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LifeSkills Training (LST)

Blueprints Program Rating: Model Plus

A classroom-based, 3-year, middle school substance abuse prevention program to prevent teenage drug and alcohol abuse, adolescent tobacco use, violence and other risk behaviors. The life skills curriculum teaches students self-management skills, social skills, and drug awareness and resistance skills.

  • Gilbert J. Botvin, Ph.D.
  • Weill Cornell Medical College
  • Division of Prevention and Health Behavior
  • 402 E. 67th Street
  • New York, New York 10065
  • USA
  • 646-962-8056
  • Alcohol
  • Delinquency and Criminal Behavior
  • Illicit Drug Use
  • Sexual Risk Behaviors
  • STIs
  • Tobacco
  • Violence

    Program Type

    • Alcohol Prevention and Treatment
    • Cognitive-Behavioral Training
    • Drug Prevention/Treatment
    • School - Individual Strategies
    • Skills Training
    • Social Emotional Learning

    Program Setting

    • School

    Continuum of Intervention

    • Universal Prevention (Entire Population)

    A classroom-based, 3-year, middle school substance abuse prevention program to prevent teenage drug and alcohol abuse, adolescent tobacco use, violence and other risk behaviors. The life skills curriculum teaches students self-management skills, social skills, and drug awareness and resistance skills.

      Population Demographics

      LifeSkills Training is implemented with middle school age youth (grades 6-9). It has been shown to be effective for both males and females, as well as with young people from a variety of different racial/ethnic, socioeconomic, and demographic backgrounds.

      Age

      • Early Adolescence (12-14) - Middle School

      Gender

      • Male and Female

      Gender Specific Findings

      • Male
      • Female

      Race/Ethnicity

      • All Race/Ethnicity

      Race/Ethnicity Specific Findings

      • White
      • African American
      • Hispanic or Latino

      Race/Ethnicity/Gender Details

      Research indicates that LST is generalizable to a variety of ethnic groups, and has been proven effective with White, middle-class, suburban and rural youth, as well as economically-disadvantaged urban minority (African American and Hispanic/Latino) youth.

      Protective: skills to resist antisocial influences and to establish positive social relationships, make decisions, solve problems, and cope with stress and anxiety; knowledge about substance use risk and norms.

      • Family
      • Peer
      • Individual
      Risk Factors
      • Individual: Early initiation of drug use, Favorable attitudes towards drug use*, Stress, Substance use
      • Peer: Interaction with antisocial peers, Peer rewards for antisocial behavior, Peer substance use
      • Neighborhood/Community: Laws and norms favorable to drug use/crime
      Protective Factors
      • Individual: Clear standards for behavior*, Coping Skills*, Perceived risk of drug use*, Problem solving skills*, Refusal skills*, Skills for social interaction*

      *Risk/Protective Factor was significantly impacted by the program.

      See also: LifeSkills Training (LST) Logic Model (PDF)

      LifeSkills Training (LST) is a classroom-based universal prevention program designed to prevent adolescent tobacco, alcohol, marijuana use, and violence. LST contains 30 sessions to be taught over three years (15, 10, and 5 sessions), and additional violence prevention lessons also are available each year (3, 2, and 2 sessions). Three major program components teach students: (1) personal self-management skills, (2) social skills, and (3) information and resistance skills specifically related to drug use. Skills are taught using instruction, demonstration, feedback, reinforcement, and practice.

      LifeSkills Training (LST) is a three-year universal prevention program for middle/junior high school students targeting the use of gateway substances (tobacco, alcohol, and marijuana) and violence. The program provides students with training in personal self-management, social skills, and social resistance skills. LST consists of 15 core sessions in the first year, ten booster sessions in the second year, and five booster sessions in the third year. Each year also contains optional violence prevention sessions (three in year one, and two for both years two and three). Sessions are taught sequentially and delivered primarily by classroom teachers. Each unit in the curriculum has a specific major goal, measurable student objectives, lesson content, and classroom activities.

      The LST program includes two generic skills training components that foster overall competence and a domain-specific component to increase resistance to social pressures to smoke, drink, or use illicit drugs. The Personal Self-Management Skills component teaches students to examine their self-image and its effects on behavior; set goals and keep track of personal progress; identify everyday decisions and how they may be influenced by others; analyze problem situations, and consider the consequences of each alternative solution before making decisions; reduce stress and anxiety, and look at personal challenges in a positive light. The Social Skills component teaches students the necessary skills to overcome shyness, communicate effectively and avoid misunderstandings, initiate and carry out conversations, handle social requests, utilize both verbal and nonverbal assertiveness skills to make or refuse requests, and recognize that they have choices other than aggression or passivity when faced with tough situations. The Resistance Skills component teaches students to recognize and challenge common misconceptions about tobacco, alcohol, other drug use, and violence. Through coaching and practice, they learn information and practical resistance skills for dealing with peers and media pressure to engage in alcohol, tobacco, and other drug use, and other risk behaviors such as violence and delinquency. The main goal of this component is to decrease normative expectations regarding substance use and violence while promoting the development of refusal skills.

      LST instructors teach the skills using a combination of interactive teaching techniques including demonstration, facilitation of behavioral rehearsal (practice), feedback and reinforcement, and guiding students in practicing the skills outside of the classroom setting.

      The booster sessions in years two and three are designed to reinforce the material covered during the first year and focus on continued development of skills and knowledge that will enable students to cope more effectively with the challenges confronting them as adolescents.

      LST is based on two theoretical foundations that focus on learning, motivation, and behavior change. The first theoretical foundation is Social Learning Theory, which posits that learning occurs within a social context and that within this social context people learn from one another by observation, imitation, and modeling. Social Learning Theory gives particular emphasis to the power of behavior modeled within one's own peer group as a force that leads youth to adopt the behaviors, values, and cognitions of others like themselves. Young people also imitate substance-using role models such as family members and celebrities and entertainers they admire. To address these negative social influences, LST focuses on teaching young people ways to resist pro-drug influences, refuse drug offers from peers, and identify and resist pro-drug messages in movies, television, music and other forms of media. The second theoretical foundation is Problem Behavior Theory, which posits that some young people engage in substance use, violence, and other risk behaviors because, from their perspective, these behaviors serve a functional purpose and can help them achieve goals they believe they are unable to achieve in more adaptive ways. For example, some youth may believe that smoking cigarettes can help them to appear grown-up, impress their peers, and assert their independence from authority. In order to help young people achieve various goals in more adaptive ways, LST provides them with the social and personal skills needed to confront developmental challenges as they transition from childhood to adolescence. These skills include coping techniques, decision-making strategies, goal-setting skills, communication skills, and assertiveness skills, which are provided to help youth address the factors that increase vulnerability to drug use.

      • Cognitive Behavioral
      • Normative Education
      • Skill Oriented
      • Social Learning

      The LST program has been evaluated in 18 cohorts of students over the past 30 years, with results published in over 32 peer reviewed publications since 1980. The first four studies published from 1980-1983 focused on cigarette smoking; subsequent studies looked at smoking as well as other problem behaviors such as alcohol and marijuana use, other illicit drugs, violence and delinquency, HIV risk behavior, and risky driving. While early studies focused primarily on suburban, White, middle-class populations, evaluations since 1984 have examined additional populations, including rural White youth and urban, economically-disadvantaged minority youth. Random assignment has been used in all studies, comparing one or more treatment groups (e.g., different providers or provider training conditions) to a control condition. These studies have examined a wide range of LST intervention effects, including short term (up to one year) and longer term (beyond one year) reductions in substance use and initiation rates, the effects of the program in low and high fidelity implementation settings, implementation by a variety of facilitators, as well as effects on different populations of youth. Several studies provide long-term (5-year) follow-up data demonstrating LST effects at the end of high school and one study provided long-term (10-year) follow-up data demonstrating prevention effects among young adults. In addition to studies conducted by Botvin and his colleagues at Cornell, the effectiveness of LST is supported by several independent evaluations.

      Short-term effects found in the research studies indicate significant reductions in cigarette smoking (Botvin & Eng, 1980; Botvin et al., 1980; 1990; 1997; 2001a; 2001b), alcohol use (Botvin et al., 1990; 1997; 2001a; 2001b), and marijuana use (Botvin et al., 1990; 1997; Spoth et al., 2002). In several of these studies, exposure to the LST curriculum also led to positive shifts in self-efficacy, and anti-drug attitudes and knowledge. Furthermore, the program has positive short-term effects on delinquency and violence (Botvin et al., 2006).

      Long-term effects have been found for cigarette smoking (Botvin et al., 1990; 1995; Zollinger et al., 2003), alcohol use (Botvin et al., 1990; 1995; 2001a), and marijuana use (Botvin et al., 1990; 1995). In addition to these findings, research also demonstrates that higher implementation fidelity leads to stronger program effects. Youth participating in the LST program are less likely to initiate smoking, alcohol and marijuana use. Long-term effects have been found for illicit drug use overall, narcotics and hallucinogens in particular (Botvin et al., 2000), as well as methamphetamine use (Spoth et al., 2008). LST significantly reduced opiod use in 12th grade compared to a control condition (Crowley et al., 2014).

      Results have shown that the LST program is effective when implemented with different populations of youth, including White, middle-class populations, rural White youth, and urban, economically-disadvantaged minority youth. Mediation analyses suggest that competence skills protect youth from substance use (1) by increasing psychological well-being; (2) by increasing refusal assertiveness, and (3) by reducing positive expectancies regarding the social benefits of drug use (e.g., poorly competent youth turn to drug use because they perceive that there are important social benefits to doing so, such as having more friends, looking grown up and “cool,” and having more fun).

      LST has also been shown to reduce risky driving in high school through grade 12 (Griffin et al., 2004). Specifically, LST reduced the number of violations on students' DMV records, controlling for gender and alcohol use. Results were similar using the number of points on the DMV record as the outcome variable: LST had a protective effect in terms of the presence of points on one's license, controlling for gender and alcohol use. Students who received LST were less likely to have indicators of risky driving on their DMV records as compared to those in the control group, and these findings remained significant when school-level clustering was taken into account.

      At the young adult follow-up (10 years post intervention), findings indicated that the intervention had a protective effect on the HIV risk index, meaning that students who received the LST program during junior high school were significantly less likely to engage in HIV risk behavior relative to controls at the ten-year follow-up (Griffin et al., 2006). This protective intervention effect remained significant after controlling for clustering within schools.

      When a parent-centered intervention, Strengthening Families Program 10-14 (SFP 10-14), was delivered in combination with LST and compared to an LST-only group and a control group in rural Iowa, one year after intervention posttest, the LST + SFP 10-14 combined condition demonstrated the lowest new user rate for the substance initiation index compared to the LST-only and control groups (Spoth et al., 2002). The LST-only and control contrasts showed a marginally significant difference in the overall substance initiation index (the index included alcohol, cigarettes and marijuana) and a marginally significant difference on the individual initiation measure for marijuana, but not alcohol and cigarettes. At the 12th grade follow-up the LST-only group was significantly lower than controls on substance initiation of cigarette use. Marijuana initiation was marginally significant, with a lower mean score among the LST-only group, compared to controls. The LST-only group also demonstrated a significantly slower rate of increase across time for cigarette initiation and drunkenness initiation. The LST + SFP group had significantly lower rates of substance initiation and a slower rate of increase in substance initiation and cigarette initiation over time than controls. In terms of methamphetamine use, the LST + SFP group showed significantly lower past year use than controls at 4.5 years, and significantly lower lifetime methamphetamine use at 4.5 and 5.5 years past baseline (Spoth et al., 2006). The LST-only group had significantly lower lifetime methamphetamine use than the control group at 5.5 years past baseline (12th grade).

