Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls

Highlights

• Longitudinal data support the efficacy of a web-based intervention for girls.

• Intervention reduced cigarette, e-cigarette, marijuana, and other drug use.

• Improved general and gender-specific risk factors for drug use

• Intervention implementation requires no staff training or facilitators.

Abstract

Introduction

Rates of drug use among early adolescent girls meet or exceed rates of their male counterparts. Girls are also vulnerable to differential risk factors for drug use. Yet, expressly designed prevention programs targeting this population are absent. The present study reports 2- and 3-year findings on a web-based drug abuse prevention program for adolescent girls.

Methods

A sample of adolescent girls (N = 788) were recruited via Facebook. Online, all girls completed pretests; girls were randomly assigned to a 9-session intervention arm or to a measurement-only control arm and all girls completed posttests. All girls also completed 1-, 2-, and 3-year follow-up measurements.

Results

At 2-year follow-up and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette, marijuana, and “other” drug use (club drugs, cocaine, ecstasy, hallucinogens, heroin, inhalants, methamphetamines, steroids, prescription drugs), lower rates of peer drug use, and increased scores on drug refusal skills, coping skills, self-esteem, media literacy, and self-efficacy. At 3-year follow-up, and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette and e-cigarette use, lower rates of peer drug use, lower reported anxiety and stress, and increased scores on drug refusal skills, self-esteem, media literacy, self-efficacy, and body image.

Conclusions

Longitudinal outcome data lend support to the efficacy of a gender-specific, web-based drug abuse prevention program to reduce adolescent girls' drug use rates and associated risk factors.

Introduction

Young girls' drug use rates rival and sometimes exceed their male counterparts' rates of use (Johnston et al., 2018a). As girls' transition from middle to high school, their drug consumption increases dramatically. Between 8th and 12th grades, the percentage of girls who vape any substance doubles from 6% to 12%; the percentage of girls who smoke cigarettes or marijuana quadruples from 2% to 8% and from 5.5% to 21.5%, respectively; and the percent of girls who drink alcohol increases by 255% (Johnston et al., 2018b).

Furthermore, as females mature, they are more vulnerable to drug addiction than males (Anker & Carroll, 2011). Females experience greater side effects during drug use, experience more negative affect during withdrawal, and are more likely to relapse than their male counterparts (Becker, McClellan, & Reed, 2017; National Institute on Drug Abuse, 2018). The sexual risks from impaired judgment that attend drug use also weigh heavier on females than on males (Chung et al., 2017). Without dispute, girls are using drugs at alarming rates and experience untoward consequences from their use. To mitigate girls' drug use and risks for drug use, effective prevention programs must be theory-based, tailored, engaging, and easy to disseminate.

For boys and girls alike, deviant peers and other social influences are the leading risk factors for adolescent drug abuse (Catalano, Haggerty, Hawkins, & Elgin, 2011; Van Ryzin, Fosco, & Dishion, 2012). Affiliation with drug using peers has long been a robust predictor of drug use (Fergusson, Swain-Campbell, & Horwood, 2002; Lee, Padilla-Walker, & Memmott-Elison, 2017). Effective prevention programming, therefore, must provide instruction to youth on the skills required to navigate the risks associated with these peer influences. Similar to boys, girls' drug use is reduced when they possess the social and cognitive skills necessary to resist peer and social influences to use drugs (Scheier, 2015). Therefore, our intervention content was guided by social learning theory (Bandura, 1986) and aimed to enhance girls' social, emotional, and cognitive competencies around such skills as goal setting, self-efficacy, media literacy, peer use, and drug use refusal. Often referred to as comprehensive skills training, the aforementioned program elements are a hallmark of effective prevention programs (Faggiano, Minozzi, Versino, & Buscemi, 2014).

Risks for drug use do, however, differ by gender. Girls, more than boys, are susceptible to internalizing behaviors of low self-esteem, difficulty coping with stress, and negative body image, as well as disorders of anxiety and depression (Dir, Bell, Adams, & Hulvershorn, 2017; Marmorstein et al., 2010). Evidence suggests that these internalizing behaviors and disorders are more strongly associated with later drug use for girls than for boys (Danzo, Connell, & Stormshak, 2017; Edwards et al., 2014; Miettunen et al., 2014).

