Exploring Connections Between Healthy Living and Substance Use Prevention Research

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Exploring Connections Between Healthy Living and
Substance Use Prevention Research

• Aleta L. Meyer, Ph.D.
• Health Scientist Administrator
• (e.g, Program Official, Cheerleader)
• Prevention Research Branch
• National Institute on Drug Abuse
• Department of Health and Human Services

2
Overview

• Strength of Cooperative Extension
• Strength of Prevention Research
• Exploring Possibilities for Common Ground
• Principles for Healthy Living?

3
Current Context of EBIs
EBIs
Evaluated- not effective
Not Evaluated
and rigorously demonstrated, long-term EBI
impact is very rare
4
Supply-Push vs. Demand-Pull

• Supply-Push
• Traditional science model
• Relatively quick
• Less uptake
• Demand-Pull
• Traditional business model
• Takes longer to develop product
• Greater uptake

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Successful Collaborations Between Cooperative
Extension and Prevention Research at NIDA

• Oops..
• What IS NIDA??

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National Institutes of Health(a sampling)

• National Cancer Institute (NCI)
• National Institute on Child and Human Development
  (NICHD)
• National Institute of Mental Health (NIMH)
• National Institute on Diabetes and Digestive and
  Kidney Disease (NIDDK)
• National Institute on Heart , Lung, and Blood
  Infections (NHLBI)
• National Institute of Drug Abuse (NIDA)

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NIDA
Office of the Director
Nora D. Volkow, MD
Director
Director, AIDS Research
Special Populations Office
Timothy P. Condon, Ph.D.
Deputy Director
Donna Jones
EEO
Acting Associate Director for Management
Office of Extramural Affairs
Office of Planning Resource Management
Office of Science Policy Communications
Center for the Clinical Trials Network
Intramural Research Program
Barry Hoffer, MD, PhD
Teresa Levitin, PhD
Donna Jones
Timothy Condon, PhD
Betty Tai, PhD
Division of Clinical Neuroscience, Development
Behavioral Treatment
Division of Epidemiology, Services Prevention
Research
Joseph Frascella, PhD
Wilson Compton, MD, MPE
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DESPR Organization and Mission
DESPR promotes epidemiology, services and
prevention research to understand and address
the range of problems related to drug abuse, in
order to improve public health.
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Division of Epidemiology, Services and Prevention
Research

• Promoting Extraordinary Public Health Research to
  Eradicate Drug Abuse

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Creation of Prevention Research Branch and
Development of Research Portfolio (1990)

• Investigator Initiated Research
• Program Announcements for Preventive
  Interventions for Substance Abuse Prevention
• R-01
• R-21
• R-03
• Specific RFAs with set-asides
• Mentorship/Training (K-series Diversity
  supplements)
• FAST TRACK for new investigators
• Small Business Grants (SBIRs/STTRs)

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Mission and Purpose of the Prevention Research
Branch

• to support a developmentally grounded program
  of research on the prevention of the initiation
  of drug use, progression to abuse and dependence,
  and transmission of drug-related HIV infection.
  (p. 4)

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Parallel Cognitive Functions of the
Brain(Competing and/or Cooperating?!!)

• Prefrontal cortex
• Executive Function
• Problem-solving, long-term planning, connection
  of action to values
• Stop System
• Amygdala
• Impulse
• Emotions
• Go System

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Alcohol, Drugs, and the Adolescent Brain

• Drugs and alcohol particularly damaging
• Short-term disengagement of prefrontal cortex
• Short and long-term impacts on memory and
  learning
• Long-term change in reward-pleasure system
• Increased risk of injury (e.g., car accidents,
  falls, physical fights)
• Risky sexual behavior and sexual assault
• Reduced ability to make decisions in line with
  values
• Predators who notice who is drunk
• Long-term impact of negative sexual experiences
• HIV/pregnancy/STDs
• Depression, PTSD, substance use disorders

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The Science of Addiction Brochure

• Office of Science Policy and Communication
• Knowledge Transfer Goals
• Draws from research done by all Divisions
• Research done through
• Program Announcements (PA)
• Request for Proposals Announcements (RFA)
• Intramural Research
• Small Business Grants (SBIRs/STTRs)
• Walk Through Content ? Application to Current
  World View
• Question How and what is relevant to the work
  of cooperative extension?

