oversight

Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations and Federal Efforts to Identify Effective Programs

Published by the Government Accountability Office on 2003-01-15.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

United States General Accounting Office
Washington, DC 20548



          January 15, 2003

          The Honorable Richard J. Durbin
          United States Senate

          Subject: Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations and
                   Federal Efforts to Identify Effective Programs

          Dear Senator Durbin:

          The use of illicit drugs, particularly marijuana, is a problem among our nation’s
          youth. The adverse effects of illicit drug use play a role in school failure, violence,
          and antisocial and self-destructive behavior. A recent national survey1 showed that
          for 1996 through 2002, more than 30 percent of tenth and twelfth grade students
          reported using marijuana in the past year. Further, about 20 percent of high school
          seniors reported using marijuana within the past 30 days. In fiscal year 2000, the
          federal government spent over $2.1 billion on illicit drug use prevention activities for
          youth, according to the Office of National Drug Control Policy (ONDCP).

          Many programs are designed to help prevent and reduce illicit drug use among youth.
          Often, these programs also address the use of other substances, such as alcohol and
          tobacco. Youth drug abuse prevention programs are implemented in school, family,
          and community settings. School-based prevention programs are the most prevalent
          because schools provide easy access to children and adolescents. The most widely
          used school-based substance abuse prevention program in the United States is the
          Drug Abuse Resistance Education (DARE) program,2 which is funded by a variety of
          sources, including private, federal, and other public entities. DARE’s primary mission
          is to provide children with the information and skills they need to live drug- and
          violence-free lives through programs at the elementary school, middle school, and
          high school levels. The DARE program is usually introduced to children in the fifth or
          sixth grade. According to research literature, concerns have been raised about the
          effectiveness of the DARE fifth and sixth grade curriculum in preventing illicit drug
          use among youth. As agreed with your staff, this report contains information you
          requested on (1) the results of evaluations on the long-term effectiveness of the




          1
           Lloyd D. Johnston, Patrick M. O’Malley, and Jerald G. Bachman, Monitoring the Future National
          Results on Adolescent Drug Use: Overview of Key Findings, 2001, NIH Publication No. 02-5105
          (Bethesda, Md.: National Institute on Drug Abuse, 2002).
          2
              The DARE program is administered by DARE America—a nonprofit foundation.


                                                              GAO-03-172R Youth Illicit Drug Use Prevention
DARE elementary school curriculum in preventing illicit drug use among children
and (2) federal efforts to identify programs that are effective in preventing illicit drug
use among children.

To identify evaluations on the effectiveness of DARE at preventing illicit drug use
among children, we searched social science, business, and education databases,
which included the Department of Health and Human Services’ (HHS) National
Institutes of Health’s (NIH) National Library of Medicine, for evaluations of DARE
published in professional journals. We identified articles published in the 1990s on six
evaluations of the DARE elementary school curriculum that included illicit drug use
as an outcome measure and that also met key methodological criteria for our review,
such as a long-term evaluation design and the use of intervention and control groups
for comparisons. The six long-term evaluations that we discuss in this report were
conducted at different times up to 10 years after student participants were initially
surveyed. The six evaluations are based on three separate studies in three states. We
reviewed each of the six evaluations and summarized the results of our review. We
also held discussions with the researchers who conducted the evaluations. We did
not independently validate the research designs or verify the results of evaluations on
the effectiveness of the DARE program. (Enclosure I contains citations for the
articles on evaluations of the DARE elementary school curriculum that we reviewed
and enclosure II describes the methodology we used to select the evaluations).

To determine federal efforts to identify programs that are effective in preventing
youth illicit drug use, we interviewed federal officials and reviewed documentation
on efforts by HHS and the Department of Education (Education) to recognize
programs that demonstrate success in reducing illicit drug use among children and
adolescents. We did not independently verify the results of prevention programs
recognized by the federal agencies. We conducted our work from January through
December 2002 in accordance with generally accepted government auditing
standards.

