El choque entre la ciencia y la realidad: Estudio El choque entre la ciencia y la realidad: Estudio sobre las experiencias del abuso de drogas en sobre las experiencias del abuso de drogas en

los adolescenteslos adolescentes

Zili Sloboda, Sc.D., Investigador PrincipalZili Sloboda, Sc.D., Investigador Principal

September 13, 2005September 13, 2005

VII Reunión del Grupo de Expertos en VII Reunión del Grupo de Expertos en

Reducción de la Demanda Reducción de la Demanda

CICAD/OEACICAD/OEA

Patrocinado por la Fundación Robert Wood Johnson Patrocinado por la Fundación Robert Wood Johnson

(Grant#s O39223 and 040371)(Grant#s O39223 and 040371)

El estudio sobre el abuso de El estudio sobre el abuso de sustancias en los adolescentessustancias en los adolescentes

Desarrollar y evaluar un programa de Desarrollar y evaluar un programa de prevención de abuso de drogas basado en la prevención de abuso de drogas basado en la evidencia con curriculos para 7mo grado evidencia con curriculos para 7mo grado (donde los niños están entre los 12 y 13 años (donde los niños están entre los 12 y 13 años de edad) y 9no grado (donde los niños están de edad) y 9no grado (donde los niños están entre los 14 y 15 años de edad) para ser entre los 14 y 15 años de edad) para ser entregado por oficiales de DARE. entregado por oficiales de DARE.

La evaluación consiste en hacer seguimiento La evaluación consiste en hacer seguimiento a una cohorte de estudiantes de 7mo a 11avo a una cohorte de estudiantes de 7mo a 11avo grado. grado.

Años de riesgo para el Años de riesgo para el abuso de sustanciasabuso de sustancias

Hay un aumento entre le 150% y el Hay un aumento entre le 150% y el 200% en el uso de todas las sustancias 200% en el uso de todas las sustancias entre los grados 8vo (13 y 14 años) y entre los grados 8vo (13 y 14 años) y 10mo (15 y 16 años)10mo (15 y 16 años)

El abuso de sustancias por parte de El abuso de sustancias por parte de los alumnos de 10mo grado es mas los alumnos de 10mo grado es mas cercano y paralelo al de los de 12avo cercano y paralelo al de los de 12avo grado)grado)

LIFETIME PREVALENCE OF CIGARETTE USE--8TH, 10TH AND 12TH GRADES: 1991-2002 (MONITORING THE FUTURE STUDY)

0

10

20

30

40

50

60

70

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

YEAR

PERC

ENTA

GE

12th Grade

10th Grade

8th Grade

Por qué D.A.R.E.?Por qué D.A.R.E.?

D.A.R.E. es un sistema de entrega de D.A.R.E. es un sistema de entrega de instrictores/oficiales que tiene presencia instrictores/oficiales que tiene presencia en el 80% de las escuelas a nivel nacional. en el 80% de las escuelas a nivel nacional.

La capacotación y el monitoreo de La capacotación y el monitoreo de D.A.R.E. refuerza la fidelidad de la D.A.R.E. refuerza la fidelidad de la implementaciónimplementación

Los oficiales están entrenados para ser Los oficiales están entrenados para ser especialistas en prevención y su entrada especialistas en prevención y su entrada en los salones de clases en horas pre en los salones de clases en horas pre programadas aseguran que el tiempo en el programadas aseguran que el tiempo en el salán sea dedicado exclusivamente a salán sea dedicado exclusivamente a prevención. prevención.

Resumen de la PresentaciónResumen de la Presentación::

Diseño del curriculo Diseño del curriculo Elementos de investigaciónElementos de investigación MedidasMedidas DesafíosDesafíos Status actualStatus actual

DISEÑO DEL DISEÑO DEL CURRICULOCURRICULO

ESTUDIANTES de SEPTIMO y ESTUDIANTES de SEPTIMO y NOVENONOVENO

ELEMENTOS DE PROGRAMAS DE ELEMENTOS DE PROGRAMAS DE PREVENCION ESCOLAR EFECTIVA PREVENCION ESCOLAR EFECTIVA

CONTENIDOCONTENIDO Deshacer mitos de prevalencia Dispel myths about Deshacer mitos de prevalencia Dispel myths about

prevalence and expectativas del uso de sustancias prevalence and expectativas del uso de sustancias Establecimoento de normas anti uso de drogas. Establecimoento de normas anti uso de drogas. Abordar tabaco y alcohol así como dorgas ilícitas. Abordar tabaco y alcohol así como dorgas ilícitas. Abordar perceopciones de consecuencias del abuso Abordar perceopciones de consecuencias del abuso

de sustanacias por parte de los adolescentes. de sustanacias por parte de los adolescentes. Desarrollo de habilidades: comunicaicones, toma de Desarrollo de habilidades: comunicaicones, toma de

decisiones, resistencia.decisiones, resistencia.

