An internet-based, gender-specific drug abuse prevention program intended to reduce substance use among early adolescent girls through improving personal, social, and drug refusal skills.
Blueprints: Promising
Traci Schwinn
School of Social Work
Columbia University
1255 Amsterdam Avenue
New York, NY 10027
Email: tms40@columbia.edu
Phone: 917-763-3786
Traci M. Schwinn
School of Social Work, Columbia University
The RealTeen internet-based program is designed to improve adolescent girls' general personal and social skills and skills specific to drug use. The program operates through a secure website, which offers a homepage with a variety of content, including feeds from the latest entertainment sites, online polls, horoscopes, beauty tips, and a quote of the day. Participants in the program also use the RealTeen website to complete 9 intervention sessions. These sessions require approximately 20 minutes to complete. The sessions cover goal setting, decision making and problem solving, puberty, self-esteem and body image, coping, drug knowledge, norms and social influences, refusal skills, and a review. In these sessions, participants are guided through content and asked to respond to questions and complete practice exercises.
The RealTeen internet-based program is designed to improve adolescent girls' general personal and social skills and skills specific to drug use. The program operates through a secure website, which offers a homepage with a variety of content, including feeds from the latest entertainment sites, online polls, horoscopes, beauty tips, and a quote of the day. Participants in the program also use the RealTeen website to complete 9 intervention sessions. These sessions require approximately 20 minutes to complete. The sessions cover goal setting, decision making and problem solving, puberty, self-esteem and body image, coping, drug knowledge, norms and social influences, refusal skills, and a review. In these sessions, participants are guided through content and asked to respond to questions and complete practice exercises.
Session 1: Introduction & Goal Setting
▪acquaint themselves with the homepage features (e.g., current events and entertainment news, beauty tips, inspirational quotes, horoscope) and the menu bar for the nine intervention sessions ▪customize certain aspect (TBD) of their homepage ▪explore the importance of goal setting as a means to achieve their aspirations and to stay healthy and safe ▪set a short- and long-term goal ▪formulate three immediate action-steps necessary to reach each goal
Session 2: Problem Solving
▪learn a 5-step decision-making sequence to help them solve the problems they will encounter as they strive to meet their goals ▪practice using the 5-step decision making sequence to handle temptations related to breaking parental rules and using drugs and alcohol
Session 3: Puberty
▪learn about the physical, mental, and emotional changes that occur during puberty ▪recognize that learning about these changes can help them better cope with the challenges they will experience during puberty ▪recognize that bodily changes are normal ▪practice positive self-talk by writing down three things they like most about themselves
Session 4: Self-Esteem & Body image
▪recognize that puberty can affect self-esteem and body image. ▪identify media and social influences (family, peers) on self-esteem and body image ▪review societal pressures to maintain a certain shape and weight ▪learn three steps to media literacy ▪learn tips to improve self-esteem and body image
Session 5: Coping with Stress & Drug Knowledge
▪identify sources of stress (e.g., peers, family, academics, society) ▪identify signs of stress ▪learn such healthy means of diffusion as regular exercise, healthy diet, adequate sleep, deep breathing, asking for help, and journaling ▪identify and explore the connection between behavior and mood by reframing events ▪learn how drug use is a counterproductive coping skill ▪learn about the prevalence of peer drug use
Session 6: Norms & Social Influences
▪explore direct and indirect influences from: peers, parents, siblings, and media messaging (television, movies, music, advertising) to use drugs
Session 7 & 8: Communication & Assertiveness
▪distinguish among assertive, aggressive, and passive communication ▪learn about verbal and nonverbal communication ▪practice expressing their thoughts, feelings, and attitudes, without infringing on others ▪learn to use effective communication to manage conflict with peers and family, and increase refusal self-efficacy and self-esteem
Session 9: Review
▪review each of the skills-based sessions ▪understand how these skills build on and are interdependent with each other ▪practice and integrate their newly acquired skills by interacting in additional role-play simulations of drug use opportunity and refusal scenarios
Primary Evidence Base for Certification
Study 2
Schwinn et al. (2017, 2019) found girls participating in the intervention reported significantly lower rates than the control group of:
And improved risk and protective factors:
Primary Evidence Base for Certification
Of the two studies Blueprints has reviewed, one study (Study 2) conducted by the developer, meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness).
