LIFE SKILLS TRAINING. Program Description. Research

Transcription

1 LIFE SKILLS TRAINING (LST) is a school- based program that aims to prevent alcohol, tobacco, and marijuana use and violence by targeting the major social and psychological factors that promote the initiation of substance use and other risky behaviors. Program Description Target Population Distributor Goals/Mission/Target outcomes Delivery Agents Intervention Strategies Date of origin Developer Initial Mission Changes in mission Material purchases Staff development Elementary and middle school students. Princeton Health Press Modify drug-related knowledge, attitudes and normative beliefs and teach resistance, personal and social skills. Classroom teachers Program teaches students how to manage emotions, analyze situations and use refusal skills. Program also teaches anger management, conflict resolution and communication skills. Role Play, relaxation techniques. Late 1970s Dr. Gilbert J. Botvin Prevent cigarette smoking by teaching personal and social skills. Now includes the prevention of alcohol, marijuana and other drug use. Teacher manual, students workbooks and audio-visuals. Strongly recommended two-day training for teachers. Research Botvin, G.J., Dusenbury, L., Baker, E., James-Ortiz, S., Botvin, E.M. (1992) Smoking Prevention Among Urban Minority Youth: Assessing Effects on Outcome and Mediating Variables. Health Psychology. (11) Study 1. Sample size Comparison group Longitudinal Change Assessment test of Significance Publication Implementation Scientific Quality

2 Adequate Random or matched assignment Pretest/posttest design but no delayed posttest tests and significance reported Peer reviewed Implementation assessed Ideal Research Questions What is the effectiveness of the program on smoking prevention especially among parochial versus public schools and among predominately Hispanic urban minority students? Methods A total of 3,153 students from 47 schools in New York City participated in the study. Eleven public schools and 36 parochial schools were broken down between those that administered the program (19 parochial and six public) and those that did not (17 parochial and five public). Fifty-six percent of the students studied were Hispanic. All students completed the same questionnaire at the beginning of the program and again four months later. Variables measured included the following: o Demographics o Cigarette smoking (smoking during the past month) o Knowledge (short-term affects of smoking, prevalence of smoking and social acceptability of smoking) o Smoking attitudes o Normative expectations (belief in prevalence of smoking among adults and belief in prevalence of smoking among peers) o Decision making o Assertiveness o Skills efficacy (confidence in ability to use personal and social skills) o Self-efficacy o Self-esteem o Psychological well-being Result Significantly less post-test smoking for program students than control students (the rate of smoking significantly decreased in program group compared to control group between pre-test and post-test). Significantly fewer new smokers in program group than control students at post-test. No main effects found for school type or ethnic composition of school. Significant s found for program group regarding smoking knowledge compared to control group between pre- and post-test. Significant s found for program group regarding normative expectation compared to control group between pre-and post-test. No significant found on remaining variables. Study 2. Botvin, G.J., Schinke, S.P., Epstien, J.A., Diaz, T., Botvin, E.M. (1995) Effectiveness of Culturally Focused and Generic Skills Approaches to Alcohol and Drug Abuse Prevention Among

3 Minority Adolescents: Two-Year Follow-Up Results. Psychology of Addictive Behaviors (9) Sample size Comparison group Longitudinal Change Assessment test of Significance Publication Implementation Scientific Quality Adequate Random or matched assignment Pretest/posttest design with delayed posttest tests and significance Peer reviewed Implementation assessed Ideal Research Questions Would prevention effects for behavioral intentions of the program be maintained two years after completion of the program? Would a culturally focused curriculum have more than a generic skills curriculum? What would the program have on mediating variables? Methods Six middle schools that had more than 85% minority student bodies were assigned to one of the following conditions: o Generic skills intervention (GSI) -- development of personal skills, social skills and knowledge related to alcohol and drugs originally designed and tested on middle-class white students. o Culturally focused intervention (CFI) -- development of personal skills, social skills and knowledge related to alcohol and drugs designed for inner-city minority students. o Information-only control (IC) -- information provided about drug and alcohol use but no skills training included. A total of 757 seventh-grade students received one of the interventions and received booster sessions in eighth grade. Pre-test administered before program implementation and followed up (post-test) two years later when students were in ninth grade. Pre- and post-tests measured the following: o Current substance use (drinking frequency, drinking amount, drunkenness frequency and marijuana frequency) o Behavioral intentions for substance abuse (Intention to use beer or wine, liquor and marijuana in next year) o Cognitive, attitudinal and individual difference variables: Demographics Knowledge (about long- and short-term effects of drinking and marijuana use) Substance use attitudes (anti-drinking, anti-marijuana and anti-cocaine and other drugs) Normative expectations (belief in prevalence of alcohol, marijuana and other substance use among adults and peers) Skills (refusal assertiveness, decision making and life skills) Personality measures (risk taking, self-esteem and efficacy)

