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Promising Program Seal

Strengthening Families 10-14

Blueprints Program Rating: Promising

A 7-session group parenting and youth skills program that includes separate weekly parent effectiveness training and child skills-building, followed by a family session to promote good parenting skills and positive family relationships, proven to reduce aggressive and hostile behavior, substance abuse in adolescence, and improve family relationships.

  • Virginia Molgaard, Ph.D.
  • Associate Professor
  • Iowa State University
  • Institute for Social and Behavioral Research
  • 2625 North Loop Drive #2500
  • Ames, IA 50010
  • (515) 294-8762
  • vmolgaar@iastate.edu
  • Alcohol
  • Antisocial-aggressive Behavior
  • Close Relationships with Parents
  • Illicit Drug Use
  • Internalizing
  • Tobacco

    Program Type

    • Parent Training
    • Skills Training

    Program Setting

    • Community (e.g., religious, recreation)
    • School

    Continuum of Intervention

    • Universal Prevention (Entire Population)

    A 7-session group parenting and youth skills program that includes separate weekly parent effectiveness training and child skills-building, followed by a family session to promote good parenting skills and positive family relationships, proven to reduce aggressive and hostile behavior, substance abuse in adolescence, and improve family relationships.

      Population Demographics

      SF10-14 (formerly Iowa Strengthening Families) was implemented with low-income sixth grade youth and their families.

      Age

      • Early Adolescence (12-14) - Middle School

      Gender

      • Male and Female

      Gender Specific Findings

      • Male
      • Female

      Race/Ethnicity

      • All Race/Ethnicity

      Race/Ethnicity/Gender Details

      Iowa Strengthening Families was implemented with a predominantly rural, Caucasian sample (98.6%). Overall levels of substance use were lower for both boys and girls in intervention relative to controls, as well as a lower rate of internalizing.

      • Individual
      • Family
      Risk Factors
      • Individual: Early initiation of drug use*, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use
      • Peer: Interaction with antisocial peers
      • Family: Family conflict/violence, Neglectful parenting, Parental attitudes favorable to drug use, Poor family management*
      Protective Factors
      • Individual: Refusal skills, Skills for social interaction
      • Family: Attachment to parents*, Non-violent discipline*, Opportunities for prosocial involvement with parents*, Parent social support, Rewards for prosocial involvement with parents

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

      See also: Strengthening Families 10-14 Logic Model (PDF)

      Strengthening Families 10-14 is a seven-session program for families with young adolescents that aims to enhance family protective and resiliency processes and reduce family risk related to adolescent substance abuse and other problem behaviors. The weekly, two-hour sessions include separate parent and child skills-building followed by a family session where parents and children practice the skills they have learned independently, work on conflict resolution and communication, and engage in activities to increase family cohesiveness and positive involvement of the child in the family. Parents are taught how to clarify expectations based on child development norms of adolescent substance use, using appropriate disciplinary practices, managing strong emotions regarding their children, and using effective communication. Children are taught refusal skills for dealing with peer pressure and other personal and social interactional skills. These sessions are led by three-person teams and include an average of eight families per session.

      The seven-session program for families with young adolescents is based on the biopsychosocial model and targets enhancement of family protective and resiliency processes and family risk reduction. Sessions are conducted once weekly for seven weeks. The first six are two-hour sessions including separate one-hour parent and child skills-building followed by a one-hour family session where parents and children practice the skills they have learned independently, work on conflict resolution and communication, and engage in activities to increase family cohesiveness and positive involvement of the child in the family. The final session is a one-hour family interaction session without the concurrent parent and child training sessions. Parents are taught means of clarifying expectations based on child development norms of adolescent substance use, using appropriate disciplinary practices, managing strong emotions regarding their children, and effective communication. Essential program content for the parent skills training sessions is contained on videotapes that include family interactions illustrating key concepts. Children are taught refusal skills for dealing with peer pressure and other personal and social interactional skills. During the family sessions, family members practice conflict resolution and communication skills and engage in activities designed to increase family cohesiveness and positive involvement of the child in the family. These sessions are led by three-person teams and include an average of eight families per session.

      The program has underpinnings in biosocial and social ecology models of adolescent substance abuse. The biopsychosocial model targets the enhancement of family protective and resiliency processes and family risk reduction. The social ecology model of the precursors of drug use suggests that family climate or environment is a root cause of later precursors of substance abuse. The family influences the youth's perceptions of the school climate, school bonding and self-esteem, choice of peers and deviant peer influence, and eventually substance use or abuse. Strong, positive relationships between child and parents create supportive, transactional processes between them that reduce the developmental vulnerability to drug use.

      • Attachment - Bonding
      • Skill Oriented
      • Social Learning

      The Strengthening Families 10-14 Program (formerly Iowa Strengthening Families) has been evaluated in a randomized, controlled test with 442 families. This large-scale trial, including long-term follow-up evaluations, was conducted in Iowa public schools. In addition to a six-month post-test, follow-up data collections were completed approximately 18, 30, 48, and 72 months following the pretest, when students were in the 7th, 8th, 10th, and 12th grades. An additional follow-up was completed by telephone when the participants were approximately 21 years of age. The experimental design entailed random assignment of 33 schools. Outcome evaluations included the use of multi-informant, multi-method measurement procedures at pre-test, post-test, and follow-up data collection points.

      The intervention outcome model was tested by incorporating three parenting outcomes: intervention-targeted parenting behaviors, general child management, and parent-child affective quality at posttest and at one year following posttest. The intervention outcome model was supported at both time periods, positing a sequence of effects by which the parenting behaviors targeted directly by the intervention influence the more global parenting practices of general child management and parent-child affective quality. At post-test, the intervention produced significant positive effects on mean differences in the total sample, and in both the higher- and lower-adherence schools on intervention-targeted parenting behaviors compared to the control group. These results were largely sustained at 1.5 years post-baseline.

      Results indicated significantly lower Alcohol Initiation Index (AII) scores for intervention group compared to control group adolescents at both one- and two-year follow-ups. Intervention adolescents showed lower rates of initiation in each of the three alcohol ever-use measures at both follow-ups, relative to the control group. Intervention adolescents in the no use status at the one-year follow-up were more likely to remain in that status at the two-year follow-up, compared to control youth. Those who had already initiated substance use at the one-year follow-up were more likely to remain in this status compared to the control group, but this finding was only marginally significant. Thus, while substance use rates increased among all groups over the course of the study, transitions to substance use at the two-year follow-up were significantly lower among intervention group adolescents.

      At the end of tenth grade, the intervention group relative to controls showed significantly lower new user proportions (initiation) scores on five lifetime substance use measures (ever drank alcohol, ever drank without parent permission, ever been drunk, ever smoked cigarettes, ever used marijuana); the differences were highest for drunkenness and marijuana use. Significantly lower proportions of intervention youth, compared to the control group, reported past month alcohol use and past month cigarette use. Thus, the findings reveal both primary prevention (delayed initiation) and secondary prevention (delayed progression) effects for adolescents receiving the intervention. Also, the frequency of past month alcohol and cigarette use, and the alcohol composite and tobacco composite index score, was lower for intervention participants relative to controls. Adolescents in the ISFP group showed significantly lower scores than their control group counterparts for the measures of observer ratings and adolescent report, but not family member report, of aggressive and hostile behaviors in interactions in the 10th grade.

      At six years following baseline (12th grade), adolescents in the intervention condition had a slower overall growth in lifetime use of alcohol, lifetime cigarette use, and lifetime use of marijuana relative to controls. Four outcomes showed significantly delayed growth rates to specific use levels: initiation of alcohol use without parental permission, drunkenness, cigarette use, and the Alcohol Use Composite Index (AUCI).

      By 12th grade, significantly fewer intervention group adolescents scored at or above borderline range of the CBCL-YSR anxious/depressed index compared to the adolescents in the control group. Intervention adolescents demonstrated a lower overall level and a lower rate of increase in monthly polysubstance use across time (sixth through the 12th grade) compared with the control adolescents. The intervention slowed the rate of increase in polysubstance use over time significantly more for girls than for boys. At the 12th grade follow-up, none of the participants in the intervention condition reported using methamphetamines in the past year; among the participants in the control condition, 5 (3.21%) reported use, resulting in a statistically significant difference.

