High School Mechanisms of Action

Mechanisms of Effectiveness for the Narconon Prevention Program. Lennox R and Cecchini M. (2013). Final Project Report to Narconon International and Friends of Narconon, Intl.

Summary

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Background

The Narconon drug education curriculum for high school grades decreased levels of drug use and improved attitudes regarding drug harmfulness six months following curriculum completion compared with controls. The program sends a powerful abstinence message that was able to produce reductions in drug use behavior. Aspects of the 8-module curriculum correct prevalent but false messages while empowering youth to observe and draw their own conclusions. The program potentially also improves interpersonal skills, including a family component, and contributes to the development of appropriate group norms. These changes may result in shifts in perception of risk and corrected attitudes as individuals and as a group. As the mechanisms of action for this program are not known, this analysis aims to characterize the youth response patterns and use differences among those patterns to explore program components.

 

Methods

The present analysis used data from the original prevention 2007 evaluation of 995 participants from 14 schools in Hawaii and Oklahoma where participating schools were assigned to either Narconon drug education or a control group. Cluster analysis of proximal outcomes (changed attitudes, perception of risk, knowledge) in the experimental group was used to create responder groups. Responder analysis then explored the determinants of program effectiveness that might mediate the more distal outcomes, in this case substance use. Mediation analysis was used to assess the extent to which retention and application of the program information explains group differences in regard to substance use attitudes and behavior.

 

Results

The 307 youth in the experimental group without missing data were categorized into four possible responder groups:

  1. 118 youth already exhibited strong anti-drug attitudes and behaviors and continued to do so after the intervention;
  2. No youth who exhibited strong anti-drug attitudes and behaviors worsened after the intervention;
  3. 99 youth exhibited pro-drug attitudes and behaviors prior to the Narconon intervention then switched to strong anti-drug attitudes and behaviors after the intervention; and
  4. 90 youth exhibited pro-drug attitudes and behaviors and remained so despite the intervention.

For actual drug use as well as perceived harm, decisions regarding drug use, and disapproval, more accurate knowledge of the prevention program content resulted in decreased substance use, increased decisions to be drug free, increased perceived harmfulness of substance use, and increased disapproval of substance use.

 

Conclusions

The responder analysis indicates that participants identified as respondents to the intervention changed the most in regard to protective factors: attitudes, decisions, beliefs and knowledge regarding substance use. As the goal of preventing future drug use is thought to be accomplished through maintaining protective factors, an encouraging finding is that the cluster analysis did not reveal any cluster of respondents who went from good to bad in regard to these protective factors. All the participants that started good stayed good—they maintained their protective attitudes and beliefs.

 

The mediation analysis indicates that the knowledge imparted by the intervention impacted both substance use attitudes and substance use behavior a full six months after program completion. One might conjecture that greater certainty with knowledge and social norms imparted by the program helped shape healthy attitudes and communication skills regarding substance use, which in turn impacted the behavior of participants who received the intervention.