MS. FOXHALL is a contributing editor for <i>Contemporary Pediatrics.</i>
Communities that use science-based approaches to problem behaviors in adolescents, including alcohol and tobacco use, are more likely to see positive results.
At the same time, the lead researcher notes that most communities don't have science-based approaches, but that pediatricians can be critical in moving their localities to programs proven to work.
In a webinar with federal officials showcasing the research, the new administration's drug czar Gil Kerlikowske said, "We know that evidence-based prevention programs can be very effective. We know that they can save money. For instance, for every dollar invested in prevention programs, you could get up to a $10 savings in substance abuse treatment."
The rates were also significantly lower for alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last two weeks, and delinquent behavior over the last year.
However, even with the positive outcomes, it was tough to make a difference in some areas, according to the study results. There were no significant differences in the levels of adolescents beginning to use marijuana or inhalants. Also, the percentages of students who had used cigarettes, inhalants, marijuana, prescription drugs, and other illicit drugs in the last 30 days (as opposed to having ever used them) were lower in the CTC communities, but not significantly.
The CTC approach differs from some programs tackling adolescent problems, NIH notes. In CTC, trained coalitions of community stakeholders use epidemiological data to assess their own prevention needs, including elevated risk factors and depressed preventive factors, then choose from a list of tested programs that target those needs, and finally evaluate the progress via surveys.
The list of programs includes, for example, prevention of drug and alcohol use and violence, reducing family conflict, life skills training, HIV/AIDS prevention, dating safety, tobacco control, and anger management.
Lead researcher David Hawkins, PhD, said, after children are first surveyed, "If academic failure or low commitment to school was a risk factor, [communities] might choose individual tutoring for young people falling behind in school. If they found rebelliousness or children needing more skills to resist drug offers was a problem, they might implement life skills training or the Olweus bullying prevention program in the schools."
Frances Harding, the head of the Center for Substance Abuse Prevention, said, "We know that one size doesn't fit all. The science has helped us to focus in on the individual issues that each community presents." Her agency funds several evidence-based prevention programs.
Hawkins also stressed the need for repeated surveys on how the programs are working: "So if we have been trying to target poor family management as a risk factor, and still a large proportion of kids say, 'My parents don't know where I am and who I am with when I am not at home,' that means that we are not really being successful yet with our programming."
He also said, "Pediatricians can be big leaders in this," whether by becoming directly involved in the community coalitions, sponsoring the workshops in their clinics, or simply stating their support. It's one thing to hear about such a program from a family services program. "When pediatricians say to parents of kids who are entering middle school, 'You know, we want all the parents in this community to participate in this effective parenting program that will help you as your child enters adolescence to reduce risk for health problems during adolescence,' parents are much more likely to listen."
He indicated that because pediatricians are opinion shapers, it's even more important that they push for the science-based programs. When community people say they already have a great parenting program, Hawkins said doctors should ask, "What's the scientific evidence that this works?...Shouldn't we be doing something that we know has been tested and shown to be effective?'"
A companion editorial to the study did assert there is a "pressing need" for training centers to help policymakers and practitioners, "to avoid correctional quackery and to undertake effective interventions."
Hawkins also said that the best list of tested programs are the "Blueprints for Violence Prevention," which also includes substance abuse prevention. It is available from the University of Colorado at Boulder's Center for the Study and Prevention of Violence, available online at http://www.colorado.edu/cspv/blueprints/.