Can School-Based Educational Programs Really Be Expected to Solve the Adolescent Drug Abuse Problem?

A three-dimensional conceptual model for health promotion interventions to prevent adolescent drug abuse is elaborated. The model is based on an analysis of the concept of health into four domains--physical, psychological, social, and personal; an analysis of intervention approaches to change behavior into two major strategies--introducing/strengthening health-enhancing behavior, and weakening/eliminating health-compromising behavior; and an analysis of the foci of interventions into three levels--environmental, personality, and behavior. Components of a specific health promotion program, the Minnesota Heart Health Program, that are designed to prevent adolescent drug abuse are described. These include health behavior campaigns, educational interventions, and community organization. The theoretical content of the components is shown to be linked logically to the health promotion model.

A summary of important findings from the School Health Education Evaluation (SHEE) are reported. This paper focuses on the four principal outcome scores of Overall Knowledge, Attitude, Practice, and Program-Specific Knowledge. The relationship of those scores to measures of program implementation and cost also is described. A consistent pattern of findings emerged across the participating health instruction programs, suggesting that health instruction was effective in meeting program objectives as taught in the study classrooms, and that school health program effectiveness was strongly related to the level of implementation. Significant increases in Overall Knowledge and Program-Specific Knowledge were found for treatment classrooms when compared with control classrooms. Smaller, yet statistically significant, increases were found for attitudes and self-reported practices. Curriculum implementation measures were related to program effectiveness. A higher level of program implementation produced greater increases in all scores, but was most strongly related to improvement in attitudes and self-reported practices. Analysis of cost data revealed wide variation across the program. Implementation costs (those associated directly with the number of classroom instruction hours) accounted for more than 90% of the total costs and were, in turn, related to program effectiveness. Analysis of effects-to-classroom hours revealed that, while relatively few hours of instruction can produce large effects for knowledge, more hours are required for the development of attitude and practice effects, and that stable effects are established for all three domains at about 40-50 classroom hours.