The International Journal of the Addictions, 19(4), 419- 430, 1984

Evaluation of a Substance Abuse Prevention Program for Junior High School Students

Joel M. Moskowitz," PhD

Eric Schaps, PhD

Gary A. Schaeffer, PhD

Janet H. Malvin, PhD

Pscific Institute for Research and Evaluation Napa, California 94558

Abstract

Seventh-grade students in the experimental school received two primary prevention strategies. One strategy, Effective Classroom Management, was an unstructured affective approach provided by the students' classroom teachers. The other strategy was Drug Education, a mini- course taught directly to students by a specialist. The seventh-grade students from another school served as a comparison group. Both process and outcome evaluation data were collected. Results indicated positive program effects for females on drug knowledge, cigarette smoking, and perceptions of their peers' attitudes toward and use of drugs. No effects attributable to the intervention were found for males. The discussion is in terms of problems inherent in unstructured affec- tive strategies and the need for further research on drug education.

*To whom requests for reprints should be sent at the Prevention Research Center, Pacific institute for Research and Evaluation, 2532 Durant Avenue, Berkeley, California 94704.

419

Copyright 0 1984 by Marcel Dekker, Inc. 0020-77 3x18411 90444 19 $3.5 010

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4 20 MOSKOWITZ ET AL.

The focus of drug abuse prevention hasmoved away from the “scare tactics” of the past. Instead, primary prevention has adopted the notion that personal satisfaction with self and institutions will inhibit the tendency to abuse sub- stances. This strategy has largely been based on correlational studies that found an association between self-attitudes and values, and drug abuse (eg., Ahlgren and Norem-Hebeisen, 1979; Smith and Fogg, 1978).

Prevention programs for schools have generally followed the lead of “humanistic” educators in their emphasis on affective development. The combi- nation of two such programs is evaluated in the present study. The first program, Effective Classroom Management (ECM), was aimed at fine-tuning teachers’ sensitivity to the cognitive and affective needs of students. In-service training was provided to increase the interpersonal skills of teachers.

The second program, Drug Education, was a course delivered directly to students. This course provided an opportunity for the development of self- understanding, decision-making skills, and resistance to peer pressure. &though some drug information was provided, the focus of the course was on affective awareness and social competencies. This should be contrasted with previous drug education courses which have featured factual information and have yielded negligible or mixed results (see reviews by Blum, 1976; Goodstadt, 1973; Schaps et al., 1981).

The present study examined the combined effects of these two strategies on the mediating dispositions of drug use and actual drug involvement. As a result of exposure to “affectively” trained teachers, students were expected to report an improved classroom climate, to have better attitudes toward school, and to have more positive self-esteem and fewer discipline problems. Because of direct skill building received in Drug Education, students were expected to know more about the consequences of substance use and t o perceive greater costs and fewer benefits (i.e., negative and positive consequences) of substance use. Positive changes in students’ attitudes toward substance use and perceptions of their peers’ attitudes toward the use of substances were also hypothesized. The course was considered somewhat less likely to influence personal involvement in substance use, because the brief interval between the completion of the course and posttest was considered insufficient time to achieve behavioral change (see Note 1). Finally, the course was considered least likely to affect students’ attitudes toward or use of “hard” drugs, because students at this grade level are typically opposed to these drugs.

METHOD Design

The study employed a nonequivalent control group design with a pretest and posttest. One of two junior high schools (grades 7-9) from a middle-class, suburban public school system in northern California was assigned to the

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PREVENTION EVALUATION 421

experimental condition and the other school to the control condition. All teachers in the experimental school were offered ECM in-service training (for 2 years including the year prior to this study), and all grade 7 students participated in Drug Education. The control school received neither program.

Subjects

The experimental and control groups consisted of all grade 7 teachers and students from the experimental and control schools (Note 2). Of the 31 grade 7 teachers in the experimental school, eight (26%) completed ECM in-service training only in the year prior to the study, four (13%) completed training only in the study year, and eight (26%) completed both years of training. There were no significant differences between the participants in the training and the 1 1 nonparticipants in terms of sex, prior teaching experience, or academic depart- ment. There were also no significant differences between experimental partici- pants and control teachers on these variables. Experimental teachers averaged 13.85 (SD = 6.49) years of teaching experience; control teachers averaged 14.10 (SD = 5.70). Of the experimental teachers, 62% were females; of the controls, 75% were females.

