# Presentation: 200112

## THE NIDA NATIONAL PREVENTION RESEARCH INITIATIVE

- NIDA Advisory Council
- February 20, 2002

**Notes:**
I’m excited to be joining DESPR at such an auspicious time...when we are launching several major new initiatives and today it is my pleasure to talk about the new prevention research initiative.

## FOUNDATIONS OF PREVENTION SCIENCE

- Epidemiology
- Origins and pathways to drug abuse
- Hypotheses derived from prior prevention research
- Theories and models from basic biological, social, psychological and behavioral sciences

**Notes:**
To begin with, I’d like to remind us about the context of the current initiative.

When we say that epidemiology serves as one of the foundations of prevention research we are tapping into the public health aspects of drug prevention.  Epidemiology reminds us both where the major needs are for prevention work and helps us to find clues that indicate where we might intervene successfully.  Etiology research reminds us of data on the origins and pathways to drug abuse including factors that influence vulnerability to drug use.  In particular, those risk and protective factors which are modifiable are the logical focus of prevention interventions.

## RISK AND PROTECTIVE FACTORS

| Risk Factors | Domain | Protective Factors |
| --- | --- | --- |
| Sensation-seeker | Individual | Successful student |
| Child of drug user |  | Bonds with family |
| No supervision | Family | Consistent discipline |
| Parent/sibling drug use |  | Anti-drug family rules |
| Pro-drug use norm | School | Anti-drug use norm |
| Availability of drugs |  | High academics |
| Crime/poverty | Community | Consistent anti-drug  message |
| No afterschool programs |  | Strong law enforcement |

**Notes:**
	One of the major findings developing from the past two decades of prevention research is that risk factors are often NOT the opposite of protective factors.  Both can have effects on outcome—sometimes in balance, sometimes on one side or the other.  For instance, protection, like parental support, can over-ride the influence of risks, such as having peers who are substance users (Wills, Cleary, 1996).   Let’s examine some of these...

## Slide 4

**Notes:**
The key to were we want to see the field of prevention go is to understand individuals within their context over time and across the course of the development.

## PAST PORTFOLIO:

- 	Primarily efficacy trials of universal 	school-based interventions
- 	Few selective or indicated 	interventions
- 	Few multi-component interventions
-        Limited developmental focus
-        Few independent replication studies

**Notes:**
NIDA’s prevention portfolio extends over the past two decades and at first consisted of fundamental studies which demonstrated the feasibility and efficacy of prevention interventions...no small task.

## Many multi-component programs
Universal through indicated levels
Early childhood through adulthood
Broadened contexts of intervention
More independent replications and meta-analyses
Prevention services focus

- Universal through indicated levels
- Early childhood through adulthood
- Broadened contexts of intervention
- More independent replications and meta-analyses
- Prevention services focus

- PRESENT PORTFOLIO:

**Notes:**
More recent studies have extended the work to cover a much broader range of strategies and populations.

## SELECTED FINDINGS ON PROGRAM COMPONENTS

- Parents who smoke can lower the risk of smoking among their children by engaging  in anti-smoking socialization (Jackson, et al., 1997).

- Intervening as early as grade one to decrease aggression and increase academic success substantially reduces subsequent substance abuse, depression and anti-social behavior (Ialongo, et al., 1999).

**Notes:**
For example:
We know from that children whose parents smoke have a 4-6 times greater chance of smoking.  Despite this increased risk, even among parents who do smoke the risk of smoking among their children can be significantly reduced by engaging  in anti-smoking socialization such as setting rules about handling tobacco products, smoking, and etablishing and enforcing consequences (Jackson, et al., 1997).

We have also seen from the long-standing work of the prevention center in Baltimore, that early interventions can have long-lasting effects across a range of outcomes.

## SELECTED FINDINGS ON  AUDIENCE

- Gender significantly affects drug offers and types of offers (Moon, et al., 2000).

- Programs adapted to address the needs of specific ethnic audiences have greater effects in reducing substance use than universal non-adapted programs (Botvin, et al.,1997).

**Notes:**
FINDINGS ON  AUDIENCE (Gender and Ethnicity)
For example, gender significantly affects drug offers and types of offers;
Compared to females, males are more at risk for offers at a younger age and	
offers are more likely to come from parents and other males (Moon, et al., 2000).
Gender differences have relevance for both the underlying processes of interventions and the ultimate outcomes. Knowledge is emerging on factors such gender and ethnicity that are important for the adaptation of programs.
Knowledge is emerging on factors such gender and ethnicity that are important for the adaptation of programs.

## SELECTED FINDINGS ON  AUDIENCE

- Media intervention for high sensation seeking youth resulted in major reductions in marijuana use (Palmgreen, et al., 2001).
- Misperceptions about normative use of drugs increases initiation and escalation of drug use (Hawkins, et al., in press).
- Associations with drug using peers accounts for monthly bursts in use among adolescents (Dishion, et al., 2000).

**Notes:**
FINDINGS ON  AUDIENCE 

## SELECTED FINDINGS ON PROGRAM IMPLEMENTATION

- Providing accommodations to families helps to attract and retain them in preventive interventions (Spoth, et al., 1999).

- Grouping anti-social youth in interventions can lead to unintended negative effects such as increases in substance use and violence (Dishion et al., 1999).

**Notes:**
FINDINGS ON PROGRAM IMPLEMENTATION
Similar to findings in treatment, making accommodations such as,
scheduling flexibility,
low time demand, 
babysitting, 
transportation, 
and personal contacts
helps to attract and retain families in interventions (Spoth,  et al., 1999).

We also have learned that not all prevention is successful.  And some negative outcomes can occur.  Thus, prevention studies nearly always need to use two-sided tests for statistical significance.

## CURRENT AREAS OF GROWTH:

*Basic Prevention Science*
- Developing reciprocity between basic and applied sciences to determine what strategies work, for whom and under what conditions.
*Prevention Services Research*
- Studying aspects of organization, management and delivery of prevention services that affect selection, adoption and sustainability.

**Notes:**
We have two areas of growth in the research portfolio which we hope will be enhanced by the prevention initiative.

## NEW FRONTIERS IN PREVENTION SCIENCE?

- Broadening the scope of theories and models on which prevention strategies are based.
- Adapting successful strategies from other diseases to drug abuse prevention.

## Prevention needs to address both initial use and ESCALATION of use.

***For example...***

## SOME IMPORTANT FACTORS IN ESCALATION:

- Poor refusal skills (Petraitis, et al, 1998).
- Cognitive preparation to use drugs (Sussman, et al., 2000).
- Coping motives for substance use (Johnson & Pandina, 2000).
- Poor parental monitoring (Eddy et al., 2000).
- Parent/sibling drug use (Kilpatrick, et al., 2000).

## We now target mostly risk and protective factors.  Might we also target initiating motivations?

*What are other factors proximal to drug abuse that are modifiable?*

*What can we learn about actual decisions to use drugs?*

- Back to the issue of initial use....

## In particular, we need to know more about adolescent decision making, taking into account a developmental neurocognitive perspective.

## WHERE ARE WE GOING?

- NIDA’s National Prevention Research Initiative:
- To accelerate research on innovative approaches to preventing initiation and progression of drug abuse;
- To aggressively foster research on the adaptation, adoption, and sustainability  of science-based prevention in diverse populations and communities throughout the Nation.

## NATIONAL PREVENTION RESEARCH INITIATIVE

**Basic Science**
**In Prevention**
** ****Research**

** ****Transdisciplinary**
**Prevention**
**Research**
**Centers**

**Community**
**Multi-site **
**Prevention**
**Trials**

## NATIONAL PREVENTION RESEARCH INITIATIVE

**Transdisciplinary**
**Prevention**
**Research**
**Centers**

**Accelerate the development of innovative drug abuse prevention interventions**

***NATIONAL PREVENTION RESEARCH INITIATIVE***

## NATIONAL PREVENTION RESEARCH INITIATIVE

**In Prevention**
** ****Research**

**Development of innovative prevention**
**interventions based on findings from basic**
**biological, psychological, and social sciences. **

***NATIONAL PREVENTION RESEARCH INITIATIVE***

## NATIONAL PREVENTION RESEARCH INITIATIVE

**Community**
**Multi-site **
**Prevention**
**Trials**

**Test efficacious and **
**effective drug abuse**
**prevention interventions**
**in multiple ‘real world’**
**settings to examine processes**
**involved in adaptation, **
**adoption and sustainability.**

***NATIONAL PREVENTION RESEARCH INITIATIVE***

## NIDA’s National Prevention Research Initiative Goal:

- To accelerate the development and testing of new interventions and to study the factors involved in the successful dissemination of proven, science-based interventions.

## PREVENTION WORKGROUP

- W. Cartwright, DESPR
- J. Colliver, DESPR
- K Davenny, CAMCODA
- S. David, DESPR
- P. Delany, DESPR
- S. Grant, DTR&D
- M. Green, OEA
- D. Grossman, DTR&D
- M. Lynch, DNBR
- L. Miner, OSPC
- I. Montoya, DTR&D

- M. O'Brien, DESPR
- L. Onken, DTR&D
- M. Racioppo, DTR&D
- S. Rao, OSPC
- E. Reider, DESPR
- E. Robertson, DESPR
- D. Shurtleff, DNBR
- V. Smeriglio, CAMCODA
- J. Stein, OSPC
- M. Volkov, OEA
- H. Weingartner, DNBR

## PREVENTION RESEARCH BRANCH STAFF

- Liz Robertson, Ph.D., *Chief*
- Aria Crump, Sc.D.
- S. Jackie Kaftarian, Ph.D.
- Susan Martin, Ph.D.
- Eve Reider, Ph.D.
- Larry Seitz, Ph.D.
- Liz Cooper, *Branch Secretary*