Study 2
Schwinn et al. (2017, 2019) conducted a randomized controlled trial in which participants (n=788) were recruited from ads on Facebook and then randomly assigned to the intervention or a control group. Drug use and a number of risk and protective factors were assessed at pretest, posttest (immediately after the intervention for intervention participants or 14 weeks after pretest for control participants), and at 1-, 2-, and 3-year follow-ups.
Study 2
Schwinn, T. M., Schinke, S. P., Hopkins, J., Keller, B., & Liu, X. (2017). An online drug abuse prevention program for adolescent girls: Posttest and 1-year outcomes. Journal of Youth and Adolescence, 47(3), 490-500. doi:10.1007/s10964-017-0714-4
Schwinn, T. M., Schinke, S. P., Keller, B., & Hopkins, J. (2019). Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls. Addictive Behaviors, 93, 86-92.
Individual: Body Image Concerns, Stress
Peer: Peer substance use*
Individual: Coping Skills*, Perceived risk of drug use, Problem solving skills, Refusal skills*, Skills for social interaction
*
Risk/Protective Factor was significantly impacted by the program
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific race, ethnic, or gender group.
Study 2 (Schwinn et al., 2017, 2019) found subgroup effects by using a homogenous sample of all females.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
Since the program targets adolescent girls, the entire sample for Study 2 (Schwinn et al., 2017, 2019) was female. Additionally, over half (63%) of participants were White, 17% were Black, and 15% were Latino.
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
No training is necessary as the program is fully self-contained online.
No information is available
Organizational site access requires a $1,000 fee, then $50 per user. An individual can access the program for $300. Fees cover 1 year of program access. A temporary demo site is available free of charge.
The 9-session program is designed to be implemented weekly; each session requires approximately 20 minutes to complete. Sessions should be completed in a single sitting. The program requires the use of a laptop of desktop with internet.
No information is available
No specific qualifications or training are necessary to deliver the self-contained online program. Staff may need to help youth remember their access codes.
No information is available
No information is available
Fidelity monitoring is not required but aggregate fidelity data may be obtained upon request.
No information is available
No information is available
No information is available
In this example, a youth-serving community organization provides the online RealTeen intervention to 50 13- to 14-year old girls over the course of a year.
| Organizational site access | $1,000.00 |
| Access for 50 users @ $50 | $2,500.00 |
| Total One Year Cost | $3,500.00 |
For the organization to provide the intervention to 50 girls, the year one cost per individual would be $70.
Traci M. SchwinnSchool of Social Work, Columbia University1255 Amsterdam AvenueNew York, NY 10027USA917-763-3786tms40@columbia.edu
An internet-based, gender-specific drug abuse prevention program intended to reduce substance use among early adolescent girls through improving personal, social, and drug refusal skills.
Girls ages 13-14, which are ages at risk for initiation of risky substance use
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific race, ethnic, or gender group.
Study 2 (Schwinn et al., 2017, 2019) found subgroup effects by using a homogenous sample of all females.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
Since the program targets adolescent girls, the entire sample for Study 2 (Schwinn et al., 2017, 2019) was female. Additionally, over half (63%) of participants were White, 17% were Black, and 15% were Latino.
Individual: Body Image Concerns, Stress
Peer: Peer substance use*
Individual: Coping Skills*, Perceived risk of drug use, Problem solving skills, Refusal skills*, Skills for social interaction
*Risk/Protective Factor was significantly impacted by the program
The RealTeen internet-based program is designed to improve adolescent girls' general personal and social skills and skills specific to drug use. The program operates through a secure website, which offers a homepage with a variety of content, including feeds from the latest entertainment sites, online polls, horoscopes, beauty tips, and a quote of the day. Participants in the program also use the RealTeen website to complete 9 intervention sessions. These sessions require approximately 20 minutes to complete. The sessions cover goal setting, decision making and problem solving, puberty, self-esteem and body image, coping, drug knowledge, norms and social influences, refusal skills, and a review. In these sessions, participants are guided through content and asked to respond to questions and complete practice exercises.