      At young adulthood, ISFP group participants, relative to controls, reported lower rates of drunkenness frequency and on a polysubstance use index, as well as for lifetime STDs and substance use during sex. Indirect program effects were observed on young adult outcome measures of: drunkenness frequency, alcohol-related problems, cigarette frequency, illicit drug frequency, a polysubstance use index, lifetime STDs, number of sexual partners, and substance use during sex.

      Study that Combined LST and SFP 10-14:

      In a separate evaluation that combined LifeSkills Training (LST) and SFP 10-14, the LST and SFP 10-14 combined condition demonstrated the lowest new user rate (for alcohol and marijuana) compared to the LST only and control groups at one year after intervention posttest. At the 11th grade follow-up, participants in the LST and SFP 10-14 combined group had significantly lower rates of past year and lifetime methamphetamine use compared to participants in the control condition. At the 12 grade follow-up, participants in both the LST and SFP 10-14 combined and LST only groups had significantly lower rates of lifetime methamphetamine compared to participants in the control group.

      The intervention, relative to a control group, showed the following significant findings:

      • Lower rates of initiation in each of the three alcohol ever-use measures at the one-, two-, and four-year follow-ups.
      • Lower transitions to substance use at the two-year follow-up.
      • Lower proportion reporting initiation of each of the five substance use behaviors (use of alcohol, alcohol without parental permission, drunkenness, cigarettes, and marijuana) at the four-year follow-up (10th grade).
      • Lower frequency and proportion reporting past month alcohol use and past month cigarette use in 10th grade.
      • Lower composite index for both alcohol and tobacco at 10th grade.
      • Lower scores for observer ratings and adolescent report of aggressive and hostile behaviors in the 10th grade.
      • Slower overall growth in lifetime use of alcohol, lifetime cigarette use, and lifetime use of marijuana at the six-year follow-up (Grade 12).
      • Delayed growth rates for initiation of alcohol use without parental permission, drunkenness, cigarette use, and the Alcohol Use Composite Index shown by Grade 12.
      • By 12th grade, fewer youth scored at or above borderline range of the CBCL-YSR anxious/depressed index.
      • Slower rate of increase in polysubstance use over time (6th to 12th grade), significantly more for girls than for boys, although overall levels of use were lower in the intervention group for both genders.
      • At the 12th grade follow-up, less methamphetamine use, although the total number of adolescents reporting methamphetamine use in the past 12 months was extremely small.
      • In young adulthood, lower rates of drunkenness frequency and on a polysubstance use index.
      • In young adulthood, lower self-reported lifetime Sexually Transmitted Diseases and substance use during sex.

      Significant Program Effects on Risk and Protective Factors:

      • Improvements in intervention-targeted parenting behaviors, which, in turn, had significant effects on both parent-child affective quality and general child management at both posttest and one year following post-test.

      The studies did little to measure the specified mechanisms of change and how they translate program participation into reduced aggression, substance abuse, and other problems. The studies, for example, did not include measures of problem-solving skills or family cohesiveness.

      One study (Spoth et al. 2009) presented a different form of mediation analysis. It examined how delayed substance use in adolescence brought about by the program led to lower substance use in early adulthood. Thus, the adolescent program indirectly reduced adult measures of drunkenness, alcohol-related problems, cigarette use, illicit drug use, and poly-substance use by reducing those same measures in adolescence. The indirect effect sizes were small, however. The standardized indirect effects averaged around -.075 for the ISFP program. This mediation analysis was repeated by Spoth et al. (2014) for health-risking sexual behavior and lifetime STD outcomes in young adulthood, and found indirect program effects on past year number of partners, substance use during sex, and lifetime STDs.

      Few studies reported effect sizes. For measures of alcohol initiation, Spoth, Redmond, and Lepper (1999) reported small-to-medium effects sizes of .26 at the one-year follow-up and .39 at the two-year follow-up. Spoth, Redmond, and Shin (2000) reported weak to medium effect sizes of the program for two of three measures of aggression and hostility: observer related (.33), family member reported (.08), and self reported (.35).

      Nearly 100% of the families included in the sample were Caucasian two-parent families from the same rural area of the Midwest (Iowa). It is difficult to predict the extent to which study findings would generalize to a more culturally diverse or urban population.

      As a whole, the studies relied on strong designs, generally good measures, and proper analysis (including use of baseline controls and adjustment for school effects). Attrition was high, but the researchers reported analyses indicating baseline equivalence and similar attrition across conditions and variables.

      The only limitations across the studies were relatively minor – the lack of attention of mediating effects and the reliance on specialized samples of rural residents.

      The Life Skills Training program mentioned within this section is also described in detail and available for review at this site.

      • Blueprints: Promising
      • Crime Solutions: Effective
      • OJJDP Model Programs: Effective
      • SAMHSA: 2.8-3.3

      Coombes, L. Allen, D. & Foxcroft, D. (2012). An exploratory pilot study of the Strengthening Families programme 10-14 (UK). Drugs: Education, Prevention and Policy, 19(5), 387-396.

      Guyll, M., Spoth, R. L., Chao, W., Wicrama, K. A. S., & Russell, D. (2004). Family-focused preventive interventions: evaluating parental risk moderation of substance use trajectories. Journal of Family Psychology, 18, 293-301.

      Harrison, R. S., Boyle, S. W., & Farley, O. W. (1999). Evaluating the outcomes of family-based intervention for troubled children: a pretest-posttest study. Research on Social Work Practice, 6, 640-655.

      Redmond, C., Spoth, R., Shin, C., & Lepper H. (1999). Modeling long-term parent outcomes of two universal family-focused preventive interventions: One-year follow-up results. Journal of Consulting and Clinical Psychology, 67(6),975-984.

      Spoth, R. L., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatric Adolescent Medicine, 160, 876-882.

      Spoth, R., Clair, S., & Trudeau, L. (2014). Universal family-focused intervention with young adolescents: Effects on health-risking sexual behaviors and STDs among young adults. Prevention Science 15(Suppl 1), S47-S58.

      Spoth, R. L., Guyll, M., & Day, S. X. (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63, 219-228.

      Spoth, R., Guyll, M., Trudeau, L., & Goldberg-Lilehoj, C. (2002) Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community-university collaboration context. Journal of Community Psychology, 30, 499-518.

      Spoth, R., Redmond, C. & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: Extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.

      Spoth, R., Redmond, C. & Lepper, H. (1999). Alcohol initiation outcomes of universal family-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol, 13, 103-111.

      Spoth, R. L., Redmond, C. & Shin, C. (2001). Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline. Journal of Consulting and Clinical Psychology, 69, 627-642.

      Spoth, R. L., Redmond, C., & Shin, C. (2000). Reducing adolescents' aggressive and hostile behaviors. Archives of Pediatric and Adolescent Medicine, 154, 1248-1257.

      Spoth, R., Redmond, C., Shin, C. & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: school-level growth curve analysis 6 years following baseline. Journal of Consulting and Clinical Psychology, 72, 535-542.

      Spoth, R. L., Redmond, C., Trudeau, L. & Shin, C.(2002). Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors, 2, 129-134.

      Spoth, R., Reyes, M. L., Redmond, C. & Shin, C. (1999). Assessing a public health approach to delay onset and progression of adolescent substance use: Latent transition and loglinear analyses of longitudinal family preventive intervention outcomes. Journal of Consulting and Clinical Psychology, 67, 619-630.

      Spoth, R. L., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77(4),620-632.

      Trudeau, L., Spoth, R., Randall, G. K., & Azevedo, K. (2007). Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: Gender comparisons. Journal of Youth and Adolescence, 36, 725-740.

      Cathy Hockaday, Ph.D.
      Iowa State University
      1087 Lebaron Hall
      Ames, IA 50011-4380
      Phone: (515) 294-7601
      Fax: (515) 294-5507
      Email: hockaday@iastate.edu
      Website: www.extension.iastate.edu/sfp

      Study 1

      Guyll, M., Spoth, R. L., Chao, W., Wickrama, K. A. S., & Russell, D. (2004). Family-focused preventive interventions: Evaluating parental risk moderation of substance use trajectories. Journal of Family Psychology, 18(2), 293-301.

      Redmond, C., Spoth, R., Shin, C., & Lepper, H. S. (1999). Modeling long-term parent outcomes of two universal family-focused preventive interventions: One-year follow-up results. Journal of Consulting and Clinical Psychology, 67, 975-984.

      Spoth, R., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatric and Adolescent Medicine, 160, 876-882.

      Spoth, R., Clair, S., & Trudeau, L. (2014). Universal family-focused intervention with young adolescents: Effects on health-risking sexual behaviors and STDs among young adults. Prevention Science 15(Supplement 1), S47-S58.

      Spoth, R., Guyll, M., Trudeau, L., & Goldberg-Lilehoj, C. (2002) Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community-university collaboration context. Journal of Community Psychology, 30, 499-518.

      Spoth, R., Redmond, C. & Lepper, H. (1999). Alcohol initiation outcomes of universal family-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol, 13, 103-111.

      Spoth, R., Redmond, C., & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: Extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.

      Spoth, R. L., Redmond, C., & Shin, C. (2000). Reducing adolescents' aggressive and hostile behaviors. Archives of Pediatric and Adolescent Medicine, 154, 1248-1257.

      Spoth, R., Redmond, C., & Shin, C. (2001). Randomized trial of brief family interventions for general populations: Reductions in adolescent substance use four years following baseline. Journal of Consulting and Clinical Psychology, 69, 627-642.

      Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting and Clinical Psychology, 72(3), 535-542.

      Spoth, R., Reyes, M., Redmond, C., & Shin, C. (1999). Assessing a public health approach to delay onset and progression of adolescent substance use: Latent transition and loglinear analyses of longitudinal family preventive intervention outcomes. Journal of Consulting and Clinical Psychology, 67, 619-630.

      Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77(4), 620-632.

      Trudeau, L., Spoth, R., Randall, G. K., & Azevedo, K. (2007). Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: Gender comparisons. Journal of Youth and Adolescence, 36, 725-740.

      Guyll, M., Spoth, R. L., Chao, W., Wickrama, K. A. S., & Russell, D. (2004). Family-focused preventive interventions: Evaluating parental risk moderation of substance use trajectories. Journal of Family Psychology, 18 (2), 293-301.

      Redmond, C., Spoth, R., Shin, C., & Lepper, H. S. (1999). Modeling long-term parent outcomes of two universal family-focused preventive interventions: One-year follow-up results. Journal of Consulting and Clinical Psychology, 67, 975-984.

      Spoth, R., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatric and Adolescent Medicine, 160, 876-882.

      Spoth, R., Clair, S., & Trudeau, L. (2014). Universal family-focused intervention with young adolescents: Effects on health-risking sexual behaviors and STDs among young adults. Prevention Science 15 (Supplement 1), S47-S58.

      Spoth, R., Guyll, M., Trudeau, L., & Goldberg-Lilehoj, C. (2002) Two studies of proximal outcomes and implementation quality of universal preventive interventions in a community-university collaboration context. Journal of Community Psychology, 30, 499-518.

      Spoth, R., Redmond, C. & Lepper, H. (1999). Alcohol initiation outcomes of universal family-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol, 13, 103-111.

      Spoth, R., Redmond, C., & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes of two universal family-focused preventive interventions: Extending a public health-oriented research base. Journal of Consulting and Clinical Psychology, 66, 385-399.

      Spoth, R. L., Redmond, C., & Shin, C. (2000). Reducing adolescents' aggressive and hostile behaviors. Archives of Pediatric and Adolescent Medicine, 154, 1248-1257.

      Spoth, R., Redmond, C., & Shin, C. (2001). Randomized trial of brief family interventions for general populations: Reductions in adolescent substance use four years following baseline. Journal of Consulting and Clinical Psychology, 69, 627-642.

      Spoth, R., Redmond, C., Shin, C., & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting and Clinical Psychology, 72 (3), 535-542.

      Spoth, R., Reyes, M., Redmond, C., & Shin, C. (1999). Assessing a public health approach to delay onset and progression of adolescent substance use: Latent transition and loglinear analyses of longitudinal family preventive intervention outcomes. Journal of Consulting and Clinical Psychology, 67, 619-630.

      Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77 (4), 620-632.

      Trudeau, L., Spoth, R., Randall, G. K., & Azevedo, K. (2007). Longitudinal effects of a universal family-focused intervention on growth patterns of adolescent internalizing symptoms and polysubstance use: Gender comparisons. Journal of Youth and Adolescence, 36, 725-740.

      Evaluation Methodology

      Design:

      Recruitment/Sample Size: Participants in the study were families of sixth graders enrolled in 33 rural schools in 19 contiguous counties in a Midwestern state. Schools were selected for participation if 15% or more families in the school district were eligible for free or reduced-cost school lunches and community size was 8,500 or fewer. All families of sixth graders in participating schools (1,309) were recruited for participation. Of these families, 667 (51%) enrolled in the project and completed pre-testing in the fall of 1993. These families were similar to the eligible families on sociodemographic characteristics.

      Study type/Randomization/Intervention: The schools were randomly assigned to one of three experimental groups: a minimal contact control condition, or to one of the following universal family-focused preventive intervention programs: the Iowa Strengthening Families Program (ISFP, now known as Strengthening Families 10-14) or Preparing for the Drug Free Years (PDFY, now called Guiding Good Choices). A randomized block design was used, in which schools were blocked on the proportion of students who resided in lower income households and on school size. Each group included 11 schools, and pretested families included 238 in the ISFP group, 221 in the PDFY group, and 208 in the control group. Among the intervention groups, 117 families assigned to the ISFP condition participated in the program and 124 families assigned to the PDFY group participated.

      Assessment/Attrition: Assessments included self-reports and in-home interviews. After completion of the 7-week intervention, families were assessed approximately 6, 18, 30, 48, and 72 months following the pretest (when the students were in the sixth, seventh, eighth, tenth, and twelfth grades, respectively). An additional follow-up was conducted with the target children when they had entered young adulthood, at the approximate age of 21. These assessments constitute seven waves. From wave 2 (posttest) to wave 7 (young adult follow-up), overall attrition rates were 17.4%, 29.2%, 34.3%, 33%, 31.5%, and 27.4%.

      Sample Characteristics:

      The majority (over 98%) of participants was Caucasian and came from dual parent families (85%). Of these dual parent families, 64% included both of the target child's biological parents. In just more than half of these families, the target child was a girl. The mean ages of mothers and fathers were 37.0 and 39.6 years, respectively, and the large majority of both mothers and fathers (97% and 96%, respectively) had completed high school. The mean age of the target child was 11.3 years at the beginning of the study, and 51% were female. Comparisons between the ISFP and PDFY families and control families were equivalent at baseline.

      Measures:

      Assessments included in-home videotapes of families in structured family interaction tasks and in-home interviews that included scales from standardized instruments and commonly used measures such as the National Survey of Delinquency and Drug Use. Measures were drawn from the self-report and observational portions of the in-home interviews. Parent-child affective quality was assessed through self-reports (e.g., “How often did you let this child know you care about him/her” or “How often did you yell, insult or swear at the child during disagreements”), and observation (e.g., levels of warmth, hostility, contempt) of positive and negative affect. General child management assessed the self-reported frequencies of standard setting, child monitoring, consistent discipline, as well as the observed standard setting (listening, communication, reasoning) and consistent discipline. Targeted behaviors were developed from self-reports and assessed substance use rules and consequences, anger and emotion management, involving children in activities and decisions, and communication of parent intentions and values (targeted only by ISFP).

      Measures of alcohol initiation and use were obtained through self-reports, and analyses were conducted on both individual items and on the sum of these as an index (AII). The former included the following four questions: “Have you ever drunk beer, wine, wine coolers, whiskey, gin, or other liquor?” “Have you ever drunk beer, wine or liquor without your parent’s permission?” “Have you ever been drunk from drinking beer, wine, wine coolers, or liquor?” and “How many times have you had beer, wine, wine coolers, or other liquor in the past month?” The last question was coded “1" for one or more times and “0" for never. Substance use was measured according to lifetime cigarette use (“Have you ever smoked cigarettes?”), lifetime alcohol use (“Have you ever drunk beer, wine, wine coolers, whiskey, gin, or other liquor?”), and advanced substance use (which included several items due to low base rates, such as past month use of cigarettes and alcohol, lifetime drunkenness, and lifetime use of illicit substances). The collapsed model had five statuses: no use, alcohol experimentation, tobacco experimentation, experimentation with both alcohol and tobacco, and more advanced use. Five measures of specific lifetime use behavior (alcohol, alcohol without parental permission, drunkenness, cigarettes, and marijuana) were also evaluated individually.

      Aggressive and hostile behavior was measured using a multi-informant, multimethod format and included independent observer ratings of adolescent aggressive and hostile behaviors in adolescent-parent interactions, family member reports of aggressive and hostile behaviors in those interactions, and adolescent self-report of aggressive and destructive conduct across settings. Each measure represented an index, calculated as the number of individual behaviors serious or frequent enough to be considered currently problematic or indicative of progression towards serious aggressive or violent behaviors.

      Internalizing symptoms were assessed with the Anxiety-Depression index from the Child Behavior Checklist - Youth Report (CBCL-YSR), as the average of 15 items (e.g., "How true is each of these statements for you now or in the past 6 months: "I feel lonely," "I am nervous or tense," and "I am unhappy, fearful or depressed") rated on a three-point scale. Past month use of alcohol, cigarettes, smokeless tobacco, marijuana, inhalants, and other illicit drugs were coded "0" (no use) or "1" (use), and responses were summed to create a scale ranging from "0" (no past month use) to "6" (past month use of all substance categories); measured scores ranged from 0 to 5. Adolescent methamphetamine use was assessed with a single item: "For each substance listed below, please write down the number of times you used it during the past 12 months...took methamphetamines (meth)." The question was then dichotomized and recoded into 0 for no reported methamphetamine use and 1 for any reported methamphetamine use. These items were not included in the pre-test surveys but were added at the 12th grade assessment.

      Academic success was measured using multiple reports from mother, father and student response to the question, "Which of the following is closest to the grades 'your child' (or 'you' for student interviews) usually gets in school?" The responses were scored on a 9-point scale.

      School engagement was measured using an exploratory factor analysis of 12 items scored on a Likert-type scale ranging from 1 (strongly agree) to 5 (strongly disagree) following the stem "How much do you agree or disagree with these statements about school?" Three indicators assessing an affective, cognitive, and behavioral component of school engagement were created. Four items (e.g., "In general, I like school a lot") comprised the affective indicator. The cognitive indicator consisted of two items (e.g., "I know how to study and how to pay attention in class so that I will do well in school"). The third indicator of school engagement, observable behavior, consisted of three items and included statements such as "I usually finish my homework."

      Student substance-related risk was measured by three indicators, based on participant self-report questionnaire items. The first was the alcohol initiation index described above, the second consisted of a single item assessing the participant's attitude toward alcohol use: "How wrong do you think it is for someone your age to do any of the following things: drink beer, wine, wine coolers, or liquor?" Responses ranged from 1 (not at all wrong) to 4 (very wrong). The third indicator also consisted of a single item assessing the participant's potential response to peer pressure for alcohol use: "If you were at a party and one of your friends offered you an alcoholic drink, how likely would you be to--... Drink it." Responses ranged from 1 (very likely) to 5 (very unlikely).

      Four indicators of a proximal Parenting Competency outcome were developed from 13 self-report questionnaire items. These indicators measured: (1) Rules: parents' explanation of substance use rules and of consequences to their child when violations occur; (2) Involvement: parental efforts to involve their child in family activities and decisions; (3) Anger Management: parental management of anger and strong emotion in the parent-child relationship; and (4) Communication: parental activities to communicate understanding of children's feelings and goals as well as parental intentions and values. Five-point Likert-type items ranging from 1 (strongly agree) to 5 (strongly disagree) were used to construct each of the indicators.

      Wave 7 (young adulthood):

      Measures of substance use frequency included

      • drunkenness frequency (i.e., “How often do you usually get drunk?”);
      • alcohol-related problems (using a modified form of the Rutgers Alcohol Problems Index);
      • past year cigarette frequency (i.e., “During the past 12 months how often did you smoke cigarettes?”);
      • past year illicit drug frequency (using nine open-ended items asking “How many times in the past 12 months did you use [specific substance]?”);
      • a polysubstance use index created using the three measures of substance use, dichotomizing each variable to indicate use (1) or no use (0) of substances, and summing the three dichotomous items to form an index with values ranging from 0 (indicating no use of any substance) to 3 (indicating at least some occurrence of all three substance use behaviors).

      Measures of health-risking sexual behavior included

      • self-reports of the number of sexual partners in the past year;
      • condom use in the past year (with five responses ranging from “none of the time” to “always” and including a “don’t know” option);
      • substance use and sex to include two questions asking “When you have sex, how often have you been drinking alcohol” or “using drugs other than alcohol?” (including the same response options as for condom use);
      • Sexually Transmitted diseases with participants asked “Have you ever been diagnosed with a sexually transmitted disease (STD or VD) other than HIV/AIDS, such as gonorrhea, genital warts, chlamydia, trich, herpes, or syphilis?”

      Adolescent Alcohol, Tobacco, and Illicit Drug Initiation Index:

      A substance use initiation index was calculated using data from waves 1 to 6. This index is the sum of the five individual substance initiation measures, each scored so that “Yes” = 1 and “No” = 0 (with measures corrected for consistency so that when “Yes” was reported for initiation of any substance at any wave, responses were scored “Yes” for each subsequent wave). Scores ranged from 0, indicating no initiation, to 5, indicating the initiation of alcohol use (without parental permission), drunkenness, tobacco, marijuana, and other illicit drugs. Internal consistency for this index, as assessed by Cronbach’s alpha, averaged .60 across waves.

      Analysis:

      The types of analyses vary by report, but range from ANOVAS to structural equation modeling and growth curve analyses.

      Waves 3 and 4: One- and Two-year Follow-ups (Seventh and Eighth Grades)

      Spoth, Redmond, and Lepper (1999): The experimental effects at the one- and two-year follow-ups were based on ANCOVA F tests.

      Spoth, Reyes, Redmond, and Shin (1998): Loglinear analyses tested for group differences in a) the proportion of adolescents beginning and ending each of the two transition periods in the no-use status, and b) proportions of adolescents having initiated substance use who did not progress in use. Analyses include only those families that actually attended the intervention (n = 101 for PDFY, n = 91 for ISFP, and n = 137 for the control group adolescents).

      Wave 5: Four-year Follow-ups (Tenth Grade)

      Spoth, Redmond, and Shin (2000): Multilevel ANCOVAs were used to analyze the measures of observer ratings of aggressive and hostile behaviors in interactions.

      Wave 6: Six-year Follow-up (Twelfth Grade):

      Spoth, Redmond, Shin, and Azevedo (2004): Nonlinear growth curve analyses analyzed data collected six years following baseline (grade 12).

      Wave 7 (Young Adulthood)

      The long-term, young adult follow-up (Spoth et al., 2009, 2014) controlled for baseline outcomes with growth models, used all subjects with available data, and adjusted for clustering within schools.

      Following the use of hierarchical latent growth curve models to assess intervention effects on adolescent initiation of alcohol, tobacco, and/or drug use, the models examine adolescent initiation growth factor effects on 1) subsequent young adult substance use outcomes (Spoth et al., 2009), and 2) health-risking sexual behaviors and STDs (Spoth et al., 2014). Growth in initiation across time was modelled as linear, controlling for pretest effects on adolescent initiation and young adult substance use outcomes as well as gender, parent marital status, parent education level, and family income reported at pretest and accounting for school clustering by including school as a higher-level cluster variable. The influence of assignment to the intervention condition was incorporated via direct effects on both the intercept and slope factors of adolescent initiation, with resulting indirect effects on young adult outcomes through those growth factors to test for indirect intervention effects on young adult outcomes. The models use an intent-to-treat analysis with full-information maximum likelihood estimates for incomplete data.

      Outcomes:

      Implementation fidelity: Approximately 50% of pretested families attended at least one session with 94% of these families represented by a family member in five or more sessions, 88% attending six or seven sessions, and 62% attending all seven (Spoth, Clair, and Trudeau, 2014). Each team of intervention implementers was observed three or four times to assess whether the teams covered all key program content in ISFP. Coverage of the component tasks or activities described in the intervention manual showed an average coverage of 87% in the family session segments, 83% in the parent session segments, and 89% in the youth session segments (Spoth, Guyll, Trudeau, and Goldberg-Lillehoj, 2002).

