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. 13 GAO-03-172R Youth Illicit Drug Use Prevention 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 14 GAO-03-172R Youth Illicit Drug Use Prevention Enclosure III Enclosure III Comments from the Department of Health and Human Services 15 GAO-03-172R Youth Illicit Drug Use Prevention Enclosure III Enclosure III 16 GAO-03-172R Youth Illicit Drug Use Prevention Enclosure III Enclosure III 17 GAO-03-172R Youth Illicit Drug Use Prevention Enclosure III Enclosure III 18 GAO-03-172R Youth Illicit Drug Use Prevention Enclosure IV Enclosure IV Comments from the Department of Education 19 GAO-03-172R Youth Illicit Drug Use Prevention Enclosure IV Enclosure IV (290165) 20 GAO-03-172R Youth Illicit Drug Use Prevention
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)