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Promising Program Seal

SPORT Prevention Plus Wellness

Blueprints Program Rating: Promising

A health promotion program that highlights the positive image benefits of an active lifestyle to reduce the use of alcohol, tobacco and drug use by high school students in addition to improving their overall physical health.

  • Alcohol
  • Illicit Drug Use
  • Physical Health and Well-Being
  • Tobacco

    Program Type

    • Alcohol Prevention and Treatment
    • Cognitive-Behavioral Training
    • Drug Prevention/Treatment
    • School - Individual Strategies

    Program Setting

    • School

    Continuum of Intervention

    • Universal Prevention (Entire Population)

    A health promotion program that highlights the positive image benefits of an active lifestyle to reduce the use of alcohol, tobacco and drug use by high school students in addition to improving their overall physical health.

      Population Demographics

      High school students.

      Age

      • Late Adolescence (15-18) - High School

      Gender

      • Male and Female

      Race/Ethnicity

      • All Race/Ethnicity

      Race/Ethnicity/Gender Details

      No analyses by gender or race/ethnicity, but the sample was representative, with 51% White, 22% African American, and 27% Other Ethnic groups.

      • Individual
      Protective Factors
      • Individual: Exercise, Perceived risk of drug use*

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

      See also: SPORT Prevention Plus Wellness Logic Model (PDF)

      SPORT Prevention Plus Wellness is a health promotion program for high school adolescents to improve their physical fitness, nutrition, and sleep habits, and avoid alcohol, tobacco and drug use. SPORT content highlights the positive image benefits of an active lifestyle by showing youth as active and fit, and emphasizes substance abuse as counterproductive to achieving positive image and behavior goals. The program consists of an in-person health behavior screen, a one-on-one consultation with the teens, a take-home fitness prescription targeting adolescent health promoting behaviors and alcohol use along with its risk and protective factors, and a flyer reinforcing key content of the consultation mailed to the home. The brief seven-item Health and Fitness Screen provides tailored feedback on six health behavior related areas, and is administered to participants individually during regularly scheduled school hours just prior to implementing the fitness consultation. SPORT fitness consultations are administered using a standardized protocol designed to provide tailored, scripted communications by trained fitness specialists (nurses and certified health specialists) to adolescents one-on-one. At the conclusion of the personal consultation, a take-home fitness prescription is provided recommending the adolescent set goals in the areas of sleep, nutrition, physical activity, and alcohol. Lastly, a one-page flyer is mailed to participants one week after the implementation of the fitness consultations, reinforcing prevention messages provided during the consultation. Although materials developed by the program designer are available in a group and a one-on-one format, as well as a parent-implemented kit, only the one-on-one version is certified by Blueprints as it is the version that was used in the evaluation that met Blueprints quality standards.

      SPORT Prevention Plus Wellness, a high school program, consists of an in-person health behavior screen, a one-on-one consultation, a take-home fitness prescription targeting adolescent health promoting behaviors and alcohol use along with its risk and protective factors, and a flyer reinforcing key content of the consultation mailed to the home. The techniques are based on the Integrative Behavior-Image Model, which asserts that positive personal and social images serve as both key motivators for health development and the glue for unifying health promoting and health risk habits within single interventions. This is accomplished through behavioral couplings which are a conceptual integration of a health promoting behavior (e.g., physical activity) and a health risk behavior (e.g., alcohol use) using personal aspirations.

      The brief seven-item Health and Fitness Screen was developed to provide tailored feedback on six health behavior-related areas, and is administered to participants individually during regularly scheduled school hours just prior to implementing the fitness consultation. The screen consists primarily of yes/no response items measuring the following behavioral areas: sport and physical activity, exercise, physical activity norms (i.e., social support from family and friends), breakfast and nutrition, sleep and rest, and alcohol initiation and use.