ENTREGAENTREGA Aprendizaje interactivo Aprendizaje interactivo Práctica de habilidades a través de juegos de rol, Práctica de habilidades a través de juegos de rol,

discusiones en grupos pequeños etc.. discusiones en grupos pequeños etc..

Criterios para el diseño del Criterios para el diseño del currículocurrículo

Actividades basadas en problemas que logren Actividades basadas en problemas que logren atraer compromiso atraer compromiso

Problemas autenticos como organizadoresProblemas autenticos como organizadores Habilidades de pensamiento crítico requeridas.Habilidades de pensamiento crítico requeridas. Secuencia espiral de desarrollo de habilidades. Secuencia espiral de desarrollo de habilidades. En 7m grado, debates en pequeños grupos; en En 7m grado, debates en pequeños grupos; en

9no grado, discusiones en grupos grandes 9no grado, discusiones en grupos grandes (catedra limitada)(catedra limitada)

Cultural y socialmente senstiva. Cultural y socialmente senstiva.

Modelo Teórico de la Teoría del comportamiento planeado

Normas subjetivas

Actitudes

Intención comportamiento

ControlDel c/tamiento percibido

Variables Externas

Demográficas

Actitudes hacia la población objetivo

Personalidad

Creencias de que el c/tamiento lleva a ciertos resultados

Evaluación de resultados

Creencias de referentes específicos como desempeño de comoprtamiento

Motivación para acceder a esas referencias

Importancia relativa de consideraciones actitudinales y normativas.

Tres contenidos de mayor enfasis Tres contenidos de mayor enfasis (mediadores) – Evidencia de Efectividad (mediadores) – Evidencia de Efectividad

Normativa de creencias entre los Normativa de creencias entre los adolescentes adolescentes

Percepciones de las consecuencias del uso y Percepciones de las consecuencias del uso y abuso de sustancias entre adolsecentes. abuso de sustancias entre adolsecentes.

Habilidades sociales para la solución de Habilidades sociales para la solución de problemas problemas Habilidades de comunicación Habilidades de comunicación Habilidades de toma de decisiónHabilidades de toma de decisión Habilidades de resistencia y asertividad. Habilidades de resistencia y asertividad.

RESEARCH RESEARCH ELEMENTSELEMENTS

ASAPS Research Questions

Are there differences in the subsequent substance use behaviors of children who receive the program compared to those who were in the control schools?

To what extent is the program’s effectiveness a function of the implementation fidelity of the delivered program?

To what extent is the program’s effectiveness a function of the student’s exposure to the program?

What is the relationship between program mediators (normative beliefs, skills, etc.) and subsequent substance use?

Proposed Extension of TPB for Proposed Extension of TPB for Targeted MediatorsTargeted Mediators

Refusal Skills

Decision-MakingSkills

Subjective Norms(Most Students Myage think it's okay

to...)

Consequences(How much does...affect how well the

brain works...)

Attitudes(I think it's okayfor students my

age to...)

Intentions(How likely is it thatyou will use...in the

next 12 months)

30 Day Use

Normative Beliefs(How many 10thgraders do you

think...)

constructs targeted by preventioncurricula

constructs in the TPB

Refusal Skills

Decision-MakingSkills

Subjective Norms(Most Students Myage think it's okay

to...)

Consequences(How much does...affect how well the

brain works...)

Attitudes(I think it's okayfor students my

age to...)

Intentions(How likely is it thatyou will use...in the

next 12 months)

30 Day Use

Normative Beliefs(How many10thgraders do you

think...)

Constructs targeted by prevention curricula

Constructs in the TPB

Methods—Study PopulationMethods—Study Population

SITES: DETROIT, HOUSTON, LOS ANGELES, NEWARK (NJ), NEW SITES: DETROIT, HOUSTON, LOS ANGELES, NEWARK (NJ), NEW ORLEANS, ST. LOUISORLEANS, ST. LOUIS

Unit of analysis=school clusters made up of a high school and all Unit of analysis=school clusters made up of a high school and all feeder middle schoolsfeeder middle schools

Random assignment of school clusters to two conditions: one Random assignment of school clusters to two conditions: one where the schools receive the new program and the other, not.where the schools receive the new program and the other, not.

