PROSPER community–university partnership delivery system effects on substance misuse through 6 1/2 years past baseline from a cluster randomized controlled intervention trial

doi:10.1016/j.ypmed.2012.12.013

Preventive Medicine

Volume 56, Issues 3–4, March–April 2013, Pages 190-196

https://doi.org/10.1016/j.ypmed.2012.12.013 Get rights and content

Abstract

Objective

To examine the effects of a delivery system for evidence-based preventive interventions through 12th grade, 6.5 years past baseline.

Method

A cohort sequential design included 28 public school districts randomly assigned to the partnership delivery system or usual-programming conditions. At baseline, 11,960 students participated. Partnerships supported community teams that implemented a family-focused intervention in 6th grade and a school-based intervention in 7th grade. Outcome measures included lifetime, current misuse, and frequencies of misuse, for a range of substances. Intent-to-treat, multilevel analyses of covariance of point-in-time misuse and analyses of growth in misuse were conducted.

Results

Results showed significantly lower substance misuse in the intervention group at one or both time points for most outcomes, with relative reduction rates of up to 31.4%. There was significantly slower growth in misuse in the intervention group for 8 of the 10 outcomes. In addition, risk moderation results indicated that there were significantly greater intervention benefits for higher- versus lower-risk youth, for the misuse of 6 of the 10 substances at 11th grade, illicit substances at 12th grade, and growth in the misuse of illicit substances.

Conclusion

Partnership-based delivery systems for brief universal interventions have potential for public health impact by reducing substance misuse among youth, particularly higher-risk youth.

Highlights

► We examine long-term effects of PROSPER, an evidence-based prevention system. ► We measure lifetime, current, and frequency of misuse for a range of substances. ► PROSPER reduced substance misuse; rates were up to 31.4% lower than the control. ► There were greater intervention benefits for higher- versus lower-risk youth. ► Partnership-based delivery systems have potential for public health impact.

Introduction

Prevalence rates of alcohol, tobacco, marijuana, and other illicit substances among adolescents continue to be high (Johnston et al., 2012) and result in adverse health effects. The long-term negative consequences of underage drinking and substance misuse are well documented (Harwood, 2000, Harwood and Bouchery, 2001, Mathurin and Deltenre, 2009, McCambridge et al., 2011, Miller and Hendrie, 2008). Early substance misuse is associated with reduced levels of educational and occupational attainment, risky sexual practices, and impaired mental health (National Institute on Drug Abuse, 2009).

Recent recommendations for addressing substance misuse through universal intervention include implementation through community-based partnerships linking scientists with community practitioners (Grumbach and Mold, 2009, Hawkins et al., 2012, National Research Council and Institute of Medicine, 2009, Spoth and Greenberg, 2005). However, community health-related systems often are ill-equipped to develop and sustain the necessary partnerships and interventions (Berwick, 2003, Gold and Bailey, 2008, Grumbach and Mold, 2009, Woolf, 2008). The current study evaluates a diffusion model that addresses these problems, in order to better translate health science into practice (Berwick, 2003, Woolf, 2008). This model, called PROSPER (PROmoting School–community–university Partnerships to Enhance Resilience), was designed as a partnership-based delivery system for scientifically-proven prevention programs or evidence-based interventions (EBIs).

The PROSPER model leverages the existing infrastructure of land grant universities' Cooperative Extension Systems (CES), which serve scientific outreach functions in every state. The three tiers of the PROSPER model consist of: (1) teams of community stakeholders linked with public schools and led by local CES staff, (2) Prevention Coordinators (PCs) connected with the land grant university's CES, and (3) a team of state-level university researchers and CES faculty. Prevention Coordinators serve as liaisons between the community and university teams, providing ongoing, proactive technical assistance to community teams to optimize team functioning and program delivery.

Effectiveness of the PROSPER model's key elements (Spoth et al., 2004, Spoth et al., 2007a) has been demonstrated through a longitudinal cluster randomized controlled trial (RCT), begun in 2001. These findings include effective participant recruitment (Spoth et al., 2007b), maintenance of implementation quality (Spoth et al., 2007c), and sustainability of intervention delivery (Greenberg et al., unpublished results). Additional results include positive effects on intervention-targeted youth and parent skills, putative mediators likely to reduce substance misuse (Redmond et al., 2009), as well as significant reductions in substance misuse at 4.5 years (10th grade) among intervention group students (Spoth et al., 2011). The current study examines longer-term effects of this partnership-based prevention program delivery model.

In addition to evaluating intervention effects on substance misuse at the end of high school (11th and 12th grades, 5.5 and 6.5 years past baseline), we also evaluate intervention effects on growth in adolescent substance misuse across 6.5 years, and risk-related moderation of these effects.

