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The Juvenile and Adolescent Substance Abuse Prevention Program: an evaluation.

Today, statistics indicate a sudden increase in drug and alcohol abuse prevention programs in the school systems of the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . This increase in drug prevention programs has been triggered by the increase in drug and alcohol use by adolescents between the ages of 12-17 years of age. According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 the Youth Risk Behaviors Survey (YRBS YRBS Youth Risk Behavior Survey ), from the years 1991 to 1999, lifetime marijuana marijuana or marihuana, drug obtained from the flowering tops, stems, and leaves of the hemp plant, Cannabis sativa (see hemp) or C. indica; the latter species can withstand colder climates.  and cocaine use increased each year by a mode of [+ or -] 2.5% among American students in the 9th to 12th grades. Between the years 1999 to 2005, the lifetime use of both drugs decreased, but the decrease of current cocaine use (use within the 30 days prior to the survey) did not begin until 2001. Illegal steroid use increased among this same age group during the years of 1991 to 2003, and a decrease was seen from 2003 to 2005. As the new millennium begins to take shape, the use of illegal drugs has decreased and the question is, is it due to the increase of youth drug and alcohol prevention programs? Several studies have tested the effectiveness of these programs and the Juvenile and Adolescent Substance Abuse Prevention (JASAP) program of Atlanta, Georgia is one of these effective programs.

Belgrave, Reed, Plybon, and Corneille (2004) used the Specific Event Drug and Alcohol Refusal Efficacy Scale (SEDARE) to measure the effectiveness of a drug abuse prevention program for urban African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race.  girls. The SEDARE was used to show the probability of drug use among these girls in certain situations. The situations in which the girls viewed themselves as being able to refuse drugs and alcohol varied; but of the 92 girls that participated, the girls in the intervention group had a higher drug and alcohol refusal rate as measured by the SEDARE than the girls in the control group. According to the study, 67% of the intervention group stated that they could refuse drugs and alcohol as opposed to the 33% of the comparison group who stated that they could refuse drugs and alcohol in the same situation. Most of the situations that were measured by the SEDARE were associated with peer relationships.

With Project KICK (Kids In Cooperation with Kids) Rollins, Rubin, and Wright (1999) used the community partnership, drug education, parent involvement, and peer counseling to evaluate the effectiveness of this program versus the programs that are only taught in the schools. Elementary school elementary school: see school.  students from a mid sized southeastern city in Florida were the actual participants, and seventh graders served as the peer mentors to two classrooms of third graders. The Curriculum used for project KICK is composed of nine units that the students will master upon completion. The Questionnaire used by Rollins et al(1999) measured attitudes related to substance abuse, teenage pregnancy teenage pregnancy Adolescent pregnancy, teen pregnancy Social medicine Pregnancy by a ♀, age 13 to 19; TP is usually understood to occur in a ♀ who has not completed her core education–secondary school, has few or no marketable skills, is  prevention, school attitudes, aggressive behavior, and stress reduction. The purpose of this program was to not only provide substance abuse prevention and education, but also to create a support base within the community where the pressure to try alcohol and drugs is lessened.

In 1993, Ellickson, Bell, and McGuigan did a longitudinal study longitudinal study

a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study.
 over six years that achieved reduced drug use during the years of junior high school. The curriculum used consisted of eleven lessons and was tested in 30 schools in eight highly diversified communities on the west coast. The curriculum focused on providing the 7th and 8th grade students the skills needed to resist drug and alcohol use. Throughout the program, approximately 4000 7th grade students were assessed six times (once every year) after the program was completed until grade 12. The results of this particular program were that as soon as the program was completed, the effects on drug use ended. Ellickson et al. (1993) found that the cognitive risk factors continued until the 10th grade for most of the students, but over all found that it is doubtful that early prevention is effective without some form of continued prevention efforts during high school.

With these studies we see an assortment of results in terms of the effectiveness of many different youth drug prevention programs; some are very effective, some are moderately effective, and some may not be effective at all. What is for certain, however, is that in order for these culturally sensitive programs to continue to be in existence, they must continuously be evaluated, updated, and enriched (Corvo & Persse, 1998). Education about substance abuse, solid backgrounds in substance abuse prevention along with community decision maker support have been identified as the cornerstones for a successful program (Callahan, Benton, & Bradley, 1995; Spooner & Hall, 2002). The Juvenile and Adolescent Substance Abuse Prevention program (JASAP) based on the knowledge base of substance abuse prevention and strong community decision maker support, was and educational intervention introduced in Fulton County
  • Fulton County is the name of a number of counties in the United States of America, most named for Robert Fulton, inventor of the first practical steamboat:
, GA. JASAP is a curriculum-based prevention and health promotion program for Fulton County youth between the ages of 13 to 18 years of age. Participants are identified through juvenile court juvenile court

Special court handling problems of delinquent, neglected, or abused children. Two types of cases are processed by a juvenile court: civil matters, often concerning care of an abandoned or impoverished child, and criminal matters, arising from antisocial
, schools, churches, community, and other youth organizations to break the cycle of addiction which leads to crime and incarceration Confinement in a jail or prison; imprisonment.