      Baseline Equivalence: Intervention and control group participants were equivalent on family sociodemographic characteristics, reported substance use, and all outcome measures collected at pretest.

      Differential Attrition: At wave 5, Guyll et al. (2004) report that families failing to complete all five assessments had younger parents, parents with less education, and children who reported more alcohol use at pretest when compared to those who completed measures at all assessment points. At wave 7, the study states that there were no significant differences in attrition across conditions.

      Waves 2 and 3: Posttest and One Year Follow-up (Sixth and Seventh Grades)

      Direct and Indirect Effects of Parenting Outcomes (Spoth, Redmond, and Shin, 1998)

      Using posttest data, the effects of the intervention on one proximal and two distal parenting outcomes was tested. ISFP vs. control group comparisons: All hypothesized structural effects were statistically significant at the .01 level, and the indirect effects were significant for general child management and parent-child affective quality. The intervention effect size on targeted behaviors was .51. Extending this test to one year following posttest, results indicate that statistically significant effects on parenting outcomes were sustained (Redmond, Spoth, Shin, and Lepper, 1999).

      Implementation Adherence (Spoth, Guyll, Trudeau, and Goldberg-Lillehoj, 2002): Each team of intervention implementers was observed three or four times to assess whether the teams covered all key program content in ISFP. Coverage of the component tasks or activities described in the intervention manual showed an average coverage of 87% in the family session segments, 83% in the parent session segments, and 89% in the youth session segments. Eight schools achieved a level of adherence that allowed them to be classified as "higher adherence." "Lower adherence" schools were those in which at least one of the three session components was lower than 80% adherence and at least one other component was lower than 85% adherence. Three of the 11 schools were classified as lower adherence. Average adherence scores demonstrated a significant difference between groups.

      At post-test, the ISFP intervention produced significant positive effects on mean differences in the total sample, and in both the higher- and lower-adherence schools, on intervention-targeted parenting behaviors compared to the control group. These results were largely sustained at 1.5 years post-baseline, with the exception that the positive difference between the lower-adherence and the control condition schools did not attain significance. There were no significant mean differences between the intervention and control conditions for the substance refusal and resistance skill outcomes at either post-test or at 1.5 years post-baseline.

      Waves 3 and 4: One- and Two-year Follow-ups (Seventh and Eighth Grades)

      Spoth, Redmond, and Lepper (1999)

      Results indicated significantly lower Alcohol Initiation Index (AII) scores for intervention group compared to control group adolescents at both follow-ups, with effect sizes in the medium and large range: .26 for the one-year follow-up and .39 at two-years. Mean scores at one year were .50 for ISFP and .73 for control students; means at two years were .78 and 1.43, respectively.

      The percent and rate of new users of alcohol were also assessed. ISFP adolescents showed lower rates of initiation in each of the three alcohol ever-use measures at both follow-ups, relative to the control group: relative reductions for ISFP vs. control at one-year were 31.5% for alcohol use, 60.5% for using without permission, and 29.2% for ever being drunk; at two years, they were 45.1%, 56%, and 55.6% respectively.

      Analysis also revealed that relative reduction rates among children whose families attended over half the intervention sessions were higher than the intervention group children as a whole: 42.7% for alcohol use, 66.7% for using without permission, and 40.3% for ever being drunk at one year, and 41.7%, 54.5%, and 58.9% at two years.

      Latent Transition and Loglinear Analyses: (Spoth, Reyes, Redmond, and Shin, 1998)

      Loglinear analyses showed the absence of a significant experiment group x outcome interaction at the end of one year. This was confirmed with Z tests which showed that the estimated probability of a positive outcome at the one-year follow-up was higher, but not significantly so, for intervention group adolescents in all instances. At the two-year follow-up, there was a significant experiment group x outcome interaction effect, and Z tests confirmed that three of four tests were statistically significant (both tests for PDFY and one for ISFP). ISFP adolescents in the no use status at the one-year follow-up were more likely to remain in that status at the two-year follow-up, compared to control youth. Those who had already initiated substance use at the one-year follow-up were more likely to remain in this status compared to the control group, but this finding was only marginally significant at the .10 level. Thus, while substance use rates increased among all groups over the course of the study, transitions to substance use at the two-year follow-up were significantly lower among intervention group adolescents.

      Wave 5: Four-year Follow-up (Tenth Grade)

      Substance Use Outcomes (Spoth, Redmond, and Shin, 2001)

      At the end of tenth grade, the ISFP group relative to controls showed significantly lower new user proportions across five lifetime substance use measures (ever drank alcohol, ever drank without parent permission, ever been drunk, ever smoked cigarettes, ever used marijuana). The differences were highest for drunkenness and marijuana use, with relative reduction rates (i.e., the difference in the proportions of new users) for ISFP adolescents of 40.1% for having ever been drunk and 55.7% for having ever used marijuana.

      Differences in the proportion of adolescents using alcohol and tobacco in the past month, and marijuana in the past year were also examined at the tenth grade follow-up. Significantly lower proportions of ISFP youth, compared to the control group, reported past month alcohol use (with a relative reduction of 30%) and past month cigarette use (with a relative reduction of 46%). Thus, the findings reveal both primary prevention (delayed initiation) and secondary prevention (delayed progression) effects for adolescents receiving the ISFP intervention.

      The frequency of past month alcohol and cigarette use, as well as the alcohol composite and tobacco composite index scores, were lower at 10th grade for ISFP participants relative to controls. The marijuana use variable was too skewed for appropriate analysis.

      Aggressive and hostile behaviors at 10th Grade (Spoth, Redmond, and Shin, 2000)

      For the measures of observer ratings of aggressive and hostile behaviors in interactions, multilevel ANCOVA’s showed significantly lower scores on the observer rated index of aggressive and hostile behaviors in the ISFP group, compared to the control group, at the 10th grade assessment. Further examinations demonstrate that 49.2% of the control group exhibited some observable problematic behaviors, compared to 39.7% of the treatment group. When these interactions were analyzed separately by the sex of the parent, there was a significant experimental group difference in the aggressive and hostile behaviors exhibited towards mothers, with lower levels of aggression and hostility in the intervention group. No significant group differences were found with fathers.

      Although the observed aggressive and hostile behavior score was lower for the experimental group, analyses failed to show significant intervention control-group differences in the family member report of aggressive and hostile behaviors in parent-adolescent interactions at the 10th grade assessment. Supplemental analyses of outcomes using individual family reports demonstrate a significant experimental group difference in the aggressive and hostile behaviors exhibited towards mothers, with lower levels of aggression and hostility in the intervention group. As with the findings on the observer rated index, no significant group differences were found with fathers.

      The ISFP group demonstrated a significantly lower score than the control group on the adolescent report of aggressive and destructive conduct at the 10th grade follow up assessment. Multilevel ANCOVA’s demonstrate a low-medium effect with 1 in 4 of all control group adolescents (24.5%) reporting one or more aggressive or destructive behaviors, compared to 1 in 7 (14.6%) for the treatment group.

      Overall, findings demonstrate the reduction of adolescent aggressive and hostile behaviors for the ISFP group. Significant effects were found in the longitudinal analysis four years following the intervention in the independent observers of aggressive and hostile behaviors in adolescent-parent interactions and by an index of adolescent reports of aggressive and destructive conduct.

      Parental risk moderation of substance use trajectories (Guyll, Spoth, Chao, Wickrama, and Russell, 2004)

      This analysis investigated whether the family risk factor of parental social emotional maladjustment moderated the effects of ISFP and PDFY. With regard to main effects over a 4-year period, relative to control group adolescents, ISFP adolescents demonstrated both lower final levels of alcohol use and slower rates of increasing use across the time frame of the study. In contrast, the PDFY intervention did not significantly affect final levels of use but did significantly reduce the rates of increasing alcohol use. As with the results for alcohol use, the ISFP youth demonstrated lower levels of final tobacco use and slower rates of increasing use when compared to youth in the control group. No significant intervention effects for tobacco use were noted in comparisons between the PDFY and control adolescents.

      There was no indication that family risk moderated the effects of ISFP or PDFY on lower final levels of alcohol use or slower rates of increasing alcohol use over time. Results also revealed no tendency for family risk to moderate the effect of either ISFP or PDY on final levels of tobacco use or rates of increasing use over time.

