Koren Hanson

Implementing effective community-based prevention programs in the community youth development study

There is mixed evidence regarding the extent to which communities can replicate science-based substance use and delinquency prevention programs with high implementation fidelity, that is, in close adherence to the theoretical rationale and specifications of the program. This article examines implementation of 16 tested and effective preventive interventions replicated during 2004—2006 by 12 communities participating in the Community Youth Development Study. Results revealed that across all programs the majority of required material, core components, and lessons were delivered; implementers were prepared, enthusiastic, and used a variety of teaching practices to convey material; and high levels of engagement by program participants were observed. The results indicate that, using a comprehensive system to proactively monitor implementation, community coalitions can ensure high-quality replication of effective prevention programs.

Effects of Communities That Care on the Adoption and Implementation Fidelity of Evidence-Based Prevention Programs in Communities: Results from a Randomized Controlled Trial

This paper describes findings from the Community Youth Development Study (CYDS), a randomized controlled trial of the Communities That Care (CTC) prevention system, on the adoption and implementation fidelity of science-based prevention programming in 24 communities. Data were collected using the Community Resource Documentation (CRD), which entailed a multi-tiered sampling process and phone and web-based surveys with directors of community-based agencies and coalitions, school principals, service providers, and teachers. Four years after the initiation of the CTC prevention system, the results indicated increased use of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, and significant differences favoring the intervention communities in the numbers of children and families participating in these programs. Few significant differences were found regarding implementation quality; respondents from both intervention and control communities reported high rates of implementation fidelity across the services provided.

Washington State Recreational Marijuana Legalization: Parent and Adolescent Perceptions, Knowledge, and Discussions in a Sample of Low-Income Families

Background: In November 2012, Washington State and Colorado became the first states in the United States to legalize recreational marijuana use for adults, and Uruguay became the first country to allow the cultivation, distribution, possession, and use of marijuana. One possible consequence of these changes is increased adolescent marijuana use. Parents may mitigate this adverse consequence; however, whether parents and adolescents have accurate knowledge about the laws and are discussing marijuana use in light of the law changes is unknown. Objective: We examine perceptions, knowledge, and parent–child discussions about Washington States recreational marijuana law in a sample of low-income families. Methods: Participants were a subset of families (n = 115) in an ongoing study that originally recruited parents and adolescents from middle schools in Tacoma, Washington. In summer 2013, when students were entering the 11th grade, students and their parents were asked questions about the recreational marijuana law. Results: Participants perceived that their marijuana-related attitudes and behaviors changed little as a result of the law, and displayed uncertainty about what is legal and illegal. Most parents reported discussing the new law with their children but only occasionally, and conversations emphasized household rules, particularly among parent lifetime marijuana users compared to non-users. Conclusions/Importance: Results suggest that there should be a public health campaign focused on families that provides clear information about the recreational marijuana laws.

Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents

BACKGROUND A growing number of states have new legislation extending prior legalization of medical marijuana by allowing nonmedical marijuana use for adults. The potential influence of this change in legislation on adolescent marijuana and other substance use (e.g., spillover or substitution effects) is uncertain. We capitalize on an ongoing study to explore the prevalence of marijuana and other substance use in 2 cohorts of adolescents who experienced the nonmedical marijuana law change in Washington State at different ages. METHODS Participants were 8th graders enrolled in targeted Tacoma, Washington public schools and recruited in 2 consecutive annual cohorts. The analysis sample was 238 students who completed a baseline survey in the 8th grade and a follow-up survey after the 9th grade. Between the 2 assessments, the second cohort experienced the Washington State nonmedical marijuana law change, whereas the first cohort did not. Self-report survey data on lifetime and past-month marijuana, cigarette, and alcohol use were collected. RESULTS Multivariate multilevel modeling showed that cohort differences in the likelihood of marijuana use were significantly different from those for cigarette and alcohol use at follow-up (adjusting for baseline substance initiation). Marijuana use was higher for the second cohort than the first cohort, but this difference was not statistically significant. Rates of cigarette and alcohol use were slightly lower in the second cohort than in the first cohort. CONCLUSIONS This exploratory study found that marijuana use was more prevalent among teens shortly after the transition from medical marijuana legalization only to medical and nonmedical marijuana legalization, although the difference between cohorts was not statistically significant. The findings also provided some evidence of substitution effects. The analytic technique used here may be useful for examining potential long-term effects of nonmedical marijuana laws on adolescent marijuana use and substitution or spillover effects in future studies.

Implementation assessment of widely used but understudied prevention programs: An illustration from the Common Sense Parenting trial

Common Sense Parenting is a parent-training program that is widely disseminated, has promising preliminary support, and is being tested in a randomized controlled trial that targets lower-income, urban 8th-grade students and their families (recruited in two annual cohorts) to improve the transition to high school. The workshop-based program is being tested in both standard 6-session (CSP) and modified 8-session (CSP Plus) formats; CSP Plus adds adolescent-skills training activities. To offer a comprehensive picture of implementation outcomes in the CSP trial, we describe the tools used to assess program adherence, quality of delivery, program dosage, and participant satisfaction, and report the implementation data collected during the trial. Results indicated that workshop leaders had high adherence to the program content and manual-stated goal times of the CSP/CSP Plus curriculum and delivered the intervention with high quality. The majority of intervention families attended some or all of the sessions. Participant satisfaction ratings for the workshops were high. There were no significant cohort differences for adherence, quality and dosage; however, there were significant cohort improvements for participant satisfaction. Positive fidelity results may be due to the availability of detailed workshop leader guides, in addition to ongoing training and supervision, which included performance-based feedback.