Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study.

BACKGROUND: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. OBJECTIVE: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. METHODS: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. RESULTS: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. CONCLUSIONS: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.

Effects of Workplace Variables on Workers Intentions to Misuse Prescription Opioids.

OBJECTIVE: Workers in industries with high rates of opioid dispensing as well as those with high rates of non-fatal work-related injuries are at greater risk for opioid misuse, which can lead to addiction, overdose, or death. METHODS: Using secondary cross-sectional data collected from 856 healthcare workers, this pilot study examines a conceptual model for workers' intentions to seek out prescription opioids and intentions to use opioids at higher doses over longer periods. RESULTS: Results showed significant protective effects of beliefs, injunctive and subjective norms, and behavioral control on intentions to seek out opioids. On intentions to use higher doses over a longer time, knowledge, beliefs, behavioral control, patient-provider communication, workplace safety, and workplace autonomy had significant protective effects. CONCLUSIONS: Findings from this study could be used to inform future multilevel interventions to prevent opioid misuse among employee populations.

Fidelity of D.A.R.E. Officers' Delivery of "keepin' it REAL" in Elementary & Middle School.

The goal of the current study is to examine the degree to which measures of quality of implementation and student engagement moderate pretest-posttest changes in mediating variables that are targeted by DARE "keepin' it REAL." DARE officers (10 elementary school, five middle school) taught DARE "keepin' it REAL lessons to 1,017 elementary students (480 boys and 534 girls) and 435 middle school students (217 boys and 215 girls). We examined teachers' and students' ratings of elementary and middle schools in response to DARE officers' delivery of the program. HLM analyses revealed that students' engagement was a significant and meaningful predictor of changes in targeted mediators. Teachers' ratings of student responsiveness added little in terms of understanding these outcomes with main effects observed only for students' ability to respond to bulling and students' estimates of peer drug use. Teachers' ratings of the quality of officer implementation, on the other hand, did add to understanding students' outcomes. Effects were seen for three (peer norms about drug use, decision-making (DM) skills, intentions to avoid drug use) out of six outcome variables and suggest a stronger positive effect for elementary versus middle school students. At least for these three outcomes, understanding quality of implementation added to our ability to interpret results. Specifically, in addition to students' engagement, quality of implementation (which varied by grade) contributed to achieving positive changes in students' outcomes.

D.A.R.E./keepin' it REAL elementary curriculum: Substance use outcomes.

In response to a need to implement an evidence-based prevention program, D.A.R.E. America adopted keepin' it REAL. The program was previously developed and tested in middle school settings. As part of its adoption, an elementary version of the program was developed. This study tests the effectiveness of keepin' it REAL when delivered to fifth graders. The intervention was delivered to two cohorts of students, the first in the 2019-2020 school year, the second in the 2020-2021 school year. Pretest surveys were completed by 6,122 students. The COVID-19 pandemic interfered with posttest and follow-up data collection. At immediate posttest, 2,049 students (33.5%) completed analyzable posttest surveys. One year after the pretest, 1,486 (24.3%) students completed usable follow-up surveys. We used algorithmically generated cases (virtual controls) that use treatment cases' pretest psychosocial scores to assess program effectiveness. When compared to virtual control cases, the program had identifiable improvements in both a key psychosocial measure and in terms of deterring the onset of 30-day alcohol use, drunkenness, and vaping. Outcomes suggest that the delivery of elementary school keepin' it REAL by D.A.R.E. officers is having a positive effect in terms of deterring the onset of alcohol use and vaping.

School-Level Longitudinal Predictors of Alcohol, Cigarette, and Marijuana Use.

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time.

Social Network Methods for Assigning Students to Teams.

