El choque entre la ciencia y la realidad: Estudio sobre las experiencias del abuso de drogas en los adolescentes

1. El choque entre la ciencia y la realidad: Estudio sobre las experiencias del abuso de drogas en los adolescentes Zili Sloboda, Sc.D., Investigador Principal September 13, 2005 VII Reunión del Grupo de Expertos en Reducción de la Demanda CICAD/OEA Patrocinado por la Fundación Robert Wood Johnson (Grant#s O39223 and 040371)

2. El estudio sobre el abuso de sustancias en los adolescentes • Desarrollar y evaluar un programa de prevención de abuso de drogas basado en la evidencia con curriculos para 7mo grado (donde los niños están entre los 12 y 13 años de edad) y 9no grado (donde los niños están entre los 14 y 15 años de edad) para ser entregado por oficiales de DARE. • La evaluación consiste en hacer seguimiento a una cohorte de estudiantes de 7mo a 11avo grado.

3. Años de riesgo para el abuso de sustancias • Hay un aumento entre le 150% y el 200% en el uso de todas las sustancias entre los grados 8vo (13 y 14 años) y 10mo (15 y 16 años) • El abuso de sustancias por parte de los alumnos de 10mo grado es mas cercano y paralelo al de los de 12avo grado)

5. Por qué D.A.R.E.? • D.A.R.E. es un sistema de entrega de instrictores/oficiales que tiene presencia en el 80% de las escuelas a nivel nacional. • La capacotación y el monitoreo de D.A.R.E. refuerza la fidelidad de la implementación • Los oficiales están entrenados para ser especialistas en prevención y su entrada en los salones de clases en horas pre programadas aseguran que el tiempo en el salán sea dedicado exclusivamente a prevención.

6. Resumen de la Presentación: • Diseño del curriculo • Elementos de investigación • Medidas • Desafíos • Status actual

7. DISEÑO DEL CURRICULO ESTUDIANTES de SEPTIMO y NOVENO

8. ELEMENTOS DE PROGRAMAS DE PREVENCION ESCOLAR EFECTIVA • CONTENIDO • Deshacer mitos de prevalencia Dispel myths about prevalence and expectativas del uso de sustancias • Establecimoento de normas anti uso de drogas. • Abordar tabaco y alcohol así como dorgas ilícitas. • Abordar perceopciones de consecuencias del abuso de sustanacias por parte de los adolescentes. • Desarrollo de habilidades: comunicaicones, toma de decisiones, resistencia. • ENTREGA • Aprendizaje interactivo • Práctica de habilidades a través de juegos de rol, discusiones en grupos pequeños etc..

9. Criterios para el diseño del currículo • Actividades basadas en problemas que logren atraer compromiso • Problemas autenticos como organizadores • Habilidades de pensamiento crítico requeridas. • Secuencia espiral de desarrollo de habilidades. • En 7m grado, debates en pequeños grupos; en 9no grado, discusiones en grupos grandes (catedra limitada) • Cultural y socialmente senstiva.

10. Variables Externas Actitudes Intención comportamiento Normas subjetivas Control Del c/tamiento percibido Modelo Teórico de la Teoría del comportamiento planeado Creencias de que el c/tamiento lleva a ciertos resultados Demográficas Actitudes hacia la población objetivo Evaluación de resultados Creencias de referentes específicos como desempeño de comoprtamiento Personalidad Motivación para acceder a esas referencias Importancia relativa de consideraciones actitudinales y normativas.

11. Tres contenidos de mayor enfasis (mediadores) – Evidencia de Efectividad • Normativa de creencias entre los adolescentes • Percepciones de las consecuencias del uso y abuso de sustancias entre adolsecentes. • Habilidades sociales para la solución de problemas • Habilidades de comunicación • Habilidades de toma de decisión • Habilidades de resistencia y asertividad.

12. RESEARCH ELEMENTS

13. ASAPS Research Questions • Are there differences in the subsequent substance use behaviors of children who receive the program compared to those who were in the control schools? • To what extent is the program’s effectiveness a function of the implementation fidelity of the delivered program? • To what extent is the program’s effectiveness a function of the student’s exposure to the program? • What is the relationship between program mediators (normative beliefs, skills, etc.) and subsequent substance use?