      One study involving eighth, ninth, and tenth graders showed the effectiveness of LST with high school students. Overall, significantly fewer students in the LST condition began smoking during the course of the study when compared to students in the control group with the results sustained at the three-month follow-up (Botvin et al., 1980). Although LST was most effective with eighth graders, there were also substantial reductions in new smoking relative to controls among ninth and tenth graders (75% and 44%, respectively).

      In a study examining violence outcomes, the LST program was found to reduce delinquency and fighting (Botvin et al., 2006).

      The numerous evaluations of Life Skills Training (LST) cover multiple outcomes and follow-up periods. Early studies focused on tobacco use, followed by studies focused on alcohol and marijuana use, polydrug use, and illicit drug use other than marijuana. More recent studies examined the effectiveness of LST on HIV/AIDS risk behaviors, risky driving, and violence and delinquency. Studies testing LST have not only demonstrated short-term effects, but also provide evidence of its long-term effectiveness, with several studies providing 5-6 year follow-up data, and one study providing 10-year follow-up data.

      • Tobacco use: Across several studies, short-term effects show that the intervention reduces smoking among intervention group participants, relative to controls, up to 87% (Botvin et al., 1983). In a long-term follow-up study, findings indicated that the intervention group had a mean rate of monthly smoking that was lower by 28% than the control group (.21 versus .29) at the 6-year follow-up (Spoth et al., 2008).
      • Alcohol use: Across studies, short-term effects show that the intervention reduces alcohol use among intervention group participants, relative to controls. At 1-year follow-up, one study found that the relative reduction rate (percentage difference in the proportion of new users in LST relative to Controls) was 4.1% (Spoth et al., 2002). In another study, the intervention group engaged in 50% less binge drinking relative to controls at the 1- and 2-year follow-up assessments (Botvin et al., 2001a).
      • Marijuana use: Several studies have shown short- and long-term effects on marijuana, with one long-term study showing a 66% reduction among intervention group participants relative to controls (Botvin et al., 1990).
      • Polydrug use: In one study (Spoth et al., 2002), the intervention group had a mean current polydrug use at the one-year follow-up that was lower by 27% than the control group (.24 versus .33). In another study (Botvin et al., 1995), prevalence of weekly use of alcohol, tobacco, and marijuana at the 6-year follow-up was 66% lower among intervention youth relative to control participants at the end of high school.
      • Illicit drug use: At 12th grade (6-year) follow-up, the LST group was significantly lower in lifetime methamphetamine use than the control group (Spoth et al., 2006). In another long-term study, with a non-random subsample of the original cohort, the LST group had lower rates of overall illicit drug use, illicit drug use other than marijuana, heroin and other narcotics, and hallucinogens, relative to the control group condition, at the 6.5 year follow-up assessment (Botvin et al., 2000). LST significantly reduced opiod use in the 12th grade, compared to controls (Crowley et al. 2014)
      • Violence and delinquency: At 3-month follow-up, the intervention group showed reductions of 32% in delinquency in the past year, 26% in high-frequency fighting in the past year, and 36% in high frequency delinquency in the past year (Botvin et al., 2006).
      • HIV risk behaviors: 10-year follow-up results, with only 37% of the original baseline sample, showed significant long-term LST prevention effects for HIV risk (having multiple sex partners, having intercourse when drunk or high, and recent high risk substance use) (Griffin et al., 2006).
      • Risky driving: At 6-year follow-up, the intervention group had 20% with violations compared to 25% in the control group (Griffin et al., 2004).

      Program Effects on Risk and Protective Factors:

      • Knowledge and attitudes: Across several studies, the intervention group showed significantly greater improvement than the control group in life skills knowledge, substance use knowledge, and perceived adult substance use, both at short-term and longer-term follow-ups.

      LST has demonstrated in multiple studies increases in knowledge about substance use and knowledge of life skills, and in some studies improvements in attitudes, self-efficacy, and life skills (assertiveness, anxiety reduction, and self-control).

      The first large-scale, long-term evaluation was conducted within middle-class suburban and rural schools in New York State. However, other large-scale evaluations were conducted with minority youth living in urban areas. Evaluation research has demonstrated that this prevention approach is effective with a broad range of students including White, middle-class youth and economically disadvantaged minority (black and Hispanic) youth. The prevention program was effective whether training was provided in a formal workshop by project staff or by videotape without feedback or support (although the strongest effects were found for the formal workshop training). Because effects were found for the treatment group that received teacher training without specialized technical assistance or support, studies indicate that the LST program is feasible and can be effective in “real-world” settings, where schools utilize their own criteria for selecting teachers, and implementation conditions (e.g., time) are less than optimal.

      In the first large-scale (six year) study of LST conducted in New York State (Botvin et al., 1990, 1995), attrition at the three-year follow-up indicates that attrition rates were higher among substance users, although this attrition was not differential with respect to the conditions examined (preserving internal validity). The results reported for the first three years of the study (Botvin et al., 1990) were limited to the sub-sample of youth who had received a minimum of 60% of the LST program. Subgroup analysis of this kind can undermine the benefits of randomization. However, additional analyses revealed no significant differences between the full sample and the sub-sample, increasing confidence that the internal validity of the study was preserved. Comparisons of the full treatment sample to the control group were not reported. Moreover, at the six-year follow-up (end of 12th grade) of this study, both the full sample and high fidelity sample were analyzed. Significant LST effects were found for both the full sample as well as the high fidelity sample. Attrition over six years was high, with 60.41% of the initial 7th grade sample completing the six year follow-up. However, attrition rates were equivalent for treatment and control conditions as were pretest levels of drug use for the final analysis sample (full and high fidelity sample), preserving internal validity. Attrition in the high fidelity sample at six years was much higher, representing about 40% of the original sample. Demographic characteristics of this study included a predominantly white, middle-class sample.

      Griffin, Botvin, & Nichols, 2006: Attrition from baseline to the young adult follow-up was high (63.3%). In addition, individuals of the greatest interest (high-risk substance users and minorities) due to their over-representation among the HIV-positive population were less likely to complete the follow-up assessment than non-minorities and low-risk or non-substance users. The intervention had no significant effect on condom use. Finally, the latent growth analyses focused on students who received 60% or more of the intervention, meaning the findings may not generalize to others who received LST implemented with lower fidelity.

      Griffin, Botvin, and Nichols, 2004: The DMV records of points on one's driving record are maintained for 18 months from the time of the violation, meaning that if a violation occurred more than 18 months ago, it is possible to have violations on one's driving record without having points. The authors acknowledged that this occurred for 42 (2%) of the participants in the study. However, separate analyses were conducted using violations and points as the outcome variable; both yielded significant prevention effects. Thus, it is clear from these findings that the loss of points data for a small portion of the sample did not affect the validity of the study or the interpretation of results.

      Botvin, Eng, and Williams, 1980b, and Botvin and Eng, 1980a: The program was less effective among high school students (ninth and tenth graders), who are more likely to smoke than students in middle school. However, while LST was more effective for eighth graders, it still produced large reductions in new smoking (relative to controls) among high school students (75% for ninth graders and 44% for tenth graders). No long-term data was collected after the three-month follow-up.

      While many other promising drug-use prevention programs decay over time, this approach endured through the end of high school. Possible reasons include: (1) greater treatment dosage (15 sessions during the primary year) and (2) greater booster sessions (15 over two years), as compared to other treatments. Research with this intervention also demonstrates the importance of implementation fidelity - greater fidelity produces stronger outcomes. Intervention effects can be produced by a variety of providers including project staff, social workers, graduate interns, peer leaders, and classroom teachers. Additionally, this school-based program has been adapted effectively to a community setting, using Boys & Girls Clubs of America, and Stay SMART program (St. Pierre, Kaltreider, Mark, & Aikin, 1992).

      • Blueprints: Model Plus
      • Coalition for Evidence-Based Policy: Top Tier
      • Crime Solutions: Effective
      • OJJDP Model Programs: Effective
      • SAMHSA: 3.9-4.0

      David Genova, LST Site Coordinator
      District Wellness Coordinator
      dgenova@pottstownsd.org
      Mobile: 610-906-6529
      Facebook - Pottstown School District Wellness
      Twitter - @DavidGenova33

      Tina Forsyth, LST Site Coordinator
      Student Assistance Specialist
      Downingtown Area School District
      Downingtown West High School
      445 Manor Avenue
      Downingtown, PA 19335
      610-269-4400, ext 7596
      Cell: 610-633-5704
      tforsythe@dasd.org

      Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. Journal of the American Medical Association, 273, 1106-1112.

      Botvin, G. J., Baker, E., Dusenbury, L., Tortu, S., & Botvin, E. M. (1990). Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: Results of a three-year study. Journal of Consulting and Clinical Psychology, 58, 437-446.

      Botvin, G. J., Dusenbury, L., Baker, E., James-Ortiz, S., Botvin, E. M., & Kerner, J. (1992). Smoking prevention among urban minority youth: Assessing effects on outcome and mediating variables. Health Psychology, 11,  290-299.

      Botvin, G. J., & Eng, A. (1980). A comprehensive school-based smoking prevention program. Journal of School Health, 50, 209-213.

      Botvin, G. J., Eng, A., & Williams, C. L. (1980). Preventing the onset of cigarette smoking through life skills training. Preventive Medicine, 9, 135-143.

      Botvin, G. J., Epstein, J. A., Baker, E. Diaz, T., & Ifill-Williams, M. (1997). School-based drug abuse prevention with inner-city youth. Journal of Child and Adolescent Substance Abuse, 6,  5-19.

      Botvin, G. J., Griffin, K. W., Diaz, T., & Ifill-Williams, M. (2001a). Drug abuse prevention among minority adolescents: Posttest and one-year follow-up of a school-based preventive intervention. Prevention Science, 2, 1-13.

      Botvin, G. J., Griffin, K. W., Diaz, T., & Ifill-Williams, M. (2001b). Preventing binge drinking during early adolescence: One- and two-year follow-up of a school-based preventive intervention. Psychology of Addictive Behaviors, 15,  360-365.

      Botvin, G. J., Griffin, K. W., Diaz, T., Scheier, L. M., Williams, C., & Epstein, J. A. (2000). Preventing illicit drug use in adolescents: Long-term follow-up data from a randomized control trial of a school population. Addictive Behaviors, 25,  769-774.

      Botvin, G. J., Griffin, K. W., & Nichols, T. R. (2006). Preventing youth violence and delinquency through a universal school-based prevention approach. Prevention Science, 7, 403-408.