Teachers often group students into teams to organize their classrooms and network-informed interventions hold great promise as a way to facilitate positive peer influence and promote the diffusion of intervention effects. Yet thus far, relatively little research has explored how teachers or prevention scientists can best use social network information to assign students to teams. The goal of the present study was to identify and compare seven methods that use different data sources and assignment algorithms to create teams of students. To test these methods, we used survey data from 247 5th through 8th grade students in three rural schools that assessed students' social networks, sociability, values and interests, and bonding to school. To create teams, we first identified popular students (i.e., those who received the highest number of peer nominations) who also had school bonding scores in the normal range and formed 4-person teams around them, applying different methods to assign students to teams. In all but one method, we placed at-risk students (i.e., those who had the lowest school bonding scores) in teams only during the final round of team creation. Team assignments were compared against three criteria: (1) team-level bonding to school, (2) patterns of affiliation among teammates, and (3) shared values and interests. Two methods, one that used only social network data and one that used social network data in combination with students' values and interests, yielded the most promising outcomes. The most positive results were obtained when a pruning algorithm akin to the one proposed by Girvan and Newman (2002) Proceedings of the National Academy ofSciences, 99, 7821-7826 was used to select which dyads to join as teammates; this pruning method joined more weakly linked students first, maximizing their potential to find suitable matches. These methods for team assignment hold promise for designing network-informed school-based interventions.

Psychosocial Indicators of Adolescent Alcohol, Cigarette, and Marijuana Use: An Analysis of Normalized, Harmonized, and Pooled Data.

We normalized, harmonized, and pooled 344,429 surveys collected from 106,470 research participants from 25 research studies that assessed past 30-day alcohol use, drunkenness, smoking cigarettes, using marijuana, and a host of psychosocial variables. After normalizing and harmonizing psychosocial measures, we completed analyses to examine the ability of psychosocial variables to serve as proxy indicators of use. Intentionality, peer descriptive normative beliefs, and age emerged as being of primary importance in indicating use. Additional variables - peer injunctive norms, beliefs about the positive and negative consequences of use, and attitudes - were also demonstrated to have the potential to serve as proxies in the assessment of substance use risk. There were developmental patterns in how intentionality and descriptive normative beliefs changed with age. Young adolescents had scores that are protective; they have positive intentionality and do not see the prevalence of alcohol and other drug use as widespread. These and other psychosocial variable's mean scores generally erode with age while the distribution of scores widens as youth grow older. The goal of analyses was to define age-related psychosocial profiles that can be used prospectively to estimate substance use risk. These profiles are useful in creating virtual control cases for evaluating disseminated prevention programs.

Adolescent Values, Interest in Extracurricular Activities and Bonding to School: A Cross-sectional Descriptive and Correlational Analysis.

The goal of this paper is to explore relations between adolescent values, interests in activities and their bonding to school. This paper presents survey research findings that examine 1,928 6th and 7th grade students' responses to survey prompts about 15 terminal values adapted from Rokeach's (1973) theory of values, prompts about 11 activities they may be interested in, and questions about how attached they felt to school. The goal of analysis is to document the relative importance of each terminal value for this sample. In addition, relation between values, activities of interest and bonding to school were estimated. All 15 values were ranked as important. Among the more highly ranked values for the sample were acceptance, independence, character, fitness and achievement. Least important overall were faith, wealth, fame, creativity and stewardship. Factor analysis resulted in three general categories that described activities of interest: interest in athletics, interest in the arts, and interest in technology. Students' bonding to school varied based on gender and grade, with females and younger students being generally more bonded to school. There were strong correlations between valuing fitness and having an interest in athletic activities (r = .599) and valuing education and having an interest in the arts (r = .340). Bonding to school was strongly correlated with only two values: education (r = .435) and character (r = .335). Having an interest in technology was not correlated with any of the 15 values or students' bonding to school. Results suggest that interventions and policies that wish to improve bonding to school might do well to take advantage of existing highly ranked positive values and provide an opportunity for students to engage in a wide array of activities of interest.

Relative Reduction in Prevalence (RRP): An Alternative to Cohen's Effect Size Statistics for Judging Alcohol, Cigarette, and Marijuana Use Prevention Outcomes.

