Evaluation in health promotion: synthesis and recommendations.
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Biomedical subjects
Publications and source records attributed to M S Goodstadt.
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Schools are attempting to reduce substance abuse by implementing policies related to use of alcohol and other drugs in school settings. A review of current trends in adolescent substance use, together with research concerning effectiveness of alcohol and drug education and the impact of legal deterrence, indicate that: 1) neither educational nor school policy strategies by themselves are likely to effectively prevent use and abuse; 2) to be effective, education and policies must acknowledge and incorporate clear statements of community norms about alcohol and drug use; 3) to be effective, educational and policy strategies must complement and reinforce each other; and 4) education and policies must acknowledge and reinforce the positive behavior of the large number of students who do not use or abuse alcohol and other drugs.
This article considers the major issues facing drug education by identifying and discussing eight dichotomies. These dichotomies capture the decisions faced by policy-makers, drug education planners, and practitioners. The dichotomies permit a cohesive, simplified, examination of the complex dilemmas currently faced by the field; they include: identification of the problems to be addressed, etiological under-pinnings, program objectives, target audiences, and effective strategies.
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Multivariate analyses (Multiple Classification Analyses) of data obtained from repeated surveys (1981 and 1983) of students (grades 7-13) supported the separate consideration of three aspects of cannabis use and nonuse: not trying cannabis; trying and quitting cannabis use; and trying and continuing cannabis use. Marked consistency was found in results obtained from between and within-survey replications. Many variables which exhibited bivariate relationships with cannabis use were not significant when considered multivariately. Few variables were related to both trying vs. continuing cannabis use. Variables which were expected to be related to cannabis use failed to show a significant relationship, most notably those measuring perceived threat of legal consequences, problems at home, problems outside the home, and threats to health. Methodological and substantive, especially educational/prevention, implications are highlighted.
This article reviews experimental literature concerning the impact of drug (including alcohol and tobacco) education. Major weaknesses are identified with respect to planning, development, implementation, and evaluation of programs. Of special significance are inadequate identification of program objectives and target groups, failure to appreciate the dynamics of effective influence, lack of attention to program dissemination and utilization, and lack of concern with establishing the impact of programs through careful evaluation.
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"Peer pressure" and "everyone is doing it" have been used as excuses for some drug-taking behavior for too long. We must look harder into reasons for drug use and neither accept these concepts nor teach our young people that this is what is really happening.
Analysis of responses from a large sample of students (grades 7-13) indicated that a large proportion of students reported never having tried cannabis, and the majority of those who had tried the drug reported no longer using it. Multivariate analyses, employing Multiple Classification Analysis procedures, identified those variables most strongly associated with initially trying cannabis and with discontinuing its use. These results indicated that some variables had a similar relationship to these two aspects of cannabis use, but other variables were related exclusively either to trying cannabis or to continuing its use. Implications for education and other preventive interventions are highlighted.
A review of the experimental evidence concerning the effectiveness of 14 alcohol education programs for university students suggests that such programs, in spite of weaknesses in their experimental evaluation, offer the promise of significant impact on college students' reported alcohol-related behavior, as well as on their attitudes and knowledge. Programs are more likely to be effective if they include field (or laboratory) experience, as well as factual and experiential strategies, and if they occur over an extended period of time.
An experimental examination of three approaches to alcohol education compared a cognitive program, a decision-making program and a values-clarification program. The cognitive program was most positively received and was superior in raising levels of knowledge; the values-clarification program was least effective, especially as measured by the program's impact on current and expected alcohol use.
Six surveys of drug use (including alcohol) among Ontario (Canada) students (grades 7-13) were conducted between 1968-1979. Cohort analyses identified significant increases in the prevalence and incidence of alcohol and cannabis use for all cohorts with, however, some moderation of cannabis use in recent years within the oldest cohort. Recent tobacco use has shown a reduction in the earlier strong trends towards increased use. Developmental influences on drug use were stronger than generational influences. Implications for preventive intervention are discussed.
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