacy of prevention programs is reported However, as Sloboda and collegues (Sloboda et al., 2008) point out, substance use prevention programs in schools have become so pervasive that it is almost impossible to test program effectiveness with “pure” control schools where no intervention is offered. This all suggests that it is time to take stock of the variety and multiplicity of the prevention programs offered in schools across the nation.

Teachers regularly tailor curricula to meet the specific needs of their students (Ringwalt et al., 2002) or their preferred teaching style, such as formal lecturing as opposed to interactive guided participant modeling techniques (Backer, 2000; Pentz, 2004). Oftentimes teachers omit key points or entire lessons from the programs they adopt. Teachers, schools, and school districts not only modify individual prevention programs, they sometimes elect to develop their own customized curricula from a variety of programs and other available curricular materials. Even when schools adopt a specific substance use prevention program, there is variability in the intensity of implementation in terms of the number of sessions offered (Payne, Gottfredson, & Gottfredson, 2006). It is also possible that school districts may implement a program in the earlier grades but refrain from offering the recommended booster sessions in later grades. Even as the quality and quantity of implementation of any one program may vary between schools; schools may choose to implement two or more prevention programs either simultaneously, or in different grades, or in different classes (e.g., health education, physical education, science, etc.). Due to these many variations in prevention program implementations, it is often difficult to ascertain their effectiveness in the real world.

Bearing in mind the imperfect nature of prevention program implementation, this paper identifies the relative prevalence and trends in state, local, and commercial programs from 2001 to 2007 based on large nationally representative samples of U.S. schools. Using reports from school administrators, we document the average number of different prevention programs students received by the time they were in 8th, 10th, and 12th grades and the mean judged effectiveness of the nine most prevalent programs. We also report the prevalence of these different programs by several school demographic factors.

The near impossibility of a definitive test of program effectiveness (Sloboda et al., 2008) and schools’ idiosyncratic implementation of prevention programs suggests that an alternative is to examine the extent of students’ exposure to key elements of prevention programs from elementary through high school. Key elements of successful prevention programs include preventive activities such as development of awareness and resistance skills (knowledge including messages from media, normative education, resistance to peer influences, and emphasis on healthy behavior), personal, efficacy, and social skills (decision-making, coping and stress management, and communication); affective components (e.g., improve self-esteem), role playing, and parental involvement intended to reduce substance use (Botvin, 1990;Drug Strategies, 1999). In this report we present the extent of exposure to each of these activities and components across the different programs – local, state, and commercial – that 8th, 10th, and 12th graders attend starting from their elementary school years up to the target grade that participated in the MTF study.

Methods

Sample

Beginning in 1998, the University of Michigan’s Youth, Education, and Society study (YES), funded under a grant from the Robert Wood Johnson Foundation, started monitoring the extent and quality of drug prevention education in American schools. (See www.yesresearch.org for more information on the study.) YES gathered data from school administrators (usually principals) from schools that participated in the Monitoring the Future (MTF) study from 2001 to 2007 (N = 1206; 458 eighth-, 408 tenth-, and 340 twelfth-grade schools). Each school participated in the study for two consecutive years; students in a single target grade (8^th, 10^th, or 12^th) were surveyed. Administrators of schools that had just completed their second year of participation in MTF were invited to complete a survey for YES. The overall response rate to the YES survey was 83%; approximately 80% of those responding were school principals, but in some cases assistant principals, teachers, or counselors completed the questionnaires.

MTF is based on large nationally representative samples of 8th-, 10th-, and 12th-grade students selected through a three-stage sampling procedure. Geographic regions are selected first, followed by schools randomly selected with a probability proportional to size. The third step involves a random selection of students within these schools, usually clustered in whole classrooms. The schools participating in this study in 2001–2007 included a national weighted representative sample of 36,434 eighth graders, 33,234 tenth graders, and 27,372 twelfth graders.

Survey Administration Procedure

Surveys were mailed to the school and these were followed up with phone calls by trained callers to ensure that school administrators had received the surveys. If the completed questionnaires were not returned within a four to six week period, further follow up phone calls were conducted. If a returned questionnaire was incomplete the respondents were called to follow-up on missing items. If sections on the prevention programming questionnaire were not returned, respondents were sent additional copies to be completed or to confirm that no such program was offered. The instructions at the beginning of the survey encouraged school administrator to ask the teachers who delivered the programs to complete the questionnaire.

To ensure that we received a detailed listing of all the prevention programs that students in the targeted grade received, school administrators or their selected representative completed a checklist of all the prevention curricula provided in their school and the schools that fed into their school. They were then asked to provide detailed information for each of the programs listed. School administrators were also requested to contact the feeder elementary or middle school principals, if necessary, to check the accuracy of the information regarding prevention programs offered to the current targeted grade – 8th, 10^th, or 12– when these students were in elementary and middle school.

School administrators reported all ATOD prevention programs including those incorporated in health education classes, taught in any classes other than health education, or any additional programs students received from elementary grades to the target grade. They were encouraged to ask the teachers who taught the program to complete the specific section devoted to the listed program. In an effort to make sure that the person teaching the program/s filled in the appropriate sections we requested a listing of all the school personnel who completed the various sections at the end of the questionnaire.

Measures

The YES survey instrument includes questions about (a) the school’s substance use policies related to alcohol, tobacco, and other drug use (ATOD) as well as physical activities and nutrition; and (b) alcohol, tobacco, and other drug prevention programs taught to 8th, 10th, or 12th graders both in their current schools and while they were in schools that fed into their current school.

For every program listed, information was requested on:

1. whether the program is developed by the state, locally, or by a commercial organization,¹

2. special curriculum features of the ATOD prevention program (e.g., providing knowledge, normative education, refusal skills, communication skills, coping skills, critical thinking skills, decision-making skills, parent involvement, and role-playing),

3. percent of students in the target grade that participated in the prevention program,

4. overall effectiveness of the ATOD prevention program as perceived by the administrator, and

5. characteristics of individual(s) responsible for delivering the program.

Demographic Characteristics

Table 1 includes the number of schools within each demographic characteristic. The prevalence and intensity of implementation of the various substance use programs were examined across the following school demographic characteristics:

Table 1.

Mean Number of Programs Students Attend by Year and School Demographic Characteristics

	N	Mean Number of Programs (1 – 6)	Bivariate Regression			Multivariate Regression (including school racial composition)			Multivariate Regression (including % students on free and reduced lunch status)
			B	SE	t-value	B	SE	t-value	B	SE	t-value
Year (2001–2007)	1206	1.62	−.05	.01	−3.58***	−.05	.01	−3.94***	−.05	.01	−3.75***
Grade
8 (Reference)	458	1.64
10	408	1.56	−.07	.06	−1.17	−.12	.06	−1.86	−.13	.06	−2.14*
12	340	1.66	.02	.07	0.34	−.01	.06	−0.20	−.05	.06	−0.76
Type of school
Public (Reference)	1092	1.63
Private	114	1.55	−.08	.09	−0.88	−.02	.10	−.25	−.18	.11	−1.65
School size
Small (Reference)	183	1.61
Medium	440	1.60	−.01	.08	−0.12	.07	.08	0.79	.01	.08	0.18
Large	583	1.64	.03	.08	0.36	.21	.09	2.35*	.15	.09	1.57
School racial composition
Predominantly White  (Reference)	768	1.74
Majority African  American	87	1.47	−.27	.10	−2.59**	−.24	.11	−2.29*
Majority Hispanic	90	1.23	−.51	.10	−5.03***	−.39	.11	−3.64***
Other	261	1.46	−.28	.07	−4.28***	−.21	.07	−3.12**
SES (Percent of students on   free and reduced-cost   lunch)	1206	1.62	−.04	.01	−3.88***				−.05	.01	−4.10***
Population Density
Non-MSA (Reference)	290	1.72
Large MSA	347	1.52	−.19	.07	−2.65**	−.17	.08	−1.98*x	−.28	.08	−3.45***
Other MSA	569	1.63	−.09	.07	−1.38	−.10	.07	−1.30	−.15	.07	−2.10*
Region of the country
West (Reference)	237	1.37
Northeast	219	1.64	.27	.09	3.18**	.20	.09	2.32*	.31	.09	3.61***
Midwest	320	1.81	.44	.08	5.65***	.34	.08	4.00***	.42	.08	5.29***
South	430	1.60	.22	.07	3.04**	.18	.07	2.30*	.23	.07	3.12**

Notes. 1. Column 1 includes the numbers indicating the category within each categorical variable. Year of participation and percent of students on free and reduced-cost lunch are treated as continuous variables.

2. B represent unstandardized regression coefficients.

^*p < .05

^**p < .01

^***p < .001

Type of school

categorized as public and private.

School size

defined by the number of students in the target grade (8th, 10th, or 12th) as small (<75), medium (≥75 and <225), and large (≥225).

Racial/ethnic makeup of the student body

Schools where administrators report that 66% or more of the student body is White are identified as “predominantly White.” Schools where African American or Hispanic students constitute 50% or more of the student body are labeled “majority African American” and “majority Hispanic,” respectively. Schools that did not fall into the above three categories were classified as “other.”

School socioeconomic status (SES)

This was measured by the percentage of students in the grade participating in the federal free and reduced lunch program; thus, higher values indicate lower SES. Eight percent had 75-100% of all students participating, 15% had 50-75% participating, 30% had 25-49% participating, and 46% had less than 25% participating in the program. On average, 33.25% of students (SD = 25.96) participated in the federal free and reduced lunch program. This measure was used as a continuous variable for the analyses.

Population density

Three strata based on population density, as defined by the U.S. Census Bureau—Large Metropolitan Statistical Areas (Large MSAs), Other Metropolitan Statistical Areas (Other MSAs), and non-Metropolitan Statistical Areas (non-MSAs) (see Johnston et al., 2009 for details).

Region of the country

Four mutually exclusive regions of the country based on Census categories—Northeast, Midwest, South, and West (see Johnston et al., 2009 for details).

Results

The descriptive results in this section pertain to all ATOD prevention programs that students received in elementary, middle, and high school. Data on reported use of local, state, and commercial programs and the frequencies of these programs by school demographic characteristics are weighted by number of students. Thus, data from a large school were weighted more than data from a small school to more accurately represent the student population’s experience with the various programs, and it is the student population to which we wish to project the results.

Extent of Exposure to ATOD Prevention Programs

School administrators frequently reported that students received more than one ATOD prevention program. The number of programs the target grade students within each school received ranged from none to as many as six programs, with a weighted mean of 1.62 programs across all schools. We conducted bivariate regression analyses in which the mean number of programs was regressed on each one of the independent variables (year, grade, type of school, school size, school racial/ethnic composition, percent of students eligible for free or reduced lunch, population density, and region of the country), followed by multivariate regression analysis. In order to avoid imprecise estimation of the effects of the two school demographics—school racial/ethnic composition and participation in the federal lunch program—on extent of exposure to prevention programs, multivariate regression analysis for the effect of school racial/ethnic composition excluded participation in the federal lunch program and vice versa².

The unstandardized bivariate and multivariate regression coefficient (B) results of these analyses are presented in Table 1. Two series of multivariate analyses are presented in Table 1, with the first series including the school racial / ethnic composition and the second series including SES of the student body in conjunction with other demographic characteristics namely, grade level, type of school (public/private) or size of school (small, medium, or large), population density, and region of the country.

Both bivariate (B = −.05, p < .001) and multivariate (B = −.05, p < .001) regression analyses indicate that there was a significant decline in the total mean number of programs³ students received from 2001 (mean = 1.72) to 2007 (mean = 1.45). Bivariate regression suggests that the total number of programs that students in the three grades received did not differ significantly; however, when all demographic variables including percent of students on free and reduced lunch were controlled, 10th-grade students received significantly fewer (B = −.13, p < .05) prevention programs than 8th-grade students. There were no significant differences across type of school (public/private) or size of school (small, medium, or large) in students’ exposure to prevention programs.

Bivariate regression analysis results indicate students in predominantly White schools had significantly higher exposure to ATOD prevention programs relative to majority African-American or Hispanic schools, and other schools. Students in lower SES schools (i.e., schools where a higher percentage of students are eligible for the free or reduced-cost federal lunch program) also received a significantly lower than average number of prevention programs.

After controlling for school demographic characteristics other than participation in the federal lunch program, students in majority African-American (B = −.24, p < .05), majority Hispanic (B = −.39, p < .001), and other schools (B = −.21, p < .01) had significantly fewer prevention programs than students in predominantly White schools. Controlling for all demographic characteristics other than school ethnic/racial composition, higher SES schools were significantly more likely to have more prevention programs than lower SES schools, (B = −.05, p < .001).

