A Multimethod Approach to Preventing Substance Use Among Youth

About This Grant

PROJECT SUMMARY Adolescent substance use is a significant public health issue with costly consequences. Youth exposed to household challenges (i.e., parental substance use, parental incarceration, and parental mental health challenges) are more likely to use substances compared to those who are unexposed. Youth exposed to negative neighborhood contexts (e.g., neighborhood violence and low social cohesion) are more likely to use substances compared to those who are unexposed. The nine selective substance use prevention programs have had little success changing outcomes for this group. None were informed by the lived experiences of children, who experience both household challenges and negative neighborhood contexts. Most programs have struggled to attract and retain these youth. Mechanisms such as social connections have primarily been ignored despite their relevance for substance use prevention among youth. Thus, additional selective prevention programs are needed to prevent substance use among youth at this intersection. The PI (Powell) partnered with families exposed to household and neighborhood challenges to develop the Better Together (BT) intervention. BT is an 8-session, age-appropriate intervention designed to prevent substance use among adolescents (ages 11 to 13) exposed to household and neighborhood challenges. BT is a novel and promising strategy to enhance internal and external assets and help youth abstain from substance use. Qualitative findings from a process evaluation suggest that BT is acceptable and feasible. Quantitative findings from a pilot study also provide strong preliminary evidence that our team can recruit, retain, and engage youth affected by household and neighborhood challenges. We propose a hybrid type 1 study with two aims to achieve our long-term goal of preventing drug use and its consequences among youth exposed to household and neighborhood challenges. In Aim 1, we will conduct a randomized trial to evaluate the effectiveness of the Better Together Intervention, compared to a time-matched control group, in preventing alcohol and marijuana use over 18 months. We will also examine individual and interpersonal factors that mediate the relationship between the intervention and substance use using the Karlson-Holm-Breen method for mediation. In Aim 2, we will examine contextual factors that impact effective program implementation using surveys, interviews, and geospatial data. In Aim 4, we will assess how contextual factors impact effective program implementation, youth participation, and substance use outcomes. This research addresses high-priority topics for NIDA and NIH, including personalized interventions informed by people with lived experiences as well as scaling and implementing an innovative evidence-based interventions that address poor health outcomes. This study will address key effectiveness, implementation, and cost questions critical for widescale dissemination. Study processes and findings can inform future research, practice, and policies on substance use prevention in other populations and across settings.