      SPORT fitness consultations are administered using a standardized protocol designed to provide tailored, scripted communications by trained fitness specialists to adolescents one-on-one. Participating students are escorted from regularly scheduled classes to designated, private spaces where consultations are conducted throughout the school day. These prevention communications promote an active lifestyle, emphasize the conflict between such a lifestyle and consuming alcohol, and portray an image of youth as active and fit, with alcohol use as counterproductive to achieving this image. Fitness specialists consist of various types of health care professionals, such as nurses and certified health specialists. At the conclusion of the personal consultation, a take-home fitness prescription is provided recommending the adolescent set goals in the areas of sleep, nutrition, physical activity, and alcohol. Lastly, a one-page flyer is mailed out to participants one week after the implementation of the fitness consultations, reinforcing prevention messages provided during the consultation.

      SPORT Prevention Plus Wellness is based on the Integrative Behavior-Image Model, which asserts that positive personal and social images serve as both key motivators for health development and the glue for unifying health promoting and health risk habits.

      • Cognitive Behavioral

      The study (Werch et al., 2005) consisted of a randomized control trial in a high school in northeast Florida. 604 students participated, 302 in the treatment group and 302 in a control group. Baseline assessment took place during the fall semester of 2002. Post-intervention data were collected three months after the implementation of the program during mid-spring semester 2003 and again 12-months after the baseline data collection during the fall semester 2003. An 18 month follow-up was also conducted, consisting of 346 students, 179 in the treatment group and 167 in the control group (Moore & Werch, 2009).

      Werch et. al., 2005: Three months after receiving the intervention, students in the treatment group scored significantly lower on alcohol consumption, alcohol use risk, drug use behaviors, and alcohol initiation measures than students in the control group. Their outcomes showed significantly more protection from alcohol use, less risk for future alcohol use, and more moderate physical activity. The only measure that did not reach significance at the 3-month follow-up was drug use initiation.

      At the 12-month follow-up, students in the treatment group scored significantly lower on alcohol use risk and protective factors and drug use initiation measures than students in the control group. They smoked cigarettes less frequently and were less advanced in stages of initiation of cigarette use. However, the measures for alcohol initiation and stages of alcohol initiation were not significant at twelve months.

      Over time, students in the treatment group scored significantly lower on measures of alcohol consumption, alcohol initiation, alcohol risk, and drug initiation. They also scored significantly lower on measures of 30-day quantity and length of alcohol use.

      When examining participants who reported previous marijuana and/or cigarette use, at 3-month follow-up, drug users who had received the intervention had significantly less 30-day alcohol frequency, 30-day quantity, and 30-day heavy use than drug users in the control group. They also scored lower on measures of 30-day cigarette frequency of consumption and marijuana frequency. At the 12-month follow-up, significant overall interactions were found for drug use behaviors, drug initiation, and exercise habits, with more positive effects for drug using adolescents receiving Project SPORT.

      Moore & Werch, 2009: At the 18-month follow-up (9 months post-intervention), none of the tests were significant. However, when analyses were limited to only drug-using adolescents, the tests were significant for four models: alcohol behaviors, drug behaviors, protective factors, and risk factors, indicating that the re-intervention was somewhat successful with students who had reported previous drug use.

      Werch et. al., 2005:

      • At three months post-intervention, the students in SPORT reported more reduction in alcohol consumption, initiation, alcohol use risk, and drug use behaviors (30 day cigarette frequency) than those in the control group, as well as increased exercise habits.
      • At 12-months post-baseline, SPORT resulted in positive effects on the frequency of cigarette smoking and cigarette smoking initiation.
      • Short term effects were found favoring previous substance users receiving SPORT on alcohol consumption, drug use, and drug initiation, while long-term effects were found on drug consumption and improved physical activity.

      Moore & Werch, 2009:

      • At 18 months, no significant effects were found in the full sample.
      • Among drug-using adolescents, those in SPORT had significantly lower scores on four substance measures: alcohol frequency, quantity, heavy use, and marijuana frequency.

      Significant Program Effects on Risk and Protective Factors:

      • Alcohol use risk and protective factors at 12-months post-baseline (Werch et al., 2005).

