Table 1.

Computer-Based Substance Use Prevention and Intervention Programs for Youth (2012–2017).

	Sample (N)	Program Description	Comparison	Outcomes and Attrition
School-Based Prevention Programs
Prevent smoking.  Bowen et al. [26]	American Indian youth in South Dakota schools (113); M age 14.6 yrs.	Online, culturally relevant modules that youth were encouraged to visit during 1-hr. daily access periods for 6 wks.; modules asked about smoking status and provided responsive content on smoking prevention and cessation.	Online module access vs. wait-list control.	At 1 mo., intentions to try cigarettes declined; youth were more likely to help others quit smoking, and had less positive attitudes about the drug effects of smoking. Roughly one-half of youth (52%) signed into the modules at least once during intervention period. Attrition was 9%.
Reduce substance abuse and energy imbalance.  Velicer et al. [27**]	Adolescents in Rhode Island schools (4,158); M age 11.4 yrs.	Five, 30-min. computer sessions; one in 6th grade, three in 7th grade, and one in 8th grade; one-half of youth received energy balance sessions and one-half received substance use prevention sessions; intervention was tailored to youths’ baseline health behaviors.	Energy balance arm vs. substance use prevention arm.	At 36 mos., energy balance intervention increased physical activity and healthy diets and reduced TV time, smoking, and alcohol use. The substance use prevention program was less effective in preventing smoking and alcohol use. Attrition at 36 mos. was 28.3%.
Prevent tobacco use.  Andrews et al. [28]	Oregonelementary and middle schools (2,322).	Computer program delivered in classroom; eight sessions in 5th grade and two boosters in 6th grade, encompassing videos, games, role-plays, and social networking activities.	Computer-based program vs. usual curriculum.	At 1 and 2 yrs., lower intentions and willingness to smoke, and positive changes in mediator variables. Attrition at 1 and 2 yrs. was 28.4% and 32.8%, respectively.
Promote health.  Bannink et al. [29]	Adolescents in Dutch high schools (1,702); M age 15.9 yrs.	1. Internet program of a questionnaire with tailoring of messages, norms, and links to websites for information about alcohol, drugs, sex, bullying, mental health, and suicide; duration 45 mins. 2. Internet program plus consultation with nurse who applied motivational interviewing on risk factors identified by questionnaire.	Both interventions vs. control.	At 4 mos., internet intervention-alone increased condom use and quality of life ratings. Internet plus consultation improved mental health status. Attrition was 26.2%.
Reduce drinking.  Doumas et al. [30, 31]	Adolescents in Northwestern U.S. schools (538); M age 14.2 yrs.	Online assessment and personalized normative feedback modules covering caloric and financial costs of drinking; individual drinking patterns compared to U.S. norms and local peers; risk status for negative consequences of drinking; risk avoidance strategies; information about alcohol; and referral information; average duration 30 mins.	Online program vs. usual drug and alcohol education.	At 3 mos., reduced positive alcohol expectancies and beliefs, drinking frequency, and alcohol-related consequences. No differences at 6 mos. Attrition at 3 and 6 mos. was 21% and 31%, respectively.
Prevent smoking.  de Josselin de Jong et al. [32]	Adolescents in Dutch high schools (6,078); M age 14 yrs.	Web-based program of text, graphics, and animated videos covering awareness, motivational, and action factors, accessed through a home page and providing tailored feedback.	Web-based program vs. control.	At 6 mos., lower rates of smoking initiation for youth aged 14 to 16 yrs., but not for the total sample of youth aged 10 to 20 yrs. Attrition was 18%.
Prevent tobacco, alcohol, and cannabis use.  Malmberg et al. [33]	Adolescents in Dutch high schools (3,784); M age 14 yrs.	1. Computer arm: Modules on tobacco, alcohol, and marijuana delivered over 4-mos., covering knowledge, risks, coping with peer pressure, and refusal skills delivered through films, animation, interactive tasks, and discussions in chatrooms and forums. 2. Integral arm: Same computer program plus parental participation, regulation (school standards), monitoring and counseling of training for school staff.	Both intervention arms vs. control.	No effects for either arm on tobacco, alcohol, or cannabis consumption. Attrition at 8, 20, and 32 mos. was 9.2%, 17.7%, and 33.9%, respectively.
Reduce truancy, psychological distress, and moral disengagement  Newton et al. [34]	Adolescents in Australian high schools (764); M age 13.1 yrs.	Internet program of two sets of six 40-min. sessions to decrease alcohol misuse and cannabis use, followed by booster sessions 6 mos. of 15- to 20-min. cartoons showing teenagers experiencing problems with alcohol and cannabis and a compatible teacher-led activity.	Internet program vs. usual health classes.	At 12 mos., reduced truancy, psychological distress, and moral disengagement. Attrition at 12 mos. was 20.7%.