4 Results Current substance use o The rates of drinking frequency, drinking amount and drunkenness frequency were significantly reduced in both program groups compared to control group between pre- and post-test. o Students in CFI reported significantly lower rates of drinking frequency, drinking amount and drunkenness frequency than students in GSI between pre- and post test. o No significant found for marijuana use. Behavioral intentions for substance use o Both program groups reported significantly lower rates of intention to use beer, wine or alcohol than control group between pre- and post-test. o Students in CFI reported significantly lower intentions to drink beer or wine than students in GSI at post-test, but did not report the same for intention to drink liquor. o No significant for intent to use marijuana. Mediating variables: o Both program groups had significantly less knowledge about marijuana use compared to control group between pre- and post-test. No significant between groups for drinking knowledge. o Both program groups had significantly higher rates of anti-drinking attitudes than control group between pre- and post-test. No significant between groups for anti-marijuana or anti-other drugs attitudes. o No significant among groups on rates of normative expectations related to alcohol. Significant increase for program groups regarding normative expectations related to marijuana use. o Both program groups reported significantly higher rate of refusal assertiveness than control group between pre-and post-test. No significant reported for decision making or life skills. o Program groups reported significantly lower rate of risk taking than control group between pre- and post-test. No significant findings for self-esteem or efficacy. Study 3. Botvin, G.J., Baker, E., Dusenbury, L., Botvin, E.M., Diaz, T. (1995) Long-Term Follow-Up Results of a Randomized Drug Abuse Prevention Trial in a White Middle-class Population. Journal of the American Medical Association. (273) Sample size Comparison group Longitudinal Change Assessment test of Significance Publication Implementation Scientific Quality Adequate Random or matched assignment Pretest/posttest design with delayed posttest tests and significance reported Peer reviewed Implementation assessed Ideal Research Questions What is the effectiveness of the program with and without implementation fidelity? What are the long-term effects of the program on drug-initiation?

5 What is the generalizability of the program from tobacco use to alcohol and marijuana use? What is the of the program on occasional drug use and on heavy drug use? Methods A total of 3,597 seventh-grade students in 56 middle schools were surveyed in 1991 to determine rates of tobacco use. Schools were assigned to one of the following groups: o Program with one-day training for teachers and implementation feedback from project staff (E1). o Program with only videotaped training and no implementation feedback from project staff (E2). o No program implementation (control). E1 and E2 students received 10 booster sessions in the eighth and ninth grades. No boosters received in 10th, 11th or 12th grades. Program fidelity was assessed in random program classes by project staff to determine how much of the curriculum was used. Tobacco, alcohol and marijuana use were assessed in terms of the following: o Frequency: Monthly and weekly use o Amount: Heavy tobacco use one pack or more per day, heavy alcohol use three or more drinks during one drinking occasion. o Frequency of getting drunk: Getting drunk one or more times per month o Frequency of polydrug use: Monthly and weekly use. All students surveyed prior to program implementation (pre-test), after ninth grade (post-test) and again after 12th grade (follow-up). o Students in ninth grade who received high-fidelity training were further assessed with same questionnaires. Result Both program groups (E1 and E2) reported significantly lower frequency rates for monthly tobacco use compared to the control group between pre-test and follow-up. The E2 group reported significantly lower frequency rates for tobacco use than the control group between pre-test and follow-up. Both program groups reported significantly lower rates of problem drinking than control group between pre-test and follow-up. Polydrug use: Both program groups reported significantly lower rates than the control group between pre-test and follow-up of the following: o Monthly use of tobacco and alcohol combined. o Weekly use of tobacco and marijuana combined. o Weekly use of all three substances combined. o The E2 group reported significantly lower rates of weekly tobacco and alcohol combined use than control group between pre-test and follow-up. In the high-fidelity groups, the following was found between pre-test and follow-up for the program groups compared to the control group: o Significantly lower rates of tobacco use as well as heavy tobacco use. o Significantly lower rates of weekly, heavy and problem drinking. o Significantly lower rates of weekly marijuana use. o Significantly lower rates of monthly use of tobacco and alcohol combined. o Significantly lower rates of monthly and weekly use of tobacco and marijuana combined. o Significantly lower rates of weekly use of alcohol and marijuana combined. o E2 students reported significantly low rates than control group of the following Monthly drinking Weekly use of tobacco and alcohol combined.