In brief, the six long-term evaluations of the DARE elementary school curriculum that
we reviewed found no significant differences in illicit drug use between students who
received DARE in the fifth or sixth grade (the intervention group) and students who
did not (the control group). Three of the evaluations reported that the control groups
of students were provided other drug use prevention education. All of the evaluations
suggested that DARE had no statistically significant long-term effect on preventing
youth illicit drug use. Of the six evaluations we reviewed, five also reported on
students’ attitudes toward illicit drug use and resistance to peer pressure and found
no significant differences between the intervention and control groups over the long
term. Two of these evaluations found that the DARE students showed stronger
negative attitudes about illicit drug use and improved social skills about illicit drug
use about 1 year after receiving the program. These positive effects diminished over
time.




2                                               GAO-03-172R Youth Illicit Drug Use Prevention
HHS and Education have identified several programs that show evidence of
effectiveness in preventing youth substance abuse and promoted their use in schools
and communities. The Substance Abuse and Mental Health Services Administration
(SAMHSA) within HHS and Education use expert panels to review program
information that the programs’ developers or others submit and rank the programs
on several criteria, such as the scientific rigor of their evaluations and the overall
usefulness of their findings for preventing substance abuse. Only those programs that
produce a consistent pattern of positive results that have been verified scientifically
are recognized as effective, according to SAMHSA. HHS has also identified other
programs supported by HHS-funded research, that show evidence of effectiveness in
preventing substance abuse among youth. Specifically, within NIH, officials from the
National Institute on Drug Abuse (NIDA) and scientists who conduct NIDA-funded
research identified effective drug use prevention programs that were scientifically
evaluated and have demonstrated positive results over time. HHS and Education
disseminate descriptions of effective programs to practitioners, schools, and the
general public. In addition to the effective programs, each of the agencies also has
identified programs that, based on initial results, show promise in preventing
substance abuse among youth. However, the outcomes of these programs either have
not yet been verified scientifically or have not consistently demonstrated positive
results in preventing or reducing substance use, according to the agencies. The
agencies also disseminate lists of these programs.

In response to HHS’s comments on a draft of this report, we revised the report’s title
to better reflect the scope of our work. HHS and Education provided additional
information about their efforts to identify effective substance abuse prevention
programs that we incorporated as appropriate.

Background

A major goal of drug abuse prevention programs is to prevent the use of illicit and
nonprescription legal drugs and other substances, such as alcohol and tobacco. Two
drug prevention approaches show promise in reducing drug use and strengthening
individuals’ ability to resist illicit drugs. The psychosocial approach emphasizes drug
resistance skills, generic problem solving/decision-making training, and modification
of attitudes and normative beliefs that encourage drug use. The comprehensive
approach to prevention focuses on the setting in which programs are implemented,
which involves the use of schools, families, and the community, working together.3

Drug abuse prevention programs are categorized by three different audiences for
which they are designed. Generally, the programs are designed for (1) the general
population, (2) individuals or subgroups that are at risk for drug abuse because of
certain conditions such as being children of drug users, and (3) those individuals who
are already experimenting with drugs or who exhibit other risk-related behavior.


3
U.S. General Accounting Office, Drug Control: Observations on Elements of the Federal Drug Control
Strategy, GAO/GGD-97-42 (Washington, D.C.: Mar. 14, 1997).


3                                                   GAO-03-172R Youth Illicit Drug Use Prevention
Established in 1983, DARE operates in about 80 percent of all school districts across
                                                      4
the United States and in numerous foreign countries. In addition to the DARE
elementary school curriculum, the DARE program also includes middle school and
high school curricula that reinforce lessons taught at the elementary school level.

The elementary school curriculum consists of 17 lessons, taught by DARE-trained
uniformed police officers, that focus on providing students with decision-making
skills, showing them how to resist peer pressure, and teaching alternatives to illicit
drug use and violence. The majority of studies evaluating DARE focus on the
elementary school curriculum in effect before 1994. According to researchers, in
1994, modest changes were made to the elementary school curriculum, including
                                                             5
revisions to the content and sequencing of the DARE lessons.

