Study looks at the prevention of adolescent substance abuse

Why do young people smoke cigarettes or use alcohol or drugs? What skills do they need to avoid starting these habits? A new study by researchers from Weill Cornell Medical College shows that competence skills can reduce adolescent substance use over the long term, even when friends smoke or use alcohol.

Previous research has shown that friends' substance use is one of the most powerful influences that lead adolescents to use themselves. Recent studies have focused on the role of competence skills, which include good self-management and positive psychological characteristics. These skills could protect young people from social risk factors for using substances.

The study, published in the April issue of the journal Addictive Behaviors, specifically looked at the skills of high refusal assertiveness (positive responses to questions like "Do you say ‘no' when someone asks you to smoke") and sound decision-making skills (positive responses to questions like "When I have a problem I think about which of the alternatives are best").

Results were taken from surveys of close to 1,500 predominantly Hispanic children from 22 inner-city middle and junior high schools in New York City over three years. The surveys included questions related to smoking cigarettes and marijuana, drinking alcohol, friends' substance use, family smoking patterns, and competence skills, including refusal assertiveness and decision-making skills. The surveys were collected from the control group only (those not receiving a prevention program) during a prior prevention project.

The study found that students with high-refusal-assertiveness skills were less likely to use multiple substances (cigarettes, alcohol and marijuana), even when their friends used substances or their siblings smoked. Similarly, students with high-refusal-assertiveness skills, as well as those with good decision-making skills, were also less likely than students without these skills to intend to smoke in the future, even if they had friends who smoked. The study controlled for ethnicity, gender, age, academic grades and family structure. The anonymity of all participating students was protected.

Since the study followed students over a three-year period, it was able to demonstrate that competence skills had a long-term effect in reducing the impact of friends' substance use. Previous research also showed that some competence skills decreased risk factors for some forms of substance use, however, these prior studies did not examine outcomes over an extended time period or concentrate on multiple substance use or future intentions. The Weill Cornell research is also unique in its focus on understudied inner-city adolescents.

"The take-home message from these findings is that competence skills matter in our understanding of substance use," says Dr. Jennifer A. Epstein, lead author and assistant professor of public health in the Division of Prevention and Health Behavior at Weill Cornell. "They can combat powerful social influences from friends and siblings to use multiple substances, including cigarettes. Moreover, this research provides important support for drug-abuse prevention programs that include the teaching of competence skills, including refusal skills and decision-making skills."

"This research highlights the complexity involved in understanding the causes of adolescent substance use," says Dr. Gilbert J. Botvin, the senior author, professor of psychology in public health and psychology in psychiatry, and chief of the Public Health Department's Division of Prevention and Health Behavior. "Such understanding is vitally important to effective prevention programs. Students need to be encouraged to develop competence skills to resist drugs, since social and other risk factors can never be entirely eliminated."

Dr. Botvin, who developed the award-winning Life Skills Training (LST) substance-abuse prevention program for junior high and middle school students more than 25 years ago, continuously works with his colleagues to refine and disseminate the program through research and teaching. (Dr. Botvin has a financial interest in LST and his consulting company provides training and technical assistance for the program.)

Dr. Heejung Bang, assistant professor of public health in the Division of Biostatistics and Epidemiology, was also a co-author of the article.

This study was supported by a grant to Dr. Epstein from the National Institute on Drug Abuse. The data for the study was collected from a smoking prevention trial that was supported by a grant to Dr. Botvin from the National Cancer Institute.