Police officers and other law enforcement officers are authorized by federal, state, and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes.
. The program was established to promote healthy decision-making skills that would eventually lead to informed choices and decisions surrounding drug and alcohol use.

Evaluation Overview

The program evaluation Program evaluation is a formalized approach to studying and assessing projects, policies and program and determining if they 'work'. Program evaluation is used in government and the private sector and it's taught in numerous universities.  for JASAP consisted of an evaluation of the implementation fidelity, process and outcomes. The evaluation plan was guided by theory and empirical research Noun 1. empirical research - an empirical search for knowledge
inquiry, research, enquiry - a search for knowledge; "their pottery deserves more research than it has received"
. Specifically, this evaluation plan was driven by the Trans-theoretical Model of Change and by the Theory of Reasoned Action The theory of reasoned action (TRA), developed by Martin Fishbein and Icek Ajzen (1975, 1980), derived from previous research that started out as the theory of attitude, which led to the study of attitude and behavior.  and Planned Behavior. The Transtheoretical Model The transtheoretical model of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made.  (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992; Prochaska & Velicer, 1997) is a model of behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness.  which integrates other theories and has been the basis for developing effective interventions to promote changes in health behaviors. The central organizing construct of the model is the Stages of Change which encompasses the model of intentional change. Intentional change involves decision making by the individual and also involves emotions, cognitions, and behavior. The present research project assesses the participants' readiness to change, thus enabling the researcher to track the participant's progress.

The Theory of Reasoned Action asserts that an individual's intention to perform a behavior under his or her direct control is a combination of attitude toward performing the behavior and subjective norms. For behaviors which were outside one's direct control, the researchers proposed Theory of Planned Behavior In psychology, the theory of planned behavior is a theory about the link between attitudes and behavior. It was proposed by Icek Ajzen (his last name is sometimes spelled "Aizen") as an extension of the theory of reasoned action. It is one of the most predictive persuasion theories.  which added the element of perceived control to predict behavioral intentions. Perceived control was considered to be a combination of perceived power and beliefs of control. Thus, this evaluation includes an evaluation of behavior intentions as dependent variables.

The evaluation plan is also guided by empirical findings related to youth intervention programs, focused on African American youth. Kemper, Spitler, Williams, Rainey (1999) analyzed youth service programs for at-risk youth. Their results revealed that successful programs have common elements such as interactive collaboration which would minimize duplication of services and maximize the impact of interventions for high-risk youth. To effectively address the unique needs of at-risk African American youth, these relationships should extend into the community to include participation by all concerned individuals. This evaluation will therefore assess social support of the participant as well as the number of referrals and outreach activities related to the participants. The survey questions adapted by Robinson et al.'s (2001) study on the effect of substance abuse education on knowledge, attitudes, and behaviors were utilized. Specifically, survey questions assessed knowledge, attitudes, short-term behaviors, long-term behaviors, and peer use behaviors. Also, Simpler and Langhinrichsen-Rohling (2005) found that individuals who had symptoms consistent with two or more psychological disorders were more likely to report higher levels of involvement with substance use than individuals who reported symptoms consistent with one or no psychological disorders. This evaluation plan thus assessed the number of referrals for mental health treatment.

The programs' impact was assessed by considering the Cognitive and behavioral impact--how has program participation changed prior knowledge, specifically the processes and outcomes related to making decisions about drug and alcohol use and how this is reflected in behavioral measures. As an evaluation of the cognitive impact, it was predicted that the participants would:

(1) Show an increase in their knowledge on the post test versus the pre test to questions related to decisions about drug and alcohol use.

(2) Demonstrate that they can accurately list the pros and cons of engaging in substance abuse.

(3) Have more cons versus pros related to drug and alcohol use after exposure to the program.

(4) Indicate the appropriate behavioral intentions and positive attitudes toward engaging in educational/career pursuit after exposure to the program.

