摘要：Objectives. We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. Methods. Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. Results. The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. Conclusions. School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments. Although drug use among secondary school students appears to have leveled off during the late 1990s, 1 US adolescents continue to use alcohol, tobacco, and marijuana at unacceptably high rates. Among 8th-graders, 52% have tried alcohol, 41% have tried cigarettes, and 20% have tried marijuana. 1 By 12th grade, these rates are substantially higher, with large numbers of adolescents engaging in regular drug use. These statistics give society cause for concern. Adolescent use of alcohol and marijuana contributes to traffic accidents and deaths, 2 poor judgment and coordination, unsafe sexual practices, and other risky behaviors. 3, 4 Cigarette use continues to be the leading cause of preventable death, 5 and early experimentation is highly likely to escalate into regular smoking. 6 Use of any of these 3 substances predicts behaviors that have productivity and public health consequences, such as school failure, violence, and emotional distress. 7– 12 Federal drug control initiatives and the health care community recognize the importance of targeting drug prevention efforts at adolescents to give them the skills and the knowledge to reach adulthood without chemical dependency problems. 13, 14 Furthermore, a number of professional organizations, including the American Medical Association and the American Academy of Pediatrics, have issued guidelines and policy statements urging physicians to actively support and participate in such efforts. 15, 16 Drug prevention programs in schools are a critical element of the antidrug effort, yet only 9% of school districts are using programs whose effectiveness has been demonstrated through rigorous research. 17 Recognizing that ineffective programs are costly and do not serve the nation’s youth, the US Department of Education set as one of the guidelines of its Safe and Drug-Free Schools and Communities Act Program the implementation of only evidence-based prevention activities. In 2001, the Department of Education designated 7 drug prevention programs as exemplary, 5 of which included a school-based curriculum for middle school adolescents. 18 One of the most successful evidence-based programs is Project ALERT, a drug prevention curriculum for middle school students that has been recognized as an exemplary program by the Department of Education and as a model program by the Center for Substance Abuse Prevention. Project ALERT seeks to motivate students against using drugs and to give them the skills they need to translate that motivation into effective resistance behavior, an approach that is widely viewed as the state of the art in drug use prevention. 19– 24 In the initial evaluation of Project ALERT conducted on the West Coast, Ellickson and Bell 25 found that the program effectively prevented or reduced both cigarette and marijuana use among 8th-grade students, although it did not help committed cigarette smokers. Project ALERT also had a modest initial impact on alcohol use, but this disappeared by 8th grade. The authors concluded that the program’s effectiveness might be improved if it put more emphasis on curbing alcohol misuse (as opposed to any use at all), found a way to help the more confirmed smokers, and brought parents into the prevention process. 26 In an unusual move for an already successful program, we revised the Project ALERT curriculum along these lines to strengthen its effectiveness. To broaden the program’s generalizability to the Midwest, we conducted a randomized trial of its effectiveness in South Dakota, drawing on schools in urban, small-town, and rural communities. Although alcohol, tobacco, and other drug use is now as prevalent in rural areas as in urban areas (and actually is higher in the Plains states than elsewhere for some substances), 27– 32 drug prevention programs, including Project ALERT, have been tested more extensively in urban and suburban school districts. 33 We evaluated the revised Project ALERT middle school curriculum over 18 months (fall of 1997 to spring of 1999) during a large-scale randomized trial. That trial also included a high school component, ALERT Plus, which is not addressed in this article. In designing the experimental trial, we tried to avoid methodological problems that have plagued many school-based evaluations, such as lack of random assignment, inadequate use of control variables to rule out alternative explanations of the results, and failure to adjust statistical tests to account for clustering of students within schools. 34 We also provided information about 2 indicators of effectiveness that have received limited attention in the literature: (1) program impacts on high-risk adolescents and (2) program effects on regular substance use and misuse.
