Evaluation Studies

Studies documenting the effectiveness of LST have been funded by the Centers for Disease Control and Prevention (CDC); the National Institute on Drug Abuse (NIDA); the National Cancer Institute (NCI); the National Heart, Lung and Blood Institute (NHLBI); and the National Institute of Child Health and Human Development (NICHD).

Williams, C., Griffin, K. W., Botvin, C., Sousa, S. & Botvin, G. J. (2023). Effectiveness of digital health tools to prevent bullying among middle school students when combined with a cognitive-behavioral skills training classroom program. Adolescents 3(1), 110-130.

This study tested the effectiveness of the Life Skills Training intervention which included the classroom curriculum, an animated video game, and e-learning modules for teachers and parents to prevent bullying behavior among middle school students. Fourteen schools were randomly assigned to receive enhanced LST(intervention group) or standard LST material without any bullying materials (comparison group). Students in both groups completed online pre- and post-test surveys to assess bullying behavior, knowledge, and life skills. Among students in the intervention group, there were significant reductions in in-person and cyberbullying perpetration and increased levels of life skills knowledge relative to students in the comparison group. This study is among the first to demonstrate that an intervention originally designed to prevent substance use and violence can also substantially reduce bullying when combined with digital health tools including a video game and e-learning modules.

Griffin, K. W., Botvin, G. J., Scheier, L. M., & Williams, C. (2023). Long-term behavioral effects of a school-based prevention program on illicit drug use among young adults. Journal of Public Health Research., 12(1), 1-5.

In the present study, middle schools were randomly assigned to receive the LifeSkills Training program or to serve as a “treatment-as-usual” control group. All students (n = 2,042) completed pre-test, post-test, and long-term follow-up surveys. Analysis revealed that compared to students assigned to the control group, those who received LST showed significantly less overall lifetime illicit drug use, as well as lifetime marijuana use, marijuana intoxication, and lifetime non-medical pill use 13 years after they originally received the program. This study provides evidence that not only does the LifeSkills Training program have immediate effects on substance use, but that the effects are long-term and durable.

Griffin KW, Williams C, Botvin CM, Sousa S and Botvin GJ (2022). Effectiveness of a hybrid digital substance abuse prevention approach combining e-Learning and in-person class sessions. Front. Digit. Health 4:931276.

The current study included 1,447 students from 23 middle schools across the United States. Schools were randomly assigned to receive the e-learning program and class sessions or serve as a “treatment-as-usual” control group. Compared to controls, students who received the e-learning program and class sessions showed significantly less cigarette smoking, e-cigarette and vaping use, excess alcohol use, marijuana use, and prescription drug misuse. They also showed increased health knowledge and skills knowledge, increased decision-making skills, increased skills related to coping with anxiety and anger, more effective communication and social skills, and increased conflict resolution and assertiveness skills.

Williams, C., Griffin, K.W., Mehta, R.K. & Botvin, G.J. (2021).Testing an evidence-based drug abuse and violence preventive approach adapted for youth in juvenile justice diversionary settings.. Health Justice 9, 3.

The present study tested the feasibility, appropriateness, and efficacy of a preventive intervention to reduce risk factors for substance use and delinquency among youth in juvenile justice diversionary settings by promoting positive youth development and building personal strengths and prosocial relationships. Participants in the study (N = 288) were predominantly male (69%) and in the 9th grade (14 years old) or higher (91%), received the preventive intervention, and completed confidential questionnaires at the pre-test and post-test. The majority of youth who participated in the intervention rated the program topics (77.9%) and activities (72%) as appropriate for their age, would recommend it to their peers (73.6%), and would use the skills learned in the future (85.4%). Comparison of post-test adjusted means revealed that the prevention program had a significant positive impact on key knowledge, attitudes, and skills including goal-setting, stress-management, and communication skills.

Griffin, K.W., Williams, C., Travis, W., & Tharp, A. (2021). Prevention of Unwanted Sexual Contact Among Cadets at the United States Air Force Academy: A Brief Small-Group Intervention. American Journal of Public Health.

This study tested the effectiveness of a small-group preventive intervention designed to prevent unwanted sexual contact among cadets at the US Air Force Academy. Among cadets in the incoming class of 2021, unwanted sexual contact was cut by nearly half in the intervention group relative to the control group. This study is one of the first rigorously designed trials to demonstrate a significant impact on unwanted sexual contact among students attending a US military service academy.

Velasco V., Griffin, K.W., Botvin, G.J., and Corrado Celata and Gruppo LST Lombardia. (2017). Preventing Adolescent Substance Use Through an Evidence-Based Program: Effects of the Italian Adaptation of Life Skills Training. Prevention Science.

Evidence-based preventive interventions for adolescent substance use, violence, and mental health issues are increasingly being adapted and disseminated internationally. In the present paper, we report the results of an effectiveness study that was part of a comprehensive initiative by a coalition of health promotion organizations in the Lombardy region of Italy to select, culturally adapt, implement, evaluate, and sustain an evidence-based drug abuse prevention program developed in the USA. Findings are presented from a large-scale effectiveness study of the LifeSkills Training prevention program among over 3000 students attending 55 middle schools in Italy. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. Relative to comparison group students, students who received the prevention program were less likely to initiate smoking at the post-test and 2-year follow-up, and less likely to initiate weekly drunkenness at the 1-year follow-up. The program had direct positive effects on several cognitive, attitudinal, and skill variables believed to play a protective role in adolescent substance use. The findings from this study show that a drug abuse prevention program originally designed for adolescents in the USA is effective in a sample of Italian youth when a rigorous and systematic approach to cultural adaptation is followed that incorporates the input of multiple stakeholders.