The RealTeen internet-based program is designed to improve adolescent girls' general personal and social skills and skills specific to drug use. The program operates through a secure website, which offers a homepage with a variety of content, including feeds from the latest entertainment sites, online polls, horoscopes, beauty tips, and a quote of the day. Participants in the program also use the RealTeen website to complete 9 intervention sessions. These sessions require approximately 20 minutes to complete. The sessions cover goal setting, decision making and problem solving, puberty, self-esteem and body image, coping, drug knowledge, norms and social influences, refusal skills, and a review. In these sessions, participants are guided through content and asked to respond to questions and complete practice exercises.
Session 1: Introduction & Goal Setting
▪acquaint themselves with the homepage features (e.g., current events and entertainment news, beauty tips, inspirational quotes, horoscope) and the menu bar for the nine intervention sessions ▪customize certain aspect (TBD) of their homepage ▪explore the importance of goal setting as a means to achieve their aspirations and to stay healthy and safe ▪set a short- and long-term goal ▪formulate three immediate action-steps necessary to reach each goal
Session 2: Problem Solving
▪learn a 5-step decision-making sequence to help them solve the problems they will encounter as they strive to meet their goals ▪practice using the 5-step decision making sequence to handle temptations related to breaking parental rules and using drugs and alcohol
Session 3: Puberty
▪learn about the physical, mental, and emotional changes that occur during puberty ▪recognize that learning about these changes can help them better cope with the challenges they will experience during puberty ▪recognize that bodily changes are normal ▪practice positive self-talk by writing down three things they like most about themselves
Session 4: Self-Esteem & Body image
▪recognize that puberty can affect self-esteem and body image. ▪identify media and social influences (family, peers) on self-esteem and body image ▪review societal pressures to maintain a certain shape and weight ▪learn three steps to media literacy ▪learn tips to improve self-esteem and body image
Session 5: Coping with Stress & Drug Knowledge
▪identify sources of stress (e.g., peers, family, academics, society) ▪identify signs of stress ▪learn such healthy means of diffusion as regular exercise, healthy diet, adequate sleep, deep breathing, asking for help, and journaling ▪identify and explore the connection between behavior and mood by reframing events ▪learn how drug use is a counterproductive coping skill ▪learn about the prevalence of peer drug use
Session 6: Norms & Social Influences
▪explore direct and indirect influences from: peers, parents, siblings, and media messaging (television, movies, music, advertising) to use drugs
Session 7 & 8: Communication & Assertiveness
▪distinguish among assertive, aggressive, and passive communication ▪learn about verbal and nonverbal communication ▪practice expressing their thoughts, feelings, and attitudes, without infringing on others ▪learn to use effective communication to manage conflict with peers and family, and increase refusal self-efficacy and self-esteem
Session 9: Review
▪review each of the skills-based sessions ▪understand how these skills build on and are interdependent with each other ▪practice and integrate their newly acquired skills by interacting in additional role-play simulations of drug use opportunity and refusal scenarios
This program is based on social learning theory with the belief that girls' risk for drug use is mitigated by enhancing their social and cognitive skills to resist peer and social influences for drug use.
Primary Evidence Base for Certification
Of the two studies Blueprints has reviewed, one study (Study 2) conducted by the developer, meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness).
Study 2
Schwinn et al. (2017, 2019) conducted a randomized controlled trial in which participants (n=788) were recruited from ads on Facebook and then randomly assigned to the intervention or a control group. Drug use and a number of risk and protective factors were assessed at pretest, posttest (immediately after the intervention for intervention participants or 14 weeks after pretest for control participants), and at 1-, 2-, and 3-year follow-ups.
Primary Evidence for Certification
Study 2
Schwinn et al. (2017, 2019) found, at posttest, intervention participants reported less cigarette use over the last month, as well as higher self-esteem, goal-setting, media literacy, and self-efficacy. At 1-year follow-up, intervention participants reported less cigarette use and less binge drinking, as well as higher alcohol refusal skills, cigarette refusal skills, marijuana refusal skills, coping skills, and media literacy. Intervention participants also reported lower peer drug use. At 2-year follow-up, intervention participants reported less frequent use of cigarettes, marijuana, and other drugs, as well as lower peer drug use, increased drug refusal skills, improved coping skills, self-esteem, media literacy, and self-efficacy. At 3-year follow-up, intervention participants reported less frequent use of cigarettes and e-cigarettes, as well as lower peer drug use, increased drug refusal skills, self-esteem, media literacy, and self-efficacy.