6 o E1 students reported significantly lower rates than control group of the following: Monthly marijuana use. Monthly use of alcohol and marijuana combined. Monthly and weekly use of all three substances combined. Study 4. Botvin, G.J., Epstein, J.A., Baker, E., Diaz, T., Ifill-Williams, M. (1997) School-Based Drug Abuse Prevention with Inner-City Minority Youth. Journal of Child & Adolescent Substance Abuse. (6) Sample size Comparison group Longitudinal Change Assessment test of Significance Publication Implementation Scientific Quality Adequate Partial or unclear basis for assignment Pretest/posttest design but no delayed posttest tests and significance reported Peer reviewed Implementation unconfirmed Acceptable Research Questions What is the of the program on inner-city minority youth for preventing tobacco, drug and polydrug use? What is the of the program on hypothesized mediating variables? Methods A total of 833 students in seven middle schools with predominately minority student bodies in New York City participated in study one group administered the program while the other group did not. Students pre-tested before program implementation and post-tested three months later on the following: o Demographics o Smoking (how much) Alcohol (drinking frequency, amount of alcohol consumed, frequency of getting drunk) Marijuana use (how much) o Polydrug use (combinations of two or all substances) o Behavioral intention to use substances within the next year (tobacco, beer/wine, liquor, marijuana, cocaine, other drugs) o Normative expectations (perceived prevalence of substance use among peers and adults) o Attitudes towards drug use (perceived characteristics of users and social benefits of using drugs) o Social competency (decision making, refusal skills, advertising influences, anxiety reduction, communication and assertiveness) Result Significantly lower rates of the following were found for the program group compared to the control group between pre- and post-test: o Smoking

7 o Drinking frequency o Amount of alcohol consumed o Drunkenness frequency o Marijuana use o Polydrug use o Intention to use cigarettes, beer/wine, marijuana and cocaine within one year. o Normative expectations o Refusal skills No significant findings for other variables Study 5. Botvin, G.J., Griffin, K.W., Diaz, T., Ifill-Williams, M. (2001) Drug Abuse Prevention Among Minority Adolescents: Posttest and One-year Follow-Up of a School-Based Preventive Intervention. Prevention Science 2:1-13. Sample size Comparison group Longitudinal Change Assessment test of Significance Publication Implementation Scientific Quality Adequate Random or matched assignment Pretest/posttest design with delayed posttest tests and significance reported Peer reviewed Implementation assessed Ideal Research Questions What is the program s on smoking and other forms of drug-use prevention for inner-city minority youth? Were behavioral outcomes mediated by changes in drug-use knowledge, attitudes, intentions, normative expectations and related factors? Methods 3,621 seventh graders from 29 New York City schools participated in the program. Students were predominately minorities from low-income households. o Students in 16 of the schools received the program, students in 13 schools did not and acted as controls. o Program students received 15 program sessions in the seventh grade and 10 booster sessions in the eighth grade. o Students were pre-tested at the beginning of the seventh grade -- prior to program implementation -- post-tested at the end of the seventh grade -- once the program was completed. Follow-up questionnaire administered one year after post-test at the end of eighth grade. Measured were the following: o

8 Cigarette smoking frequency and quantity Alcohol consumption drinking frequency, drunkenness frequency and amount of alcohol consumed per drinking session. Marijuana use -- frequency Inhalant use frequency o Polydrug Use Use of tobacco, alcohol, marijuana and inhalants lifetime use and current use. o Behavioral Intentions Intention to use any of the following within the next year: cigarettes, beer or wine, marijuana, inhalants and cocaine or other hard drugs. o Normative Expectations Perceived prevalence of drug use among peers Perceived prevalence of drug use among adults o Drug Attitudes and Knowledge Student attitudes about smoking, drinking, marijuana, cocaine or other drugs Students perceptions of user characteristics Students perceptions of the social benefits of using drugs. o Social and personal competence Decision making Assertiveness Risk-taking Drug-refusal skills Advertising resistance skills Anxiety reduction skills Communications skills How often in the past month the student had gotten into trouble at school, home or with the police. o Implementation fidelity Trained staff members observed classrooms and recorded how much of the program was being implemented by teachers. Result At post-test (at the end of seventh grade), program students showed significant gains compared to controls for the following: o Lower drinking frequency o Lower drunkenness frequency o Lower drinking quantity o Lower lifetime polydrug use o Greater drinking knowledge o Lower peer normative expectations for smoking and drinking o Lower adult normative expectations for smoking, drinking, cocaine/hard drug use and inhalant use No significant findings for other variables At one-year follow-up (at the end of eighth grade), program students showed significant gains from pre-test compared to controls for the following: o Lower smoking frequency and quantity o Lower drinking frequency o Lower drunkenness frequency o Lower drinking quantity o Lower marijuana-use frequency o Lower inhalant-use frequency o Lower lifetime and current polydrug use

