Piloting of the Just Say Know Prevention Program: A Psychoeducational Approach to Translating the Neuroscience of Addiction to Youth

Abstract

Background:

Substance use during adolescence can have a number of negative consequences and interfere with normal brain development. Given limited time and resources, brief group- and school-based prevention programs are an efficient strategy for educating youth about the effects of substance use on health outcomes.

Objectives:

To determine if a science-based, interactive substance prevention program could improve student knowledge and influence students’ attitudes towards future substance use behaviors.

Methods:

The Just Say Know program was given to 1,594 middle and high school students. The facilitator engaged students in an interactive, hour-long session covering brain basics and effects of substance use. Students completed an eight-item pre- and post-knowledge-based test to measure learning outcomes along with feedback questions about youths’ attitudes toward substance use and the program.

Results:

After the program, 94% of students reported that it provided helpful information; 92% reported it may influence their approach to substance use, with 76% specifying that they would delay or cut back on substance use. Knowledge-based test performance increased by 78%, with high schoolers displaying significantly higher scores than middle schoolers, but both showing similar improvements in scores. Students who reported higher levels of friends’ substance use had smaller improvements from pre- to post-test.

Conclusion:

Results suggest Just Say Know, a scientifically-based prevention program, is effective in increasing adolescents’ program based-knowledge, has the potential to affect youths’ attitudes towards substance use, and is well-received. These findings provide preliminary evidence that a cost-effective, neuroscience-informed group prevention program might reduce or delay adolescents’ future substance use.

Introduction

Adolescence encompasses a period of physical, emotional, social, and neurodevelopmental changes as youth transition from childhood into young adulthood. It is also a period of time associated with increasing rates of substance use and risk-taking behaviors. The average age of alcohol use initiation in the U.S. is approximately 15 years, and by age 16, over one-third of youth report using alcohol in the past year (1), while over a quarter report past-year cannabis use (2). Additionally, use of electronic nicotine delivery systems (e.g., e-cigarettes, vapes, pod-mod devices like JUUL) have risen markedly among youth and rates of vaping nicotine are now comparable to alcohol and cannabis use rates (2–5). Other illicit substance use (i.e., opioids, cocaine, hallucinogens) remains less common among adolescents (2), yet their use tends to increase as they move into young adulthood.

Given the prevalence of initiation and continued use of alcohol and other substances among adolescents, middle and early high school years are an important time to educate and moderate these behaviors through prevention strategies. A harm-reduction framework, which focuses on reducing negative consequences associated with substance use and setting moderation goals (6), may be an especially compatible strategy when working with adolescents and young adults. Delaying, preventing, and reducing adolescent substance use has the potential to confer long-lasting benefits to both the individual and public. For example, exposure to the neurotoxic effects of alcohol and other substances at an early age serves as a risk factor for disordered use in adulthood (7, 8), lower educational achievement (9), and abnormal brain development (10, 11). On a larger scale, substance use problems have serious health and economic impacts, with alcohol being the leading cause of premature death and disability among individuals 15–49 years and having an estimated annual economic impact at over $250 billion (13). Opioid dependence and cigarette smoking remain major public health concerns as well (14, 15). In the United States, cigarette smoking alone contributes to more than 480,000 preventable deaths each year (16), while opioid use contributed to more than 47,000 drug overdose deaths in 2017 (17).

Numerous large-scale school and community-based drug prevention programs have been developed, but the majority have produced only limited effects on substance use prevention or reduction. Specifically, less than 50% of alcohol prevention programs were more efficacious than their control counterparts (18). One early well-known program, Drug Abuse Resistance Education (D.A.R.E.), otherwise known as the Just Say No campaign, aimed to educate students on the dangers of substance use through police-led education. Not only did most students surveyed report neutral or negative affect towards those delivering this zero-tolerance campaign (19), but the project also demonstrated no effectiveness in influencing adolescent substance use behaviors (6). Numerous newer prevention programs have been developed to educate youth on the dangers of illicit substance use and several have reported successfully reducing, delaying, and preventing later substance use (20–26). These programs have encompassed multiple modalities, including various delivery formats, intervention types, and lengths. Many of these programs have been implemented in school settings, given the ease and benefits of accessing large groups of youth.

Multiple promising long-term school-based programs have focused on developing prosocial behaviors and social skills and correcting misperceptions about drug use. Much success has been shown for the EUropean Drug Addiction Prevention trial, which is a 12-hour course implemented throughout Europe that utilizes a comprehensive social-influence approach (21). Student data collected from over 170 schools found that the intervention reduced adolescent drunkenness by 38% and reduced cannabis use by 26% (21). Similarly, the Unplugged program is a year-long program that focuses on reducing the risk of substance use and developing appropriate knowledge, attitudes, and both interpersonal and intrapersonal skills surrounding substance use (22). Those who received the Unplugged intervention were 25% less likely than the control group to report any smoking (22).

Given limited resources, less time-intensive program options are needed as well. A 2015 meta-analysis focusing on brief (<5 hours) alcohol interventions explored various components of prevention programs (e.g., modality and length) that predicted successful outcomes (23). Individual interventions were found to be effective in changing health, prosocial, and alcohol behaviors, but existing group interventions produced mostly null findings. However, beneficial effects of group-delivered interventions may have been attenuated by deviant peers, implementation issues (e.g., lack of adherence to program protocol), and heterogeneity in modality type. More recent findings suggest that a brief, group-delivered intervention, Preventure, was highly effective in reducing substance use and related problems (20). Preventure is a psychosocial, personality-targeted prevention program that focuses on students with at-risk personality traits and consists of two 90-minute sessions. For high-risk youth engaged in this program, alcohol and drug use were reduced by 50%, and mental health issues by 25%, with effects lasting for up to 3 years, suggesting promise for this type of brief, group-based prevention format.

Existing prevention formats often require several delivery sessions and intensive training for the drug educators (23). However, schools are often limited in the amount of time they are able to dedicate to individual students with non-academic activities and in the resources required to train teachers or other staff members. These barriers are especially relevant for high-risk communities and large public schools. Thus, efforts focused on identifying brief, group-based psychoeducational interventions that can be incorporated into existing science curriculum are important, as these lower cost alternatives are easier to disseminate in schools. Most previously developed psychoeducational programs have focused on educating youth on the harms of substance use, but novel psychoeducational approaches are warranted.

Just Say Know

The current project includes data collected from the Medical University of South Carolina’s (MUSC) Just Say Know program. This program is a research-based alcohol and drug prevention program developed by researchers specializing in the neuroscience of addiction and youth substance use. This program addresses the common challenge of translating scientific advances into easily applied and communicated information to youth (27–29). The presentation and hands-on learning experience are designed to teach middle and high school students the science behind developing problematic alcohol and drug use. This program highlights how the brain works and how alcohol and other drugs can alter brain structure and function, leading to risky behaviors and continued drug use, especially among adolescents. Just Say Know avoids using tactics that have been proven to be unsuccessful, such as directly discouraging drug and alcohol use. Instead, the program implements knowledge-based teaching strategies to inform students on how substance use affects the developing brain and gives youth the agency to make healthy decisions for themselves.

The Just Say Know presentation was piloted and implemented in school and community settings. Students completed brain- and substance use-based knowledge questions before and after the presentation and provided feedback about the program, as well as information about their friends’ substance use behaviors. A priori hypotheses included: (1) students would show significant, increased knowledge regarding substance use and brain development in response to the presentation, above and beyond baseline performance, (2) high school students would perform significantly better on both tests, but middle school students would have similar test score gains as high schoolers, and (3) students would report generally positive attitudes about the program. As an exploratory analysis, (4) we predicted that students who reported high amounts of peer substance use would have lower test score gains than those students reporting low peer substance use.

