The influence of program mediators on eleventh grade outcomes for seventh grade substance users and nonusers.
OBJECTIVE
In their work examining the effects of the Take Charge of Your Life (TCYL) program, Sloboda and colleagues (This Issue) found that the TCYL program had significant positive effects on baseline marijuana users and significant negative effects on baseline nonusers of cigarettes and alcohol.


METHODS
Mediational analyses were used to understand why the program had these differential impacts on baseline users and nonusers.


RESULTS
Path models for binary outcomes revealed significant program impacts on marijuana normative beliefs and refusal skills. The treatment impacts were between 1.5 and 3 times larger for the baseline users than for nonusers. These direct effects of the program on normative beliefs and refusal skills mediated the treatment impact on use for baseline marijuana users. In contrast, the negative treatment effects on alcohol and cigarette use could not be explained by the program's targeted mediators (normative beliefs, refusal skills, consequences, attitudes and intentions). The direct effects of treatment on use for the baseline nonusers of cigarettes and alcohol remain unexplained.


CONCLUSIONS
Possible explanations for this pattern and implications for strengthening universal prevention programs that are delivered to both users and nonusers are discussed. The importance of mediational analyses for programs that show negative impacts, as well as for those that show positive impacts is stressed.
Teasdale
Brent
B
Department of Criminal Justice, The Partnership for Urban Health Research, P.O. Box 4018, Georgia State University, Atlanta 30302-4018, GA, USA. bteasdale@gsu.edu
Stephens
Peggy C
PC
Sloboda
Zili
Z
Grey
Scott F
SF
Stephens
Richard C
RC
D000293:Adolescent; D000428:Alcohol Drinking / Q000517:prevention & control; D003142:Communication; D003657:Decision Making; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000517:prevention & control; D008960:Models, Psychological; D000074606:Smoking Prevention; D012919:Social Behavior; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome