title: Evaluating the effectiveness of the SMART contract-signing strategy in reducing the growth of Swedish Adolescents' substance use and problem behaviors.
abstract: In 2013, around 40 % of the schools in Sweden had structured programs to prevent tobacco and alcohol debut in compulsory school. There has unfortunately been a lack of scientific evidence to support most of the prevention methods focusing on primary prevention in schools in Sweden. The aim and purpose of the present study is to evaluate the effectiveness of the Non-Governmental Organization SMART contract-signing strategy in reducing the growth of youth substance use and other problem behaviors amongst Swedish adolescents.
  
  
  
  Students from five schools in a medium-sized Swedish municipality were surveyed in three waves from 7(th) to 9(th) grade of compulsory school. We used General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures smoking, use of snus and alcohol, drunkenness, delinquency, and bullying significantly changed different amounts over time in groups that had participated in the SMART program for long time, a short time, sporadically- or not at all. Groups were compared on demographic background variables, and outcome measures were assessed on all measurement occasions by a one-way ANOVA. The magnitude of group differences at the end of the study was estimated according to Cohen's d.
  
  
  
  Number of years with a contract has an effect on the levels of self-reported youth problems in 9(th) grade. We found small to medium-sized differences in measured outcomes between students who participated in the program for the longest period of time, 5 years, and who participated for the shortest time, 0-2 years.
  
  
  
  Findings suggests that the SMART program has preventive effects on adolescent substance use.
authors.affiliation: School of Health and Medical Sciences Örebro University, SE-701 82, Örebro, Sweden. cristian.bortes@live.com.
authors.forename: Cristian
authors.initials: C
authors.lastname: Bortes
authors.affiliation: School of Health and Medical Sciences Örebro University, SE-701 82, Örebro, Sweden.
authors.forename: Susanna
authors.initials: S
authors.lastname: Geidne
authors.affiliation: School of Health and Medical Sciences Örebro University, SE-701 82, Örebro, Sweden.
authors.forename: Charli
authors.initials: C
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D016497:Adolescent Health Services; D032982:Contracts; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D000066553:Problem Behavior / Q000523:psychology*; D015397:Program Evaluation; D012572:School Health Services; D012574:Schools; D013334:Students / Q000523:psychology*; D019966:Substance-Related Disorders / Q000517:prevention & control* / Q000523:psychology; D013548:Sweden
keywords: Adolescent substance use; Prevention; Program evaluation; Swedish