      Griffin, K. W., Botvin, G. J., & Nichols, T. R. (2004). Long-term follow-up effects of a school-based drug abuse prevention program on adolescent risky driving. Prevention Science, 5,  207-212.

      Griffin, K. W., Botvin, G. J., & Nichols, T. R. (2006). Effects of a school-based drug abuse prevention program for adolescents on HIV risk behaviors in young adulthood. Prevention Science, 7, 103-112.

      Mackillop, J., Ryabchenko, K. A., & Lisman, S. A. (2006). Life Skills Training outcomes and potential mechanisms in a community implementation: A preliminary investigation. Substance Use and Misuse, 41, 1921-1935.

      Spoth, R. L., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Arch Pediatr Adolesc Med, 160, 876-882.

      Spoth, R. L., Randall, G., Trudeau, L., Shin, C., & Redmond, C. (2008). Substance use outcomes 5 1/2 years past baseline for partnership-based family school preventive interventions. Drug and Alcohol Dependence, 96,  57-68.

      Spoth, R. L., Redmond, C., Trudeau, L., & Shin, C. (2002). Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors, 16, 129-134.

      St. Pierre, T. L., & Kaltreider, D. (1992). Drug prevention in a community setting: A longitudinal study of the relative effectiveness of a three-year primary prevention program in Boys and Girls Clubs across the nation. American Journal of Community Psychology, 20,  673-706.

      Zollinger, T. W., Saywell, R. M., Cuegge, C. M., Wooldridge, J. S., Cummings, S. F., & Caine, V. A. (2003). Impact of the Life Skills Training curriculum on middle school students' tobacco use in Marion County, Indiana, 1997-2000. Journal of School Health, 20, 338-346.

      National Health Promotion Associates, Inc.
      711 Westchester Avenue, 3rd Floor
      White Plains, NY 10604
      (914) 421-2525
      (914) 421-2007 fax
      lstinfo@nhpamail.com
      www.lifeskillstraining.com

      Study 1

      Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. Journal of the American Medical Association, 273, 1106-1112.

      Botvin, G. J., Baker, E., Dusenbury, L., Tortu, S., & Botvin, E. M. (1990). Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: Results of a three-year study. Journal of Consulting and Clinical Psychology, 58, 437-446.

      Botvin, G. J., Griffin, K. W., Diaz, T., Scheier, L. M., Williams, C., & Epstein, J. A. (2000). Preventing illicit drug use in adolescents: Long-term follow-up data from a randomized control trial of a school population. Addictive Behaviors, 25, 769-774.

      Study 7

      Botvin, G. J., Griffin, K. W., & Nichols, T. R. (2006). Preventing youth violence and delinquency through a universal school-based prevention approach. Prevention Science, 7, 403-408.

      Study 9

      Spoth, R. L., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Arch Pediatr Adolesc Med, 160, 876-882.

      Spoth, R. L., Randall, G., Trudeau, L., Shin, C., & Redmond, C. (2008). Substance use outcomes 5 1/2 years past baseline for partnership-based family school preventive interventions. Drug and Alcohol Dependence, 96, 57-68.

      Spoth, R. L., Redmond, C., Trudeau, L., & Shin, C. (2002). Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors, 16, 129-134.

      Botvin, Baker, Dusenbury, Tortu, & Botvin (1990); Botvin, Baker, Dusenbury, Botvin, & Diaz (1995); Botvin, G. J., Griffin, K. W., Diaz, T., Scheier, L. M., Williams, C., & Epstein, J. A. (2000).

      This large-scale randomized controlled trial tested the LST intervention in 56 schools in New York State. Results are presented at the initial posttest, 3-year follow-up (end of ninth grade), 6-year follow-up (end of 12th grade), and 6 1/2 year follow-up.

      Evaluation Methodology

      Design: New York State Evaluation: In the spring of 1985, 56 participating schools in three geographic areas of New York State were surveyed to determine the amount of cigarette use of students. The schools were then divided into high, medium or low use schools. The original sample contained 5,954 students who were in 7th grade at the time. From within groups of schools with similar levels of cigarette smoking, schools were randomly assigned to one of the following groups: (1) E1 (n=18 schools): prevention program with a formal 1-day training workshop and implementation feedback by project staff, (2) E2 (n=16 schools): prevention program with training provided by videotape and no implementation feedback, and (3) a treatment as usual control group (n=22 schools). Random assignment successfully ensured equivalent groups at baseline. The program was administered by regular classroom teachers selected by each participating school.

      Sample: The sample was approximately half (52%) male and predominantly (91%) white. Sample retention (based on all available students at the pretest) was 93% at the initial posttest (mid-7th grade), 81% at the 16-month follow-up (end of the 8th grade), 75% at the 28-month follow-up (end of the 9th grade), 67% at the 40-month follow-up (end of the 10th grade), and 60% at the end of the 60 month follow-up (end of 12th grade). Retention rates were virtually identical across conditions. Analysis of demographic characteristics of the sample using MANOVA revealed no significant differences between study groups at baseline. ANOVA revealed that substance use at pre-test had a significant effect on attrition rate for the 3-year study, a finding consistent with previous research. Analyses were conducted at the school level to provide for a more conservative test of the intervention.

      The sample at the 6-year follow-up studies consisted of 447 individuals who had participated in the original trial and were contacted by mail at the end of the 12th grade (6.5 years from baseline data collection). This sample was 92.3% White and 40% male. Average age was 18.1 years and most (82.5%) lived in two-parent families. At the 6-year study, no significant differences were found between the samples at pre-test, nor were there any differential attrition differences at follow-up, based on demographic characteristics.

      Measures: Prior to implementation, breath samples (to measure carbon monoxide levels) were collected from all participants, in order to increase validity of self-report data collected. In order to assess implementation fidelity, researchers observed LST lessons and recorded the amount of lesson information covered per session. A three year cumulative implementation score was computed for each student in the two intervention groups. To assess drug use, students reported frequency of use on three scales (one for each substance: tobacco, alcohol, marijuana). Students were also asked to report on the amount of tobacco and alcohol used on two scales. An additional scale was used to determine how often individuals drank to the point of intoxication. From these scales, measures to assess “heavy” use and polydrug use were created by partitioning collected measures into binary variables.

      At the 6-year follow-up, participants were asked about frequency of illicit drug use, using 13 different categories of drugs that were based on the Monitoring the Future study. Six composite scores were created that reflected the sum of the individual drug items (marijuana, cocaine, inhalants, nonmedical pill use, heroin and other narcotics, and hallucinogens), and a second summary score that represented the sum of all "illicit drug use other than marijuana."

      Analysis: The school was used as the unit of analysis, although 9th grade analyses were also supplemented with individual level analyses. Analyses were based on means for each drug use and polydrug use variable. Ordinary least-squares (OLS) regression was conducted, with the school as the unit of analysis. Separate regressions were performed for the full sample and the high fidelity sample. Inferences were based on one-tailed significant tests.

      The 6 year follow-up on illicit drug use (Botvin et al., 2000) analyzed data using GLM ANCOVAs, adjusting for relevant covariates. Generalized estimating equations (GEE) were also conducted to control for intracluster correlations among students within schools. P-values for both analyses represented two-tailed significance levels.

      Outcomes

      Post-test: (Botvin, 1989)
      The only behavioral effects found during the first 2 years of this study (grade 7 and grade 8) were for cigarette smoking. Prevention effects were evident for interpersonal skills knowledge, domain-specific knowledge and normative expectations concerning tobacco, alcohol, and marijuana use.

      Long-term: 3-year - End of 9th grade (Botvin, Baker, Dusenbury, Tortu, & Botvin, 1990)
      Results were restricted to the sample of students who had received a minimum of 60% of the prevention program. While the mean implementation fidelity score was 68%, researchers lowered the standard in order to establish a minimum standard of acceptable program implementation while retaining as much of the sample as possible. After inclusion criteria were applied, 75% of the sample remained. There were no significant differences found between the full sample and the analyzed sub-sample. Significant treatment effects were found using MANCOVA for cigarette smoking and marijuana use, with lower rates in both E1 and E2. Although there were no significant effects found for drinking frequency or amount, the frequency of getting drunk was significantly less in E2 than among controls.

      6-year (End of 12th Grade): (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995)
      Full Sample: The prevalence of weekly and monthly cigarette smoking was significantly lower for both intervention groups than the control group (monthly = .27, .26.33; and weekly = .23, .21, .27, for E1, E2, and control groups respectively). Heavy smoking was significantly lower for the E2 intervention group than the control group (.09 vs .12). The prevalence of heavy drinking was significantly lower for the intervention groups (.34, .33, .40, for E1, E2, and control group). There were no significant differences for the monthly, weekly, or 3 drinks or more per occasion rates, nor were there significant differences for marijuana use. On polydrug use measures, prevalence of weekly use of all three drugs was significantly lower among intervention youth (both groups) than for the control participants. Other polydrug measures with two drugs also showed significantly lower prevalence rates among both treatment groups than in the control group, with the exception of prevalence of weekly cigarette smoking and alcohol use among the E1 group (approached significance).

      6.5 year illicit drug use results - six months after 12th grade (Botvin, Griffin, Diaz, Scheier, Williams, & Epstein, 2000)
      Overall rates of illicit drug use were relatively low overall at follow-up, with a few exceptions. Of the 13 drugs evaluated, three showed rates of use across the sample of over 10% or more: marijuana (48.5%), LSD or other psychedelics (15.1%), and amphetamines (10.6%). The raw proportion of students using each illicit drug was higher in the control group than in the experimental group for all drugs. The GLM analysis showed significant differences in means at follow-up favoring the treatment over the control groups on four of the six composite scores: marijuana, inhalants, heroin and other narcotics, and hallucinogens. P-values were also significant for total illicit substance use and total illicits other than marijuana. After GEE analysis, marijuana became marginally significant and inhalants was nonsignificant. Lifetime rates of illicit drug use among treatment youth were 25% lower than those from the control group (22.5 vs. 30.1); rates of hallucinogen use were 38% lower (13.0 vs. 21.0); rates of narcotics use were 56% lower (3.4 vs. 7.7).

      High Fidelity Sample: The results were stronger for the high-fidelity sample. This group received at least 60% of the intervention (n=2,752). No differences were found between this group and the full sample in terms of demographic characteristics. The experimental groups were significantly different from the control group for all measures of cigarette use, weekly alcohol use, 3 drinks or more per occasion, drunk, and weekly marijuana use. Monthly marijuana use was significantly lower for the E1 group compared to the control group. Monthly alcohol use was significantly lower for the E2 group compared to the controls. Polydrug use results yielded similar findings. Treatment youth had significantly lower rates of polydrug use than control youth for nearly all combinations of the three drugs (both monthly and weekly levels of use). Both intervention groups reported 66% fewer adolescents who used all three drugs at least weekly.

      Summary of Sustained Effects: Reductions in alcohol, tobacco, and marijuana use endure to the end of high school in the high-fidelity sample. In the full sample, effects are sustained for tobacco and heavy alcohol use.