At the beginning of the study, the experimental group consisted of 419 students and the control group consisted of 268 students. Seventy-two students (17%) from the experimental group and 47 students (18%) from the control group were excluded from the analysis due to attrition or lack of parental permission for testing. In addition, 12 experimental group students and four control group students were excluded because they reported using a fictitious drug.

The analysis included 335 students in the experimental group (53% male and 96% White) and 217 students in the control group (47% male and 87% White). Mexican-Americans (3%) comprised the largest minority group.

Procedures

ECM

ECM training in the study year consisted of seven 2-hour sessions held weekly after school, followed by two “reunion” sessions of 2 hours each (Adams, Slimmon, and Schaps, 1982). The participating teachers were paid $200 and were offered postgraduate credit.

Experimental teachers were trained in one or both of two versions of ECM. In the year prior to this study, participating teachers received 24 hours of train- ing in communication, problem solving, and self-esteem enhancement. In the year of the study, participating teachers were taught techniques in communica- tion, classroom management, and self-esteem enhancement (see Table 1 ).

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422 MOSKOWITZ ET AL.

Table I

SkiNs Taught in ECM In-Service Trnining

Communica tion I-messages (Gordon, 1974) Clarifying responses (Raths, Harmin, and Simon, 1966) Reflecting feelings (Gordon, 1974) Reflecting content (Gordon, 1974)

Positive and negative verbal feedback Positive and negative nonverbal cues Tangible reinforcers Time out

Classroom management (Dreikurs and Cassel, 1972; Glasser, 1969)

Self-esteem enhancement (Canfield and Wells, 1976)

The training sessions followed a standard format. First, a self-concept enhancement technique or activity was introduced. Then the skills taught in prior sessions were reviewed and the teachers’ experiences using the skills were discussed. After this, new skills were introduced and practiced.

One of two trainers observed the teachers in their classrooms at least three times during the school year. After each visit, the trainer met briefly with the teacher to provide feedback on the teacher’s classroom behavior.

Drug Education

The drug education course consisted of 12 weekly, 45-minute sessions con- ducted from February through May 1980, during regular class time in 1 4 social studies classes (Tuck and Scliaps, 1982). The course was taught by a specialist in health education.

In the first three sessions, a model of human motivation (based on Maslow, 1980) and a model of systematic decision making were taught. In session four, students selected individual projects based on personal goals (e.g., weight loss). As homework, students kept journals documenting their progress toward reach- ing their goals over the next 8 weeks. In the fifth and sixth sessions, different styles o f group decision making were examined. Also, the influence of advertis- ing on behavior was discussed. In the seventh and eighth sessions, assertiveness training was taught. In session nine a film (“Drugs, Alcohol or Alternatives”; Note 3) was presented that analyzed reasons for using drugs and alternatives to drug use. Session 10 was a discussion of student questions about tobacco and alcohol use. Session 11 was a discussion of student questions about marijuana and other substances. In the final session, students prepared class “newspapers” summarizing their personal projects.

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PREVENTION EVALUATION 423

Measures

Process Evaluation

Teacher implementation of ECM was assessed by surveys of teachers after each training session and at the end of the school year. Students completed course evaluations of Drug Education after the fifth, eighth, and final sesssions.

Student SelfR eport

Two questionnaires, the Student Questionnaire (SQ) and the Drug and Alcohol Survey (DAS), were administered to all students (Note 4). The SQ measures students’ perceptions of themselves and their relationships with their peers, their teachers, and their school. This instrument also measures the belief in one’s own control over intellectual or academic performance (locus of control). The SQ assesses affective teaching climate, locus of control for success, locus of control for failure, academic self-esteem, social self-esteem, attitudes toward school, and perceived peer attitudes toward school. The scale reliabilities (coefficient alpha) range from .61 to .89 (Mdn = .80). The DAS assesses drug knowledge; general drug attitudes; perceived benefits (i.e., positive consequences) and costs (i.e., negative consequences) of alcohol, marijuana, and “pill” use (Note 5 ) ; attitudes toward “soft” and “hard” drug use (Note 6); perceived peer attitudes toward, and perceived peer use of, soft and hard drugs; and personal involvement in use of each of 10 substances (Note 7). The scale reliabilities ranged from .70 to .96 (Mdn = 28) except for drug knowledge (.40), where guessing probably attenuated the reliability.

The pretest was administered in October 1979 and the posttest in May 1980 during two class sessions. The SQ was administered during the first session, and the DAS was administered during the second session. Makeup sessions were held for students who were absent for the original sessions.

