Abstract
One of the important research issues in the emerging area of research on dissemination of prevention programs relates to the type and extent of training needed by program providers to prepare them to implement effective programs with fidelity. The present paper describes the immediate outcomes of a dissemination and implementation trial of Project Toward No Drug Abuse, an evidence-based prevention program for high school students. A total of 65 high schools in 14 school districts across the USA were recruited and randomly assigned to one of three experimental conditions: comprehensive implementation support for teachers, regular workshop training only, or standard care control. The comprehensive intervention was comprised of on-site coaching, web-based support, and technical assistance, in addition to the regular workshop. Students (n = 2,983) completed self-report surveys before and immediately after program implementation. Fidelity of implementation was assessed with a classroom observation procedure that focused on program process. Results indicated that relative to the controls, both intervention conditions produced effects on hypothesized program mediators, including greater gains in program-related knowledge; greater reductions in cigarette, marijuana and hard drug use intentions; and more positive changes in drug-related beliefs. There were stronger effects on implementation fidelity in the comprehensive, relative to the regular, training condition. However, seven of the ten immediate student outcome measures showed no significant differences between the two training conditions. The implications of these findings for dissemination research and practice are discussed.
Similar content being viewed by others
References
Abbott, R.D., O’Donnell, J., Hawkins, J.D., Hill, K.G., Kosterman, R., & Catalano, R.F. (1998). Changing teaching practices to promote achievement and bonding to school. American Journal of Orthopsychiatry, 68, 542–552.
Allison, K.R., Silverman, G., & Digman, C. (1990). Effects on students of teacher training in use of a drug education curriculum. Journal of Drug Education, 20, 31–46.
Ames, S.L., Sussman, S., & Dent, C.W. (1999). Pro-drug-use myths and competing constructs in prediction of substance use among youth at continuation high schools: A one-year prospective study. Personality and Individual Differences, 27, 987–1003.
Backer, T.E. (2000). The failure of success: Challenges of disseminating effective substance abuse prevention programs. Journal of Community Psychology, 28, 363–373.
Basen-Engquist, K., O’Hara-Tompkins, N., Lovato, C.Y., Lewis, M.J., Parcel, G.S., & Gingiss, P. (1994). The effect of two types of teacher training on implementation of Smart Choices: A tobacco prevention curriculum. Journal of School Health, 64, 334–339.
Botvin, G.J., Baker, E., Dusenbury, L., Tortu, S., & Botvin, E.M. (1990). Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: Results of a 3-year study. Journal of Consulting and Clinical Psychology, 58, 437–446.
Botvin, G.J., Baker, E., James-Ortiz, S., Botvin, E.M., & Kerner, J. (1992). Smoking prevention among urban minority youth: Assessing effects on outcome and mediating variables. Health Psychology, 11, 290–299.
Botvin, G.J., Griffin, K.W., Diaz, T., & Ifill-Williams, M. (2001). Drug abuse prevention among minority adolescents: One-year-follow-up of a school-based prevention intervention. Prevention Science, 2, 1–13.
Bowen, D.J., Sorensen, G., Weiner, B.J., Campbell, M., Emmons, K., & Melvin, C. (2009). Dissemination research in cancer control: Where are we and where should we go? Cancer Causes Control, 20, 473–485.
Connell, D.B., Turner, R.R., & Mason, E.F. (1985). Summary of findings of the School Health Education Evaluation: Health promotion effectiveness, implementation, and costs. Journal of School Health, 55, 316–321.
Dane, A.V., & Schneider, B.H. (1998). Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychology Review, 18, 2345.
Dent, C.W., Sussman, S., McCuller, W.J., & Stacy, A.W. (2001). Project towards no drug abuse: Generalizability to a general high school sample. Preventive Medicine, 32, 514–520.
Dent, C.W., Sussman, S., Hennesy, M., Galaif, E.R., Stacy, A.W., Moss, M., & Craig, S. (1998). Implementation and process evaluation of a school-based drug abuse prevention program: Project Towards No Drug Abuse. Journal of Drug Education, 28, 361–375.