      Griffin, Botvin, & Nichols (2006)
      Long-term (10-years) follow-up from Study 1 that assesses the impact of LST on HIV/AIDS risk behaviors.

      Evaluation Methodology

      This evaluation examined the long-term impact of the Life Skills Training program on drug use and sexual behaviors that put one at elevated risk for HIV infection. The data for this study were collected as part of a larger long-term follow-up study of a randomized drug abuse prevention trial.

      Design: In the original school-based prevention trial, a randomized block design was used. Please see above (Study 1) for a detailed description of the study design. At the baseline assessment in 1985, surveys were completed by 5,569 participants prior to the start of the intervention, of which 3,815 (68.5%) received the prevention program. For the follow-up assessment during young adulthood, attempts were made to confirm contact information for all participants who completed the baseline survey. A total of 3,108 (56%) addresses for the original sample were confirmed by telephone records or mail requests for change of address information, while 1,519 (27%) home addresses were obtained but not confirmed by either telephone or mail. Contact information was not obtained for 17% of the original population. The follow-up survey was mailed to those for whom home addresses had been confirmed or unconfirmed and participants were offered $20.00 as an incentive to complete the survey. Of the 2,042 youth (37% of the original baseline sample) who participated in the 10-year follow-up, 1,360 (66.6%) received the prevention program and 682 were in the control group of the original prevention study. The final follow-up sample consisted of 1,080 girls and 962 boys. There were no significant pre-test differences in the young adult follow-up sample between the experimental and control groups in terms of any of the demographic variables, or in terms of rates of substance use or grades received in school in the 7th grade. At the follow-up assessment, there were no significant differences across conditions in terms of percent married or cohabitating, percent of college graduates, or percent with incomes of $15,000 per year or less. Overall attrition from the baseline to the young adult follow-up assessment was 63.3% and was similar across conditions. Those who reported smoking, drinking, or marijuana use at baseline were more likely to drop out of the study relative to those who did not report using these substances. However, the rate of attrition of substance users did not differ across experimental conditions. Males and minorities dropped out of the study at a higher rate compared to females and non-minorities, but this did not differ across experimental conditions.

      Sample: Participants were primarily from middle-class suburban and rural areas of New York State, and 77.6% lived in two-parent families during junior high school. The sample was 52.8% female, and the vast majority was Caucasian (91.2%). Almost half (49.6%) were college graduates, 39.6% were married or cohabitating, and the median age was 24.6 years.

      Measures:
      School-based surveys: Frequency of alcohol intoxication was measured by responses to the question "How often (if ever) do you get drunk?" with response options ranging from "Never" to "More than once a day." Frequency of marijuana use was measured by the question "How often (if ever) do you usually smoke marijuana?" with response options including "Never," "Tried it but don't use it now," up to "More than once a day."

      Young adult follow-up survey: HIV risk behavior outcomes included several high-risk sexual and substance use behaviors. Questions related to risky sexual behavior inquired about the number of sexual partners in the past year, the frequency of engaging in sexual intercourse while drunk or very high, and condom use. Substance use was assessed by asking participants how often (if ever) they had used any of 13 different illicit drug categories based on those used in the Monitoring the Future study, including marijuana, cocaine, amphetamines, Quaaludes, barbiturates, tranquilizers, heroin, narcotics other than heroin, inhalants, amyl or butyl nitrites, LSD PCP, and MDMA (ecstasy), with response options on a seven-point Likert-type scale. Alcohol and marijuana intoxication were assessed with items that asked about the frequency of drinking until drunk and smoking until high on a nine-item Likert-type scale. Participants were identified as high-risk substance users if they reported alcohol or marijuana intoxication or using any other illicit substance in the past month, and were considered to be engaging in high-risk behavior for HIV infection if they reported (1) having multiple sex partners, (2) having intercourse when drunk or very high, and (3) recent (past month) high-risk substance use.

      Analysis: A logistic regression analysis was conducted to examine the effect of the intervention on the HIV risk index with the dependent variable being the dichotomous HIV risk index score, and demographic covariates included gender and minority status, along with lifetime smoking, lifetime alcohol use, lifetime marijuana use, percent living in two-parent families, percent receiving grades in school of C or less, and (at the young adult follow-up assessment) percent married, percent cohabitating, percent of college graduates, and percent with incomes of $15,000 per year or less. Growth modeling procedures were used to examine potential mechanisms of intervention effects.

      Outcomes

      Long-term: Findings indicated that the intervention had a protective effect on the HIV risk index. Covariates that were predictive of being at high HIV risk included being male and protective factors for being at high HIV risk included being married or cohabitating with a partner. This protective intervention effect remained significant after controlling for clustering within schools.

      Mediating mechanisms: Prior to testing for intervention effects, a confirmatory factor analysis was conducted to examine the measurement properties of the HIV Risk Behavior latent factor, which was designed to capture covariation among three dichotomous indicator items assessing whether the participant had multiple sex partners, had sex when drunk or high, and reported high risk substance use. There were no differences across experimental conditions at the follow-up assessment in terms of the use of condoms, therefore this behavior was not included in the analyses. The percentage of the treatment group engaging in each behavior was lower than the percentage of the control group in all three cases. The confirmatory factor analysis showed that the factor loadings for these three indicators on the HIV Risk Behavior latent factor were all statistically significant. Next, prior to looking at mediating mechanisms, a direct effect model of the intervention on HIV Risk Behavior within a SEM framework was tested. Findings indicated, however, that the path from experimental condition to HIV Risk Behavior was not significant for the entire sample. Additional analyses were conducted on a subgroup of participants who had received at least 60% of the intervention during the three intervention years (n = 1,487; n = 690 men and n = 797 women). The demographic characteristics of this sample were virtually identical to those of the full follow-up sample. Among this high-fidelity follow-up subsample, the path from experimental condition to HIV Risk Behavior was significant, indicating that there was a protective effect of the intervention on HIV Risk Behavior in young adulthood, with those assigned to the intervention condition reporting less HIV risk behavior at the end of follow-up compared to control participants. Growth in serious levels of substance use involvement was measured by Alcohol and Marijuana Intoxication (AMI) during the 7th through 12th grades. The model included an AMI Slope factor to estimate growth over time and an AMI Intercept factor to estimate individual differences in alcohol and marijuana intoxication at baseline. The correlation between slope and intercept factors were estimated in the model to account for the possibility that differences in initial levels of substance use may affect rate of growth over time. A path from experimental condition to the AMI Intercept factor was also included to control for pre-test differences. One-tailed tests of significance revealed that the rate of growth in alcohol and marijuana intoxication was lower in the intervention group relative to controls. There was also a significant direct effect from the AMI slope factor to the HIV Risk Behavior factor, indicating that more growth in alcohol and marijuana intoxication during junior and senior high school was associated with greater HIV risk behavior in adulthood. In the final model, the correlation between the AMI Intercept and Slope factors was not significant, nor was the path from experimental condition to the AMI Intercept factor. Furthermore, the direct effect from experimental condition to HIV Risk Behavior dropped to nonsignificance, suggesting that the effect of the intervention on HIV risk during young adulthood was partially mediated by reduced growth in alcohol and marijuana intoxication over the course of adolescence.

      Outcomes - Brief Bullets

      • Students who received the LST program during junior high school were significantly less likely to engage in HIV risk behavior relative to controls at the ten-year follow-up.

      Generalizability: As this evaluation used follow-up data collected from the original sample, please see above for a description of the generalizability of the findings.

      Limitations: Attrition from baseline to the young adult follow-up was high (63.3%). In addition, individuals of the greatest interest (high-risk substance users and minorities) due to their over-representation among the HIV-positive population were less likely to complete the follow-up assessment than non-minorities and low-risk or non-substance users. The intervention had no significant effect on condom use. Finally, the latent growth analyses focused on students who received 60% or more of the intervention, meaning the findings may not generalize to others who received LST implemented with lower fidelity.

      Griffin, Botvin, & Nichols (2004)

      This study examined long-term follow-up data from a large-scale randomized trial (Botvin et al., 1995 - Study 1) to determine the extent to which participation in LST during junior high school led to less risky driving among high school students.

      Evaluation Methodology

      Design: Please see Botvin et al., 1995 above for a detailed description of the randomized block design used in the school-based drug prevention program. In order to obtain data on risky driving for the current evaluation, a list of names and addresses of students in the prevention program was provided to the New York State Department of Motor Vehicles (DMV). For students whose name and address could be matched to the DMV database, the DMV provided information on traffic violations on students' driving records. Of the over 3,500 students that participated in the long-term follow-up study, the DMV was able to provide a match for 2,042 (58%) students. The length of the follow-up period between the initial baseline data collection for the LST and the DMV data was approximately six years. The final sample of 2,042 students included 1,360 students from the treatment group and 682 control students from the original study. There were no baseline differences between experimental conditions at baseline in terms of gender or the alcohol use index.

      Sample: The sample was 53% male, 91% were Caucasian, and the median age was 18.1 years. Participants were primarily from middle-class suburban and rural areas of New York State, and 86% lived in two-parent families.

      Measures: Data on demographic factors, self-reported alcohol use, and experimental condition in the seventh grade were used in the present analysis. Follow-up data on antidrinking attitudes in the 10th grade and self-reported alcohol use in the 12th grade from the school-based survey were also used. Antidrinking attitudes were assessed with 10 items such as "Drinking alcohol makes you look cool" and "Drinking alcohol makes you look more grown-up," with higher scores indicating greater disagreement. Alcohol consumption was measured using three items reflecting the frequency of alcohol use, the quantity of use per drinking occasion, and the frequency of drunkenness. Participants were designated as regular alcohol users if they (1) drank alcohol in the past week, (2) reported having three or more drinks per occasion, or (3) got drunk in the past month. Data on risky driving was obtained through the state department of motor vehicles (DMV). In addition to the number of traffic violations, the number of points on students' driver's licenses was also used as outcome variables.

      Analysis: A series of logistic regression analyses were conducted to examine the effect of the intervention on risky driving during high school. In each analysis, gender and alcohol use in the 12th grade were included as covariates.

      Outcomes

      Post-test: As this is a longitudinal follow-up, no post-test data was analyzed.

      Long term: In the 12th grade, 27% of students reported drinking in the last week, 56% reported typically taking three or more drinks per occasion, and 35% reported getting drunk in the past month. In terms of risky driving, 77% of the sample had no violations and 79% had no points on their DMV record. For those with violations on their record, the mode was 3 violations (range 1-9); for those with points on their licenses, the mode was 4 points (range 2-12). Due to the skewed nature of the driving outcomes, two dichotomous scores (one indicating the presence of any violations on one's driving record and the other indicating the presence of any points) as the main outcomes in the subsequent analyses.