Results based on both bivariate and multivariate regression suggest that students in large MSA schools were exposed to significantly fewer programs than students in non-MSA schools, and students in schools in the Western region of the U.S. were exposed to significantly fewer prevention programs than those in all other regions of the country (Table 1). Post hoc tests revealed that compared to the South, students in Midwestern schools received more prevention programs (B_(bivariate) = .22, t = −3.22***, B_{(multivariate)} = .17, t = 2.44*).

Frequently Adopted ATOD Prevention Programs (2001–2007)

The most frequently reported programs that students received were locally developed. In fact, of all the programs that schools used, 47% were described as local programs, 9% as state programs, and 35% as commercial programs including D.A.R.E. Of the state and commercial programs, D.A.R.E. is the most widely adopted, accounting for 30% of all programs mentioned (Table 2). Approximately 3% of the programs were listed as health education curriculum. The next five most popular ATOD programs in descending order were Alert, Here’s Looking at You, Life Skills Training, Lions Quest, and Too Good for Drugs II. Four (DARE, Alert, Here’s Looking at You, and Life Skills Training) of the six popular commercial programs listed above, also made it within the top six list in the Hallfors and Getette’s (2002) report of frequently used prevention programs. The mean judged effectiveness for the nine most frequently reported programs on a scale of 1 (Not at all effective) to 5 (Very effective) ranged between 3.13 to 3.90, and the standard deviations ranged between .60 to 1.00 (Table 2). This suggests that school administrators were relatively neutral to slightly positive about the perceived effectiveness of the ATOD prevention programs that students in the target grade received either in their school or in feeder schools. One way analysis of variance comparing the five commercially developed programs plus D.A.R.E and health education curriculum indicated that there were no significant differences in the judged effectiveness among these programs, except between D.A.R.E (Mean effectiveness _D.A.R.E = 3.14, SD = .92) and Lion’s Quest (Mean effectiveness _{Lion’s Quest} = 3.90, SD = .68) (F_{(1, 645)} = 10.16, p < .02), which received the highest rating.

Table 2.

Number and Judged Effectiveness of the Nine Most Frequently Offered ATOD Prevention Programs (2001 to 2007)

Name of Program	Number of Programs	Percentage of All Programs	Mean Judged Effectiveness (1 to 5 scale)	SD Judged Effectiveness
Locally developed program	1067	47.1	3.29	0.74
D.A.R.E.	671	29.6	3.14	0.92
State curriculum	193	8.6	3.35	0.87
Health education curriculum	59	2.6	3.21	0.75
Alert	45	2.0	3.45	0.86
Here’s Looking at You	29	1.3	3.26	0.71
Life Skills Training	23	1.0	3.65	1.00
Lion’s Quest	15	0.7	3.90	0.68
Too Good for Drugs II	15	0.6	3.13	0.60

Notes. Effectiveness was measured on a 1 to 5 Likert type scale with 1 = Not at all effective to 5 = Very effective. Health education curriculum includes health textbooks that we could confirm were school health curriculum. There are 2267 programs listed by schools, 150 programs were a variety of other commercial programs. The denominator for percent was 2267 the total number of reported programs.

Use of Local, State, Commercial, and D.A.R.E. Programs in Schools (2001–2007)

Table 3 documents the weighted percentage of students who received prevention programs developed 1) locally at the school or district level, 2) at the state level, and 3) commercially from 2001 to 2007. As noted earlier, we present results for all commercial programs other than D.A.R.E jointly, and the results for D.A.R.E separately because of its extensive use. Table 3 also presents the odds ratios as to whether a school provided locally developed, state developed, commercial, and/or D.A.R.E programs based on bivariate and multivariate logistic regression analysis with school demographic characteristics, grade, and year as independent variables.

Table 3.

