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It is becoming increasingly common for community teams or coalitions to implement programming for children and families designed to promote positive youth development and prevent adolescent problem behaviors. However, there has been only limited rigorous study of the effectiveness of community teams' programming efforts to produce positive outcomes. This study employed a community-level randomized control design to examine protective parent and youth skills outcomes of evidence-based preventive interventions selected from a menu and delivered by community teams supported by a community-university partnership model called PROSPER. Twenty-eight rural communities in two states were randomized across intervention and control conditions. Data were collected through written questionnaires that were completed by approximately 12,000 middle school students in the fall of the 6th grade, prior to intervention delivery, and again in the spring of the 7th, 8th, and 9th grades. Positive intervention effects were found for youth, parent, and family outcomes (e.g., association with antisocial peers, child management, parent-child affective quality) at each post-intervention assessment point. Improvements in these family and youth skill outcomes are expected to support long-term reductions of adolescent problem behaviors, such as substance abuse. EDITORS' STRATEGIC IMPLICATIONS: In this important and well controlled trial, the authors demonstrate that university partnership-supported community teams, especially when supported with ongoing technical assistance, can continue to produce positive outcomes even after much of the control over delivery of programs is turned over to representatives of the communities in which they are implemented. [ABSTRACT FROM AUTHOR]

This article reports adolescent substance use outcomes of universal family and school preventive interventions 5(1/2) years past baseline. Participants were 1677 7th grade students from schools (N=36) randomly assigned to the school-based Life Skills Training plus the Strengthening Families Program: For Parents and Youth 10-14 (LST+SFP 10-14), LST-alone, or a control condition. Self-reports were collected at baseline, 6 months later following the interventions, then yearly through the 12th grade. Measures included initiation-alcohol, cigarette, marijuana, and drunkenness, along with a Substance Initiation Index (SII)-and measures of more serious use-frequency of alcohol, cigarette, and marijuana use, drunkenness frequency, monthly poly-substance use, and advanced poly-substance use. Analyses ruled out differential attrition. For all substance initiation outcomes, one or both intervention groups showed significant, positive point-in-time differences at 12th grade and/or significant growth trajectory outcomes when compared with the control group. Although no main effects for the more serious substance use outcomes were observed, a higher-risk subsample demonstrated significant, positive 12th grade point-in-time and/or growth trajectory outcomes for one or both intervention groups on all measures. The observed pattern of results likely reflects a combination of predispositions of the higher-risk subsample, the timing of the interventions, and baseline differences between experimental conditions favoring the control group. [ABSTRACT FROM AUTHOR]

Conduct problems are strong positive predictors of substance use and problem substance use among teens, whereas predictive associations of depressed mood with these outcomes are mixed. Conduct problems and depressed mood often co-occur, and such co-occurrence may heighten risk for negative outcomes. Thus, this study examined the interaction of conduct problems and depressed mood at age 11 in relation to substance use and problem use at age 18, and possible mediation through peer substance use at age 16. Analyses of multirater longitudinal data collected from 429 rural youths (222 girls) and their families were conducted using a methodology for testing latent variable interactions. The link between the conduct problems x depressed mood interaction and adolescent substance use was negative and statistically significant. Unexpectedly, positive associations of conduct problems with substance use were stronger at lower levels of depressed mood. A significant negative interaction in relation to peer substance use also was observed, and the estimated indirect effect of the interaction on adolescent use through peer use as a mediator was statistically significant. Findings illustrate the complexity of multiproblem youth. [ABSTRACT FROM AUTHOR]

Universal and selective preventive interventions targeting youth behavioral problems have shown crossover effects on suicide risk, the second leading cause of death among youth. However, the mechanisms that explain this long-term unanticipated benefit are understudied and unclear. The current study examines the crossover effects of PROSPER, a community-university partnership model for delivering interventions for the prevention of adolescent substance misuse. We examine whether intervention effects on developmental trajectories of parent-child relationship quality and school belongingness explain the putative crossover effects. The analytical sample was 1,974 youth who participated in a randomized controlled trial of PROSPER in the 6th grade and completed an age 19 follow-up assessment. Participants completed annual assessments of parent-child relationship quality and school belongingness from the 6th to 12th grades, and reported on suicidal thoughts during the young adulthood assessment. Our developmental cascade model showed that PROSPER reduced the magnitude of declines in youths' reports of school belongingness from the 6th to 12th grade. In turn, youth who reported less decline in school belongingness reported fewer depression symptoms and suicidal thoughts during young adulthood. Study findings highlight the role of decline in school belongingness as a factor that contributes to the effects of universal prevention programs on youth suicide risk., Competing Interests: Declarations. Ethics Approval: All procedures contributing to this work complied with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects were approved by the institutional review boards at the Penn State and Iowa State Universities. Consent to Participate: All participants in this study provided informed consent or assent. Conflict of Interest: The authors declare no competing interests., (© 2024. Society for Prevention Research.)

We examined whether participation in adolescent substance use prevention programming can enhance long-term resilience into adulthood such that individuals were better able to cope with adversities during the initial months of the COVID-19 pandemic, yielding benefits for the individuals, their partners/spouses, and children; 197 adults (28-30 years old) who entered the PROSPER randomized trial of substance use prevention programming as 6th graders and subsequently had become parents-and 128 of their partners-participated in two waves of long-term follow-up data collection. Respondents completed questionnaires on substance use, adjustment, parenting quality, and children's mood and behavior problems 15 years after baseline, and again via an online survey in the first three months of the COVID-19 pandemic. Results were mixed, with some indications of better adjustment of PROSPER intervention compared to control participants during the early phase of the pandemic (less increase in alcohol use and less decrease in parenting warmth) and their children (lower levels of externalizing and internalizing problems) but several null results as well (no differences in other substance use behaviors, other parenting measures, or parent depression). Adolescent substance use prevention programs can foster long-term individual and interpersonal resilience factors that allow participants-as well as their children-to adapt and cope with unforeseen periods of acute stress and adversity with less deterioration in health and well-being., (© 2022. Society for Prevention Research.)

