Teachers' Perceptions of a Multiple High-Risk Behavior Prevention Program and Delivery of Universal Programming.

In the United States, adolescent alcohol and drug use increases each year during high school (CDC, 2009). However, alcohol and drugs are among a growing list of high-risk behaviors youth have the choice to engage in today. Researchers have demonstrated the increase in adolescent high-risk behaviors such gambling (Powell, Hardoon, Derevensky, & Gupta, 1999), pornography (Braun-Courville & Rojas, 2009), self-injury (Alfonso & Dedrick, 2010; Hilt, Nock, Lloyd-Richardson, & Prinstein, 2008), cyberbullying (Agatston, Kowalski, & Limber, 2007), eating disorders (Pisetsky, Chao, Dierker, May, & Striegel-Moore, 2008), video game addiction (Griisser, Thalemann, & Griffiths, 2007), suicide (Pelkonen, & Marttunen, 2003), driving while drinking (CDC, 2009), and dating violence (Hickman, Jaycox, Aronoff, & Rand, 2004; Spencer & Bryant, 2000). In addition, some adolescents display a pattern of simultaneous engagement in multiple high-risk behaviors that increases from freshman to senior year in high school (Biglan, Brennan, Foster, & Holder, 2005; Brener & Collins, 1998; Fox, McManus, & Arnold, 2010; Lindberg, Boggess, & Williams, 2000). Thus, the need for effective prevention programs that target multiple high-risk behaviors is evident. For decades, researchers have analyzed prevention programs in the hope of discovering what approaches are most effective in preventing diverse child and adolescent problem behaviors (Faggiano et al., 2005; Biglan et al., 2005; Drug Strategies, 1999; Gottfredson & Wilson, 2003; Hansen, 1992; Porath-Waller, Beasley, & Beirness, 2010; Rohrbach, Grana, Sussman, & Valente, 2006; Schinke, Brounstein, & Gardner, 2002; Tobler & Stratton, 1997; Tobler et al., 2000). Most of these studies agree with a key finding of Tobler et al.'s (2000) meta-analysis of 207 prevention program evaluations that interactive, universal change programs possessed the highest level of effectiveness. Universal or school-wide prevention programs target the entire student population. The Substance Abuse and Mental Health Services Administration (SAMHSA) classifies prevention programs into three categories. According to SAMHSA, universal programming benefits all members of a community whereas selective programs target individuals possessing certain risk factors and indicated programs target those already engaged in high-risk behaviors (Substance Abuse and Mental Health Services Administration's National Registry of Evidence-based Programs and Practices website, 2011). Much of the success of universal programs rests on the shoulders of teachers who deliver the curriculum (Drug Strategies, 1999). Such an effort involves a great number of teachers willing to invest time and energy to implement programs about topics they may know little about such as alcohol and drug abuse. A new trend in evaluation involves conducting qualitative studies with teachers or counselors who implement universal programming and using the data to enhance the development, implementation, and success of programs (Baker-Henningham & Walker, 2009; Boxer, Musher-Eizenman, Dubow, Danner, & Heretick, 2006; Crothers & Kolbert, 2004; Klimes-Dougan et al., 2009; Lohrmann, Forman, Martin, & Palmieri, 2008; SozaVento & Tubman, 2004). Although this research is sparse, the addition of qualitative data, such as teachers' perceptions, offers a kaleidoscope of rich information regarding factors that can promote or hinder success of prevention programs that traditional quantitative evaluation may miss. For example, positive school climate is associated with effective risk prevention and health promotion efforts (Cohen, McCabe, Michelli, & Pickeral, 2009). According to Cohen et al. (2009), the experience, norms, and values of students and teachers within the school's organizational structure determine the quality of school climate and improving that climate includes the "whole village" of parents, students, teachers, school administration, and the community. …