Questionnaires were prelabled with student names on the cover sheet and student identification numbers on page 1. The administrators stressed the confidentiality of the survey and, for added emphasis, instructed students to remove their names from the DAS.

Archival Records

Students discipline records for 4 months in the spring of 1980 were obtained from both schools. Indices were constructed for drug-related problems including use, possession, or sale of tobacco, alcohol, marijuana, and other drugs; and for general behavior problems including all other types of student misbehavior. It was found that due to differences in the two schools’ discipline

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4 24 MOSKOWITZ ET AL.

policies, the discipline records were not comparable. Therefore, these data were not used in the between-school comparisons. In addition, drug problems were not analyzed because there were only eight incidences among 5 5 2 students.

Other records obtained from the school district were the number of unex- cused absences for 1979-1980 and grade point averages for each semester (Note 8).

An index of exposure to ECM-trained teachers was created for students in the experimental school. This index equaled the number of courses in which the student was enrolled that were taught by teachers trained in ECM.

Data Analysis

Two approaches were employed in the data analysis. In the first approach experimental versus control group differences were examined. This approach included analysis of the pretest data t o explore biases attributable t o initial nonequivalence and attrition. Then, posttest data were subjected t o analysis of covariance controlling for some initial differences. This analysis examined the combined effects of ECM and Drug Education. The second approach examined students within the experimental school in order to determine whether posttest changes were related to students’ amount of exposure t o ECM-trained teachers. As all students had Drug Education, this analysis examined the effects of ECM. Type 1 error was set at .01 t o control for experimentwise error, and separate analyses were conducted for males and females due to heterogeneity of variance in many measures (Note 9).

RESULTS

Process Evaluation

The teachers who participated in the ECM in-service training found it inter- esting, enjoyable, and well organized. They reported that they had mastered most of the skills covered in the training and found them t o be useful in the classroom. Daily use of the different communication skills was reported by 11% (clarifying responses) to 26% (reflecting feelings, reflecting content) of the teachers, and daily use of the various discipline skills was reported by 0% (tang- ible reinforcers, time out) to 61% (positive nonverbal cues) of the teachers. The self-concept enhancement activities were used daily by 6% of the teachers.

Students reported that Drug Education was interesting, enjoyable, useful, and well organized. Although the individual classes differed substantially in how they rated the first five sessions of the course, all classes rated the subsequent sessions highly.

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PREVENTION EVALUATION 4 25

Outcome Evaluation

Initial Equivalence and Attrition

Analyses were conducted to determine (1) whether students in the experi- mental and control groups were equivalent on the pretest measures and (2) whether the experimental and control groups were affected differentially by attrition. A two-way analysis of variance was performed on each pretest measure with condition (experimental vs control) and attrition status (attrited vs non- attrited) as the factors. A main effect for condition would suggest initial nonequivalence, and hence would limit both internal and external validity. A main effect for attrition status would limit external validity, and the interaction between condition and attrition status would limit both internal and external validity.

For males, significant main effects for condition were obtained on 2 of 25 pretest meausres, GPA, F (1 , 291) = 17.82, p < .001; and hard drug attitudes, F (1, 295) = 7.19, p < .01. As compared to the control students, experimental males were initially lower on GPA and more opposed to hard drug use. A signifi- cant main effect for attrition status was obtained on one variable, GPA, F (1, 291) = 11.13, p < .001. As compared to attrited students, nonattrited students had higher CPA. A significant condition X attrition interaction was obtained on drug knowledge, F (1,297) = 9 . 0 8 , ~ < .01. For the experimental group, attrited students has less drug knowledge; whereas for the control group, attrited students had more knowledge.

For females, significant main effects for condition were obtained on three measures, locus of control for success, F (1, 292) = 7.20, p < .01; locus of control for failure, F (1, 295) = 13.13, p < .001 ; and social self-esteem, F (1, 297) = 6.96, p < .01. Compared to control females, experimental females were initially higher on these affective variables. No significant main effects for attri- tion status or attrition status X condition interactions were found.

In sum, initial differences occurred primarily for females on affective vari- ables. These differences favoring the experimental students may bias the posttest analyses of related affective measures toward finding positive treatment effects (Reichardt, 1979). Attrition status differences were found only for males on both types of variables limiting the generalizability of the posttest results. The only significant interaction occurred for males on drug knowledge. A treatment effect obtained on this variable would be confounded with the alternative explanation of differential attrition.

