Evaluation of life skills training and infused-life skills training in a rural setting: Outcomes at two years

Abstract This study reports on findings from the first two years of a study to compare a standard Life Skill Training (LST) program with an infused (I-LST) approach. Nine small, rural school districts were randomly assigned to LST, I-LST, or control conditions in grade seven. The LST program significantly reduced alcohol use, binge drinking, marijuana use, and inhalant use after one year for females, and the I-LST program significantly reduced smoking, binge drinking, and marijuana use for females. At the end of the second year the I-LST program continued to impact female smoking, but all other results were non-significant. There were no effects on males at either time point. Key Words: Substance Use, Adolescents, Prevention INTRODUCTION Although a variety of substance abuse prevention programs have been implemented in many school districts throughout the U.S. for several decades, the use of alcohol, tobacco and other drugs continues to be a major health and behavior problem for American youth. Many adolescents initiate alcohol consumption at a very young age, and a high proportion of young people drink often and/or heavily (Johnston, O'Malley, & Bachman, 2001). Furthermore, substance use is as prevalent in rural areas as urban locales (Johnston, O'Malley, & Bachman, 2000). The Center for Addiction and Substance Abuse (CASA) reported that rural eighth grade students are more likely to report alcohol use, drunkenness and smoking cigarettes than their urban counterparts (Center on Addiction and Substance Abuse, 2000). While most scientifically supported prevention efforts have been aimed at urban and suburban youth, these recent data indicate that prevention programs are also needed in rural areas (Johnston et al., 2000). The field of prevention has identified a number of effective prevention programs and an emerging science of prevention. Examples for early adolescents include: Life Skills Training (LST) (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995); Star and community task forces model (Pentz et al., 1989); the All Stars normative education program (Hansen, 1996); Alert (Ellickson & Bell, 1990); and Project Smart (Hansen, Johnson, Flay, Graham, & Sobel, 1988). Reviews of these and other prevention approaches indicate that, overall, these strategies have shown favorable results in reducing adolescent substance use (Botvin, & Botvin, 1997; Hansen, 1992; Tobler, & Stratton, 1997). Conversely, Gorman (1998) argued that the results of these programs have been exaggerated and have not been sustained over time. Life Skills Training, in particular, may have selected a biased sample in the six year follow up in which only those subjects who had received 60% or more of the program (high fidelity sample) were included (Gorman, 1998). Regardless of the relative merits and long term effectiveness, these "model" programs constituted only one third of all drug prevention programs currently being implemented under one Federal program designed to increase use of science-based programs (Swisher, 2001). Ennett et al. (2002) reported that approximately one-quarter of teachers implementing substance use prevention are using an evidence-based curriculum. A number of reasons account for this lack of diffusion. Included among these reasons is the requirement that LST and other curricula require that a separate time be provided for drug prevention. In face of scholastic demands for increased performance and accountability, this separate time requirement presents obstacles for both school administrators and teachers. Infusion as an alternative delivery mechanism Infusion is an approach that integrates prevention objectives and activities into basic academic objectives and activities at the same time. For example, an English teacher might teach vocabulary and integrate knowledge of risk of chewing tobacco. Similarly, a social studies teacher might teach personal decision making steps in relationship to critical decisions made at some point in history, and math teachers can teach charts and graphs with normative education data about non-use trends. …