In fiscal year 2000, the Department of Justice’s Bureau of Justice Assistance, which
supports various substance abuse prevention programs for youth, provided about
$2 million for DARE regional training centers to support the training of new police
officers that help deliver the DARE program lessons. Also, in fiscal year 2000,
Education provided states about $439 million in grants for schools and communities
                                                                                 6
under the Safe and Drug-Free Schools and Communities Act (SDFSCA) of 1994.
Some of the SDFSCA grant funds could have been used to support DARE. However,
Education has no estimate of the amount of SDFSCA fiscal year 2000 state grant
funds that were used for DARE.




4
 Data obtained from the DARE America Web site at http://www.DARE.com (as of July 30, 2002) and
information released by the University of Akron Institute for Health and Social Policy.
5
 The DARE middle and high school program curricula are being revised and will be evaluated, under a
Robert Wood Johnson Foundation research grant, by researchers from the University of Akron in
cooperation with DARE America Foundation officials. According to the Akron researchers who are
conducting the study, the revised middle school curriculum places more emphasis on and devotes
more time to three prevention program areas (1) normative beliefs about drug use, (2) consequences
of drug and alcohol use, and (3) drug use resistance skills. The curriculum also includes more
interaction among students through small group discussions and role-play. The study is experimenting
with using police officers as course facilitators rather than as instructors. The purpose of these
changes is to improve the effectiveness of DARE. Revisions to the high school curriculum were not
complete at the time of our review. The researchers plan to complete their evaluation of the revised
DARE curricula in 2006.
6
    Pub. L. No. 103-382, §101, 108 STAT. 3518, 3672-3690 (classified to 20 U.S.C. §§ 7101-7144 (2000)).


4                                                          GAO-03-172R Youth Illicit Drug Use Prevention
Evaluations of the DARE Elementary School
Curriculum Show No Significant Differences in Drug
Use Between DARE and Non-DARE Students

The six evaluations that we reviewed of the long-term effectiveness of the DARE
elementary school curriculum found no statistically significant differences in illicit
drug use between students who received DARE lessons in the fifth or sixth grade,
referred to as intervention groups, and students who did not—the control groups.7
Three of the six evaluations reported that the control groups of students that did not
receive DARE were provided other drug use prevention education. The six
evaluations we reviewed were based on three separate studies in three states—
Colorado, Kentucky, and Illinois. Table 1 summarizes the information on the six
evaluations that we reviewed. Each of the six evaluations, conducted at intervals
ranging from 2 to 10 years after the fifth or sixth grade students were initially
surveyed, suggested that DARE had no statistically significant long-term effect on
preventing illicit drug use. Five evaluations also reported on students’ attitudes about
illicit drug use and other nonbehavioral measures and found no significant
differences between the DARE and non-DARE students over the long term.

Table 1: Long-Term Evaluations on the Effectiveness of the DARE Elementary School Curriculum in
Preventing Illicit Drug Usea

    Evaluation/date of
    article                   Sample description                Measures             Prevention outcome
    Kentucky Studies
    1. Sensation Seeking as   The initial sample included a     Past year use of     No statistically significant
    a Potential Mediating     total of 2,071 sixth graders      marijuana.           differences were observed
    Variable for School-      from 31 elementary schools.                            between the intervention and
    Based Prevention          Twenty-three schools and                               control schools on students’
    Intervention: A Two-      1,550 students were assigned                           past year marijuana use 2 years
    Year Follow-Up of         to receive the DARE                                    after the intervention.
    DARE, 1991                intervention and 8 schools and
                              521 students were designated
    Location:                 control groups that received
    Lexington, Kentucky       drug use prevention education
                              provided under a standard
                              health curriculum. The sample
                              size at the 2-year follow-up,
                              when students were in the
                              eighth grade, was 1,207,or
                              about 78 percent of the
                              baseline for the intervention
                              group and 413,or about 79
                              percent for the control group.




7
 The studies surveyed individuals about their lifetime, past year, and past month marijuana, alcohol, or
cigarette use. They were also asked about their attitudes towards drugs, peer pressure resistance, and
self-esteem.