Exp erim en tal Versus Control Differences

A one-way analysis of covariance was conducted on each posttest measure with condition (experimental vs control) as the factor and the corresponding

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4 26 MOSKOWITZ ET AL.

pretest as the covariate (Note 10). As unexcused absences were not measured at pretest, analysis of variance was conducted on this variable. Treatment effect sizes are presented in the metric of the posttest control group standard deviation.

The results of the posttest analyses are summarized in Table 2 . For males, positive effects were obtained on 2 of the 25 variables, unexcused absences (.32 SD) and drug knowledge (.41 SD). For females, six positive effects were found. Positive effect sizes were obtained on drug knowledge (.42 SD), soft

Table 2

Summary of Results of Covariance Analysesa

Posttest measures

Males Females

B F B F

Affective climate Attitudes toward school Social self-esteem Academic self-esteem Peer attitudes toward school Locus of control for success Locus of control for failure GPA Unexcused absences Drug knowledge General drug attitudes Soft drug attitudes Alcohol benefits Pot benefits Alcohol costs Pot costs Soft peer attitudes Soft peer use Alcohol involvement Cigarette involvement Pot involvement Hard drug attitudes Pill benefits Pill costs Hard peer attitudes Hard peer use

.6 1

.70

.68

.64

.45

.37

.6 1

.88

.31

.70

.57

.51

.64

.49

.53 S O .4 2 .76 .88 .95 .44 .45 .53 .46 .38

-

< I < I <I <1

<I

< I

1.01

3.50

6.80* 9.67*

1.50 2.16

2.20

< I

< I

< I <1

1.62 2.20

< I < I <1 < I < I

3.95 3.12

.6 7

.6 3

.6 1

.6 8

.54

.54 -54 .98

.4 0

.71

.63

.6 1

.6 1

.52

.53

.32

.43

.76

.78

.89

.4 1

.5 1 4 6 .27 .36

-

2.03

3.39 5.62 3.3 1

1.15

<1

< I

<1 <1 10.40**

1.31 1.19 3.62 1.14

<1 < 1 12.97** 13.92**

< I 9.82* 1.44 1.68 2.82

< I 14.73* * 15.27**

dThe error df ranged from 221 to 277 for males and from 237 to 271 for females. B refers to the unstandardized regression coefficient. Analysis of variance was performed on unexcused absences.

* p < .01. **p < ,001.

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PREVENTION EVALUATION 421

peer attitudes (.41 SD), soft peer use (.45 SD), hard peer attitudes (.43 SD), hard peer use (.48 SD), and cigarette involvement (.27 SD).

Effects o f ECM Exposure

Within the experimental school, students were enrolled in from 1 to I1 classes taught by ECM-trained teachers. The students were categorized into three levels of ECM exposure. The first level contained students who were enrolled in 1 to 4 ECM classes; the second level, 5 to 7 classes; and the third level, 8 to 11 classes.

The relationship between the level of ECM exposure and the 10 school- related posttest measures was hypothesized to be monotonic. The exposure level was coded as two orthogonal components, and each posttest measure was regressed in a stepwise procedure on its corresponding pretest (where available) and on the two components. Either a significant linear component or significant linear and quadratic components could be interpreted as an effect of ECM. If only the quadratic component were significant, an ECM effect would not be implied because the relation would not be monotonic.

In none of the 20 regressions was the linear or the quadratic ECM exposure component significant. Hence, there was no evidence that greater exposure to ECM-trained teachers was associated with more positive student outcomes.

DISCUSSION

The intervention produced a pattern of positive effects for female students that are more likely the result of Drug Education than ECM. Of the six effects, all were hypothesized for Drug Education but none was hypothesized for ECM. Furthermore, amount of exposure to ECM-trained teachers was unrelated to students’ outcomes on these variables.

The two isolated effects found for male students in the experimental- control comparisons are readily explained by differential attrition or school differences unrelated to the intervention. Hence, both strategies appear to have been ineffective for males.

ECM apparently failed to equip teachers to overcome school-related factors that predispose students to abuse substances. The technology of ECM largely consists of unstructured verbal and nonverbal behaviors that teachers are expected to integrate into their regular classroom behavior. This technology may have been ineffective for many important reasons, not the least of which is the fact that ECM skill implementation is contingent upon the occurrence of parti- cular student behaviors. That is, students must “give” teachers the opportunity to use the skills. Such opportunities vary considerably from classroom to class- room; thus, the level of treatment any classroom receives is variable. Moreover, there may be little opportunity to apply the skills in many classrooms.