Derzon, J.H., Sale, E., Springer, J.F., & Brounstein, P. (2005). Estimating intervention effectiveness: Synthetic project of field evaluation results. Journal of Primary Prevention, 26, 321–343.
Du Bois, D.L., Holloway, B.E., Valentine, J.C., & Cooper, H. (2002). Effectiveness of mentoring programs for youth: A meta-analytic review. American Journal of Community Psychology, 30, 157–198.
Durlak, J.A., & DuPre, E.P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.
Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W.B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research, 18, 237–256.
Ellickson, P.L., McCaffrey, D.F., Ghosh-Dastidar, B., & Longshore, D.L. (2003). New inroads in preventing adolescent drug use: Results from a large-scale trial of Project ALERT in middle schools. American Journal of Public Health, 93, 1830–1836.
Elliott, D.S., & Mihalic, S. (2004). Issues in disseminating and replicating effective prevention programs. Prevention Science, 5, 47–53.
Fagan, A.A., & Mihalic, S. (2003). Strategies for enhancing the adoption of school-based prevention programs: Lessons learned from the Blueprints for Violence Prevention replications of the Life Skills Training program. Journal of Community Psychology, 31, 235–253.
Fagan, A.A., Hanson, K., Hawkins, J.D., & Arthur, M.W. (2008). Bridging science to practice: Achieving prevention program implementation fidelity in the Community Youth Development Study. American Journal of Community Psychology, 41, 235–249.
Fixsen, D.L., Naoom, S.F., Blase, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).
Flay, B.R. (1986). Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Preventive Medicine, 15, 451–474.
Glasgow, R.E., Vogt, T.M., & Boles, S.M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89, 1322–1327.
Glasgow, R.E., Lichtenstein, E., & Marcus, A.G. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93, 1261–1266.
Gottfredson, D.C., & Gottfredson, G.D. (2002). Quality of school-based prevention programs: Results from a national survey. Journal of Research in Crime and Delinquency, 39, 3–35.
Gottfredson, D.C., & Wilson, D.B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4, 27–38.
Graham, J.W., Flay, B.R., Johnson, C.A., Hansen, W.B., Grossman, L.M., & Sobel, J.L. (1984). Reliability of self-report measures of drug use in prevention research: Evaluation of the Project SMART questionnaire via the test-retest reliability matrix. Journal of Drug Education, 14, 175–193.
Hansen, W.B., & McNeal, R.B. (1999). Drug education practice: Results of an observational study. Health Education Research, 14, 85–97.
Harrington, N.G., Giles, S.M., Hoyle, R.H., Feeney, G.J., & Yungbluth, S.C. (2001). Evaluation of the All Stars character education and problem behavior prevention program: Effects on mediator and outcome variables for middle school students. Health Education & Behavior, 28, 533–546.
Joyce, B., & Showers, B. (1980). Improving inservice training: The messages of research. Educational Leadership, 37, 379–385.
Joyce, B., & Showers, B. (2002). Student achievement through staff development (3rd ed.). Alexandria, VA: Association for Supervision and Curriculum Development.
Kam, C.-M., Greenberg, M.T., & Walls, C.T. (2003). Examining the role of implementation quality in school-based prevention using the PATHS curriculum. Prevention Science, 4, 55–63.
Komro, K.A., Perry, C.L., Veblen-Mortenson, S., Farbakhsh, K., Kugler, K.C., Alfano, K.A., et al. (2006). Cross-cultural adaptation and evaluation of a home-based program for alcohol use prevention among urban youth: The “Slick Tracy Home Team Program.” Journal of Primary Prevention, 27, 135–154.
Lau, R.R., Hartman, K.A., & Ware, J.E. (1986). Health as a value: Methodological and theoretical considerations. Health Psychology, 5, 25–43.
McCormick, L.K., Steckler, A., & McLeroy, K.R. (1995). Diffusion of innovations in schools: A study of adoption and implementation of school-based tobacco prevention curricula. American Journal of Health Promotion, 9, 210–219.
Mihalic, S.F., & Irwin, K. (2003). Blueprints for Violence Prevention: From research to real-world settings—Factors influencing the successful replication of model programs. Youth Violence and Juvenile Justice, 1, 307–329.