Methods

Study Population

This program took place in both public and private middle and high schools, as well as community groups such as a youth community center or local camp, in coastal and upstate areas of South Carolina during the 2016–2018 school years. School and program administrators were approached with the science-based Just Say Know presentation on substance use prevention offered through the MUSC’s Addiction Sciences Division. If interested, schools or community group leaders reached out to our program coordinator about scheduling a date for participation. All presentations were given by the same instructor (co-author, S. R.) and to ensure consistency, the instructor followed a standard format, providing the same educational information each time. Presentations were largely delivered in classroom settings, such as science or physical education classes. Anonymous data from pre- and post- surveys were collected from 1,594 students. Respondents ranged from 6^th to 12^th grade. Sixty- three percent of student data was collected from public schools (two school districts), 29% from private schools, and 8% from a community group setting. Data were primarily collected from public schools in the coastal area which have students with the following racial/ethnic identities: 45% White, 40% Black, 10% LatinX, and 5% mixed or other. Approximately one-quarter of the data was collected from an upstate public school district which has students with the following racial/ethnic identities: 78% White, 8% LatinX, 7% Black, 7% mixed or other. The MUSC Institutional Review Board determined the data were exempt from institutional review given no identifiable information was collected and data were collected for program development.

Study Design

The Just Say Know program is a research-based substance use prevention program developed by researchers specializing in the neuroscience of addiction and youth alcohol and other substance use. The goal of the program is to translate scientific knowledge into easily communicated information and provide an interactive learning experience for youth to ultimately prevent both the initiation and escalation of adolescent substance use. The presentation is an hour-long, instructor-led psychoeducational session split into three distinct parts. The first part educates students on the basic functions of how the brain and neural reward system works. The second part focuses on how drugs affect neurotransmitters in the brain and the negative neural and behavioral consequences of continued substance use. This portion of the presentation incorporates scientific literature on substance use and includes a video of a drug-dependent rat self-administering cocaine and functional magnetic resonance imaging (fMRI) brain scans comparing differential neural reward activation to substance cues among heavy substance users versus non-substance users. The third part of the presentation centers specifically on the adolescent brain and provides students with a rationale for why their brains are more vulnerable to the effects of substances. The instructor provides an interactive environment by promoting questions from students and encouraging students to seek out non-substance using peer groups. The presentation closes by inviting students to use their new knowledge to help make healthy decisions about alcohol and other substance use.

Measures

All students were asked to complete a knowledge pre-test, post-test, and feedback questions. Students independently completed the knowledge pre-test prior to the Just Say Know presentation, while knowledge post-tests were completed immediately following the presentation. Both tests included the same eight multiple-choice questions covering brain and substance use material directly discussed in the presentation (available online). The knowledge pre-test served as a baseline measure of students’ individual knowledge of the brain and substance use. The knowledge post-test was used to measure change in baseline knowledge following exposure to the program. At the end of the knowledge post-test, students were asked to complete a brief self-report survey (referred to as Feedback Questions; full set of questions available online) regarding personal attitudes about the presentation, attitudes towards future alcohol and other substance use, ratings of their friends’ alcohol and substance use patterns, and whether they had seen the Just Say Know presentation before. Specifically, students were asked to classify their friends’ alcohol and substance use patterns according to the following options: “most friends are nonusers”, “most friends use occasionally”, “most friends use weekly” or “most friends are problem users.” Students were not asked about their own alcohol or other substance use to prevent student concern over lack of anonymity.

Data Analytic Procedure

Students’ test data were collected on paper forms and knowledge pre- and post-tests were matched with anonymous codes to ensure within-subject data collection. If two or more answer choices were circled, or if an answer choice was not clearly indicated, that data point was left blank and counted as incorrect. Tests were considered incomplete and were excluded if a student left all questions blank on either the pre- or post-test. Thus, students’ test data were excluded from test score analyses if all eight test questions were left blank on either test. Pre- and post-test knowledge scores were determined separately as the total number of correct responses. Knowledge change scores were calculated by subtracting a student’s knowledge pre-test score from knowledge post-test score. Students were grouped into middle (grades 6–8) or high school (9–12) grade levels according to classroom grade. IBM SPSS Statistics Version 25 (IBM Corp, 2017) was used for entering data and conducting summary statistics involving test scores and feedback questions.

