To what extent do programs designed to prevent young people from engaging in risky behaviors incorporate aspects of decision-making skills? Several program designers and evaluators addressed this matter at the workshop.
Research on programs to prevent drug use has found that programs that focus only on information about drugs do not work, according to presenter Mary Ann Pentz, director of the Center for Prevention Policy Research at the University of Southern California. Neither do programs that focus on feelings or building self-esteem have any effect on drug use. Pentz indicated that what has been found to work are long-term programs designed to counter social influences (Johnson et al., 1990; MacKinnon et al., 1991; Pentz and Trebow, 1991; Pentz et al., 1989). These effective programs begin in elementary or middle school and are supplemented by booster sessions throughout the high school years. The general strategies that are used in such programs are:
- peer opinion leaders to assist in program delivery;
- active social learning methods, involving role plays, behavioral rehearsal, and group discussion; and
- inclusion of parents through homework and other activities.
Similar results have been found by Botvin (1995, 1996, 1997) for smoking prevention programs. He notes that "nearly two decades of careful research amply demonstrate . . . that the most effective approaches for preventing adolescents from starting to smoke are those that are implemented in school settings and target psychosocial causes of smoking initiation. These approaches teach middle/junior high school students the skills needed to resist social influences to smoke (especially from peers and the media), promote antismoking norms, and, in some cases, teach general life skills to enhance overall personal competence" (Botvin, 1997:47). Botvin also stressed the importance of booster sessions to maintain the program effects.
In the STAR program, which Pentz has been directing and evaluating over the past 14 years (Pentz et al., 1989), the school-based social influences program beginning in middle school is supplemented by a mass media program to reinforce the messages for prevention. The evaluation has tracked young people from the STAR program and a control group through their early twenties. Program participants were found to have significantly less drug use than the control group both at the end of high school and at age 23. Even though the program dealt only with drug use, program participants also exhibited fewer unintended pregnancies, dropped out of school less, and were more likely to be employed at age 23 than the control group. Skills learned for drug abuse resistance may have been translated to resisting other problem behaviors. Although the program did not explicitly use a decision-making model, many aspects of the program may actually incorporate decision-making skills that are transferable to a variety of domains. Such programs can include decision-making skill building by providing information that teenagers need for effective decision making in a clear and personalized way; by encouraging teenagers to take responsibility for their actions and to analyze their options; and by showing adolescents how to discuss decisions in a group setting. Indeed, many social skills training programs include explicit decision-making modules (Baron and Brown, 1991).
Presenter Richard Catalano, professor and associate director of the Social Development Research Group at the University of Washington, stressed that programs should seek to encourage positive youth development through risk reduction and protective factor enhancement (see, for example, Catalano et al., 1998). Both youth development practitioners and prevention scientists have called for a broader focus in youth programs because:
- the same risk and protective factors may predict various problems, so it would seem to be more efficient to focus on common etiologies rather than individual problems;
- risk and protective factors may be found in the environment as well as in the individual, but single-problem-focused programs have focused mainly on the individual;
- developmental needs, processes, and tasks should be taken into account in program design, but they are often overlooked in single-problem-focused programs; and
- as youth development practitioners have pointed out, problem-free behavior does not mean that a young person is well prepared or healthy, but promoting positive development focuses on enhancing protective factors and preparing a young person to be a contributing, healthy citizen.
Presenter Richard Murphy, director of the Center for Youth Development and Policy Research, seconded the importance of emphasizing positive youth development over problem behaviors.
Catalano and colleagues at the University of Washington's Social Development Research Group have been studying evaluations of both youth development and prevention programs that take a youth development approach. The programs that show behavioral change tend to include programming in more than one domain (i.e., school and family, school and community, family and community). Almost all of these programs promoted social or emotional competencies by promoting social skills, decision-making skills, self-management skills, refusal or resistance skills, and coping strategies. Effective programs promoted positive social norms and provided both recognition for positive behavior and opportunities for prosocial involvement. Over half of these programs promoted bonding to prosocial adults in family and schools. These programs also lasted at least nine months and had mechanisms for ensuring implementation quality. Most of these programs were successful in both promoting positive behavior and preventing problem behaviors.
At the federal level, government agencies have a number of ongoing efforts to address high-risk behavior among young people. Lloyd Kolbe, director of the Adolescent and School Health Division of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), described strategies that CDC has put into place to try to bridge research findings and program practice. The first strategy is to identify and monitor critical health events, policies, and programs. This strategy includes using surveys, such as the Youth Risk Behavior Survey, to collect national and state-level data on the involvement of young people in high-risk behaviors, such as drug use, alcohol use, tobacco use, and unprotected sex. Collecting information on program implementation and effectiveness, through efforts such as a school health policy and program surveillance system, is another aspect of CDC's information collection strategy. A second CDC strategy is pooling research in order to ensure better dissemination. CDC is also committed to strategies to enable local institutions to implement and evaluate prevention programs.
Denniston described other Department of Health and Human Services efforts, in particular efforts by the Substance Abuse and Mental Health Services Administration (SAMHSA), to use research to inform their efforts. In particular, there is an emphasis on the evaluation of programs so that only effective prevention programs are encouraged at the local level. Five regional Centers for the Application of Prevention Technology have been established to assist states that have been awarded incentive grants to use various funding streams to implement programs with documented effectiveness. SAMHSA is also involved in promoting consistent messages about substance abuse, not only in mass media, but also from churches, schools, parents, and community organizations. Denniston stressed that these messages should be tailored to the concerns of young people, by focusing on social and legal risks, not just long-term health risks, which may seem too far removed to be of consequence to adolescents. For example, some antismoking messages try to portray a social risk of smoking by likening kissing a smoker to licking an ashtray. Denniston noted that the Office of National Drug Control Policy planned to launch an $185 million antidrug media campaign in 1998.