; PROSPER Underage Drinking Underage Alcohol Abuse
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

PROSPER Underage Drinking Underage Alcohol Abuse

VIEWS: 2 PAGES: 33

  • pg 1
									Prevention of Substance-Related Problems:
Effectiveness of Family-Focused Prevention

                   Richard Spoth
    Partnerships in Prevention Science Institute
               Iowa State University
    United Nations Office on Drugs and Crime
Technical Seminar on Drug Addiction Prevention and
       Treatment: From Research to Practice
                December 17, 2008
1. Advances in Family-focused Prevention

Positive outcomes from rigorous studies
       Caregiver-child bonding
       Child management
       Social, emotional and cognitive
        competencies (e.g., problem solving, goal setting)
       Substance use, delinquency, conduct problems
       Mental health problems

See summaries in Spoth, R. (In press). Translation of family-focused prevention science into public health impact:
Toward a translational impact paradigm. Current Directions in Psychological Science; Spoth, R., Greenberg, M. &
Turrisi, R. (2008). Preventive interventions addressing underage drinking: State of the evidence and steps toward public
health impact. Pediatrics, 121, 311-336.
.
Selected Examples of
Prevention Programs
Meeting Rigorous Outcome Criteria
• Raising Healthy Children
     [Catalano et al. (2003); Brown, Catalano, Fleming, Haggerty, & Abbott (2005); depts.washington.edu/sdrg]

• Nurse-Family Partnership Program (NFP)
     [Olds et al. (1998); www.nursefamilypartnership.org]

• The Incredible Years
     [Reid, Webster-Stratton, & Beauchaine (2002); Webster-Stratton & Taylor (2001); www.incredibleyears.com]

• Triple P-Positive Parenting
     (Heinrichs et al. (2006); Sanders, Markie-Dadds, Tully, & Bor (2000); www.triplep.net ]

• Family Matters
     [Bauman et al. (2000); Bauman et al. (2002); http://familymatters.sph.unc.edu/index.htm]

• Families That Care: Guiding Good Choices
     [Park et al. (2000); Spoth et al. (2004); http://www.dsgonline.com/mpg]


 See criteria in Spoth, R., Greenberg, M., & Turrisi, R. (2008). Preventive interventions addressing underage
 drinking: State of the evidence and steps toward public health impact. Pediatrics, 121, 311-336.
2. Challenge of General Population
   Intervention Impact—Substance Initiation
          U.S. Monitoring the Future Study, 2005—
      among 8th-12th graders, lifetime use prevalence rates
                                                                    •Escalating rates
               Cigarettes   Marijuana      Alcohol    Drunkenness
80%
                                                                    of use from
70%                                                                 8th-12th grades
60%
50%                                                                 •Early initiation
40%
30%                                                                 linked with
20%                                                                 misuse/high
10%
0%
                                                                    social, health,
          8th Grade           10th Grade             12th Grade     economic costs
Two Windows of Opportunity for
Intervention with General Populations

                                               Substance                                    Advanced
       No Use
                                                Initiation                                    Use


                                              Intervene to
                                           Reduce Probability
                                             of Transition



See Spoth, Reyes, Redmond, & Shin (1999). Assessing a public health approach to delay onset and progression of
adolescent substance use: Latent transition and log-linear analyses of longitudinal family preventive intervention
outcomes. Journal of Consulting and Clinical Psychology, 67, 619-630.
Conditions for Public
Health Impact on Substance Use—Requires…
…a larger “piece” of evidence-based programs (EBPs) to delay
two types of transition with general community populations
…sustained, quality implementation on a large scale
                                    Sustained, quality EBPs
                      EBPs
              Evaluated-
              not effective
                                             Not Evaluated



Rigorously demonstrated, long-term EBP impact is very rare (Foxcroft et al., 2003).
3. Illustrations of Evidence
   That Universal Family Programs Work...

      ...with potential for public health impact.
   Intervention Implementation Model for
   Project Family Randomized Controlled
   Trial II (First generation partnership model)

                          School/Community Implementers
                       assisted by University Outreach System




                             State University
            Prevention Research Team and Extension Specialists

See partnership model description in Spoth, R. (2007). Opportunities to meet challenges in rural prevention
research: Findings from an evolving community-university partnership model. Journal of Rural Health, 23, 42-54.
One Example―
Strengthening Families
Program: For Parents and Youth 10-14* (SFP 10-14)
• Objectives
   ─ Enhance family protective factors (e.g., caregiver-child
     bonding)
   ─ Reduce family-based risk factors for child problem
     behaviors (e.g., ineffective discipline; low peer
     resistance)
• Program Lengthweekly two-hour sessions
• Program Formatsessions include one hour for separate
  parent and child training and one hour for family training
  *Formerly known as Iowa Strengthening Families Program (ISFP)
SFP 10-14 Content
• Key program content for parents
   ─ Effective family management
   ─ Managing emotions/affective quality
• Key program content for adolescents
   ─ Peer resistance skills
   ─ Pro-social attitudes
   ─ Coping with stress and strong emotions
• Key program content for families
   ─ Problem-solving
   ─ Communication
• Observers confirm consistency with protocol
Project Family Trial II
Substance Initiation Results
                                            Lifetime Drunkenness Through 6 Years Past Baseline:
                                                           Logistic Growth Curve
                              0.8
                                                             Trajectory for ISFP Condition