9 o Greater smoking and drinking knowledge o Less intention to use tobacco, alcohol, smoke marijuana and inhalants in the coming year. o More negative attitudes about smoking, drinking and marijuana use. o Lower peer and adult normative expectations for smoking and drinking o Higher drug-refusal skills o Lower risk-taking o Less trouble in school, at home and with the police No significant findings for other variables The following variable were found to mediate the effects of the program: o Prevention effects on smoking were partly mediated by intention to smoke and by risk taking. o Prevention effects on drinking were mediated in part by intention to drink. o Prevention effects on drunkenness frequency were partly mediated by intention to drink and risk taking. o Behavioral effects on inhalant use were mediated in part by intention to use inhalants and peer normative expectations for inhalant use. Study 6. Spoth, R., Redmond, C., Trudeau, L., Shin, C. (2002) Longitudinal Substance Initiation Outcomes for a Universal Preventive Intervention Combining Family and School Programs. Psychology of Addictive Behaviors. (16) Sample size Comparison group Longitudinal Change Assessment test of Significance Publication Implementation Scientific Quality Adequate Random or matched assignment Pretest/posttest design with delayed posttest tests and significance reported Peer reviewed Implementation assessed Ideal Research Questions (This study examined the combined use of LST and the Strengthening Families Program). Would use of LST alone result in lower levels of long-term initiation of drug use compared to controls? Would using both LST and SFP result in lower levels of long-term initiation of drug use compared to controls? Would combining LST and SFP show stronger s than LST alone? Methods Participants included 7th graders in 36 randomly selected rural schools in one state. A total of 1,664 students were involved with the study. Three experimental conditions were established:

10 o Schools that administered LST o Schools that administered both LST and SFP o Control schools that administered neither program. The SFP was conducted for two hours once per week after school during the students second semester; LST was administered during school hours, every day, for minutes during students second semester. Booster sessions in both programs were administered to same students in the eighth grade. Research measured what percentage of program students compared to controls began using controlled substances after participating in the program. Questionnaires were administered several months before program began, one month after the seventhgrade program ended and one month after eighth-grade booster classes. Data gathered included firsttime use of marijuana, alcohol and cigarettes. Result The percentage of new-users of alcohol was significantly lower in the LST+SFP group than either the LST-only group or controls (35% in LST-only; 25.7% in LST+SFP; and 36.7% in controls). Both LST and LST+SFP groups reported significantly lower rates of new- users of marijuana than the control group (4.3% in LST; 4.1% in LST-SFP; and 7.9% in controls). No significant findings for new-users of cigarettes. Additional Information Awards and Recognition Model Program: Center for Substance Abuse Prevention, 1999 Model Program: Centers for Disease Control and Prevention Model Program: Office of Juvenile Justice and Delinquency Prevention, 1998 Model Program: White House Office of National Drug Control Policy Exemplary Program: U.S. Department of Education Programs That Work: National Institute of Drug Abuse Contact Information National Health Promotion Assocaites, Inc. 711 Westchester Ave. White Plains, NY To learn more about implementation, contact: Craig Zettle (914) czettle@nhpamail.com References To learn more about research, contact: Gilbert J. Botvin, Ph.D. (646) gjbotvin@med.cornell.edu Botvin, G.J., Dusenbury, L., Baker, E., James-Ortiz, S., Botvin, E.M. (1992) Smoking Prevention Among Urban Minority Youth: Assessing Effects on Outcome and Mediating Variables. Health Psychology. (11)