      Results of the logistic regression analyses indicated that the intervention had a significant protective effect on risky driving. Specifically, LST had a protective effect in terms of the presence of violations on one's DMV record, controlling for gender and alcohol use. In this analysis, being male was associated with increased likelihood of violations, as was regular alcohol use. Results were similar using the presence of points as the outcome variable: LST had a protective effect in terms of the presence of points on one's license, controlling for gender and alcohol use. Being male was associated with an increased likelihood of points on one's license, as was regular alcohol use. The protective effects of the intervention on violations and points remained significant when alcohol use was not included as a covariate. Additional analyses were conducted to control for intracluster correlations (ICCs) among students within schools. When the ICCs were taken into account using the generalized estimating equations (GEE) method, the prevention effects remained statistically significant for both number of violations and number of points. Thus, findings indicate that those who received the intervention were less likely to have indicators of risky driving on their DMV records as compared to those in the control group, and these findings remained significant when school-level clustering was taken into account.

      Mediational analyses on a subgroup of participants that completed survey data in the 10th grade were examined to identify potential mediators of program effects on risky driving. Findings indicated that those in the intervention group had higher antidrinking attitudes in the 10th grade compared to controls; higher antidrinking attitudes predicted significantly fewer total violations in the 12th grade; and the direct effect of the intervention on the total violations became nonsignificant with antidrinking attitudes included in the model. These findings indicate that the program effects on total violations were mediated in part by increased antidrinking attitudes among those that received the prevention program. However, the mediational model was not significant for total number of points on participants' licenses.

      Outcomes - Brief Bullets

      • Those who received LST were less likely to have indicators of risky driving on their DMV records as compared to those in the control group, and these findings remained significant when school-level clustering was taken into account.

      Limitations: The DMV records of points on one's driving record are maintained for 18 months from the time of the violation, meaning that if a violation occurred more than 18 months ago, it is possible to have violations on one's driving record without having points. The authors acknowledged that this occurred for 42 (2%) of the participants in the study.

      Botvin, G.J., Griffin, K.W., Diaz, T., & Ifill-Williams, M. (2001a; 2001b). 

      This large-scale randomized trial tested the effectiveness of LST on cigarette smoking and other drug use, including polydrug use, with inner-city, minority youth.

      Evaluation Methodology

      Design: Twenty-nine New York City public schools participated in the study. Schools were surveyed to determine the amount of cigarette use of students. The schools were then divided into high, medium or low use schools and randomized to either receive the LST intervention (16 schools) or be in the control group (13 schools). Students in the intervention condition received the 15 session LST curriculum in the 7th grade, and the 10 session booster curriculum in the 8th grade. Modifications to the standard LST curriculum were made to make the program more appropriate for the targeted population. These modifications included the inclusion of pictures of minority youth, appropriate language and behavioral rehearsal scenarios, and adjustment of the reading level. No changes were made that would affect the underlying prevention strategy of the lessons. The sessions were taught by the regular classroom teacher. Control youth received the standard curriculum in place in NYC schools.

      Teachers who taught the program had attended a 1-day teacher training workshop. Trained observers randomly attended classes and completed observational forms to assess implementation fidelity in each year.

      Sample: The sample consisted of a total of 5,222 seventh grade students. Demographic characteristics of the sample included approximately half (47%) male and predominantly minority (61% African-American, 22% Hispanic, 6% Asian, 6% White, and 5% other or mixed background). Sixty-two percent of participants were eligible for the free lunch program. Approximately half (53%) of students lived in dual-parent households and 36% lived in mother-only households. After the schools were randomized into groups, 69% of the sample (n=3,621) were in the treatment condition.

      Measures: Participants were surveyed prior to treatment (pretest), 3 months after the first year of the intervention, and at one-year follow-up after the initial posttest at the end of the 8th grade. Students completed questionnaires of self-reported drug use behavior. Questionnaires were administered by a team of data collectors who were members of the same ethnic groups as participating students. Prior to implementation, breath samples (to measure carbon monoxide levels) were collected from all participants, in order to increase validity of self-report data collected. Two measures of cigarette smoking were conducted: frequency (9-item scale) and quantity (11-item scale). Two measures of alcohol consumption were conducted: frequency (9-item scale) and amount consumed per drinking occasion (6-item scale). Frequencies of smoking marijuana, getting “high” from marijuana, and using inhalants were also measured by using a 9-item scale. Polydrug use measures were based on the responses to single drug use frequencies and examined in terms of lifetime use and current use. Also included in the analysis of this study were assessments of behavioral intentions, drug attitudes and knowledge, and social and personal competence.

      Analysis: Generalized linear models (GLM) ANCOVA were used to compare means of drug use between the conditions at posttest and follow-up. Since the intervention was administered at the school level, researchers also controlled for intra-cluster correlations (ICCs) among students within the schools by using generalized estimating equations (GEE) to adjust the estimated standard error. Regression analyses were conducted to determine the effects of mediating factors (knowledge, intention, normative expectations). Effects on binge drinking at the one- and two-year follow-up assessments were tested.

      Outcomes

      Baseline Equivalence and Differential Attrition: Pretest analyses indicated no significant differences between conditions for any of the substance-use variables. There were a few demographic differences between the groups in terms of race and proportion of students who received free lunch. These variables were controlled for in the regression analyses for program effects. Analyses conducted to determine differential attrition at posttest revealed that participants who reported substance use at pretest were more likely to not be included in the posttest measures. This resulted in a more conservative test of the program.

      Fidelity Monitoring: The mean level of implementation fidelity was 48%, which suggests a lower level of fidelity than had been found in previous research.

      Posttest: Posttest data were collected three months after intervention. Analysis revealed significant effects on each of the alcohol use measures (frequency, drunkenness, and drinking quantity) as well as lifetime polydrug use, compared with the control condition. When the ICCs were included in the more conservative GEE analysis, the p-value for drinking frequency became nonsignificant and polydrug use approached significance. Prevention effects included increased drinking knowledge, and normative expectations for smoking and drinking.

      One-year: GLM analysis indicates significant effects after one year on measures of all drugs, tobacco (frequency and quantity), alcohol (frequency, getting drunk, quantity), and marijuana (frequency, getting high), as well as inhalant use, as compared to the control condition. When GEE analysis was conducted, p-values for both marijuana variables became nonsignificant, while all other variables retained significant effects.

      One- and two-year effects on binge drinking: The prevention program had protective effects in terms of binge drinking at the 1-year (8th grade) and 2-year (9th grade) follow-up assessments. The proportion of binge drinkers was over 50% lower in the intervention group relative to the control group at the follow-up assessments. There were also several significant program effects on proximal drinking variables, including drinking knowledge, pro-drinking attitudes, and peer drinking norms.

      Generalizability: This study analyzed effects of the program targeting inner-city minority (Black and Hispanic) youth. Some modifications to the original program design were made to accommodate the population (adjusted reading level and appropriate examples used), but no changes were made to the underlying prevention strategy.

      Limitations: Effects were maintained up to one year following intervention (up to two years for binge drinking). Further studies would need to be conducted to measure the sustainability of the effects beyond one year. In addition, data collection relied on self-reporting by students on substance use behaviors. Finally, with respect to generalizability, the study specifically targeted Black and Hispanic youth, and the researchers caution against assuming the program would maintain its effects among other populations of minority youth, including students with special needs (i.e., newly immigrated students or those at the highest risk). In this study, bilingual classes in the participating schools were excluded from the analysis.

      Zollinger, Saywell, Jr., Mueffe, Wooldridge, Cummings, & Caine (2003)

      This study is an independent replication of the LST program in Indianapolis Public Schools.

      Evaluation Methodology

      Design: Sixteen middle schools from the Indianapolis Public School (IPS) system were included in the study. The Life Skills Training curriculum was implemented in 12 of the 16 schools. Intervention schools were not randomly chosen, but the specifics surrounding their selection were not discussed in the study. Self-report surveys were administered by the IPS system in December of each study year (1997-2000) for all middle school students. The survey used a repeated panel design including those who were and those who were not exposed to the program. Survey administrators were instructed on guidelines and protocols for administering the survey, including issues regarding confidentiality, consistency, and logistics. Baseline data were collected in 1997 on sixth-grade students. In 1998, sixth- and seventh-grade students were surveyed, and in 1999 and 2000, sixth-, seventh-, and eighth-grade students in middle school were surveyed. Student identification numbers assigned by IPS were used to match the surveys completed by students in the sixth, seventh, and eighth grades. Two cohort groups were identified: those who participated in all of the 1997, 1998, and 1999 surveys, and those who participated in all of the 1998, 1999, and 2000 surveys. For this analysis, the two cohorts were combined (n = 1,598).

      Responses to tobacco use items were used to classify students as frequent smokers, current smokers, those who tried smoking cigarettes, and non-smokers. Current smokers had smoked in the past 30 days. Non-smoking students had never smoked a cigarette, not even a puff or two. All other students were classified as having tried smoking.

      Sample: Students enrolled in the IPS system from 1997-2000 (n = 27,865) were included in the study. About one-fourth (28.9%, n = 8,048) of students declined to participate or were not available when the survey was administered. A total of 610 surveys (2.2%) were excluded because students did not answer at least half of the questions, or staffing judged students did not complete the survey with true or serious responses. Average response rate used for analysis was 68.9% for the four surveys. A final total of 1,598 eighth-grade students completed the Youth Tobacco Survey while in the sixth, seventh, and eighth grades. Approximately 56% of the participants were female, 59% were African American, and 31% were White. Although the intervention schools were not randomly chosen, tobacco-related behavior and attitudes of these students at baseline did not differ significantly from nonintervention schools.

      Measures: A self-administered survey collected data about middle school students' knowledge, attitudes, beliefs, self-efficacy, decision-making ability, and behavior toward tobacco use and related issues. Items for the survey instrument were derived from published instruments including the CDC Youth Risk Behavior Survey Questionnaire, 1993, CDC Behavioral Risk Factor Surveillance System Questionnaire, 1997, Health Survey for England-the Booklet for 13-15 year-olds, 1996, Alcohol and Other Drug Use Survey, Indiana Prevention Resource Center, 1995, Maryland Adolescent Survey, 1994, and Statewide Survey of Drug and Alcohol Use Among California Students, grades 7, 9, and 11, 1986. Other items were developed specifically for the survey.

      Analysis: Completed surveys were compiled and verified. Responses were compared using the z -test for proportions to determine statistical significance. Results were presented for students with no exposure to the LST program (26.9%), exposure during one school year (32.9%), and exposure during two school years (40.2%).

      Outcomes

      Although survey data were collected annually from 1997-2000, no post-test analyses were conducted immediately after program implementation. Data was analyzed after the completion of the final round of data collection.

      Smoking behaviors:

      Current smokers: Overall, 12.5% of the participants were currently smoking, and 39.4% had tried smoking in the past. Roughly one-half (48.2%) had never tried smoking, not even a puff or two. Significantly fewer current smokers existed among those who completed the LST curriculum once (one year) or twice (two years) (10.5% and 10.3%) compared to those with no exposure (18.1%). There were significantly more non-smokers in the group exposed to LST at least one time. No differences existed between one and two exposures to LST in any of the smoking behavior categories. Significantly fewer White students exposed twice to the LST curriculum were currently smoking, compared to those not exposed. Significantly more students of both genders and racial groups exposed to LST indicated they did not hang out with friends who smoke cigarettes.