Weighted Percentage of Students Receiving Various Prevention Programs by School Demographic Characteristics: Bivariate and Multivariate Logistic Regression Results

		Local			State			Commercial			D.A.R.E
			Odds Ratio			Odds Ratio			Odds Ratio			Odds Ratio
	N	%	Bivariate	Multi- variate	%	Bivariate	Multi- variate	%	Bivariate	Multi- variate	%	Bivariate	Multi- variate
Total sample	1206	63.6			13.6			22.0			55.6
Grade  8 (Reference)	458	59.9			9.1			29.2			57.6
10	408	64.8	1.24	1.13	13.9	1.61*	1.79*	21.7	.67*	.72*	51.5	.78	.67**
12	339	67.1	1.37*	1.29	16.5	1.97**	2.20***	15.6	.45***	.47***	58.0	1.01	.90
Year (2001 to 2007)	1206	63.6	.89***	.89***	13.6	1.14**	1.15**	22.0	.94	.94	55.6	.93**	.91**
Type of school  Public (Reference)	1092	63.0			13.9			23.5			57.4
Private	114	69.4	1.33	1.17	2.3	.14**	.22*	16.3	.64	.56	38.7	.47***	.51**
School size  Small (Reference)	183			58.9			9.1			27.1	51.7
Medium	440	64.6	1.27	1.38	12.7	1.45	1.01	24.5	.87	.82	53.2	1.06	1.13
Large	583	64.3	1.26	1.36	14.0	1.63	1.39	20.2	.68*	.62	58.7	1.33	1.71*
School racial composition  Predominantly White  ( Reference)	768	67.6			10.7			21.9			60.9
Majority African  American	87	58.0	.66	.74	23.0	2.49***	2.24*	28.1	1.40	1.18	43.3	.45***	.47*
Majority Hispanic	90	47.1	.43***	.43**	14.2	1.38	1.93	34.9	1.92**	1.76	41.6	.52**	.58
Other	261	59.3	.70*	.80	15.1	1.49	1.32	19.5	.87	.90	49.0	.64**	.67*
SES (Percent of students on free and reduced lunch)	1206		.90***	1.0		1.10**	.97		1.09**	1.03		.96	.99
Population Density Non-MSA (Reference)	290	57.8			17.8			23.3			61.2
SR-MSA	347	65.3	1.38	1.35	8.7	.44***	.37**	20.4	.85	1.01	50.7	.65**	.72
NSR-MSA	569	65.5	1.39*	1.38	12.7	.68*	.57*	24.0	1.04	1.30	55.8	.80	.81
Region of the country West (Reference)	237	60.6			8.1			24.3			46.9
Northeastern	219	68.8	1.43	1.23	8.6	1.08	1.43	23.8	.97	1.10	47.7	1.03	1.07
Midwest	320	74.8	1.93***	1.68**	4.1	.49	.52	24.3	1.00	1.07	66.2	2.22***	2.12***
South	430	54.4	.77	.72	24.0	3.06***	3.45***	20.4	.80	.81	56.6	1.48*	1.52*

Notes. 1. Column 1 includes the number of schools indicating the category within each categorical variable.

2. Year of participation and percent students on free and reduced-cost lunch are treated as continuous variables.

3. B represent unstandardized regression coefficients.

^*p < .05

^**p < .01

^***p < .001

Overall, across grades and years, 63.6% of 8th-, 10th-, and 12th-grade students received substance use prevention programs that were developed locally in their school or district. The next most frequently reported prevention program was D.A.R.E, with 55.6% of students participating in this program. School administrators reported that 22.0% of students received a commercially developed prevention program other than D.A.R.E. Only 13.6% of students received prevention programs developed at the state level.

Trends in reported use of local, state, commercial, and D.A.R.E. programs

There was a significant, though moderate, decline from 2001 to 2007 in the odds of schools providing locally developed programs and D.A.R.E. In contrast, over the years, there was a significant increase in the odds of schools providing state developed programs. However, the overall percentage of students who attend state developed programs was much less than for the other types. There were no significant shifts over the years in the odds of schools implementing commercial programs.

School demographic characteristics and use of local, state, commercial, and D.A.R.E. programs

Across all schools and within every demographic characteristic, a much higher percentage of students attend locally developed prevention programs, followed by D.A.R.E. and other commercial programs. Only a very small percentage of students attend state developed programs (Table 3).

There were no significant differences, as indicated by the bivariate and multivariate logistic regression estimates, between public and private schools in the odds of providing local or commercial programs. However, the odds of providing D.A.R.E were significantly higher in public as compared to private schools. Very few (N < 3) private schools provided state run programs thus precluding any comparison in the odds of private and public schools providing state run programs.

Bivariate regression estimates suggest that school size was not significantly predictive of the odds of providing local, state, or D.A.R.E. programs. However, multivariate regression results suggest that when other demographic factors are accounted for, the odds of large schools providing D.A.R.E. were significantly higher than small schools. In bivariate regression, large schools were significantly less likely than small schools to provide commercially developed programs, but this association was not significant in multivariate regression.