      Wave 6: Six-year Follow-up (Twelfth Grade)

      Growth curve analyses (Spoth, Redmond, Shin, and Azevedo, 2004)

      At the six-year follow-up (six years following baseline, grade 12), nonlinear growth curve analysis demonstrated that adolescents in the ISFP condition had a slower overall growth in lifetime use of alcohol, lifetime cigarette use, and lifetime use of marijuana relative to controls. In addition, a significant pretest difference was observed for lifetime use of alcohol without parental permission. Within the ISFP group at baseline, a lower level of alcohol use without parental permission relative to the control group was noted, followed by a growth rate similar to controls, yielding a growth rate lagging behind that of the control group over the course of the study. Finally, there were significant differences in times to inflection points for three outcomes, the alcohol composite use index, lifetime drunkenness, and lifetime cigarette use. In all instances, control group growth rates reached their maximum values at an earlier point in time than in the ISFP group.

      Four outcomes showed significantly delayed growth rates to specific use levels (levels approximately half that of control group 12th-grade rates). This delayed growth was evident for initiation of alcohol use without parental permission, drunkenness, cigarette use, and the alcohol use composite index. The growth in substance use among PDFY adolescents lagged behind those of control group adolescents for the two tobacco outcomes (the tobacco composite use index and lifetime cigarette use).

      Internalizing symptoms and polysubstance use (Trudeau, Spoth, Randall, and Azevedo, 2007)

      The ISFP condition adolescents demonstrated a lower rate of increase across time on internalizing symptoms than control condition adolescents; however, ISFP did not have a significant effect on overall levels of internalizing across the time frame studies. It should be noted that approximately 18% of the adolescents surveyed scored in the borderline to clinical range of the CBCL-YSR anxious/depressed index on average across Waves 2-6. Supplemental analyses found that the intervention clearly had a positive impact on clinically significant levels of internalizing. By 12th grade, significantly fewer ISFP group adolescents scored at or above borderline range compared to the adolescents in the control group.

      ISFP adolescents demonstrated a lower overall level and a lower rate of increase in monthly polysubstance use across time (sixth through the 12th grade) compared with the control adolescents. The intervention slowed the rate of increase in polysubstance use over time significantly more for girls than for boys, although overall levels of use were lower in the intervention group for both genders. There were significant associations between internalizing and polysubstance use on both overall levels and rates of change of polysubstance use for girls, but not for boys. Girls demonstrated a higher overall level of internalizing, a greater rate of increase and a greater rate of deceleration over time than boys. Both boys and girls in the ISFP demonstrated a lower rate of increase in internalizing than control group adolescents.

      Methamphetamine Use (Spoth, Clair, Shin, and Redmond, 2006)

      At the 12th grade follow-up (the only data point at which information on methamphetamine use was collected), none of the 148 participants in the ISFP intervention condition reported using methamphetamines in the past year; among the 156 participants in the control condition, 5 (3.21%) reported use, resulting in a statistically significant difference. Among the PDFY condition participants, 5 (3.57%) reported using methamphetamines in the past 12 months - a rate similar to that in the control group.

      Wave 7: Long-term Follow-up in Young Adulthood (approximately age 21)

      Substance Use Frequency (Spoth, Trudeau, Guyll, Shin, and Redmond, 2009)

      For all models, the ISFP condition significantly predicted the slope for the adolescent substance initiation index, indicating slower growth in the index among ISFP subjects.

      The direct effects models found significant ISFP effects on drunkenness frequency and the polysubstance use index, a marginally significant direct effect on cigarette frequency (p<.10), and insignificant effects on alcohol-related problems and illicit drug frequency.

      Significant indirect effects of the ISFP intervention were observed for all outcome measures, with lower values reported by the intervention group when compared to the control group. The models including both direct and indirect effects found no improvements in model fit (when compared to the indirect effects models) for any of the outcome variables, or a significant direct intervention effect.

      The analysis of relative reduction rates found significant effects (p<.01, one-tailed) for the ISFP intervention on all dichotomized young adult outcome measures: drunkenness frequency, alcohol-related problems, cigarette frequency, illicit drug frequency, and on the polysubstance use index.

      Health-risking Sexual Behaviors and Sexually Transmitted Diseases (Spoth, Clair, and Trudeau, 2014)

      For all models, the ISFP condition predicted the slope for the adolescent substance initiation index (p<.01, one-tailed tests), indicating less change for the ISFP subjects.

      The direct effects models found significant ISFP program effects on lifetime STDs and substance use during sex.

      Significant indirect effects of the ISFP intervention (p<.01, one-tailed tests) were observed for lifetime sexually transmitted diseases, past year number of partners, and substance use during sex (but not condom use) with lower reported values among the intervention group when compared to the minimal contact control group. For lifetime STDs only, the model including direct and indirect effects showed a significant improvement in model fit (when compared to the indirect effects model) with the direct effect path being marginally significant (p=.043, one-tailed), and the total effect of ISFP on lifetime STDs significantly improved.

      Because failure to use condoms and substance use during sex is assumed by the researchers to be less likely in the context of a married or cohabitating relationship (when compared to single individuals), post hoc two-group analyses were run to test whether intervention effects for those two variables differed by relationship status. This analysis found that single individuals in the ISFP condition were significantly less likely to combine substance use with sex than single individuals in the control condition; however, the p-value for this analysis is not reported, and with one-tailed tests reported elsewhere, this difference may be only marginally significant (i.e., p<.10).

      The analysis of relative reduction rates found significant indirect effects (p<.01, one-tailed tests) for the ISFP intervention on lifetime STDs, number of sexual partners, and substance use during sex (but not condom use).

      Spoth, R. L., Redmond, C., Trudeau, L. & Shin, C.(2002). Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors, 2, 129-134.

      This study evaluated the substance initiation effects of an intervention combining family (the Strengthening Families Program 10-14) and school-based competency-training intervention components (Life Skills Training). Because the Strengthening Families Program 10-14 was evaluated in a combined condition that also included the Life Skills Training curriculum rather than in a separate experimental condition, this evaluation cannot be considered a replication of the Strengthening Families Program 10-14.

      Evaluation Methodology

      Design: Participants in the study were seventh graders enrolled in 36 randomly selected rural schools in 22 contiguous counties in a midwestern state. Criteria for the selection of the initial pool of schools were: 20% or more of households in the school district within 185% of the federal poverty level; community size (school district enrollment under 1,200); and all middle-school grades (6-8) taught at one location. A randomized block design guided the assignment of the 36 schools to one of three experimental conditions: 1) a combined Life Skills Training (LST) and Strengthening Families Program 10-14 (SFP 10-14) group, 2) an LST only group, and a no-treatment control group. Students in the combined LST and SFP 10-14 group received both curriculums, including booster sessions (n = 4 booster sessions for the SFP 10-14 and n = 5 booster sessions for LST), while students in the LST only group received the LST curriculum including 5 booster sessions. After schools were matched and randomly assigned to conditions, school officials were contacted and informed of the experimental condition to which their school had been assigned. All seventh grade students in participating schools were recruited for participation.

      On average, 46 students in each school completed the pre-test (n = 1,664 total), with 549 in the combined LST and SFP 10-14 group, 621 in the LST only group, and 494 in the control group. A total of 1,563 students completed the post-test (n = 517 in the combined LST and SFP 10-14 group, n = 583 in the LST only group, and n = 463 in the control group), while 1,372 students completed the one year follow-up (n = 453 in the LST and SFP 10-14 group, n = 503 in the LST only group, and n = 416 in the control group). At the 11th grade follow up (4.5 years post-baseline), a total of 558 families participated (n = 190 in the combined LST and SFP 10-14 group, n = 202 in the LST only group, and n = 196 in the control group), and at the 12th grade follow-up (5.5 years post-baseline), a total of 597 families participated (n = 191 in the combined LST and SFP 10-14 group, n = 209 in the LST only group, and n = 197 in the control group). For the evaluation of modeling factors influencing enrollment in the intervention, a total of 730 families were eligible for participation because they had previously completed a prospective telephone survey after the pre-test was administered.