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The Time is Ripe!

• NIDA is investing in the development of a
  research portfolio that looks at potential role
  of physical activity, healthy leisure, outdoor
  adventure, and restorative recreation in the
  prevention of drug use
• SA Treatment and Physical Activity Science
  Meeting in December 2007
• PA and relapse prevention
• PA and healing of reward-pleasure circuitry
• Prevention Science Meeting June 5 6, 2008

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Successful Collaborations Between Cooperative
Extension and Prevention Research at NIDA

• Iowa State
• Washington State
• Penn State

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PROSPER Partnership Process-to-Outcome Model for
Implementation of Evidence-Based Youth and
Family Competence-Building Interventions
Organization Initial Operations
Early Sustainability Ongoing Operations
Phase Phase
Phase
Sustainability Phase
Quality of Partnership/Team Process
Partnership/Team
Effectiveness
Team Member Characteristics
InterventionProcess/Outcomes
Source Spoth Greenberg, 2005. Toward a
comprehensive strategy for effective
practitioner-scientist partnerships and
larger-scale community benefits. American Journal
of Community Psychology, 35, 107-126.
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Going Beyond Best Practices and Evidence-Based
Programs

• PRINCIPLES OF PREVENTION

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(No Transcript)
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Clearly Established Principles

• Arrived at from an extensive literature review of
  articles from NIDA funded research
• Reviewed by an expert scientific panel
• Reviewed by a professional practitioner panel
• Resulted in 18 principles

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Risk and Protective Factors
Principles Related to

• Prevention programs should
• enhance protective factors and reverse or reduce
  risk factors
• address all forms of drug abuse, alone or in
  combination
• Address the drug abuse problems of the local
  community by targeting modifiable risk factors
  and strengthening protective factors
• Be tailored to address the risks specific to the
  target population

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Comparison of Aggregated Neighborhood Risk Factors
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Profile of Neighborhood Risk Factors
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(No Transcript)
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Prevention Planning
Principles Related to

• Family programs should
• Enhance family bonding, parenting skills, and
  communication
• School Programs should be specific to the
  developmental status of the children
• Before/during the elementary school years self
  control, emotional awareness, problem solving,
  communication academic readiness/competence
• Middle, junior high, and high school peer
  relations, study habits and academic support,
  communication, self-efficacy and assertiveness,
  drug resistance skills

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Family-level Risk and Protective Factors
Reduce these
Elevate these
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Universal Family-based Prevention Reduces
Methamphetamine Use
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Effects of Early Family Intervention on
Destructive Behavior
Intervention and control group scores on the
Child Behavior Check List Destructive Scale from
ages 2 to 4. Effect size at age 3 .64 standard
deviations effect size at age 4 .45 standard.
Error bars represent 95 confidence intervals.
Shaw et al., JCCP, 2004
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Effects of Media Campaign School Curriculum on
Drug use
Percent of Youth Using Each Substance by Study
Condition at Wave 4 Post-test (n 4,216)
Slater et al. (2006). Combining in-school and
community-based media efforts Reducing marijuana
and alcohol uptake among younger adolescents.
Health Education Research, 21, 157-176.
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Prevention Planning
Principles Related to

• Community Programs
• Aimed at the general population during key
  transition points (e.g, moving to junior high)
  can be beneficial for those at all levels of risk
• That combine 2 or more effective programs (e.g.,
  school and family component) can be more
  effective than one program
• When using multiple context to implement
  programs, policies and practices consistent
  messages should be presented across settings

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Project TND-1 CHS 5-year Results
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Prevention Program Delivery
Principles Related to

• When communities select programs to meet their
  needs, the implementation should retain the core
  elements of the original program
• Prevention is an on-going effort with repeated
  programming over time to reinforce earlier goals
  and develop new skills
• Teacher training in classroom management is a
  critical school-based prevention strategy
• Evidence based prevention interventions are cost
  effective