Jacob Cohen developed two statistical measures for judging the magnitude of effects produced by an intervention, known as Cohen's d, appropriate for assessing scaled data, and Cohen's h, appropriate for assessing proportions. These have been widely employed in evaluating the effectiveness of alcohol, cigarette, marijuana, and other drug prevention efforts. I present two tests to consider the adequacy of using these statistics when applied to drug use prevention programs. I used student survey data from grades 6 through 12 (N = 1,963,964) collected by the Georgia Department of Education between 2015 and 2017 and aggregated at the school level (N = 1036). I calculated effect sizes for an imaginary drug prevention program that (1) reduced 30-day alcohol, cigarette, and marijuana prevalence by 50%; and (2) maintained 30-day prevalence at a pretest level for multiple years. While both approaches to estimating intervention effects represent ideal outcomes for prevention that surpass what is normally observed, Cohen's statistics failed to reflect the effectiveness of these approaches. I recommend including an alternative method for calculating effect size for judging program outcomes. This alternative method, Relative Reduction in Prevalence (RRP), calculates ratio differences between treatment and control group drug use prevalence at posttest and follow-up, adjusting for differences observed at pretest. RRP allows researchers to state the degree to which an intervention could be viewed as efficacious or effective that can be readily understood by practitioners.

Specialized Smartphone Intervention Apps: Review of 2014 to 2018 NIH Funded Grants.

BACKGROUND: The widespread adoption of smartphones provides researchers with expanded opportunities for developing, testing and implementing interventions. National Institutes of Health (NIH) funds competitive, investigator-initiated grant applications. Funded grants represent the state of the science and therefore are expected to anticipate the progression of research in the near future. OBJECTIVE: The objective of this paper is to provide an analysis of the kinds of smartphone-based intervention apps funded in NIH research grants during the five-year period between 2014 and 2018. METHODS: We queried NIH Reporter to identify candidate funded grants that addressed mHealth and the use of smartphones. From 1524 potential grants, we identified 397 that met the requisites of including an intervention app. Each grant's abstract was analyzed to understand the focus of intervention. The year of funding, type of activity (eg, R01, R34, and so on) and funding were noted. RESULTS: We identified 13 categories of strategies employed in funded smartphone intervention apps. Most grants included either one (35.0%) or two (39.0%) intervention approaches. These included artificial intelligence (57 apps), bionic adaptation (33 apps), cognitive and behavioral therapies (68 apps), contingency management (24 apps), education and information (85 apps), enhanced motivation (50 apps), facilitating, reminding and referring (60 apps), gaming and gamification (52 apps), mindfulness training (18 apps), monitoring and feedback (192 apps), norm setting (7 apps), skills training (85 apps) and social support and social networking (59 apps). The most frequently observed grant types included Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants (40.8%) and Research Project Grants (R01s) (26.2%). The number of grants funded increased through the five-year period from 60 in 2014 to 112 in 2018. CONCLUSIONS: Smartphone intervention apps are increasingly competitive for NIH funding. They reflect a wide diversity of approaches that have significant potential for use in applied settings.

Self-Reported Engagement in a Drug Prevention Program: Individual and Classroom Effects on Proximal and Behavioral Outcomes.

Numerous studies emphasize the role of student engagement in academic learning and performance. Less known is whether engagement plays a role in drug prevention program outcomes. We examined a self-report measure of engagement as part of the All Stars Core drug prevention program evaluation, assessing its impact on target risk mechanisms and behavioral outcomes. Students completed pretests just prior to and posttests just after completing the intervention. Surveys assessed demographics, proximal intervening measures (i.e., commitments to avoid substance use and antisocial behavior, perceived lifestyle incongruence with substance use and antisocial behavior, normative beliefs about substance use and antisocial behavior, and parental attentiveness), and distal outcome measures of alcohol, cigarette use, and antisocial behaviors. A brief 6-item posttest measure including items tapping the students' perspective on the quality of teaching the program material and their level of engagement with the program was internally consistent (α = .79). Multi-level analyses positing engagement effects at both the classroom- and individual-level indicated that classroom average engagement was significantly associated with all the targeted risk mechanisms, and outcomes of antisocial behavior and alcohol use, controlling for pretest measures and classroom size. Individual student engagement relative to classroom peers was significantly associated with all posttest target risk mechanisms and behavioral outcomes. The current findings suggest that students should routinely provide assessments of engagement and perceived quality of teaching, which would improve our understanding of how prevention programs work. Teachers can improve engagement by paying attention to students when they speak in class, making the program enjoyable to participants, encouraging students to share opinions, stimulating attentiveness, being well prepared to deliver the intervention, and helping students think broadly about implications of drug prevention as it affects their lives. This type of support will ultimately engage students in ways that will enhance the likelihood that these programs will have their desired effects.