To address clustering in the data, multilevel mixed modeling in which students were nested within their specific schools/programs (k=15) was conducted in SAS Version 9.4 on the sample of students who reported seeing the Just Say Know presentation for the first time. Since classroom level information was unavailable, clustering students in their schools/programs provided the most fine-grained approach. For two models comparing pre- and post-knowledge test scores, three-level repeated measures mixed models were utilized in which tests (pre vs. post) were nested within students and students were nested within their school/program. A second model included the addition of a grade level (middle vs. high school) predictor and a grade level by occasion (pre- vs. post-knowledge test) interaction. For additional analyses comparing knowledge change scores by peer use networks, two-level mixed models were utilized in which students were nested within their schools/programs and friend alcohol use and substance use levels predicted knowledge change score. All models were fit using the MIXED procedure in SAS and with maximum likelihood estimation and random intercepts. For all comparisons, statistical significance was set at p<0.05, expect for post-hoc individual comparisons (Bonferroni family-wise correction set at p<.0083; where α’=α/c, # of comparisons=6).

Results

Feedback Questions

Out of 1,594 respondents, 281 students reported seeing the Just Say Know presentation previously and 153 did not respond to this feedback question. Thus, descriptive statistics for feedback questions were run on both the full sample (N=1,594), as well as the sample who indicated that they had not seen the Just Say Know presentation previously (N=1,160). Sample sizes for individual questions vary slightly based on available student responses (see Table 1). Overall, feedback was very positive. From those students seeing the Just Say Know presentation for the first time (N=1,160; see Table 1), 93.9% of students reported the Just Say Know presentation provided helpful information about their brain and substance use and 87.9% reported it was worth their time. Additionally, 92.1% of students said that information from the presentation would (68.2%) or might (23.3%) influence how they approach substance use in the future, with 76.0% (middle school: 79.0%, high school: 66.4%) reporting specifically that they would delay or cut back on alcohol or drug use based on the information provided to them within the presentation. According to chi-square test of independence, middle and high school students responded significantly differently on two of the four feedback questions; high schoolers reported lower rates of ‘Yes’ and higher rates of ‘Maybe’ for two questions asking about future substance use behaviors (p’s<.01; see Table 1). For the full sample of students (N=1,594), feedback was similarly positive, with 85.7% reporting the presentation was worth their time and 74.4% reporting that they would delay or cut back on alcohol or drug use based on the information provided to them.

Table 1.

Student Reponses to Feedback Questions.

Feedback Question	Number of respondents	Yes	Maybe	No	χ2 value (p-value)
Was this presentation worth your time?					1.36 (p=.244)
Total Sample	1,147	87.9%	--	12.1%
Middle School Students	813	88.7%	--	11.3%
High School Students	249	85.9%	--	14.1%
Did the presentation provide helpful information about your brain and substance use?					0.55 (p=.459)
Total Sample	1,153	93.9%	--	6.1%
Middle School Students	815	94.5%	--	5.5%
High School Students	251	93.2%	--	6.8%
Will you delay or cut back on any alcohol/drug use based on this presentation?					16.53 (p<.001)*
Total Sample	1,143	76.0%	15.1%	8.8%
Middle School Students	809	79.0%	13.5%	7.5%
High School Students	247	66.4%	21.0%	12.6%
Will this presentation influence how you approach substances in the future?					10.27 (p<.01)*
Total Sample	1,149	68.8%	23.3%	7.8%
Middle School Students	812	71.1%	21.1%	7.9%
High School Students	250	61.6%	30.8%	7.6%

Note: 434 students were excluded for missing data or having seen the Just Say Know presentation previously; sample sizes vary based on student responses to individual feedback questions and missing grade level information

^*denotes a significant difference in reporting between middle and high school students.