Botvin, G.J., Griffin, K.W., Williams, C. (2015). Preventing Daily Substance Use among High School Students Using a Cognitive-Behavioral Competence Enhancement Approach. World Journal of Preventive Medicine, 3(3):48-53.

The present study tested the effectiveness of a substance abuse prevention program for deterring tobacco, alcohol, and marijuana use among high school students. The prevention program teaches social resistance skills and general personal and social competence skills. Rates of substance use behavior were examined among students (N = 452) from 12 public high schools that were randomly assigned to either receive the prevention program (5 schools, n = 196) or serve as a treatment-as-usual control group (7 schools, n = 256). The impact of the prevention program was tested using composite indicators of daily substance use based on items measuring the frequency of smoking, drinking, drunkenness, marijuana use, and marijuana intoxication. Data were analyzed using generalized estimating equations to adjust for school-level clustering. Comparison of the posttest adjusted means (controlling for school clustering, gender, race/ethnicity, and family structure) revealed that the intervention produced significant prevention effects on daily substance use, both in terms of a daily polysubstance use index and the proportion of daily substance users across experimental condition. Findings indicated that there were 52% fewer daily substance users in the intervention condition compared to controls. Conclusions drawn from this study are that: (1) daily substance use can be prevented in high school students using a competence enhancement approach that addresses key risk and protective factors; (2) prevention approaches that are effective for middle school students can also be effective for high school students, if adapted to be developmentally appropriate; and (3) universal prevention approaches delivered by classroom teachers with minimal specialized training offer the potential for widespread dissemination and a cost-effective approach to an important public health problem.

Crowley, D., Jones, D. E., Coffman, D. L., Greenberg, M.T. (2014). Can We Build an Efficient Response to the Prescription Drug Abuse Epidemic? Assessing the Cost Effectiveness of Universal Prevention in the PROSPER Trial. Preventive Medicine.

Prescription drug abuse has reached epidemic proportions. Nonmedical prescription opioid use carries increasingly high costs. Despite the need to cultivate efforts that are both effective and fiscally responsible, the cost-effectiveness of universal evidence-based-preventive-interventions (EBPIs) is rarely evaluated. This study explores the performance of these programs to reduce nonmedical prescription opioid use. Crowley and his co-authors found that only one school-based program was effective when used by itself. The Botvin LifeSkills Training program resulted in 4 percent lower drug abuse rates, compared with a control group. The 18-session course teaches social skills that build competence and encourage assertiveness. LifeSkills Training was also among the most cost-effective programs studied, costing an average of $15 per child. By contrast, the study notes that prescription drug abusers cost society an average of $7,500 each for treatment and other expenses, by conservative estimates.

Spoth, R., Trudeau, L., Redmond, C., Shin, C. (2014). Replication RCT of early universal prevention effects on young adult substance misuse. Journal of Consulting and Clinical Psychology, 82(6):949-963.

Objective
For many substances, more frequent and problematic use occurs in young adulthood; these types of use are predicted by the timing of initiation during adolescence. We replicated and extended an earlier study examining whether delayed substance initiation during adolescence, resulting from universal preventive interventions implemented in middle school, reduces problematic use in young adulthood.

Method
Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program plus Life Skills Training (SFP 10–14 + LST), LST-only, or a control condition. Self-report questionnaires were collected at 11 time points, including four during young adulthood. The intercept (average level) and rate of change (slope) in young adult frequency measures (drunkenness, alcohol-related problems, cigarettes, and illicit drugs) across ages 19–22 were modeled as outcomes influenced by growth factors describing substance initiation during adolescence. Analyses entailed testing a two-step hierarchical latent growth curve model; models included the effects of baseline risk, intervention condition assignment, and their interaction.

Results
Analyses showed significant indirect intervention effects on the average levels of all young adult outcomes, through effects on adolescent substance initiation growth factors, along with intervention by risk interaction effects favoring the higher-risk subsample. Additional direct effects on young adult use were observed in some cases. Relative reduction rates were larger for the higher-risk subsample at age 22, ranging from 5.8% to 36.4% on outcomes showing significant intervention effects.

Conclusions
Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance use and associated problems, into young adulthood.

Spoth R., Trudeau L, Shin C., Ralston E., Redmond C., Greenberg M., Feinberg M. (2013). Longitudinal effects of universal preventive intervention on prescription drug misuse: three randomized controlled trials with late adolescents and young adults. American Journal of Public Health.

Researchers examined long-term prescription drug misuse outcomes in 3 randomized controlled trials evaluating brief universal preventive interventions conducted during middle school. In 3 studies, they tested the Iowa Strengthening Families Program (ISFP); evaluated a revised ISFP, the Strengthening Families Program: For Parents and Youth 10-14 plus the school-based Botvin LifeSkills Training (LST) (SFP 10-14 + LST); and examined the SFP 10-14 plus 1 of 3 school-based interventions. In study 2, SFP 10-14 + LST showed significant or marginally significant effects across all ages (21, 22, and 25 years); higher-risk participants showed stronger effects. Brief universal interventions have potential for public health impact by reducing prescription drug misuse among adolescents and young adults.