CAPT Presentation
Adolescent Risk Reduction
Focusing on Evidence-Based Strategies
Kim Dash, PhD, MPH, CAPT Scientific Advisor and Senior Research Scientist, Education
Development Center, Inc.
Presented at A Public Health Approach to Addressing Substance Misuse and Addiction, Region 5, Indianapolis, IN
2
Roadmap
1. Background and Significance
2. Prevention Principles
3. Prevention Programs
4. Prevention Policy Solutions
5. Community-based Models
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Background and Significance
Why should we be concerned about adolescent
substance use?
4
Trends in Lifetime Use
Lifetime Prevalence of Use of Various Drugs in Grade 121
0
10
20
30
40
50
60
70
80
902
00
0
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
Pe
rce
nt
Alcohol
Cigarettes
Any Rx Drug
Marijuana
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Trends in Initiation of Use
0
5
10
15
20
25
30
35
2001 2003 2005 2007 2009 2011
Pe
rce
nt
Age of Initiation Younger than 13 Years2
Alcohol
Marijuana
Cigarettes
6
Adolescent Brain Development
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Consequences of Use3
• School failure
• Problems with family and friends
• Loss of interest
• Impaired memory
• Increased risk of contracting infectious disease
through risky sexual behavior or sharing
contaminated needles
• Overdose death
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Risk and Protective Factors4
Community
School
Relationship
Individual
•Poverty (-)
•Opportunities for positive social involvement (+)
•Drug availability (-)
•Anti-drug policies (+)
• Family conflict (-)
•Peer substance abuse (-)
•Parental monitoring (+)
•Peer academic competence (+)
•Early aggressive behavior (-)
• Self-control (+)
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Prevention Principles
What principles guide adolescent risk reduction?
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General Guiding Principles4
• Enhance protective factors and reverse
or reduce modifiable risk factors.
• Attend to all local substance abuse
problem/s.
• Address risks specific to population groups of interest.
• Intervene early to prevent risk and promote well-being.
• Focus on key transition points.
• Combine two or more effective programs.
• Present consistent, community-wide messages across
settings.
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Types of Prevention Interventions5
Universal
General population
Selective
Population at increased risk
Indicated
Involved in risky behavior
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Prevention Programs
What are examples of evidence-based prevention
programs for adolescents?
13
Prevention Programs
Program Population Unit of Practice Outcomes
The Good Behavior Game
Universal School, Classroom Less likely to use tobacco, cocaine, or heroin by grade 86
Raising Healthy Children
Universal School Less heavy alcohol use at 18 year of age7
Fast Track Universal, Selective
School Increased social competence; and fewer conduct problems8
Abecedarian Project
Selective School Less likely to smoke marijuana at age 219
Nurse-Family Partnership
Selective Family, home Less likely to use marijuana at 12 years of age10
Implemented Prior to Adolescence
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Prevention Programs
Program Population Unit of Practice
Substance Use Behaviors Affected
Keepin’ It Real Universal School Alcohol and marijuana use11
Iowa Strengthening Families: 10-14
Universal School, Family
Long-term alcohol, tobacco, and marijuana use;12 and prescription drug misuse13
Familias Unidas Selective Family Illicit drug use and alcohol dependence14
Project Toward No Drug Abuse
Selective School Alcohol15 and long-term hard drug use16
Positive Family Support
Universal, Selective, Indicated
School, Family
Alcohol and cigarette use;17,18 problematic marijuana use,19 and marijuana use disorder20
Implemented During Adolescence
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Prevention Policies
What policies are associated with reducing
adolescent substance abuse?
16
Prevention Policies
Program Youth Substance Use Behaviors Affected
Alcohol Advertising Restrictions
Alcohol use;21 binge drinking;22 alcohol-related, single-vehicle, driver traffic fatalities23
Alcohol Price Increases Alcohol use;24 harmful drinking;25 traffic fatalities26
BAC Limits Alcohol use;27 binge drinking;28 driving after drinking; alcohol-related traffic fatalities29
Social Host Liability Alcohol-related traffic fatality rates;30 harmful drinking;31 drinking and driving;31 drinking in private settings32
Compliance checks Retail sales of alcohol to minors; alcohol consumption, binge drinking;33 requests for identification from individuals attempting to purchase alcohol34
Minimum age of sale, purchase, and server
Alcohol use; binge-drinking (underage college students)35
Underage Drinking and Its Consequences
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Prevention Policies
Program Outcomes of Interest
PDMPs Doctor shopping (TN, NY); individuals with opioid prescription (TN, NY); prescriptions for all opioids (TN, NY); and dispensing of controlled substances (KY)36
System-wide prescriber education
Workers on disability compensation who received an opioid prescription, and overdose deaths among those individuals (WA);37 medication-related overdose deaths and inappropriate prescribing habits (UT);38
Model pain clinic regulations
Drug prescriptions; prescribers dispensing high volume of oxycodone prescriptions; overdose deaths; drug diversion39
Doctor-shopping laws
Pharmacy hopping and nonmedically-necessary tranquilizer prescriptions (NY)40
Nonmedical Use of Prescription Drugs
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Community-Based Models
What are effective processes for implementing
prevention programs?
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Prevention System Models
Program Adolescent Substance Use Behaviors Affected
Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER)
Lifetime prescription drug misuse, lifetime opioid misuse, lifetime illicit substance use, past-year methamphetamine use, and marijuana use in 12th grade (5-year follow-up); adherence rate to EBP models41
Communities Mobilizing for Change on Alcohol (CMCA)
DUI arrests; alcohol use; providing alcohol to peers; alcohol sales to minors; age ID checks during alcohol transactions42
Communities that Care Alcohol use and cigarette use through grade 1043
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Effective Implementation
• Diverse, representative, cross-sector community
participation
• Responsiveness to local needs
• Fit, feasibility and cultural appropriateness
• Long-term sustainability
• Process and outcome evaluation
Facilitating Factors44
21
Questions?
22
Contact and Follow Up
If you have questions or comments, please don’t
hesitate to contact:
Kim Dash
CAPT Scientific Advisor
Senior Research Scientist
Education Development Center
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This presentation was developed under the Substance
Abuse and Mental Health Services Administration’s Center
for the Application of Prevention Technologies task order.
Reference #HHSS283201200024I/HHSS28342002T.
The views expressed in this presentation do not necessarily
represent the views, policies, and positions of the Substance
Abuse and Mental Health Services Administration or the U.S.
Department of Health and Human Services.
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