Study protocol for a randomized controlled trial of the Parent-Child Assistance Program: a case management and home visiting program for people using substances during pregnancy.

BACKGROUND: Perinatal substance use can have significant adverse effects on maternal and child health and family stability. Few interventions are specifically designed to address this significant public health problem. The Parent-Child Assistance Program (PCAP) is a 3-year case management and home-visiting intervention that seeks to help birthing persons with at-risk substance use during pregnancy to achieve and maintain substance use disorder recovery and avoid exposing future children to substances prenatally. At-risk refers to a level of substance use that creates problems in the individuals' lives or puts them or their children at risk of harm either prenatally or postnatally. Although the program has consistently shown substantial pre- to post-intervention improvements in its participants, PCAP remains to be tested with a rigorous randomized controlled trial (RCT). This study protocol describes a randomized controlled trial that aims to examine the effectiveness of the intervention compared to services as usual in affecting primary outcomes related to substance use and family planning. Secondary outcomes will concern connection to recovery support services and family preservation. METHODS: Using an intent-to-treat design, the study will recruit from two metro areas in Oklahoma and enroll 200 birthing individuals who are pregnant or up to 24 months postpartum with at-risk substance use during their current or most recent pregnancy. Participants will be randomly assigned, stratified by location, to receive either PCAP or services as usual for 3 years. Participants in the PCAP condition will meet with their case manager approximately biweekly over the course of the intervention period, in their local communities or in their own homes whenever possible. Case managers will assist with goal setting and provide practical assistance in support of participants' goals. Primary and secondary outcomes will be assessed at baseline and 12, 24, and 36 months post-baseline using the Addiction Severity Index interview and a self-administered survey. DISCUSSION: Results from this trial will help to gauge the effectiveness of PCAP in improving parent and child well-being. Results will be reviewed by federal clearinghouses on home-visiting and foster care prevention to determine the strength of evidence of effectiveness with implications for federal financing of this program model at the state level. TRIAL REGISTRATION: ClinicalTrials.gov NCT05534568. Registered on 6/8/2022.

Exclusionary School Discipline and Delinquent Outcomes: A Meta-Analysis.

Excluding students from school remains a common form of punishment despite growing critique of the practice. A disparate research base has impeded the ability to make broader assessments on the association between exclusionary discipline (i.e., suspensions and expulsions) and subsequent behavior. This article synthesizes existing empirical evidence (274 effect sizes from 40 primary studies) examining the relationship between exclusionary discipline and delinquent outcomes, including school misconduct/infractions, antisocial behavior, involvement with the justice system, and risky behaviors. This meta-analysis identifies exclusionary discipline as an important and meaningful predictor of increased delinquency. Additional examinations of potential moderators, including race/ethnicity and type of exclusion, revealed no significant differences, suggesting the harm associated with exclusions is consistent across subgroups. These findings indicate exclusionary discipline may inadvertently exacerbate rather than mollify delinquent behaviors.

Effects of state education requirements for substance use prevention.

We provide the first evidence on the effects of state laws requiring students to receive education about alcohol, tobacco, and other drugs using data on over a million youths from the 1976-2010 Monitoring the Future study. In difference-in-differences and event-study models, we find robust evidence that these laws significantly reduced recent alcohol and marijuana use among high school seniors by 1.6-2.8 percentage points, or about 8-10% of the overall decline over this period. Our results suggest that information interventions can reduce youth substance use.

State Education Standards for Tobacco Prevention and Classroom Instruction.

OBJECTIVES: We examine whether state educational standards regarding tobacco correspond with teacher reports of classroom instruction. METHODS: We test this relation with data on tobacco use prevention standards, reports of middle and high school teachers from the 2008 and 2010 School Health Profiles study, and logistic regression models. RESULTS: State education standards are significantly related to increased likelihood of a lead health education teacher in that state reporting that the specific topic was taught in the school. These relationships are stronger for middle school teachers than for high school teachers. CONCLUSIONS: Associations between state standards and teacher reports of actual instruction are consistent with education standards influencing the teaching of these health education topics.

State-level education standards for substance use prevention programs in schools: a systematic content analysis.

PURPOSE: Three fourths of public schools in the United States maintain instructional programs to discourage alcohol, tobacco, and other drug (ATOD) use. State-sanctioned instructional standards attempt to direct this ATOD preventive education. No existing research, however, systematically codes these standards across all grades and states. We performed such an analysis. METHODS: We retrieved ATOD standards information from all 50 states and the District of Columbia from multiple sources, including the National Association of State Boards of Education's State School Health Policy Web site. Three independent researchers classified and cross-validated ATOD standards (inter-rater agreement = 98%) based on recommended content domains and pedagogic delivery methods. RESULTS: We find substantial grade-level variation in standards. Elementary schools emphasize generic social skills and affective skills, whereas middle and high school standards focus on knowledge about biological and behavioral consequences of ATOD use. States also vary widely in their content and coverage of standards. Two thirds of states do not include standards in all content areas considered "evidence-based." CONCLUSIONS: The ATOD curricular agenda for the majority of states falls well below recommended content and delivery benchmarks. We intend for our harmonized data set-the first of its kind-to promote research that examines the relation among state ATOD standards, actual classroom instruction, and adolescent ATOD use.