The quality of romantic relationships formed during early adulthood has critical implications for physical and psychological wellbeing, future romantic relationships, and subsequent parenting of the next generation. The present study evaluates the cross-over effects of the PROSPER-delivered adolescent substance use prevention programming on young adult romantic relationship functioning through a long-term developmental cascade of adolescent skills and behaviors, along with subsequent family-of-origin functioning. Prospective, longitudinal, bivariate growth models were used to analyze the effects of the PROSPER-delivered interventions in a sample of 1008 youths living in rural and semi-rural communities in Iowa and Pennsylvania, starting in sixth grade (Age M  = 11.8; 62% female) who were in a steady romantic relationship at the young adult assessment (Age M  = 19.5). Findings indicated a cascading effect through which PROSPER promotes adolescent problem-solving skills during early-to-mid-adolescence; problem-solving skills were associated with better family functioning during mid-adolescence; and family functioning was associated with better romantic relationship quality, indicated by lower levels of relationship violence and more effective relationship problem-solving in young adulthood. PROSPER, which primarily targets adolescent substance misuse and conduct problem prevention, has lasting, collateral effects that benefit young adults in their romantic relationship functioning - which may have further downstream benefits for their own relationships and those of their children (i.e., intergenerational transmission effects). These findings add to the growing body of literature evidencing important cross-over effects of widely disseminated substance use prevention programs delivered during adolescence., (© 2021. Society for Prevention Research.)

Achieving sustained engagement in family-based preventive intervention programs is a serious challenge faced by program implementers. Despite the evidence supporting the effectiveness and potential population-level impacts for these programs, their actual impact is limited by challenges around retention of participants. In order to inform efforts to better retain families, it is critical to understand the different patterns of attendance that emerge across the duration of program implementation and the factors that are associated with each attendance pattern. In this study, we identified latent classes of attendance patterns across the seven program sessions of the Strengthening Families Program: For Parents and Youth Ages 10-14 (SFP 10-14). Youth and their parents who attended at least one SFP 10-14 program session together were included in the analysis. Four distinct classes emerged: First-Session Attenders (7%), Early Attenders (9%), Declining-High Attenders (18%), and Consistent-High Attenders (66%). An examination of individual, family, and sociodemographic predictors of class membership revealed that adolescent school bonding predicted families having relatively high attendance, adolescent involvement with deviant peers predicted early dropout, and family low-income status predicted early dropout. Findings point to the need for potential targeted strategies for retaining these groups, such as involving school personnel, employing brief interventions to identify and address barriers at the outset, and leveraging the positive influence of Consistent-High Attenders. Findings also shed light on ways to reach those who may continue to drop out early, such as restructuring program content to address critical material early in the program. This study adds to the growing body of literature that seeks to understand for whom, when, and in which ways program dropout occurs., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Family-based prevention programs increasingly are being disseminated and can be effective for an array of adolescent problem behaviors, including substance use initiation. Yet, we continue to have little understanding of how and why these programs work. Increased specificity in our understanding of what components drive program effects can facilitate refinement of programs, with potential for greater impact at a lower cost. Using attendance data, previously coded intervention components, and a previously developed propensity model to adjust for potential bias, this study evaluated content component-specific dosage effects of the Strengthening Families Program: for Parents and Youth Ages 10-14 on three substance use initiation outcomes by grade 12. Results indicated that greater dosages of program content related to (a) parental monitoring and behavior management strategies and (b) promoting positive family relationships had potent and robust effects on reduction of risk for initiating drunkenness and marijuana use and (c) self-regulation and stress management had potent and robust effects on reduction of risk for initiating cigarette and marijuana use. Results indicate potential critical components within SFP 10-14 and offer a path forward for continuing work in efforts to optimize this widely disseminated program.

Better integrating human developmental factors in genomic research is part of a set of next steps for testing gene-by-environment interaction hypotheses. This study adds to this work by extending prior research using time-varying effect modeling (TVEM) to evaluate the longitudinal associations between the PROSPER preventive intervention delivery system, a GABRA2 haplotype linked to alcohol use, and their interaction on adolescent delinquency. Logistic and Poisson analyses on eight waves of data spanning ages 11 to 19 (60% female, 90% Caucasian) showed the intervention reduced delinquency from ages 13 to 16. Moreover, interaction analysis revealed that the effect of the multicomponent intervention was significantly greater for T-allele carriers of the GABRA2 SNP rs279845, but only during the 13 to 16 age period. The results are discussed in terms of adolescent delinquency normativeness, implications for preventive intervention research, and the utility of incorporating development in GxE research.

Data from the in-school sample of the PROSPER preventive intervention dissemination trial were used to investigate associations between alcohol dehydrogenase genes and alcohol use across adolescence, and whether substance misuse interventions in the 6th and 7th grades (targeting parenting, family functioning, social norms, youth decision making, and peer group affiliations) modified associations between these genes and adolescent use. Primary analyses were run on a sample of 1,885 individuals and included three steps. First, we estimated unconditional growth curve models with separate slopes for alcohol use from 6th to 9th grade and from 9th to 12th grade, as well as the intercept at Grade 9. Second, we used intervention condition and three alcohol dehydrogenase genes, 1B (ADH1B), 1C (ADH1C), and 4 (ADH4) to predict variance in slopes and intercept. Third, we examined whether genetic influences on model slopes and intercepts were moderated by intervention condition. The results indicated that the increase in alcohol use was greater in early adolescence than in middle adolescence; two of the genes, ADH1B and ADH1C, significantly predicted early adolescent slope and Grade 9 intercept, and associations between ADH1C and both early adolescent slope and intercept were significantly different across control and intervention conditions.

This study investigated the oxytocin receptor (OXTR) gene's moderation of associations between exposure to a substance misuse intervention, average peer substance use, and adolescents' own alcohol use during the 9th-grade. OXTR genetic risk was measured using five single nucleotide polymorphisms (SNPs), and peer substance use was based on youths' nominated closest friends' own reports of alcohol, cigarette, and marijuana use, based on data from the PROSPER project. Regression models revealed several findings. First, low OXTR risk was linked to affiliating with friends who reported less substance use in the intervention condition but not the control condition. Second, affiliating with high substance-using friends predicted youth alcohol risk regardless of OXTR risk or intervention condition. Third, although high OXTR risk youth in the intervention condition who associated with low substance-using friends reported somewhat higher alcohol use than comparable youth in the control group, the absolute level of alcohol use among these youth was still among the lowest in the sample.