      Tried smoking: No significant impact on students who had tried smoking.

      Non-smokers: There were significantly more non-smokers with one or two years exposure to the program compared to those with no exposure. This was also true in the subgroups of males, females, and Whites.

      Intentions to smoke: When non-smokers were asked about their intention to try smoking in the next 12 months, 83.7% indicated they would not do so. Significantly more males compared to females and more African American students compared to White students indicated they would not try smoking in the next 12 months. Significantly larger proportions of female students, White students, and all students exposed twice to the program indicated they did not think they would try smoking, compared to the no-exposure groups.

      The program had no significant impact on quit-attempt rates among smokers.

      Self-efficacy: Significantly more students exposed to LST indicated it would not be difficult to refuse an offer of a cigarette. Significantly more female students twice exposed to the curriculum reported it would not be difficult to say "no." Significantly fewer female students with more than one exposure to the program reported that their decision to smoke was affected by friends' smoking behaviors compared to students with no exposure. Significantly fewer African American students with exposure to the program were affected by their friends' smoking.

      Attitudes: Significantly more students exposed to LST once or twice thought it was a good idea to pass laws against smoking in schools and other public buildings, compared to those with no exposure. More students in each gender group exposed to the curriculum thought it was a good idea to pass laws restricting smoking.

      Knowledge: Although the vast majority (90%) of students knew cigarette smoking caused damage to the lungs, makes teeth look bad, and causes lung cancer and bad breath, significantly more students exposed to LST one or two times knew smoking caused damage to the heart, eyes, unborn babies, cancer of the mouth and lungs, strokes to the brain, and damage to the ears. These results were consistent across gender and racial variables.

      Summary of effects: The LST curriculum positively impacted tobacco use and attitudes of IPS middle school students. Exposure to LST one or two times was associated with a reduction in the prevalence of youth smoking as well as positive shifts in self-efficacy, attitudes and knowledge. Most improvements occurred with one exposure, although some required two exposures.

      Outcomes - Brief Bullets

      • Reduction in prevalence of youth smoking.
      • Positive shifts in self-efficacy, attitudes about, and knowledge of the potential dangers of smoking.

      Generalizability: This replication of the Life Skills Training curriculum was independently evaluated and appears to support the previous findings of Botvin et al. The program appears to generalize well across gender and racial groups.

      Limitations: Due to a high level of family mobility (students moving in or out of the school district) within the IPS, students may not have received the full LST curriculum. Attrition was high over the course of the three surveys. A possible selection bias may have occurred where students who completed all three surveys (the analysis sample) might represent more stable families who may be better suited to respond to the LST curriculum. Smoking was not reduced among students who had tried cigarettes and exposure to the program did not impact quit rates.

      Botvin, Epstein, Baker, Diaz, & Ifill-Williams (1997)

      This study tested the effects of the LST program on drug use with a sample of inner-city minority youth in New York City. Mediating variables were also examined. This was the first study testing for multiple drug outcomes on a minority population.

      Evaluation Methodology

      Design: Seven junior high schools in New York City participated in the study. Assignment was at the school-level to either the Life Skills Training treatment condition or the standard care control condition. Treatment condition students received the 15-session Life Skills Training program. The program was revised to be more appropriate for the targeted population. Modifications included adjusting the reading level, illustrative examples, and suggested situations for behavioral exercises. Treatment teachers attended a one-day training workshop.

      Sample Characteristics: There were 833 participating students at pretest. Of these, 721 (87%) also completed posttest measures. The majority of students were girls (53%) and the mean age of the students was 12.6 years. The ethnic-racial composition of the sample was 25.8% African-American, 69.6% Hispanic, .7% White, 1.4% Asian, 1.5% Native American, and 1.0% Other. Most of the sample lived with their mother-only (37.3%) or both parents (35%). The majority of students (78.6%) qualified for free or reduced lunch.

      Measures: Measures were collected at pretest and at post-intervention (about three months after pretest). Students completed two measures: a questionnaire and a carbon monoxide (CO) breath sample to enhance the validity of the self-reported data. Students completed the questionnaire during class and answered questions about current drug use (5 behavioral measures: smoking, drinking, drinking amount, drunkenness, marijuana use; 2 multiple substance measures: ever use and current use) and intentions for drug use in the future. Also assessed were behavioral intention (for drug use), normative expectations, attitudes towards drug use, and social competence (decision making, advertising influences, anxiety reduction, and communication).

      Analysis: General Linear Modeling was used for the analysis, and used only data provided by students who completed both the pre- and posttest. One-tailed significance tests were used. To examine the impact of mediating variables, ANCOVAs were used on measures of attitudes, normative expectations, and skills use.

      Outcomes

      Baseline Equivalence: Crosstabs were performed to determine pretest equivalence of the demographic variables by condition. There were no significant differences between conditions for gender, free lunch, or family structure. There were differences between conditions on race/ethnicity, with a lower proportion of Hispanic students and a higher proportion of African-American students in the control condition compared to the treatment condition. However, race/ethnicity was not related to any of the pretest drug use variables, meaning conditions were comparable at pretest.

      Posttest: There were significant treatment effects found on all five individual drug use behavior variables and both multiple drug use measures, indicating that students in the treatment condition reported using all measured substances less often than students in the control condition. Significant treatment effects were also found on intentions to use for three of six measures (cigarettes, beer/wine, and marijuana). On the mediating variables, significant differences were found on all but one of the normative expectations variables, indicating that the intervention resulted in lower normative expectations for treatment students concerning various drugs, compared to students in the control group. Refusal assertiveness (under skills use measures) was also found to be a significant mediating variable.

      Generalizability: This study expanded the early work of program evaluation to predominantly minority populations attending inner-city schools.

      Limitations: This study was conducted on a smaller scale than was typical of other LST evaluations. Therefore, examination of treatment effects on sub-groups of the population was not possible. Analysis was not intent-to-treat.

      Botvin, Griffin, & Nichols (2006) 

      This large-scale randomized trial examines the impact of the LST intervention on violence outcomes with inner-city youth.

      Evaluation Methodology

      Design: The sample consisted of 4,858 sixth grade students from 41 randomly assigned NYC public and parochial schools. There were 20 LST schools (n=2,374) and 21 control schools (n=2,484) who received the standard health eduction curriculum. Pretest assessment was in the sixth grade and posttest approximately three months later, after the LST students had received the first year of the curriculum.

      Sample: The sample was 51% boys and 49% girls; 39% African American, 33% Hispanic, 10% White, 6% Asian, 2% Native American, and 10% of other or mixed ethnicity.

      Measures: Measures assessed verbal and physical aggression, fighting, and delinquency.

      Analysis: Analyses were run using generalized estimating equations to account for the within-cluster correlation. Pretest values of each outcome, plus gender, percent black, percent Hispanic, grades, and implementation score were used as covariates in the models.

      Outcomes

      Baseline Equivalence: The two conditions did not differ at baseline on any of the violence or delinquency scales, or on gender or academic performance. The intervention group had more Hispanic students (36.7%) than controls (30.2%), while the control group had more black students (43.8%) than the intervention group (33.1%).

      Posttest Results:

      In the full sample, the intervention reduced "any delinquency in the past year," "frequent fighting in the past year," and "frequent delinquency in the past year." Five other variables were not significantly different including past month and high frequency verbal and physical aggression, as well as fighting in the past year.

      In the high fidelity sample, with students who received at least half of the LST intervention, there were significant prevention effects on Physical Aggression in the Past Month, Violence in the Past Year, and Delinquency in the Past Year. There were also significant effects for the high frequency of outcome behaviors (top quartile), including Frequent Verbal Aggression in the Past Month, Frequent Physical Aggression in the Past Month, Frequent Fighting in the Past Year, and Frequent Delinquency in the Past Year.

      Mackillop, Ryabchenko, & Lisman (2006)

      This is an independent evaluation of the LST intervention in two school districts in upstate New York.

      Evaluation Methodology

      Design: An experimental pre- post-test design was used in this evaluation. Two school districts in suburban towns in Upstate New York were selected in an unspecified manner to implement LST to groups of 6th graders (approximately 11 years of age). The towns from which the school districts were drawn maintained populations of approximately 40,000 and 17,000, respectively, and were primarily Caucasian (92% in School District One and 96% in School District Two) with small percentages of ethnic minorities present. Prior to the study, parents of children enrolled in the sixth grade in participating districts were informed by letter that a new substance use prevention program was being implemented as part of the educational curriculum and would be evaluated on two occasions. Parents were given the option of refusing to allow their child to complete the assessments, but all children in classes where LST was implemented would receive the program as a part of the standard curriculum. No parents withdrew consent for their children to participate in the evaluation. The LST curriculum was delivered once per week for 15 weeks in School District One, while School District Two delivered the curriculum once per day in 15 consecutive class periods. In School District One, six students (7%) provided data for only one time point and were not included in the study; in School District Two, seven students (4%) provided data for only one time point and were not included in the study.

      Sample: The sample for School District One was 55% male, 89% Caucasian, 4% African American, 0% Hispanic, 4% Native American, 1% Asian, and 0% Other. The sample for School District Two was 54% male, 83% Caucasian, 2% African American, 2% Hispanic, 9% Native American, 2% Asian, and 1% Other. An unusually large percentage of respondents indicated they were of Native American heritage, which is possible, but may also indicate a misunderstanding of the category Native American meaning "born in America."

      Measures: The Life Skills Training Questionnaire (LSTQ) was used in both school districts. The LSTQ assesses a number of domains related to the LST program. The 90-item, 7 subscale Alcohol Expectancy Questionnaire-Adolescent Version (AEQ-A) was used to evaluate adolescents' outcome expectancies for drinking alcohol. Due to school district administrators' concerns, subscale 7, Sexual Enhancement, was not administered. The 36-item Self-Perception Profile for Children (SPPC) was used to measure perceived self-competence in children. Due to class period time constrictions, only one additional measure could be included with the LSTQ; therefore, students in School District One were administered the LSTQ and AEQ-A, while the students at School District Two were administered the LSTQ and the SPPC. Fidelity was assessed using two approaches. First, at the end of each lesson, teachers completed a Life Skills Training Implementation Checklist (LST-IC), a checklist for teachers and independent observers to assess two aspects of LST lesson adherence: objectives and topics/activities. Second, on 16 occasions independent observers rated fidelity using the LST-IC.

      Analysis: Individual within subjects analyses of variance (ANOVAs) were conducted for each school district. In order to reduce skewness and kurtosis, in School District One inverse transformations were used on the pro-attitude toward substance use subscales and perceived peer substance use subscale, and a square root transformation was used on the second drug refusal skills subscale. In School District Two transformations were used in the substance use and intention to use scales. In both school districts, the substance use and intention to use scales were severely skewed due to low rates of substance use behavior, and transformations did not improve skewness. As a result, the data were recoded dichotomously and the McNemar test was used for these variables. For all variables, analyses included participants who provided valid pre-intervention and post-intervention data. Potential treatment-by-gender interactions were examined using 2 (male/female) X 2 (pre-test/post-test) mixed ANOVAs.

