Prevention Research at the National Institute on Drug Abuse
Transcript of Prevention Research at the National Institute on Drug Abuse
Mission
NIDA’s Prevention Research Branch supports a theory driven program of basic, clinical, and services research across the lifespan to reduce risks and prevent the initiation and progression of drug use to abuse and prevent drug-related HIV acquisition, transmission and progression.
Approach
Bio, Psycho, Social Behavioral Approach to Prevention
= Whole Person
In Context Across the Life Course
Prevention Intervention Development
Attachment Theory
Personality Theories
Learning Theories
Identity Theory
Developmental Theories Life Course
Theory
Social Cognitive Theory
Family Systems Theories
Ethology
Some Theories Contributing to Prevention Intervention Development
Target Group Characteristics
• Genetic Vulnerability • Gender • Learning Style • Developmental Status • Sexual Orientation • Race/Ethnicity • Geographic Location • Socio-economic status
Environments and Level of Risk
Family Peer group School Community Workplace Clinic Media Policy
Foster Care WIC Juvenile Justice
Pre-natal Clinics Rape Clinics STD Clinics
Continuation Schools
College Drug Violation Programs
Universal Selective Indicated
Age Risk
How do Prevention Interventions Work
MODERATORS
MODIFIABLE RISKS
INTERVENTION
Age Gender Race/ethnicity Poverty level
Early aggression Social skills deficit Academic problem Misperceived drug use norms Association with deviant peers Neighborhood availability Media glamorization
Parent skills training Social skills training Tutoring Norms training Refusal skills Community policing Health Literacy
Prevention Approaches Aim to Enhance Protective Factors & Reduce Risk Factors
Reduce these Elevate these
Intervention Strategy
Emotional Regulation Social Skills Academic Competency Resistance Skills Parenting Skills Normative Change Surrounding Environment Change (e.g., Family, Teacher/School, Practitioner Training) Larger Environment Change (e.g., Alcohol, Tobacco, RX, Drugged Driving Policies)
Intrapersonal
Interpersonal
Nurse Family Partnership – Age 12 Kitzman et al.,Arch Pediatr Adoles Med, 164(5) 412-418, 2010
Olds et al., Arch Pediatr Adoles Med, 164(5) 419-424, 2010
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Percent of Children Who Used Tobacco, Alcohol, or Marijuana (Last 30 Days)
Percent of Mothers with Role Impairment
due to Alcohol or Drug Use
P = .04 OR = 0.31
P = .04
• ***Higher scores on academic achievement ages 5 & 7.5 (Woodcock-Johnson)
• ****Faster rate of growth in child inhibitory control from ages 2 to 9.5 (Rothbart scale)
• These improvements typically mediated by improvement in positive behavior support or child disruptive behavior in early childhood
Intervention findings from Early Steps Multisite Study Family Check Up: Follow-up to Age 9.5
*Dishion, Brennan, Shaw et al., 2013 **Sitnick et al., 2013 ***Brennan, Shaw et al., in press ****Chang, Shaw et al., 2013
The Good Behavior Game: Drug Abuse or Dependence Disorders for Males in Young Adulthood
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Teacher Ratings of Aggression: Fall of 1st Grade
GBG (n = 72 ) All Controls (n = 134 )
Kellam et al. (2008). Drug and Alcohol Dependence 95 S, S5-S28.
Sixth Graders in Middle School Behave Worse than Sixth Graders in Elementary School
Predicted Probability of Infraction
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Attended 6th inMiddle
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Duke Univ TPRC - P20 DA017589 - Philip Cook, Robert MacCoun and Clara Muschkin (2008). The Negative Impacts of Starting Middle School in Sixth Grade. Journal of Policy Analysis and Management, 27: 104-121
Source: n = 76,915 - Administrative database covering all public schools and students in the state of North Carolina. The indicators of behavioral problems are derived from a statewide database of disciplinary infractions recorded during the 2000-2001 academic year. Each disciplinary report reflects a decision on the part of a school official (usually a teacher) of whether to “write up” a student for misbehaving, and then a decision on the part of the principal of whether to report to the state.
Effects of Preventive Intervention on Lifetime Prescription Drug Use: Data from 2 Studies
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LST+SFP10-14
Adapted from Spoth, Trudeau, Shin, & Redmond (2008).
Project TND: No Effects for Self-Instruction Condition
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tobacco alcohol marijuana harddrugs
health educatorself instruction
p=024
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Sussman, Sun, McCuller & Dent. (2003). Project TND: Two-year outcomes comparing health educator delivery to self-instruction. Preventive Medicine, 37 (2), 155-162.