      Although the studies did not perform a mediation analysis, researchers found that the program affected risk and protective factors as well as outcome substance use behaviors. For example, at the 1-year assessment, subjects in the fitness consultation group improved more than the control group on one risk factor (intention to drink) and three protective factors (perceived susceptibility, parent-child communication, and positive parent-child relationship). The risk and protective factors may be seen as mediators of substance use outcomes.

      None reported.

      The program was effective in the full sample of high school students as well as for students who were previous drug users at 12 month follow-up.

      The study took place at only one school, so there could have been some cross-contamination between students in the treatment and the control group. For the 18-month follow-up, much of the initial sample was lost. In addition, the long-term outcomes were mixed; only students who reported previous drug use benefited from the re-intervention. Thus, although the program is promising at 3 and 12 months, effects are gone at 18 months for the general population.

      • Blueprints: Promising
      • SAMHSA: 2.8 - 3.0

      Mike Graham-Squire
      Community Health Manager
      Neighborhood House
      4410 29th AVE S, Seattle WA 98108
      (206) 353-7945 cell
      (206) 461-6954 x 4111
      mikegs@nhwa.org

      Laurie Reynolds
      Director of Program Services
      Chautauqua Alcoholism & Substance Abuse Council (CASAC)
      501 West Third Street
      Suites 3 & 4 Sprinchorn Building
      Jamestown, NY 14701
      716.664.3608
      716.664.3661 (fax)
      laurie@casacweb.org

      Christine Cavallucci, LCSW, CPP
      Executive Director
      ADAPP
      2789 Schurz Ave.
      Bronx, NY 10465
      718-904-1333 ext 13
      www.adapp.org

      Ann E Brodsky, ABrodsky@chicousd.org
      Tobacco Use Prevention Education Coordinator
      Chico Unified School District
      PVHS (530)891-3050, ext 112

      Werch, C., Moore, M.J., DiClemente, C., Bledsoe, R., & Jobli, E. (2005). A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents. Prevention Science, 6(3), 213-226.

      Moore, M.J., & Werch, C. ( 2009). Efficacy of a brief alcohol consumption reintervention for adolescents. Substance Use & Misuse, 44, 1009-1020.

      Chudley Werch, Ph.D., President
      PreventionPLUSWellness
      3595 Forest Bend Terrace
      Jacksonville, FL 32224
      904-472-5022
      cwerch@preventionpluswellness.com
      preventionpluswellness.com

      Study 1

      Moore, M.J., & Werch, C. ( 2009). Efficacy of a brief alcohol consumption reintervention for adolescents. Substance Use & Misuse, 44, 1009-1020.

      Werch, C., Moore, M.J., DiClemente, C., Bledsoe, R., & Jobli, E. (2005). A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents. Prevention Science, 6(3), 213-226.

      Evaluation Methodology

      Design:

      Werch et. al., 2005: The study was a randomized controlled trial conducted in a suburban high school in the northeast Florida region. In the fall of 2002, a total of 604 participants, 335 ninth and 269 eleventh-grade students were randomly assigned within grade levels by computer to either the intervention or control group. Baseline data were collected at the beginning of the fall semester 2002, and post-intervention data were collected 3-months after the implementation of the program during mid-spring semester 2003 and again 12-months after the baseline data collecting during the fall semester 2003. All outcome data were collected from participants, assembled by classroom in the school auditorium, by trained project staff following a standardized protocol. At the three month follow-up, 584 of the original 604 students participated, representing an attrition rate of 3.3%. At the twelve-month follow-up, 514 of the original 604 students participated, representing an attrition rate of 15%.

      Those in the control group received two commercially prepared generic alcohol prevention and health promotion print materials. The first was a booklet titled: "What Everyone Should Know About Wellness", which included information about wellness, smoking, alcohol, exercise, nutrition, and stress management. The 15-page booklet with illustrations was administered in a private, secured setting within the participating school. The control intervention was administered simultaneously with fitness consultations. The process involved providing control participants with the reading material, seating them in a quiet place, and providing instruction to carefully read the material at their own pace. One week after participants were given the control booklets, and corresponding to the mailing of the intervention flyer, control subjects were sent a generic health and fitness pamphlet. The six-panel pamphlet titled "For Teens Only: Staying Healthy and Fit" included information about fitness, nutrition, stress management, alcohol and drugs, and changing unhealthy habits.

