Program Profile: Classroom-Centered Intervention to Reduce Risk of Substance Use

This program was a preventive intervention for first-grade students, which was designed to reduce substance use risk by improving teachers’ behavior-management skills and enhancing classroom curricula. The program is rated Promising. Overall, results were mixed. The treatment group showed a statistically significant lower likelihood of self-reporting initiation of tobacco use and other drugs, compared with the control group. The program had no statistically significant impact on alcohol, mariju

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

The Classroom-Centered Intervention to Reduce Risk of Substance Use (CCI) was a universal, first-grade preventive intervention designed to reduce students’ risk for later drug involvement. The intervention was designed to enhance regular classroom curricula, improve teachers’ instructional and behavior-management skills, and address students’ poor achievement and aggressive and shy behavior, which are known risk behaviors for later substance use (Storr et al. 2002).

Program Components

CCI had three main components: 1) curricular enhancements, 2) improved classroom behavior-management practices, and 3) supplementary strategies for children who are not performing adequately. Various components were added to the existing school curriculum in language arts and mathematics to enhance students’ critical thinking, composition, and listening and comprehension skills. These included an interactive read-aloud component to improve students’ listening and comprehension skills, journal writing to increase composition skills, and a “Critique of the Week” assignment to increase critical-thinking skills. In addition, to improve mathematics skills, teachers used a whole-language approach.

Teachers used the Good Behavior Game (GBG), a whole-class strategy designed to promote social problem solving within a group context, to manage student behavior. Classes were divided into three teams. Points were given to teams in which members displayed precisely defined good behavior; points were taken away when team members displayed off-task and other negative behaviors, such as fighting. Later, earned points could be exchanged for tangible rewards, such as stickers or erasers. A weekly social problem-solving class was also included in the program.

For students who failed to respond to the GBG, back-up strategies were used (such as creating single-member teams). Such strategies allowed the link between students’ behavior and rewards and punishments to be more direct, to increase the rate of learning appropriate behavior.

Program Theory

The program was based on the theory that modifying early characteristics, conditions, and processes could render a more health-promoting set of behaviors later in life and reduce the risk for substance use, depression, and antisocial behavior (Kellam and Rebok 1992; Patterson et al. 1992).

Study

Storr and colleagues (2002) used a sample of 678 urban first graders and their families from nine elementary schools, which were located mostly in western Baltimore, Maryland. A randomized block design was employed, with schools serving as the blocking factor. Three first-grade classrooms in each of the nine elementary schools were randomly assigned to one of the two intervention conditions (Classroom-Centered Intervention [CCI] or Family–School Partnership [FSP]) or to a control condition (that did not receive any special prevention program). The CrimeSolutions review of this study focused on the differences between students in the CCI treatment group and students in the control group. Teachers and children were randomly assigned to intervention conditions. The interventions were limited to first-grade students.

Of the 678 students randomized, 219 were assigned to control conditions, 230 were assigned to CCI classrooms, and 229 were assigned to FSP classrooms. Of these 678 children, 53 percent were male, 86 percent were African American, and 14 percent were white. Children receiving free or reduced lunch made up 62 percent of the sample. At entrance into first grade, the children ranged in age from 5.3 to 7.7 years, with a mean age of 5.7 years. Compared with students in the CCI and FSP interventions, children in the control group were somewhat less likely to be male and to be African American, and somewhat more likely to come from two-parent households. In addition, the teacher ratings of problem behavior were modestly higher for children in the CCI group.

The primary outcome of interest was initiation of tobacco use. Youth self-reported use of tobacco was assessed 6 years after the end of the intervention year using the audio computer-assisted self-interview (ACASI) when the students were, on average, 12 years old. Parents/caregivers completed hour-long telephone interviews in the fall of first grade. Teachers rated the children’s adequacy of performance on core classroom tasks, using the Teacher Observation of Classroom Adaptation-Revised (TOCA-R) scale. Cox regression models were used to estimate the impact of the intervention on the risk of starting to smoke. Statistical adjustments were made for the between-group baseline differences in age, race, parental monitoring and supervision, family tobacco use, and teacher rating of the TOCA-R score. No subgroup analyses were conducted.

Study

Furr-Holden and colleagues (2004) used the same sample as Study 1 (Storr et al. 2002). Of the 678 students in the original sample, approximately 84 percent (n = 566) participated in the follow-up assessment 5, 6, and 7 years after randomization (sixth, seventh, or eighth grade). The CrimeSolutions review of this study focused on the differences between students in the CCI treatment group and students in the control group, at the 7 year follow up.

At follow up, students used ACASI methods to self-report on drug involvement, specifically related to early onset (i.e., prior to mid-adolescence) initiation of tobacco, alcoholic beverages, inhalants (e.g., glue and gases), marijuana, or other illegal drugs, including cocaine and heroin. The data was analyzed using regression models and generalized estimating equations. No subgroup analyses were conducted.

Teachers received 60 hours of training and worked with standardized materials, such as detailed outlines and checklists, to ensure fidelity to the Classroom-Centered Intervention (CCI) model. They were also taught supplementary strategies to use with children who failed to respond to other curricular enhancements. Teachers and school staff met with intervention experts to promote effective implementation of the program. Intervention teachers also attended monthly meetings to discuss common issues that arose while implementing the intervention and to receive ongoing support (Storr et al. 2002).

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Kellam, S.G., and G.W. Rebok. 1992. “Building Developmental and Etiological Theory through Epidemiologically Based Preventive and Intervention Trials.” In J. McCord and R.E. Tremblay (eds.). Preventing Antisocial Behavior: Interventions From Birth Through Adolescence. New York: The Guilford Press, pp. 162–95.

Patterson, G.R., J. Reid, and T. Dishion. 1992. A Social Learning Approach: IV. Antisocial Boys. Eugene, Ore: Castalia.