Section snippets

Community selection and assignment

Twenty eight communities participated; 14 in both Iowa and Pennsylvania. The sample size recruited was based on multilevel power calculations incorporating effect sizes and ICCs estimated from previous evaluation trials of programs on the PROSPER menu. Pairs of communities were matched (14 blocks) on school district size and geographic location, and then randomly assigned to either the partnership intervention or the “usual programming” comparison condition. Because the intervention condition

Sample quality

Pretest equivalence of the two conditions was assessed; there were no significant differences on any sociodemographic measure (e.g., gender, age, race, school lunch status) or on any of the 10 outcomes. Differential attrition was assessed by examining whether the two-way interaction of Condition × Pretest score on the outcome variables predicted drop-out at each wave. No significant interactions were found.

Lifetime illicit substance use index

Point-in-time analyses of the ISUI showed significant overall intervention-control

Discussion

Overall, the effects of interventions delivered via the PROSPER partnership-based delivery system on long-term, adolescent substance use outcomes were robust, considering both growth across the middle- and high-school years, as well as point-in-time results for 5.5 and 6.5 years past-baseline. Positive long-term effects were observed for lifetime illicit use and for current use and frequencies of use, for all types of substances. Relative reduction rates for point-in-time outcomes ranged from

Conflict of interest statement

The authors have no conflict of interest to report.

Acknowledgments

Work on this paper was supported by the National Institute on Drug Abuse (grant DA 013709).

References (37)

G.J. Botvin et al.
A cognitive-behavioral approach to substance abuse prevention
Addict. Behav.
(1984)
D.M. Crowley et al.
Resource consumption of a dissemination model for prevention programs: the PROSPER delivery system
J. Adolesc. Health
(2012)
R. Spoth et al.
Substance use outcomes at 18 months past baseline: the PROSPER community–university partnership trial
Am. J. Prev. Med.
(2007)
R. Spoth et al.
Preventing substance misuse through community–university partnerships: Randomized controlled trial outcomes 4 1/2 years past baseline
Am. J. Prev. Med.
(2011)
D.M. Berwick
Disseminating innovations in health care
JAMA
(2003)
G.J. Botvin
Life skills training and the prevention of adolescent drug abuse
G.J. Botvin
Life Skills Training
(2000)
D.S. Elliott et al.
The Prevalence and Incidence of Delinquent Behavior: 1976-1980
(1983)
M.S. Gold et al.
Addiction treatment: science and policy for the twenty-first century
JAMA
(2008)
Greenberg, M.T., Feinberg, M.E., Johnson, L.E., Perkins, D.F., Spoth, R.L., Unpublished results. Factors that predict...

K. Grumbach et al.

A health care cooperative extension service: transforming primary care and community health

JAMA

(2009)

W.B. Hansen

Prevention programs: what are the critical factors that spell success?

H. Harwood

Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data

(2000)

H.J. Harwood et al.

The Economic Costs of Drug Abuse in the United States, 1992–1998

(2001)

J.D. Hawkins et al.

Testing communities that care: the rationale, design and behavioral baseline equivalence of the community youth development study

Prev. Sci.

(2008)

J.D. Hawkins et al.

Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial

Arch. Pediatr. Adolesc. Med.

(2012)

L.D. Johnston et al.

Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2011

(2012)

P. Mathurin et al.

Effect of binge drinking on the liver: an alarming public health issue?

Gu

(2009)

Cited by (70)

