Joel M. Moskowitz

A Review of 127 Drug Abuse Prevention Program Evaluations

This review examines outcome evaluations of 127 primary drug abuse prevention programs issued between 1968 and 1977. Included were studies which measured program effects on drug use, intentions to use drugs, and/or attitudes toward drug use. The studies were gathered through an extended search, and they may represent the largest collection of prevention program outcome evaluations currently available. As part of the review process, detailed summaries of all studies were prepared. Each study was described along 70 programming and research dimensions. The descriptive data were subjected to various cross-tabular and correlational analyses. This article describes characteristics of the prevention programs, program settings and target populations, research methods, and the evaluation reports themselves. Trends over time in programming and research practices are also identified. The most important findings concern program effectiveness. Overall, the 127 programs produced only minor effects on drug use behaviors and attitudes. However, in a substudy of the ten best-researched, highest-intensity service programs, effectiveness was judged to be more substantial. The best of the available evaluations are tentatively encouraging about the efficacy of “new generation” prevention programs. The review concludes with recommendations for prevention policy making, program planning, and program evaluation.

Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials.

BACKGROUND The effects of Web- and computer-based smoking cessation programs are inconsistent in randomized controlled trials (RCTs). We evaluated those effects using a meta-analysis. METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Review in August 2008. Two evaluators independently selected and reviewed eligible studies. RESULTS Of 287 articles searched, 22 RCTs, which included 29 549 participants with 16 050 enrolled in Web- or computer-based smoking cessation program groups and 13 499 enrolled in control groups, were included in the final analyses. In a random-effects meta-analysis of all 22 trials, the intervention group had a significant effect on smoking cessation (relative risk [RR], 1.44; 95% confidence interval [CI], 1.27-1.64). Similar findings were observed in 9 trials using a Web-based intervention (RR, 1.40; 95% CI, 1.13-1.72) and in 13 trials using a computer-based intervention (RR, 1.48; 95% CI, 1.25-1.76). Subgroup analyses revealed similar findings for different levels of methodological rigor, stand-alone vs supplemental interventions, type of abstinence rates employed, and duration of follow-up period, but not for adolescent populations (RR, 1.08; 95% CI, 0.59-1.98). CONCLUSION The meta-analysis of RCTs indicates that there is sufficient clinical evidence to support the use of Web- and computer-based smoking cessation programs for adult smokers.

Mobile Phone Use and Risk of Tumors: A Meta-Analysis

PURPOSE Case-control studies have reported inconsistent findings regarding the association between mobile phone use and tumor risk. We investigated these associations using a meta-analysis. METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library in August 2008. Two evaluators independently reviewed and selected articles based on predetermined selection criteria. RESULTS Of 465 articles meeting our initial criteria, 23 case-control studies, which involved 37,916 participants (12,344 patient cases and 25,572 controls), were included in the final analyses. Compared with never or rarely having used a mobile phone, the odds ratio for overall use was 0.98 for malignant and benign tumors (95% CI, 0.89 to 1.07) in a random-effects meta-analysis of all 23 studies. However, a significant positive association (harmful effect) was observed in a random-effects meta-analysis of eight studies using blinding, whereas a significant negative association (protective effect) was observed in a fixed-effects meta-analysis of 15 studies not using blinding. Mobile phone use of 10 years or longer was associated with a risk of tumors in 13 studies reporting this association (odds ratio = 1.18; 95% CI, 1.04 to 1.34). Further, these findings were also observed in the subgroup analyses by methodologic quality of study. Blinding and methodologic quality of study were strongly associated with the research group. CONCLUSION The current study found that there is possible evidence linking mobile phone use to an increased risk of tumors from a meta-analysis of low-biased case-control studies. Prospective cohort studies providing a higher level of evidence are needed.

Rates and independent correlates of Pap smear testing among Korean-American women.

OBJECTIVES This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. METHODS Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing RESULTS Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). CONCLUSIONS Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities.