5                                                              GAO-03-172R Youth Illicit Drug Use Prevention
    Evaluation/date of
    article                   Sample description                 Measures               Prevention outcome
    2. The Effectiveness of   In the 5-year follow-up to the     Past year use of       No statistically significant
    Drug Abuse Resistance     1991 study, students were          illicit drugs.         differences were observed
    Education (Project        surveyed each year during the      Nonbehavioral          between intervention and
    DARE): 5-Year Follow-     sixth through tenth grades.        measures included      control groups on marijuana use
    Up, 1996                  The sample size at the 5-year      attitudes towards      1 year after the intervention and
                              follow-up, when students were      drugs, peer pressure   at the 5-year follow-up.
    Location:                 in the tenth grade, was 858, or    resistance, and        Although, significant positive
    Lexington, Kentucky       about 55 percent of the            perceived peer         DARE effects were observed
                              baseline for the intervention      substance use.         during the seventh grade (about
                              group and 285, or about 55                                1 year after the intervention) for
                              percent, for the control group.                           measures of students’ attitudes
                                                                                        towards drugs, capability to
                                                                                        resist peer pressure, and
                                                                                        perceived peer drug use, these
                                                                                        positive effects diminished over
                                                                                        time and were not significant at
                                                                                        the 5-year follow-up.
    3. Project DARE: No       Follow-up to the 1991 and          Lifetime, past year,   No statistically significant
    Effects at 10-Year        1996 studies. The final sample     and past month use     differences were observed
    Follow-Up, 1999           consisted of 1,002 young           of marijuana.          between the intervention and
                              adults between the ages of 19      Nonbehavioral          control groups for illicit drug
    Location:                 and 21,who were in the             measures included      use, peer pressure resistance,
    Lexington, Kentucky       original sixth grade sample of     peer pressure          and self-esteem at the 10-year
                              both intervention and control      resistance and self-   follow-up.
                              groups. Seventy-six percent of     esteem.
                              the participants had received
                              DARE lessons.
    Colorado Studies
    4. Three-Year Follow-up   The initial sample included 38     Use of illicit drugs   No statistically significant
    of Drug Abuse             elementary schools in              and the delay of       differences were found between
    Resistance Education      Colorado Springs, Colorado—        experimentation with   the intervention and control
    (DARE), 1996              21 schools received the DARE       illicit drugs.         groups with regard to illicit drug
                              intervention and 17 control        Nonbehavioral          use, delay of experimentation
    Location:                 group schools did not. The 3-      measures included      with illicit drugs, self-esteem, or
    Colorado Springs,         year follow-up sample              self- esteem and       resistance to peer pressure
    Colorado                  consisted of 940 ninth grade       resistance to peer     after 3 years.
                              survey respondents from the        pressure.
                              initial sample of elementary
                              school students. Excluding
                              invalid responses, the final
                              sample consisted of 849 ninth
                              grade students (497 students
                              in the intervention group and
                              352 in the control group).
    5. Long-Term Impact of    Follow-up to the 1996 study.       Use of illicit drugs   No statistically significant
    Drug Abuse Resistance     The 6-year follow-up sample        and the delay of       differences were found between
    Education (DARE):         consisted of 676 twelfth grade     experimentation with   the intervention and control
    Results of a 6-Year       survey respondents from the        illicit drugs.         groups regarding the use of
    Follow-Up, 1997           initial sample of elementary       Nonbehavioral          marijuana and the delay of
                              school students. Excluding         measures included      experimentation with illicit
    Location:                 invalid responses, the final       self-esteem and        drugs, self esteem, and
    Colorado Springs,         sample consisted of 620            attitudes toward       attitudes toward drug use, at the
    Colorado                  twelfth grade students (356        drug use.              6-year follow-up.
                              students in the intervention
                              group and 264 students in the
                              control group).




6                                                               GAO-03-172R Youth Illicit Drug Use Prevention
    Evaluation/date of
    article                    Sample description                Measures                Prevention outcome
    Illinois Study
    6. Assessing the Effects   A total of 1,798 students from    The study measured      No statistically significant
    of School-Based Drug       36 urban, suburban, and rural     past 30-day and any     differences were observed
    Education: A Six-Year      schools in Illinois were          use of illicit drugs.   between the intervention and
    MultiLevel Analysis of     surveyed each year from the       Nonbehavioral           control groups with regard to
    Project DARE, 1998         sixth through twelfth grade.      measures included       recent or any use of illicit drugs
                               Eighteen elementary schools       attitudes towards       1 year after the intervention and
    Location:                  received the DARE                 drugs, peer pressure    at the 6-year follow-up. The
    Chicago, Illinois          intervention and the 18           resistance, and self-   DARE students were more
                               elementary schools in the         esteem.                 likely to report stronger negative
                               control group did not.                                    attitudes about drug use and
                                                                                         improved social resistance skills
                                                                                         immediately after the
                                                                                         intervention. However, these
                                                                                         positive effects eroded over
                                                                                         time.
a
  These evaluations also measured the effects of DARE on other behavioral outcomes such as preventing alcohol
and tobacco use.