Mihalic, S., Fagan, A., & Argamaso, S. (2008). Implementing the Life Skills Training drug prevention program: Factors related to implementation fidelity. Implementation Science, 3, 5.
Mowbray, C.T., Holter, M.C., Teague, G.B., & Bybee, D. (2003). Fidelity criteria: Development, measurement, and validation. American Journal of Evaluation, 24, 315–340.
Murray, D.M. (1998). Design and analysis of group-randomized trials. New York: Oxford University Press.
Murray, D.M., & Hannan, P.J. (1990). Planning for the appropriate analysis in school-based drug-use prevention studies. Journal of Consulting and Clinical Psychology, 58, 458–468.
National Research Council and Institute of Medicine. (2009). Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research advances and promising interventions. In M. E. O’Connell, et al. (Eds.), Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.
Parcel, G., Ross, J., Lavin, A., Portnoy, B., Nelson, G., & Winters, F. (1991). Enhancing implementation of the teenage health teaching modules. Journal of School Health, 61, 35–38.
Perry, C.L., Murray, D.M., & Griffin, G. (1990). Evaluating the statewide dissemination of smoking prevention curricula: Factors in teacher compliance. Journal of School Health, 60, 501–504.
Ringwalt, C.R., Pankratz, M.M., Hansen, W.B., Dusenbury, L., Jackson-Newsom, J., Giles, S.M., et al. (2007). The potential of coaching as a strategy to improve the effectiveness of school-based substance use prevention curricula. Health Education and Behavior, 36, 696–710.
Ringwalt, C.R., Vincus, A., Ennett, S.T., Hanley, S., Bowling, J.M., & Rohrbach, L.A. (2009). The prevalence of evidence-based substance use prevention curricula in U.S. middle schools in 2005. Prevention Science, 10, 33–40.
Rohrbach, L.A., Graham, J.G., & Hansen, W.B. (1993). Diffusion of a school-based substance abuse program: Predictors of program implementation. Preventive Medicine, 22, 237–260.
Rohrbach, L.A., Sussman, S., Dent, C.W., & Sun, P. (2005). Tobacco, alcohol, and other drug use among high-risk young people: A five-year longitudinal study from adolescence to emerging adulthood. Journal of Drug Issues, 35, 333–356.
Rohrbach, L.A., Grana, R., Valente, T.W., & Sussman, S. (2006). Type II translation: Transporting prevention interventions from research to real-world settings. Evaluation in the Health Professions, 29, 302–333.
Rohrbach, L.A., Dent, C.W., Skara, S., Sun, P., & Sussman, S. (2007). Fidelity of implementation in Project Towards No Drug Abuse (TND): A comparison of classroom teachers and program specialists. Prevention Science, 8, 125–132.
Rosenbaum, P.R., & Rubin, D.B. (1984). Difficulties with regression analyses of age-adjusted rates. Biometrics, 40, 437–443.
Ross, J.G., Luepker, R.V., Nelson, G.D., Saavedra, P., & Hubbard, B.M. (1991). Teenage health teaching modules: Impact of teacher training on implementation and student outcomes. Journal of School Health, 61, 31.
SAS Institute (2004). SAS release 9.0. Cary, NC: SAS Institute.
Skara, S., Rohrbach, L.A., Sun, P., & Sussman, S. (2005). An evaluation of the fidelity of implementation of a school-based drug abuse prevention program: Project Towards No Drug Abuse (TND). Journal of Drug Education, 35, 305–329.
Spoth, R.L., Redmond, C., Shin, C., Greenberg, M., Clair, S., & Feinberg, M. (2007). Substance-use outcomes at 18 months past baseline: The PROSPER community-university partnership trial. American Journal of Preventive Medicine, 32, 395–402.
St. Pierre, T.L., Osgood, D.W., Mincemoyer, C.C., Kaltreider, D.L., & Kauh, T.J. (2005). Results of an independent evaluation of Project ALERT delivered in schools by cooperative extension. Prevention Science, 6, 305–317.