Universe stratified by high and low stress (proportion of district Universe stratified by high and low stress (proportion of district students eligible for free lunch and proportion of minority students eligible for free lunch and proportion of minority students)students)

Research DesignResearch Design

2001-2002

(7TH)

2002-2003

(8TH)

2003-2004

(9TH)

2004-2005

(10TH)

2005-2006

(11TH)

EXPERIMENTAL

CONTROL

O1 X O2 O3 O4 X O5 O6 O7

O1 O2 O3 O4 O5 O6 O7

ON=STUDENT SURVEY

X=NEW CURRICULUM

Consenting Procedures for Student Surveys

CONSENT PACKAGE ACTIVE PARENTAL CONSENT FORM ACTIVE STUDENT ASSENT FORM TRACKING INFORMATION FOR FOLLOWUP COVERLETTER WITH BULLETS

SUMMARIZING KEY CONSENT ITEMS TELEPHONE NUMBER FOR INFORMATION

WORKED WITH SCHOOLS AND TEACHERS TO HAND OUT AND COLLECT

INCENTIVES TO STUDENTS AND TEACHERS

Consent Procedure And Survey CompletionConsent Procedure And Survey Completion

TREATMENTTREATMENT CONTROLCONTROLHIGH STRESSHIGH STRESS LOW LOW

STRESSSTRESSHIGH STRESSHIGH STRESS LOW STRESSLOW STRESS

HIGH SCHOOLS (83)HIGH SCHOOLS (83) 2525 1616 2626 1616MIDDLE SCHOOLS MIDDLE SCHOOLS (122)(122)

4141 1818 4545 1818

TOTAL STUDENTS TOTAL STUDENTS (34,198)(34,198)

12,08412,084 5,8185,818 10,53110,531 5,6435,643

CONSENTS CONSENTS RETURNED RETURNED (24,311/71%)(24,311/71%)

8,939 8,939 (74%)(74%)

4,504 4,504 (77.4%)(77.4%)

7,035 7,035 (66.8%)(66.8%)

3,833 3,833 (68%)(68%)

APPROVALSAPPROVALS

% RETURNED/% % RETURNED/% TOTAL (19,272; TOTAL (19,272; 79.3%/56.4%)79.3%/56.4%)

7,4367,436

83.2%/ 83.2%/ 61.5%61.5%

3,6613,661

81.3%/ 81.3%/ 63%63%

5,2235,223

74.2%/ 74.2%/ 50%50%

2,9522,952

77%/ 77%/ 52.3%52.3%

Measures MEDIATORS

NORMATIVE BELIEFS (MONITORING THE FUTURE ETC.)

PERCEPTIONS OF CONSEQUENCES OF SUBSTANCE USE IN ADOLESCENCE (MONITORING THE FUTURE ETC)

COMMUNICATION, DECISION MAKING AND RESISTANCE SKILLS (OTHER SOURCES AND MODELS)

MODERATORS DEMOGRAPHICS RISK STATUS (MONITORING THE FUTURE ETC)

OUTCOMES SUBSTANCE USE—TOBACCO, ALCOHOL, INHALANTS,

MARIJUANA, OTHER ILLICIT DRUGS, AND ABUSE OF PRESCRIPTION DRUGS (MONITORING THE FUTURE)

Survey Administration

Self-administered within a class 40 minutes to complete Supervised by University of Akron

staff (no DARE officer) Confidential (sealed envelope in box)

Confidentiality

Hold a National Institute of Health Certificate of Confidentiality

Student data are identified by a numeric code

All survey data will be stored in a secure environment at the University of Akron

Sample Characteristics

Control Districts Control Districts

(n=41)(n=41)Experimental Districts Experimental Districts

(n=42)(n=42)

Average AgeAverage Age 12.5 (.26)12.5 (.26) 12.5 (.26)12.5 (.26)

MaleMale 44%44% 43%43%

WhiteWhite 44%44% 41%41%

LatinoLatino 13%13% 16 %16 %

BlackBlack 14 %14 % 12 %12 %

AsianAsian 4 %4 % 6 %6 %

American IndianAmerican Indian 6 %6 % 6 %6 %

Other Race/EthnicityOther Race/Ethnicity 12 %12 % 13 %13 %

Ethnicity MissingEthnicity Missing 7%7% 6%6%

30-day Prevalence Of Substance Use 30-day Prevalence Of Substance Use At Pretest (Baseline)At Pretest (Baseline)

