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 DOI: 10.1177/0163278703258100

2003 26: 355Eval Health ProfSteve Sussman, Dongyun Yang, Lourdes Baezconde-Garbanati and Clyde W. Dent

Drug Abuse Prevention Program Development: Results among Latino and Non-Latino White Adolescents  

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10.1177/0163278703258100ARTICLEEvaluation & the Health Professions / December 2003Sussman et al. / DRUG ABUSE PREVENTION PROGRAM DEVELOPMENT

Five program development studies from Pro-ject Towards No Drug Abuse (TND) were re-analyzed to discern Latino versus non-LatinoWhites similarities and differences in recep-tivity to a wide variety of high school–baseddrug abuse preventionactivities. In most of theprogram development studies, these youthattended alternative (continuation) highschools in Southern California. Althoughthere were a total of 46% Latino students inthese schools, 99% of the students indicatedEnglish as the main language spoken at schooland home. Thus, taken together, almost allLatino youth in the various studies analyzedpreferred to respond to survey questions inEnglish. Latinos were relatively low in socio-economic status (SES) and used drugs less fre-quently. Still, this group of highly acculturatedLatinos and non-Latino Whites (37% of theschool population) perceived that they wereattending alternative schools for the samereasons (e.g., lack of credits, truancy). Veryfew differences in receptivity ratings of pro-posed TND activities were found as a functionof ethnicity. In other words, the data suggestthat the same types of lessons are applicable toolder teens in both ethnic groups.

Keywords: ethnicity; substance abuse andprogram development; teenage;Latino-White differences

DRUG ABUSEPREVENTION PROGRAM

DEVELOPMENTResults Among Latinoand Non-Latino White

Adolescents

STEVE SUSSMANDONGYUN YANG

LOURDES BAEZCONDE-GARBANATI

CLYDE W. DENTInstitute for Health Promotion

and Disease Prevention Research,University of Southern California

355

EVALUATION & THE HEALTH PROFESSIONS, Vol. 26 No. 4, December 2003 355-379DOI: 10.1177/0163278703258100© 2003 Sage Publications

AUTHORS’ NOTE: This research was sup-ported by grants from the National Institute onDrug Abuse (DA07601, DA13814, andDA16094).

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Empirical program development is a means used by drug educationresearchers to maximize program effects on hypothesized medi-

ators of change (knowledge, attitudes, and immediate expectedchanges in behavior; Sussman, 2001). Empirical program develop-ment involves at least three features. First, consumer demand forpotential activities is assessed. Consumers of programming are rela-tively likely to be able to report what programming is most helpful tothem. Even if they were not accurate on all aspects of potentially help-ful drug education strategies, consumers indicate which programmingthey will or will not attend to or accept. Second, program developmentideally is an iterative process by which potential activities may bescreened (concept evaluation, perceived efficacy) and then evaluatedindividually (as component studies), prior to being combined into acomplete package. Through an iterative process, many ideas for activ-ities can be assessed. Finally, empirical program developmentinvolves evaluation of curriculum mediators (of change) as the curric-ulum is being developed rather than employing evaluation only duringa main study trial or application. By considering these three featuresof program development, it may be possible to develop evidence-based programs that demonstrate effects across multiple populationsand locations.

One area seldom explored in program development research per-tains to evaluations provided by different target groups (Simon,Bosworth, & Unger, 2001). In particular, few studies have comparedethnic group evaluation responses in developing drug education pro-grams. There is reason to believe that ethnic groups will react dif-ferently to programming (as a function of their country of origin),differential allostatic load, acculturative stress (Whitfield, Weidner,Clark, & Anderson, 2002), acculturation levels, language dominanceand/or preference, socioeconomic status (SES), and differentialeffects of psychosocial influence (Unger et al., 2000). Although sev-eral studies have examined Latino/non-Latino White similarities anddifferences in the correlates and predictors of teen drug use (Dent,Sussman, Ellickson, Brown, & Richardson, 1996; Simon, Stacy,Sussman, & Dent, 1994), few program development studies havelooked directly at comparing these groups on receptivity to potentialdrug abuse prevention programming. This is the first article that com-pares Latino and non-Latino White differences across five differentprogram development–type studies.

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Some studies on correlates and predictors of teen drug use wouldsuggest that program development work should find differencesbetween Latinos and non-Latino Whites. For example, some studiessuggest that family social influences may be relatively important pre-dictors of health behaviors among Latinos compared to non-LatinoWhites (Dent, Sussman, et al., 1996; Marin, 1993). One may specu-late that family social influence program contents may be more favor-ably received among older Latino teens relative to older non-LatinoWhite teens.

One of the problems with this body of literature, however, is thatlarge gaps exist in our understanding of Latino receptivity to potentialdrug abuse prevention programming and in drug education programdevelopment work. Few studies, for example, have looked directly atLatino and non-Latino White similarities or differences in receptivityto these programs. Many studies do not account for Latino specificcharacteristics that may influence such receptivity or for those com-monalities found among more acculturated Latino and non-LatinoWhite youth that may account for more generalized responses andgeneralized receptivity to these programs. This lack of attention toLatino receptivity to prevention programming is due in part to a lackof Latino participation in drug abuse research until the late 1980s. Inaddition, there has been a lack of a unifying framework for conductingdrug abuse research with Latinos (Freeman, Lewis, & Colon, 2002)that could help to better explain similarities and differences withinand between Latinos and other population groups.

Research by Oetting & Beauvais (1990) suggested that culturalidentification is a critical variable that interacts with a person’s envi-ronment and may mediate or help explain an individual’s response todrug abuse prevention efforts. High identification with a particularculture, for example, is related to increased probability of engaging inbehaviors specific to, and valued in that culture. These authors suggestthat identification with another culture, in addition to the culture ofone’s origin, does not necessarily imply an association or a conflictwith elements of cultural content in the original culture. Results of astudy with Mexican American, Spanish American, and tribal Indiansin the southwestern United States (Oetting & Beauvais, 1990)revealed that job success, for example, was linked to non-LatinoWhite identification. Family relations in the same individuals, how-ever, were linked to identification with the specific ethnic group of

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origin (Mexican, Spanish, or Native American). Number of non-Latino White friends in this study also was related to non-LatinoWhite identification among Latino youth and the adoption of non-Latino White values, beliefs, and behaviors. What Oetting andBeauvais (1990) calledanomic youthwere adolescents with the low-est self-esteem, who also had the weakest links to family and schooland were most likely to engage in high-risk behaviors. Biculturalyouth, who identified with more than one culture, reported the highestself-esteem and strongest socialization links in terms of family andschool, protecting them from engaging in high-risk behaviors.