(5) Have identified mentors/individuals who they could turn to when challenged with a decision related to drug and alcohol use.

(6) Indicate a moderate to high score on the Social Support Scale.

(7) Rate confidence (self efficacy) in making healthy substance abuse related decisions.

(8) Demonstrate progress along the Stages of Change and Readiness to change scale to indicate resources enabling them to pursue, maintain, and apply the healthy decision-making skills learned in the program to their life.

(9) Rate teacher and program evaluations positively (above neutral ratings). Behavioral impact

(10) Evidence of continuing school/work pursuits

(11) Absence/termination of substance use/abuse involvement

Design and Participants

Design.

A pre-test post-test between-groups design was used by comparing the pre test measures obtained from the participants entering the program. Although the pre and post test items on the survey was the same, the post test evaluated some additional outcome measures deemed necessary to conduct implementation fidelity and products of the program.

Variables.

The independent variable was the JASAP program and the dependent variables were the effect of the education program on the teenagers exposed to the program. Specifically, the independent variables were the processes constituting the JASAP program such as:

(1) Tools/activities associated with JASAP, such as enrollment of the participants, initiation of education curriculum, referrals and tracking of participants, (2) Entities involved in the implementation of JASAP in Fulton County including schools and youth service programs. The dependent variables constituted the outcomes and products of JASAP education component. Participants. A total of 246 participants were surveyed and information was entered into the database. The reported attendance by the participants varied from 3 to 8 sessions. Demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data.  from the database indicated an almost even distribution of males (57%) and females (43%). The grade/age distribution however varied from the 3rd grade to the 11th grade. The average age was 13, the average student GPA GPA
abbr.
grade point average

Noun 1. GPA - a measure of a student's academic achievement at a college or university; calculated by dividing the total number of grade points received by the total number attempted
 was 2.96.

Materials

The curriculum of the educational intervention consisted of the following:

Drug and alcohol prevention

Promoting healthy lifestyles and introducing options to using drugs and smoking

Alcohol Prevention Curriculum

Review of the impact of smoking on the body

Short term and long term effects of smoking

Review of the effects of peer pressure associated with drinking

Identify advertising techniques for media which promote drinking, smoking and advocate unhealthy lifestyles.

Decision Making

Improving and developing healthy decision making and communication skills

Identifying positive and negative influences

Developing Relationships

Identifying problems

Developing resolution for problems

Making informed choices

Career planning

Identifying long term and short term goals

Career Development (13-17) (15 min)

Introduction to career development

Introduction to career choices and options

Advocacy in the community

Advocating Drug free and Healthy behaviors and lifestyles

Identifying and explaining why it is important to become involved in your community.

Examples of how students can become more involved in their schools and communities

Additionally, the curriculum was adapted according to age group as follows:

Ages 10-12 Life Skills training

Communication Skills

A letter informed parents of what topic was taught to encourage them to follow up with re-enforcing the lesson at home.

Ages 13-17 Begin with the 'Drug Free Living for

Teens'--Powerpoint presentation. This presentation emphasized:

Values

Facts about drugs

Kind of offers

What to say or do in different situations

Positive vs. negative influences

Figuring out if a friend has a drug problem

Evaluation tools were developed to assess the dependent variables. The tools consisted of survey questions and archival records. Survey questions gauged the cognitive impact and the archival records gauged the behavioral impact of JASAP. Specifically, the following scales were utilized in addition to other survey questions:

Stages of Change and Readiness Ruler (Prochaska & Diclemente, 1982)--This assessed the cognitive progress of the teen after being exposed to the program. Decisional Balance Worksheet for Pros and Cons Assessment (Prochaska & Diclemente, 1984).This assessed if the teenager has learned correct information about the pros and cons of substance abuse.

Self-efficacy scale (Bandura ban`dur´a   

n. 1. A traditional Ukrainian stringed musical instrument shaped like a lute, having many strings.
, 1977). This assessed the teen's confidence in her/his knowledge about the information provided by the program. This assessed the teen's confidence in her/his knowledge about the information provided by the program and decisions related to substance abuse, career, and education.

Knowledge, attitudes, short-term behaviors, longterm behaviors, and peer use behaviors survey. This was adapted from Robinson et al.'s (2001) assessment of substance abuse education. The survey questions were adapted to the information provided by the JASAP tools. Such an adaptation ensured high content validity content validity,
n the degree to which an experiment or measurement actually reflects the variable it has been designed to measure.
.

