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The Healthy for Life Project: Behavioral Outcomes

Abstract

The Healthy for Life program was designed to positively influence the health behaviors of middle school students in five related areas: alcohol, tobacco and marijuana use, nutrition and sexuality. The in-school, social influences program was supplemented by parent and community components. Twenty-one schools were assigned to two treatment conditions or a random control. Students (n = 2,483) were surveyed annually from grade 6 until grade 10. The results indicate that overall Healthy for Life had minimal effect on the participating students relative to those in the control schools. The Intensive version of the program was more effective than an Age Appropriate version, with small positive results on four measures (frequency of meals, perceptions of peer use, cigarettes and marijuana smoked) and small negative effects for drinking alcohol. Implications for prevention theory are suggested.

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References

  • Beane, J. (1990). Middle school curriculum: From rhetoric to reality. Columbus, OH: National Middle School Association.

    Google Scholar 

  • Botvin, G. J., Baker, R. & Botvin, E. M. (1983). The effects of scheduling format and booster sessions on a broad spectrum psychosocial approach to smoking prevention. Journal of Behavioral Medicine 6:359-379.

    Google Scholar 

  • Botvin, G. J. (1986). Substance abuse prevention research: Recent developments and future directions. Journal of School Health 56(9), 369-374.

    Google Scholar 

  • Botvin, G. J. & Botvin, E. M. (1992). Adolescent tobacco, alcohol and drug abuse: Prevention strategies, empirical findings and assessment issues. Developmental and Behavioral Pediatrics 13 (4), 290-301.

    Google Scholar 

  • Brown, B. B. (1990). Peer groups and peer cultures. In S. S. Feldman, and G. R. Elliott (Eds.), At the threshold: The developing adolescent (pp. 171-196). Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Brown, J. H. & Horowitz, J. E. (1993). Deviance and deviants: Why adolescent substance use prevention programs do not work. Evaluation Review 17 (5), 529-555.

    Google Scholar 

  • Bruvold, W. H. (1993). A meta-analysis of adolescent smoking prevention programs. American Journal of Public Health 83 (6, June), 872-880.

    Google Scholar 

  • Bryk, A. S. & Raudenbush, S. W. (1992). Hierarchical linear models: Applications and data analysis methods. Newbury Park, CA: Sage Publications, Inc.

    Google Scholar 

  • Bryk, A. S., Raudenbush, S. W., and Congdon, R. T (1996). HLM: Hierarchical linear and nonlinear modeling with the HLM/2L and HLM/3L programs. Chicago: Scientific Software International.

    Google Scholar 

  • Bukoski, W. J. (1991). A framework for drug abuse prevention research. In C. G. Leukefeld and W. J. Bukoski (Eds.), Drug Abuse Prevention Intervention Research: Methodological Issues (pp. 7-28). Washington DC: US Government Printing Office.

    Google Scholar 

  • Carnegie Council on Adolescent Development. (1989). Turning points: Preparing American youth for the 21st century. New York: Author.

    Google Scholar 

  • Chewning, B., Van Koningsveld, R., Hawkins, R., Gustafson, D., Bosworth, K. & Lohr, S. (1987). Sexual risk-taking as part of larger adolescent risk-taking behavior. Paper presented. Annual Meeting of the American Public Health Association. New Orleans, LA., October.

  • Chewning, B. & Van Koningsveld, R. (1988). Adolescent sexual risk-taking: Antecedents and sequelae. Report to the Office of Population Affairs.

  • Connell, D. B., Turner, R. R. & Mason, E. F. (1985). Summary of the findings of the school health education evaluation: Health promotion effectiveness, implementation, and costs. Journal of School Health 55 (8), 316-321.

    Google Scholar 

  • Cook, T. D. & Walberg, H. J. (1985). Methodological and substantive significance. Journal of School Health 55 (8, October), 340-342.

    Google Scholar 

  • Dryfoos, J. G. (1990). Adolescents at risk. New York: Oxford University Press.

    Google Scholar 

  • Dryfoos, J. G. (1993). Preventing substance use: Rethinking strategies. American Journal of Public Health, 83, 793-795.