Source: GAO analysis of six evaluations.

Two of the six evaluations (Lexington, Kentucky, 1996 and Chicago, Illinois, 1998)
also reported information on the short-term effects of DARE. These evaluations
found no significant differences in illicit drug use between the intervention and
control groups within a year after completing the DARE lessons. They also found that
DARE students showed stronger negative attitudes about illicit drug use and
improved peer pressure resistance skills and self-esteem about illicit drug use about 1
year after the intervention. These positive effects diminished over time.

Federal Agencies’ Efforts to Identify Effective
Substance Abuse Prevention Programs

HHS and Education have identified several programs that show evidence of
effectiveness in preventing or reducing the use of illicit drugs and other substances,
such as alcohol and tobacco, among youth. Each agency identifies effective programs
to recognize their success and promote their use in schools and communities in the
United States. HHS and Education selected many of the effective prevention
programs from among those submitted by the program developers for review and
recognition. According to HHS and Education officials, the programs they selected
through an expert panel process do not include all programs that could potentially be
effective in preventing substance use among youth. Other effective programs that
HHS identified were selected from those whose development was supported by HHS-
funded research.




7                                                               GAO-03-172R Youth Illicit Drug Use Prevention
Specifically, within HHS, SAMHSA identified substance abuse prevention programs
that based on rigorous evaluation, consistently demonstrate positive results.
SAMHSA created the National Registry of Effective Prevention Programs (NREPP)8
to recognize many of these programs and help policymakers and those working in the
field of substance abuse prevention learn more about science-based prevention
programs. Under the NREPP process, teams of scientists who are expert in
prevention research, review and assess information, such as evaluation
methodologies and evaluation results, on prevention programs. Many of these
programs are selected and submitted by the program developers. The programs are
scored using established criteria and ranked on the scientific rigor of their evaluation
and the overall usefulness of their findings for preventing substance abuse. The
criteria that programs are evaluated on include factors such as design and
implementation, data collection and analysis, program outcomes, and replication and
dissemination capabilities. Only those programs that positively affect the majority of
the intended populations and produce a consistent pattern of results are recognized
as effective. HHS officials stated that the process of having program developers select
their programs for review tends to encourage the submission of those programs that
can be tested through conventional, low-cost evaluation procedures but discourages
the submission of potentially effective interventions that result in broad changes in
school or community activities. As of October 2002, SAMHSA had selected 41
effective programs from among 718 submissions. SAMHSA promotes the use of these
programs through dissemination, training, and collaboration activities with other
substance abuse prevention partners. Table 2 contains examples of effective
substance abuse prevention programs recently identified.




8
 NREPP incorporates the work of SAMHSA, Education, NIH, and the Department of Justice, as well as
the work of foundations and other entities.


8                                                   GAO-03-172R Youth Illicit Drug Use Prevention
Table 2: Examples of Effective Substance Abuse Prevention Programs HHS and Education Identified

    1. Life Skills Training     LST is a school-based substance abuse prevention program for children ages 10-
    Program (LST)               14. LST is designed to address a wide range of risk and protective factorsa to
                                reduce illicit drug use by teaching general personal and social skills in
                                combination with drug resistance skills and normative education.
    2 Child Development         CDP is a school improvement initiative designed to reduce the risk of alcohol and
    Project (CDP)               illicit drug use and bolster protective factors among elementary school children.
    3. Project ALERT            Project ALERT is a program that is provided to middle school students. Its course
                                content focuses on establishing no-drug use norms, developing reasons not to
                                use illicit drugs, and resisting pro-drug pressures.
    4. Strengthening Families   SFP targets families that are at risk for drug abuse. The multicomponent, family-
    Program (SFP)               focused program provides prevention programming for substance-abusing
                                families with 6- to 10-year-old children.
    5. Project STAR, known as   MPP is a comprehensive, community-based drug abuse prevention program that
    the Midwestern Prevention   uses school, mass media, parent education, community organization, and health
    Project (MPP)               policy programming to prevent and reduce alcohol, tobacco, and illicit drug abuse
                                among adolescents.

