Bridging the Gap: The Impact of Implementation Strategies for Universal Drug Use Prevention on Student Outcomes in Low-Income Areas

Authors

1. Dr. Andria Eisman (⚑ United States) 1

2.Ms. Christine Koffkey (⚑ United States) 1

3.Ms. Christina Harvey (⚑ United States) 2

4.Ms. Judy Fridline (⚑ United States) 3

5.Dr. Carol Boyd (⚑ United States) 4

6.Dr. Amy Kilbourne (⚑ United States) 4

1. Wayne State University, 2. Oakland Intermediate School District, 3. Genesee Intermediate School District, 4. University of Michigan

Abstract

Adolescence, a time of heightened vulnerability, brings the risk of drug use escalation, posing significant threats to youth well-being and contributing to preventable morbidity and mortality. Evidence-based interventions (EBIs), like the Michigan Model for Health^TM (MMH), offer solutions, particularly in school settings. However, challenges exist in achieving fidelity and public health objectives when implementing MMH and similar interventions. This study explores the impact of implementation strategies for universal drug use prevention in low-income areas, aiming to enhance student outcomes.

This pilot cluster randomized controlled trial compared standard implementation with Enhanced Replicating Effective Programs (REP) for MMH delivery in 2021-2022. A theoretically-based implementation strategy, REP promotes intervention fidelity with curriculum materials, training, and as-needed technical assistance. Enhanced REP adds intervention tailoring and training to meet student needs and customized implementation support (i.e., Facilitation). Student measures included drug use and risk perceptions (Monitoring the Future: MTF), mental health (Patient Health Questionnaire, PHQ-9 and Generalized Anxiety Disorder, GAD-7), and drug use consequences (Problem Oriented Screening for Teenagers: POSIT). We conducted regression analyses in MPlus with Full Information Maximum Likelihood (FIML) for missing data and accounted for clustering and covariates.

The analytic sample included 282 students, with entropy balancing to address differential attrition. Enhanced REP students showed no differences in drug use, drug risk perception, or depressive symptoms with standard implementation students. Enhanced REP students reported lower anxiety symptoms (p<.001) and drug use consequences (p<.05) versus standard implementation.

Preventing drug use onset can alleviate social, emotional, and economic burdens. Effective school-based prevention could save an estimated $171 billion (USD). Our results highlight the potential of implementation strategies to enhance the public health impact of school-based universal prevention, especially among at-risk youth. These findings underscore the importance of addressing drug use early to reduce the societal costs associated with these disorders.