Each site was evaluated by an adaptation of the following tool:

Youth Program Quality Assessment (High/Scope Educational Research Foundation, 2005). This assessment is designed to evaluate the quality of youth programs and identify staff training needs. An instructor evaluation form was also used. This assessed the teaching effectiveness of the instructor and the learning process of the student. Students evaluated their teachers on the following three elements: Instructor Appraisal--"The instructor's knowledge of the subject and discipline is excellent " Course Appraisal--"Overall, I would rate this program as "excellent " Self- Appraisal--"I know significantly more about this subject than I did before I took this course "

Procedures

Health Outreach workers (HOWs) in social work, public health, or a related field were trained by the supervisor to deliver a Curriculum Based Education Program Utilizing Best Practices. This curriculum delivered information about substance abuse which was accurate and developmentally appropriate. Participants were taught to identify and resist social pressure, and the information was presented interactively, including role playing role playing,
n in behavioral medicine, learning exercise in which individuals assume characters different from their own. The individual may also be asked to simulate a particularly difficult situation and apply the characteristics that are common to his
, discussion and small group activities. The Life skills training activities were also utilized during the educational sessions. The Health Outreach workers also conducted home visits using a structured form.

Participants were recruited from Fulton county partners, and a contact person at each site was established. Parental permission was obtained and assessment sheets were administered to the participants as a prerequisite for entering the program. Assessment sheets noted participant demographics and psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.

psy·cho·so·cial
adj.
Involving aspects of both social and psychological behavior.
 baselines related to substance abuse. A pretest pre·test  
n.
1.
a. A preliminary test administered to determine a student's baseline knowledge or preparedness for an educational experience or course of study.

b. A test taken for practice.

2.
 was then administered to establish the knowledge and attitudes baselines for substance abuse. The HOWs met the participants for 8, one hour sessions. Toward the end of the sessions, DiClemente's pros/cons sheet and readiness ruler was administered. A post test was finally administered prior to graduation. The post test consisted of similar items as the pretest and additional tests including, an equivalent forms 'knowledge of substance abuse' test, a set of scenarios where participants were asked to make healthy decisions about substance abuse, and ratings of confidence in future productive activities such as career and education. HOWs also conducted home visits to some participants and referred participants for further treatment if necessary. The evaluation team compiled the tests for the participants and evaluated the participant responses, sites, instructors, and delivery of the curriculum.

Results and Discussion

Data related to the Readiness Ruler, Decisional Balance Worksheet was analyzed towards the conclusion of the educational sessions. The confidence of the participant in her/his knowledge about the information provided by the program and decisions related to substance abuse, career, and education were evaluated on the post test. Knowledge and attitudes were also evaluated on the post test. Instructor teaching was evaluated by the evaluators and the students. Additionally, a site evaluation was also conducted.

Results pertaining per·tain  
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.

2.
 to the cognitive outcomes revealed that when participants were asked where they were in their readiness to change their problematic behaviors on a scale of 0 (not at all ready to change) to 10 (already changed), the mean readiness to change was 6.9. Problematic behaviors identified by most of the children included attitude, anger, behaviors. Drug/substance abuse references were made relative to cons for not changing their behaviors (junky, drug addict Any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or who is so drawn to the use of such narcotic drugs as to have lost the power of self-control with reference to his or her drug use. , jail) by many elementary children. Substance abuse behaviors which participants wanted to change were apparent only from the participants at the Juvenile Justice Center.

Students were evaluated on their perceptions of pros and cons related to a problematic behavior. Overall, students identified the same number of pros and cons (2.0)for changing behaviors, with the cons for not changing the behaviors (1.8) being more than the cons for changing behaviors (.8).

Participants' decision-making skills regarding alcohol/drug abuse were also evaluated. Results indicated that the majority of the participants (94%) made significantly more healthy decisions (Decision scenario 1, * (2) (1, n = 92)=85.172). When asked the reasons for their decision, participant responses varied from: 'it is illegal' to "I will never do drugs Verb 1. do drugs - use recreational drugs
drug

ingest, consume, have, take in, take - serve oneself to, or consume regularly; "Have another bowl of chicken soup!"; "I don't take sugar in my coffee"

inject - take by injection; "inject heroin"
".

Furthermore, participants were asked to indicate if they have considered career options and higher education. These considerations are incompatible with substance abuse and hence were considered important queries. Participants rated their confidence in their choices on a scale of Strongly Disagree to Strongly agree. Furthermore, participants were asked to indicate if they have considered career options and higher education. Participants reported a higher confidence in future decisions: Jobs, * (2) (2, n = 102)=23.011, p < .001; Education, * (2) (2, n = 102)=20.176, p < .001.