Primary Evidence Base for Certification
Study 2
Schwinn et al. (2017, 2019) found girls participating in the intervention reported significantly lower rates than the control group of:
And improved risk and protective factors:
In Study 2 (Schwinn et al. 2017, 2019), incident rate ratios ranged from .146 - .549.
One study meets Blueprints standards for high quality methods with strong evidence of program impact (i.e., "certified" by Blueprints): Study 2 (Schwinn et al., 2017, 2019). The study took place online with 13-14-year-old girls from 48 states and the District of Columbia. The treatment was compared to a non-treatment control group.
Additional Studies (not certified by Blueprints)
Study 1 (Schwinn et al., 2010)
Blueprints: Promising
Traci Schwinn
School of Social Work
Columbia University
1255 Amsterdam Avenue
New York, NY 10027
Email: tms40@columbia.edu
Phone: 917-763-3786
Schwinn, T. M., Schinke, S. P., & Di Noia, J. D. (2010). Preventing drug abuse among adolescent girls: Outcome data from an internet-based intervention. Prevention Science, 11, 24-32.
Certified
Schwinn, T. M., Schinke, S. P., Hopkins, J., Keller, B., & Liu, X. (2017). An online drug abuse prevention program for adolescent girls: Posttest and 1-year outcomes. Journal of Youth and Adolescence, 47(3), 490-500. doi:10.1007/s10964-017-0714-4
Certified
Schwinn, T. M., Schinke, S. P., Keller, B., & Hopkins, J. (2019). Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls. Addictive Behaviors, 93, 86-92.
Study 1 served as the pilot test for RealTeen. This study used an earlier version of the program including 12 sessions.
Summary
Schwinn et al. (2010) conducted a randomized controlled trial and recruited participants through solicitation e-mails sent from Kiwibox.com, a youth-oriented website. Girls were randomly assigned to the intervention (n = 118) or control (n = 118) groups. Drug use and a number of risk and protective factors were assessed at baseline, posttest, and 6-month follow-up.
Schwinn et al. (2010) found at the 6-month follow-up, compared to the control group, girls participating in the program showed lower rates of:
Evaluation Methodology
Design:
Recruitment: This randomized controlled trial recruited 13- and 14-year-old girls through solicitation e-mails to users of Kiwibox.com, a youth-oriented website. Information packets were sent to the approximately 450 girls (and their parents) who responded to the solicitation, requiring parents to provide written consent to their daughter's participation.
Assignment: Of the roughly 450 girls who submitted interest forms, 236 were enrolled and randomly assigned to the treatment (n=118) or control (n=118) group. The authors do not state why only 236 girls were enrolled in the study; presumably some did not qualify or return consent forms.
Assessments/Attrition: Participants completed online assessments at baseline, posttest, and at 6-month follow-up. Girls in the treatment group completed the posttest survey at the conclusion of the last intervention session, while control group participants completed the posttest 6 weeks after the baseline. The attrition at posttest was 6.8% and the attrition at the 6-month follow-up was 9%.
Sample: The sample was 236 13- and 14-year old girls, from 42 U.S. states and 4 Canadian provinces. The racial composition was 60.6% White, 16.5% Black, 7.2% Latina, 6.8% Asian, and 8.9% other race. The average letter grade participants reported receiving in school was between an "A" and a "B." About half the sample reported living with both a mother and father, and about 90% reported attending a public school.
Measures: The outcome measures consisted of substance use items adapted from the CDC's Youth Risk Behavior Survey, which asked how many times in the past month and week participants used alcohol, cigarettes, marijuana, cocaine, inhalants, methamphetamines, and ecstasy. These responses were then used to create indicators for how many times the following substances were consumed in the last 30 days:
The posttest outcomes measured substance use in the last 30 days, but on average the girls completed the intervention in 1 month, so for those finishing faster than average, the posttest may have captured pre-intervention behaviors. The timing may explain why there were no effects for the posttest.
Additionally, potential mediators, all based on items presumably generated by the investigators, included:
Analysis: The study determined significant intervention effects using generalized linear models analysis of covariance. Effect sizes were calculated using Cohen's d. Analyses adjusted for baseline outcomes, length of time between pretest and posttest, age, and average letter grade in school. Randomization and analysis were both conducted at the individual level.
