Universal school-based substance abuse prevention programs: Modeling targeted mediators and outcomes for adolescent cigarette, alcohol and marijuana use.
OBJECTIVE
We examined the relationships among targeted constructs of social influences and competence enhancement prevention curricula and cigarette, alcohol and marijuana use outcomes in a diverse sample of high school students. We tested the causal relationships of normative beliefs, perceptions of harm, attitudes toward use of these substances and refusal, communication, and decision-making skills predicting the self-reported use of each substance. In addition, we modeled the meditation of these constructs through the intentions to use each substance and tested the moderating effects of the skills variables on the relationships between intentions to use and self-reported use of each of these substances.


METHODS
Logistic regression path models were constructed for each of the drug use outcomes. Models were run using the Mplus 5.0 statistical application using the complex sample function to control for the sampling design of students nested within schools; full information maximum likelihood estimates (FIML) were utilized to address missing data.


RESULTS
Relationships among targeted constructs and outcomes differed for each of the drugs with communication skills having a potentially iatrogenic effect on alcohol use. Program targets were mediated through the intentions to use these substances. Finally, we found evidence of a moderating effect of decision-making skills on perceptions of harm and attitudes toward use, depending upon the outcome.


CONCLUSIONS
Prevention curricula may need to target specific drugs. In addition to normative beliefs, perceptions of harm, and refusal and decision-making skills, programs should directly target constructs proximal to behavioral outcomes such as attitudes and intentions. Finally, more research on the effects of communication skills on adolescent substance use should be examined.
Stephens
Peggy C
PC
Department of Public Administration and Urban Affairs, The University of Akron, 225 S. Main Street, Suite 265, Akron, OH 44325-7904, United States. tonkin@uakron.edu
Sloboda
Zili
Z
Stephens
Richard C
RC
Teasdale
Brent
B
Grey
Scott F
SF
Hawthorne
Richard D
RD
Williams
Joseph
J
D000293:Adolescent; D000428:Alcohol Drinking / Q000517:prevention & control*; D003142:Communication; D003627:Data Interpretation, Statistical; D003657:Decision Making; D005260:Female; D006266:Health Education; D006801:Humans; D016015:Logistic Models; D008297:Male; D008385:Marijuana Smoking / Q000517:prevention & control*; D015233:Models, Statistical; D010379:Peer Group; D000074606:Smoking Prevention; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome