Understanding Risk,

Protection, and Substance 

Use Among High-Risk Youth

Understanding Risk,

Protection, and Substance 

Use Among High-Risk Youth

Monograph Series No. 2
Acknowledgements

This document was developed under the direction of Soledad Sambrano, Ph.D., of the Center for

Substance Abuse Prevention (CSAP) through contract #277-95-5002 with EMT Associates, Inc.,

and ORC Macro (formerly Macro International, Inc.).

The principal authors of this document are Elizabeth Sale, Ph.D., of EMT Associates, Inc.; Soledad

Sambrano, Ph.D., of the Center for Substance Abuse Prevention; J. Fred Springer, Ph.D.; Jack

Hermann, Ph.D., of ORC Macro; and Rafa Kasim, Ph.D., of EMT Associates, Inc. Special thanks to

Paul J. Brounstein, Ph.D., and Fred Seitz, Ph.D., of CSAP; Charles Turner, Ph.D.; Wei Pan, Ph.D.;

David Cordray, Ph.D.; Will Shadish, Ph.D.; Chrystalla Ellina, Ph.D.; and Mary Nistler, M.P.P.A., for

their important contributions.

Special thanks to the CSAP staff who managed the projects and the 48 grantees who participated in

the study. Also appreciation to Juana Mora, Ph.D; Craig Love, Ph.D.; and Jane Maxwell, Ph.D. for

their review of these documents.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from the Substance Abuse and Mental Health Services Administration.

However, this publication may not be reproduced or distributed for a fee without specific,

written authorization of the Office of Communications, SAMHSA, U.S. Department of Health 

and Human Services. Citation of the source is appreciated. Suggested citation:

Substance Abuse and Mental Health Services Administration. The National Cross-Site Evaluation 

of High-Risk Youth Programs. Center for Substance Abuse Prevention, DHHS Publication 

No. (SMA)00-3375. Rockville, MD, 2002.

Obtaining Additional Copies of Publication

Copies may be obtained, free of charge, from the National Clearinghouse for Alcohol and Drug

Information (NCADI). NCADI is a service of the Substance Abuse and Mental Health Services

Administration (SAMHSA). For copies of publications, please write or call:

National Clearinghouse for Alcohol and Drug Information (NCADI)

P.O. Box 2345

Rockville, MD 20847-2345

(301) 468-2600; 1-800-729-6686

TDD 1-800-487-4889

Electronic Access to Publication

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connection listed below.

World Wide Web Internet connection: http://www.samhsa.gov

Originating Office

The Center for Substance Abuse Prevention

5515 Security Lane

Rockville, MD 20852

January 2002

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Prevention

Table of Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Summary of Major Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The National Cross-Site Evaluation of High-Risk Youth Programs . . . . . . . . . . . 4

Relevance of the Cross-Site Study to Prevention Practitioners . . . . . . . . . . . . . . . . . 4

Characteristics of Sample Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Implications of Sample Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

High-Risk Youth and the “Web of Influence” . . . . . . . . . . . . . . . . . . . . . . 7

The “Web of Influence” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

External Risk and Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Internal Risk and Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Substance Use Norms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Patterns of Substance Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Associations Among Risk and Protection Measures and Substance Use . . . . . . . . . . . . 15

External Risk and Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Pathways of Influence Among Risk and Protection Factors and Substance Use . . . . . . . . . 19

Pathways of Influence for Subgroups of Youth at Risk . . . . . . . . . . . . . . . . . . . . . 22

Model Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Conclusion and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Page

1

Foreword

The Center for Substance Abuse Prevention (CSAP) in the Substance Abuse and Mental Health Services Administration

(SAMHSA) is the Nation’s lead agency for substance abuse prevention. The Center funds community-based organizations,

universities, behavioral health providers, and public agencies to identify effective prevention programs and practices and disseminates findings, program models, and other prevention materials to practitioners and policymakers across the country.

This document summarizes the findings of CSAP’s National Cross-Site Evaluation of High-Risk Youth Programs. This

large multiple-site evaluation was designed to assess 48 prevention programs and to identify those program characteristics

that are associated with strong substance abuse prevention outcomes.

The National High-Risk Youth Demonstration (funded from 1987 to 1995) has been one of the most ambitious and productive of CSAP’s funding initiatives. In its early years, the demonstration focused on identifying promising approaches to prevention. As the demonstration matured, individual site and cross-site research produced knowledge about risk and protective

factors related to substance use and helped to identify model programs for effective prevention. Research and experience in

the High-Risk Youth Demonstration also contributed to the awareness of the importance of culturally sensitive, age-appropriate and gender-specific programming. This progress in prevention theory and practice laid the foundation for the

research reported in this document, the largest and most comprehensive of CSAP’s High-Risk Youth studies.

In addition to individual-level information on substance use, risk, and protection, the evaluation includes detailed information on the nature and amount of prevention services in which each child participated, as well as systematic process information on the study programs. This monograph highlights the study’s contributions to the growing evidence that “Prevention

Works.” The monograph also highlights the study’s contributions to the understanding of how substance use develops in

youth at high risk, and the risk and protective factors that contribute to or protect against substance use. More specifically,

this document summarizes major findings concerning changes in substance use, risk, and protection as youth mature through

adolescence, summarizes findings concerning the pathways between external and internal risk and protective factors and substance use during adolescence, and identifies implications for policies and programs designed to prevent substance use.

This document is part of a series of Points of Prevention publications that document the contribution of CSAP’s National

Cross-Site Evaluation of High-Risk Youth Programs to prevention knowledge and provide science-based guidance for

improved prevention policy and practice.

Charles G. Curie, M.A., A.C.S.W. Ruth Sanchez-Way, Ph.D.

Administrator Director

Substance Abuse and Mental Health Center for Substance Abuse Prevention 

Services Administration Substance Abuse and Mental Health

Services Administration

Center for Substance Abuse Prevention
Introduction

Substance use is increasingly recognized as one of the Nation's most pervasive, costly, and challenging health and social

problems. The use, and particularly the early use, of tobacco, alcohol, marijuana, and other illicit drugs is intricately entwined

with serious personal and social problems, including school failure, crime, family violence and abuse, and a host of additional

social and personal problems that constitute a continuing national tragedy. For over a decade, the Center for Substance

Abuse Prevention (CSAP) within the Substance Abuse and Mental Health Services Administration (SAMHSA) has been 

the Federal agency charged with providing leadership in preventing the profound negative consequences of substance use.

Important components of this leadership responsibility include design and funding of demonstration substance use prevention programs, followed by evaluation of those programs to identify prevention services that work in real community 

settings.

The prevention concept is simple. It postulates that changing the social and personal conditions that promote and support

substance use will benefit society and individuals more than trying to treat the physical and psychological results of use or

control its social consequences. Implementing the prevention concept, however, is complex. A growing body of research has

documented a “web of influence” through which circumstances of community, family, school, and peer group condition

youths’ risk for substance use (CSAP, 1999).

Despite the complexity of implementing the prevention concept, CSAP 

has made great progress in generating new knowledge about the design,

implementation, and effectiveness of prevention strategies and activities.

Most recently, CSAP launched a large, multisite study of substance abuse

prevention programs for high-risk youth. That study—called the National

Cross-Site Evaluation of High-Risk Youth Programs—collected data on 

substance use and conditions thought to be associated with it from a diverse

sample of youth. The science-based knowledge emerging from this study 

is strengthening our understanding of conditions that can influence 

substance use patterns among high-risk youth. These risk and protective 

factors, as they are called, include both internal (individual) and external

(environmental) influences. Results of the Cross-Site Evaluation are 

boosting our understanding of the complex relationships among these 

factors and aiding future prevention planning.

This monograph addresses a topic that is important to both prevention practitioners and researchers. While the risk and protection framework heavily influences the work of both professional groups, the interrelationships among risk and protective

factors have not been well understood. Previous efforts to model how risk and protection factors relate to substance use

have been based on data from the general youth population, often using relatively small samples. The data collected by the

CSAP National Cross-Site Evaluation of High-Risk Youth Programs provide an excellent opportunity to investigate these

interrelationships and, through modeling, to advance our understanding of how certain risk and protective factors influence

the behaviors of at-risk youth. The Cross-Site sample reflects a diversity of youth from many population subgroups. A

robust model of risk, protection, and substance use can show practitioners which factors to target and suggest appropriate

intervention strategies. Researchers can use such a model to identify critical variables, guide measurement selection decisions,

and focus data analysis plans.

Substance Abuse and Mental Health Services Administration

2

The science-based knowledge

emerging from this study is strengthening our understanding of conditions that can influence substance

use patterns among high-risk youth.
More specifically, this monograph contributes to understanding how prevention can strengthen conditions that help youth at

risk avoid substance use by presenting evidence, findings, and recommendations in the following areas:

! Risk and protective factors have been categorized and conceptualized in different ways. This monograph follows CSAP’s

“web of influence” (CSAP, 1999) categorization of factors into environmental factors “external” to youth and individual

factors “internal” to youth. The external and internal distinction is presented as particularly useful because prevention

programs and strategies for addressing each category tend to be distinct.

! Differences in levels of risk and protection for internal and external factors are identified by age, demonstrating the 

dramatic increases in risk experienced in some areas as youth move from pre-adolescence into the teen years.

! The degree to which different risk and protective factors are associated with substance use is examined, suggesting the

relative importance of specific internal and external factors as contributors to, reinforcers of, or protections against 

substance use.

! Finally, structural modeling is used to represent plausible pathways among external risk and protection, internal risk 

and protection, and substance use among youth in high-risk circumstances.

Summary of Major Findings

Major findings presented in this monograph include the following:

! As youth age, levels of risk and protection shift considerably. The findings on risk, protection and substance use and the

age of youth reveal a consistent pattern. As youth move through the adolescent years there is a steady movement from

the protective to the risk conditions in most of the external and internal factors. That movement is particularly great in

family bonding, school bonding, and peer attitudes—those factors that refer to the social environments to which youth

are building attachments as they mature.

! Gender plays an important role in risk, protection, and substance use. The data suggest that conditions in the neighborhood have a greater influence on substance use in males than in females, while the relationships among all the internal

risk and protection factors and substance use are substantially stronger for females than for males.

! Connectedness protects against substance use. Positive behavioral outcomes among youth reflect a tight interweaving 

of external and internal protective factors. Connectedness to family and school forms the core of this protection.

Meaningful involvement is key to connectedness. When the external environments of family and school offer youth

involvement that is challenging, provides recognition, and is rewarding, these environments serve as powerful protective

factors against substance use.

! The peer environment is critically linked to substance use. Youth whose peers do not use substances tend not to use 

substances themselves. Youth whose peers disapprove of substance use also report less use of substances. Because peer

relationships are strongly associated with the family, school, and community environments in which youth reside, positive

changes in those external environments can affect the peer environment and impact individual substance use.

! Broadening the range of protective influences in the external environments increases protection against substance use.

Efforts to strengthen families (by encouraging communication, appropriate supervision, and positive norm setting) 

and to strengthen schools as caring communities (to improve school bonding) increase the protection of youth against

substance use.

Center for Substance Abuse Prevention

3
The National Cross-Site Evaluation of High-Risk Youth Programs

The National Cross-Site Evaluation of High-Risk Youth (HRY) Programs is a 5-year study that CSAP began in 1995

(Sambrano, Springer, and Hermann, 1997). Forty-eight HRY demonstration programs across the Nation participated in the

study.1 These grantees were funded by CSAP to implement and assess programs to prevent and reduce the use of alcohol

and illicit drugs among at-risk youth. A rigorous research design incorporating lessons from earlier evaluations of prevention

service implementation and effectiveness guided the study. The evaluation used a quasi-experimental comparison group

design to study the more than 6,000 youth who were participating in the 48 demonstration programs, comparing them with

more than 4,500 similar youth in the same communities who were not participating in the programs.

The study has several unique features, including:

! The use of a common questionnaire (the CSAP National Youth Survey) in all sites.

! Data collection at four points in time: program entry (baseline), program completion (exit), 6 months after program

completion, and 18 months following program completion.

! A viable comparison group at each participating site.

! Complete documentation of the amount and type of program contact for each participant (dosage data).

! Detailed information on program implementation and prevention strategies at each site.

The study design allowed CSAP to test the effectiveness of programs by measuring changes in participants’ risk, protection,

and substance use over time and comparing the results to changes in similar youth who did not receive program services.2

Relevance of the Cross-Site Study to Prevention Practitioners

Prevention staff, teachers, counselors, and other youth workers look for “blueprints” of

effective practice to help guide their efforts to promote positive youth development. They

also implicitly understand that no one blueprint will fit all youth. Youth workers in communities know what prevention research has increasingly documented—that effective ways of

reaching and impacting youth must consider their uniqueness, their stage of growth and

experience, their gender, and their cultural circumstances.

Effective program strategy must involve messages and activities that are meaningful to the particular circumstances of youth.

The maturation process, which is rapid in the earlier years of life, provides clear examples. Prevention objectives that are

appropriate for teenagers at a stage when tobacco and alcohol experimentation is widespread are not appropriate for 9-yearold children. As youth take steps toward the independence that is necessary for autonomy in adulthood, the protective and

supervisory role of family evolves as well. Young men’s and young women’s risk and protection influences differ, pointing to

the need for differing gender-based strategies. What faces the prevention field at this stage in its development is a “sorting

out” process—one of identifying from among the many prevention objectives and strategies those approaches that prove

most effective for youth at risk.

Prevention professionals can use the information generated by CSAP’s study to improve their aim at this moving target of

approaches. This diverse high-risk study sample provides an excellent proving ground for identifying connective paths among

risk and protection factors and substance use. It also provides a basis from which to assess the appropriateness of specific

prevention objectives and practices in a variety of settings.

Substance Abuse and Mental Health Services Administration

4

Effective program

strategy must involve

messages and activities that are meaningful to the particular 

circumstances of

youth.

1 CSAP funded 94 programs in 1994 and 1995. Programs were not included in the Cross-Site Evaluation if they served children primarily under the age of 9.

Approximately half of the 48 programs that participated in the Cross-Site study were funded in 1994 for 5 years and the other half were funded in 1995 for 3 years.

These program were located throughout 22 States, including Alaska and Hawaii.

2 Findings on program effectiveness are reported in other monographs published in the CSAP Points of Prevention Series.
This report cites findings using data from both program participants and comparison

group youth because its objective is to convey the importance of differences in youth

risk and protection characteristics as they relate to substance use. Typically, baseline

data were collected within a few weeks before or after participating youth began

receiving services, and at the same time for comparison group youth. The information that follows on study sample diversity, patterns of risk and protection by age,

and patterns of substance use by age and gender draws on these baseline data.

Characteristics of Sample Youth

The age at which to target youth for preventive interventions has been a topic of discussion and debate among prevention

practitioners and researchers. Prevention or early intervention programs have been developed for all full age ranges of youth.

These encompass preschool programs aimed at enhancing children’s development and addressing negative behaviors, as well

as programs aimed at college binge-drinking and at safely negotiating life’s major transitions. Youth selected for inclusion in

CSAP’s National Cross-Site Evaluation were limited to those between the ages of 9 and 18. Within that broad age range,

from preadolescence through the late teens, the target focus of each program determined the age of the youth it served.

Figure 1 displays age and gender information for youth (both program participants and comparison group youth) in the

study sample.

More than half (57%) of the youth in the study were between 11 and 13 years of

age when they entered the study, reflecting the fact that the prevention programs

in this study recruited and served predominantly children of middle school age.

This concentration of effort in the middle school years reflects a planned response

to the perception that middle school youth are at a transition point that puts them

at particular risk for starting to use substances. It also reflects the fact that middle

school youth are still relatively accessible for organized programming because they

do not yet drive, hold part-time jobs, or have the freedom of movement of the

later teen years. Whatever the reasons, it is clear that the HRY prevention programs funded by CSAP in the mid-1990’s often targeted preteens.

Because 19 (40%) of the programs included in the study targeted female adolescents, there are many more females (66%)

than males (34%) in the total sample. The gender-specific age profiles within Figure 1 indicate that, in this sample, the

females are somewhat older than the males (mean female age = 12.84; male = 12.76), with a higher percentage of females in

the 14- to 17-year-old age groups.

Center for Substance Abuse Prevention

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This diverse high-risk study

sample provides an excellent

proving ground for identifying

connective paths among risk

and protection factors and

substance use.

This concentration of program

effort in the middle school

years reflects a planned

response to the perception

that middle school youth are 

at a transition point that puts

them at particular risk for 

starting to use substances.

Figure 1

Distribution of Sample by Age and Gender

(N = 10,473)
Many of the HRY prevention programs were community-based, focusing on particular community populations. Figure 2

indicates that these programs served a diversity of racial/ethnic groups. More than 33 percent of the youth were African

American and around 25 percent were Hispanic. Of the remaining youth, approximately 10 percent were Native American,

10 percent were Asian/Pacific Islander, and 10 percent were White/non-Hispanic. There is cultural and/or regional diversity

within the racial/ethnic groups as well (e.g., programs targeting youth in recent-immigrant communities).

Some programs used recruitment procedures that targeted special populations, adding diversity to the youth sample. Most

programs recruited youth from high-risk settings: schools, neighborhoods, housing developments, or youth organizations.

As an alternative, several programs based participant selection on a common individual behavioral or personal attribute.

Specifically, two programs served youth who had been placed in a secure facility by court order; two programs targeted youth

with disabilities (physical and developmental/emotional); one program focused on young women with histories of sexual

abuse; and one program focused on youth in the foster care system.

Implications of Sample Characteristics

Characteristics of the study sample influence the contribution the Cross-Site Evaluation can

make to prevention knowledge and have implications for the ways in which the study data

must be analyzed. Because youth in the study were not selected systematically from the entire

population of youth at risk, their behaviors and outcomes cannot be assumed to represent

those of the full at-risk youth population. On the other hand, sample youth are drawn from a

generally representative set of community-based programs serving the full spectrum of at-risk

youth. In that sense, the diversity of the youth in the sample strengthens the study’s ability to

identify general characteristics of at-risk youth. It also provides a setting for testing the generalizability of connections between risk and protective factors and substance use in youth at risk.

Substance Abuse and Mental Health Services Administration

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Figure 2

Distribution of Sample by Race and Gender

(N = 10,473)

The diversity of the

youth in the sample

strengthens the

study’s ability to

identify general

characteristics of 

at-risk youth.
High-Risk Youth and the “Web of Influence”

Over the past decade, research and practice in prevention have produced a dominant approach to thinking about how to prevent substance use and associated problems among youth. A large body of research informs this approach. It proposes that

substance use and other problems are part of a consistent pattern of circumstances that tend to occur together. Community

and neighborhood environment, school conditions and performance, family environment, and particularly, peer attitudes and

behaviors all contribute to substance use. This literature also established that early behaviors are highly predictive of the

development of problem behaviors as youth mature.

Articulation of the role of risk factors in the initiation and growth of substance use among youth had important implications for prevention programming. Early prevention efforts were often based on the assumption that young people used substances largely because they were not informed of their health, legal, and social dangers. Programs based on this assumption

were limited in content and disappointing in result. Knowledge about risk factors gave prevention practitioners another focus

for their efforts. If the conditions associated with substance use could be improved, substance use itself might be stopped.

Targeting this broad range of conditions identified by the research, prevention practitioners developed programs aimed at

reducing risk in the community, in schools, in families, and among peers. Research has shown that when risks in a child’s life

are reduced, the child is less vulnerable to substance use and related social and health problems as he or she matures

(Hawkins, Lishner, Jenson, and Catalano, 1987).

Risk factor research substantially influenced the ways in which prevention funding organizations, program designers, and

service deliverers thought about their program activities and objectives. Parenting programs, community-wide prevention

coalitions, and programs aimed at transforming schools as communities (Battistich, Schaps, Watson, and Solomon, 1996) 

all were added to educational and informational efforts as strategies to prevent substance use. However, the “risk” literature

is not always a comfortable fit with the orientation of prevention workers, who want to improve the lives of youth and

strengthen their communities. Some prevention researchers have dubbed the risk paradigm a “damage model” (Wolin and

Wolin, 1995) that focuses on negative influences on youth. Research on protective factors has emerged to focus, alternatively,

on “what is positive and healthy in young people” (CSAP, 1999, p. 3).

While researchers have argued that protective factors are not simply a mirror image

of risk factors, the distinction is not clearly drawn (Newcomb and Felix-Ortiz,

1992). A recent CSAP (1999) review notes that “the literature on protective factors

and resilience is more diffuse than that for risk factors, and there is less clarity

about which factors are most important in the prevention of substance use” (p. 7).

What is clear about protective factors is that they represent the influences, orientations, and behaviors in youth’s lives that contribute to positive development and

help prevent negative behaviors and outcomes such as substance use. Researchers

and program designers have identified and promoted protective factors to balance

or counter risks in the full range of environmental and personal domains.

When thinking about the design and implementation of prevention programs, it is useful to categorize risk and protective

factors into two groups:

! Those external to youth in their “social ecology” (Hawkins and Weiss, 1985).

! Those internal to youth in the way that they process, interpret, and respond to their environment.

Center for Substance Abuse Prevention

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Protective factors represent

the influences, orientations,

and behaviors in youth’s lives

that contribute to positive

development and help prevent

negative behaviors and outcomes such as substance use.
Program activities designed to reduce risk or promote protection in the external

environments of community, school, and family are very different from prevention strategies that work directly with youth to develop internal protective factors.

Therefore, the programmatic implications of changing external risk and protection are very different from those for working on the development of internal

factors in young people.

The importance of external and internal risk and protection for the development

of effective prevention interventions depends on the interrelationships of these

factors and on their association with substance use. The diverse Cross-Site

Evaluation sample of high-risk youth presents an exceptional opportunity to

assess the ways in which risk and protection factors change with maturation, interact, and relate to substance use. The Cross-Site Evaluation measured specific

dimensions of external and of internal risk and protection. Although not exhaustive of the many factors that have been proposed in the literature, the Cross-Site

measures include important factors frequently targeted in prevention strategies.

The study also used a set of substance use norm variables. These focus on the attitudes and behaviors—specifically related

to the use of alcohol, tobacco, and marijuana—of significant reference groups in the lives of youth. Past research has shown

strong relationships between self-reported substance use and these normative contexts. Ability to assess the relationship of

these social norm contexts to general risk and protective factors with known correlations to many youth behaviors is another

benefit of this study.

All of the measures presented in this report are from the CSAP National Youth Survey completed by both participant and

comparison group youth themselves. Self-report measures are consistent with a model of influence in which the individual

youth remains at the core. All external influences are “processed, interpreted, and responded to based upon those characteristics that the individual brings to the situation” (CSAP, 1999, p. 2).

The “Web of Influence”

To summarize and order the existing research findings and program assumptions about risk and protection, CSAP developed

a framework representing the “web of influence” through which risk and protection shape substance use (CSAP, 1999). As

Figure 3 shows, this framework groups external influences on youth into five areas (domains): family, peers, school, community, and society.

Substance Abuse and Mental Health Services Administration

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The diverse Cross-Site

Evaluation sample of 

high-risk youth represents 

an exceptional opportunity 

to assess the ways in which

risk and protection factors

change with maturation,

interact, and relate to 

substance use.

Figure 3 

The “Web of Influence” on Substance Use
The external risk and protective factors and substance use norms identified earlier in this report (and measured by the selfreported National Youth Survey) can be placed within these five domains. The internal risk and protective factors identified

earlier shape each individual’s response to the external factors. Protective internal factors may strengthen protective external

influences, or they may help youth resist the external influences that increase risk for substance use. The reverse is also true:

internal risk factors may heighten the effect of external influences that increase risk or may blunt even protective external

factors. In the National Cross-Site measurement of risk and protection, substance use norms are individual risk and protection factors that represent the youth’s perception of the substance use expectations and behaviors of significant others in her

or his life.

Because it organizes the risk and protection influences identified by a wide range of

research, programs, and approaches, this framework can be applied broadly in developing

prevention strategies. The “web of influence” framework raises important questions

about the ways in which external influences and internal orientations interact to prevent

or promote substance use among young people. It leads the prevention professional to

ask just how, and why, specific individual orientations and behaviors may strengthen or

weaken the influence that external circumstances have on substance use by youth.

The framework also orients inquiry to the ways in which different external domains of

influence may interact to influence risk and protection. The framework focuses on the

dynamic complexity of youth development in a social environment. In summary, the

value of this framework lies in its service as an orienting structure and as an organizer of

a diverse body of knowledge. Because of the size and diversity of its youth sample and

its breadth of measurement, the Cross-Site Evaluation provides a unique opportunity to begin to answer the question posed

by the framework. It offers a rich vehicle for exploring and specifying some of the dynamics that operate between external

influences and the internal characteristics of individual youth to determine substance use outcomes. This report responds to

this opportunity by describing the age trajectories of risk, protection, and substance use by young people at high risk; by

assessing the degree to which individual risk and protective factors are associated with substance use; and by modeling the

complex interactions of the most important risk and protective factors and substance use.

External Risk and Protection

Risk and protection research indicates that the risk for substance use during adolescence is strongly related to identifiable

characteristics of the environment in which adolescents live. The family management practices of parents or family caregivers, the opportunities and policies of the school environment, and the quality of life and opportunities for participation

that characterize the community all influence the development of positive or problem behaviors in youth. The National

Youth Survey designed for the Cross-Site Evaluation asked youth respondents about their perceptions of their family, school,

and community and defined these measures as follows:

! Family supervision indicates the respondent’s perceptions of the degree to which

parents or caregivers set and monitor rules about the youth’s behavior and are

concerned about and aware of the youth’s friends and activities.

! School prevention environment indicates the respondent’s perceptions of the degree

to which the classroom environment conveys prevention messages about substance use and positive personal development.

! Community protection environment indicates the degree to which the respondent

participates in organized opportunities for positive activity in the community,

including clubs, athletics, and learning opportunities.

! Neighborhood risk indicates the respondent’s perceptions of neighborhood disorganization, including public substance use and crimes against persons and

property.

Center for Substance Abuse Prevention

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The framework raises

important questions

about the ways in which

external influences and 

internal orientations

interact to prevent or

promote substance use

among young people.

The challenge for prevention

professionals is to make these

environments more 

protective and less 

characterized by risk, to help

youth connect more 

effectively with protective 

influences, and to help youth

resist the negative influences

of environmental components

characterized by risk.
The risk and protection framework suggests that more protection in each of these elements of a youth’s environment will

increase the opportunities for positive development and outcomes and reduce the chances of negative outcomes. The challenge for prevention professionals is to make these environments more protective and less characterized by risk, to help

youth connect more effectively with protective influences, and to help youth resist the negative influences of environmental

components characterized by risk.

Strategies for helping youth successfully negotiate environmental influences must be appropriate to the changing relationship

between young people and their environments as they mature. Figure 4 displays the responses of sample youth, aged 9 to 18,

to the external risk and protection measures. Responses are baseline measures taken when the youth entered the study.

Figure 4 

Distribution of Youths’ Perceptions of External Risk and Protective Factors By Age at Program Entry

(N = 10,473)

As youth age, their perceptions of the level of risk or protection offered by external circumstances shift considerably. For

each of the four external risk and protection measures, the perceived level of protection decreases with age, most markedly

after the age of 12. The decline in perceived protection with age is greatest for school prevention environment and family

supervision. This pattern is partly expected and normal. As youth mature and become more autonomous, the character of

family supervision and involvement changes to allow youth more responsibility in their daily lives. The pattern for school

indicates that the school environment has fewer opportunities for promoting positive choices and development as youth

move through middle school into the high school years. The pattern of decline is less dramatic with respect to the community and neighborhood measures, indicating a more moderate change in youth involvement in positive community activities, or

in their perception of social disorganization in their neighborhood, as they age. The relative stability of involvement in positive community activities indicates potential for community-based prevention activities to influence youth. As youth age and

become more independent of home, they form associations in the community. The challenge to prevention is to help make

these associations positive ones.

Internal Risk and Protection

Not only have prevention practitioners incorporated awareness of external risk into

their program strategies through family, school, and community interventions, they

have contributed significantly to the understanding of internal risk and protection

as well. The predispositions of youth, whether they express them as attitudes, in

orientations to behavior, or in actual behavior, filter how they experience their

external environment. Prevention researchers and practitioners have been particularly interested in internal factors because they often find they cannot directly 

influence environmental factors beyond their program scope and resources. This

makes identifying personal protective factors that will help youth resist negative

environmental influences—and that prevention practitioners can help youth 

develop—a high priority.

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Although researchers do not

agree on what makes a youth

resilient, they often cite belief

in one’s ability to produce a

meaningful and worthwhile

future as a component.
Protection is not simply the absence or the opposite of risk factors,

researchers and prevention practitioners have pointed out (Newcomb and

Felix-Ortiz, 1992). Indeed, many young people thrive and experience positive development in environments of high risk. These youth, whose internal protective characteristics overcome the influence of external risk, have

been termed “resilient” (Wolin and Wolin, 1993). Exploring and defining

what makes a youth resilient has become a major prevention theme, especially for practitioners who want to help young people cope with high-risk

environments they cannot control. Although researchers do not agree on

what makes a youth resilient, they often cite belief in one’s ability to produce

a meaningful and worthwhile future as a component.

Some resiliency researchers emphasize the importance of attachments to positive social influences, such as a caring and trusted adult (Benard, 1991). The influence of these attachments, sometimes called “bonding” or “connectedness,” is an emerging

focus in the prevention literature. Most often, this bonding is seen as an individual (internal) attribute, the young person’s

belief that this external connection is important and meaningful to him or her. Bonded youth feel a stake in the external

environment. They believe that interacting and accomplishing in that environment are worthwhile and contribute to a positive future. Thus, developing a sense of connectedness (Resnick et al., 1997) to meaningful segments of the environment

that provide and support positive opportunities is an important aspect of the internal protective orientation of young people

in high-risk environments.

CSAP’s National Youth Survey provided self-reported information on the following internal risk and protective factors:

! Family bonding measures the degree to which the respondent has a positive orientation to home and parents. The concept

includes pride in family, a sense of contribution, and enjoyment of the family environment.

! School bonding measures the respondent’s orientations toward school as an environment for meaningful connectedness and

identifies the degree to which the youth sees school as a place that warrants and rewards effort.

! Self-efficacy captures the degree to which the respondent is confident that he or she can tackle meaningful tasks and the

degree to which the youth believes his or her efforts will succeed.

! Belief in self is a measure of the respondent’s optimism or pessimism about the future and feeling about himself or herself.

! Self-control is a measure of the degree to which the respondent acts on or controls aggressive impulses.

! Social confidence captures the degree to which the respondent believes that he or she gets along well with others, contributes to the social group, is trusted and respected by peers, and makes friends easily.

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Developing a sense of connectedness

to meaningful segments of the 

environment that provide and support

positive opportunities is an important

aspect of the internal protective 

orientation of young people in 

high-risk environments.

Like external risk and protection, internal orientations may change as youth mature.
Like external risk and protection, internal orientations may change as youth mature. Figure 5 displays the change in average

responses for each of the internal risk and protection factors with age in the baseline sample.

Figure 5

Internal Risk and Protective Factors by Age at Program Entry

(N = 10,473)

Similar to the results for external risk and protection, the responses of younger children are indicative of more protective

orientations, including stronger bonding with family and school, stronger perceptions of self-efficacy and self-control, and

more belief in self. For this sample, all but one of the protective factors are highest for the youngest age group. The exception is social confidence, which rises slightly from preadolescence to the midteen years. The rest of the orientations drop

toward greater risk between the ages of 11 and 15, indicating a reduction in the internal protective orientations during the

middle and early high school years.

The change in protective factors with age is particularly dramatic with respect to the indicators of bonding or connectedness.

Family bonding changes the most, with a precipitous drop from a positive family orientation at the age of 9 to a less strong

feeling that the family is a place for meaningful communication, contribution, or recreation during the midteen years. School

bonding shows a similar change. Other orientations, with the exception of social confidence, follow a similar but less pronounced pattern.

Substance Use Norms

The prevention field has clearly recognized the power of social norms—the attitudes and behaviors perceived to prevail in the social environment—as an influence

on youth behavior. “Peer influence” is an often-cited reason that youth begin to use

substances. Research has established peer attitudes and behaviors as one of the

strongest correlates of self-reported substance use (Akers, 1977; Elliot et al., 1982;

Ford, 1983; Fors and Rojek, 1983; Foster, 1984; Oetting and Beauvais, 1986).

Broader social norms (conveyed in the media and in advertising) and family norms

(Newcomb, Huba, and Bentler, 1986) have also been identified as correlates of use,

or resistance to use, among youth.

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Research has established

peer attitudes and behaviors

as one of the strongest 

correlates of self-reported

substance use.
CSAP’s National Youth Survey measured several substance use norms in those social contexts that are closest to youth: parents and friends. Youth were asked to report their perceptions of their parents’ reactions to substance use, as well as their

perceptions of their friends’ substance use behaviors and their friends attitudes toward use:

! Parental attitudes captures the degree to which the respondent believes his or her parents would be upset if they found out

that the youth smoked cigarettes, drank alcohol, or used marijuana sometimes.

! Peer attitudes measures the respondent’s assessment of the degree to which his or her peers would disapprove if they

found out that the respondent smoked cigarettes, drank alcohol, or used marijuana sometimes.

! Peer use measures whether the respondent thinks his or her “best friend” smokes cigarettes, drinks alcohol, or uses marijuana sometimes.

As with the other risk and protection domains, youths’ perceptions of substance use norms in these significant reference

groups change rapidly with age. Figure 6 shows that, within the 5-year age range from 11 to 17, youth perceive substance use

norms as moving dramatically from prohibitive to permissive. To underscore this change, 17 percent of the 10-year-olds

compared with 73 percent of the 16-year-olds thought their best friend used alcohol sometimes.

Figure 6

Substance Use Norms by Age at Program Entry

(N = 10,473)

In sum, as youth age, they perceive a decline in the protective nature of external factors, internal factors, and substance use

norms toward greater risk. The following section looks at patterns of substance use as youth mature.

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In sum, as youth age, they perceive a decline in the protective nature of external factors, internal factors,

and substance use norms toward greater risk.
Patterns of Substance Use

The CSAP HRY demonstration programs have as their main objective preventing or reducing substance use and its associated problems. Therefore, it is essential to know how many and which youth were using substances when they entered the 

programs. The self-report survey given to youth at the start of the programs asked respondents about their use of a number

of substances within the preceding 30 days3 and over their lifetime. Table 1 shows prior 30-day substance use rates for the

portion of the study sample ages 12 through 17, by age subgroups. It also compares those results with data from the 1998

National Household Survey on Drug Abuse (NHSDA) (SAMHSA/OAS, 1998), a randomly sampled general population 

survey of persons 12 years of age or older.

Table 1

Comparison of NHSDA and Cross-Site Substance Use for 12- to 17-Year-Old Respondents

NOTE. National Household Survey on Drug Abuse (NHSDA) sample size for 12- to 17-year-olds (n = 6,778);

Cross-Site sample size for 12- to 17-year-olds (n = 7,245).

Youth in the Cross-Site sample reported higher use rates for all substances in all

age groups than did youth in the NHSDA general population sample. Also, the

use rates among high-risk youth increased more rapidly with age, a pattern that is

particularly emphatic for marijuana. The comparison confirms that the Cross-Site

programs serve youth in a higher-risk population than young people in the general population.

Looking specifically at the percentage of youth in the Cross-Site sample reporting use of any one substance during the previous 30 days, the rate of use is low (Figure 7). The most frequently reported substances used are alcohol (18%), cigarettes

(18%), and marijuana (14%). Relatively few youth reported recent use of drugs such as cocaine or crack, speed, tranquilizers,

PCP, and heroin. This pattern suggests that the program sites recruited youth who were usually not regularly involved in substance use and were, therefore, appropriate participants in prevention or early intervention programs.

Figure 7

Self-Reported 30-Day Substance Use at Baseline: Percentage of Study Sample

(N = 10,473)

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The Cross-Site programs serve

youth in a higher-risk population

than young people

in the general population.

3 Youth were asked: “How many days in the last 30 days did you smoke a cigarette/have a drink of alcohol/use marijuana?” Responses ranged from 0 to 5 

(six response categories). Possible responses included (0) none, (1) 1 or 2, (2) 3 to 5, (3) 6 to 9, (4) 10 to 19, and (5) 20 to 31.
To profile the sample, a composite measure of “30-day substance use” was constructed. This composite measure includes

the use of any one of three substances—tobacco, alcohol, or marijuana—within the past 30 days. Figure 8 displays the percentage of youth who reported substance use by age and gender using this composite measure of 30-day use.

Figure 8

Self-Reported 30-Day Substance Use at Baseline by Age and Gender

(N = 10,473)

The use rates for younger children remain low until around age 13 and then rise rapidly

until age 16 for females and age 17 for males. Use rates across the age groups are consistently higher among males than females. Substance use among females levels off at age 16

and remains somewhat constant through age 18. Males in the 16- and 17-year-old age

groups are mainly from very high-risk sites serving incarcerated males, which accounts for

the high use pattern in the age group at program entry. The lower 30-day use rates for 18-

year-olds suggests that the older youth who were willing to participate in the study programs were individuals who were not as involved in recent drug use as the younger highschool aged youth.

Summary

The findings on risk, protection, and substance use and the age of youth reveal a consistent pattern. As youth move through

the adolescent years, there is a steady movement from the protective to the risk conditions in most of the external and internal factors identified here. That movement is particularly great in family bonding, school bonding, and peer attitudes and use,

those factors that refer to the social environments to which youth are building attachments as they mature. The following

section explores these risk and protective factors further by explicitly assessing their relation to substance use.

Associations Among Risk and Protection Measures and Substance Use

All risk and protection frameworks assume that each youth has a personal “web of influence”: a set of risk and protective

factors, external and internal, that are related to that youth’s use or nonuse of substances. Testing this assumption involves

identifying the degree to which a relationship exists between self-reported substance use and the presence of protective

influences or internal orientations. These relationships for the entire youth sample and for males and females are examined

separately to determine whether there are differences between these groups in use levels, increases in use, or other aspects of

substance use related to risk and protective influences.

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Use rates across the age

groups are consistently

higher among males than

females. 
The analysis of these relationships uses correlation coefficients (Pearson’s r) to compare relationship strengths, with coefficients of ±1.0 indicating complete association and 0.0 meaning no association. Because of the very large sample size, statistical significance is not a meaningful indicator for this analysis; in fact, all reported correlations are highly significant.4 The

external, internal, and substance use norm domains are analyzed separately. Substance use is measured as combined 30-day

substance use of cigarettes, alcohol, or marijuana.

External Risk and Protection

Figure 9 shows the strength of association between each of four external risk and protection factors and self-reported substance use. The four factors were selected from three external domains: one each from the family (family supervision) and

school (school prevention environment) domains, and two from the community domain (community protection environment, neighborhood risk). Strength of association is shown separately for males and for females. In the case of protective

factors, the degree of the negative association indicates the strength of the factor’s protective influence against substance

use. In the case of a risk factor, the degree of the negative association indicates the tendency of the factor to make substance use more likely. The larger the negative correlation, the greater the degree of protection against use or risk for use the

influence provides.

Figure 9

Bivariate Correlations Between External Risk and Protection Factors and Substance Use,

by Gender (N = 10,473)

NOTE. All external risk factors are coded so that higher scores 

indicate more positive behaviors.

The figure indicates that for this sample of youth, the stronger the external

protection, the less substance use youths will experience. For example, in riskfree neighborhoods, youth are less likely to use substances than youth in highrisk neighborhoods. On the other hand, youth with little family supervision are

more likely to use substances.

Males and females demonstrate different patterns of association between external influences and substance use. Family

supervision influences male and female behaviors similarly, but each of the other external influences is more strongly5

associated with substance use for males than for females, dramatically so in the case of neighborhood risk. This suggests 

that conditions in the neighborhoods have a greater influence on substance use in males than in females.

Looking at the sample as a whole, family supervision shows the strongest protective association against substance use.

The correlations for school prevention and neighborhood risk indicate moderate protective associations, and the Cross-Site

measure of community protection is less correlated with use. Finally, low neighborhood risk is much more negatively 

associated with substance use among males than females.

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The data suggest that conditions

in the neighborhood have a

greater influence on substance

use in males than in females.

4 The statistical significance of an association is determined by the strength of the relationship between the two variables and the number of cases used in the analysis.

As the size of a sample increases, weaker relationships become statistically significant.

5 For this analysis, values of 0.0 to -0.19 are considered weak, -0.20 to -0.34 are considered moderate, -0.35 to -0.49 are strong, and -0.50 and above are very strong.
Substance Use Norms

In the “web of influence” framework, the substance use norms including the youths’ perception of parental attitudes, peer attitudes, and peer use fall into the external domains of family

and peers.6

Figure 10 summarizes the patterns of association between these external substance use norm

influences and substance use. The results confirm the strong association between substance use

by peers and personal use that has consistently been found in research literature. In fact, the

association between peer use and personal substance use is the strongest among all the risk and

protection factors investigated in this study. Parental attitudes are also very strongly associated

with personal use, and peer attitudes are strongly associated. In all cases, these associations are

slightly stronger among males than among females, particularly for peer attitudes and peer use.

Figure 10

Bivariate Correlations Between Substance Use Norms and Substance Use: Males and Females

(N = 10,473)

Internal Risk and Protection

The patterns of association between internal risk and protection factors and substance use are shown in Figure 11. Of the

six internal factors investigated, school bonding and family bonding—two factors that indicate connectedness to social 

contexts-clearly show the strongest associations with substance use, although the associations are in the “moderate” range.

Belief in self, self-control, and self-efficacy are less associated with substance use, and social confidence is very weakly 

related to substance use.7

Figure 11

Bivariate Correlations Between Internal Risk and Protection Factors and Substance Use: Males and Females

(N = 10,473)

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The association

between peer use

and personal 

substance use is

the strongest

among all the risk

and protection 

factors investigated

in this study.

6 All risk and protective factors are coded so that a higher value indicates stronger protection. Therefore, negative correlations of parental and peer attitudes and peer use

with substance use indicates negative relationships between these factors and substance use.

7 All internal factors are coded so that higher numbers represent greater protection.
The pattern of gender differences for the internal factors is very different from the pattern for both of the external influence categories. The relationships between all the internal risk and protection factors and substance use are substantially

stronger for females than for males. This is especially true for family bonding.

The differences in association with substance use among the internal risk and

protection factors investigated in this study have implications for understanding

the influences of these factors on substance use and for increasing the effectiveness of prevention interventions. This study’s findings reinforce the body of

existing prevention research on internal factors in several areas:

! The strength of both school bonding and family bonding as correlates of substance use supports the argument that connectedness to family and to school are the most robust and important protective factors for both the “quietly disturbed

behaviors” that are more common in girls, and the “acting out behaviors” more typical of boys (Resnick, Harris, and

Blum, 1993). In a summary of protection research, Resnick (1999) notes that “measures of closeness to and connectedness with family and school were the most salient, cross-cutting protective factors.”

! The very low level of association between social confidence and substance use suggests that personal confidence in one’s

ability to relate well socially is not by itself a protective factor. Indeed, detailed analysis of this affective factor indicates

that it is positively associated with substance use among the highest-risk youth. This finding is consistent with other

research that has questioned measures of personal affect such as self-esteem and other indicators of self-confidence that

do not relate confidence to a particular social environment (Hansen, 1997).

! The remaining internal risk and protection factors—self-efficacy, self-control, and belief in self—are only weakly associated with substance use for males and moderately associated for females. Although these self-image measures have some

relevance as protective factors, they do not include the connectedness dimension that appears important in this analysis

and others.

Associations with Use: A Summary

The findings from the Cross-Site Evaluation confirm the premises of CSAP’s “web of influence” and support use of the

risk and protection framework as a foundation for prevention programming. Risk and protection factors across the internal

and external domains correlate with substance use by youth. Furthermore, the results are consistent with findings from less

comprehensive studies. Youth perceptions of peer norms are very strongly associated with use, and parental norm setting is

strongly associated with use. School bonding, school prevention environment, family connectedness, and family supervision

are moderately related to substance use. The consistent pattern across domains is that male substance use behavior is shaped

more by the external environment than female behavior, whereas female substance use behavior is more sensitive to internal

influences. Most important, the findings concerning internal risk and protection highlight the importance of the school and

family connectedness orientations. These findings suggest that internal risk and protection is not primarily an “inoculation”

against external influences, but a catalyst and facilitator for building connectedness with positive external environments.

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The relationships between all

the internal risk and protection

factors and substance use are

substantially stronger for

females than for males.

Internal risk and protection is not primarily an “inoculation” against external influences, but a catalyst and

facilitator for building connectedness with positive external environments. 
Pathways of Influence Among Risk and Protective Factors and Substance Use

The findings in the previous section provide insights into the structure of the relationships among individual risk and protective factors within the domains that are part of the “web of influence.” However, the findings do not reflect the interrelationships among the domains themselves, which are depicted by the arrows and lines in Figure 12.

To investigate more specifically the relationships suggested in the “web of influence,” a modeling technique8 was used to

describe what can be called “pathways of influence” among the risk and protective factors and substance use. This technique

does not test cause-and-effect relationships, but it does indicate whether such relationships are plausible. Figure 12 shows the

model, which is based on data from the full (both participant and comparison youth) study sample.9

Figure 12

Structural Equation Model for Risk and Protection Factors and Substance Use Among High-Risk Youth

(N = 10,473)

The model includes the array of risk and protection factors and substance use norms explained in the previous section,

reflecting a comprehensive application of the CSAP framework. The number next to each arrow indicates the strength of

the relationship the arrow represents (i.e., the relationship between one factor and another).10 The model fits the data well

(CFI = 0.90, RMSEA = 0.03, NNFI = 0.90),11 meeting the high standard for good model fit in these kinds of analyses.

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Summary Statistics

CFI = 0.90 RMSEA = 0.03 NNFI = 0.90 

NOTE. Negative correlations between parental attitudes and peer substance use with personal substance use result because all measures with the exception of substance use are coded so that higher

numbers represent more positive behaviors. Widest lines indicate correlations of 0.50 or more, medium-width lines are correlations ranging from 0.20 to 0.49, thin lines are correlations of less than 0.20.

8 Structural equation modeling was conducted using LISREL (Joreskog and Sorbom, 1999).

9 Multigroup analyses contrasting treatment and comparison youth demonstrated no substantial differences in model fit or path coefficients, justifying use of the combined sample of youth at high risk.

10 The width of each arrow shaft indicates the strength of the association between the individual protective factor and substance use; i.e., the degree to which higher protection on the factor relates to less use. Wider arrows shafts are indicative of stronger relationships.

11 The Comparative Fit Index (CFI) statistic measures the goodness of fit. Models with indices of 0.90 or more are considered to be strong-fitting models.
Modeling Decisions

To produce a lean model and improve statistical fit, the number of factors included in the model was reduced analytically.

The following decisions were made during model building:

! Internal Risk and Protective Factors. The number of internal factors was reduced to three: school connectedness,

family connectedness, and self-control. School connectedness and family connectedness are newly constructed latent

variables that emerged from the modeling process. They emphasize the importance of connectedness by expanding the

bonding measures to include closely related items that convey the meaningful returns of connectedness in the lives of

the youth.12 The reduction was based on the connectedness concept and on confirmatory factor analysis. Each of these

factors is described below:

School connectedness is composed of the school bonding and self-efficacy items, forming a single measure that represents

the importance of the school as a forum in which youth can realize self-efficacy. This variable suggests that meaningful

connectedness to school is associated with youth’s realizing the ability to achieve.

Family connectedness is a latent variable that combines the original family bonding measure with a family communication

measure. The new measure represents the importance of family as a forum for safe and supportive communication during the developmental years.

Self-control is maintained in its original form because it consistently emerges as a factor with a moderate-strength relationship to substance use and because it did not combine with other dimensions in latent variable modeling.

! External Risk and Protective Factors. The model includes external factors from the family, peer, school, and community domains to aid understanding of how these domains interrelate in their influence on substance use. Two schoolrelated factors require explanation. School prevention environment was included in the model because of the importance

of school-based programs in current prevention strategies. School performance, a factor combining self-reported measures of grades in school and school attendance, was added to the model as a latent variable. It mediates between school

connectedness and peer substance use.

! Substance Use Norm Measures. In the model, substance use norm measures serve as intermediaries through which

other influences pass. The positioning of the peer norm measures (peer attitudes, peer substance use) implies that the

creation of friendship groups is an important consequence of various external and internal factors. Youth are involved

in positive peer groups because their families and schools have stressed the importance of developing positive relationships with peers. The positioning of the parent norm measure (parental attitudes) implies that family connectedness and

family supervision create an environment in which parents’ messages carry weight. These norms were placed close to

one another in the model because of their very strong correlation with substance use, as well as findings reported in the

prevention literature.

The model is consistent with and elaborates on prior prevention research using a social ecology approach. Hawkins and Weis

(1985) showed that peer influences did not entirely explain the phenomenon of substance use and that external factors

played a vital role in shaping the resiliency of youth and their ability to resist substance use. Kumpfer and Turner (1991) later

supported and expanded on this work in studies of youth living in Utah.

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12 Confirmatory factor analysis was conducted on all latent variables; all model fits exceeded 0.90.
Interpreting the Model

The model in Figure 12 shows one possible explanation for the way risk and protection factors from different domains in

the “web of influence” interact in their connection with substance use.

! Family connectedness is a key to the substantial path of family influence on substance use shown in the model. When

family bonding is high, family supervision and parental attitudes exert strong influences on peer associations and substance use. When family bonding is high and family supervision is high, parental attitudes carry particular weight. The

substantial direct negative effect (coefficient = -0.40) on substance use indicates that parental attitudes matter in the

bonded family even when those attitudes are at odds with peer attitudes and behaviors.

! School connectedness is a crucial link in the internal risk and protection path. Family connectedness and self-control

contribute to school connectedness, which relates to school performance, peer substance use, and ultimately personal

substance use. The measure of school performance (self-reported grades and attendance) provides an important link in

this path. Apparently school success enhances the association that school connectedness has with nonusing peers and

reduced personal substance use.

! In the community domain, neighborhood risk is associated with peer substance use as an influence on personal use,

reflecting the importance of social environment in shaping youth behaviors.

Based on the model, it is possible to form broader conclusions about the dynamics of the “web of influence.” The model

clearly supports the interactive nature of protective influences—internal, external, and normative—against substance use.

! Connectedness protects against substance use. Positive behavioral outcomes among youth reflect a tight interweaving of external

and internal protective factors. Connectedness to family and to school forms the core of this protection. Meaningful

involvement is key to connectedness. When the external environments of family and school offer youth involvement

that is challenging, provides recognition, and is rewarding, these environments serve as powerful protective factors

against substance use.

! The peer environment is critically linked to substance use. Youth whose peers do not use substances tend not to use substances

themselves. Youth whose peers disapprove of substance use also report less use of substances. Because peer relationships are strongly associated with the family, school, and community environments in which youth reside, positive

changes in those external environments can affect the peer environment and impact individual substance use.

! Broadening the range of protective influences in youth’s external environment increases protection against substance use. The 48 programs

in the Cross-Site Evaluation focused on strengthening youth’s internal protective factors and on increasing community

protection activities. The importance of family bonding and school connectedness in the model indicates that broadening the program focus could increase program effectiveness. Efforts to strengthen families (by encouraging communication, appropriate supervision, and positive norm setting) and to strengthen schools as caring communities (to improve

school bonding) should increase youth protection against substance use.

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Pathways of Influence for Subgroups of Youth at Risk

The model shown earlier (see Figure 12) depicts pathways of influence for all the youth in the Cross-Site study sample.

Prevention practitioners may question whether the dynamics of risk and protection presented in the model apply equally to

subgroups of youth at risk. To answer that question, the study sample was analyzed by gender, age, and ethnicity.

Gender Group Differences

The model shown in Figure 13 is partitioned by gender. (Coefficients in parentheses are for females.) There is a strong fit for

both males and females with minimal differences, and the overall statistical fit of the model is good (CFI = 0.90). All of the

hypothesized paths hold for both gender groups.

Figure 13

Structural Equation Model for Gender Groups

(Males, N = 3,596; Females, N = 6,941)

Some interesting implications emerge from the few gender differences shown in the model. School connectedness is a

stronger predictor of reported school performance (grades and school attendance) for females than for males, suggesting

that school provides a more relevant forum of connectedness for females than for males. Parental attitudes toward substance

use are slightly more strongly related to personal use for females (-0.42) than for males (-0.37). Both paths from neighborhood

risk to peer substance use to the subject’s own substance use are slightly stronger for males (0.31 and -0.56) than females 

(14 and -0.48). These differences are minor within the overall similarity of the paths to substance use for both genders.

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Summary Statistics

CFI = 0.90 RMSEA = 0.03 NNFI = 0.90

NOTE. Coefficients in parentheses are for females. Widest lines indicate correlations of 0.50 of

more, medium-width lines are correlations ranging from 0.20 to 0.49, thin lines are correlations of

less than 0.20.

School connectedness is a stronger predictor of reported school performance for females than for males.
Age Group Differences

Partitioning the model by age reveals some important differences, as shown in Figure 14. (Coefficients in parentheses are for

the older youth.) The model is strong for both younger (9- to 11-year-old) and older (12- to 17-year-old) youth.

Figure 14

Structural Equation Model for Age Groups

(Younger, N = 2,879; Older, N = 7,566)

Several major age-related differences emerge in the model. The first is the importance of family factors for older youth.

Family supervision and parental attitudes are stronger predictors of substance use behavior in youth age 12 years and older

than they are for preteens. Some of this difference may be attributed to reduced variation in the younger group, where 

positive orientation toward family is higher in general. Nevertheless, the data indicate that family continues to play a critical

protective role as youth develop through adolescence—despite the fact that teens report a decline in family supervision and 

family connectedness as they grow older (see Figures 4 and 5). Second, peers influence older youth more than younger

youth. Peer attitudes and perceptions of peer use are stronger predictors of substance use among older youth than they are

for those younger than 12. This reflects the developing sensitivity to social perceptions that begins in early adolescence and

continues into adulthood.

Third, the path from school connectedness to school performance is stronger for younger

youth than for the older group. This suggests that school plays a critical role in influencing

negative behaviors that may lead to substance use among younger youth.

Fourth, school performance is a stronger predictor of substance use behavior in older

youth than in younger youth. For students older than 12, the model suggests that poor

grades are associated with substance-using peers and personal substance use.

Center for Substance Abuse Prevention

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Summary Statistics

CFI = 0.90 RMSEA = 0.025 NNFI = 0.90

NOTE. Coefficients in parentheses are for the 12- to 17-year-old youth. Widest lines indicate 

correlations of 0.50 or more, medium-width lines are correlations ranging from 0.20 to 0.49, thin

lines are correlations of less than 0.20.

School performance is a

stronger predictor of

substance use behavior

among older youth than

in younger youth.
Ethnic Group Differences

Figure 15 shows the model partitioned by ethnicity. Multiple-group structural modeling indicates that all the paths hypothesized in the model hold for all ethnic groups.

Differences between the groups for most paths are typically small and idiosyncratic.

A few of these differences do suggest particular areas of concern about risk and protection for specific racial and ethnic groups. For example, school performance among

African-American youth is more strongly associated with family supervision and less

strongly associated with the youth’s own school connectedness than for youth in

other racial/ethnic groups. For Hispanic youth, the opposite pattern is present.

Overall, however, the model has a high degree of consistency across the major ethnic

groups and cultures of America.

Figure 15

Structural Equation Model for Racial/Ethnic Groups

(N = 10,473)

Model Summary

In summary, the model of risk and protection factors for substance use among high-risk youth is robust. It is based on a

large sample of at-risk youth, and it applies to females and males, younger and older youth, and across ethnic groups. The

model emphasizes the critical importance of family, peers, and individual protective factors for buffering youth from substance use. More importantly, it suggests the interdependence of these domains. The key to prevention is not to make youth

insensitive to their social environment, but to ensure that they are strongly connected to positive, healthy environments.

Given the stability of the model across these important population subgroups, practitioners can use it to address important

questions about which risk and protective factors prevention programs should be targeting. By reducing to a manageable

number the important predictors of substance use, the model should help practitioners focus their resources efficiently to

improve program outcomes.

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NOTE. Coefficients are listed from top to bottom in the following order:

Native American (n = 1313) Asian/Pacific Islander (n = 1164) African American (n = 3722)

Hispanic (n = 2742) Non-Hispanic/White (n =1212)

The model has a high

degree of consistency

across the major ethnic

groups and cultures 

of America.

Family continues to play a critical protective role as youth develop through adolescence. Parental 

attitudes, peer attitudes, and perceptions of peer use are stronger predictors of substance use among

older youth than they are for those younger than 12.
Conclusion and Discussion

The National Cross-Site Evaluation of High-Risk Youth Programs has created an excellent opportunity to expand knowledge about risk and protective factors and substance use among youth at high risk. The diversity in the sample allowed analyses of patterns in risk and protective factors and substance use as youth mature through the adolescent years, across genders,

and across racial and ethnic groupings. These analyses produced important findings with profound implications for prevention policy and program design.

! With respect to age, the analysis revealed a consistent pattern of increased risk, in both external circumstances and internal orientations and perceptions, between the ages of 12 and 16. Substance use escalated sharply during these years as

well, suggesting an association of increased risk with increased use.

! While all of the external, internal, and perceived norms measures moved in the direction of increased risk during the

adolescent years, there were some differences in the rate of change. In other words, risk increased more in some areas

than others.

In particular, measures associated with youth’s connectedness to family and school decreased particularly steeply among

internal factors. Youth’s perceptions of parental and peer disapproval of substance use also declined sharply during these

years. On the other hand, youth’s social confidence decreased much less. Among these youth at risk, it was not their

belief that they could establish social ties that changed dramatically, it was their perception of the focal point of those

ties. In particular, the importance of family and school as a source of meaningful ties decreased.

! Analysis of the association of each risk and protective dimension with self-reported substance use confirms the relative

importance of those variables related to connectedness. Among the internal risk and protective factors, family and

school bonding are most strongly associated with use. Youth who are more bonded with family and school report less

use.

! The association between risk and protection and substance use highlights differences between males and females.

Specifically, the association of external factors, particularly neighborhood risk, and substance use is stronger for males.

The association of internal factors and personal substance use is stronger for females.

Finally, structural modeling brings additional coherence and focus to the ways in which risk, protective, and normative factors may influence substance use among youth. The analyses produced a robust model of adolescent substance use and its

correlates among high-risk youth populations. The relationships displayed in this model substantiate prior findings on the

relationships among risk and protective factor measures and substance use. The model also expands on this research by

showing the indirect and direct relationships among individual, family, peer, school, and community factors. The model is relatively stable across age, gender, and ethnic groups. There is some evidence that family influences are more important for

females than males and that neighborhood risk influences are stronger for males.

By specifying plausible pathways within and between external, internal, and normative risk factors and substance use, the

model adds detail to understanding of the “web of influence” on adolescent substance use.

! Internal Risk and Protection. The analyses have important implications for research on internal protective factors

among youth at risk. The previous literature on internal risk and protection has proposed numerous attitudes, orientations, and personal competencies as critical factors in youth’s use of substances. The result has been confusion. This

analysis suggests a much simpler structure of important issues. Factors that build connectedness with positive external 

environments (e.g., family connectedness and school bonding) are critical deterrents to adolescent substance use.

! Family. The model reinforces much of the research regarding the importance of family in preventing or reducing 

adolescent substance use. Among females and older youth, family supervision and parental attitudes appear to be 

particularly important.

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! School. The analyses point to the importance of school in changing substance use patterns. Both school connectedness

and school performance show strong associations with individual substance use. School can be an important forum for

changing patterns of use.

! Peer. The findings from this study substantiate prior research

showing that association with peers who use tobacco, alcohol, or

marijuana is highly related to individual substance use. The relationship between peer effects and individual substance use is the

strongest among the latent variables in the model. This finding is

supported among males and females, as well as older and younger

youth. Peer effects also serve as a powerful mediator between

internal, family, and community factors and individual substance

use.

Finally, by highlighting the importance of the family and the school, the model suggests that youth develop important personal competencies (such as cooperativeness, a positive view of the future, a belief in self, and a feeling of personal efficacy)

through positive orientations to, and interactions with, the social settings that are central to our society. Successful and fulfilling interaction with a positive social environment is a key to positive development. Thus the model places “connectedness”

with the social settings of family and school at the core of prevention programming.

All of this has direct implications for prevention policy and practice. The trends in risk, protection, and use confirm the critical status of the middle school years as a period of experimentation and initiation of substance use, as well as a critical transition in the social bonds that youth form. The data also indicate that programs serving youth at risk in middle school must

reach some youth who have already initiated use. These are important years for prevention.

The overall findings also confirm the importance of comprehensive prevention that addresses the range of environmental

factors as well as the individual orientations and behaviors of the youth themselves. Community, family, school, and peer circumstances clearly condition substance use. For schools, youth’s connection and performance are the central issue with

respect to preventing substance use. The school is the major forum for accomplishment and recognition in youth at these

ages. Those who are connected with that environment use cigarettes, alcohol, and marijuana less.

The central implication for prevention is the need to build connections to positive and meaningful social environments for

youth. Though important, just changing the environment, or just changing individual orientations, is not enough. Protection

and positive development requires connection between the two. Building and supporting these connections is a central challenge to prevention and a positive promise to youth.

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Successful and fulfilling interaction with a

positive social environment is a key to

positive development. The model places

connectedness with the social settings 

of family and school at the core of 

prevention programming.
References

Akers, R. L. (1977). Deviant behavior: A social learning approach. Belmont, CA: Wadsworth.

Battistich, V., Schaps, E., Watson, M. and Solomon, D. (1996). Prevention effects on the Child Development Project: Early

findings from an ongoing multi-site demonstration trial. Journal of Adolescent Research, 11, 6-11.

Benard, B. (1991). Fostering resiliency in kids: Protective factors in the family, school, and community. Northwest Regional

Educational Laboratory/Western Regional Center for Drug-Free Schools and Communities.

Center for Substance Abuse Prevention. (1999). Understanding substance abuse prevention, toward the 21st century: A

primer on effective programs. CSAP Monograph, DHHS Publication No. (SMA) 99-3301. Rockville, MD: Substance

Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

Elliott, D., Huizinga, D., and Ageton, S. S. (1982). Explaining delinquency and drug use. Report No. 21. Boulder, CO:

Behavioral Research Institute.

Ford, D. S. (1983). Factors related to the anticipated use of drugs by urban junior high school students. Journal of Drug

Education, 13(2), 187-197.

Fors, S. W. and Rojek, D. G. (1983). The social and demographic correlates of adolescent drug use patterns. Journal of Drug

Education, 13, 205-222.

Foster, B. (1984). Upper middle class adolescents’ drug use: Patterns and factors. Advances in Alcohol and Substance Abuse.

4, 27-36.

Hansen, W. B. (1997). Prevention programs: Factors that individually focused programs must address. In Resource papers

for the Secretary’s Youth Substance Abuse Prevention Initiative, (pp. 53-66). Rockville, MD: Center for Substance

Abuse Prevention, Substance Abuse and Mental Health Services Administration.

Hawkins, J. D., Lishner, D., Jenson, J. and Catalano, R. (1987). Delinquents and drugs: What the evidence suggests about prevention and treatment programming. Youth at Risk for Substance Abuse: National Institute on Drug Abuse 1987, 81-

131.

Hawkins, J. D. and Weiss, J. G. (1985). The social development model: An integrated approach to delinquency prevention.

Journal of Primary Prevention, 6, 73-97.

Joreskog, K. G. and Sorbom, D. (1999). Lisrel 8: New statistical features. Chicago: SSI.

Keith, J. G., and Perkins, D. F. (1995). 13,000 adolescents speak: A profile of Michigan youth. East Lansing, MI: Michigan

State University, Institute for Children, Youth, and Families.

Kumpfer, K. L. and Turner, C. W. (1991). The social ecology model of adolescent substance use: Implications for prevention. The International Journal of Addictions, 25, 435-463.

Newcomb, M. D., Huba, G. J., and Bentler, P. M. (1986). Risk factors for drug use among adolescents: Concurrent and longitudinal analyses. American Journal of Public Health, 776, 525-531.

Newcomb, M. D., and Felix-Ortiz, M. (1992). Multiple protective and risk factors for drug use and abuse: Cross-sectional

and prospective findings. Journal of Personality and Social Psychology, 63(2), 280-296.

Oetting, E. E., and Beauvais, F. (1986). Peer cluster theory: Drugs and the adolescent. Journal of Counseling and

Development, 65, 17-22.

Resnick, M. D. (1999). The impact of caring and connectedness on adolescent health and well-being: Research summary, in

getting results: Developing safe and healthy kids Update 1, 22. Sacramento, CA: California Department of Education.

Center for Substance Abuse Prevention

27
Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., Tabor, J., Beunning, T., Sieving, R.,

Shew, M., Ireland, M., Bearinger, L., and Udry, J. R. (1997). Protecting adolescents from harm: Findings from the

National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278, 823-832.

Resnick, M. D., Harris, L. J., and Blum, R. W. (1993). The impact of caring and connectedness on adolescent health and well

being. Journal of Pediatrics and Child Health, 29(1), 83-89.

Sambrano, S., Springer, J. F., and Hermann, J. (1997). Informing the next generation of prevention programs: CSAP’s CrossSite Evaluation of the 1994-1995 High-Risk Youth Grantees. Journal of Community Psychology, 25, 375-395.

SAMHSA/OAS. (1998). National Household Survey on Drug Abuse population estimates 1998. Rockville, MD: Office of

Applied Studies.

Wolin, S. J. and Wolin, S. (1993). The resilient self: How survivors of troubled families rise above adversity. New York:

Villard Books.

Wolin, S., and Wolin, S. (1995). Resilience among youth growing up in substance-abusing families. Pediatric Clinics of North

America, 42, 415-429.

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DHHS Publication No. (SMA)00-3375

Reprinted 2002