Pre post tests assessed knowledge gain and attitude change (n = 246). Knowledge was tested using the same test as the pretest and another equivalent test. The equivalent test was administered as a post test. Results indicated that the knowledge on the similar pretest increased significantly after the educational program, t (205)= -3.03, p =.001 (Mean = 11.32, SD = 3.2) to the post test (Mean = 12.68, SD = 2.6 ),. Scores on the equivalent test of knowledge about alcohol and substance abuse revealed that participants scored an average of 9 points out of a total of 12. Also, although non significant, the attitude about alcohol and drugs improved from the pretest (Mean = 3.63, SD = 1.6) to the post test (Mean = 3.84, SD = 1.4).

The YPQA analyses of 15 sites was conducted. All sites were evaluated on dimensions such as Safety = Physical environment accommodates program offerings; Supportive environment = Provides opportunities to be actively engaged; Interaction opportunities = Provides opportunities to participate in small groups; Youth centered = Supports a positive youth development focus; Publicity = Schedules of program sessions are reliable and well publicized pub·li·cize  
tr.v. pub·li·cized, pub·li·ciz·ing, pub·li·ciz·es
To give publicity to.

Adj. 1. publicized - made known; especially made widely known
publicised
; Access = Program locations, schedules, and costs facilitate youth access. All the 15 sites did not meet one major element of 'Publicity'.

Instructors were evaluated by the evaluator on their teaching effectiveness and also by the students in the program. Students rated their instructor on three items related to the instructor appraisal, course appraisal and student self appraisal of knowledge gained. The ratings were on a 5 point scale varying from 5 = strongly agree; to 0= not at all agree. In general, students strongly agreed with the following statements, and all the instructors had very similar ratings across sites.

Telephone contact was made with participants in the past. Respondents were asked three questions--Whether they were still in school and/or working; whether they were using/abusing alcohol or drugs; and improvements that could be made to the JASAP program. To date, contact was made with 88 participants. Results from direct conversations, and with conversations with significant others revealed that 1 out of 88 past participants, reported abusing drugs. Majority of the participants were still in school or working on their GED GED
abbr.
1. general equivalency diploma

2. general educational development

GED (US) n abbr (Scol) (= general educational development) →
. Two of them reported they were looking for work. The only one who reported drug use was out of work. Improvements for the JASAP program were suggested by very few participants, with one complaint being that it was boring at times. The rest of the participants and significant others reported that they were happy with the program and that they liked it. Several of the respondents recalled the instructor names. The results therefore revealed a significant impact of JASAP on cognitive and behavioral outcomes. Results show an increase in knowledge on the post test versus the pre test to questions related to decisions about drug and alcohol use, demonstrate that they can accurately list the pros and cons of engaging in substance abuse, had more cons versus pros related to drug and alcohol use. Results also indicated that the participants demonstrated appropriate behavioral intentions and positive attitudes toward engaging in educational/career pursuit. Participants identified a moderate level of Social Support by reporting the presence of mentors/individuals who they could turn to when challenged with a decision related to drug and alcohol use, with the HOWs being one such source. Participants made healthy substance abuse related decisions; demonstrated progress along the Stages of Change and Readiness to change scale to indicate resources enabling them to pursue, maintain, and apply the healthy decision-making skills learned in the program to their life. Furthermore, teacher and program evaluations were positive. Self report by participants and significant others also revealed a behavioral impact of the program on continuing school/work pursuits, and reporting an absence/termination of substance use/abuse involvement.

These results are in agreement with the positive findings of Belgrave et al. (2004), Rollin et al.'s (1999) studies. The follow-up of participants a year later indicates that the positive effects were sustained for at least a short period of time. It is surmised that these positive results of the early substance abuse intervention program-JASAP may be due to the curriculum and also due to the social support provided by the HOWs, in a high-risk environment (SAMHSA SAMHSA Substance Abuse and Mental Health Services Administration , 2005) where substance abuse and meager mea·ger also mea·gre  
adj.
1. Deficient in quantity, fullness, or extent; scanty.

2. Deficient in richness, fertility, or vigor; feeble: the meager soil of an eroded plain.

3.
 resources are prevalent. This 'halo effect' created by the presence and investment of the HOWs in the children, may have made the children more receptive to information from the HOWs.