Generally, however, studies that compare Latino and non-LatinoWhite youth have shown higher rates of drug use among more accul-turated Latinos than their immigrant counterpart, resembling orexceeding the rates of drug use in the non-Latino White population(Unger et al., 2000). Perceived lack of life choices experienced afterlearning English and adapting to U.S. society may lead Latino youthto succumb to social influences to use drugs. Also, the importanceattributed to group consensus among Latinos may make it difficult torefuse drug offers by drug-using peers and siblings (Brindis, Wolfe,McCarter, Ball, & Starbuck-Morales, 1995; Castro, 1994; Chavez,Beauvais, & Oetting, 1986; Freeman et al., 2002; Maddahian,Newcomb, & Bentler, 1988).

This body of research leads one to believe that program develop-ment work should explore ethnic receptivity differences. Then, oneshould try to either create highly generalizable programming thatfocuses on the similarities between groups, or target programming tospecific groups (Sussman, 2001; Sussman, Dent, Burton, Stacy, &Flay, 1995), that accounts for cultural identification and ethnic spe-cific values and that accounts for differences not just between groupsbut also within groups.

Project Towards No Drug Abuse (TND) is one of the few drugabuse prevention programs developed for senior high school youth(Sussman, Dent, & Stacy, 2002). This program was developed andimplemented in continuation high schools (CHSs). When students inCalifornia reach high school age, those youth who are unable toremain in the regular or comprehensive school system for functionalreasons, including substance use, are transferred to a CHS. Theseyouth are at risk for dropout, but they have transferred to an alternativeschool to fulfill a California mandate that all youth receive part-time

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education until they are 18 years of age (California Educational CodeSection 48400; established in 1919).

The Project TND classroom program was developed through fiveiterative program development studies (Sussman, Dent, Stacy, &Craig, 1998). These studies were conducted primarily in a set of 21CHSs in Southern California. The present reanalysis of these programdevelopment studies contrasted self-reports of Latino versus non-Latino White teens. These schools were composed of 46% Latino,37% non-Latino White, and 17% other ethnic groups. A total of 99%of the Latino population indicated English as the main language spo-ken at school and home (Sussman et al., 1998). Students with otherethnic categories were not included in these analyses, because theirpercentage was too small to be compared to Latino and non-LatinoWhites in multigroup analyses.

Study 1 involved an interview of youth about reasons for attendingCHS (fall 1992). Study 2 examined the immediate impact of socialinfluence programming on youth at traditional as well as CHSs (win-ter 1992). Study 3 made use of a theme study format (ratings of para-graphs) to assess the perceived efficacy of proposed activities for thedrug abuse prevention curriculum (spring 1993). Study 4 involvedassessment of the immediate impact of individual drug abuse preven-tion activities (fall 1993). Finally, Study 5 provided an examination ofthe immediate impact of the complete curriculum at the baseline of themain trial of Project TND (fall through spring 1994-1995). By report-ing these studies together, any evident ethnic differences insociodemographics or receptivity to programming at school wereidentified through use of different samples and methodologies and, ifany differences were found, whether they replicated across programdevelopment studies.

STUDY 1—STUDENT INTERVIEW

PURPOSE

This study was the first of the program development studies com-pleted in Project TND. Private interviews of CHS students were con-ducted. Assessment domains included demographic characteristicsand reasons that students transferred to CHS. The study reanalysis

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permitted the evaluation of whether Latino youth’s judgments of whypeople attended CHSs were the same as for White non-Latino youth.

PARTICIPANTS

All continuation schools from 29 school districts (half rural, halfurban areas from five Southern California counties) were selected forthe study. Six students per school across 16 of 20 continuation schoolswere randomly selected for an interview. Four of the 20 schools weremuch larger than the other schools. At these larger schools, 12 stu-dents per school were interviewed. A total of 144 students were inter-viewed from 20 continuation schools. There were 63 Latino studentsand 59 non-Latino White students. Fifty-nine percent of the Latinostudents and 37% of the non-Latino White students were men.

PROCEDURE AND INSTRUMENT

Trained institute data collectors administered the interviews. Dur-ing the regular classroom period individual youths were removedfrom the classroom and interviewed in a private office. Informationassessed included pertinent demographic characteristics (schoolname, date, age, gender, grade, ethnic background, parental educa-tion), reasons for attending among peers, and items on attitudestoward education. Because of the interview format, no random orinconsistent responses were reported (Sussman, Stacy, et al., 1995).

ANALYSIS AND RESULTS

Analysis of these data consisted primarily of simple frequencycounts (e.g., to identify reasons that students attend CHS),t tests, andcalculation of chi-square models of response categories that examinedproblems in high school between Latino and non-Latino White stu-dents. There was a significant difference between Latino and non-Latino White students in SES. The Latino students were less likelyto have parents who received education past high school (41% vs.73%;p = .001). Latinos differed from non-Latino Whites regardingissues they had been experiencing in high school. Latinos were rela-tively less likely to report that a high school education would beimportant for what they did in the future (14% vs. 37%;p = .004).

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They were relatively more likely to report that there was no future forthem in education (24% vs. 10%;p = .046) and that they could notafford college so why try in high school (38% vs. 15%;p = .005). Inaddition, however, they were relatively less likely to report that theyjust could not stand going to school (32% vs. 51%;p= .032), that theywere spending too much time socializing (58% vs. 75%;p = .055), orthat they did not feel that they really belonged at school (10% vs. 24%;p = .034). Reasons stated for attending CHS (prevalence of reasons“out of every 10 students at the school”) were not found to differ as afunction of ethnicity (see Table 1).

INTERPRETATION

The Latino youth reported being of lower SES in comparison withtheir non-Latino White counterparts. They were less likely to vieweducation as important to their future. However, they reported thesame prevalence of reasons as White non-Latinos for attending CHS,the most popular being to get more credits toward graduation fromhigh school (about 8 out of every 10 students). Other relatively pop-ular reasons included truancy or drug use (about 6 out of every 10

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TABLE 1Comparison of Reasons for Attending CHS as Perceived by

Latino Versus Non-Latino White Students (Study 1)

Mean Number Out of Every 10 Students

Reasons Latino (N=63) Non-Latino White (N=59)

Truancy 6.66 6.00Behavior problems 4.83 4.76Drug use 5.79 5.46Pregnancy 3.62 2.98Learning difficulties 3.41 2.86Emotional or psychological problems 3.03 2.81Personal preference 4.34 5.08Because their brother or sister went there 1.02 1.05To get more credits 8.13 8.20

NOTE: CHS = continuation high school. The specific item requested that participants indicatethe number of students out of every 10 students at their school that were attending the school forthe listed reasons. There were no statistically significant differences in reasons between Latinoand non-Latino White students. For example, both Latino and non-Latino White students per-ceived that approximately 8 out of every 10 youth were attending their continuation high schoolto get more credits.p > .05.

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students), and behavior problems or personal preference (about 5 outof every 10 students).

STUDY 2—COMPARISON EVALUATION

PURPOSE

This study was the second program development study completedin Project TND. The immediate influence of nine social influence–oriented activities on drug-related knowledge and beliefs was investi-gated in students at traditional and CHSs. For the reanalysis, the SESof Latinos versus non-Latino Whites was examined across schooltype. In addition, drug use–related variables were examined as a func-tion of ethnicity and school type. Finally, evaluation of the nine socialinfluence activities was explored as a function of ethnicity and schooltype.

PARTICIPANTS

A total of 479 CHS students were surveyed from six schools inSouthern California and 706 regular high school (RHS) students weresurveyed from six schools within the same six school districts (oneCHS and one RHS per district). Completed demographic and drug usedata were obtained from 994 of 1,174 students (85%), which did notvary by school type. There were 508 Latino students and 397 non-Latino White students. Fifty-four percent of the Latino students and54% of the non-Latino White students were men.

PROCEDURE AND INSTRUMENT

Six classrooms at each CHS (classrooms included multiple gradelevels) and four 10th-grade classrooms at each RHS were randomlyselected for the study. Across school type, nine comprehensive socialinfluences lessons were evaluated (consistent with components sug-gested by Glynn, 1989). Self-report questionnaire data were col-lected. These surveys included one general background pretest form,one brief activity-specific pretest form, and one brief activity-specificposttest form for each of nine lessons. General background items

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included parental education, living situation, youth’s parental status,trial and current drug use, friends’ trial and current drug use, andfriends’ approval of drug use. Activity-specific belief and knowledgeitems were forced-choice. Three knowledge items and two beliefitems tapped each lesson (Sussman, Dent, Simon, et al., 1995).

ANALYSIS AND RESULTS

T tests and chi-square tests were used to compare the differences ofdemographic and drug use–related variables between Latino and non-Latino White students in CHS or RHS. The differences of meanchange in knowledge and beliefs for each activity between Latino andnon-Latino White students by school type also were examined usingt tests. Latinos in both CHSs and RHSs reported statistically signifi-cantly lower educational attainment among fathers and mothers thandid non-Latino Whites (all Student’st-testp values < .001; see Table2). Latinos were relatively more likely to report being a parent, at CHS

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TABLE 2Comparison of Demographic and Drug Use–Related Variables

Between Latino Versus Non-Latino White Studentsin CHS and RHS (Study 2)

M andSDs, or Percentages

CHS RHS

Latinos Non-Latino Whites Latinos Non-Latino WhitesItem (N = 241) (N = 154) (N = 267) (N = 243)

Father’s education 2.52(1.10) 3.29(1.11) 2.87(1.35) 3.91(1.12)Mother’s education 2.58(1.14) 3.26(1.01) 2.69(1.20) 3.66(1.02)Trial of drugs index 2.59(1.98) 3.24(2.10) 0.99(1.27) 1.13(1.53)Current drug use index 0.84(0.75) 1.08(0.90) 0.30(0.43) 0.40(0.61)Friends’ trial of drug index 2.42(1.34) 2.68(1.28) 1.29(1.08) 1.27(1.09)Friends’ current drug use

index 1.78(1.27) 1.92(1.21) 0.83(1.00) 0.72(0.95)Friends’ approval of one’s

own drug use 1.60(1.39) 1.95(1.46) 0.67(0.95) 0.71(1.01)

NOTE: CHS = continuation high school; RHS = regular high school. All comparisons contrastedLatinos versus non-Latino Whites within school type. Bolded row cells indicate statistically sig-nificant differences between Latino and non-Latino youth within school type atp< .05. Standarddeviations are indicated in parentheses. Each of the drug use–related indices was measured as aquantitative variable, averaged across the eight drug categories (cigarettes, alcohol, marijuana,heroin, cocaine, inhalants, stimulants, and other recreational drugs).

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(17.5% vs. 9.8%,p= .035) but not RHS (0.8% vs. 0.0%,p> .05). Lati-nos also were relatively likely to report living with both parents, atRHS (76.8% vs. 64.2%;p= .002) but not at CHS (48.6% vs. 44.2%,p> .05). In CHS but not RHS, Latinos reported significantly lower like-lihood of having tried drug use (p= .003) and using drugs currently (p= .009), and lower friends’ approval to use drugs, than non-LatinoWhites (p= .023). Thet-test results are shown in Table 2. Several ofthe lessons elicited changes in knowledge (i.e., physical conse-quences, social awareness, and activism) or beliefs for each ethnicgroup, as might be expected. However, the effects of the nine lessonson knowledge and beliefs, within each school type, did not changesignificantly for Latinos versus non-Latino Whites (a total of 36 anal-yses). The knowledge and belief results are shown in Table 3.

INTERPRETATION

This study revealed that in both school types Latinos were from alower socioeconomic background than non-Latino Whites (parents’education). These results replicated the first study and ruled outschool type as the reason for this difference in status. On the otherhand, Latinos reported relatively lower scores on drug use–relatedvariables, but only in the CHS context. One may speculate that Whitenon-Latino youth were more likely than Latino youth to attend CHSdue to drug-related problems, whereas Latinos were relatively likelyto attend due to lower educational aspirations or due to pregnancy.Regarding reactions to social influences programming, ethnic differ-ences failed to be found. Apparently, the Latinos and non-LatinoWhites reacted similarly to that type of prevention programming.

STUDY 3—THEME STUDY

PURPOSE

This was the third program development study in Project TND. Asthe reaction to the social influence activities had been “lukewarm” inthe previous program development study, this study involved a con-cept evaluation of potential new activities, as were described in writ-ten paragraphs. The preference of traditional social influence drug

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prevention program activities were compared to alternative activitiesusing the same themes underlying the traditional activities and tonovel activities generated from newly developed themes. Thirty-fivetheme paragraphs were evaluated in CHS students.

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TABLE 3Comparison of Mean Change in Knowledge and Beliefs (PosttestMinus Pretest) for Each Activity Examined Within Latino and

Non-Latino White Ethnicity and Within CHS and RHS (Study 2)

CHS RHS

Activity-Specific Non-Latino Non-LatinoKnowledge and Latinos Whites Latinos WhitesBelief Indices (N = 241) (N = 154) (N = 267) (N = 243)

KnowledgeListening or involvement 0.05 0.07 0.00 0.02Physical consequences 0.07 0.08 0.09 0.09Decision making 0.12 0.18 0.07 0.06Prevalence estimates 0.21 0.59 0.32 0.48Social awareness 0.11 0.14 0.21 0.19Activism 0.12 0.19 0.09 0.19Normative restructuring –0.07 –0.14 –0.24 –0.23Assertion refusal 0.02 0.07 0.05 0.10Refusal practice 0.06 0.05 0.14 0.17

BeliefsListening or involvement 0.03 0.02 0.03 0.04Physical consequences 0.04 0.07 0.05 0.00Decision making 0.11 0.06 0.09 0.15Prevalence estimates –0.03 0.08 0.04 0.05Social awareness –0.05 0.05 –0.02 –0.11Activism –0.05 –0.03 0.03 0.08Normative restructuring –0.02 0.17 0.05 0.05Assertion refusal –0.02 –0.05 0.12 0.01Refusal practice –0.02 –0.17 0.07 0.01

NOTE: CHS = continuation high school; RHS = regular high school. Bolded cells indicate a sig-nificant change atp< .05 in knowledge or beliefs from pretest to posttest. For example, there wasa statistically significant change in beliefs from pretest to posttest on the normative restructuringlesson among non-Latino Whites in CHSs (.17), indicating a change in an expected direction (to-ward greater disapproval of drug use). A positive (negative) sign indicated that participants per-formed better (worse) on knowledge items. Likewise, a positive sign indicated that participants’beliefs changed in an expected direction toward decreased approval of drug use, whereas a nega-tive sign indicated the converse (toward greater approval of druguse). The specific cell results arediscussed in detail in Sussman, Dent, Simon et al. (1995). Additional analyses examined Latinoversus non-Latino White differences for each lesson within each school type (36 contrasts), butno significant differences were found.

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PARTICIPANTS

A total of 315 students from seven CHSs participated in this study.There were 119 Latino students and 115 non-Latino White students.Sixty-one percent of the Latino students and 59% of the non-LatinoWhite students were men.

PROCEDURE AND INSTRUMENT

Pairs of activity sets were assigned to the seven schools in a system-atically rotated order and were counterbalanced such that four sepa-rate classes from two separate schools evaluated each activity set.Classrooms were randomly assigned to different combinations ofactivity sets.

Students were administered a package of materials containing abrief demographic survey, five activity descriptions, and five activityevaluation forms. Each activity description was in a standardized for-mat that included an activity title, the activity goal, and a brief (half-page) description of what the activity entailed. A traditional socialinfluence activity (e.g., prevalence overestimates reduction) and itstwo alternatives (e.g., stereotyping and name that number) were pre-sented first, followed by the two novel activities (e.g., cognitiverestructuring and drug use perspectives). Activity descriptions wereapproximately the same length, detail, and reading level. Titles variedfor each activity. The goals were presented in a concise and under-standable manner. The statement of the activity goal was the same forthe traditional and alternative activities but varied from the two novelactivity goals.

Questions regarding the activity paragraphs assessed (a) how inter-esting it would be to do the activity, (b) how understandable the activ-ity would be, (c) how much the students could learn from doing theactivity, (d) how likely the activity would help to not increase or to notstart drug use, and (e) the ability of the activity to meet the stated goalit was intended to accomplish (e.g., Flay, 1981). These items were allrated on 4-point response scales: 1 (very), 2 (moderately), 3 (a little),and 4 (not at all). A factor analysis of the five items produced a singlefactor, and the items were reversed, standardized (M = 0,SD= 1), andaveraged to form a single activity “quality” rating. Cronbach’s alphafor the scale was .84. The raw scale mean was 2.45, and the standard

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deviation was 0.76. More details of this study are found in Dent,Galaif, Sussman, & Stacy (1996).

ANALYSIS AND RESULTS

T tests were used to examine differences in standard mean qualityratings for 35 theme paragraphs between Latino and non-LatinoWhite students. Among the 35 theme paragraphs, Latinos providedmore favorable ratings for three activities, and they provided lessfavorable ratings for two activities. Latinos rated those activities morefavorably that involved social cognitive manipulations (prevalencereduction (p= .047), cognitive restructuring (p = .043), and drug useperspectives (p = .028)). Latinos rated less favorably activities thatinvolved peers directly portraying the negative physical or social con-sequences of drug use (normative videos,p= .054, and narratives,p=.040). Still, no differences were found in the ratings of the remaining30 activities. (These results are not tabled.)

INTERPRETATION

The purpose of the theme study was to screen out from amongnumerous potential activities those that were perceived to be relativelyefficacious by the consumer (student) for future testing of the actualimmediate impact of the activity. Few differences were found betweenLatinos and non-Latino Whites regarding their evaluations of 35activities. These results suggest that drug abuse activities that werebeing developed would generalize across these two ethnic groups.Still, a few differences were found. Social cognitive manipulationsinvolved teaching that relatively few people use drugs, that one couldbe liked without using drugs, and that being a moderate person meantnot using drugs. These activities appealed to the Latino youth morethan to the non-Latino White youth. One may speculate that thesetypes of activities instilled the belief that one could maintain goodrelations with others and not use drugs. Such instruction would beconsistent with a hallmark Latino norm of simpatia (Castro, 1994).Conversely, direct confrontation by peers regarding drug use conse-quences would seem contrary to that norm.

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STUDY 4—COMPONENT STUDY

PURPOSE

This was the fourth program development study in Project TND. Atotal of 16 of the 35 theme study activities that were rated most posi-tively were retained from Study 3 and developed into program ses-sions. A comparison of the immediate impact of this retained set ofactivities was examined. Knowledge and perceived quality wasassessed among CHS students. For the reanalysis, immediate posttestknowledge and perceived quality on each session, and averagedacross sessions, were compared as a function of ethnicity. In the previ-ous program development studies, most program activities or con-cepts were rated as similar in perceived quality by both Latinos andnon-Latino Whites.

PARTICIPANTS

A total of 388 students from six CHSs were provided with a pretest-activity-posttest component study protocol. There were 209 Latinostudents and 108 non-Latino White Students. Fifty-eight percent ofthe Latino students and 57% of the non-Latino White students weremen.

PROCEDURE AND INSTRUMENT

Six classes were selected randomly from each of five schools andtwo classes were selected randomly from one more school, for thestudy evaluation. Classes were provided with lessons in a 3-day for-mat. Each 3-day sequence was provided as a minicurriculum at fiveschools (Ns ranged from 61 to 78 per school). Each sequence con-sisted of a pretest followed by the first lesson, then a posttest related tothat lesson; a second lesson followed by a posttest specifically tailoredfor that lesson, accomplished on the second day; then a third lessonfollowed by a posttest anchored specifically to that lesson, completedon the third day. The specific lesson combinations, in order of deliv-ery—first through third lesson—were chemical dependency, funeral,and stereotyping at one school; listening, talk show, and self-control ata second school; coping with stress, apathy, and self-esteem at a third

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school; decision making, health as a value, and family roles at a fourthschool; and myth correction, effective communication, and perspec-tives at a fifth school. At a sixth school, youth only viewed the videolesson paired with class discussion or with self-instruction materials(n = 37).

For each lesson, students were asked to answer four lesson-specificforced choice knowledge items. Response anchors varied from two tofive responses, in which one response was the correct one. For exam-ple, one of the stereotyping lesson items was “What is a self-fulfillingprophecy?”: (a) Becoming what others expect by believing their judg-ments (correct answer), (b) doing what you want to do, and (c) finallyachieving your goals. Also, for each lesson, students were asked torate the lesson on interest level, how much they felt they had learnedfrom participating in the lesson, and the helpfulness of the lesson (tonot use drugs). On 4-point scales, the response choices ranged from 4(very) to 1 (not at all). Students also were asked to rate each lessonaccording to how much they liked it. Eleven response choices wereoffered for the liking question. The response choices ranged from 0(did not like it) to 10 (liked it very much). More details on the methodsused in this study are found in Sussman et al. (1997).

ANALYSIS AND RESULTS

Descriptive statistics were used to analyze these data at posttest.For the knowledge items, the percentage of correct responses for eachitem was calculated. Also, the average correct score across itemswithin each lesson was calculated to produce a knowledge index. Forthe four quality ratings (interest, learning, helpfulness, liking), meanscores were calculated. The scores on the four quality ratings werestandardized and averaged to create an index score that was on thesame scale for each lesson.T tests were used to compare percentage ofcorrect responses on posttest knowledge indices for each activity byethnicity.

The percentage correct on the posttest knowledge indices failed todiffer significantly between Latino and non-Latino White students onany of the 16 session specific ratings or the overall percentage correct.In addition, the perceived quality index ratings only differed on self-esteem (p= .018) and confronting myths (p = .028), lessons that Lati-nos rated more favorably than non-Latino Whites. Overall, Latinos

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did perceive the lessons more favorably than non-Latino Whites (p <.001). See Table 4.

INTERPRETATION

Apparently, Latinos and non-Latino Whites learned material fromeach the 16 lessons equally well. Perceived quality ratings differed ononly 2 of 16 lessons. Latino youth perceived that self-esteem and mythcorrection lessons were relatively better quality than non-LatinoWhites. As in the theme study, one might have conjectured that Lati-nos relatively preferred lessons that were relevant to Latino culture.Possibly, Latino youth cultural values of dignidad-self worth mayhave explained preference for the self-esteem lesson. Also, one of themyths being corrected pertained to self-worth. In addition, another

370 Evaluation & the Health Professions / December 2003

TABLE 4Comparison of Percentage of Correct Responses on Posttest Knowl-edge Indices and Perceived Quality Index for Each Activity Between

Latino and Non-Latino White Students (Study 4)

Correct Responses (%) on Standardized PerceivedPosttest Knowledge Quality Index Posttest Ratings

Latinos Non-Latino Whites Latinos Non-Latino WhitesLesson Name (N = 209) (N = 108) (N = 209) (N = 108)

Listening or involvement 74.1 79.6 –0.02 –0.40Chemical dependency 41.3 50.0 –0.10 0.26Talk show 62.9 63.2 0.14 0.23Funeral 76.9 62.5 0.32 0.53Norm/recovery 50.6 61.5 –0.10 –0.49Provocative behavior 58.3 69.1 0.11 –0.12Stereotyping 71.1 91.7 0.29 0.71Decision making 74.1 64.3 0.05 –0.02Health as a value 65.7 63.2 0.23 –0.16Coping with stress 49.2 56.0 –0.08 –0.43Family roles 80.3 71.4 0.19 0.02Apathy 56.7 57.2 0.01 –0.29Self-esteem 75.0 80.8 0.01 –0.71Perspectives 47.9 56.3 0.19 –0.15Confronting myths 56.8 63.0 0.18 –0.34Effective communication 64.6 75.0 0.02 0.09Total 63.3 66.8 0.10 –0.20

NOTE: Bolded row cells indicate statistically significant differences in knowledge or in stan-dardized perceived quality index ratings comparing Latino and non-Latino youth.p < .05.

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myth pertained to relations with others. Latino youth may have pre-ferred this material in terms of its relevance to the cultural value ofsympatia—getting along with others (Castro, 1994). That interpreta-tion is speculative. It is possible that differences were found by chancealone, because a total of 34 comparisons were made (Table 4).

STUDY 5—EVALUATION OF IMMEDIATE IMPACT

PURPOSE

From among the lessons developed in the component study, a totalof 9 were retained for the main TND experimental trial. The lessonswere integrated to first introduce participants to the program and teachthem how to listen to material with an open mind. Next, youth weremotivated to change favorable and misleading impressions about druguse and were taught consequence information, coping skills, and deci-sion making. Finally, youth were requested to make a personal com-mitment about drug use (e.g., to discuss it with others, ask others toquit drug use, or quit their own drug use; Sussman, 1996). The ses-sions are outlined in Table 5. The impact of the complete comprehen-sive drug abuse prevention program (TND) delivered in classroomonly, or classroom plus school-as-community, versus a standard carecontrol condition on knowledge was evaluated among CHS youth.The classroom-only condition included only the nine lessons. Thesecond program condition added to the classroom program use of aschool-level student group that organized activities throughout theyear. Those activities permitted a limited movement out to the largercommunity. The reanalysis permitted an investigation of ethnic differ-ence in likability of each lesson of the TND program or differences inmaterial learned in each session. For the reanalysis, ratings were aver-aged among all those who received the classroom program (consid-ered across the two program conditions).

PARTICIPANTS

During the main trial of Project TND, there were 2001 completedpretest questionnaires of which 1,538 were consented. A total of1,318 consented students completed postprogram questionnaires.

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The sample of 1,318 constituted the analysis sample. There were 721Latino students and 466 non-Latino White Students. Fifty-four per-cent of the Latino students and 59% of non-Latino White studentswere men.

PROCEDURE AND INSTRUMENT

Immediate pretest and posttest measures were collected from stu-dents using a standardized, self-report, closed-ended response,

372 Evaluation & the Health Professions / December 2003

TABLE 5Project TND Session Preview: Nine-Lesson Curriculum

Session Title Description

1 Active listening Students are introduced to Project TND and discuss theimportance of being active listeners. They also learnlistening and communication skills.

2 Stereotyping Students learn that believing stereotypes can lead to self-fulfilling prophecies and can put one at risk for drugabuse. They also learn corrective drug use prevalenceinformation.

3 Myths and denials Students learn to identify myths associated with drug use,how to distinguish facts from myths, and how people usevarious beliefs to deny or justify their drug abuse.

4 Chemical dependency Students learn about the course of negative consequencesassociated with chemical dependency. They also learneffects of drug abuse on family and friends.

5 Talk show Students role-play a talk show whose guests are affected bydrug abuse. They learn about many physical, emotional,and social consequences of drug abuse.

6 Stress, health, &goals

Students learn various ways to cope with stress and theimportance of health as a life value to accomplish lifegoals.

7 Self-control Students learn to examine their own level of self-control,how to match their behavior to different social contexts,and the importance of being assertive.

8 Perspectives Students present differing views on such topics as publicsmoking laws and drug use and find out that most peoplehave moderate views regarding drug use. Alignment ofattitudes and behavior is suggested.

9 Decision making &commitment

Students realize they have many choices and can makedifferent decisions regarding drug use and abuse. Theythink through different options and make a commitmentto themselves regarding drug use.

NOTE: TND = Towards No Drug Abuse.

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written questionnaire. Student data included demographics, age (inyears), gender, ethnicity, and drug use history. Students also answereda number of knowledge items derived from the curriculum content.Specifically, they responded to nine 3-item scales, each 3-item scaleeither measuring active listening and effective communication(Hawkins, Catalano, & Wells, 1986), stereotyping, drug myths (e.g.,Lennard, Epstein, Bernstein, & Ransom, 1971), chemical depend-ence, coping with stress (e.g., Wills, 1986), perspective taking, self-control, role-play (talk show), or decision making. Items were in aforced-choice format and were scored as correct or incorrect and aver-aged for the analysis. In addition, students responded on the posttestquestionnaire to a number of program process measures. Theseincluded a general rating of how much the studentliked each lesson(rated on a 9-point scale ranging from 1 (liked very much) to 9 (did notlike at all). More details on the methods used in this study are found inDent et al. (1998).

ANALYSIS AND RESULTS

Data analysis was completed by usingt tests to compare for each ofthe nine lessons (a) the overall mean likability rating of the lessons and(b) the posttest minus pretest mean change in percentage of correctknowledge among Latino versus non-Latino White students. Non-Latino Whites liked the introductory (listening;p = .030) and con-cluding (decision making;p= .005) lessons slightly less than Latinos,but no other lesson. There was not a difference in overall programlikability. See Table 6.

There were no differential changes in knowledge comparing Lati-nos with non-Latino Whites, except on Lesson 2 (stereotyping) ineach of the program conditions. Latinos reported a greater percentagecorrect at baseline (p= .050) and less change between pretest andposttest in both the classroom only (p = .003) and the classroom plusschool-as-community (p = .008) conditions but not the standard carecontrol condition (in which TND programming was not offered).Inthe program conditions (which did not differ from each other),approximately 26% versus 21% reported correct answers at baselineon the stereotyping knowledge item set, comparing Latinos to non-Latino Whites, respectively. The average change in percentage correct

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from pretest to immediate posttest was approximately 11% versus24%, comparing Latinos to non-Latino Whites, respectively.

INTERPRETATION

Overall, likability was rated as moderately favorable. The only dif-ferences between ethnic groups were on the first and last lesson,which were favored more by Latinos. One may speculate that theeffects were due to non-Latino White youth’s greater entrenchment indrug use. It could have been more difficult to involve youth in the pro-gram (Lesson 1) if they were more involved in a drug use lifestyle. Inaddition, it could have been more difficult for them to feel comfortableabout making a personal commitment not to use drugs (Lesson 9).Many other interpretations are possible including potential primacy-recency affective differences across different ethnic groups, but theplausibility of such alternative interpretations is not clear. The stereo-type knowledge results may be explained by the fact that Latinoyouth, as a disadvantaged group, were quite likely to have a betterbaseline understanding of its effects on one’s behavior. Hence, theywould improve less in knowledge about stereotyping from pretest to

374 Evaluation & the Health Professions / December 2003

TABLE 6Comparison of Mean Ratings of How Well Liked Each Lesson Is

Comparing Latino and Non-Latino White Students (Study 5)

Latinos Non-Latino WhitesLesson Name (N = 721) (N = 466)

Active listening 4.62 4.99Stereotyping 4.64 4.79Myths & denial 4.63 4.72Chemical dependency 4.67 4.67Talk show 4.30 4.50Stress, health, & goals 4.37 4.73Self-control 4.35 4.70Perspectives 4.55 4.67Decision making 4.44 4.98Overall average 4.51 4.73

NOTE: Bold row cells indicate statistically significant differences in lesson likability ratingsbetween Latino and non-Latino youths.p < .05.

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posttest than a group that was relatively likely to learn more about ste-reotyping effects (non-Latino Whites).

GENERAL DISCUSSION

Latino and non-Latino White youth sociodemographic characteris-tics and responses in the program development studies were very sim-ilar. The reasons for attending CHS were the same, with lack of cred-its, truancy, and drug use being perceived as the most prevalentreasons. There were some group differences. The Latino youth didappear to be of relatively lower SES and less likely to view schoolattendance as important to their future. They also were more likely toperceive that their potential for upward mobility was limited. Non-Latino Whites, on the other hand, appeared more problem prone.They were relatively more likely to report that they just could notstand going to school, and at CHS, non-Latino Whites reported signif-icantly greater likelihood of current drug use and greater friends’approval to use drugs.

One way to examine the contrasts between Latinos and non-LatinoWhites is whether there was a consistent pattern of differences found.Regarding receptivity to programming, differences failed to be foundfor the social influences sessions except that Latinos perceived as lesseffective the admonitions of peers depicted on videos and perceived asmore effective prevalence overestimates reduction session. Possibly,Latinos are relatively more influenced by information stated aboutgroups as opposed to dramatic portrayals stated by individuals. Thiswould be consistent with previous work regarding the importanceattributed to group consensus among Latinos (Castro, 1994; Freemanet al., 2002). They seemed to perceive as more effective a few othercognitive modification-type sessions (cognitive restructuring anddrug use perspective in Study 3 and confronting myths in Study 4).These sessions largely involved group consensus building activities.Regarding the motivation-skills-decision-making program, Latinosprovided relatively high perceived effectiveness ratings overall inStudy 3 but not other studies, and only four lesson comparisonsreached significance individually (self-esteem and confrontingmyths) in Study 4 and the first and last sessions (active listening anddecision making) in Study 5.

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Another way to look at these contrasts is in terms of which sessionmaterial was retained for the final curriculum. One would hope thatmaterial retained after an iterative program development sequencewould be generalizable across ethnic groups, even if variation acrossethnicity were not directly tested during the development process. Inother words, the hope would be that through an iterative process ofprogram development, material that would not be effective for any siz-able segment of the target population would be screened out of thecurriculum. Among the five significant contrasts in Study 3, only onesession concept was retained as a separate lesson in the final curric-ulum (Perspectives). Latino/non-Latino White differences was notfound on this session when it was revised for Study 4 and in its finalform in Study 5. Between the two significant session contrasts inStudy 4, only confronting myths were retained as a separate lesson inthe final curriculum. In its final form, it was not found to receive dif-ferent ratings by Latinos versus non-Latino Whites. In Study 5, Lati-nos liked the first and last sessions more and learned less in the secondlesson on stereotyping (Latinos showed higher baseline knowledge).

A third way to consider these contrasts is in terms of the number ofcontrasts examined and probability of finding significant effects bychance alone. Across studies, of a total of 155 Latino versus non-Latino White lesson contrasts (36 contrasts in Study 2, 35 contrasts inStudy 3, 34 contrasts in Study 4, and 40 posttest contrasts in Study 5),only 12 contrasts were significant atp < .05. Approximately 8 con-trasts might be expected to be significant by chance alone. No patternof consistent differences was found across studies, few differences(and no meaningful differences) were found regarding evaluations ofthe final program, and most of these differences might be attributed tochance alone.

One interesting aspect in all these studies is that almost all of theyouth spoke English and preferred English at home and at school.This is important in the interpretation of the findings, because it helpsexplain why there were similarities in the responses of the adolescentsto the program. The results of the present reanalysis suggest that forboth older highly acculturated Latinos and non-Latino Whites, a moti-vation-skills-decision-making curriculum maintains high receptivityand may mediate program effects. The results of the two outcomestudies that use this nine-session curriculum (Dent, Sussman, &Stacy, 2001; Sussman et al., 1998) indicate no ethnic differences in 1-

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year follow-up outcomes. Hence, it would appear that although differ-ent types of drug abuse prevention programming may be differentiallyrelevant for young versus older teens, these differences are consistentacross Latino and non-Latino White ethnicity.

There are several limitations in the interpretations of these results.The Latino sample appeared to be highly acculturated, because almostall preferred to speak English at home and at school. These resultsmight not generalize to a sample that is less acculturated (Baezconde-Garbanati, 2001). Specific parental jobs were not assessed so any cul-tural differences as a function of parent employment within the samesocial stratum could not be assessed. Issues such as differential ethnicstresses were not examined, nor was preference for more subtle differ-ences in activities (e.g., name of character in an activity). With theselimitations in mind, this study suggests that programs that are devel-oped among heterogeneous groups of youth are likely to work forthose heterogeneous groups of youth. Indeed, Project TND now hasshown preventive effects on alcohol and hard drug use at 1-year follow-up across three experimental trials (Sussman et al., 2002) and is nowconsidered a model program by several agencies (e.g., Blueprints,CSAP, NIDA, Health Canada, U.S. Department of Education).Although ethnic-specific programming is of obvious importance,these results suggest that drug education effects themselves may behighly generalizable.

REFERENCES

Baezconde-Garbanati, L. (2001). Understanding tobacco use research among Hispanic/Latinoadolescents: A sociocultural perspective. In N. C. Institute (Ed.),Changingadolescent smok-ing prevalence. Smoking and tobacco control monograph, No. 14(pp. 227-241). Bethesda,MD: U.S. Department of Health and Human Services, NIH, NCI, NIH Pub.

Brindis, C., Wolfe, A. L., McCarter, V., Ball, S., & Starbuck-Morales,S. (1995).The associationsbetween immigrant status and risk-behavior patterns in Latino adolescents.Journal of Ado-lescent Health, 17(2), 99-105.

Castro, F. G. (1994). Drug use and drug related issues. In C. W. Molina & M. A. Molina (Eds.),Latino health in the U.S. a growing challenge(pp. 425-446). Washington, DC: AmericanPublic Health Association.

Chavez, E. L., Beauvais, F., & Oetting, E. R. (1986). Drug use by small town Mexican Americanyouth: A pilot study.Hispanic Journal of Behavioral Sciences, 8(3), 243-258.

Dent, C. W., Galaif, E. R., Sussman, S., & Stacy, A. W. (1996).Use of the “theme study” as meansof curriculum development in continuation high schools.Journal of Drug Education, 26(4),377-393.

Sussman et al. / DRUG ABUSE PREVENTION PROGRAM DEVELOPMENT 377

at UNIV OF SOUTHERN CALIFORNIA on July 15, 2014ehp.sagepub.comDownloaded from

Dent, C. W., Sussman, S., Ellickson, P., Brown, P., & Richardson, J. (1996). Is current drug abuseprevention programming generalizable across ethnic groups?American Behavioral Scien-tist, 39(7), 911-918.

Dent, C. W., Sussman, S., Hennesy, M., Galaif, E. R., Stacy, A. W., Moss, M., et al. (1998).Implementation and process evaluation of a school-based drug abuse prevention program:Project Towards No Drug Abuse.Journal of Drug Education, 28(4), 361-375.

Dent, C. W., Sussman, S., & Stacy, A. W. (2001). Project Towards No Drug Abuse:Generalizability to a general high school sample.Preventive Medicine, 32(6), 514-520.

Flay, B. R. (1981).Evaluation of mass media prevention campaigns. In R. R. Rice & W. J. Paisley(Eds.),Public communications campaigns(pp. 239-313). Beverly Hills, CA: Sage.

Freeman, R. C., Lewis, Y. P., & Colon, H. M. (2002).Handbook for conducting drug abuseresearch with Hispanic populations. Westport, CT: Praeger.

Glynn, T. J. (1989). Essential elements of school-based smoking prevention programs.Journalof School Health, 59(5), 181-188.

Hawkins, J. D., Catalano, R. F., Jr., & Wells, E. A. (1986). Measuring effects of a skills trainingintervention for drug abusers.Journal of Consulting and Clinical Psychology, 54(5), 661-664.

Lennard, H. L., Epstein, L. J., Bernstein, A., & Ransom, D. C. (1971).Mystification & drug mis-use. New York: Jossey-Bass.

Maddahian, E., Newcomb, M. D., & Bentler, P. M. (1988). Risk factors for substance use: Ethnicdifferences among adolescents.Journal of Substance Abuse, 1(1), 11-23.

Marin, G. (1993).Research with Hispanic populations. Newbury Park, CA: Sage.Oetting, E. R., & Beauvais, F. (1990). Orthogonal cultural identification theory: The cultural

identification of minority adolescents.International Journal of the Addictions, 25(5A/6A),655-685.

Simon, T. R., Bosworth, K., & Unger, J. B. (2001). Component studies. In S. Sussman (Ed.),Handbook of program development for health behavior research and practice(pp. 321-345).Thousand Oaks, CA: Sage.

Simon, T. R., Stacy, A. W., Sussman, S., & Dent, C. W. (1994). Sensation seeking and drug useamong high risk Latino and Anglo adolescents.Personality & Individual Differences, 17(5),665-672.

Sussman, S. (1996). Development of a school-based drug abuse prevention curriculum for high-risk youths.Journal of Psychoactive Drugs, 28(2), 169-182.

Sussman, S. (Ed.). (2001).Handbook of program development for health behavior research andpractice. Thousand Oaks, CA: Sage.

Sussman, S., Dent, C. W., Burton, D., Stacy, A. W., & Flay, B. R. (1995).Developing school-based tobacco use prevention and cessation programs. Thousand Oaks, CA: Sage.

Sussman, S., Dent, C. W., Simon, T. R., Stacy, A. W., Galaif, E. R., Moss, M. A., et al. (1995).Immediate impact of social influence-oriented substance abuse prevention curricula in tradi-tional and continuation high schools.Drugs & Society, 8(3/4), 65-81.

Sussman, S., Dent, C. W., & Stacy, A. W. (2002). Project towards no drug abuse: A review of thefindings and future directions.American Journal of Health Behavior, 26(5), 354-365.

Sussman, S., Dent, C. W., Stacy, A. W., & Craig, S. (1998). One-year outcomes of projecttowards no drug abuse.Preventive Medicine, 27(4), 632-642.

Sussman, S., Simon, T. R., Dent, C. W., Stacy, A. W., Galaif, E. R., Moss, M. A., et al. (1997).Immediate impact of thirty-two drug use prevention activities among students at continua-tion high schools.Substance Use and Misuse, 32(3), 265-281.

Sussman, S., Stacy, A. W., Dent, C. W., Simon, T. R., Galaif, E. R., Moss, M. A., et al. (1995).Continuation high schools: Youth at risk for drug abuse.Journal of Drug Education, 25(3),191-209.

378 Evaluation & the Health Professions / December 2003

at UNIV OF SOUTHERN CALIFORNIA on July 15, 2014ehp.sagepub.comDownloaded from

Unger, J. B., Cruz, T. B., Rohrbach, L. A., Ribisl, K. M., Baezconde-Garbanati, L., Chen, X.,et al. (2000). English language use as a risk factor for smoking initiation among Hispanic andAsian American adolescents: Evidence for mediation by tobacco-related beliefs and socialnorms.Health Psychology, 19(5), 403-410.

Whitfield, K. E., Weidner, G., Clark, R., & Anderson, N. B. (2002). Sociodemographic diversityand behavioral medicine.Journal of Consulting and Clinical Psychology, 70(3), 463-481.

Wills, T. A. (1986). Stress and coping in early adolescence: relationships to substance use inurban school samples.Health Psychology, 5(6), 503-529.

Sussman et al. / DRUG ABUSE PREVENTION PROGRAM DEVELOPMENT 379

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