Parent-based interventions to improve multiple lifestyle risk behaviors among adolescents: A systematic review and meta-analysis
2022, Preventive Medicine
Citation Excerpt :
One third of successful studies (5/15)(Choo et al., 2020; Marsiglia et al., 2019a; Mason et al., 2012; Estrada et al., 2015; Gonzales et al., 2012) were underpinned by ecodevelopmental theory, most of which were interventions targeting alcohol and tobacco use. The majority of effective studies(Chen et al., 2011; Choo et al., 2020; Kim and Leve, 2011; St George et al., 2013; St George, 2014; Mason et al., 2012; Spoth et al., 2011; Estrada et al., 2015; Gonzales et al., 2012; Spoth et al., 2013; Pourshamsian et al., 2019) (11/15) used some form of weekly interaction to prompt participant involvement and commitment to the study (ranging from weekly text messages to 3 online lessons per week). There were no clear characteristics of successful studies in terms of follow-up length or participant age.
Lifestyle risk behaviors often co-occur and are prevalent among adolescents. Parent-based interventions addressing risk behaviors concurrently have the potential to improve youth and parent outcomes. This systematic review evaluated the efficacy of parent-based interventions targeting multiple lifestyle risk behaviors among adolescents and parents. MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), Scopus, CINAHL, the Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2010-May 2021. Eligible studies were randomised controlled trials (RCTs) of parent-based interventions addressing 2+ risk behaviors: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviors, and poor sleep. Studies directly targeting parents, and that assessed adolescent outcomes (11–18 years) were eligible. Where possible, random-effects meta-analysis was conducted. From 11,975 identified records, 46 publications of 36 RCTs (n = 28,322 youth, n = 7385 parents) were eligible. Parent-based interventions were associated with improved adolescent moderate-to-vigorous physical activity (MVPA) [Odds Ratio (OR) = 1.82, 95% CI = 1.18, 2.81; p = 0.007], and reduced screen time (SMD = −0.39, 95% CI = -0.62, −0.16, p = 0.0009) and discretionary food intake (SMD = -0.18; 95% CI = −0.30, −0.06; p = 0.002) compared to controls. However, there was some evidence that interventions increased the odds of ever using tobacco in the medium-term (OR = 1.47, 95% CI = 0.99, 2.18, p = 0.06) and of past month tobacco use in the long-term (OR = 1.46, 95% CI = 1.12, 1.90; p = 0.005). Overall, the quality of evidence was moderate. Parent-based interventions targeting multiple risk behaviors improved adolescent MVPA, and reduced screen time discretionary food intake. Further research is needed to address sleep problems and increase intervention efficacy, particularly for alcohol and tobacco use.
Behavioral Intervention for Nonmedical Use of Prescription Drugs Among Adolescents and Young Adults: A Narrative Review
2022, Pediatric Clinics of North America
Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes
2022, Child and Adolescent Psychiatric Clinics of North America
Rx for addiction and medication safety: An evaluation of teen education for opioid misuse prevention
2019, Research in Social and Administrative Pharmacy
Rhode Island (RI) ninth graders report lifetime nonmedical use of prescription opioids (NMUPO) of 8.9%. NMUPO is associated with transition to heroin use, opioid overdose, and death.
Measure changes in 9th grade students' knowledge, confidence, perceptions of opioid use disorder prevention, overdose response with naloxone, treatment, and recovery, following the delivery of an interactive substance use disorder curriculum.
Eight RI public high schools were recruited to participate. Freshman in each school were administered identical surveys that collected demographic data, substance use and misuse knowledge, students' perceptions of substance misuse harm, reported drug use, and risk and protective behaviors before and after the curriculum.
Among 969 pre-intervention survey respondents, 19% reported use of marijuana, 3% heroin use, and 21% nonmedical use of prescription opioids. Between the pre-intervention to the post-intervention survey, significantly more students identified that addiction is a chronic brain disease (79%–83%, p = 0.05), drug users are not responsible for their addiction (81%–88%, p = 0.001), and that non-medical use of a prescription medication is use without a prescription (81%–88%, p = 0.001). Improved confidence was also reported in identifying opioid withdrawal symptoms (26%–45%, p < 0.0001), identifying signs of an opioid overdose from 29% to 46% (p < 0.0001), and knowing when to administer naloxone (17%–45%, p < 0.0001). Confidence to refer someone to treatment improved from 31% to 45% (p < 0.0001). Logistic regression showed associations between mental health, peer use, parental affection, and academic performance factors as related to NMUPO.
Students reported significant NMUPO prevalence. Ninth grade students' knowledge and confidence of opioid misuse, overdose response, and recovery resources increased following the delivery of a multi-modal interactive substance use disorder curriculum. Community, school, and student-level interventions are needed to reduce NMUPO.
Developmental cascade effects of a parenting-focused program for divorced families on competence in emerging adulthood
2021, Development and Psychopathology
Letter to the Editor: Sources of bias and need for caution in interpreting the results of Spoth et al.'s (2017) PROSPER study
2018, Psychological Medicine

View all citing articles on Scopus

View full text

PROSPER community–university partnership delivery system effects on substance misuse through 6 1/2 years past baseline from a cluster randomized controlled intervention trial

Abstract

Objective

Method

Results

Conclusion

Highlights

Introduction

Section snippets

Community selection and assignment

Sample quality

Lifetime illicit substance use index

Discussion

Conflict of interest statement

Acknowledgments

Addict. Behav.

J. Adolesc. Health

Am. J. Prev. Med.

Am. J. Prev. Med.

Disseminating innovations in health care

JAMA

Life skills training and the prevention of adolescent drug abuse

Life Skills Training

The Prevalence and Incidence of Delinquent Behavior: 1976-1980

Addiction treatment: science and policy for the twenty-first century

JAMA

A health care cooperative extension service: transforming primary care and community health

JAMA

Prevention programs: what are the critical factors that spell success?

Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data

The Economic Costs of Drug Abuse in the United States, 1992–1998

Testing communities that care: the rationale, design and behavioral baseline equivalence of the community youth development study

Prev. Sci.

Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial

Arch. Pediatr. Adolesc. Med.

Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2011

Effect of binge drinking on the liver: an alarming public health issue?

Gu