SUBSTANCESUBSTANCE CONTROLCONTROL EXPERIMENTALEXPERIMENTAL MTF 8MTF 8THTH

GRADEGRADE

CIGARETTESCIGARETTES 7%7% 6%6% 11%11%

ALCOHOLALCOHOL 14%14% 11%11% 20%20%

GET DRUNKGET DRUNK 5%5% 6%6% 7%7%

MARIJUANAMARIJUANA 4%4% 4%4% 8%8%

INHALANTSINHALANTS 4%4% 4%4% 4%4%

MONITORING FINDINGSMONITORING FINDINGS

YEAR 1-4YEAR 1-4 MEDIATORSMEDIATORS

• Normative beliefs—all 3 years ASAPS better* scoresNormative beliefs—all 3 years ASAPS better* scores• Consequences—Ceiling effects, changed Consequences—Ceiling effects, changed

measurements for 8measurements for 8thth grade, ASAPS better scores at grade, ASAPS better scores at 99thth grade grade

• SkillsSkills Decision making—ASAPS better scores immediately after Decision making—ASAPS better scores immediately after

intervention and at 8intervention and at 8thth grade (changed our measure at 9 grade (changed our measure at 9thth grade survey)grade survey)

Communication—No differencesCommunication—No differences Resistance—ASAPS better scores immediately after Resistance—ASAPS better scores immediately after

interventionsinterventions

*Statistically significant at .05 level*Statistically significant at .05 level

RECRUITMENT:SUPERINTENDENTPRINCIPALS (HIGH

AND MIDDLE

LETTERS OF AGREEMENT TOPARTICIPATE IN

STUDY

RANDOMLY SELECTA REPLACEMENT

EXPERIMENTAL

CONTROL

OFFERED PREVENTION PROGRAM

REMAINED CONTROLS

HI FIDELITYLO FIDELITY

REAL WORLD CHANGES 1

HI ATTENDANCE LO ATTENDANCE HI ATTENDANCE LO ATTENDANCE

Other “Real World” IssuesOther “Real World” Issues

9/119/11 School RiotsSchool Riots Burned down schoolBurned down school Hurricane KatrinaHurricane Katrina No Child Left Behind Law; allowing No Child Left Behind Law; allowing

students to select high schools outside students to select high schools outside of their neighborhoodsof their neighborhoods

Percentage of Students With At Least One Survey by Survey Wave

0102030405060708090

100

7thPretest

7thPosttest

8th 9thPretest

9thPosttest

Survey Wave

Pe

rce

nta

ge

Control

Treatment

Total

Lost to follow-up by Year 3Lost to follow-up by Year 3Control Schools= 34.2%Control Schools= 34.2%

Treatment Schools= 39.6%Treatment Schools= 39.6%

Estimated Loss to follow-up by Year Estimated Loss to follow-up by Year 5= 50%5= 50%

Examination of Attrition at 9Examination of Attrition at 9thth Grade Grade Post-SurveyPost-Survey

Number of students without 9Number of students without 9thth grade post-survey=6,927 grade post-survey=6,927 Comparison of attrition by condition showed no Comparison of attrition by condition showed no

significant difference (design-based chi square test)significant difference (design-based chi square test) Logistic regression models run to predict substance use Logistic regression models run to predict substance use

(use/no use) at baseline also showed no significant (use/no use) at baseline also showed no significant differences using a multiplicative interaction term differences using a multiplicative interaction term between attrition status and treatment status (although between attrition status and treatment status (although for both groups those who are attritors are more likely to for both groups those who are attritors are more likely to have used substances at baseline)have used substances at baseline)

Examination of gender and ethnicity using logistic Examination of gender and ethnicity using logistic regression models find that males in the treatment regression models find that males in the treatment condition are more likely to be attritors as were American condition are more likely to be attritors as were American Indians in the control conditionIndians in the control condition

Implementation FidelityImplementation Fidelity

Content CoverageContent CoverageOfficer BehaviorOfficer BehaviorTime on ActivityTime on Activity

Officer CharacteristicsOfficer CharacteristicsStudent AssessmentsStudent Assessments

Current StatusCurrent Status

Cleaning up 10Cleaning up 10thth grade survey data grade survey data Running analysesRunning analyses Administration of 11Administration of 11thth grade surveys grade surveys