11 Botvin, G.J., Schinke, S.P., Epstien, J.A., Diaz, T., Botvin, E.M. (1995) Effectiveness of Culturally Focused and Generic Skills Approaches to Alcohol and Drug Abuse Prevention Among Minority Adolescents: Two-Year Follow-Up Results. Psychology of Addictive Behaviors (9) Botvin, G.J., Baker, E., Dusenbury, L., Botvin, E.M., Diaz, T. (1995) Long-Term Follow-Up Results of a Randomized Drug Abuse Prevention Trial in a White Middle-class Population. Journal of the American Medical Association. (273) Botvin, G.J., Epstein, J.A., Baker, E., Diaz, T., Ifill-Williams, M. (1997) School-Based Drug Abuse Prevention with Inner-City Minority Youth. Journal of Child & Adolescent Substance Abuse. (6) Spoth, R., Redmond, C., Trudeau, L., Shin, C. (2002) Longitudinal Substance Initiation Outcomes for a Universal Preventive Intervention Combining Family and School Programs. Psychology of Addictive Behaviors. (16) Outcomes 1997 Communication skills No Pro- social competencies Communicative competency 2001 Communication skills - - Follow- up No Pro- social competencies Communicative competency 2001 Communication skills - - Immediate No Pro- social competencies Communicative competency 1992 Self- efficacy No General social- emotional 1995 Life skills No General social- emotional 1995 Self- efficacy No General social- emotional Coping Coping Coping 1992 Cigarette smoking in the past month

12 1995 Marijuana use No 1995 Drinking amount 1995 Drinking frequency 1995 Drunkenness frequency 1995 Frequency rates for tobacco use 1995 Polydrug use 1995 Problem drinking 1997 Amount of alcohol consumed 1997 Drinking frequency 1997 Drunkenness frequency 1997 Polydrug use 1997 Smoking amount 2001 Drinking frequency - - Follow- up 2001 Frequency of inhalant use - - Immediate 2001 Frequency of marijuana use - - Immediate 2001 Frequency of smoking - - Immediate 2001 Quantity of smoking - - immediate No No No No No

13 2001 Amount of alcohol consumed - - Follow- up 2001 Amount of alcohol consumed - - Immediate 2001 Drinking frequency - - Immediate 2001 Drunkenness frequency - - Follow- up 2001 Drunkenness frequency - - Immediate 2001 Frequency of marijuana use - - Follow- up 2001 Frequency of smoking - - Follow- up 2001 Polydrug use - - Follow- up 2001 Polydrug use - - Immediate 2001 Quantity of smoking - - Follow- up 1992 Psychological well- being No General social- emotional 1997 Anxiety reduction skills No General social- emotional Emotional competency Emotional competency 2001 Anxiety reduction skills - - Follow- up No General social- emotional Emotional competency 2001 Anxiety reduction skills - - Immediate No General social- emotional Emotional competency 1992 Assertiveness No General social- emotional 1992 Decision making No General social- emotional 1995 Decision making skills No General social- emotional Independence and initiative Independence and initiative Independence and initiative 1997 Assertiveness No General social- Independence and

14 emotional initiative 1997 Decision making No General social- emotional 2001 Assertiveness - - Follow- up No General social- emotional 2001 Assertiveness - - Immediate No General social- emotional Independence and initiative Independence and initiative Independence and initiative 2001 Decision making - - Follow- up No General social- emotional Independence and initiative 2001 Decision making - - Immediate No General social- emotional Independence and initiative 1992 Skills efficacy No General social- emotional Problem- solving skills 1995 Refusal assertiveness Protective skills 1997 Advertising resistance skills No Protective skills 1997 Refusal skills Protective skills 2001 Advertising resistance skills - - Follow- up 2001 Advertising resistance skills - - Immediate 2001 Drug refusal skills: Immediate No Risk behavior Protective skills No Protective skills No Protective skills 2001 Drug refusal skills - - Follow- up Protective skills 1992 Smoking attitudes No 1992 Knowledge about smoking 1992 Normative expectations 1995 Anti- drug attitudes No

15 1995 Intention to use marijuana No 1995 Knowledge about drinking knowledge 1995 Normative expectations related to alcohol No No 1995 Anti- drinking attitudes 1995 Intention to use alcohol 1995 Knowledge about marijuana 1995 Normative expectations related to drugs 1995 Risk taking Risk behavior Risk Attitudes 1997 Attitudes towards drug use No 1997 Intention to use tobacco, alcohol and drugs 1997 Normative expectations regarding substance use 2001 Intention to use alcohol or drugs - - Immediate No 2001 Risk taking - - Immediate No 2001 Drug attitudes and knowledge - - Follow- up 2001 Drug attitudes and knowledge - - Immediate 2001 Intention to use alcohol or drugs - - Follow- up 2001 Normative expectations regarding drug use - - Follow- up

16 2001 Normative expectations regarding drug use - - Immediate 2001 Risk taking - - Follow- up 1992 Self- esteem No General social- emotional 1995 Self- esteem No General social- emotional Self- concept Self- concept 2001 How often student got in trouble at home, in school or with police in past month - - Immediate No Violence/aggression 2001 How often student got in trouble at home, in school or with police in past month - - Follow- up Violence/aggression 1995 Drinking Frequency Impact Ideal