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Comparisons of Low and High Implementation
Conditions to Controls in Boys
Classroom-Centered Interventions
plt.05
plt.05
p.05
p.11
ns
ns
Source Ialongo et al., 1999. Ordinate values
are t-scores for comparisons.
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Continued Prevention in High School Reduces
Progression to Regular Marijuana Use Project
Alert vs. ALERT Plus
High-Risk Females
High-Risk Males
Use at Grade 9

Significant at plt.05 Students in ALERT Plus
school received prevention lessons in Grades 7, 8
and 9. Students in ALERT-Only schools received
lessons in Grades 7 and 8. These high-risk girls
and boys had used either cigarettes or marijuana
by grade 7. Ellickson, et al., 2006
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Schools where Principals are supportive and high
quality
teacher
implementation
of PATHS leads
to significant decreases in aggressive behavior
0
-0.1
-0.2
-0.3
Aggression
Predicted Decrease in Student
-0.4
-0.5
-0.6
-0.20033198
Low Support
-0.55224619
High Support
Different Levels of Principal Support
Kim, Greenberg and Wells, 2004
Kam, Greenberg, Wells, 2004
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Cost
(Aos et al., 2004) - WA State Institute of Public
Policy
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Emerging Principles

• Preventive interventions can have long term
  effects
• Preventive interventions can have cross over
  effects
• Early intervention may alter the life course
  trajectory in a positive direction
• High risk populations may benefit the most from
  prevention interventions
• Prevention interventions can influence
  physiological functioning
• Drug abuse prevention can be HIV prevention
• Environment can be a natural intervention

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Preventive Interventions Can Have Long Term
Effects
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Long Term Effects of the SSDP Intervention on
Selling Drugs
Hawkins, et al. (2005)
At age 21
Late PV
Grade Age
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Preventive Interventions Can Have Cross Over
Effects
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Life Skills Training Program Six-Year
Follow-up Cross-over Effect on Driving Behaviors
Plt.01
Plt.01
Griffin et al. Prevention Science 2004
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Early Intervention May Alter The Life Course
Trajectory In A Positive Direction
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Borderline/Clinical Internalizing Problems
(Self-Report) Child Age 12
P .044, OR 0.63
David Olds, PhD
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High Risk Populations May Benefit The Most From
Prevention Interventions
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High Risk Populations Benefit the Most
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Prevention Interventions Can Influence
Physiological Functioning
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Group effects on morning cortisol levels across
time for all children
MTFC-P
Regular foster care
Community Comparison
Fisher, Gunnar, Dozier, Bruce, Pears (2007),
Annals NYAS
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Drug Abuse Prevention Can Be HIV Prevention
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Drug Abuse Prevention IS HIV Prevention
Latent Growth Model of LST Intervention Effects
on HIV Risk Behavior During Young Adulthood in
Suburban White Youth Partial Mediation of
Prevention Effects via Reduced Growth in Alcohol
and Marijuana Intoxication Griffin et al., 2006
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Environment Can Be A Natural Intervention
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Sixth Graders in Middle School Behave Worse than
Those in Elementary School
Source n 76,915 - Administrative database
covering all public schools and students in the
state of North Carolina. The indicators of
behavioral problems are derived from a statewide
database of disciplinary infractions recorded
during the 2000-2001 academic year. Each
disciplinary report reflects a decision on the
part of a school official (usually a teacher) of
whether to write up a student for misbehaving,
and then a decision on the part of the principal
of whether to report to the state.
Duke Univ TPRC - P20 DA017589 - Philip Cook,
Robert MacCoun and Clara Muschkin (2007). Sixth
Graders in Middle School Behave Worse than Sixth
Graders in Elementary School. Under Review,
revised 5/06.
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6Expanding Our Understanding of Prevention,
Health Promotion, and Positive Youth Development

• Moving Beyond
• A focus on individuals
• A focus on programs
• Conceptual models based on early aggression
• Moving Toward
• Health Promotion Across Domains
• Positive Youth Development
• Conceptual Models Based on New Science from the
  Micro to the Macro
• Systems-Level Change

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Going Beyond Best Practices and Evidence-Based
Programs

• PRINCIPLES OF HEALTHY LVING

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2Given what you know about cooperative
extension.

