***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIMS Despite widespread prevention efforts to decrease adolescent risk-taking , substance use and driving after drinking ( DD ) are prevalent in the United States . The current study compared the efficacy of an abbreviated version of Drug Abuse and Resistance Education ( DARE-A ) to a new Risk Skills Training Program ( RSTP ) . DESIGN Adolescent participation in drinking , drug use , DD and riding with a drunk driver was examined longitudinally . After baseline assessment s , adolescents were r and omly assigned to the RSTP . DARE-A or a no intervention control group and then completed 2-month post-test and 6-month follow-up assessment s. SETTING Adolescents attended a mid-sized suburban high school . PARTICIPANTS The sample ( N = 300 ) was comprised of 58 % females and the age range was 14 - 19 years . INTERVENTION The RSTP was developed to target several risk behaviors and to examine the feasibility of conducting a brief personalized prevention program in a group setting . DARE-A focused on increasing knowledge and underst and ing the deleterious effects of substance use . MEASUREMENTS Risk-taking behavior , perception of peer risk-taking and positive and negative alcohol expectancies were assessed . FINDINGS RSTP participants decreased participation in several risk behaviors at post-test , but reductions were not maintained at 6-month follow-up . The control and DARE-A groups increased their positive and decreased their negative alcohol expectancies . The control group increased their alcohol consumption . CONCLUSIONS Results suggest that a brief , personalized , group prevention program is a feasible approach to reducing adolescent risk-taking . Strategies must be developed to solidify these positive changes so that they are longer-lasting OBJECTIVE To evaluate the effect of the middle and junior high school Drug Abuse Resistance Education ( D.A.R.E. ) and D.A.R.E. Plus programs on drug use and violence . DESIGN R and omized controlled trial of 24 schools , with 3 conditions : D.A.R.E. only , D.A.R.E. Plus , and delayed program control . SETTING Schools and neighborhoods , primarily in Minneapolis-St Paul . PARTICIPANTS All seventh- grade students in 24 schools in the academic year 1999 - 2000 ( N = 6237 at baseline , 67.3 % were white , and there was 84.0 % retention at final follow-up ) . INTERVENTIONS The middle and junior high school D.A.R.E. curriculum in the 16 schools that received D.A.R.E. only and D.A.R.E. Plus . In the 8 schoolts that received D.A.R.E. Plus , additional components included a peer-led parental involvement classroom program called " On the VERGE , " youth-led extracurricular activities , community adult action teams , and postcard mailings to parents . The interventions were implemented during 2 school years , when the cohort was in the seventh and eighth grade s. MAIN OUTCOME MEASURES Self-reported tobacco , alcohol , and marijuana use ; multidrug use ; violence ; and victimization , assessed at the beginning and end of seventh grade and at the end of eighth grade . Growth curve analytic methods were used to assess changes over time by condition . RESULTS There were no significant differences between D.A.R.E. only and the controls ; significant differences among boys between D.A.R.E. Plus and controls for tobacco , alcohol , and multidrug use and victimization ; significant differences among boys between D.A.R.E. Plus and D.A.R.E. only in tobacco use and violence ; and no significant behavioral differences among girls . CONCLUSION D.A.R.E. Plus significantly enhanced the effectiveness of the D.A.R.E. curriculum among boys and was more effective than the delayed program controls , underscoring the potential for multiyear , multicomponent prevention programs and demonstrating sex differences in response to intervention programs Background This study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive , evidence -based , harm reduction focused school drug education program for junior secondary students aged 13 to 15 years . The intervention draws on the recent literature as to the common elements in effective school curriculum . It seeks to incorporate the social influence of parents through home activities . It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons . Methods / Design A cluster r and omised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years . Both the schools and students have actively consented to participate in the study . The education program comprises ten lessons in year eight ( 13 - 14 year olds ) and eight in year nine ( 14 - 15 year olds ) that address issues around the use of alcohol , tobacco , cannabis and other illicit drugs . Control students will receive the drug education normally provided in their schools . Students will be tested at baseline , at the end of each intervention year and also at the end of year ten . A self completion question naire will be used to collect information on knowledge , patterns and context of use , attitudes and harms experienced in relation to alcohol , tobacco , cannabis and other illicit drug use . Multi-level modelling will be the method of analysis because it can best accommo date hierarchically structured data . All analyses will be conducted on an Intent-to-Treat basis . In addition , focus groups will be conducted with teachers and students in five of the 14 intervention schools , subsequent to delivery of the year eight and nine programs . This will provide qualitative data about the effectiveness of the lessons and the relevance of the material s. Discussion The benefits of this drug education study derive both from the knowledge gained by trialling an optimum combination of innovative , harm reduction approaches with a large , student sample , and the result ant product . The research will provide better underst and ing of what benefits can be achieved by harm reduction education . It will also produce an intervention , dealing with both licit and illicit drug use that has been thoroughly evaluated in terms of its efficacy , and informed by teacher and student feedback . This makes available to schools a comprehensive drug education package with prevention characteristics and useability that are well understood . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Prevention research continues to focus on school-based substance use programs aim ed at adolescents . These programs are design ed to reduce substance use and risk behavior by targeting key mediators , such as normative beliefs , which in turn reduce substance use .  