Preventive intervention effects on adolescent alcohol misuse may differ based on genotypes in gene-by-intervention (G x I) interactions, and these G x I interactions may vary as a function of age. The current study uses a novel statistical method, time-varying effect modeling (TVEM), to test an age-varying interaction between a single nucleotide polymorphism in the GABRA2 gene (rs279845) and a preventive intervention in predicting alcohol misuse in a longitudinal study of adolescents (ages 11-20). The preventive intervention was PROSPER, a community-based system for delivery of family and school programs selected from a menu of evidence-based interventions. TVEM results revealed a significant age-varying GABRA2 x intervention interaction from ages 12 to 18, with the peak effect size seen around age 13 (IRR = 0.50). The intervention significantly reduced alcohol misuse for adolescents with the GABRA2 TT genotype from ages 12.5 to 17 but did not reduce alcohol use for adolescents with the GABRA2 A allele at any age. Differences in intervention effects by GABRA2 genotype were most pronounced from ages 13 to 16-a period when drinking is associated with increased risk for alcohol use disorder. Our findings provide additional evidence that intervention effects on adolescent alcohol misuse may differ by genotype, and provide novel evidence that the interaction between GABRA2 and intervention effects on alcohol use may vary with age. Implications for interventions targeting adolescent alcohol misuse are discussed.

This study addresses replication in candidate gene × environment interaction (cG×E) research by investigating if the key findings from Brody, Beach, Philibert, Chen, and Murry (2009) can be detected using data (N = 1,809) from the PROSPER substance use preventive intervention delivery system. Parallel to Brody et al., this study tested the hypotheses that substance misuse initiation would increase faster from age 11 to age 14 and be higher at age 14 among: (a) 5-HTTLPR short carrier adolescents versus long homozygotes, (b) control versus intervention adolescents, and (c) 5-HTTLPR short carriers in the control condition versus all other participants. The hypotheses were generally supported and results were consistent with Brody et al.'s cG×I finding. Results are discussed in light of replication issues in cG×E research and implications for intervention., (© 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.)

Factors that might exacerbate or mitigate the transmission of depressive symptoms from parents to adolescents and the continuity of depressive symptoms into early adulthood are poorly understood. This study tested the hypothesis that the intergenerational transmission and stability of depressive symptoms would be stronger for girls than boys over adolescence and into early adulthood, while considering the possibility that the pattern of gender moderation might vary depending on parent gender and developmental timing. The participants were 667 rural Midwestern adolescents (52 % female) and their parents. Survey data on maternal and paternal depressive symptoms (at youth age 11) and on adolescent and young adult depressive symptoms (at youth ages 11, 18, and 21) were analyzed via multiple group structural equation modeling. Maternal depressive symptoms predicted increased late adolescent depressive symptoms for girls but not boys, and adolescent depressive symptoms were more stable in girls. Paternal depressive symptoms predicted increased late adolescent depressive symptoms for all youth. The findings suggest the need for early, tailored interventions., Competing Interests: The authors report no conflict of interests.

Purpose: Depressive symptoms during adolescence are positively associated with peer-related beliefs, perceptions, and experiences that are known risk factors for substance misuse. These same risk factors are targeted by many universal substance misuse prevention programs. This study examined whether a multicomponent universal substance misuse intervention for middle schoolers reduced the associations between depressive symptoms, these risk factors, and substance misuse., Methods: The study used data from a place-randomized trial of the Promoting School-Community-University Partnerships to Enhance Resilience model for delivery of evidence-based substance misuse programs for middle schoolers. Three-level within-person regression models were applied to four waves of survey, and social network data from 636 adolescents followed from sixth through ninth grades., Results: When adolescents in control school districts had more symptoms of depression, they believed more strongly that substance use had social benefits, perceived higher levels of substance misuse among their peers and friends, and had more friends who misused substances, although they were not more likely to use substances themselves. Many of the positive associations of depressive symptoms with peer-related risk factors were significantly weaker or not present among adolescents in intervention school districts., Conclusions: The Promoting School-Community-University Partnerships to Enhance Resilience interventions reduced the positive associations of adolescent symptoms of depression with peer-related risk factors for substance misuse., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The large-scale dissemination of evidence-based practices (EBPs) is often hindered by problems with sustaining initiatives past a period of initial grant funding. Communities often have difficulty generating resources needed to sustain and grow their initiatives, resulting in limited public health impact. The PROSPER project, initiated in 2001, provided community coalitions with intensive technical assistance around marketing, communications, and revenue generating strategies. Past reports from PROSPER have indicated that these coalitions were successful with sustaining their programming, and that sustainability could be predicted by early aspects of team functioning and leadership. The current study examines financial sustainability 8 years following the discontinuation of grant funding, with an emphasis on sources of revenue and the relationships between revenue generation, team functioning, and EBP participation. This study used four waves of data related to resource generation collected between 2004 and 2010 by PROSPER teams in Iowa and Pennsylvania. Teams reported annually on the amount and sources of funding procured, as well as annual reports of team functioning and leadership and annual reports of EBP participation by youth and parents. Data revealed that teams' overall revenue generation increased over time. There was significant variation in success with revenue generation at both the community level and across the two states. Teams accessed a variety of sources. Cash revenue generation was positively and predictively associated with EBP participation, but relationships with team functioning and leadership ratings varied significantly by state. State level differences in in-kind support were also apparent. The results indicated that there are different pathways to sustainability, and that no one method works for all teams. The presence of state level infrastructures available to support prevention appeared to account for significant differences in sustainability success between Pennsylvania and Iowa.