Odds Ratios
p=.016
Video Doctor: Health In Pregnancy Discussion of Risks by Randomization
60.0% 15 6 9 Control
100.0% 19 0 19 Intervention
Tobacco **
23.5% 17 13 4 Control
85.0% 20 3 17 Intervention
Total No Yes Domestic Violence *
Discussed with provider
* p = 0.0002 ** p = 0.0037
Humphreys et al., 2011, Women’s Health Issues, 21 (2), 136-144; Calderon et al, 2008, Am J Prev Med 2008;34(2):134–137
New Video Doctor Makes House Calls
• Launch of Video Doctor for service members, veterans and their families
• Anonymous, web-based program that gives the opportunity to consult with a video doctor about depression, anxiety, PTSD, alcohol, bipolar disorder, and brief screen for adolescent depression
• Asks about symptoms and readiness to change
• Provides self-care tips and recommendations on how and where to access mental health resources
• www.militarymentalhealth.org
Prevention of Drug Misuse in Chronic Pain:
Therapeutic Interactive Voice Response
Naylor et al. (2008) Pain, 134, 335–345
High Risk Populations Benefit the Most: Effects of a Brief Intervention for Rape Victims on Marijuana Use
PMTO Fidelity Across Generations Certification
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Forgatch & DeGarmo, 2011, Prevention Science, 12, 235-246. 31
ADAPT = After Deployment: Adaptive Parenting Tools
• Grant funded through military RFA-DA-10-001
• PMTO adapted for military families and culture
• Web-enhanced, group-based format
• Targets common post-deployment adjustment reactions
• Focuses on emotion regulation within a parenting context
Gewirtz, Erbes, Polusny, Forgatch, & DeGarmo. (2011). Helping military families Through the deployment process: Strategies to support parenting. Professional Psychology, 42,56-62.
Communities That Care
Creating
Communities That Care
Get Started
Get Organized
Develop a Profile Create a Plan
Implement and Evaluate
24 Communities; ~45,000 participants
Fagan, Hawkins & Catalano, 2007; Quinby et al, 2007
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CTC Change in Targeted Risk Factors
Note. Observed means averaged over 40 imputations. N = 4407
p < .05
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Hawkins et al., 2011, Archives of Pediatrics and Adolescent Medicine
Summary • Compared to control communities, 10th
graders in CTC communities showed:
– Lower incidence of delinquent behavior, alcohol use, and cigarette use.
– Lower prevalence of past-month cigarette use.
– Lower prevalence of past-year delinquency
– Lower prevalence of past-year violence. Hawkins et al., 2011, Archives of Pediatrics and Adolescent Medicine
PROSPER Partnership Model
State Management Team
Prevention Coordinator Team
Local Community Teams Linking Extension and Public School Systems
PROSPER Impact on Illicit Substance Use Index
Spoth, Redmond, Shin, Greenberg, Feinberg, et al. (2013). Preventive Medicine, 56, 190-196.
Reduced Growth in Use Through 6½ Years Past Baseline
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Control
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PROSPER Illicit Substance Use Index: Higher- vs. Lower-Risk Subgroups
Spoth, Redmond, Shin, Greenberg, Feinberg, et al. (2013). Preventive Medicine, 56, 190-196.
Trajectories Through 6½ Years Past Baseline
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Higher-Risk in Control
Lower-Risk in Control
Higher-Risk in Intervention
Lower-Risk in Intervention
Drug Abuse Prevention can be
Cost Beneficial
• Nurse Family Partnership: $2.88 saved for each dollar invested.
• Seattle Social Development Project : $3.14 saved for each dollar invested.
• The Good Behavior Game: $25.92 saved for each dollar invested
Aos et al. (2004). Benefits and Costs of Prevention and Early Intervention Programs for Youth. Washington State Institute for Public Policy.
Participant Taxpaye
r Other TOTAL Smoking $671 $140 -- $812
Delinquency -- $2,033 $2,405 $4,438
Total Benefits $671 $2,173 $2,405 $5,250
Costs $991
Net Present Benefit $4,259
Benefit-Cost Ratio $5.30
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$991
$5,250
Cost Benefit
Benefits & Costs Per Youth
$6,000
$4,000
$5,000
$3,000
$2,000
$1,000
$0
Delinquency $4,438
Smoking $812
CTC Benefit-Cost Analysis
Benefit - Cost Analysis Per Youth
CTC returns $5.30 for every $1.00 invested.
Kuklinski et al. (2012) Cost-benefit analysis of Communities That Care outcomes at eighth grade. Prev Sci. ,13(2), 150-61.