All Stars is a newly developed program that was recently evaluated in a r and omized field trial in 14 middle schools in Lexington and Louisville , Kentucky . The authors examined targeted and nontargeted variables as possible mediators of program effectiveness . Findings indicate that All Stars achieved reductions in substance use and postponed sexual activity when teachers were successful at altering targeted mediators : normative beliefs , lifestyle incongruence , and manifest commitment to not use drugs . The program was not successful when it was delivered by specialists . At least in part , this failure is attributable to specialists ’ inability to change mediators as intended by the program Background While a number of preventive interventions delivered within schools have shown both short-term and long-term impact in epidemiologically based r and omized field trials , programs are not often sustained with high- quality implementation over time . This study was design ed to support two purpose s. The first purpose was to test the effectiveness of a universal classroom-based intervention , the Whole Day First Grade Program ( WD ) , aim ed at two early antecedents to drug abuse and other problem behaviors , namely , aggressive , disruptive behavior and poor academic achievement . The second purpose --the focus of this paper -- was to examine the utility of a multilevel structure to support high levels of implementation during the effectiveness trial , to sustain WD practice s across additional years , and to train additional teachers in WD practice s. Methods The WD intervention integrated three components , each previously tested separately : classroom behavior management ; instruction , specifically reading ; and family-classroom partnerships around behavior and learning .  Teachers and students in 12 schools were r and omly assigned to receive either the WD intervention  or  the st and ard first- grade program of the school system ( SC ) .  Three consecutive cohorts of first grade rs were r and omized within schools to WD or SC classrooms and followed through the end of third grade to test the effectiveness of the WD intervention . Teacher practice s were assessed over three years to examine the utility of the multilevel structure to support sustainability and scaling-up . Discussion The design employed in this trial appears to have considerable utility to provide data on WD effectiveness and to inform the field with regard to structures required to move evidence -based programs into practice .Trial Registration Clinical Trials Registration Number : Outcome research has shown that drug prevention programs based on theories of social influence often prevent the onset of  adolescent drug use .  However , little is known empirically about the processes through which they have their effects . The purpose of the present study was to evaluate intervening mechanism theories of two program models for preventing the onset of adolescent drug use . Analyses based on a total of 3077 fifth grade rs participating in the Adolescent Alcohol Prevention Trial revealed that both normative education and resistance training activated the causal processes they targeted . While beliefs about prevalence and acceptability significantly mediated the effects of normative education on subsequent adolescent drug use , resistance skills did not significantly predict subsequent drug use . More impressively , this pattern of results was virtually the same across sex , ethnicity , context ( public versus private school students ) , drugs ( alcohol , cigarettes , and marijuana ) and levels of risk and was durable across time . These findings strongly suggest that successful social influence-based prevention programs may be driven primarily by their ability to foster social norms that reduce an adolescent 's social motivation to begin using alcohol , cigarettes , and marijuana AIM To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study ( EUropean Drug Addiction Prevention trial ) . MATERIAL S AND METHODS Cluster R and omized Controlled Trial . Seven European countries participated in the study ; 170 schools ( 7079 pupils 12 - 14 years of age ) were r and omly assigned to one of three experimental conditions or to a  control condition during the school year 2004/2005 . The program consisted of a 12-h curriculum based on a comprehensive social influence approach . A pre-test  survey assessing past and current substance use was conducted before the implementation of the program , while a post-test survey was carried out about 18 months after the pre-test . The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio ( POR ) , estimated by multilevel regression models . RESULTS Persisting beneficial program effects were found for episodes of drunkenness ( any , POR=0.80 ; 0.67 - 0.97 ; frequent , POR=0.62 ; 0.47 - 0.81 ) and for frequent cannabis use in the past 30 days ( POR=0.74 ; 0.53 - 1.00 ) , whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up . Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition , but no difference was detected in the proportion of quitters or reducers among baseline daily smokers . CONCLUSION The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach , indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use , but not for cigarette smoking Background Alcohol misuse amongst young people is a serious concern . The need for effective prevention is clear , yet there appear to be few evidence d-based programs that prevent alcohol misuse and none that target both high and low-risk youth . The CAP study addresses this gap by evaluating the efficacy of an integrated approach to alcohol misuse prevention , which combines the effective universal internet-based Climate Schools program with the effective selective personality-targeted Preventure program . This article describes the development and protocol of the CAP study which aims to prevent alcohol misuse and related harms in Australian adolescents . Methods / Design A cluster r and omized controlled trial ( RCT ) is being conducted with Year 8 students aged 13 to 14-years-old from 27 secondary schools in New South Wales and Victoria , Australia . Blocked r and omisation was used to assign schools to one of four groups ; Climate Schools only , Preventure only , CAP ( Climate Schools and Preventure ) , or Control ( alcohol , drug and health education as usual ) . The primary outcomes of the trial will be the uptake and harmful use of alcohol and alcohol related harms . Secondary outcomes will include alcohol and cannabis related knowledge , cannabis related harms , intentions to use , and mental health symptomatology . All participants will complete assessment s on five occasions ; baseline ; immediately post intervention , and at 12 , 24 and 36 months post baseline . Discussion This study protocol presents the design and current implementation of a cluster RCT to evaluate the efficacy of the CAP study ; an integrated universal and selective approach to prevent alcohol use and related harms among adolescents . Compared to students who receive the st and -alone universal Climate Schools program or alcohol and drug education as usual ( Controls ) , we expect the students who receive the CAP intervention to have significantly less uptake of alcohol use , a reduction in average alcohol consumption , a reduction in frequency of binge drinking , and a reduction in alcohol related harms . Trial registration This trial is registered with the Australian and New Zeal and Clinical Trials registry , ACTRN12612000026820 An interactive CD-ROM program design ed to reduce adolescent substance use was developed and evaluated . The program uses video vignettes to teach refusal skills and socially acceptable responses to substance use situations , specifically offers of marijuana . In a r and omized pretest-to-posttest experiment with 74 public school students from six classes in 
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The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesis e. AUTHORS ' CONCLUSIONS School programmes based on a combination of social competence and social influence approaches showed , on average , small but consistent protective effects in preventing drug use , even if some outcomes did not show statistical significance .