• .how could Extraordinary research that makes a
  difference happen without it??
• Core Experiential Learning Theory Assertions
• The actual behavior is elicited in context with
  real-life contingencies
• Behavioral reinforcement is built-in to the
  activity
• Effective use of metaphors promotes transfer
  across contexts
• Learning styles of youth favor experiential
  strategies

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Evidence-Based Kernels and Behavior Vaccines
(Embry, 2004)

• Evidence-based kernels are irreducible units of
  behavior-change technology, and they can be put
  together into behavioral vaccines (daily
  practices) with powerful longitudinal results.
• Breadth of reach (self-directed, dyadic, group,
  community)
• Multi-level Approach
• Level One Cultural Modeling
• Level Two Brief Tools
• Level Three Narrow Focus Tools
• Level Four Broad Focus Tools
• Level Five Intensive Tools

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Related Paradigm Shifts

• Public Health Model vs. Medical Model
• Curve Shifters
• Supply-Push vs. Demand-Pull
• Public Health Approach vs. Service Development
  Model

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If we spend so lavishly on medical care and we
care so much about health, why are we so
unhealthy? (Cohen Farley, 2005)

• A public health approach used to address
  preventable chronic diseases ? Shifting the Curve
• A focus on environmental contexts that serve as
  cues or triggers for behaviors that are risks for
  health or are health promoting
• Environments can be physical or social
• Example of heart disease
• What aspects of our environment make it easy to
  do the things that put us at risk for heart
  disease?

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Bell Curves

• Basic shape of bell curve
• High and low tails of extreme behavior
• Mean or average in the middle (at the height of
  the curve)
• Example of eating salt
• A medical approach would focus on changing ALL
  the unhealthy behaviors of people at the high end
  (in addition to medications)
• A focus on getting rid of the tail at the right
  of the curve
• A public health approach would focus on changing
  small behaviors of ALL people
• A focus on shifting the mean of the curve to the
  left
• This reduces level of risk for all
• This moves the extreme tail farther to the
  left, so even though the same number of people,
  they are at less risk
• Greater reduction of public health burden of
  heart disease when mean is shifted (than when
  efforts are focused on those at highest risk)

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Curve Shifters

• Curve shifters are changes in the physical and
  social environment that move the curve to the
  left
• More sidewalks, mass transit
• Time in schedule for taking a walk with
  family/friends
• Not surprisingly, changing the environment to
  support healthy behavior is easier said than done
• Even so, it is a powerful tool for thinking about
  how we can prevent youth violence and/or bullying

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Developing Effective Prevention Services for the
Real World (Sandler et al., 2005)

• Prevention Research Cycle
• Description of the problem
• Development of intervention
• Experimental test
• Experimental test in service setting
• Adoption and implementation
• Problems with this model (e.g., on-going services
  research)
• Has not made a dent in prevalance at population
  level
• Not being adopted / Sustainability issues

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Prevention Service Development Model

• Service Marketing Perspective considers customer
  input at all stages (both ultimate client who is
  recipient and the agency that adopts)
• Front-end planning
• Organizational mission and goals?
• Idea generation
• Concept development
• Feasibility Analysis
• New Phases Prototype Development and Testing
  Introduction to the Market Post Introduction
  Evaluation

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Case Studies What are priority areas of to
understand between for cooperative extension and
public health outcomes?

• Character Building
• Workforce Preparation
• Social Skills
• Neighborhood and Community Attachment
• Parent Training
• Clubs

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Food for Thought

• Testing Experiential Learning Approaches
• Comparison of EBPs with and without EE
• Additive Effects ? Use of metaphors/language from
  school-based prevention curriculum to field trips
• Teach parents how to facilitate natural high
  experiences to promote competence and transfer
  across settings (and over time)
• E Sharps research on leisure guidance from
  parents

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• Event-Affect Links
• Social-Emotional-Information Processing
• Relational Frame Theory / Contextual Psychology
• Move from belief we need to change beliefs or
  thoughts before behavior will change
• Focus on function over form
• Have you feet follow values, not thoughts
• Positive Risk-Taking
• Learning Orientation Toward Goals
• Possible Selves / Willingness to Fail
• Mindfulness

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Barriers and Supports to Asking Those Questions
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Contact

• meyera2_at_nida.nih.gov