An Algorithm for Creating Virtual Controls Using Integrated and Harmonized Longitudinal Data.

We introduce a strategy for creating virtual control groups-cases generated through computer algorithms that, when aggregated, may serve as experimental comparators where live controls are difficult to recruit, such as when programs are widely disseminated and randomization is not feasible. We integrated and harmonized data from eight archived longitudinal adolescent-focused data sets spanning the decades from 1980 to 2010. Collectively, these studies examined numerous psychosocial variables and assessed past 30-day alcohol, cigarette, and marijuana use. Additional treatment and control group data from two archived randomized control trials were used to test the virtual control algorithm. Both randomized controlled trials (RCTs) assessed intentions, normative beliefs, and values as well as past 30-day alcohol, cigarette, and marijuana use. We developed an algorithm that used percentile scores from the integrated data set to create age- and gender-specific latent psychosocial scores. The algorithm matched treatment case observed psychosocial scores at pretest to create a virtual control case that figuratively "matured" based on age-related changes, holding the virtual case's percentile constant. Virtual controls matched treatment case occurrence, eliminating differential attrition as a threat to validity. Virtual case substance use was estimated from the virtual case's latent psychosocial score using logistic regression coefficients derived from analyzing the treatment group. Averaging across virtual cases created group estimates of prevalence. Two criteria were established to evaluate the adequacy of virtual control cases: (1) virtual control group pretest drug prevalence rates should match those of the treatment group and (2) virtual control group patterns of drug prevalence over time should match live controls. The algorithm successfully matched pretest prevalence for both RCTs. Increases in prevalence were observed, although there were discrepancies between live and virtual control outcomes. This study provides an initial framework for creating virtual controls using a step-by-step procedure that can now be revised and validated using other prevention trial data.

Using Attitudes, Age and Gender to Estimate an Adolescent's Substance Use Risk.

PURPOSE: The purpose of this paper is to present a strategy for estimating an individual's risk of alcohol, cigarette and cannabis use that relies on an assessment of an adolescent's age, gender and attitude. METHODOLOGY: The authors assembled surveys from 35,987 11 through 17 year-olds assembled from 36 databases were analysed to examine the relationship between attitude and behaviour. FINDINGS: Attitudes were strongly correlated with concurrent use of alcohol, drunkenness, smoking, and cannabis, with point biserial correlations of -0.555, -0.517, -0.552 and -0.476, respectively. Logistic regression provided a means for using age, gender and attitudes to estimate an individual's risk of engaging in substance use behaviour. Developmental changes in attitudes were estimated by analysing changes in scores associated with percentile rankings for each age and gender group. Projected year-to-year changes in attitude were used as a heuristic for estimating future risk. RESEARCH LIMITATIONS: Analyses relied on cross-sectional panel data. Analyses would benefit from longitudinal data in which age-related changes in attitudes could be more precisely modelled. PRACTICAL IMPLICATIONS: Information about estimated current and future risk may use useful for motivating the adoption and implementation of effective prevention approaches by parents and care providers. ORIGINALITY: The authors present a novel method for estimating an individual's risk of substance use knowing attitude, age and gender.

Differences in observers' and teachers' fidelity assessments.