The odds of providing local, state, or D.A.R.E. programs varied significantly by population density. The odds of providing locally developed programs are significantly higher and the odds of providing state developed programs and for D.A.R.E. are significantly lower in schools in the large and other MSAs as compared to schools in non-MSAs.

The odds of schools providing local, state, and D.A.R.E. programs varied significantly depending on the region where schools were located. The odds of having state developed programs were highest in schools in the South, while the odds of Southern schools having locally developed programs were lower than for schools in the Northeast and Midwest. Bivariate and multivariate regression results indicate that schools in the Midwest had the highest odds of offering D.A.R.E.

Predominantly White schools were more likely to provide D.A.R.E., and they were less likely than schools with a majority African-American student body to provide state developed programs. They were also less likely than schools with a majority Hispanic student body to provide locally and commercially developed programs.

Bivariate regression results suggest that the odds of providing state and commercial programs were significantly higher in lower SES schools, and the odds of providing locally developed programs lower in higher SES schools. However, when other demographic variables were included these odds were no longer significant.

Weighted Coverage of Key Components across Programs

For each of the ATOD program reported as being taught in the school or in feeder schools, administrators were asked to indicate the specific features or key components included, which we have grouped into four general categories here—cognitive (knowledge, normative education, refusal skills, communication skills, decision-making skills, analysis of media messages), affective (coping skills, improving self-esteem), behavioral (emphasizing healthy behavior and role playing), and parental involvement. As indicated earlier, respondents in the target grades received from none to as many as 6 programs (Mean_{(number of programs taught)} = 1.62). Therefore, the coverage for each of the key components can potentially range from none to 6. The descriptive data for extent of coverage of the key components are presented in Table 4.

Table 4.

Weighted Sum of Key Components Offered to Students (8th, 10th, and 12th Grades)

Key Components Taught	Coverage of Components (Possible range = 0 to 6)
	Mean	SD
Cognitive components  Knowledge of effects of drug   use	1.73	0.82
Decision-making skills	1.63	0.85
Refusal skills	1.58	0.85
Normative education	1.54	0.85
Affective components  Coping skills	1.41	0.86
Communication skills	1.48	0.86
Improve self-esteem	1.44	0.85
Behavioral components  Emphasize healthy behaviors	1.19	0.72
Analyze media messages	1.37	0.85
Involves role play	0.71	0.73
Involves parents	0.37	0.60

Note. N schools = 1206

The pattern of key component coverage is similar across the three grades, so results are shown for the three grades combined. Cognitive components rank highest, with providing knowledge regarding the long- and short-term effects of substance use and teaching decision-making and refusal skills receiving maximum coverage. Coverage of affective components is less, but higher than the behavioral components (e.g., emphasizing health behavior, analyzing media messages, and role playing) or parental involvement.⁴

Prevention Program Instructors

School administrators were asked who delivers the various prevention programs, excluding D.A.R.E., which is delivered exclusively by police officers. The great majority of instructors of prevention programs were teachers, including health education teachers, (88.7%). Other persons who were listed as instructors of prevention programs were other outside ATOD prevention instructors (17.4%), students (16.9%) police officers (16.1%), health care professionals (13.0%), and school counselors (7.7%). Very few curriculum coordinators (1.6%), recovering users (1.2 %), and principals or assistant principals (0.1%) were listed as instructors. (Multiple selections were permitted.)

Discussion

In this study we found that schools and school districts offer students, on average, 1.62 prevention programs across the school years from elementary through high school. D.A.R.E. continues to be the most widely used prevention program, though its use declined from 2001 to 2007. It was offered to more than half the national sample of students over the seven year interval. Two thirds of the sampled schools offer locally developed programs. As administrators report, oftentimes both schools and school districts draw on different prevention programs and health education textbooks to create their own curriculum. Thus the efficacy and validity of program implementation varies among schools, supporting the need to consider “real world conditions” (Flay et al., 2005) in developing evidence-based prevention programs.