Introduction: Prevention intervention programs reduce substance use, including smoking, but not all individuals respond. We tested whether response to a substance use prevention/intervention program varies based upon a set of five markers (rs16969968, rs1948, rs578776, rs588765, and rs684513) within the cluster of nicotinic acetylcholine receptor subunit genes (CHRNA5/A3/B4)., Methods: Participants (N = 424) were randomly assigned to either control condition, or a family-based intervention in grade 6 and a school-based drug preventive intervention in grade 7. Smoking in the past month was assessed in grades 9-12 using a four-point scale (0 = never smoked, 1 = smoked but not in last month, 2 = one or a few times, 3 = about once a week or more)., Results: There was a main effect of both the intervention (b = -0.24, P < .05) and genotype at rs16969968 (b = 0.14, P < .05) on high school smoking. Using dummy coding to allow for nonlinear effects, individuals with the A/A genotype smoked more often than those with G/G (b = 0.33, P < .05). A genotype × intervention effect was found with reduced smoking among those with A/A and G/A genotypes to levels similar to those with the G/G genotype (G/G vs. A/A: b = -0.67, P < .05; A/G vs. A/A: b = -0.61, P < .05; G/G vs. A/G ns). Results were nonsignificant for the other four markers., Conclusions: Preventive interventions can reduce the genetic risk for smoking from rs16969968., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We report long-term effects of the PROSPER delivery system for universal evidence-based preventive interventions on adolescent conduct problem behaviors (CPBs). A cluster randomized trial included 28 school districts assigned to PROSPER or a control condition. Community-based teams in PROSPER condition school districts selected evidence-based interventions-a family-focused intervention in sixth grade and a school-based intervention the next year; follow-up assessments were conducted through 12th grade. CPBs were measured with 12 self-report items derived from the National Youth Survey. Intervention-control differences were tested via a multi-level Zero-Inflated Poisson (ZIP) model. Differences were significant from 9th through 12th grades; Relative Reduction Rates were between 10.1% and 14.5%. The intervention group was delayed in reaching a 10th grade reference level of CPBs by 10.7 months. Moderation analyses indicated stronger effects for early substance initiators. Findings suggest that the PROSPER delivery system has the potential to reduce CPBs in general populations., (Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

This study is a longitudinal investigation of the Promoting School-community-university Partnerships to Enhance Resilience (PROSPER) partnership model designed to evaluate the level of sustainability funding by community prevention teams, including which factors impact teams' generation of sustainable funding. Community teams were responsible for choosing, implementing with quality, and sustaining evidence-based programs (EBPs) intended to reduce substance misuse and promote positive youth and family development. Fourteen US rural communities and small towns were studied. Data were collected from PROSPER community team members (N = 164) and prevention coordinators (N = 10) over a 5-year period. Global and specific aspects of team functioning were assessed over six waves. Outcome measures were the total funds (cash and in-kind) raised to implement prevention programs. All 14 community teams were sustained for the first 5 years. However, there was substantial variability in the amount of funds raised, and these differences were predicted by earlier and concurrent team functioning and by team sustainability planning. Given the sufficient infrastructure and ongoing technical assistance provided by the PROSPER partnership model, local sustainability of EBPs is achievable.

Despite growing recognition of the important role implementation plays in successful prevention efforts, relatively little work has sought to demonstrate a causal relationship between implementation factors and participant outcomes. In turn, failure to explore the implementation-to-outcome link limits our understanding of the mechanisms essential to successful programming. This gap is partially due to the inability of current methodological procedures within prevention science to account for the multitude of confounders responsible for variation in implementation factors (i.e., selection bias). The current paper illustrates how propensity and marginal structural models can be used to improve causal inferences involving implementation factors not easily randomized (e.g., participant attendance). We first present analytic steps for simultaneously evaluating the impact of multiple implementation factors on prevention program outcome. Then, we demonstrate this approach for evaluating the impact of enrollment and attendance in a family program, over and above the impact of a school-based program, within PROSPER, a large-scale real-world prevention trial. Findings illustrate the capacity of this approach to successfully account for confounders that influence enrollment and attendance, thereby more accurately representing true causal relations. For instance, after accounting for selection bias, we observed a 5% reduction in the prevalence of 11th grade underage drinking for those who chose to receive a family program and school program compared to those who received only the school program. Further, we detected a 7% reduction in underage drinking for those with high attendance in the family program.

Aims: This study tests risk factors for four dimensions of alcohol use in the sequence from (i) early onset prior to age 13 to (ii) adolescent alcohol use and (iii) alcohol problems to (iv) young adult alcohol abuse. It also examines whether family-focused preventive interventions buffer predictive relationships., Design: Data were from a randomized prevention trial extending from ages 11 to 21 years., Setting: Families of sixth graders enrolled in 33 rural schools in the Midwestern United States were invited to participate., Participants: Families (n = 667) were pretested and assigned randomly to a control group (n = 208) or to family interventions (n = 459). The average age of participating youth was 11.3 years when the study began (52% female)., Measurements: Questionnaire data were collected on alcohol dimensions during adolescence (early onset, alcohol use, alcohol problems) and young adulthood (alcohol abuse), and on risk factors in early adolescence (male gender, impulsive behaviors, aggression-hostility, peer deviance and parent problem drinking)., Findings: Impulsive behaviors predicted early onset, peer deviance predicted alcohol use and parent problem drinking predicted alcohol problems (P < 0.05). Aggression-hostility and alcohol problems predicted alcohol abuse in the control group (P < 0.05), but not in the family interventions group (P > 0.05)., Conclusions: Different dimensions of alcohol use and problems from before age 13 to young adulthood are predicted by different risk factors. Family-focused preventive interventions can reduce the influence of some of these risk factors, including early adolescent aggression-hostility and late adolescent alcohol problems., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Purpose: An earlier randomized controlled study found that a universal, family-focused preventive intervention produced protective shield effects-reduced adolescent exposures to illicit substance opportunities-among adolescents in grade 12. This study examined a follow-up assessment of the sample during young adulthood., Methods: A randomized controlled trial evaluated the Iowa Strengthening Families Program that was implemented in 22 rural schools (N = 446 families) when the participants were in grade six. Measures included adolescent exposure to illicit substance use and young adult lifetime substance use (age 21; N = 331). Growth curve modeling examined indirect intervention effects through growth factors of adolescent exposure., Results: Findings from this study confirm protective shield effects that mediate long-term reduction of illicit substance use (β = -.14, p = .02, Relative Reduction Rate = 28.2%)., Conclusions: The benefits of decreasing exposure to substance use during adolescence through universal interventions were supported, with positive effects extending into young adulthood., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To prepare public systems to implement evidence-based prevention programs for adolescents, it is necessary to have accurate estimates of programs' resource consumption. When evidence-based programs are implemented through a specialized prevention delivery system, additional costs may be incurred during cultivation of the delivery infrastructure. Currently, there is limited research on the resource consumption of such delivery systems and programs. In this article, we describe the resource consumption of implementing the PROSPER (PROmoting School-Community-University Partnerships to Enhance Resilience) delivery system for a period of 5 years in one state, and how the financial and economic costs of its implementation affect local communities as well as the Cooperative Extension and University systems., Methods: We used a six-step framework for conducting cost analysis, using a Cost-Procedure-Process-Outcome Analysis model (Yates, Analyzing costs, procedures, processes, and outcomes in human services: An introduction, 1996; Yates, 2009). This method entails defining the delivery System; bounding cost parameters; identifying, quantifying, and valuing systemic resource Consumption, and conducting sensitivity analysis of the cost estimates., Results: Our analyses estimated both the financial and economic costs of the PROSPER delivery system. Evaluation of PROSPER illustrated how costs vary over time depending on the primacy of certain activities (e.g., team development, facilitator training, program implementation). Additionally, this work describes how the PROSPER model cultivates a complex resource infrastructure and provides preliminary evidence of systemic efficiencies., Conclusions: This work highlights the need to study the costs of diffusion across time and broadens definitions of what is essential for successful implementation. In particular, cost analyses offer innovative methodologies for analyzing the resource needs of prevention systems., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