To address girls' gender-specific risk factors linked to mood management, self-esteem, and coping with stress, our intervention was further guided by a resiliency framework (Masten & Powell, 2003). Content on stress, puberty, body image, media images related to beauty, and coping strategies was included to bolster essential characteristics of resiliency that include positive self-regard, competency coping with stress, and managing mood (Hodder et al., 2017). Our intervention, therefore, addressed girls' general and gender-specific risk factors for drug use.

Support for the use of gender-specific programming is evident in such fields as HIV prevention (Wechsberg et al., 2015), health education (LeCroy, Cosgrove, Cotter, & Fordney, 2018), behavioral and cognitive psychology (Belgrave, Chase-Vaughn, Gray, Addison, & Cherry, 2000; McCabe, Connaughton, Tatangelo, Mellor, & Busija, 2017), criminal justice (Wakai, Sampl, Hilton, & Ligon, 2014), and drug abuse treatment (Chen et al., 2004; Saxena, Messina, & Grella, 2014). Yet, despite decades of evidence noting gender differences in drug use rates, risk factors, and sequelae of use, prevention interventions tailored for adolescent girls remain in short supply (Kumpfer, Smith, & Summerhays, 2008). In addition to our prior work pilot testing gender-specific programming (Schinke & Schwinn, 2005; Schwinn, Schinke, & Di Noia, 2010), only two additional drug prevention programs for adolescent girls appear in the literature.

One effort to stem adolescent girls' drug use is a comprehensive skills-based intervention delivered in high school to female athletes (ATHENA; Elliot et al., 2008). Females randomly assigned to ATHENA reported less alcohol, cigarette, and marijuana use compared to girls in the control arm, 1 to 3 years following the program. The lower rates of drug use observed in this longitudinal study speak to the promise of providing gender-specific, skills-based content to reduce girls' later vulnerabilities to drug use. A second promising effort to address adolescent girls' risk for drug use is a skills-based intervention developed by Girls Incorporated (Weiss & Nicholson, 1998). This facilitator-led program aimed to help girls who participated in an afterschool program to navigate the peer and societal pressures to use drugs. Study findings were modest and included delaying the onset of alcohol use and avoiding situations where alcohol was present.

The scarcity of gender-specific drug abuse prevention programming may be attributed to the implementation demands that attend delivery of any traditional prevention program, but which are heightened when tailored programming requires additional staff and space for delivery to distinct groups (e.g., boys and girls). Web-based interventions, however, hold promise to ease the implementation of delivering programming to a sub-population, with the added promise of high fidelity, improved participant engagement, and inexpensive distribution. With 92% of teens aged 13–17 years going online daily (Lenhart, 2015), novel, web-based, interactive drug abuse prevention program can reach youth where they socialize and spend much of their free time. Recent reviews and meta-analyses of web-based interventions suggest that researchers are capitalizing on the potential promise of online intervention delivery to mitigate adolescent drug use (Champion, Newton, Barrett, & Teesson, 2013; Rodriguez, Teesson, & Newton, 2013; Schinke & Schwinn, 2017; Tait, Spijkerman, & Riper, 2013).

Toward advancing the field of prevention science, our team developed and tested a web-based intervention that addresses risk and protective factors salient to girls' drug use. We hypothesize lower rates of past 30-day drug use among girls randomly assigned to receive the intervention compared to girls randomly assigned to receive no intervention. We also hypothesize that girls who receive the intervention will have improved scores on risk and protective factors salient to drug use (anxiety, depression, body image, coping, stress, media literacy, goal setting, self-esteem, self-efficacy, refusal skills, and peer use) compared to girls who receive no intervention. The data presented here extend our previous reporting on posttest and 1-year follow-up data finding intervention effects on cigarette use, binge drinking, peer drug use, self-esteem, goal setting, self-efficacy, drug refusal skills, coping skills, and media literacy (Schwinn, Schinke, Hopkins, Keller, & Liu, 2017).