Clearly there is no lack of available prevention programs. Over 200 commercial programs are currently available. It appears, based on administrators’ listings of programs taught, that schools oftentimes develop their own curriculum, cherry-picking from different programs to suit their needs. Under these circumstances, it is difficult to determine the effectiveness of any one program. Further complicating the issue, programs are often implemented in different grades and in different courses such as health education, physical education, or other classes such as biology. The findings suggest that program implementation is idiosyncratic, depending on the school or school district, and the teacher(s) in charge of delivering prevention education to students.

The popularity of programs does not necessarily mean that they are the most effective in preventing substance use. As Hallfors and Godette (2000) suggest evidence-based programs, if ineffectively marketed, are less likely to be adopted by schools. However, among the nine most popular programs identified in this study, Lion’s Quest (though offered in only 15 schools in the sample) had the highest judged effectiveness based on school administrator ratings, possibly due to the comprehensive nature of the program. It is one of the few programs that actively solicit participation from family, community members, and the school. It also engages students at all grade levels—elementary, middle, and high school—to provide developmentally appropriate prevention instruction on essential skills needed for living healthy and productive lives.

Certain key components are incorporated in all prevention programs (e.g., providing knowledge, refusal and decision-making skills); other components are less frequently included (coping and communication skills, analyzing media); and some are seldom included (e.g., role playing and parental involvement). Recent research (Hansen & Dunesbury, 2004) indicates that some of these components (e.g., decision-making skills) are more effective than others (e.g., providing knowledge about different substances) in preventing adolescent substance use. Regarding the problems related to fidelity of implementation and the need to consider real world conditions in developing programs, it may be worthwhile in future to examine the effectiveness of individual components within a program rather than the effectiveness of the program as a whole in preventing and reducing substance use among students. Further research is also required to examine the intensity of exposure to each of these key components as it relates to substance use among adolescents.

Limitations of the Study

The purpose of this study was to report on the existing state of affairs in our schools with regard to prevention programs. In this report we present the relative prevalence and trends in state, local, and commercial programs in the United States. While the information contained in this report is valuable and unique there are some limitations to this study. This is a descriptive report of what exists in schools. Therefore, it does not examine the relationship between the intensity and fidelity of implementation of prevention programs and students’ use of substances. This is important and needs to be pursued for future research.

The findings suggest that starting from the elementary grades, students in targeted grades received a combination of prevention programs, some that are identified as documented research-based programs and others with little documented research evidence. Thus, while the study identifies the nine most frequently offered programs, it was not feasible to document the proportional percentage of research-based programs currently offered by schools. This study does, however, highlight the problems associated with determining the fidelity with which programs are implemented in schools. The findings suggest that it is probably better to examine the relative effectiveness of key cognitive, affective, and behavioral components of the program.

Another limitation of this study is that a high percentage of principals state that the programs they list were developed locally in the district. Occasionally they also report on state developed programs. However, there was great variability in the content and curricula of the locally and state developed prevention programs, precluding us from making any inferences about them. Even with regard to commercially developed programs, the numerous programs that were listed and the great variability in the intensity of implementation of these programs prevented us from making any sort of inferences that distinguished commercial programs from other programs. It was only in the case of a few popular programs, six to be precise, that we were able to examine the school administrators’ report on the quality of program implementation. These findings are in line with Hallfors & Godette’s (2002) report that 53% of the surveyed school coordinators reported using locally developed curricula and 52% indicated that they had adapted or combined curricula from different prevention programs.

Results from this study provide evidence that across the nation predominantly White schools and high SES schools are likely to provide more prevention programs for their students. This finding requires collection of additional data that focuses on this issue. Unfortunately, the school administrator survey does not provide us the data to understand the reasons for this discrepancy between high and low SES schools and predominantly White and majority Black schools,

Another limitation is the reliance on self-reported information. For the most part we have no data on reliability and validity. It was not possible to monitor how conscientiously school administrators responded to our request regarding contacting the feeder elementary and middle schools for accurate information about the prevention programs that students in the targeted grade received. However, we believe most of the key information on what programs are used is likely to be known by either the principal or the person designated to fill out those sections of the questionnaire, and there is little “social desirability” reason not to be forthcoming in responding.

Conclusion

Despite these limitations, this study is one of the first to document, based on a nationally representative sample of schools, the existing state of affairs regarding the nature and implementation of school prevention programs. This first step will help us reassess our strategies for examining fidelity of program implementation, and whether or not tailoring programs to local needs makes them more relevant and meaningful.