Mediation analyses regressed 9 mediator variables on the baseline outcomes, and for the 2 significant predictors, ANCOVA determined significant differences between treatment and control groups at the posttest and 6-month follow-up.
Intent-to-Treat: The study appears to be intent-to-treat. Ten girls in the intervention group failed to complete the full 12 sessions, these girls also did not take the posttest or 6-month follow-up survey, though presumably surveys were offered to these participants.
Outcomes
Implementation Fidelity: Ninety-two percent of the intervention group girls completed all 12 sessions of the prevention program. Further detail on the extent to which girls interacted with the intervention program and the larger website is unknown.
Baseline Equivalence: Authors stated that participants in the intervention and control groups were comparable on demographics (see tests in Table 1), mediating variables, and substance use; however, tests were not shown for the mediating and substance use measures.
Differential Attrition: The attrition rate was 6.8% for the posttest and 9% for the 6-month follow-up; these rates did not differ by condition. Authors indicated that differential attrition analyses were conducted on the same variables analyzed for baseline equivalency, but did not provide the results. No other information was offered on the relationship between baseline characteristics and attrition.
Though the study gave attrition rates for both follow-up surveys, it did not report the effective sample size. Of the 236 girls at baseline, 15 were dropped due to unreliable responses and 9% were lost to attrition, but it appears from the degrees of freedom that analyses included less than 200 participants. It therefore appears that the analyses only included girls who completed both follow-ups, but the study provides no further detail on the effective sample.
Posttest and 6-month follow-up: Those participating in the program showed reduced rates of alcohol, marijuana, poly drug, and total substance use at the 6-month follow-up (respective effect sizes= .20, .20, .19, .20). There were no significant differences for cigarette use at the 6-month follow-up. The results from the posttest administered at the end of the intervention indicated no significant difference for any outcome.
Of the 9 possible mediating effects, only self-efficacy significantly predicted the outcome at baseline and showed a significant difference across conditions at the 6-month follow-up. Normative beliefs also significantly predicted the baseline outcome, but significant difference across conditions were not maintained at the 6-month follow-up. No other mediator significantly predicted the baseline outcome. Overall, the mediation analysis was incomplete and the results were weak.
Summary
Schwinn et al. (2017, 2019) conducted a randomized controlled trial in which participants (n=788) were recruited from ads on Facebook and then randomly assigned to the intervention or a control group. Drug use and a number of risk and protective factors were assessed at pretest, posttest (immediately after the intervention for intervention participants or 14 weeks after pretest for control participants), and at 1-, 2-, and 3-year follow-ups.
Schwinn et al. (2017, 2019) found girls participating in the intervention reported significantly lower rates than the control group of:
And improved risk and protective factors:
Evaluation Methodology
Design:
Recruitment: Participants were 13-14 year old girls from 48 states and the District of Columbia. They were recruited through Facebook ads (ads were targeted toward just 13-14 year old girls). Those who indicated interest in the study and returned signed consent forms were enrolled in the study.
Assignment: The sample consisted of 788 13-14 year old girls from the United States. Participants were randomly assigned to either the treatment condition or control condition. All participants were given access to the study's website and directed to complete the pretest measures. Intervention group participants (n = 396) were then directed to begin completing the intervention sessions. Control group participants (n = 392) were not given any tasks to complete.
Assessments/Attrition: Participants were assessed at five time points: pretest, posttest, 1-year follow-up, 2-year follow-up, and 3-year follow-up. For intervention group participants, the posttest was administered upon completion of the intervention sessions. For control group participants, the posttest was administered 14 weeks after the pretest was completed. All participants completed the 1-year follow-up 12 months after the completion of their posttest. The 2-year and 3-year follow-ups were completed roughly two and three years after posttest.
Very little information was provided about attrition. The authors indicated that there was 97.5% sample retention for the risk and protective factors measures at posttest, 97% retention at 1-year follow-up, 94% retention at 2-year follow-up, and 93.4% retention at 3-year follow-up, but they did not report on retention rates for the behavioral outcomes.