      Data collection in the form of student surveys were completed in classrooms at pre-test, post-test (one month after completion of the intervention), at the one-year follow-up (one year after completion of the intervention), at the 11th grade follow-up and at the 12th grade follow-up. In addition, a bogus pipeline procedure was performed in order to promote honesty in answering smoking related questions. The sample was analyzed for pre-test equivalence on sociodemographic and outcome measures; the only significant difference discovered was that the control group contained more dual-parent families than the two intervention groups. This variable was included as a control variable in the subsequent outcome analyses. Analysis of differential attrition revealed no significant dropout by condition interactions from pre- to post-test or from post-test to follow-up for any outcome or sociodemographic variable. The only data reported from the 11th and 12th grade follow-ups was on past year and lifetime methamphetamine use.

      Sample: The sample was 53% male and predominantly Caucasian (96%).

      Measures: Self-reported use of alcohol, cigarettes, and marijuana was obtained from the classroom-administered questionnaire. Individual items included (a) "Have you ever had a drink of alcohol?", (b) "Have you ever smoked a cigarette?", (c) "Have you ever smoked marijuana or hashish?" All three items were answered using a yes/no format. Inconsistent reports in lifetime substance use were corrected. Lifetime use measures were adjusted to control for baseline use, with these adjusted lifetime use measures (new-user rates) indicating whether use was initiated since baseline. Three lifetime use items were individually examined and summed to form the substance initiation index (SII). Adolescent past year methamphetamine use was assessed using the single item: "In the past 12 months, how many times have you used methamphetamines (meth)?" Adolescent lifetime use of methamphetamines was assessed using the single time "Have you ever used methamphetamine (meth)?" These items were then dichotomized and recoded into 0 for respondents who did not use methamphetamines and 1 for those who did. These items were not included in the pre-test surveys, but were added at later waves, starting at the 7th grade spring semester data collection point (post-test), and at all subsequent waves of data collection.

      Implementation adherence was measured using a detailed checklist on which an observer rated whether or not the program implementer covered each aspect of each activity. A total of 25 to 50% of the total number of observed sessions for each of the three ISFP components was observed by a second observer to calculate interrater reliability. LST implementation forms allowed observers to record whether each lesson had been implemented as originally designed. Classroom observers were asked to evaluate a series of lesson objectives and activities and to indicate whether or not the program content was covered when the lesson was taught.

      As a part of the predictors of parental inclination to enroll in preventive interventions, three family sociodemographic factors were included: (a) respondent educational attainment, (b) number of children, and (c) household income. Respondent education was coded from 1-8 with 1 representing less than a high school education and 8 representing an advanced degree. Household income was coded on a 7-point scale, with 1 representing incomes of less than $5,000 and 7 representing incomes of greater than $75,000 annually.

      The parenting resource use measure was constructed as the mean of six 3-point items assessing the use of particular resources for parenting support during the previous two years. These resources included reading newspaper or magazine articles, talking with friends and relatives, talking to a religious leader, talking to a family counselor, use of support groups for parents, and attendance in skills-building programs. The response format included "not at all," "occasionally," or "regularly," except for the item on skills-building programs, which was originally scored 0-5 or more, then rescaled to have a 3-point range.

      A standardized measure of child behavior problems was modified to accommodate time constraints on the telephone interview. Nine problem behaviors (e.g., argues a lot, is disobedient at home, has temper tantrums or a hot temper) were assessed and scores were averaged into an overall measure of problematic behavior. Each behavior was rated by the parent as being "not true," "somewhat true," or "very true" of their 6th grader during the past 6 months.

      Analysis:

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

      Descriptive analyses of observed implementation adherence measures were conducted and interrater agreement was assessed. After determining the classification criteria for higher- versus low-adherence intervention implementation groups, the differences between the two groups were assessed using t -tests. Analyses of covariance were used to test for intervention outcome effects in the total sample, along with the higher-adherence and the lower-adherence subgroups. The analysis also included two planned contrasts: once comparing the LST-only condition with the control group, and one comparing the LST and SFP 10-14 combined group with the control group.

      Tests of statistical significance were conducted for methamphetamine use data only for those waves in which at least 5 participants reported methamphetamine use in at least one of the three conditions. Because of the small cell sized, the Fisher exact test was used to assess differences in methamphetamine use between the intervention and control conditions in each study.

      After conducting initial descriptive and correlational analyses, structural equation modeling was conducted with LSREL 8. Weights were applied to the sample data to adjust for differences in the sampling rates across the 36 schools (all families were selected in small schools; families were randomly selected from larger schools). Modeling analyses were based on a correlation matrix incorporating polychoric correlations. The overall fit of the model was determined through the likelihood ratio chi-square statistic, the Goodness-of-Fit Index (GFI), and Adjusted Goodness-of-Fit Index (AGFI), the Normed Fit Indwx (NFI), and Hoelter's Critical N (CN). T-tests were used to assess the statistical significance of individual model parameters. In addition, modification indices were examined for evidence of important parameter omissions. Finally, supplemental modeling analyses also were conducted using robust standard errors and full information techniques to assess possible biases associated with multivariate non-normality and missing data, respectively.

      Outcomes

      Because only initiation measures were applied in the outcome analysis, the post-test was considered to be the baseline time point (since the analyses examined differences in substance initiation after delivery of the interventions).

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

      New User Rates: The LST and SFP 10-14 combined condition demonstrated the lowest new user rate (for alcohol and marijuana) compared to the LST-only and control groups. The relative reduction rate (the percentage difference in the proportion of new users in the intervention group relative to the control group) for the combined condition was 30% for alcohol initiation, while the same rate for the LST-only condition was 4.1%. There were no significant findings associated with cigarette initiation.

      Implementation Adherence: Each LST classroom was observed either two or three times. As in Study 1, observers confirmed that a high level of program content was delivered; the average adherence level in the classroom implementation of LST was 85%. Higher-adherence schools were defined as those demonstrating that at least 80% of program content was delivered in all classrooms. Fifteen of 24 schools achieved that rate while eight were classified as lower-adherence. Mean LST intervention implementation adherence scores differed between the higher- and lower-adherence schools.

      Proximal outcome variables included substance-related knowledge, perceived substance use among peers and adults, and substance refusal and resistance skills. In both experimental conditions, the intervention tended to increase substance-related knowledge (smoking, drinking, and marijuana use knowledge) in both the total sample and in the higher-adherence schools at post-test. Compared with the higher-adherence schools, substance-use knowledge scores in the lower-adherence group of schools were influenced only in the LST condition, and not in the LST and SFP 10-14 combined condition. At the 1.5 year follow-up, positive intervention effects on substance-related knowledge remained, though fewer significant effects emerged. Effects on smoking knowledge were significant in the LST and SFP 10-14 combined condition for the total sample and higher-adherence schools, whereas positive effects emerged in the LST-only condition in the lower-adherence group of schools; drinking knowledge attained significance only for the LST-only condition in the lower-adherence group of schools. Students in both the LST and LST and SFP 10-14 combined schools viewed adult substance use to be less prevalent than did their counterparts in the control condition, for both the total sample and the higher-adherence group of schools. Overall, the pattern of means for perceptions of adult use remained stable from post-test to the 1.5 year follow-up, with significant effects still evident in the total sample and higher-adherence schools for both treatment groups, and positive effects in the lower-adherence schools becoming significant for the LST-only group.

      Long Term

      At the 11th grade follow-up, only 1 adolescent of the 187 in the combined LST and SFP 10-14 group reported using methamphetamines in the past year; among the 193 participants in the control condition, 8 reported use, resulting in a statistically significant difference. Of the 199 LST-only condition participants, 5 reported using methamphetamines in the past year, which was not statistically different from the control group. Of the 187 participants in the LST and SFP 10-14 group, only 1 reported lifetime methamphetamine use, while 10 of the 193 participants in the control condition reported lifetime use, a significant difference. Of the 199 LST-only participants, 5 reported lifetime methamphetamine use, which was not significantly different from the control group.

      At the 12th grade follow-up, 4 of the 189 participants in the combined LST and SFP 10-14 group reported past year methamphetamine use; 9 of the 196 participants in the control condition reported past year methamphetamine use, a non-significant difference. Of the 208 participants in the LST-only group, 3 reported past year methamphetamine use, a difference from the control group that approached statistical significance. A total of 5 of the 190 participants in the LST and SFP 10-14 combined group reported lifetime methamphetamine use, while 15 of the 197 participants in the control condition reported lifetime use, a significant difference. Of the 208 LST-only condition participants, 5 reported lifetime methamphetamine use, which was significantly different from the control group.