                                                             Trajectory for Control Condition
      First Time Proportion




                              0.6




                              0.4




                              0.2




                               0
                                    0 months    6 months         18 months                30 months    48 months    72 months
                                    (Pretest)   (Posttest)        (Grade 7)                (Grade 8)   (Grade 10)   (Grade 12)




Source: Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent
substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal
of Consulting and Clinical Psychology, 72, 535-542.
Project Family Trial II
Substance Initiation Results
                                             Lifetime Marijuana Use Through 6 Years Past Baseline


                                 0.4
                                                                      Trajectory for ISFP Condition
         First Time Proportion




                                                                      Trajectory for Control Condition
                                 0.3




                                 0.2




                                 0.1




                                    0
                                 0 mo. (Pretest)   6 mo. (Posttest)              18 mo. Grade 7          30 mo. Grade 8   48 mo. Grade 10   72 mo. Grade 12




Source: Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent
substance initiation: School-level curvilinear growth curve analyses six years following baseline.
Journal of Consulting and Clinical Psychology, 72, 535-542.
Project Family Trial II
Substance Initiation Results
                 Average age at given prevalence levels

                                                             Prevalence                                Age
                                                                Rate                         Intervention Control
  Lifetime Alcohol Use
     without parental permission                                   40%                             15.5                   17.0*
  Lifetime Drunkenness                                             35%                             15.3                   17.5*
  Lifetime Cigarette Use                                           30%                             15.7                   17.9*
  Lifetime Marijuana Use                                           10%                             15.5                   17.8
 *p < .05 for test of group difference in time from baseline to point at which initiation levels reach the
 stated levels—approximately half of 12th grade levels—in control group.
 Source: Spoth, Redmond, Shin, & Azevedo. (2004). Brief family intervention effects on adolescent substance initiation: School-level
 curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72, 535-542.
Project Family Trial II―
Wide Ranging Positive Outcomes
       Adolescents─Up to 6 Years Past Baseline
• Improved parenting skills
• Improved youth skills (e.g., peer resistance, social
  competencies)
• Improved school engagement and grades
• Decreased aggressive/destructive behaviors, conduct
  problems
• Decreased mental health problems (e.g., depression)
  Other Long-term
  Effects of Family Program
                     Young Adults─10 Years Past Baseline
    • Significant effects on young adult drunkenness, cigarette use, illicit
      drug use, offending behavior, health-risky sexual behavior
    • Examples of practical significance

                                                         Drunkenness             Illicit Use        Offending
           Family Program                                     20.2%                 14.8%               7.1%
           Control                                            29.5%                 18.2%             14.3%
           Yields relative reduction rate                     22.0%                 19.0%             50.0%
Sources: Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2008). Universal intervention effects on substance use
among young adults via slowed growth in adolescent substance initiation. Under review (Journal of Consulting & Clinical
Psychology); Spoth, R., Trudeau, L., Shin, C., & Redmond, C. (August, 2008). Universal intervention effects on offending
behaviors among young adults via reduction in growth of adolescent problem behaviors. Invited presentation at the annual
conference of the American Psychological Association, Boston, MA.
Countries in Which
SFP:10-14 Has Been Implemented to Date
 Costa Rica                       Poland
 El Salvador                   Puerto Rico
  England                         Spain
   Greece                        Sweden
    Italy                      United States
 Nicaragua                   US Virgin Islands
  Norway                          Wales
Does the family
program work universally well?
           Are observed initiation outcomes
   truly “universal”—do they benefit all participants
      comparably, regardless of initial risk status?
Conclusions from
Risk-Related Outcome
Studies─Benefits to
Higher-Risk
• Comparable benefit across risk-related subgroups
  or higher-risk benefit (multiple studies)
• Leveraging effect (lower risk benefit more)
  intuitively appealing but not empirically supported
• Findings are from studies wherein successfully
  recruited and retained both higher-risk and
  lower-risk participants
Does the family program
yield economic benefits?



                     (What are the economic
                     benefits of universal
                     intervention effects on
                     substance initiation?)
Project Family Trial II
Benefit-Cost Analysis




                      *Estimated $9.60 returned for each dollar invested
                               under actual study conditions.
Source: Spoth, Guyll, & Day (2002). Universal family-focused interventions in alcohol-use disorder prevention:
Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63, 219-228.
Family plus school more
effective than school alone?