14. Refusal Skills Refusal Skills Consequences Consequences Attitudes Attitudes (How much does... (How much does... (I think it's okay (I think it's okay affect how well the affect how well the for students my for students my brain works...) brain works...) age to...) age to...) Intentions Intentions (How likely is it that (How likely is it that 30 Day Use 30 Day Use you will use...in the you will use...in the next 12 months) next 12 months) Normative Beliefs Normative Beliefs Subjective Norms Subjective Norms (How many (How many 10th 10th (Most Students My (Most Students My graders do you graders do you age think it's okay age think it's okay think...) think...) to...) to...) Decision-Making Decision-Making Skills Skills constructs targeted by prevention curricula constructs in the TPB Proposed Extension of TPB for Targeted Mediators Constructs targeted by prevention curricula Constructs in the TPB

15. Methods—Study Population • SITES: DETROIT, HOUSTON, LOS ANGELES, NEWARK (NJ), NEW ORLEANS, ST. LOUIS • Unit of analysis=school clusters made up of a high school and all feeder middle schools • Random assignment of school clusters to two conditions: one where the schools receive the new program and the other, not. • Universe stratified by high and low stress (proportion of district students eligible for free lunch and proportion of minority students)

16. Research Design 2001-2002 (7TH) 2002-2003 (8TH) 2003-2004 (9TH) 2004-2005 (10TH) 2005-2006 (11TH) O1XO2O3O4XO5O6O7 EXPERIMENTAL CONTROL O1 O2 O3 O4 O5 O6 O7 ON=STUDENT SURVEY X=NEW CURRICULUM

17. Consenting Procedures for Student Surveys • CONSENT PACKAGE • ACTIVE PARENTAL CONSENT FORM • ACTIVE STUDENT ASSENT FORM • TRACKING INFORMATION FOR FOLLOWUP • COVERLETTER WITH BULLETS SUMMARIZING KEY CONSENT ITEMS • TELEPHONE NUMBER FOR INFORMATION • WORKED WITH SCHOOLS AND TEACHERS TO HAND OUT AND COLLECT • INCENTIVES TO STUDENTS AND TEACHERS

18. Consent Procedure And Survey Completion

19. Measures • MEDIATORS • NORMATIVE BELIEFS (MONITORING THE FUTURE ETC.) • PERCEPTIONS OF CONSEQUENCES OF SUBSTANCE USE IN ADOLESCENCE (MONITORING THE FUTURE ETC) • COMMUNICATION, DECISION MAKING AND RESISTANCE SKILLS (OTHER SOURCES AND MODELS) • MODERATORS • DEMOGRAPHICS • RISK STATUS (MONITORING THE FUTURE ETC) • OUTCOMES • SUBSTANCE USE—TOBACCO, ALCOHOL, INHALANTS, MARIJUANA, OTHER ILLICITDRUGS, AND ABUSE OF PRESCRIPTION DRUGS (MONITORING THE FUTURE)

20. Survey Administration • Self-administered within a class • 40 minutes to complete • Supervised by University of Akron staff (no DARE officer) • Confidential (sealed envelope in box)

21. Confidentiality • Hold a National Institute of Health Certificate of Confidentiality • Student data are identified by a numeric code • All survey data will be stored in a secure environment at the University of Akron

22. Sample Characteristics

23. 30-day Prevalence Of Substance Use At Pretest (Baseline)

24. MONITORING FINDINGS • YEAR 1-4 • MEDIATORS • Normative beliefs—all 3 years ASAPS better* scores • Consequences—Ceiling effects, changed measurements for 8th grade, ASAPS better scores at 9th grade • Skills • Decision making—ASAPS better scores immediately after intervention and at 8th grade (changed our measure at 9th grade survey) • Communication—No differences • Resistance—ASAPS better scores immediately after interventions • *Statistically significant at .05 level

25. REAL WORLD CHANGES 1 RECRUITMENT: SUPERINTENDENT PRINCIPALS (HIGH AND MIDDLE OFFERED PREVENTION PROGRAM LETTERS OF AGREEMENT TO PARTICIPATE IN STUDY CONTROL REMAINED CONTROLS RANDOMLY SELECT A REPLACEMENT EXPERIMENTAL LO FIDELITY HI FIDELITY HI ATTENDANCE LO ATTENDANCE HI ATTENDANCE LO ATTENDANCE

26. Other “Real World” Issues • 9/11 • School Riots • Burned down school • Hurricane Katrina • No Child Left Behind Law; allowing students to select high schools outside of their neighborhoods

28. Lost to follow-up by Year 3Control Schools= 34.2%Treatment Schools= 39.6%Estimated Loss to follow-up by Year 5= 50%

29. Examination of Attrition at 9th Grade Post-Survey • Number of students without 9th grade post-survey=6,927 • Comparison of attrition by condition showed no significant difference (design-based chi square test) • Logistic regression models run to predict substance use (use/no use) at baseline also showed no significant differences using a multiplicative interaction term between attrition status and treatment status (although for both groups those who are attritors are more likely to have used substances at baseline) • Examination of gender and ethnicity using logistic regression models find that males in the treatment condition are more likely to be attritors as were American Indians in the control condition

30. Implementation Fidelity Content Coverage Officer Behavior Time on Activity Officer Characteristics Student Assessments

31. Current Status • Cleaning up 10th grade survey data • Running analyses • Administration of 11th grade surveys