Although the early intervention ear·ly intervention
n. Abbr. EI
A process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay.
 showed promising results, it is acknowledged that the impact is albeit short-term, and long-term support may be essential in sustaining the positive impact of the JASAP program. In summary, the results of this study provide converging evidence for the need for such early interventions to prevent substance abuse, to empower the community and provide support systems for those who need it most!

References

Belgrave, F. Z., Reed, Reed, M. C., Plybon, L. E., Corneille, M., (2004). The impact of a culturally enhanced drug prevention program on drug and alcohol refusal efficacy among urban African American girls. Journal of Alcohol and Drug Education, 34(3), 267-279.

Callahan, B. M., Benton, S. L., & Bradley, F.O. (1995). Implementing a drug prevention program: A comparative case study of two rural Kansas schools. Journal of Alcohol and Drug Education, 41(1), 26-48.

Corvo, K., & Persse, L. (1998). An evaluation of a pre-school based prevention program: Longitudinal effects on children's alcohol-related expectancies. Journal of Alcohol and Drug Education, 43(2), 36-47.

Ellickson, P. L., Bell, R. M., & McGuigan, K. (1993). Preventing adolescent drug use: Long-tern results of a junior high program. American Journal of Public Health, 83 (6), 856-861.

Rollin, Stephen A.; Rubin, Roberta I.; Wright, John C. (2000). The evolution of a community-based drug prevention program youth. Journal of Alcohol and Drug Education, 45(3), 33-46.

Spooner, C., & Hall, W., (2002). Preventing drug misuse by young people: We need to do more than 'just say no'. Addiction, 97, 478-481.

Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center.  (2007). National Youth Risk Behavior Survey The Youth Risk Behavior Survey (YRBS) is a biannual survey of adolescent health risk and health protective behaviors such as smoking, drinking, drug use, diet, and physical activity conducted by the Centers for Disease Control and Prevention.  2007. Health Risk Behaviors by Race/ Ethnicity.

Centers for Disease Control and Prevention (2005a). National Youtn Risk Behavior Survey 1991- 2005. Trends in the prevalence of Alcohol Use.

Centers for Disease Control and Prevention (2005b). National Youth Risk Behavior Survey 1991-2005. Trends in the prevalence of Marijuana, Cocaine, and Other Illegal Drug Use.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology The Journal of Consulting and Clinical Psychology (JCCP) is a bimonthly psychology journal of the American Psychological Association. Its focus is on treatment and prevention in all areas of clinical and clinical-health psychology and especially on topics that appeal to a broad , 51, 390-395.

Prochaska, J. O., & Velicer, W.F. (1997). The Transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38-48.

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behavior Addictive behavior is any activity, substance, object, or behavior that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially. . American Psychologist, 47, 1102-1114.

Prochaska, J. O., & DiClemente, C. C. (1984). Self-change processes, self-efficacy and decisional balance across five stages of smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective. . In Advances in cancer control-1983. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
: Alan R. Liss, Inc.

SAMHSA (2005). Substance abuse and mental health services administration The Substance Abuse and Mental Health Services Administration (SAMHSA), an operating division of the Health and Human Services Department (HHS), was established in 1992 by the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act (Pub. L. No. 102-321). : Substate estimates from the 2002-2004 National Surveys on Drug Use and Health.http://www.oas.samhsa.gov/substate2k8/SecD.htm#TabD 11

Robinson, S. E., Roth, S. L., Gloria, A. M., Keim, J. &Sattler, H. (1993). Influence of substance abuse education on undergraduates' knowledge, attitudes and behaviors. Journal of Drug and Alcohol Education, 39, 123-130.

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Kemper, K.A., Spitler, H., Williams, E., Rainey, C. (1999). Youth service agencies: Promoting success of at-risk African American youth. Family Community Health, 22(2), 1-15.

Simpler, A.H. & Langhinrichsen-Rohling, J. (2005). Substance use in prison: How much occurs and is it associated with psychopathology psychopathology /psy·cho·pa·thol·o·gy/ (-pah-thol´ah-je)
1. the branch of medicine dealing with the causes and processes of mental disorders.

2. abnormal, maladaptive behavior or mental activity.
? Addiction Research and Theory, 13 (5), 503-511.

Abreu and Santos Santos (sän`ts), city (1996 pop. 412,288), São Paulo state, SE Brazil, on the island of São Vicente in the Atlantic just off the mainland.  
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Author:Talpade, Medha; Lynch, Diane; Lattimore, Barbara; Graham, Ashlee
Publication:The International Journal of Behavioral Consultation and Therapy
Date:Dec 22, 2008
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