Note: SAMHSA identified all five of the substance abuse prevention programs in 1999. In 2001, Education
identified all of the programs except CDP and MPP. In 2002, NIDA identified all the programs except MPP.
a
 According to NIDA’s research-based guide, risk and protective factors encompass psychological, behavioral,
family, and social characteristics. Risk factors, which include ineffective parenting, failure in school performance,
affiliations with deviant peers, and aggressive behavior in the classroom, are associated with greater potential for
drug use. Protective factors, such as strong family and community bonds, success in school performance, and
adoption of normative beliefs about drug use, reduce the potential for drug use.

Source: HHS and Education documents.

Also, within HHS, NIDA officials and scientists who conduct NIDA-funded research,
identify effective drug abuse prevention programs that have been studied over time
and achieved positive results. The development of these programs is supported by
NIDA. NIDA publishes a guide on preventing drug use among children and
adolescents that describes research-based concepts for developing and implementing
effective drug abuse prevention programs and several research-based programs that
NIDA and the scientists identify.9

Education established the Safe, Disciplined, and Drug-Free Schools Expert Panel to
help identify programs effective in preventing and reducing substance abuse and
violent behavior among students. The panel consisted of teams of experts in
research, evaluation, and prevention programming. The expert panel used a
multilevel review process to identify effective programs based on information
submitted by entities or individuals applying for program recognition. The programs
submitted for review must show evidence of effectiveness in reducing substance use,
violent behavior, or other conduct problems for a year or longer based on at least one
methodologically sound evaluation. Also, the programs must obtain a certain rating
based on other criteria, such as whether the program’s content is appropriate for its
target population and whether the program provides the necessary information and
guidance for replication by others. Education officials stated that the programs
identified as effective and designated “exemplary,” showed statistically significant
differences in outcomes that were sustained for at least 1 year beyond the baseline.

9
    NIDA is having the 2003 edition of its guide reviewed before publication.


9                                                             GAO-03-172R Youth Illicit Drug Use Prevention
The expert panel makes recommendations to the Secretary of Education, who
announces those programs recognized as effective. Education began making a list of
these programs available to schools and others in 1999.

Education has also developed guidance, referred to as “Principles of Effectiveness,”
that identifies standards for state and local educational agencies to use in
implementing research-based prevention programs. According to Education officials,
SDFSCA funds can be used for programs that meet these standards and the effective
programs identified by the expert panel process.

HHS and Education also identify programs that show promise in preventing and
reducing the use of illicit drugs and other substances among youth. These programs
have shown positive initial results that have not yet been verified scientifically or
have not consistently demonstrated a positive effect on the prevention or reduction
of substance use. Each agency also publishes lists of the promising programs they
identify to recognize the programs’ contributions, based on initial results, to
preventing and reducing the use of illicit drugs, alcohol, and tobacco among youth.

Comments from HHS and Education
And Our Response

HHS and Education provided comments on a draft of this report. (See enclosure III
and enclosure IV, respectively.) Specifically, HHS commented that the title of the
draft report implied that the scope of our work was broader than the report’s
discussion. We revised the report title to better reflect the content of the report. With
regard to the DARE elementary school curriculum that we reviewed, HHS
commented that to evaluate DARE on the basis of a portion of the program may be
equivalent to arbitrarily evaluating the effects of only 1 year of multiyear
interventions of programs, such as Project STAR and Life Skills Training. We limited
the scope of our work to reviewing published articles on long-term evaluations of the
effectiveness of the DARE elementary school curriculum that included illicit drug use
as an outcome measure because of concerns that had been raised about the
effectiveness of DARE in preventing illicit drug use and because most of the research
has focused on the DARE elementary school fifth and sixth grade curriculum.