A substantial challenge in improving public health is how to facilitate the local adoption of evidence-based interventions (EBIs). To do so, an important step is to build local stakeholders' knowledge and decision-making skills regarding the adoption and implementation of EBIs. One EBI delivery system, called PROSPER (PROmoting School-community-university Partnerships to Enhance Resilience), has effectively mobilized community prevention efforts, implemented prevention programming with quality, and consequently decreased youth substance abuse. While these results are encouraging, another objective is to increase local stakeholder knowledge of best practices for adoption, implementation and evaluation of EBIs. Using a mixed methods approach, we assessed local stakeholder knowledge of these best practices over 5 years, in 28 intervention and control communities. Results indicated that the PROSPER partnership model led to significant increases in expert knowledge regarding the selection, implementation, and evaluation of evidence-based interventions. Findings illustrate the limited programming knowledge possessed by members of local prevention efforts, the difficulty of complete knowledge transfer, and highlight one method for cultivating that knowledge.

BACKGROUND: The majority of knowledge related to implementation of family-based substance use prevention programs is based on programs delivered in school and community settings. The aim of this study is to examine procedures related to implementation effectiveness and quality of two family-based universal substance use prevention programs delivered in health care settings, the Strengthening Families Program: For Parents and Youth 10-14 (SFP) and Family Matters (FM). These evidence-based programs were delivered as part of a larger random control intervention study designed to assess the influence of program choice vs. assignment on study participation and adolescent substance use outcomes. We also assess the effects of program choice (vs. assignment to program) on program delivery. METHODS: A mixed method case study was conducted to assess procedures used to maximize implementation quality and fidelity of family-based prevention programs delivered in health care settings. Families with an 11 year old child were randomly selected for study participation from health plan membership databases of 4 large urban medical centers in the San Francisco Bay Area. Eligible families were initially randomized to a Choice study condition (families choose SFP or FM) or Assigned study condition (assigned to FM, SFP or control group); 494 ethnically diverse families were selected for participation in study programs. RESULTS: Successful implementation of family prevention programs in health care settings required knowledge of the health care environment and familiarity with established procedures for developing ongoing support and collaboration. Ongoing training of program deliverers utilizing data from fidelity assessment appeared to contribute to improved program fidelity over the course of the study. Families who chose FM completed the program in a shorter period (p<.0001) and spent more time implementing program activities (p=0.02) compared to families assigned to FM. SFP "choice" families attended more sessions than those assigned to SFP (3.5 vs. 2.8), (p=0.07). CONCLUSION: Program choice appeared to increase family engagement in programs. The goals and approach of universal family-based substance use prevention programs are congruent with the aims and protocols of adolescent preventive health care services. Future effectiveness trials should assess approaches to integrate evidence-based family prevention programs with adolescent health services.

Thrill seeking is a robust positive predictor of adolescent substance use. Religiosity is negatively associated with substance use among teens, although findings are mixed. Few studies have examined the interplay between these two prominent risk and protective factors. The current study addresses this gap by examining the joint, interactive, and indirect influences of thrill seeking and each of two dimensions of religiosity, religious salience and religious attendance, in relation to adolescent substance use. Participants were 667 rural youths (345 girls and 322 boys) and their families participating in a longitudinal family-focused prevention trial. Data were collected via self-report surveys at six time points across 7 years, spanning ages 11 through 18. Results from latent growth curve analyses showed that both religious salience and religious attendance growth factors were associated negatively with late adolescent substance use, while adjusting for thrill seeking and selected covariates. Although the link between thrill seeking and substance use was not moderated by religiosity, there was a statistically significant indirect effect of thrill seeking on the outcome through a faster rate of downturn in religious attendance. Family intervention also predicted a slower rate of downturn in religious attendance and was associated negatively with substance use in late adolescence. Early adolescent substance use predicted a faster rate of decrease in religious salience throughout the teen years. The pattern of associations was similar for boys and girls. Findings suggest that teens who are elevated on thrill seeking could be targeted for specially designed substance use prevention programs and provide additional evidence for the efficacy of family interventions.

Adolescent alcohol involvement is associated with numerous negative outcomes, but also appears to have positive correlates, including subjective well-being. Additional research is needed to understand these paradoxical findings. The current study examines alcohol use, adverse alcohol-related (and other substance-related) consequences, and subjective well being in adolescence, and prediction to problem alcohol use in early adulthood. Participants in this longitudinal study, which extended from age 11 to age 21, were 208 rural teens (109 girls) and their families. Covariates included early substance use, early conduct problems, early depressed mood, gender, and parent educational attainment. Structural equation modeling showed that subjective well-being at age 16 positively predicted increased alcohol use at age 18. Alcohol use was not a significant predictor of subjective well-being; however, alcohol use at age 18 positively predicted alcohol problems at age 21, even while controlling for earlier adverse consequences and other predictors. Results help to further elucidate both the negative and positive correlates of underage drinking, and support the value of delaying alcohol initiation.