      Outcomes

      Implementation Fidelity: In School District One, the teacher presented the 15 LST lessons to six classes for a total of 90 class periods. A total of 48 of 90 (53%) LST-ICs were completed, which revealed that the mean proportion of objectives completed was 95% and that the mean topics/activities completed was also 95%. Six lessons were independently observed with the mean proportion of objectives completed rated at 99% and the mean proportion of topics/activities completed was rated at 100% by the independent observer. Mean student daily attendance was 94%.

      In School District Two, the teacher also implemented LST for six classes and completed LST-ICs following all 90 lessons with a mean proportion of objectives completed of 93% and a mean proportion of topics/activities of 80%. Independent observation of 12 lessons resulted in a mean rating of 99% of objectives completed and 73% of topics/activities completed. Mean student daily attendance was 93%.

      LST Outcomes:

      School District One: At post-test there were statistically significant changes in the Overall Knowledge, Life Skills Knowledge, Drug Knowledge, Perceived Adult Substance Use, Pro-Smoking Attitudes, Pro-Drinking Attitudes, Assertiveness Skills, and Anxiety Reduction Skills subscales. All of these changes were in the hypothesized direction, reflecting positive prevention effects. The McNemar test revealed no changes in Use or Intention to Use from pre- to post-test for either specific substances or aggregate estimates.

      School District Two: At post-test there were statistically significant changes on the Overall Knowledge, Life Skills Knowledge, Drug Knowledge, Assertiveness Skills, Self-control Skills, Perceived Adult Substance Use, and Perceived Peer Substance Use subscales. All changes were in the hypothesized direction, with two exceptions: A significant effect on the Perceived Peer Substance Use subscale reflected an increase in perceived prevalence and a significant effect on the Drug Refusal Skills II subscale reflected a decrease in self-reported drug refusal skills. As was the case for School District One, the McNemar tests detected no changes from pre- to post-test on the substance use or intention to use for either specific substances or aggregate estimates.

      Effects by Gender: In School District One, no main effects or interactions were evident between gender and LST, with one exception: A main effect for anxiety reduction skills indicated that females generally reported greater anxiety reduction skills than males, regardless of the intervention. In School District Two, gender interaction effects were found on the Drug Knowledge subscale, with females learning more about drugs than males, and on the Anxiety Reduction Skills subscale, with females again exhibiting an improvement in anxiety reduction skills while males actually reported a decrease in self-reported anxiety skills. The analyses also revealed main effects of gender on the Overall Knowledge subscale and Life Skills Knowledge subscale, with both cases reflecting poorer performance in males.

      Outcomes - Brief Bullets

      • At post-test there were statistically significant positive changes in the Overall Knowledge, Life Skills Knowledge, Drug Knowledge, and Perceived Adult Substance Use subscales for both school districts.
      • School District One demonstrated significant positive changes from pre to post-test on the Pro-Smoking Attitudes, Pro-Drinking Attitudes, Assertiveness Skills, and Anxiety Reduction Skills subscales.
      • School District Two demonstrated statistically significant positive changes on the Self-control Skills subscale.
      • A significant effect on the Perceived Peer Substance Use subscale for School District Two indicated an increase in the perceived prevalence and a significant effect on the Drug Refusal Skills II subscale reflected a decrease in self-reported drug refusal skills.
      • There were no changes in substance Use or Intention to Use from pre- to post-test for either specific substances or aggregate estimates in either school district.

      Generalizability: The sample for this evaluation was drawn from two predominantly Caucasian suburban school districts in Upstate New York. It is unknown to what degree the results may be generalizable beyond this population.

      Limitations: Random assignment to the treatment condition was not used. A no-treatment control group was also not used. No long-term data were collected or analyzed in this pre- post-test study. The students in the two school districts completed different measures (School District One were administered the LSTQ and AEQ-A, while the students at School District Two were administered the LSTQ and the SPPC), making comparisons between groups on all measures impossible. There were no significant changes in Use or Intention to Use from pre- to post-test for either specific substances or aggregate estimates for either school district. For School District Two, a significant effect on the Perceived Peer Substance Use subscale reflected an increase in perceived prevalence and a significant effect on the Drug Refusal Skills II subscale reflected a decrease in self-reported drug refusal skills.

      Spoth, Redmond, Trudeau, & Shin (2002); Spoth, Randall, Trudeau, Shin, & Redmond (2008); Spoth, Clair, Shin, & Redmond (2006)

      This study evaluated the substance initiation effects of an intervention combining family (the Strengthening Families Program 10-14) and school-based competency-training intervention components (Life Skills Training) in Iowa.

      Evaluation Methodology

      Design: Participants in the study were seventh graders enrolled in 36 randomly selected rural schools in 22 contiguous counties in a Midwestern state. Criteria for the selection of the initial pool of schools were: 20% or more of households in the school district within 185% of the federal poverty level; community size (school district enrollment under 1,200); and all middle-school grades (6-8) taught at one location. A randomized block design guided the assignment of the 36 schools to one of three experimental conditions: 1) a combined Life Skills Training (LST) and Strengthening Families Program 10-14 (SFP 10-14) group, 2) an LST only group, and 3) a no-treatment control group.

      Students in the combined LST and SFP 10-14 group received both curricula, including booster sessions (n = 4 booster sessions for the SFP 10-14 and n = 5 booster sessions for LST), while students in the LST-only group received the LST curriculum including 5 booster sessions. For a detailed description of the SFP 10-14 program, see the complete write-up. After schools were matched and randomly assigned to conditions, school officials were contacted and informed of the experimental condition to which their school had been assigned. All seventh grade students in participating schools were recruited for participation. On average, 46 students in each school completed the pre-test (n = 1,664 total), with 549 in the combined LST and SFP 10-14 group, 621 in the LST-only group, and 494 in the control group. A total of 1,563 students completed the post-test (n = 517 in the combined LST and SFP 10-14 group, n = 583 in the LST- only group, and n = 463 in the control group), while 1,372 students completed the long-term follow-up (n = 453 in the LST and SFP 10-14 group, n = 503 in the LST only group, and n = 416 in the control group).

      Data collection in the form of student surveys was completed in classrooms at pre-test, post-test (one month after completion of the intervention), and at the long-term follow-up (one year after completion of the intervention). In addition, a bogus pipeline procedure was performed in order to promote honesty in answering smoking related questions. The sample was analyzed for pre-test equivalence on sociodemographic and outcome measures; the only significant difference discovered was that the control group contained more dual-parent families than the two intervention groups. This variable was included as a control variable in the subsequent outcome analyses. Analysis of differential attrition revealed no significant dropout by condition interactions from pre- to post-test or from post-test to follow-up for any outcome or sociodemographic variable.

      Sample: Participants included all seventh grade students at these schools, who were recruited to participate. On average, 46 students per school participated in the pre-test, slightly over half (53%) were male, and the majority of participants (96%) were Caucasian. Analysis of the demographic characteristics of the groups at baseline revealed one difference: the control group contained more youth with dual-parent families, thus lowering their level of risk. This variable was included in the outcome analysis as a control variable. At post-test and follow-up, analyses were conducted to rule out differential attrition in the sample by examining Condition X Dropout Status interactions. No significant interactions were found at either follow-up, for any outcome or sociodemographic measure.

      Measures: Self-reported use of alcohol, cigarettes, and marijuana was obtained from the classroom-administered questionnaire. Individual items included (a) "Have you ever had a drink of alcohol?", (b) "Have you ever smoked a cigarette?", (c) "Have you ever smoked marijuana or hashish?" All three items were answered using a yes/no format. Inconsistent reports in lifetime substance use were corrected. Lifetime use measures were adjusted to control for baseline use, with these adjusted lifetime use measures (new-user rates) indicating whether use was initiated since baseline. Three lifetime use items were individually examined and summed to form the substance initiation index (SII). Prior to implementation, breath samples (to measure carbon monoxide levels) were collected from all participants, in order to increase validity of self-report data collected.

      Analysis: A multilevel (mixed model) analysis of covariance (ANCOVA) using SAS Proc Mixed with restricted maximum likelihood estimation and listwise deletion of missing data was used to test for intervention effects on the SII. Because assignment to treatment conditions was made at the school level, school was incorporated as a random effect in the analyses. In addition, new-user analyses for specific substances were conducted at the school level, based on the proportions of new users in each school.

      Outcomes

      1.5 Years After Baseline (Spoth, Redmond, Trudeau, and Shin, 2002)

      Because only initiation measures were applied in the outcome analysis, the post-test was considered to be the baseline time point (since the analyses examined differences in substance initiation after delivery of the interventions), and the pretest was delivered several months before the intervention was delivered. Results are reported at one year after the intervention posttest (1-1/2 years after baseline).

      The substance initiation index (SII) score was lowest for the LST and SFP 10-14 combined condition, while the LST-only group had the next lowest SII score and the control group had the highest SII score. Adjusting for the one-tailed tests, the LST and SFP 10-14 combined group scored significantly lower on the SII than the control group, but the difference between the combined group and the LST only group was non-significant. The LST-only group was marginally significantly lower on the SII than the control group.

      New User Rates: The LST and SFP 10-14 combined condition demonstrated the lowest new user rate for alcohol and marijuana compared to the LST only and control groups. The relative reduction rate (the percentage difference in the proportion of new users in the intervention group relative to the control group) for the combined condition was 30% for alcohol initiation, while the same rate for the LST only condition was 4.1%. There were no significant findings associated with cigarette initiation. With regard to the contrast of LST and the control group, marijuana new users was marginally significantly lower in the LST group, but the contrasts with new users of alcohol and cigarettes were not significant.

      5.5 Years After Baseline (12th Grade Outcomes):

      Spoth, Randall, Trudeau, Shin, Redmond, 2008

      Using multilevel analysis of covariance (HLM with students nested within schools) with 428 12th grade LST-only students and 347 Control students, adjusting for the one-tailed tests, the index of substance use initiation (which includes alcohol, marijuana, and cigarette use) was significantly lower for LST-only vs. Controls. The growth trajectory was marginally significant. Examining the individual initiation measures showed that the LST-only group had significantly lower mean levels of cigarette initiation and marginally significant lower levels of marijuana initiation. The LST-only group also showed a significantly slower rate of increase across time for cigarette initiation and drunkenness initiation.

      There were no significant effects found for either the 12th grade mean levels or for the growth trajectories for any of the more serious substance use outcomes (frequency of use, monthly poly-substance use, and advanced poly-substance use index). However, there were significant effects on all measures, with the exception of drunkenness frequency, for a higher-risk subgroup defined as those students who reported use of at least two of three substances (alcohol, cigarettes, and marijuana) at pretest.

      11th and 12th Grade Methamphetamine Use (Spoth, Clair, Shin, Redmond, 2006): There was no significant difference in methamphetamine use between LST-only and control conditions at the 11th grade follow-up. At 5.5 years (12th grade), there was a significant difference between the LST-only and control groups in lifetime methamphetamine use. The LST + SFP group was lower in lifetime methamphetamine use at both 4.5 and 5.5 years, and in past year methamphetamine use at 4.5 years.