As evidence-based programs become disseminated, understanding the degree to which they are implemented with fidelity is crucial. This study tested the validity of fidelity ratings made by observers versus those made by teachers. We hypothesized that teachers' reports about fidelity would have a positivity bias when compared to observers' reports. Further, we hypothesized that there would generally be low correspondence between teachers' and observers' ratings of fidelity. We examined teachers' and observers' ratings as they were related to mediating variables targeted for change by the intervention. Finally, we examined the role that years of teaching experience played in achieving fidelity. Eighteen teachers and four research assistants participated in this project as raters. Teachers made video recordings of their implementation of All Stars and completed fidelity assessment forms. Trained observers independently completed parallel forms for 215 sampled classroom sessions. Both teachers and observers rated adherence, quality of delivery, attendance, and participant engagement. Teachers made more positive fidelity ratings than did observers. With the exception of ratings for attendance, teachers and observers failed to agree on fidelity ratings. Observers' ratings were significantly related to students' pretest assessments of targeted program mediators. That observers' ratings were related to students' pretest scores, suggests it is easier to teach well when students are predisposed to program success. Teachers' ratings were infrequently related to mediators, but when they were, the relationship was counterintuitive. Experienced teachers taught with greater fidelity than novice teachers. While possibly inflated and inaccurate, gathering fidelity assessments from teachers may sensitize them to issues of fidelity as a result of requiring form completion. Assessing fidelity through observers' ratings of video recordings has significant merit. As a longterm investment in improving prevention outcomes, policy makers should consider requiring both teacher and observer fidelity assessments as essential components of evaluation.

A Synthetic Comparator Approach to Local Evaluation of School-Based Substance Use Prevention Programming.

We propose a method for creating groups against which outcomes of local pretest-posttest evaluations of evidence-based programs can be judged. This involves assessing pretest markers for new and previously conducted evaluations to identify groups that have high pretest similarity. A database of 802 prior local evaluations provided six summary measures for analysis. The proximity of all groups using these variables is calculated as standardized proximities having values between 0 and 1. Five methods for creating standardized proximities are demonstrated. The approach allows proximity limits to be adjusted to find sufficient numbers of synthetic comparators. Several index cases are examined to assess the numbers of groups available to serve as comparators. Results show that most local evaluations would have sufficient numbers of comparators available for estimating program effects. This method holds promise as a tool for local evaluations to estimate relative effectiveness.

Measuring Fidelity and Adaptation: Reliability of a Instrument for School-Based Prevention Programs.

There is a need to standardize methods for assessing fidelity and adaptation. Such standardization would allow program implementation to be examined in a manner that will be useful for understanding the moderating role of fidelity in dissemination research. This article describes a method for collecting data about fidelity of implementation for school-based prevention programs, including measures of adherence, quality of delivery, dosage, participant engagement, and adaptation. We report about the reliability of these methods when applied by four observers who coded video recordings of teachers delivering All Stars, a middle school drug prevention program. Interrater agreement for scaled items was assessed for an instrument designed to evaluate program fidelity. Results indicated sound interrater reliability for items assessing adherence, dosage, quality of teaching, teacher understanding of concepts, and program adaptations. The interrater reliability for items assessing potential program effectiveness, classroom management, achievement of activity objectives, and adaptation valences was improved by dichotomizing the response options for these items. The item that assessed student engagement demonstrated only modest interrater reliability and was not improved through dichotomization. Several coder pairs were discordant on items that overall demonstrated good interrater reliability. Proposed modifications to the coding manual and protocol are discussed.

Factors associated with collaboration among agencies serving children with complex chronic conditions.

