标题：Longitudinal Effects of Universal Preventive Intervention on Prescription Drug Misuse: Three Randomized Controlled Trials With Late Adolescents and Young Adults
摘要：Objectives. We examined long-term prescription drug misuse outcomes in 3 randomized controlled trials evaluating brief universal preventive interventions conducted during middle school. Methods. In 3 studies, we tested the Iowa Strengthening Families Program (ISFP); evaluated a revised ISFP, the Strengthening Families Program: For Parents and Youth 10–14 plus the school-based Life Skills Training (SFP 10–14 + LST); and examined the SFP 10–14 plus 1 of 3 school-based interventions. Self-reported outcomes were prescription opioid misuse (POM) and lifetime prescription drug misuse overall (PDMO). Results. In study 1, ISFP showed significant effects on POM and PDMO, relative reduction rates (RRRs; age 25 years) of 65%, and comparable benefits for higher- and lower-risk subgroups. In study 2, SFP 10–14 + LST showed significant or marginally significant effects on POM and PDMO across all ages (21, 22, and 25 years); higher-risk participants showed stronger effects (RRRs = 32%–79%). In study 3, we found significant results for POM and PDMO (12th grade RRRs = 20%–21%); higher-risk and lower-risk participants showed comparable outcomes. Conclusions. Brief universal interventions have potential for public health impact by reducing prescription drug misuse among adolescents and young adults. The Centers for Disease Control and Prevention and the Office of National Drug Control Policy have declared that prescription drug misuse is epidemic; 1,2 a US Surgeon General Expert Panel on Prescription Drug Abuse convened in 2011 has called for universal preventive intervention. Both Centers for Disease Control and Prevention data and expert panel findings have demonstrated that prescription drug misuse (PDM) is a major public health problem. Among adolescents and young adults (aged 12–25 years), the only illicit drug that is abused more frequently is marijuana. 3–5 Nationally, in 2010, the rate of lifetime PDM for those aged 12 to 18 years was 22%; for those aged 18 to 25 years, it was 26%. 3,5 Notably, adolescent PDM can be somewhat higher in rural areas than in urban and suburban areas. 6 Negative health consequences of escalating PDM include increased injuries and hospitalizations, physical and sexual assaults, sexually transmitted infections, and poisoning deaths; longer-term physical health problems include brain damage and learning disability. 2,7–9 Moreover, PDM is highly comorbid with psychiatric disorders (e.g., depressive and anxiety disorders), along with alcohol or drug use disorders. 10–13 Generally, individuals who misuse prescription drugs are more likely to use other illicit drugs 14,15 and, especially in combination with opiate misuse, engage in more violence. 16 Finally, PDM is associated with other problem behaviors among high school and college students (e.g., suspension or expulsion, driving after drinking, or being a passenger with a drunk driver). 17,18 Observing that the most common sources of prescription narcotics are friends and relatives 2,5,17,18 and noting the limited uptake of preventive interventions that effectively address the problem, the Surgeon General Expert Panel recommended that a range of evidence-based preventive interventions targeting PDM be developed, tested, and broadly implemented. 19,20 We, however, could find no randomized controlled studies of community-based, universal preventive interventions that targeted PDM and established long-term effects. An alternative approach entails community-based interventions that were not specifically designed to address PDM but, rather, substance misuse more generally. 15,21,22 Programs addressing the problem as part of a broader intervention to reduce youth risky behaviors could be effective and efficient (i.e., they could reduce the need for multiple programs targeting individual substances). Among universal interventions not specifically directed toward PDM, it is important to consider ones that (1) effectively address multiple risk and protective factors common among many different types of substance misuse; (2) have demonstrated crossover effects on diverse outcomes, such as conduct problems and health-risking sexual behaviors; and (3) have shown positive effects among higher - risk populations. 20 These features characterize the interventions evaluated for this article. Guided by etiological research, several substance misuse preventive interventions have been designed to reduce risk and enhance protective factors by modifying family and school environments or building youth competencies. 23 These interventions have been shown to produce a wide range of positive outcomes (e.g., enhanced youth life skills and academic performance, improved parenting and family functioning, reduced youth health-risking sexual behaviors, substance misuse, and conduct problems) as many as 10 years past baseline. 24 In this article, we summarize results of 3 randomized controlled studies testing universal preventive interventions implemented during middle school. Originally, the trials were designed to test universal interventions addressing other outcomes; adding PDM measures allowed us to examine these outcomes long term. As noted earlier, few studies have tested universal prevention programs on PDM, and no studies have examined results 6 to 14 years past program implementation into late adolescence and young adulthood—an important developmental stage when PDM can affect many areas of functioning. 11,17 The 3 trials extend or replicate analyses of a family-focused program, either standing alone (study 1) or implemented in combination with school-based programs (studies 2 and 3). Analyses of study 1 and study 2 PDM outcomes at earlier ages were summarized in a previous article. 25 For this article, we (1) examined longer - term outcomes from young adult follow-up assessments (in studies 1 and 2) and (2) evaluated risk-related moderation of outcomes to determine whether comparable or stronger effects existed for higher - risk subsamples. In study 3, we examined the same outcomes among late adolescents (grade 12) in more recent cohorts, with real-world intervention implementation that entailed programming organized and delivered by local community teams.