Knowledge Test Scores

A multilevel mixed model analysis was conducted for the students who reported seeing the Just Say Know presentation for the first time (N=1,128; 265 students were excluded for having seen the presentation before and 110 students were excluded due to missing data on this item; see Table 3). For this group of students (N=1,128), the estimated mean number of correct responses on knowledge pre-test was 3.68 (SE=0.18), while the average number of correct responses on the knowledge post-test was 6.56 (SE=0.18; see Table 2), a statistically significant increase (F(1128)=2627.33, p<.0001). Overall, students’ performance increased an average of 78.2% from pre- to post- knowledge test, with knowledge pre- and post-test scores averaging 46.0% and 82.0% correct, respectively. Correspondingly, the average knowledge change score (post-score minus pre-score) was 2.88 points. Of note, the average knowledge pre-test score for the 268 students who indicated that they had seen the presentation before, was significantly higher than those who had not seen the presentation before (p<.001).

Table 3.

Modeling of Knowledge Test Scores by Grade Level

	Pre- vs. Post-test Model N=1,128		Pre- vs. Post-test by Grade Level Model N=1,046
	b	SE	b	SE
Fixed Effects:
Intercept	3.68**	0.18	3.49**	0.19
Post-Score (vs. Pre-Score)	2.88**	0.06	2.92**	0.07
High School (vs. Middle School)	-	-	0.56**	0.16
Time × Grade-Level	-	-	−0.10	0.14
Akaike Information Criterion	8311.9		7696.8

^**p<0.001

Beta estimates (b) are unstandardized.

Table 2.

Knowledge Test Scores Among Student Respondents.

Group	Pre-test Score Mean (SE)	Post-test Score Mean (SE)	Change Score Mean
Total Sample (N=1,128)a	3.68 (0.18)	6.56 (0.18)	2.88
Middle School Students (N=805)b	3.49 (0.19)	6.41 (0.19)	2.92
High School Students (N=241)b	4.05 (0.21)	6.87 (0.21)	2.82

Note:

^a466 students were excluded for missing data or having seen the Just Say Know presentation previously

^b82 additional students were excluded due to missing grade level information. Model estimated means are reported. For total sample, a significant difference between knowledge pre-test and post-test score (p<.0001) was found. For the grade level analyses, both effect of test score (pre- vs. post-) and grade level (middle vs. high school) were significant (p<.001). Knowledge test scores are out of 8 total possible points.

Knowledge Test Scores by Grade Level

For grade level analyses on the group of students who were seeing the Just Say Know presentation for the first time, 82 students were excluded from the sample of 1,128 students due to missing grade level information, resulting in a sample of 1,046 respondents (805 middle schoolers, 241 high schoolers; see Table 2). A repeated measures multilevel mixed model was conducted to test for change in knowledge test scores (within-subject factor; pre- vs. post-test score) and knowledge test score by grade level (between-subject factor; middle vs. high school; see Table 3). Analyses did not produce a significant grade level by test interaction effect (F(1, 1046)=0.56, p=.456), suggesting that changes in knowledge test scores did not significantly differ by grade level. However, a significant effect of change in knowledge test score was detected (F(1, 1046)=1720.33, p<.0001), with knowledge post-scores being greater than knowledge pre-scores (see Figure 1). Additionally, a significant effect of grade level on knowledge test score was detected (F(1, 1046)=12.64, p<.001), with high schoolers performing better across tests (see Figure 1).

Figure 1.

Average student knowledge pre-test and post-test scores by grade level (estimated means) for those seeing the presentation for the first time (Middle vs. High School; N=1,046; Total number of questions=8).

Note: A significant effect (p<.001) for both change in knowledge test score and grade level was detected

Knowledge Change Scores by Friend Use

Friends’ Alcohol Use

Of the 1,128 students with valid test data who had not seen the presentation before, 1,113 completed the feedback question regarding friends’ alcohol use (15 excluded for missing data). Using a multilevel mixed model analysis (see Table 4), a significant effect of peer alcohol use in predicting knowledge change score was found, F(3, 2223)=3.28, p=.02 (see Figure 2). Post-hoc analyses of individual comparisons showed that after Bonferroni correction (α’=.0083), knowledge change scores for students reporting “most friends are non-drinkers” differed significantly from students reporting “most friends are problem drinkers” (p<.005), such that students reporting lower friend alcohol use had greater positive knowledge change scores (see Figure 2). No other post-hoc individual comparisons were significantly different.