      Outcomes - Brief Bullets

      • The LST and SFP 10-14 combined condition demonstrated the lowest new user rate (for alcohol and marijuana) compared to the LST only and control groups.
      • New user rates for marijuana were marginally significantly lower for LST-only as compared to the control condition.
      • At 5.5 years post-baseline, the LST-only group had a significantly lower mean score than controls on the overall substance use initiation index and a marginally significant growth trajectory (slower rate of increase over time).
      • Individual initiation measures at 5.5 years showed that the LST-only students had significantly lower mean scores for cigarette initiation and marginally significantly lower scores for marijuana initiation.
      • LST-only had a significantly slower growth rate on cigarette initiation and drunkenness.

      Generalizability: This study was conducted with a large, predominantly Caucasian sample from the Midwest. It is unknown to what degree these findings may be generalizable outside of this population.

      Limitations: One-tailed tests were used. Thus, the only significant finding, accounting for this, in the 1.5 year follow-up would be the contrast on the overall substance initiation index between LST+SFP vs. Control. Additionally, the posttest assessment was used as the baseline. The analysis of methamphetamine use at 11th and 12th grades is based on a very small number of methamphetamine users.

      Botvin, Eng, & Williams (1980); Botvin & Eng (1980)  (first evaluation of LST--cigarette smoking)

      This evaluation measured the effectiveness of a ten-session Life Skills Training cigarette prevention program administered to eighth, ninth, and tenth graders in suburban New York.

      Evaluation Methodology

      Design: A sample of 281 students was drawn from a population of eighth, ninth, and tenth grade science and health education students in two suburban New York City schools in an unspecified manner. Both schools (School A and School B) were generally comparable with respect to socioeconomic status and the prevalence of cigarette smoking and were predominantly middle class. The two schools were randomly assigned to either the experimental (n = 121) or the control (n = 160) condition. All participants were pre- and post-tested by questionnaire with respect to self-reported smoking status, smoking knowledge, psychosocial knowledge, locus of control, self-image, social anxiety, influenceability, and the need for group acceptance. Following the pre-test, students in the experimental condition participated in a 10-session smoking prevention program. Although sessions were conducted weekly, the time interval between the beginning and the end of the program was 12 weeks due to school holidays. The program was administered by an outside specialist and utilized a combination of group discussion and special skills training. Sessions included content on self-image, decision making, advertising techniques, coping with anxiety, communication skills, social skills, and assertiveness training. In addition to the material covered in each session, students were given outside assignments either to prepare them for specific sessions or to reinforce material already covered. All students participated in a Self-Improvement Project in which they worked over the course of the 10-week program toward improving some skill or toward changing some specific personal behavior. Self-improvement goals were broken down into a series of weekly subgoals in order to enable students to gradually shape their own behavior and to chart their weekly progress. Students in both groups completed two post-tests. The first post-test was administered at the completion of the smoking prevention program (12 weeks after the pre-test), and the second post-test was administered approximately three months later. Data for the three month post-test was collected on roughly 77% of the immediate post-test sample (80% for the experimental group and 74% for the control group).

      Sample: No specific information regarding the gender or racial composition of the sample was provided.

      Measures: The questionnaire consisted of 58-items (excluding basic demographic data) and was divided into 3 sections: questions relating to smoking behavior (10 items), knowledge questions (20 items), and questions designed to tap various psychological variables (28 items).

      Analysis: All pre-test smokers were eliminated from the analysis of smoking status, permitting the comparison of the experimental and control groups in terms of the number of new smokers. A Chi-square analysis was performed to test between group differences in the number of new smokers in the experimental and control groups. A two-way analysis of variance (sex X treatment condition) was used to compare the between-group differences in knowledge and personality scores from pre- to post-test. These between-group comparisons were performed both for the total sample and for each of the three grade levels within the total sample.

      Outcomes

      Post-test: Botvin, Eng, and Williams, 1980
      Significantly fewer students in the experimental group began smoking during the course of the study when compared to students in the control group. The LST smoking prevention program was not equally effective for all grade levels, however. LST was most effective (100%) in preventing the onset of smoking among eighth graders, less effective (75%) among the ninth graders, and the least effective (44%) among the tenth graders. Overall, the experimental group had a significantly greater increase in smoking knowledge than the control group, and there was a significant two-way interaction between sex and treatment condition for social anxiety, with the males in the experimental condition showing the greatest decrease in social anxiety.

      Long-term: Botvin and Eng, 1980
      At the three-month follow-up, there were still significantly fewer new smokers in the experimental group compared to the control group, although the percentage of students beginning to experiment with cigarettes increased between the immediate and three-month post-tests in both groups. For the eighth graders, there was a significantly greater decrease in the need for group acceptance among the students in the experimental group compared to the control group, with males in the experimental group showing the greatest decrease in social anxiety. For the ninth graders, there was a significantly greater increase in smoking knowledge among students in the experimental group than among the controls as well as a significantly greater decrease in the need for group acceptance. Among tenth graders, as with the eighth graders, there was a significant interaction between sex and treatment condition for social anxiety, with the males showing the greatest decrease.

      Overall, the experimental group had a significantly greater increase in smoking knowledge between the immediate and three-month posttest than did the control group, with males in the experimental condition again showing the greatest decrease in social anxiety. Girls in the experimental group maintained a significantly greater decrease in identification with their peers. Among the eighth graders, the students in the experimental group had a significantly greater decrease in social anxiety compared to the control group. Similarly, there was a significantly greater decrease in the need for group acceptance and peer identification. For the ninth graders, the only significant difference between the experimental and control groups was where students in the experimental group had a greater decrease in the influenceability between the immediate and the three-month follow-up compared to the control group. Finally, among the tenth graders there was a significant two-way interaction between sex and condition for smoking knowledge.

      Outcomes - Brief bullets

      • Significantly fewer students in the experimental group began smoking during the course of the study when compared to students in the control group.
      • LST was most effective (100%) in preventing the onset of smoking among eighth graders, less effective (75%) among the ninth graders, and the least effective (44%) among the tenth graders.
      • At the three-month follow-up, there were still significantly fewer new smokers in the experimental group compared to the control group.
      • Overall, the experimental group had a significantly greater increase in smoking knowledge between the immediate and three-month posttest than did the control group, with males in the experimental condition again showing the greatest decrease in social anxiety.

      Generalizability: This early evaluation of LST on preventing the onset of smoking was most effective among eighth grade students, with males in the experimental condition demonstrating the greatest decrease in social anxiety.

      Limitations: The program was more effective among eighth graders than among high school students (who are more likely to smoke than middle school students). However, it still produced strong effects for high school students, with a 75% reduction in new smoking among ninth graders and 44% reduction among tenth graders. No long-term data was collected after the three-month follow-up.

      Botvin, Dusenbury, Baker, James-Ortiz, Botvin, & Kerner (1992)

      This study was an early RCT evaluation of smoking outcomes using Life Skills Training with a population of predominantly Hispanic youth in an urban setting (New York City).

      Evaluation Methodology

      Design: Forty-seven schools in four boroughs of New York City participated in the study, with 3,153 students (90% of the available 3,518 seventh graders) providing pre- and post-test data. Schools were first blocked by school type (public or parochial) and percentage of Hispanic students per school (25-49%, 50-74%, 75-100%) and then randomized into either a treatment or control condition. Blocking occurred due to expected differences in smoking or smoking risk. The study sample consisted of 25 schools (19 parochial, 6 public; 1,795 students) in the treatment condition and 22 schools (17 parochial, 5 public; 1,358 students) in the control condition.

      Treatment students received the 15-session prevention program. This version of the curriculum only addressed cigarette smoking (and not alcohol and marijuana). In order to make the curriculum more appropriate for the targeted population (urban minority), a few modifications were made, including adjusting the reading level, examples used to illustrate program content, and suggested situations for behavioral rehearsal exercises. Teachers who taught the program had attended a 1-day teacher training workshop. Trained observers randomly attended classes and completed observational forms to assess implementation fidelity.

      Sample Characteristics: The majority of students (n=1,836) attended one of the 11 participating public schools (there were 1,364 parochial school students in 36 schools). Students were 51% female and 49% male and students had a mean age of 12 years, 10 months. Most schools (83%) had students with average income levels at or below 150% of the federal poverty level. The majority of students (56%) were Hispanic, followed by Black (19%), White (14%), and Other (12%).

      Measures: Measures were collected at baseline and post-intervention. Students completed a questionnaire during class that collected information about smoking status (self and significant others), as well as cognitive, attitudinal, and psychological characteristics hypothesized to be related to (mediate) smoking initiation (smoking knowledge, skills knowledge, attitudes and normative beliefs, skills use, skills confidence, skills efficacy, self-efficacy, and psychological well-being). Reliability estimates on measures ranged from .69 to .82. Students also submitted carbon monoxide (CO) breath samples to enhance the validity of the self-reported data.

      Analysis: Analysis was conducted only on individuals who provided both pre- and posttest data (n=3,153). Individual-level data was aggregated for each school for data analysis. A general linear model procedure was used using pretest scores as covariates. Results were presented as overal mean differences, as well as by school type and ethnic composition (percent Hispanic). Mediating effects were also analyzed using a structural modeling approach.

      Outcomes

      Baseline Equivalence and Differential Attrition: T-tests were performed to determine baseline equivalence, and showed no significant differences between treatment and control groups prior to program implementation.

      Fidelity Monitoring: The mean level of implementation fidelity was 59.8%, with distribution of implementation scores indicating that at least half the treatment participants received at least 60% of the program. There was a trend of lower implementation fidelity among the public schools, but this trend was not significant.

      Posttest: On the measure of smoking behavior, results indicated significant program impact on the percentage of treatment students reporting past month smoking and smoking onset, compared to control condition students. The reductions in onset of smoking rates compared to the control condition were almost 30% lower. There were no significant differences between groups on current smoking, past week smoking, or behavioral intention. On the psychosocial variables assessed, there were significant program effects on knowledge and normative expectation measures (promximal variables), but not on attitudes. Students who participated in the program had significantly higher posttest knowledge scores and significantly lower normative expectation scores than students who did not receive the program. Causal modeling analysis also demonstrated that the impact of the intervention on cigarette smoking was mediated by these variables.

      Generalizability: This study expanded the early work of program evaluation to predominantly minority populations attending inner-city schools.

      Limitations: Researchers were unable to detect differences in the effectiveness of the program on the different subgroups involved in the study. Also, measures on smoking were limited to current experimental smoking, rather than more regular smoking, which narrows the scope of assessing the program's potential for chronic disease risk reduction with the targeted population. Finally, analysis was not intent to treat.

      The Life Skills Training program has been evaluated in 18 cohorts of students over the past 30 years, with results published in over 32 peer reviewed publications since 1980. This website highlights nine of these cohorts, plus an additional independent evaluation (Study 8). To access the matrix outlining the outcomes and corresponding references for all 18 cohorts, please see: LST_matrix_of_cohort_studies.pdf

      Video

      http://www.blueprintsprograms.com/video/lifeskills-training-lst