      Moore & Werch, 2009: Students who were originally randomized to receive the experimental intervention received a booster in the fall of 2003, consisting of an iterative consultation (n=179) while those who received the minimal intervention control again received a commercially published health brochure. The key difference in the re-intervention was that the consult was iterative and provided feedback based on one's prior screen responses. Data were collected 18 months after the initial study baseline. Outcome data were collected from participants, assembled by classroom in the school auditorium, by trained project staff following a standardized protocol. The 346 students who participated at the 18-month follow-up (of an original 604 students in the sample) represent an attrition rate of 42.72%.

      Sample:

      Werch et. al., 2005: The initial sample consisted of 604 participants, 302 in the treatment group and 302 in the control group. 335 were in the ninth grade and 269 were in the 11th grade. 51.0% were White, 21.5% were African-American, and the remaining 27.5% were all other ethnic groups combined. 56% of participants were female and 44% were male. 12.7% of participating students were enrolled in the free or reduced cost lunch program. 38.7% reported having a family member with an alcohol or drug problem, and a majority of fathers (60.3%) and mothers (53.0%) drank alcohol at least a few times a year. 60.9% reported some alcohol or drug education within the last year. A greater proportion of control adolescents (42.7%) reported a family alcohol or drug problem than intervention adolescents (34.9%). No other differences were found between the two groups at baseline.

      Attrition analyses showed that at 12-month follow-up, 85% of the sample was successfully maintained (n=514), with comparable numbers of missing adolescents equally distributed across the intervention (n=42) and control (n=48) groups. A comparison of participants who dropped from the study in each group at 12-months was conducted using baseline data. No differences were found between dropouts in the two groups on any of the alcohol and drug consumption measures, or exercise behavior measures. Also, no differences were found between dropouts by group on any of the socio-demographic measures with one exception. A greater percentage of participants who dropped from the control group had mothers who reported drinking at least a few times a year (71.7%) than were among those who dropped from the intervention group (47.4%).

      Moore & Werch, 2009: The sample for the reintervention consisted of 346 students, 179 in the treatment group and 167 in the control group. 51.7% were White, 22.3% were African-American, and 26.0% were all other ethnic groups combined. 63.3% were female and 36.7% were male. 9.8% of participating students were enrolled in the free or reduced lunch program. 38% reported someone in their family having an alcohol or drug problem. The sample participating in the re-intervention consisted of 67% of the original sample.

      To determine differences between the original sample and the sample for this study, comparison of those who participated with those who did not using original baseline data was conducted. There were four differences on socio-demographic variables. A greater percentage of the initial sample who dropped out were males (51.9% vs. 35.6% of females), in the free/reduced lunch program (57.1% vs. 40.5% not in the program), frequently absent from school (60.6% dropped vs. 44.5% of those who reported never being absent, 37.8% rarely, and 49.3% 1-2 per month), and not living with both parents (50.8% living with their mother only dropped, as did 44.2% living with father, 66.7% living with other vs. 36.1% living with both parents). No differences were found between the initial sample and the current sample on any of the alcohol and drug consumption measures or exercise behavior measures.

      Measures:

      Werch et. al., 2005: The Youth Alcohol and Health Survey was used to collect data on alcohol and drug consumption, risk, and protective factors associated with alcohol use, and exercise habits. Alcohol consumption was measured by items adapted from previous substance abuse prevention research. Measures used for this study's analysis included items assessing 30-day frequency and quantity of alcohol use; heavy alcohol use, defined as consuming five or more drinks in a row during the last 30 days; 13 items measuring negative consequences (problems) experienced during drinking; and length of time using alcohol (ranging from "I do not drink" and "30 days or less," to "6 months or more."). In addition, a measure of the stage of initiation of alcohol use was taken, adopted from previous stage research and theory. This item had seven response categories, reflecting recent advances in staging the initiation of alcohol consumption, ranging from strong pre-contemplation stage (will never try alcohol) to a maintenance stage (drinking for longer than six months).