Prevent psychostimulant and cannabis use.  Vogl et al. [35]	Adolescents in Australian high schools (1,734); M age 15.4 yrs.	Computer- and teacher-delivered program of six, 40-min., lessons, divided into 15- to 20 min. segments; involving cartoon depictions of high-risk situations. Classroom segment delivered by teachers involved role-plays, discussion, and skill rehearsals.	Computer- and teacher-delivered program vs. usual health curriculum control.	At post-intervention, improved psychostimulant knowledge, lower ever use and frequency of use of ecstasy, lower intentions to use psychostimulants; at 5 and 10 mos., improved cannabis knowledge; at 10-mos., less favorable attitudes toward cannabis; at post-intervention and 10-mos., less favorable attitudes toward psychostimulants. Females showed more positive changes than males. Attrition at post-intervention and 5 and 10 mos. was 15.6%, 24.6%, 28.8%, respectively.
Prevent smoking.  Cremers et al. [36]	Preadolescents in Dutch elementary schools (3,213); M age 10.4 yrs.	1. Prompt arm received questionnaires and tailored feedback messages sent on 3 consecutive days plus six prompt messages via email and SMS each year encouraging use of intervention website. 2. No-prompt arm received same questionnaires and tailored feedback, but did not receive the additional six messages.	Both intervention arms vs. control.	No effects for either intervention at 12 or 25 mos. Attrition was 33.2% and 53.8% at 12 and 25 mos., respectively.
Prevent substance use.  Arnaud et al. [37]	Adolescents in Swedish, German, Belgian, and Czech high schools (1,449); M age 16.8 yrs.	Computer program of six-motivational interviewing components presented in text and graphics; median duration 15 mins., ranging from 5 to 30 mins.	Program vs. control.	At 3 mos., reduced past-month drinking (findings not substantiated by imputed analyses). Attrition was 85.5%.
Reduce alcohol and cannabis use.  Champion et al. [38]	Adolescents in Australian high schools (1,103); M age 13.3 yrs.	Twelve, 20-min. cartoon components accessed online, followed by teacher-led discussions, role-plays, and worksheet completions.	Online plus teacher intervention vs. control.	At post-intervention, increased alcohol and cannabis knowledge and decreased alcohol use and intentions to use alcohol. Attrition was 20%.
Reduce ecstasy and psychoactive substance use.  Champion et al. [39]	Adolescents in Australian high schools (1,126); M age 14.9 yrs.	Four, 20-min. cartoon components accessed online, followed by optional online and teacher-delivered discussions and online worksheets.	Online plus teacher intervention vs. control.	At post-intervention, altered knowledge about psychoactive drugs and ecstasy. At 12 mos., reduced likelihood to use psychoactive substances. Attrition was 35.3% and 36.3% at post-intervention and 12-mos., respectively.
Reduce binge drinking.  Jander et al. [40]  Drost et al. [41]	Adolescents in Dutch high schools (2,649).	Computer game of five sessions in which youth are presented with drinking situations, asked to respond, and receive tailored feedback on their drinking behavior and plans; duration varied by youth.	Computer game vs. control.	At 4 mos., reduced binge drinking for 15- and 16-yr- olds, but not for older youth. Computer intervention was cost-effective for subgroups of adolescents. Attrition was 68.9%.
Prevent tobacco and alcohol use.  Kiewik et al. [42]	Adolescents with developmental disabilities in Dutch special-needs high schools (254); M age 13.6 yrs.	Computer program of games, videos, quizzes, and examples of refusal skills; avatar provided explanations, tips, feedback, and support; youth completed program at own pace.	Computer program vs. control.	At post-intervention, improved knowledge of smoking and drinking and lower peer use of tobacco. Attrition was 17.4%.
Prevent smoking.  Nădășan et al. [43]	Adolescents in Romanian high schools (1,369); M age 15.9 yrs.	Web delivery of five weekly, 45- to 50-min. sessions, covering determinants of smoking, nicotine addiction, strategies to quit and resist smoking, and dealing with stress, peer pressure, temptations, and mood changes.	Web program vs. control.	At 6 mos., reduced likelihood of smoking initiation among never-smoked youth. Lower initiation rates most pronounced for youth exposed to at least 75% of the program. Attrition was 30.7% for web arm and 20.9% for control arm.
Reduce alcohol risk factors.  Doumas et al. [44]	Adolescents in Northwestern U.S. high schools (346); M age 17.2 yrs.	Online assessment and personalized normative feedback modules, including graphic depictions of the consequences of drinking in caloric content, physical performance, myths, peer drinking norms, beliefs, expectancies, risk factors, and potential for problems; duration 30 mins.	Web program vs. alcohol and drug education delivered by school counselor.	At 4 to 6 wks., reduced perceptions of peer drinking, beliefs about alcohol, and positive alcohol expectancies for females. Attrition was 23.4%.
School-Based Intervention Program
Reduce heavy drinking.  Voogt et al. [45]	Adolescents in Dutch preparatory and vocational schools who reported recent heavy drinking (609); M 17.3 yrs.	Web-based motivational interviewing program covering knowledge, social norms, and self-efficacy; single session of roughly 20 mins.	Web program vs. control.	At 1 mo., lowered binge drinking (in completers-only analyses; intent-to-treat analyses revealed no differences). Attrition was 35.5% and 54% at 1 and 6 mos., respectively.