Table 4.

Modeling of Knowledge Change Scores by Friends’ Drinking/ Substance Use

	Change Score by Friends’ Drinking Model N=1,113				Change Score by Friends’ Substance Use Model N=1,108
	b	SE	Estimated Mean	SE	b	SE	Estimated Mean	SE
Fixed Effects:
Intercept	2.15**	0.30	-	-	2.58**	0.28	-	-
No use	0.73**	0.26	2.87	0.16	0.31	0.24	2.89	0.16
Occasional Use	0.55*	0.28	2.70	0.19	0.08	0.27	2.66	0.20
Weekly Use	0.58	0.32	2.72	0.25	−0.47	0.30	2.11	0.24
Problem Use	0	-	2.15	0.30	0	-	2.58	0.28

^**p<0.001

^*p<0.05

Beta estimates (b) are unstandardized. For individual comparisons (Bonferroni family-wise corrected), knowledge change scores for students reporting “no drug use” differed significantly those reporting “weekly drug use” (p<.0001) and knowledge change scores for students reporting “no drinking” differed significantly from those reporting “problem drinking” (p<.005)

Figure 2.

Average student knowledge change score (estimated marginal means) by self-reported friends’ alcohol use frequency/severity (N=1,113).

Note: Knowledge change scores for students reporting “no drinking” differed significantly from those reporting “problem drinking” (p<.005)

Friends’ Substance Use

Of the 1,128 students with valid test data who had not seen the presentation before, 1,108 completed the feedback question regarding friend substance use (20 excluded for missing data). Using a multilevel mixed model analysis (see Table 4), a significant effect of peer substance use in predicting knowledge change score was found, F(3, 2209)=6.65, p<.001 (see Figure 3). After Bonferroni correction, post-hoc individual comparisons showed that knowledge change scores for students reporting “most friends are non-drug users” differed significantly from students reporting “most friends use drugs weekly” (p<.0001), such that students reporting lower peer substance use had greater positive knowledge change scores. No other post-hoc individual comparisons were significantly different.

Figure 3.

Average student knowledge change score (estimated marginal means) by self-reported friends’ drug use frequency/severity (N=1,108).

Note: Knowledge change scores for students reporting “no drug use” differed significantly those reporting “weekly drug use” (p<.0001)

Discussion

The Just Say Know program is a one-hour neuroscience-based, interactive psychoeducational substance use prevention program that was piloted with 1,594 middle and high school students in South Carolina. The goal of this program is to provide students with scientific knowledge on how drugs influence their developing brain to help guide their own decisions and behaviors. Overall, feedback about the program was overwhelmingly positive. The majority of students reported that the presentation provided helpful information about substance use and the brain (94%) and was worth their time (88%), and 91% reported that they may delay or cut back their alcohol or substance use based on the information presented. These results are encouraging and show that students responded positively towards learning about how their brain functions and the neuroscience of addiction. When comparing feedback from the full sample of students to those who were seeing the presentation for the first time, the full sample had a similar proportion of students reporting positive feedback results, highlighting the utility of Just Say Know as a brief, single session prevention program and suggesting that a repeated session of Just Say Know can still provide a positive experience for students.

As hypothesized, student test performance improved from pre- to post-knowledge test with knowledge-based test scores increasing 78%, demonstrating student engagement and learning. When comparing students who were seeing the presentation for the first time to students who had seen the presentation previously, knowledge pre-test scores were significantly higher for the repeat group, suggesting that students retained knowledge from previous Just Say Know program attendance. For grade level analyses, high school students scored significantly higher on this knowledge-based test than middle school students at both pre- and post-presentation timepoints. This is expected given that high school students are more likely to have been exposed to neurobiology during their education and they are likely better able to recall and understand the material presented during the program. Yet, the results show that high school and middle school students increased their knowledge test scores by a similar amount (knowledge change score: middle school=2.92; high school=2.82). Overall, these findings indicate that students were engaged in the presentation and the material covered was appropriate for both middle and high school levels. This is in line with previous work with college students suggesting that courses and online programs covering alcohol and substance use behaviors can increase substance-related knowledge, improve attitudes, and promote more accurate perceptions of peer alcohol and substance use rates (30, 31).