Because they often set out with a guarantee of only short-term funding, many community partnerships will face a threat to their sustainability almost as soon as the first money runs out. Research into the factors that enable some coalitions and partnerships to meet the challenge when others fail is limited. This study begins to fill this gap in our understanding by examining influences on the process of sustainability planning in the context of a collaborative partnership focused on youth development. We report on a longitudinal examination of the quality of planning and attitudes underpinning the sustainability of PROSPER community prevention teams whose members implement evidence-based programs designed to support positive youth development and reduce early substance use and other problem behaviors. The current research concentrates on a particular dimension of partnership effectiveness to establish whether perceptions about team functioning in play at 6 and 18 months predict the quality of sustainability planning at 36 and 48 months. How well teams functioned in the early stages was found to be strongly related to the quality of their later preparations for sustainability. Recruitment and integration of new team members, and the encouragement they subsequently received were also found to be key factors. The results strengthen the argument for providing technical assistance to meet the needs of those who promote prevention partnerships, and they provide longitudinal empirical data to support the hypotheses of other researchers who have similarly found a correlation between effective sustainability and early planning and support., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Underage drinking is a pervasive problem in the United States, with serious consequences for youth, families, communities, and society as a whole. Family-focused preventive interventions for children and adolescents have shown potential for reducing underage drinking and other problem behaviors. Research findings indicate that clear advances have been made, in terms of both the number of evidence-based interventions available, and in the quality of the methods used to evaluate them. To fully reap the benefits of such preventive interventions and achieve public health impact, the findings of family-focused preventive intervention science must be translated into real-world, community practices. This type of translation can be enhanced through four sets of translational impact factors-effectiveness of interventions, extensiveness of their population coverage, efficiency of interventions, and engagement of eligible populations, with sustained quality intervention implementation. Findings from studies conducted by researchers at the Partnerships in Prevention Science Institute and other empirical work highlight the importance of these factors. A model for community- university partnerships has been developed that potentially can facilitate the dissemination and public health impact of universal interventions to prevent underage drinking and other problem behaviors. This model fits well within a comprehensive strategic framework for promoting effective prevention.

This study examined the long-term impact of Preparing for the Drug Free Years (PDFY) on young adult alcohol abuse disorder, addressing theory-based questions about how, and for whom, the program had its effects on the outcomes. Participants were 429 families of 6th graders enrolled in 33 rural schools located in the Midwestern United States. Schools were randomly assigned to conditions. Target adolescents (52% female) were interviewed periodically from age 11 to age 22; throughout adolescence, information was collected also from the youths' parents. Moderation and mediation analyses were conducted using regression analysis and structural equation modeling with covariates measured at baseline (age 11), mediators measured at posttest (age 12), and the outcome measured at the young adult follow-up (age 22). Results showed that PDFY reduced the rate of alcohol abuse among target young women, with evidence that this effect was mediated by increased prosocial skills. The rate of alcohol abuse among PDFY group men was not significantly different from that of control group men. Findings have implications for reducing the public health burden of alcohol abuse among young women.

The transition from middle to late adolescence brings challenges that increase risk for emotional, behavioral, and social problems. The nature of the associations among these types of problems is poorly understood. This National Institute on Drug Abuse-funded study examined longitudinal relations among negative affect, substance use, and peer deviance from ages 16 to 18 years. Multiwave youth and parent questionnaire data collected from 429 sixth graders (222 girls) and their families residing in the rural Midwestern United States and recruited in 1993 were analyzed via structural equation modeling. Consistent with the self-medication hypothesis, negative affect statistically predicted increased substance use over time. Implications for theory and prevention are discussed and the study's limitations are noted.

Objective: Adolescent alcohol involvement may increase risk for young-adult depression; however, findings are mixed and important questions remain unanswered. Because alcohol involvement among teens is multidimensional, this study examined the extent to which four different adolescent alcohol dimensions (i.e., frequency of alcohol use, quantity of consumption, frequency of heavy episodic drinking, and frequency of problem use) were predictive of young-adult major depressive disorder (MDD)., Method: Participants in this prospective longitudinal study, which extended from age 11 to age 22, were 429 rural teens (including 222 girls) and their families. Self-reports of each dimension of adolescent alcohol involvement were obtained at ages 16 and 18. Depression diagnoses were obtained at age 22, using a structured interview. Analyses included adolescent depressed mood, measured via self-report at ages 16 and 18. Data were analyzed using confirmatory factor analysis and structural equation modeling., Results: The multidimensional nature of adolescent alcohol involvement was best represented by a first-order problem-use factor and a second-order alcohol-intake factor comprised of quantity, frequency, and heavy drinking. After controlling for gender and depressed mood, adolescent problem use, but not alcohol intake, was a significant positive predictor of young-adult MDD., Conclusions: Findings help clarify the link between alcohol involvement and depression and suggest that harm-reduction strategies may help prevent later mood disorders.

This research examines the early development of community teams in a specific university-community partnership project called PROSPER (Spoth et al., Prev Sci 5:31-39, 2004). PROSPER supports local community teams in rural areas and small towns to implement evidence-based programs intended to support positive youth development and reduce early substance use. The study evaluated 14 community teams and included longitudinal data from 108 team members. Specifically, it examined how community demographics and team member characteristics, perceptions, and attitudes at initial team formation were related to local team functioning 6 months later, when teams were planning for prevention program implementation. Findings indicate that community demographics (poverty), perceived community readiness, characteristics of local team members (previous collaborative experience) and attitudes toward prevention played a substantial role in predicting the quality of community team functioning 6 months later. EDITORS' STRATEGIC IMPLICATIONS: The authors identify barriers to successful long-term implementation of prevention programs and add to a small, but important, longitudinal research knowledge base related to community coalitions.