      Outcomes - Brief Bullets

      • The LST and SFP 10-14 combined condition demonstrated the lowest new user rate (for alcohol and marijuana) compared to the LST-only and control groups at one year after intervention posttest.
      • Significantly lower rates of past year and lifetime methamphetamine use in the LST and SFP 10-14 combined condition at the 11th grade follow-up.
      • Significantly lower rates of lifetime methamphetamine use in both the LST and SFP 10-14 and LST-only groups at the 12th grade follow-up.

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

      Limitations: Tests at the one year after intervention posttest were one-tailed.

      Coombes, L., Allen, D., & Foxcroft, D. (2012). An exploratory pilot study of the Strengthening Families programme 10-14 (UK). Drugs: Education, Prevention and Policy, 19 (5), 387-396.

      Evaluation Methodology

      Design: This exploratory, quasi-experimental study was designed to evaluate the effectiveness of an adapted version of the Strengthening Families Program 10-14 (UK) on a sample of children in the United Kingdom. A total of 53 parents/caregivers as well as 69 youth from 37 families were used in the evaluation. All youth were from three schools in England. Data were collected at baseline, post-test and at 3-month follow-up.

      Families were allocated to treatment or control conditions at the judgment of the researchers, who attempted to match the two groups on demographic characteristics. The intervention group included 26 parents/guardians and 34 youth. The control group included 27 parents/guardians and 35 youth. The program was delivered in schools for two of the locations and a community center for the third location.

      The evaluation used materials of the Strengthening Families program that were adapted for the UK. Here, the program was used as a universal intervention to target a whole population group that had not been identified on a basis of individual risk. Families with youth age 10-14 years were recruited from advertisements in three schools from three different geographical regions of the UK.

      • Location 1 was a city in England with approximately 77,040 people and 15 schools. The intervention was delivered in one school with children age 11-16 years. The school had a total of 323 students.
      • Location 2 was a former industrial town with a population of 71,599 and 14 schools. This location served as the control school, and contained children age 11-16. The population of this school was 956.
      • Location 3 was a city in south Whales with a population of 341,054 and 20 schools. Here, the school served children age 11-19 and had a total population of 737 students.

      Attrition: Of the 1,352 eligible families, 3% were recruited and completed baseline assessment. This included 53 parents/guardians and 69 youth. A total of 100% of the sample was retained at the 3-month follow-up.

      Sample: The percentage of population considered "White British" averaged 93% across the three locations (96% in Location 1, 91% in Location 2 and 92% in location 3). The mean age of parents/guardians was 38.2 years with a mean education of 13.3 years. A total of 43% of the families were dual-parent, and the mean number of children in the families was 3.2. The youth had a mean age of 11.2 years and 52% were female.

      Measures: All measures were self-report. Few details of the measures were provided, other than they were incorporated from validated measures used in previous SFP10-14 evaluations in the US.

      Youth measures included:

      • Substance use: Youth were asked about their alcohol and drug initiation and use.
      • Aggressive and destructive behavior: Youth were asked about their conduct and interpersonal relationships.
      • School absence: Youth were asked about school attendance.

      Parent measures included:

      • Parenting behavior: Parents were asked about discipline practices, setting standards and child-monitoring.
      • Family life: Parents were asked about family cohesion, expressiveness and conflict.

      Analysis: A quantitative analysis was conducted, but no details of the analysis are provided. However, a qualitative analysis of a small, purposive sample of parents/guardians (n = 14) was performed. Here, a content analysis of focus group discussions was analyzed for meaningful themes.

      Outcomes:

      Implementation fidelity: A total of three, 5-person teams conducted the intervention in the three locations. All team members were experienced facilitators who had undergone a 3-day training. Group size ranged from 6-7 families. A total of 98% of families were present at 5 or more of the sessions, 86% attended 6-7 sessions and 66% attended all 7 sessions.

      Baseline equivalence: There was no significant difference between baseline and control groups on sociodemographic variables, but differences in outcome variables were not examined.

      Differential attrition: The full sample was retained throughout the analysis.

      Post-test: There were no statistically significant effects. Qualitative analysis of treatment parents revealed that they listened more to their child when they were upset, worked together with their children to solve problems and had improved family functioning. Qualitative analysis of youth revealed the program was successful in teaching peer resistance skills and developing positive friendships. Youth also reported feeling an improved relationship with their family.

      Brief Bullets

      • There were no significant improvements in substance use, aggressive/destructive behavior, school absence, parenting behavior or family life.

      Limitations

      • Non-randomized, quasi-experimental design.
      • Small sample size and non-representative sample.
      • No details on the quantitative analysis.
      • Quantitative analysis produced no significant findings.

      Rulison, K. L., Feinberg, M., Gest, S. D., & Osgood, D. W. (2015). Diffusion of intervention effects: The impact of a family-based substance use prevention program on friends of participants. Journal of Adolescent Health, 57, 433-440.

      Evaluation Methodology

      Design:

      Recruitment: All non-exempt students who did not participate in the previous trial of SF10-14 (described in Study 1) were used for their post-intervention data. The participating 6th-grade students came from the 13 intervention communities only.

      Assignment: The participating students were originally assigned to the intervention and completed surveys that named their friends but choose not to participate in the program. Rather than using assignment, the study compared subjects with few and many friends who participated in the program. A majority consistently reported having no friends who attended SF10-14 (54-66%), while the rest reported between one and three friends attending SF10-14. No more than 1.2% ever reported having more than three friends attending the program.

      Attrition: Subjects completed a baseline survey at school in the fall of sixth grade and post-intervention follow-up surveys in spring of sixth, seventh, eighth, and ninth grade. Attrition is unclear. The text says only that, of the 5,449 students in the final analytic sample, 61.1% completed surveys at all four waves, 28.7% completed surveys at two or three waves, and 10.2% completed a survey at one wave.

      Sample:

      The sample was split evenly across gender (50.5% female), but was predominantly white in all four waves (~82%). There was a fairly high percentage receiving free or reduced-price lunches (~32-24%), and a majority of participants came from two-parent households (75-77%).

      Measures:

      To assess substance use, participants were asked about whether they had been drunk or smoked cigarettes in the last month. Anti-substance use attitudes were assessed on four standardized subscales of moral attitudes, expectations, refusal intentions, and refusal efficacy. Friends’ characteristics were collected to assess how many had friends participating in SF10-14 and how often they spent time with them doing “unstructured socializing.” Using the data collected on SF10-14 participants in previous studies/publications, researchers used these friends’ self-reports of substance use, parent – youth relationships, and parental discipline style.

      Analysis:

      The diffusion effects of SF10-14 were evaluated with multilevel models, nesting time within students within school cohorts. The models controlled for sociodemographic background factors but did not control for the baseline outcome (perhaps because levels were near zero at the start of 6th grade).

      Intent-to-Treat: The study appears to have used data from all participants, even if they completed only one wave of data collection.

      Outcomes

      Implementation Fidelity:

      Not applicable.

      Baseline Equivalence:

      Without conditions, the study examined selection by number of friends who participated in the program. It correlated this key measure with 15 baseline measures. Only one significant correlation emerged: frequency of attending religious services was significantly, although very weakly, correlated with mean proportion of SFP-attending friends across waves (r = .03, p = .044).

      A related issue concerns selection into non-participation in the program. The study compared those who participated in the program (and were not studied here) with those who did not participate (and made up the sample). Differences between nonparticipants and participants before program delivery would indicate selection bias. Of the 15 variables tested, three significant differences emerged: participants had higher grades, were more likely to come from a two-parent family, and attended religious services more often.

      Differential Attrition:

      Attrition was not discussed.

      Posttest and Long-term:

      In posttest and follow-up, the cumulative proportion of friends attending SF10-14 significantly reduced the self-reported likelihood of drunkenness and cigarette use. Unstructured, unsupervised time with friends also increased the odds of drunkenness and substance abuse and mediated the influence of the cumulative proportion of friends attending SF10-14.

      Limitations:

      • Compared self-selected groups
      • Few details on sample size
      • Little information on reliability and validity
      • No baseline controls, perhaps because outcomes were rare at start
      • Some evidence of non-equivalence at baseline
      • No analysis of differential attrition