      Drug use behaviors measured included 30-day frequency of cigarette smoking and marijuana use, paralleling the alcohol frequency measure. Similarly, measures of cigarette and marijuana stage were taken, which also corresponded to the measure of alcohol use initiation. Measures of moderate and vigorous physical activity were collected, adopted from the Youth Risk Behavior Survey. These items measured 7-day participation in vigorous physical activity (at least 20 minutes with sweating and breathing hard) and moderate physical activity (at least 30 minutes with no sweating or breathing hard).

      Cognitive, social, and environmental risk and protective factors found to mediate alcohol consumption were also measured. Measures of alcohol use risk factors (targeted for reduction) included positive expectancy beliefs (pros), perceived peer prevalence of alcohol use, influenceability, social norms, intention to use alcohol, and attitudes. Measures of alcohol use protective factors (targeted for increase) included negative expectancy beliefs (cons), behavioral capability, resistance self-efficacy, self-control, perceived susceptibility, parental monitoring, parent/child communication, positive parent/child relationship, and value incompatibility.

      Moore & Werch, 2009, used the Youth Alcohol and Health Survey to collect data on alcohol and drug use, alcohol use-related risk and protective factors, and exercise habits.

      Analysis:

      Werch et. al., 2005: Descriptive statistics including frequencies, percentages, means, and standard deviations were generated to describe the sample. Baseline measures were compared by experimental group using chi-square tests for categorical data and independent t-tests for continuous scores. MANCOVAs were used to test the primary objective of examining the efficacy of the intervention at both 3 and 12-month follow-ups, with baseline scores serving as covariates, first analyzing alcohol consumption, then risk/protective factors for alcohol use, and lastly, drug use and exercise behaviors. MANCOVA was used due to the multiple health behaviors addressed by the intervention, and because the dependent variables were not perfectly correlated.

      Repeated measures MANCOVAs were then used to examine temporal effects across baseline, 3-month and 12-month data collections, again examining alcohol consumption, followed by alcohol/risk protective factors, and then other drug use and exercise habits. Lastly, factorial MANCOVAs were conducted to test the secondary objective of examining possible interaction effects of prior drug use (past 30-day marijuana and/or cigarette use) and intervention exposure on alcohol use, drug consumption, and exercise behavior measures.

      Moore & Werch, 2009: Descriptive statistics including frequencies, percentages, means, and standard deviations were used to describe the sample. Baseline equivalence and attrition analysis were conducted using chi-square tests for categorical data and independent sample t-tests for continuous scores. MANCOVAs were used to the primary objective of examining the efficacy of the re-intervention at an 18-month follow-up, first analyzing alcohol consumption, then drug use, exercise behaviors, and risk and protective factors for alcohol use. Baseline data were used as covariates. Lastly, factorial MANCOVAs were conducted to test the secondary objective of examining possible interaction effects of prior drug use (past 30-day marijuana, cigarette and/or heavy alcohol use at baseline) and re-intervention exposure on alcohol consumption, then drug use, exercise behaviors, and risk and protective factors for alcohol use, again using baseline data as covariates.

      Outcomes

      Werch et. al., 2005: Overall MANCOVA tests at 3-months post-intervention were significant for alcohol consumption and initiation factors, drug use behaviors, and exercise habits, with positive effects for those exposed to Project SPORT. Only drug use initiation was not significant 3-month follow-up. Univariate analyses showed that among alcohol consumption behaviors, significantly less 30-day frequency, 30-day quantity, and 30-day heavy use was found for those receiving Project SPORT compared to those receiving the control treatment. Significantly less alcohol use initiation was seen for adolescents exposed to Project SPORT compared to those exposed to the minimal intervention control, on measures of both state of alcohol initiation and length of alcohol use. SPORT youth also displayed significantly more protection from alcohol use than control youth on measures of negative expectancy beliefs, behavioral capability, perceived susceptibility, parental monitoring, and parent/child communication. SPORT participants also showed less risk for alcohol use compared to control participants on measures of intention to drink in the future, alcohol attitudes, and influenceability. Lastly, youth exposed to the SPORT intervention engaged in more moderate physical activity and smoked cigarettes less frequently than those exposed to the minimal intervention control.