In addition, findings from the current project suggested that immediate knowledge gained from the presentation differed for student reporting varying levels of friends’ alcohol and substance use. Students who reported higher levels of friends’ alcohol and substance use (i.e., weekly use, problematic use) had smaller gains in their knowledge acquisition than students who reported lower levels of friends’ use (i.e., no use, occasional use). Given that both middle school and high school students did not significantly differ in their knowledge change scores and both groups reported friend use ranging from “no use” through “problem use”, this is likely not driven by older students reporting higher peer substance use rates. While students reporting high peer use networks may have been less responsive and had less immediate knowledge gains than those with lower peer use networks, these students still saw significant improvements in their scores and learned potentially valuable information. We hypothesize that this lesser knowledge acquisition among students reporting higher rates of friends’ substance use may be partially mediated by engagement issues and peer influence. These results are supported by theories surrounding deviant peer networks (32, 33), where during the teen years, peer groups become increasingly influential (34). Research suggests that youth exhibiting more risky, deviant behaviors tend to “cluster” with similar youth and continuously reinforce these behaviors within the group (35), including increasing rates of alcohol, cannabis, and nicotine use (36). Additionally, this literature suggests that reports of peer use may serve as a proxy for youth’s own use. This highlights the need to screen and support these students with early implementation and prevention efforts such as the Just Say Know program, perhaps followed by more time-intensive, personalized interventions (20).

This program and current analyses are not without their limitations. Due to confidentiality issues, student-level demographic data were not available, therefore, we were not able to assess how gender identity, race, ethnicity, or socioeconomic status might affect test performance or feedback responses. Additionally, to alleviate concern over anonymity, students were not asked to report their personal experiences with substances. However, students reported on their friends’ alcohol and other substance use patterns, which were included in secondary analyses. Given that students were not asked about substance use attitudes or behaviors before the program, we cannot conclude that the program directly influenced students’ perceptions; instead, we relied on post-intervention reporting, such that students were asked how the program would influence their future substance use behaviors. Further, on feedback questions, students were not asked about substance-specific (i.e., alcohol, cocaine, nicotine) attitudes or use behaviors and thus we cannot readily account for potential differences between substances. Although this brief program is a group-delivered psychoeducational presentation that can be implemented in schools with minimal resources and time, research has shown that longer, individually and psychosocially oriented programs may be more effective in preventing or reducing adolescent substance use (20). Although the majority of students reported that they believed this program would influence how they would approach substances in the future, no long-term outcomes on substance use behaviors were collected. However, previous literature suggests that alcohol and substance use attitudes and intentions are viable estimators of current substance use, future substance use, and risk (37–39). For example, one study found that risk related to alcohol use among girls was primarily attributable to their attitudes (i.e., prevalence and acceptability of substance use; 39). Additionally, in the present study only immediate knowledge gains were assessed; follow-up assessment would be necessary to evidence long-term retention of program-based knowledge. However, it is notable that knowledge pre-test scores for the students who had seen the presentation before were significantly higher than those who had never seen the presentation, giving preliminary evidence that there may be long-term retention of material.

Overwhelmingly, youth, including those with high peer substance use networks, reported positive experiences with this program, exhibited gains in neuroscience-informed knowledge, and reported it would change their approach towards future substance use. As the program relies on scientifically-accurate information about alcohol and drug use, it complements existing science curricula in schools, and could be a cost-effective approach towards youth substance use prevention. In sum, the Just Say Know program seeks to overcome previous challenges faced by psychoeducational programs and its strengths include brevity, ease of implementation, scientific teachings, and student engagement and positive experience.