Sun, W., Skara, S., Sun, P., Dent, C.W., & Sussman, S. (2006). Project Towards No Drug Abuse: Long-term substance use outcomes evaluation. Preventive Medicine, 42, 188–192.
Sun, P., Dent, C.W., Sussman, S., & Rohrbach, L.A. (2008). One-year follow-up evaluation of Project Towards No Drug Abuse (TND4). Preventive Medicine, 47, 438–442.
Sussman, S., & Dent, C.W. (1996). Correlates of addiction concern among adolescents at high risk for substance abuse. Journal of Substance Abuse, 8, 361–370.
Sussman, S., Dent, C.W., & Stacy, A.W. (1996). The relation of pro-drug use myths with self-reported drug use among youth at continuation high schools. Journal of Applied Social Psychology, 26, 214–267.
Sussman, S., Dent, C.W., Simon, T.R., Stacy, A., & Craig, S. (1998). One year outcomes of Project Towards No Drug Abuse. Preventive Medicine, 27, 632–642 (Erratum: 27(5. Pt. 1), 766, 1998).
Sussman, S., Dent, C.W., & Stacy, A.W. (2002). Project Towards No Drug Abuse: A review of the findings and future directions. American Journal of Health Behavior, 26, 354–365.
Sussman, S., McCuller, W.J., & Dent, C.W. (2003a). The associations of social self-control, personality disorders, and demographics with drug use among high-risk youth. Addictive Behaviors, 28, 1159–1166.
Sussman, S., Sun, P., McCuller, W.J., & Dent, C.W. (2003b). Project Towards No Drug Abuse: Two-year outcomes of a trial that compares health educator delivery to self-instruction. Preventive Medicine, 37, 155–162.
Sussman, S., Rohrbach, L., & Mihalic, S. (2004a). Blueprints for violence prevention, book twelve: Project Towards No Drug Abuse. Boulder: Center for the Study and Prevention of Violence.
Sussman, S., Earleywine, M., Wills, T., Cody, C., Biglan, T., Dent, C.W., et al. (2004b). The motivation, skills, and decision-making model of ‘drug abuse’ prevention. Substance Use & Misuse, 39, 1971–2016.
Taggart, V., Bush, P., Zuckerman, A., & Theiss, P. (1990). A process evaluation of the District of Columbia ‘Know Your Body’ project. Journal of School Health, 60, 60–66.
Tobler, N.K. (1986). Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues, 16, 537–567.
Tobler, N.S., & Stratton, H.H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of the research. Journal of Primary Prevention, 18, 71–128.
Tobler, N.S., Roona, M.R., Ochshorn, P., Marshall, D.G., Streke, A.V., & Stackpole, K.M. (2000). School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention, 20, 275–336.
Valente, T.W., Ritt-Olson, A., Stacy, A., Unger, J.B., Okamoto, J., & Sussman, S. (2007). Peer acceleration: Effects of a social network tailored substance abuse prevention program among high-risk adolescents. Addiction, 102, 1804–1815.
Wills, T.A. (1986). Stress and coping in early adolescence: Relationships to substance use in urban school samples. Health Psychology, 5, 503–529.
Wilson, S.J., Lipsey, M.W., & Derzon, J.H. (2003). The effects of school-based intervention programs on aggressive behavior: A meta-analysis. Journal of Consulting and Clinical Psychology, 71, 136–149.
Woolf, S.H. (2008). The meaning of translational research and why it matters. Journal of the American Medical Association, 222, 211–213.
Acknowledgements
This study was funded by a grant from the National Institute on Drug Abuse (no. 1 R01 DA16090). The authors wish to thank Gaylene Gunning and Rachel Grana for their assistance in program management and data collection.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s11121-009-0155-8
Rights and permissions
About this article
Cite this article
Rohrbach, L.A., Gunning, M., Sun, P. et al. The Project Towards No Drug Abuse (TND) Dissemination Trial: Implementation Fidelity and Immediate Outcomes. Prev Sci 11, 77–88 (2010). https://doi.org/10.1007/s11121-009-0151-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-009-0151-z