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428 MOSKOWITZ ET AL.

Another problem may have been the teachers themselves. With unstructured affective prevention programs like ECM, teacher effects are unavoidably confounded with program effects. Teachers’ classroom styles may be incompat- ible with the ideology of ECM, and their behavior could undermine program Implementation. However, given our sample of teachers who self-selected for training, marked incompatibility with the philosophy of ECM is rather unlikely.

The failure t o find positive program effects for ECM might b e linked t o our training procedures. However, there is no indication in the scant literature on implementation as t o what constitutes optimal procedures to promote effective implementation (Scheirer and Rezmovic, 1982). Inasmuch as the ECM teachers volunteered for training, and received 18 t o 42 hours of training and at least three follow-up classroom visits by a trainer, it seems reasonable t o assume that ECM would be implemented adequately. Nevertheless, the teacher self-reports indicated that most skills were not used daily.

The effects obtained for Drug Education in this study differed from those found in an evaluation of an earlier version of the course (Schaps et al., 1982). Whereas both studies found positive effects for girls on drug knowledge and per- ceptions of peer attitudes toward “soft” drug use, the present study also found effects on perceived peer attitudes toward “hard” drug use and perceived peer use o f “soft” and “hard” drugs. The prior study found positive effects on alcohol and marijuana involvement while the present study revealed a decrease in cigarette involvement.

There is no parsimonious explanation for the different effects obtained in the two evaluations. The reasons are not apparent from examination of the two curricula. Perhaps the efficacy of drug education interacts with characteristics of different school environments or student populations. This possibility might lead to the matching of schools with certain types o f programs. One direction for future research is the tailoring of drug education t o various populations and settings. This seems particularly warranted given the finding that only girls were positively influenced by the courses.

Overall, this study shows that drug education holds some promise as a substance abuse prevention strategy for seventh-grade girls in a suburban California school. The results also suggest that is is difficult t o change the class- room socioemotional environment through in-service training in an unstructured affective strategy. Even if such change were achievable, it remains to be seen whether it would promote more positive self-concepts among students and reduce the risk of substance abuse. In contrast, a drug education course that trains students in intra- and interpersonal competencies appears to have at least some short-term impact on females.

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PREVENTION EVALUATION 429

AC KNOW L E DG M E NTS

This research was supported by a grant from the Prevention Branch, National Institute on Drug Abuse (DA02147). The opinions stated in this report are those of the authors. We thank John W. Condon for assisting in the data analysis.

NOTES

1. Follow-up data collected 1 year after the posttest have been reported by Moskowitz, Malvin, Schaeffer, and Schaps ( I 982).

2. Special education students and teachers in both schools were not included in this study.

3. Film is available from Barr Films, P.O. Box 5667, Pasadena, CA 91 107. 4. The details of the scaling procedures and results have been reported by Moskowitz,

Condon, Brewer, Schaps, and Malvin (1979); and by Moskowitz, Schaeffer, Condon, Schaps, and Malvin (1 98 1).

5 . Operationalized as “pep pills, sleeping pills, uppers, downers, soapers.” 6 . The “soft” substances included alcohol, cigarettes, and marijuana; the “hard” sub-

stances included seven drugs: inhalants, barbiturates or tranquilizers, amphetamines or stimulants, cocaine, PCP, LSD or psychedelics, and heroin or morphine.

7. The involvement scales consisted of items assessing current use, lifetime use, and intentions to use, for the following substances: alcohol, cigarettes, marijuana or hash- ish, inhalants, barbiturates or tranquilizers, amphetamines or stimulants, cocaine, PCP, LSD or psychedelics, and heroin or morphine. “Street” names were provided for most substances. Current use was operationalized as “during the last 4 weeks,” and inten- tions to use was operationalized as “during the next year.”

8. The “pretest” measure of GPA is not truly a pretest because i t was obtained after the treatment began and may have been affected by ECM.

9. Due to nonnormality and heterogeneity of variance, log(X + 1) transformations were performed on the following variables: unexcused absences, general behavior problems, hard drug attitudes, and hard peer use.

10. Additional analyses of covariance employed the corresponding pretest and pretest- treatment interaction as covariates. The latter term allows for different regression slopes in the two conditions. In one of the 50 analyses the pretest-treatment interac- tion term was significant. These results did not affect the interpretation of the results from the ANCOVA employing only the pretest as a covariate. Thus, there was no evidence that the effectiveness of the treatment was related to the students’ initial status.

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