Our objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children with complex chronic conditions (CCC). We hypothesized that an agency will collaborate with more partners in the network if the agency had a coordinator and participated in a community coalition. We surveyed representatives of 63 agencies that serve children with CCC in Forsyth County, North Carolina about their agencies' collaborations with other agencies. We used social network analytical methods and exponential random graph analysis to identify factors associated with collaboration among agencies. The unit of analysis was the collaborative tie (n = 3,658) between agencies in the network. Agencies participating in a community coalition were 1.5 times more likely to report collaboration than agencies that did not participate in a coalition. Presence of a coordinator in an agency was not associated with the number of collaborative relationships. Agencies in existence for a longer duration (≥11 vs. ≤10 years; adjusted odds ratio (aOR): 2.1) and those with a higher proportion of CCC clientele (aOR: 2.1 and 1.6 for 11-30 % and ≥31 % compared to ≤10 %) had greater collaboration. Care coordination agencies and pediatric practices reported more collaborative relationships than subspecialty clinics, home-health agencies, durable medical equipment companies, educational programs and family-support services. Collaborative relationships between agencies that serve children with CCC are increased by coalition participation, longer existence and higher CCC clientele. Future studies should evaluate whether interventions to improve collaborations among agencies will improve clinical outcomes of children with CCC.

Styles of Adaptation: The Impact of Frequency and Valence of Adaptation on Preventing Substance Use.

Purpose: To be effective, evidence-based programs should be delivered as prescribed. This suggests that adaptations that deviate from intervention goals may limit a program's effectiveness. This study examines the impact that number and quality of adaptations have on substance use outcomes. Design: We examined 306 video recordings of teachers delivering 'All Stars', a middle school drug prevention program. Multiple observers coded each recording, noting the number and type of adaptation each teacher made. Each adaptation was given a valence rating. Adaptations that were deleterious to program goals received negative valence ratings; positive ratings were given for adaptations that were likely to facilitate achievement of program goals; neutral ratings were given to adaptations that were expected to have neither a positive nor negative impact on program goals. Findings: All teachers made adaptations. Teachers were consistent across time in the types of adaptations they made, suggesting each teacher has a personalized style of adapting. Those who made few adaptations, and whose average adaptation was rated as being positive had a higher percentage of students who remained non-drug users. In contrast, teachers who made many adaptations, whether their average valence rating was positive, neutral or negative, failed to have as many students remain non-drug users. Measures of fidelity, including quality of delivery and teacher understanding were related to valence of adaptations, with better performance related to making positive adaptations. Practical Implications: Through training and supervision, teachers should be guided and encouraged to follow programs directions, making few adaptations and ensuring that adaptations that are made advance the goals of intervention. Programs should define acceptable and unacceptable ways they may be adapted. Value: This study provides significant evidence about the challenges that face disseminated evidence-based programs.

Promoting quality of program delivery via an internet message delivery system.

This article presents results from a study that evaluated an online message system designed to improve the delivery of prevention programs. We conducted a quasi-experimental study with 32 agencies and schools that implemented substance use prevention programs and examined differences between the comparison and intervention groups. We also examined the impact of dosage of the message system by comparing results among three groups of teachers: non-users, low users, and high users. Results for norm setting were marginally significant, such that teachers within the agencies assigned to the intervention condition scored higher on their understanding of norm setting at posttest compared to teachers within comparison agencies, after controlling for pretest knowledge scores and demographic items. In the model examining impact of dosage, high users of the intervention scored significantly higher on self-reported understanding of their program, quality of delivery, and program effectiveness compared to non-users. Low users of the intervention reported significantly higher quality of delivery compared to non-users.

The role of teacher communicator style in the delivery of a middle school substance use prevention program.

We examine whether teachers' communicator style relates to student engagement, teacher-student relationships, student perceptions of teacher immediacy, as well as observer ratings of delivery skills during the implementation of All Stars, a middle school-based substance use prevention program. Data from 48 teachers who taught All Stars up to 3 consecutive years and their respective seventh-grade students (n = 2,240) indicate that having an authoritative communication style is negatively related to student engagement with the curriculum and the quality of the student-teacher relationship, while having an expressive communicator style improves teachers' immediacy to student needs. Adaptations made by a subsample of teachers (n = 27) reveal that those who were more expressive asked students more questions, used more motivational techniques, and introduced more new concepts than authoritarian teachers.