HHS also commented that the conclusions drawn in the draft report should not
necessarily be applied to the future DARE program and suggested that we may want
to incorporate more recent findings from the ongoing evaluation of DARE that were
released by the Robert Wood Johnson Foundation. However, information from the
ongoing evaluation of DARE that was released by the Robert Wood Johnson
Foundation did not contain any interim findings on the effectiveness of the DARE
program in preventing illicit drug use among youth. Moreover, according to the
University of Akron researchers who are conducting this work, the focus of their
study is on revising and evaluating the DARE middle school and high school curricula
and not the elementary school curriculum that we discuss in this report. The
researchers expect to have the final results of their study in 2006.



10                                             GAO-03-172R Youth Illicit Drug Use Prevention
Education questioned the accuracy and source of the statement in our draft report
that DARE operates in about 80 percent of school districts in the United States. We
obtained this information from the DARE America Web site and information released
by the University of Akron researchers related to their current evaluation of the
DARE middle school and high school curricula. We added these sources of the data
to the report. Education also questioned the basis for the estimate in the draft report
of SDFSCA funds that the department made available to support DARE in fiscal year
2000. The estimate in the draft report was obtained from ONDCP. ONDCP and
Education staff developed the estimate using a formula that assumed a certain
percentage of SDFSCA state grant funds could be used to support DARE. In response
to Education’s comment, we contacted officials in Education’s Budget Office and the
Office of Elementary and Secondary Education Safe and Drug-Free Schools Program,
to discuss the estimate that Education and ONDCP staff developed. According to
Education officials, the assumptions that were used to estimate the amount of
SDFSCA funds that could be used for DARE were hypothetical. Therefore, we deleted
the estimate from our report.

HHS and Education provided additional information about their efforts to help
identify effective substance abuse prevention programs. Where appropriate, we made
changes to the report to reflect the agencies’ comments, including technical changes
that HHS provided.

                                         -----

We are sending copies of this report to the Secretary of HHS, the Secretary of
Education, the Director of the Office of National Drug Control Policy, and others who
are interested. We will also make copies available to others upon request. In addition,
the report is available at no charge on GAO’s Web site at http://www.gao.gov.

If you or your staff have questions about this report, please contact me at (202) 512-
7119 or James O. McClyde at (202) 512-7152. Darryl W. Joyce and David W. Bieritz
made key contributions to this report.

Sincerely yours,




Marjorie E. Kanof
Director, Health Care—Clinical
 and Military Health Care Issues

Enclosures - 4




11                                               GAO-03-172R Youth Illicit Drug Use Prevention
Enclosure I                                                                 Enclosure I


Articles on Evaluations of the Effectiveness of the DARE Elementary School
                      Curriculum That GAO Reviewed

1. Clayton, Richard, R., Anne M. Cattarelo, and Katherine P. Walden. “Sensation
Seeking as a Potential Mediating Variable for School-Based Prevention
Intervention: A Two-Year Follow-Up of DARE.” Health Communication
(1991): 229-239.

2. Clayton, Richard, R., Anne M. Cattarelo, and Bryan M. Johnstone. “The
Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-Year Follow-
Up Results.” Preventive Medicine Vol. 25, No. 3 (May 1996): 307-318.

3. Dukes, Richard, L., Jodie B. Ullman, and Judith A. Stein. “Three-Year Follow-Up of
Drug Abuse Resistance Education (DARE).” Evaluation Review, Vol. 20, No. 1
(February 1996): 49-66.

4. Dukes, Richard, L., Judith A. Stein, and Jodie B. Ullman. “Long-Term Impact of
Drug Abuse Resistance Education (DARE): Results of a 6-Year Follow-Up.”
Evaluation Review, Vol. 21, No. 4 (August 1997): 483-500.

5. Lynam, Donald, R., Richard Milich and others. “Project DARE: No Effects At 10-
Year Follow-Up.” Journal of Consulting and Clinical Psychology Vol. 67, No. 4
(August 1999): 590-593.