This study compared alternative hypotheses (from general deviance, life course, and developmental psychopathology perspectives) regarding the effects of early adolescent delinquency on psychosocial functioning in family, school, and peer contexts, and on alcohol use. Analyses also examined parent-child negative affective quality, prosocial school orientation, and peer substance use as possible direct predictors of problem substance use. Participants in this longitudinal study, extending from age 11 to age 18, were 429 rural teens (222 girls) and their families. Path model comparisons supported the tenability of a partial mediation model that included mediating pathways and a direct effect of delinquency on alcohol use, as hypothesized by developmental psychopathology. A supplemental analysis controlling for the stability of the family, school, and peer variables revealed that delinquency had less pervasive direct effects on, and a nonsignificant indirect effect through, changes in the mediators over time. Results also showed that peer substance use was a direct positive predictor of problem use.

This study examined the longitudinal predictors of quality of functioning of community prevention teams during the "operations" phase of team development. The 14 community teams were involved in a randomized-trial of a university-community partnership project, PROSPER (Spoth et al., Prevention Science, 5(1): 31-39, 2004b), that implements evidence-based interventions intended to support positive youth development and reduce early substance use, as well as other problem behaviors. The study included a multi-informant approach to measurement of constructs, and included data from 137 team members, 59 human service agency directors and school administrators, 16 school principals, and 8 Prevention Coordinators (i.e. technical assistance providers). We examined how community demographics and social capital, team level characteristics, and team member attributes and attitudes are related to local team functioning across an 18-month period. Findings indicate that community demographics (poverty), social capital, team member attitudes towards prevention, and team members' views of the acceptability of teen alcohol use played a substantial role in predicting various indicators of the quality of team functioning 18 months later.

Delinquency is a positive predictor of adolescent problem substance use, and depressed mood may increase risk for substance problems. The extent to which effects of delinquency and depressed mood on problem substance use vary depending on when during adolescence the predictors are assessed is unknown. The authors used 5 multigroup path analyses to examine effects of delinquency and depressed mood at ages 11, 12, 13, 14, and 16 years on problem substance use at age 18, and mediation of those effects through alcohol use at age 16 across gender. Participants were 429 rural youths (222 girls and 207 boys) and their families. Indirect positive effects of delinquency on the outcome were observed for boys; direct positive effects of depressed mood were observed for girls. Prevention implications are discussed., ((c) 2007 APA, all rights reserved.)

Objective: To examine the long-term effects of universal preventive interventions on methamphetamine use by adolescents in the general population during their late high school years., Design: Two randomized, controlled prevention trials., Setting: Public schools in the Midwest from 1993 to 2004., Participants: Study 1 began with 667 sixth grade students from 33 rural public schools; the follow-up included 457 students. Study 2 began with 679 seventh grade students from 36 rural public schools; the follow-up assessment included 597 students., Interventions: In study 1, schools were assigned to the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years, or a control condition. In study 2, schools were assigned to a revised ISFP (SFP 10-14) plus Life Skills Training (SPF 10-14 + LST), LST alone, or a control condition., Results: Self-reports of lifetime and past-year methamphetamine use were collected at 6(1/2) years past baseline (study 1) and at 4(1/2) and 5(1/2) years past baseline (study 2). In study 1, the ISFP past-year rate was 0.0% compared with 3.2% in the control condition (P = .04). In study 2, SFP 10-14 + LST showed significant effects on lifetime and past-year use at the 4(1/2) year follow-up (eg, 0.5% lifetime use in the intervention condition vs 5.2% in the control condition, P = .006); both SFP 10-14 + LST and LST alone had significant lifetime use effects at the 5(1/2) year follow-up., Conclusion: Brief universal interventions have potential for public health impact by reducing methamphetamine use among adolescents.

In this study, the efficacy of the Strong African American Families Program (SAAF) was tested. The trial, which included 332 families, indicated that families who participated in SAAF experienced increases over time in regulated, communicative parenting; increases in targeted parenting behaviors, according to youths' reports; and low rates of high-risk behavior initiation among youths. Changes in regulated, communicative parenting mediated the intervention's impact on youths' recognition of changes in parenting, which in turn was linked to changes in youths' high-risk behavior., (Copyright 2006 APA, all rights reserved.)

This article articulates joint priorities for the fields of prevention science and community psychology. These priorities are intended to address issues raised by the frequent observation of natural tensions between community practitioners and scientists. The first priority is to expand the knowledge base on practitioner-scientist partnerships, particularly on factors associated with positive outcomes within communities. To further articulate this priority, the paper first discusses the rapid growth in community-based partnerships and the emergent research on them. Next described is an illustrative research project on a partnership model that links state university extension and public school delivery systems. The article then turns to the second, related priority of future capacity-building for diffusion of effective partnership-based interventions to achieve larger-scale health and well-being across communities. It outlines two salient tasks: clarification of a conceptual framework and the formulation of a comprehensive capacity-building strategy for diffusion. The comprehensive strategy would require careful attention to the expansion of networks of effective partnerships, partnership-based research agendas, and requisite policy-making.

This research examined whether parents' and children's perceptions of one another have reciprocal self-fulfilling effects on each other's behavior. Parents and their adolescent children completed self-report surveys and engaged in dyadic videotaped interaction tasks. The surveys assessed mothers', fathers', and children's perceptions of their own and the other's hostility and warmth. Observers coded the videotaped interactions to assess the actual hostility and warmth exhibited by parents and children. Data from 658 mother-child dyads were consistent with the conclusion that children had a self-fulfilling effect on their mothers' hostility but that mothers did not have a reciprocal self-fulfilling effect on their children's hostility. No other self-fulfilling prophecy effects emerged. Findings are discussed in terms of family relations and the differential power of negative versus positive self-fulfilling prophecies., (Copyright 2004 American Psychological Association)

Four years of longitudinal data from 373 families participating in a randomized intervention-control clinical trial were used to examine whether intervention effects on adolescent alcohol and tobacco use trajectories were moderated by family risk, as defined by parental social emotional maladjustment. Consistent with earlier outcome evaluations based on analyses of covariance, analyses confirmed that both the Preparing for the Drug Free Years program and the Iowa Strengthening Families Program favorably influenced alcohol use index trajectories across the time frame of the study; only the latter program, however, evidenced positive effects on a tobacco use index. Concerning the primary research question, analyses provided no support for family risk moderation of any intervention effect. Findings indicate the feasibility of developing universal preventive interventions that offer comparable benefits to all families.