Evaluation of Seven School-Based Prevention Programs: A Final Report on the Napa Project

Described is a series of evaluation studies of seven school-based prevention programs, including four generic in-service teacher-training programs, two alternatives programs, and a drug education course. The programs were delivered to elementary or junior high students, and were evaluated individually and in several combinations or sequences, using rigorous research procedures and a comprehensive set of process and outcome measures. Only the drug education course showed any pattern of significant effects, and these were short-term and obtained only for girls. The findings call into question the efficacy of generic prevention programs, at least as such programs are commonly implemented.

Design and Analysis Issues in Community-Based Drug Abuse Prevention

This article reviews the design and analysis issues that face community-based drug abuse prevention trials. Such trials allocate intact social groups to study conditions and fall within the general class of studies called “community trials.” Special concerns for community trials include selection bias, differential mortality and maturation, contamination, poorly defined constructs, weak interventions, violation of assumptions underlying analysis methods, and low power. Potential solutions include careful selection of comparison units, tight control over distribution of intervention materials, matching, randomization, adding more units to each condition or more frequent observations in each unit, monitoring exposure to intervention-like activities in all sites, regression adjustment for covariates, modeling time, and selection of an appropriate analysis model. Four approaches to analysis are illustrated in an example based on an adolescent tobacco use prevention study.

Evaluation of Jigsaw, a cooperative learning technique

Cooperative learning techniques have been promoted for the development of academic and social competencies. One such technique, Jigsaw, creates cooperation by structuring student interdependence through the learning task, rather than through the grading system. A process and outcome evaluation of Jigsaw was conducted. Eleven teachers of fifth-grade classes received Jigsaw in-service training and conducted Jigsaw in their classes over a school year. Students in 13 other fifth-grade classes served as a comparison group. Students received a pretest and a post-test assessing attitudes toward self, peers, and school, and achievement and attendance records were collected. The process evaluation revealed that the quality and frequency of Jigsaw implementation varied greatly. Jigsaw failed to have a positive effect on the outcome variables, even for the five classes where it was implemented proficiently. The results, which are consistent with an earlier study (J. Moskowitz, J. Malvin, G. Schaeffer, & E. Schaps, 1983, American Education Research Journal, 20, 687-696), are discussed in terms of a theoretical

Effect of provider status on preventive screening among Korean-American women in Alameda County, California

BACKGROUND Previous research suggests that having a doctor of the same ethnicity may be associated with lower rates of breast and cervical cancer screening in some Asian-American women. This study analyzes the effect of having a Korean, non-Korean, or no regular doctor upon several measures of screening among Korean-American women. METHODS A random sample of 339 Korean-American women in Alameda County, California, were surveyed by telephone. Contingency tables and multivariable logistic regression were used to evaluate the association between provider status and six measures of recent screening, controlling for insurance and demographics. RESULTS Having a non-Korean doctor was associated with an increased likelihood of having a Pap smear (odds ratio = 2.19, 95% confidence interval = 1.00, 4.80), mammogram (odds ratio = 7.63, 95% confidence interval = 2.35, 24.84), and clinical breast examination (odds ratio = 3.76, 95% confidence interval = 1.54, 9.20) in the past 2 years, compared to having a Korean doctor. This relationship is less apparent for nonfemale specific screening tests like cholesterol exams and routine checkups. CONCLUSIONS Women who have a Korean doctor have less than optimal rates of breast and cervical cancer screening compared to women who have a non-Korean doctor. Having a Korean doctor may indicate less access to preventive health services, and programs to increase screening should target both Korean physicians and their female patients.

Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.

Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

The impact of California's smoking ordinances on worksite smoking policy and exposure to environmental tobacco smoke.

A subsample of 5776 respondents to the California Tobacco Survey who do not smoke and work indoors outside of their home was analyzed regarding worksite smoking policy and worksite exposure to environmental tobacco smoke. To obtain study results, survey responses were linked to tobacco ordinance data. Nonsmokers who worked in localities with moderate or strong laws were more likely to report worksite smoking policies than nonsmokers in localities without laws. Even in localities with strong laws, 23.5% of respondents reported no worksite policy, and 26.4% reported recent exposure to environmental tobacco smoke at the worksite. Comprehensive laws with minimal exemptions may be necessary to ensure adequate compliance and protection from environmental tobacco smoke.