      At the 12-month follow-up, significant overall MANCOVAs were found for alcohol use risk and protective factors, drug behaviors, and drug use initiation, with positive effects for those exposed to Project SPORT. The overall MANCOVA for alcohol initiation was not significant, however the univariate analysis for length of alcohol use was significant, with intervention adolescents using alcohol for a briefer period of time than control adolescents. Project SPORT provided more alcohol use protection than the minimal intervention control on parent/child communication and positive parent/child relationship, but less protection on perceived susceptibility. Intervention participants had less alcohol risk than control participants, as measured on intentions to drink in the next six months. Youth receiving the treatment also smoked cigarettes less frequently than control youth and were less advanced in their stage of initiation cigarette smoking than control students.

      When testing the temporal effects of the intervention, significant overall MANCOVA interaction effects were found for alcohol consumption and initiation, alcohol risk and protective factors, and drug initiation, with positive effects over time for those exposed to Project SPORT. Univariate ANOVAs were significant for 30-day alcohol quantity, length of alcohol use, and stage of alcohol initiation, with trends indicating intervention youth measures decreasing at 3-months and increasing at 12-months and control youth measures increasing at both 3 and 12-months. Univariate analyses showed significant interactions on 30-day cigarette frequency and cigarette stage of initiation, with intervention youth showing less use at 3-months and somewhat of an increase at 12-months, whereas control youth showing increases at 3-months and greater increases at 12-months.

      When testing the secondary objective of examining interaction effects between prior marijuana and/or cigarette use and intervention exposure, overall factorial MANCOVA interaction effects at 3-months postintervention were significant for alcohol consumption behaviors, drug use behaviors, and drug initiation, with more positive effects for drug using adolescents who received Project SPORT. Univariate analyses showed that at 3-month follow-up, drug users who received the intervention had significantly less 30-day alcohol frequency, 30-day quantity, and 30-day heavy use than drug users receiving the minimal intervention control. Likewise, drug users exposed to Project SPORT had less 30-day cigarette frequency of consumption and 30-day marijuana frequency.

      At 12-months follow-up, significant overall factorial MANCOVA interactions were found for drug use behaviors, drug initiation, and exercise habits, with more positive effects for drug using adolescents receiving Project SPORT. The univariate analysis for 30-day heavy alcohol use was significant, with drug using youth exposed to the intervention drinking heavily less frequently than drug using control youth. Drug users receiving Project SPORT also used cigarettes less frequently in the past 30-days and marijuana less frequently in the past month than drug users receiving the minimal intervention control. Similarly, findings were seen for cigarette and marijuana initiation, with drug using adolescents given the intervention having less advanced drug use initiation than drug using adolescents given the control. Lastly, adolescents using drugs and exposed to Project SPORT engaged in more frequent vigorous physical activity and moderate physical activity than those adolescents exposed to the minimal intervention control.

      Moore & Werch, 2009: The researchers examined the effects of the re-intervention for all participants using a series of MANCOVAs, and none of the results were significant. When examining the effects of the re-intervention for drug-using versus non-drug using adolescents, the multivariate tests were significant for four of the models: alcohol behaviors, drug behaviors, protective factors, and risk factors. Univariate tests for group by drug user status interaction revealed that drug-using adolescents in the intervention group had significantly lower use/risk than the control group, while the scores for the non-drug users were similar across the two groups on 30-day alcohol frequency, alcohol quantity, heavy alcohol use, and marijuana use. This same significant pattern of lower risk scores for the substance-using youth in the intervention group was found for Protective Factors self-control, lifestyle and value incompatibility, perceived susceptibility, and parent-child communication, as well as the Risk Factor attitude.