6. Rosenbaum, Dennis, P. and Gordon S. Hanson. “Assessing the Effects of School-
Based Drug Education: A Six-Year MultiLevel Analysis of Project D.A.R.E.”
Journal of Research in Crime and Delinquency, Vol. 35, No. 4 (November 1998):
381-412.




12                                           GAO-03-172R Youth Illicit Drug Use Prevention
Enclosure II                                                                  Enclosure II


  Methodology GAO Used to Select Evaluations of the Effectiveness of the
 DARE Elementary School Curriculum at Preventing Illicit Drug Use Among
                                Youth

To identify evaluations of the effectiveness of the DARE elementary school
curriculum at preventing illicit drug use among children, we searched social science,
business, and education databases, which included NIH’s National Library of
Medicine, within HHS, for evaluations of DARE published in professional journals.
The majority of the published articles on evaluations of the effectiveness of DARE
focused on the program’s fifth and sixth grade elementary school curriculum. We
identified 27 articles on evaluations of the DARE elementary school curriculum that
included illicit drug use as an outcome measure. Of these articles, we selected for
review those evaluations that used at least three of the following four criteria for
methodological design: (1) long-term study design (study period of 2 years or longer),
(2) intervention and control groups for comparisons, (3) random assignment of study
groups, and (4) pretest and post-test or surveys of study participants. These criteria
are among the ones suggested by researchers as key components of rigorous
experimental research design. Six evaluations met at least three of these criteria (see
table 3). The six evaluations were based on three separate studies of the DARE
elementary school program in three different states—Colorado, Kentucky, and
Illinois.

We reviewed the sample design, research results, and conclusions for each of the six
evaluations and summarized the results of our review. We did not independently
validate the research design or verify the results of evaluations on the effectiveness of
the DARE elementary school curriculum.




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Enclosure II                                                                                    Enclosure II

Table 3: Six Evaluations of the DARE Elementary School Curriculum GAO Selected For Review

                                     Period
                                   evaluation                                 Random             Pretest and
                                    covered          Intervention and      assignment of       posttest of study
 Evaluation/date of article        (in years)         control groups       study groups          participants
 Sensation Seeking as a                 2                   Yes                 Yes                  Yes
 Potential Mediating
 Variable for School-Based
 Prevention Intervention: A
 Two-Year Follow-Up of
 DARE, 1991

 Location:
 Lexington, Kentucky
 The Effectiveness of Drug              5                   Yes                  Yes                  Yes
 Abuse Resistance
 Education (Project DARE):
 5-Year Follow-Up, 1996

 Location:
 Lexington, Kentucky
 Project DARE: No Effects              10                   Yes                  Yes                  Yes
 at 10-Year Follow-Up,
 1999

 Location:
 Lexington, Kentucky
                                                                                  a
 Three-Year Follow-up of                3                   Yes                                       Yes
 Drug Abuse Resistance
 Education (DARE), 1996

 Location:
 Colorado Springs,
 Colorado
                                                                                  a
 Long-Term Impact of Drug               6                   Yes                                       Yes
 Abuse Resistance
 Education (DARE): Results
 of a 6-Year Follow-Up,
 1997

 Location:
 Colorado Springs,
 Colorado
 Assessing the Effects of               6                   Yes                  Yes                  Yes
 School-Based Drug
 Education: A Six Year
 MultiLevel Analysis of
 Project DARE, 1998

 Location:
 Chicago, Illinois
a
  Evaluation did not have initial random assignment of intervention and control groups. Random assignment
allows for the development of experimental and control groups that are equivalent on all known and unknown
variables. Instead of random assignment, the evaluation included periodic random tests that included checks of
students’ demographic characteristics such as, age, gender, and ethnicity and students’ attitudes toward alcohol,
tobacco, and other drugs to ensure equivalency among the groups. No statistically significant differences were
found between the two study groups on those variables tested.

Source: GAO analysis of six evaluations



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Enclosure III                                                      Enclosure III


       Comments from the Department of Health and Human Services




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Enclosure III                                 Enclosure III




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Enclosure III                                 Enclosure III




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Enclosure III                                 Enclosure III




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Enclosure IV                                                       Enclosure IV


               Comments from the Department of Education




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Enclosure IV                                 Enclosure IV




(290165)



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