A randomized prevention trial contrasted families who took part in the Strong African American Families Program (SAAF), a preventive intervention for rural African American mothers and their 11-year-olds, with control families. SAAF is based on a contextual model positing that regulated, communicative parenting causes changes in factors protecting youths from early alcohol use and sexual activity. Parenting variables included involvement-vigilance, racial socialization, communication about sex, and clear expectations for alcohol use. Youth protective factors included negative attitudes about early alcohol use and sexual activity, negative images of drinking youths, resistance efficacy, a goal-directed future orientation, and acceptance of parental influence. Intervention-induced changes in parenting mediated the effect of intervention group influences on changes in protective factors over a 7-month period.

The relationship between growth in adolescent substance use and delinquency was examined in a longitudinal, randomized controlled study of the Preparing for the Drug Free Years Program (PDFY), a universal family-focused prevention intervention. Latent growth curve modeling was used to analyze 5 waves of data collected from 429 rural adolescents. Results showed that adolescents assigned to the PDFY intervention condition had a slower rate of linear increase over time in both substance use and delinquency compared with adolescents assigned to the control condition. Moreover, pretest level of delinquency was a reliable, positive predictor of growth in substance use, whereas pretest level of substance use did not predict growth in delinquency.

This research examined whether mothers' expectations about their children's drinking behavior influenced their children's future alcohol use through self-fulfilling prophecies. It also investigated whether children's self-esteem, family social class, or the valence of mother expectations moderated this process. Analyses of longitudinal data from 505 mother-child dyads yielded results consistent with a self-fulfilling prophecy. The inaccurate portion of mother expectations predicted children's future alcohol use after accounting for relevant control variables. Moderation analyses indicated that this effect was stronger among higher self-esteem children and when mother expectations were positively valenced (i.e., when mothers underestimated their children's future alcohol use). The findings are discussed in terms of parent-child relationship quality, peer influences, self theories, and out-group stereotypes.

Findings from Project Family are presented to illustrate how a partnership-based program of research on universal family- and youth-focused interventions is addressing a public health challenge. One aspect of this public health challenge is the high prevalence of youth problem behaviors and a second aspect concerns barriers to scaling-up empirically-supported preventive interventions designed to ameliorate those problem behaviors. Illustrative findings are presented within a conceptual framework for scaling-up preventive interventions to achieve greater public health impact. Three interrelated sets of research requirements and findings are addressed within this framework: (a) rigorously demonstrating intervention effectiveness; (b) attaining sufficient levels of intervention utilization in diverse general populations, requiring study of recruitment/retention strategies, cultural sensitivity, and economic viability; and (c) achieving implementation quality, involving investigation of adherence and dosage effects, along with theory-driven, intervention quality improvement. The paper concludes with discussion of the need for careful investigation of community-university partnership models as a key mechanism for large-scale implementation.

The field of family-centered preventive intervention science is well poised to seize an opportunity for larger-scale intervention implementation and greater public health impact. This opportunity has been created by earlier research in the areas of epidemiology, developmental etiology, and intervention outcome research. Both earlier and current research define a number of key tasks required to meet the many challenges involved in scaling-up for greater impact. Illustrations of how these tasks can be addressed are provided in articles on programs of family-centered research with infants, children, and adolescents. Each article in this special issue treats one or more tasks that concern (a) expansion of the set of rigorously evaluated, theory-driven interventions that have potential to reach large numbers of children, youth, and families; (b) effective strategies for family recruitment and retention; (c) cultural sensitivity of interventions; (d) application of a developmental life course perspective; (e) strategies for linking higher-risk population subgroups with potentially beneficial services; (f) improved diffusion mechanisms for sustained, quality delivery; and (g) policy making informed by research, including economic analysis. A summary of how articles address these tasks concludes with a discussion of the importance of futher strengthening a public service orientation in prevention science.

This study evaluated the substance initiation effects of an intervention combining family and school-based competency-training intervention components. Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) and the Strengthening Families Program: For Parents and Children 10-14, (b) LST only, or (c) a control condition. Outcomes were examined 1 year after the intervention posttest, using a substance initiation index (SII) measuring lifetime use of alcohol, cigarettes, and marijuana and by rates of each individual substance. Planned intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the SII and on marijuana initiation. Relative reduction rates for alcohol initiation were 30.0% for the combined intervention and 4.1% for LST only.

Objective: Epidemiologic research suggests that significant public health benefits can accrue from preventive interventions that delay the initiation of youth alcohol use. This analysis compares the cost effectiveness of tvo interventions designed for general population families of adolescents. It also conservatively estimates their benefit-cost ratios and net benefits., Method: Cost-effectiveness and cost-benefit analyses were performed on data from a longitudinal prevention trial with families of sixth graders from 33 rural schools in a midwestern state. Schools were blocked on size and proportion of lower income families and then randomly assigned either to one of two interventions or to a control condition. Interventions included the Iowa Strengthening Families Program (ISFP), a seven-session intervention with parents and students together, and Preparing for the Drug Free Years (PDFY), a five-session intervention focusing primarily on parents., Results: Conservative estimates for the ISFP intervention were a cost-effectiveness figure of $12,459 per case prevented, a benefit-cost ratio of S9.60 per $1 invested, and a net benefit of $5,923 per family. For PDFY, estimates were a cost effectiveness of $20,439 per case prevented, a benefit-cost ratio of $5.85 per $12 invested, and a net benefit of $2,697 per family., Conclusions: Family skills training interventions designed for general populations have the potential to delay the onset of alcohol use and may avoid substantial costs to society at a proportionally small intervention cost. Economic analysis of such interventions is a largely unexplored area that could provide valuable guidance in forming public policy.

This study examined the long-term substance use outcomes of 2 brief interventions designed for general population families of young adolescents. Thirty-three public schools were randomly assigned to 3 conditions: the 5-session Preparing for the Drug Free Years Program, the 7-session Iowa Strengthening Families Program, and a minimal contact control condition. The pretest involved 667 6th graders and their families. Assessments included multiple measures of initiation and current use of alcohol, tobacco, and marijuana. Pretest data were collected in the 6th grade and the reported follow-up data were collected in the 10th grade. Significant intervention-control differences in initiation and current use were found for both interventions. It is concluded that brief family skills-training interventions designed for general populations have the potential to reduce adolescent substance use and thus have important public health implications.