• Both family and school are primary
  socializing environments
• Etiological research confirms powerful
  risk and protective factors originating
  in both
• Prospect of intervention synergy—
  teaching similar skills in two settings
• No prior randomized, controlled
  studies of this universal combination
• Capable Families and Youth (CaFaY) Trial
CaFaY Meth Initiation Results at
4½ Years Past Baseline

                         8

                         7

                         6

                         5
            Percentage




                         4
                                                               5.18
                         3
                                                  2.51
                         2

                         1         .53

                         0
                             SFP+LST (p<.05)       LST       Control
                                               11th Grade




  Source: Spoth, R., Clair, S., Shin, C., & Redmond , C. (2006). Long-term effects of universal
  preventive interventions on methamphetamine use among adolescents. Archives of Pediatrics
  and Adolescent Medicine, 160, 876-882.
When “combined” with school program, how
well is it implemented—and working—under
“real world” conditions?
         When the multicomponent intervention
         is implemented by a community team
         (“real world conditions”) is the quality
         of intervention implementation
         sufficiently high?
         Are the effects significantly better than
         “intervention as usual?”
Third Generation Sustainability Partnership
Design For PROSPER Randomized Controlled Trial

             Local Community Teams



           Prevention Coordinator Team



            University/State-Level Team
PROSPER
Community Team Activities

• Meet regularly to plan activities/review progress
• Recruit participants for family-focused program
• Hire and supervise program
  implementers
• Handle all logistics involved with
  program implementation
• Market PROSPER programs in
  their communities
• Locate resources for sustaining
  programs
PROSPER Implementation Study Findings
• Poor implementation threatens validity
• The range of percentage of adherence to protocol in
  literature reviews is 42% to 86%.
• Average over 90% adherence to the intervention
  protocol with family EBIs
• Average over 90% adherence with school EBIs
• High ratings on other quality indicators
• Quality maintained across cohorts
  Source: Spoth, Guyll, Lillehoj, Redmond, Greenberg (In press). PROSPER study of evidence-
  based intervention implementation quality by community-university partnerships. Journal of
  Community Psychology.
PROSPER Sustainability Trial
Substance Initiation Results
                  Outcomes at 1½ and 3½ Years Past Baseline
         Intervention                       Past Year Use Rates
         Control
                           .20
                                                                           0.19
                           .15
                                                                   0.14
                           .10

                           .05                   0.05
                                          0.03

                           .00
                                     Marijuana Use**           Marijuana Use**
                                      (I 1/2 years)             (3 1/2 years)                       **p <0.01


Source: Spoth, Redmond, Shin, Greenberg, Clair, & Feinberg (2007). Substance use outcomes at 1½ years past baseline
from the PROSPER community-university partnership trial. American Journal of Preventive Medicine, 32(5), 395-402.
General Conclusions about Family Programs
• Ultimate goal is measurable public health impact on
  substance-related (and other health) problems—using
  universal preventive interventions delivered with
  quality on a large scale
• In this connection, our research suggests
  ISFP/SFP 10-14 (plus school interventions)
     can work well—effective long-term,
     across the risk spectrum,
     with economic benefits,
     even when “turned over” to community teams
Needed Work in Family-Focused
Prevention―The 4 Es of Intervention Impact
• EffectivenessMore programs evaluated more vigorously (e.g.,
   long-term follow-ups)
• Extensiveness of coverage Fill gaps re population needs (e.g.,
   for sociodemographically diverse populations, rural to urban)
• EfficiencyMore programs with multiple outcomes,
   economically efficient programs
• EngagementEffective strategies at individual and
   organizational levels (e.g., increase organizational readiness to
   adopt and sustain quality implementation)

 Spoth, R. (In press). Translation of family-focused prevention science into public health impact: Toward a
 translational impact paradigm. Current Directions in Psychological Science.
Plotting the Future Course―
Key Tasks in Translating Science into Practice
 • Adopt comprehensive public health impact oriented models
       ─ Integrate service development models with evaluation research
       ─ Factor organizational readiness and capacity building
       ─ Factor quality implementation with sustainability

 • Implement policies that
       ─ Prioritize implementation of programs with evidence of potential
         economic/public health impact
       ─ Fund broad-spectrum translational research to guide effective large-scale
         delivery, guided by comprehensive public health models
       ─ Support infrastructure for effective large-scale delivery (e.g., practitioner-
         scientist networks)
Spoth, R. (In press). Translation of family-focused prevention science into public health impact: Toward a
translational impact paradigm. Current Directions in Psychological Science; Spoth, R. L., & Greenberg, M. T.
(2005). Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community
benefits. American Journal of Community Psychology, 35, 107-126.
…Linked with an International
    Research “Network”
                Acknowledgement of
               Our Partners in Research
                   Investigators/Collaborators
R. Spoth (Director), C. Redmond & C. Shin (Associate Directors),
      T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair,
              T. Dishion, M. Greenberg, D. Hawkins,
           K. Kavanagh, K. Kumpfer, C. Mincemoyer,
          V. Molgaard, V. Murry, D. Perkins, J. A. Stout
                  Associated Faculty/Scientists
         K. Azevedo, J. Epstein, M. Feinberg, K. Griffin,
         M. Guyll, K. Haggerty, S. Huck, R. Kosterman,
    C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels,
               T. Nichols, K. Randall, L. Schainker,
            T. Tsushima, L. Trudeau, J. Welsh, S. Yoo
                     Prevention Coordinators
          E. Berrena, M. Bode, B. Bumbarger, E. Hanlon
          K. James, J. Meek, A. Santiago, C. Tomaschik
Welcome to our website at...
   www.ppsi.iastate.edu

								
To top
;