Sample: Participants were, on average, 13.7 years old (SD = .67), and were 63% White, 17% Black, 15% Latino, 4% Asian, and 16% some other ethnic/racial group. More than 80% of participants came from urban areas, 9% came from large towns, and 10% from small towns. Their most recent average letter grade in school was between "mostly A's" and "mostly B's." In the previous month, 26% had used alcohol, 12% had been binge drinking, 14% had used cigarettes, and 14% had used marijuana.
Measures: The primary outcomes for this study were self-reported frequency, over the last month, of using alcohol, cigarettes, e-cigarettes (at 2- and 3-year follow-ups), marijuana, other drugs (e.g., club drugs, cocaine), as well as self-reported frequency of binge drinking. In addition, participants completed measures of anxiety, depression, body image, coping, stress, media literacy, goal setting, self-esteem, self-efficacy, alcohol refusal, cigarette refusal, marijuana refusal, and peer drug use. Outside of anxiety and depression, these latter measures assessed risk and protective factors and all exhibited acceptable reliability (alphas > .70 across all measurements).
Analysis: The primary outcome measures were analyzed using negative binomial generalized linear regression models. At posttest and 1-year follow-up, these models predicted each drug use measure, independently, from treatment condition while controlling for pretest drug use, age, average letter grade in school, and parents' education. At 2- and 3-year follow-ups, the models only controlled for pretest drug use. All risk and protective factors were analyzed using ordinary least squares regression models. At pretest and 1-year follow-up, the models controlled for pretest score, age, average letter grade in school, and parents' education level. The authors also examined the robustness of their findings by running each model 1) with only the pretest measure as a covariate, and 2) with no covariates. The results were the same under these specifications. No covariates were specified at 2- and 3-year follow-ups.
Intent-to-Treat: No information was provided about intent-to-treat. Authors mention that some participants did not complete all of the intervention sessions but they do not state what was done with their data. In addition, 13 participants (1.6%) had their data removed for reporting extreme scores or unreliable patterns of drug use at posttest and 1-year follow-up; 29 were removed for the same reasons at 2- and 3-year follow-ups.
Outcomes
Implementation Fidelity: The intervention was presented to participants online, and therefore was standardized for everyone. Among intervention participants, 87% completed all sessions; 3% completed zero sessions.
Baseline Equivalence: There were no significant differences between conditions on 11 measures at baseline. These measures included demographic information and baseline substance use. The tests did not include the numerous measures of risk and protective factors.
Differential Attrition: No information was provided concerning differential attrition, but it may be that attrition was only 3-7% across all measures and time points.
Posttest: At posttest, intervention participants, compared to control participants, reported less cigarette usage over the past month (IRR = .419), with 1 of 5 tests for behavioral outcomes reaching significance. For risk and protective factors, intervention participants reported higher self-esteem (B = -.11), goal setting (B = .09), media literacy (B = -.12), and self-efficacy (B = -.12) compared to control participants.
Long-Term: Sustained effects were detected on one of six outcome measures (since e-cigarettes were added at the 2- and 3-year-follow-ups). Intervention participants, compared to control participants, reported less cigarette usage over the past month at the 1-year (IRR = .326), 2-year (IRR = .474) and 3-year (IRR = .353) follow-ups. The other five behavioral outcomes showed mixed results across time. Treatment participants reported less binge drinking at the 1-year follow-up (IRR = .477). At 2-year follow-up, intervention participants, compared to control participants, reported less frequent use of marijuana (IRR = .549) and other drugs (IRR = .365) over the last month. At 3-year follow-up, intervention participants, compared to control participants, reported less frequent use of e-cigarettes (IRR = .146) over the last month.
For risk and protective factors, at the one-year follow-up, intervention participants, compared to control participants, reported higher alcohol refusal skills (B = -.22), cigarette refusal skills (B = -.16), marijuana refusal skills (B = -.18), coping skills (B = .11), and media literacy (B = -.08), as well as lower peer drug use (B = -.60). At the two-year follow-up, intervention participants, compared to control participants, reported lower peer drug use (B = -.55), increased drug refusal skills (B = -.12), improved coping skills (B = .12), self-esteem (B = -.11), media literacy (B = -.11), and self-efficacy (B = -.10). And at the three-year follow-up, intervention participants, compared to control participants, reported lower peer drug use (B = -.76), increased drug refusal skills (B = -.15), self-esteem (B = -.09), media literacy (B = -.09), and self-efficacy (B = -.09).