Non-Traditional Setting Prevention Programs
Prevent cannabis use.  Walton et al. [46]	Adolescent patients at Midwestern U.S. urban primary care clinics (714); M 14.9 yrs.	Animated interactive program with virtual therapist; role-play scenarios; average duration 33 mins. over 2 wks.	Computer therapist vs. same program delivered by live therapist vs. control	At 3 mos., computer program lowered other drug use; at 3, 6, and 12 mos., lowered cannabis use. Live therapist intervention did not affect cannabis use, but lowered other drug use at 6 mos. and delinquency rates at 3 mos. Attrition at 3, 6, and 12 mos. was 11%, 12%, and 12%, respectively.
Non-Traditional Setting Intervention Programs
Prevent HIV disease.  Marsch et al. [47]	Adolescents in outpatient treatment in New York City (141); M age 16.4 yrs.	Web program of 26 modules on drug- and sex-related risk factors for HIV, skills for coping with HIV, and maintaining a healthy lifestyle, including a customized plan; duration 10 to 30 mins. per module.	Web-based program vs. same program delivered by prevention specialist.	At 2 weeks, web program showed increases comparable to prevention specialist in HIV/disease-related knowledge, condom use self-efficacy, condom use skills, and decreases in HIV risk behavior. Web program rated as easier to understand than prevention specialist. No attrition.
Reduce tobacco use.  Mason et al. [48]	Adolescents in community substance abuse clinic in Virginia (72); M age 15.8 yrs.	Motivational interviewing (MI) of rapport building, tobacco use feedback, social network information and feedback, and plans for change, delivered by text messages to smartphones.	MI texts vs. health-related texts sent to attention control arm.	At 6 mos., MI arm decreased cigarettes smoked in past 30 days, increased intentions to not smoke, and increased peer social support. Attrition not reported.
Reduce violence and alcohol misuse.  Cunningham et al. [49]	Adolescents at an emergency department who screened positive for violence and alcohol use in Michigan (726); M 16.8 yrs.	1. Computer program alone: interactive cartoons and tailored feedback. 2. Therapist-assisted: same computer program plus assistance from in-person therapist.	Computer program vs. therapist-assisted program vs. control.	At 12 mos., therapist-assisted arm reduced peer aggression and peer victimization. No differences for computer-only arm. Attrition was 16.4%.
Reduce risky drinking.  Walton et al. [50]  Cunningham et al. [51]	Adolescents at an emergency department who screened positive for risky drinking in Michigan (836); M 18.6 yrs.	1. Computer program of three sections covering normative feedback, personal strengths, and alternatives to drinking; M duration 34.7 mins. 2. Therapists who led youth through the same computer program; M duration 45.5 mins.	Computer program vs. therapist program aided by computer vs. control.	Computer and therapist arms lowered rates of alcohol consumption at 3 mos., alcohol consequences at 3 and 12 mos., and prescription drug use at 12 mos. Computer arm lowered DUI rate at 12 mos. Therapist arm reduced frequency of alcohol-related injuries at 12 mos. Attrition was 13.2% and 12% at 3 and 6 mos., respectively.
Home-Based Prevention Programs
Prevent substance use.  Fang et al. [52]	Adolescent Asian-American girls and their mothers from across the U.S. (108 dyads, 216 total participants); M 13.1 yrs.	Interactive online program of nine 35- to 45-min. sessions of audio, graphics activities to engage mothers and daughters in skills demonstrations and guided rehearsals with feedback; duration M = 175 days.	Online program vs. control.	At 2 yrs., daughters and mothers increased closeness and communication, maternal monitoring, and imposition of family rules against substance use. Daughters increased self-efficacy and refusal skills, lowered their intentions to use harmful substances, and reported less alcohol, marijuana, and prescription drug use. Attrition was 13.9%.
Reduce illicit drug use.  Schwinn et al. [53]	Adolescents who identify as LGBTQ from across the U.S. (236); M age 16.1 yrs.	Three online sessions of interactive games, role-playing, writing activities, stress management skills, decision making, and drug refusal skills; duration of each session 14 mins. Youth took an average of 4 mos. to complete.	Online intervention vs. control.	Lower 3 mos. rates of stress, peer drug use, and 30-day other drug use, and higher coping, problem-solving, and drug refusal skills. Attrition was 15%.
Reduce drug use.  Schwinn et al. [54]	Adolescent girls from across the U.S. (788); M age 13.7 yrs.	Web program of nine sessions, each requiring 15 to 20 mins. to complete, covering goal setting, body image, coping, drug knowledge, and refusal skills, and involving virtual role-playing in response to stimulus scenarios.	Web program vs. control.	At posttest, fewer cigarettes smoked and higher self-esteem, goal setting, media literacy, and self-efficacy scores. At 1 yr., less binge drinking and smoking and better marijuana refusal skills, coping skills, and media literacy and lower peer drug use. Attrition was a 2.5% and 3% at posttest and 1-yr. follow-up, respectively.