    Google Scholar 

  • D'Emdio-Caston, M. & Brown, J. H. (1998). The other side of the story: Student narratives on the California Drug, Alcohol, and Tobacco Education Programs. Evaluation Review 22 (1, February), 95-117.

    Google Scholar 

  • Eckert, P. (1983). Beyond the statistics of adolescent smoking. American Journal of Public Health 73 (4), 4-9.

    Google Scholar 

  • Ellickson, P. L., Bell, R. M. & McGuigan, K. (1993). Preventing adolescent drug use: Long-term results of a junior high program. American Journal of Public Health 83, 856-861.

    Google Scholar 

  • Flay, B. R. (1985). Psychosocial approaches to smoking prevention: A review of findings. Health Psychology 4 (5), 449-488.

    Google Scholar 

  • Flay, B. R., Koepke, D., Thomson, S. J., Santi, S., Best, A. & Brown, K. S. (1989). Six-Year follow-up of the first Waterloo School Smoking Prevention Trial. American Journal of Public Health 79 (10), 1371-1376.

    Google Scholar 

  • Gorman, D. M. (1998). The irrelevance of evidence in the development of school-based drug prevention policy, 1986–1996. Evaluation Review 22 (1, February), 95-117.

    Google Scholar 

  • Hansen, W. B., Anderson-Johnson, C., Flay, B. R., Graham, J. W. & Sobel, J. (1988). Affective and social influences approaches to the prevention of multiple substance abuse among seventh grade students: Results from Project SMART. Preventive Medicine 17 (2), 135-154.

    Google Scholar 

  • Hawkins, J. D., Catalano, R. F. & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin 112, 64-105.

    Google Scholar 

  • Hennessy, M. (1994). Adolescent syndromes of risk for HIV infection. Evaluation Review 18 (3), 312-341.

    Google Scholar 

  • Hill, H., Piper, D. & King, M. (1993). The nature of school-based prevention experiences for middle school students. Journal of Health Education 24 (6), 15-23.

    Google Scholar 

  • Hill, H., Piper, D. & Moberg, D. P. (1994–95). 'Us planning prevention for them:' The social construction of community prevention activities for youth. International Quarterly of Community Health Education 15 (1), 65-89.

    Google Scholar 

  • Holtzman, D., Mathias, M. P., Kann, L., Collins, J. L. & Kolbe, L. J. (1995). Trends in risk behaviors for HIV infection among U.S. high school students, 1989–1991. AIDs Education and Prevention 7 (3), 265-277.

    Google Scholar 

  • Howard, M. (1992). Delaying the start of intercourse among adolescents. Adolescent Medicine: State of the Art Reviews 3 (2), 181-193.

    Google Scholar 

  • Howard, M. & McCabe, J. B. (1990). Helping teenagers postpone sexual involvement. Family Planning Perspective 22 (1), 21-26.

    Google Scholar 

  • Jessor, R. & Jessor, S. L. (1977). Problem Behavior and Psychosocial Development. New York: Academic Press.

    Google Scholar 

  • Johnson, C. A., Pentz, M. A., Weber, M. D., Dwyer, J. H., Baer, N., MacKinnon, D. P. & Hansen, W. B. (1990). Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents. Journal of Consulting and Clinical Psychology 58 (4), 447-456.

    Google Scholar 

  • Klitzner, M.D. (1988). An Assessment of the Research on School-Based Prevention Programs. Prepared for the U.S; Department of Education's Report to Congress on the Nature and Effectiveness of Federal, State and Local Drug Prevention/Education Programs. Vienna, VA: Center for Advanced Health Studies.

    Google Scholar 

  • Klitzner, M. D., Fisher, D., Moskowitz, J., Stewart, K. & Gilbert, S. (1991). Report to the Robert Wood Johnson Foundation on Strategies to Prevent the Onset and Use of Addictive and Abusable Substances Among Children and Early Adolescents. Bethesda. MD: Pacific Institute for Research and Evaluation.

    Google Scholar 

  • Koepke, M. D. & Flay, B. R. (1989). Levels of analysis. In M. T. Braverman (Ed.), New Directions for Program Evaluation, Vol. 43: Evaluating Health Promotion Programs (pp. 75-87). San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Krahn, D., Piper, D. L., King, M., Olson, L. & Moberg, D. P. Frequency of Dieting in the Sixth Grade Predicts Alcohol Use in the 9th Grade. Journal of Substance Abuse 8 (3): 293-301.

  • Kreft, I. G. G. (1994). Multilevel models for hierarchically nested data: Potential applications in substance abuse prevention research. In L. M. Collins, and L. A. Seitz (Eds.) Research Monograph Series, pp. 141-183. Rockville, MD: National Institute on Drug Abuse.

    Google Scholar 

  • Levin, J. R. & Serlin, R. C. (1993). No way to treat a classroom: Alternative units-appropriate statistical strategies. Paper. Annual Meeting of the American Educational Research Association. Atlanta, GA, April.

  • Mason, D. T., Lusk, M. W. & Gintzler, M. (1992). Beyond ideology in drug policy: The primary prevention model. The Journal of Drug Issues 4 (22), 959-976.

    Google Scholar 

  • Mauss, A. L., Hopkins, R. H., Weisheit, R. H. & Kearney, K. A. (1988). The problematic prospects for prevention in the classroom: Should alcohol education be expected to reduce drinking by youth. Journal of Studies on Alcohol 49 (1), 51-61.

    Google Scholar 

  • Maxwell, S. E., Delaney, H. D. & Dill, C. A. (1984). Another look at ANCOVA versus blocking. Psychological Bulletin 95 (1), 136-147.

    Google Scholar 

  • McCord, J. (1990). Problem behaviors. In S. S. Feldman, and G. R. Elliot (Eds.) At The Threshold: The Developing Adolescent, pp. 414-430. Boston MA.: Harvard University Press.

    Google Scholar 

  • Millstien, S. G. & Litt, I. F. (1990). Adolescent health. In S. S. Feldman, and G. R. Elliot (Eds.) At The Threshold: The Developing Adolescent, pp. 431-456. Boston MA.: Harvard University Press.

    Google Scholar 

  • Moberg, D. P. & Piper, D. L. (1990a). An outcome evaluation of Project Model Health: A middle school health promotion program. Health Education Quarterly 17 (1), 37-51.

    Google Scholar 

  • Moberg, D. P. & Piper, D. L. (1990b). Obtaining active parental consent via telephone in adolescent substance abuse prevention research. Evaluation Review 14 (3), 315-323.

    Google Scholar 

  • Moberg, D. P., Piper, D. L., Wu, J. Y. & Serlin, R. C. (1993). When total randomization is impossible: Nested randomized assignment. Evaluation Review 17 (3), 271-291.

    Google Scholar 

  • Moberg, D. P. & Piper, D. L. (1998). The Healthy for Life Project: Sexual risk behavior outcomes. AIDS Education and Prevention 10 (2), 128-148.

    Google Scholar 

  • Moskowitz, J. M. (1989). Preliminary guidelines for reporting outcome evaluation studies of health promotion and disease prevention programs. In M. T. Braverman (Eds.), Evaluating Health Promotion Programs, pp. 101-112. San Francisco, CA: Jossey-Bass

    Google Scholar 

  • Moskowitz, J. M. (1993). Why reports of outcome evaluations are often biased or uninterpretable: examples from evaluations of drug abuse prevention programs. Evaluation and Program Planning 16, 1-9.

    Google Scholar 

  • Murray, D.M. & Perry, C. L. (1985). The prevention of adolescent drug abuse: Implications of etiological, developmental, behavioral and environmental models. In C. L. Jones and R. Battjes (Eds.), Etiology of Drug Abuse: Implications for Prevention (pp. 236-356). Rockville MD: National Institute on Drug Abuse.

    Google Scholar 

  • Murray, D. M., O'Connell, C. M., Schmid, L. A. & Perry C. L. (1986). The validity of smoking selfreports by adolescents: A re-examination of the Bogus Pipeline Procedure. Addictive Behavior 12 (7), 15.

    Google Scholar 

  • 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 (4), 458-468.

    Google Scholar 

  • Murray, D. M. & Wolfinger, R. D. (1994). Analysis issues in the evaluation of community trials: Progress toward solutions in SAS/STAT MIXED. Journal of Community Psychology Monograph Series (CSAP Special Issue), 140-155.

  • Murray, D. M., Hannan, P. J. & Baker, W. L. (1996). A Monte Carlo study of alternative responses to intraclass correlation in community trials. Evaluation Review 20 (3, June), 313-337.

    Google Scholar 

  • Olejnik, S. & Algina, J. (1985). Development and application of the student test used in the school health education evaluation. Journal of School Health 55 (8), 309-315.

    Google Scholar 

  • Pechacek, T. F., Murray, D. M., Luepker, R. V., Mittelmark, M. B., Anderson Johnson, C. & Schutz, J. M. (1984). Measurement of adolescents' smoking behavior: Rationale and methods. Journal of Behavioral Medicine 7 (1), 123-140.

    Google Scholar 

  • Pentz, M. A. (1983). Prevention of adolescent substance abuse through social skills development. In T. J. Glynn, and J. P. Ludford (Eds.), Preventing Adolescent Drug Abuse. NIDA Monograph 47 (pp. 195-232). Rockville, MD: National Institute on Drug Abuse.

    Google Scholar 

  • Pentz, M. A., Dwyer, J. H., MacKinnon, D. P., Flay, B. R., Hansen, W. B., Wang, E. & Johnson, CA. (1989). A multi-community trial for primary prevention of adolescent drug abuse: Effects on drug use prevalence. Journal of the American Medical Association 261 (22), 2359-3266.

    Google Scholar 

  • Perry, C. L. & Grant, M. (1988). Comparing peer-led to teacher-led youth alcohol education in four countries. Alcohol Health and Research World 12 (4), 322-326.

    Google Scholar 

  • Perry, C. L. & Jessor, R. (1985). The concept of health promotion and the prevention of adolescent drug abuse. Health Education Quarterly 12, 169-184.

    Google Scholar 

  • Piper, D. L., Moberg, D. P., King, M. J., Jiyuan Wu, Wright, S. & Hill, H. (1993a). Final Report: HEALTHY FOR LIFE—An Efficacy Test of Two Program Versions. Report to the National Institute on Drug Abuse.

  • Piper, D. L., King, M. & Moberg, D. P. (1993b). Implementing large-scale health promotion research projects: Lessons your textbook didn't teach you. Evaluation and Program Planning 16, 171-180.

    Google Scholar 

  • Piper, D. L., Rudstam, H. H., King, M. & Moberg, D. P. (manuscript). Peer influences and resistance to substance use: rethinking refusal skills and school-based prevention.

  • Reichardt, C. (1979). The statistical analysis of data from nonequivalent group design. In T. Cook, and D. Campbell (Eds.), Quasi Experimentation (pp. 147-205). Chicago, IL: Rand McNally.

    Google Scholar 

  • Rooney, B. L. & Murray, D. M. (1996). A meta-analysis of smoking prevention programs after adjustment for errors in the unit of analysis. Health Education Quarterly 23 (1), 48-64.

    Google Scholar 

  • Slavin, R. (1988). Cooperative Learning and Student Achievement. Center for Research on Elementary and Middle Schools. Baltimore: The Johns Hopkins University.

    Google Scholar 

  • Slavin, R., Karwelt, N. L. & Madden, N. A. (1990). Effective Programs for Students at Risk. Boston, MA: Allyn and Bacon.

    Google Scholar 

  • Stephenson, C. (1991). Teaching 10 to 14 YR Olds. White Plains, NY: Longman.

    Google Scholar 

  • Tobler, N. S. (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 4 (16), 539-567.

    Google Scholar 

  • Tobler, N. S. (1992). Drug prevention programs can work: Research findings. Journal of Addictive Diseases 11, 1-28.

    Google Scholar 

  • Tobler, N. S. & Stratton, H. H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of the research. Journal of Primary Medicine 18 (1), 17-128.

    Google Scholar 

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Piper, D.L., Moberg, D.P. & King, M.J. The Healthy for Life Project: Behavioral Outcomes. The Journal of Primary Prevention 21, 47–73 (2000). https://doi.org/10.1023/A:1007005430924

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  • DOI: https://doi.org/10.1023/A:1007005430924

  • adolescence
  • prevention research
  • social influences model
  • middle school
  • multi-component
  • alcohol
  • tobacco
  • eating behaviors
  • sexuality
  • substance use