Youth Illicit Drug Use Prevention
DARE Long-Term Evaluations and Federal Efforts to Identify Effective Programs Gao ID: GAO-03-172R January 15, 2003This report contains information on (1) the results of evaluations on the long-term effectiveness of the Drug Abuse Resistance Education program (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.
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. 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.
GAO-03-172R, Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations and Federal Efforts to Identify Effective Programs
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GAO-03-172R:
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 survey [Footnote 1] 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, [Footnote
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 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.
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. [Footnote 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.
Established in 1983, DARE operates in about 80 percent of all school
districts across the United States and in numerous foreign countries.
[Footnote 4] 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
revisions to the content and sequencing of the DARE lessons. [Footnote
5]
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 under
the Safe and Drug-Free Schools and Communities Act (SDFSCA) of 1994.
[Footnote 6] 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.
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.
[Footnote 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 Use[A]:
Kentucky Studies:
Evaluation/date of article: 1. Sensation Seeking as a Potential
Mediating Variable for School-Based Prevention Intervention: A Two-
Year Follow-Up of DARE, 1991. Location: Lexington, Kentucky;
Sample description: The initial sample included a total of 2,071 sixth
graders from 31 elementary schools. Twenty-three schools and 1,550
students were assigned to receive the DARE intervention and 8 schools
and 521 students were designated control groups that received 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;
Measures: Past year use of marijuana;
Prevention outcome: No statistically significant differences were
observed between the intervention and control schools on students‘
past year marijuana use 2 years after the intervention.
Evaluation/date of article: 2. The Effectiveness of Drug Abuse
Resistance Education (Project DARE): 5-Year Follow-Up, 1996; Location:
Lexington, Kentucky;
Sample description: In the 5-year follow-up to the 1991 study, students
were surveyed each year during the sixth through tenth grades. The
sample size at the 5-year follow-up, when students were in the tenth
grade, was 858, or about 55 percent of the baseline for the intervention
group and 285, or about 55 percent, for the control group;
Measures: Past year use of illicit drugs. Nonbehavioral measures
included attitudes towards drugs, peer pressure resistance, and
perceived peer substance use;
Prevention outcome: No statistically significant differences were
observed between intervention and control groups on marijuana use 1
year after the intervention and at the 5-year follow-up. Although,
significant positive DARE effects were observed during the seventh
grade (about 1 year after the intervention) for 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.
Evaluation/date of article: 3. Project DARE: No Effects at 10-Year
Follow-Up, 1999; Location: Lexington, Kentucky;
Sample description: Follow-up to the 1991 and 1996 studies. The final
sample consisted of 1,002 young adults between the ages of 19 and
21,who were in the original sixth grade sample of both intervention and
control groups. Seventy-six percent of the participants had received
DARE lessons;
Measures: Lifetime, past year, and past month use of marijuana.
Nonbehavioral measures included peer pressure resistance and self-
esteem;
Prevention outcome: No statistically significant differences were
observed between the intervention and control groups for illicit drug
use, peer pressure resistance, and self-esteem at the 10-year follow-
up.
Colorado Studies:
Evaluation/date of article: 4. Three-Year Follow-up of Drug Abuse
Resistance Education (DARE), 1996; Location: Colorado Springs,
Colorado;
Sample description: The initial sample included 38 elementary schools in
Colorado Springs, Colorado”21 schools received the DARE intervention
and 17 control group schools did not. The 3-year follow-up sample
consisted of 940 ninth grade survey respondents from the 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);
Measures: Use of illicit drugs and the delay of experimentation with
illicit drugs. Nonbehavioral measures included self-esteem and
resistance to peer pressure;
Prevention outcome: No statistically significant differences were found
between the intervention and control groups with regard to illicit drug
use, delay of experimentation with illicit drugs, self-esteem, or
resistance to peer pressure after 3 years.
Evaluation/date of article: 5. Long-Term Impact of Drug Abuse
Resistance Education (DARE): Results of a 6-Year Follow-Up, 1997;
Location: Colorado Springs, Colorado;
Sample description: Follow-up to the 1996 study. The 6-year follow-up
sample consisted of 676 twelfth grade survey respondents from the
initial sample of elementary school students. Excluding invalid
responses, the final sample consisted of 620 twelfth grade students (356
students in the intervention group and 264 students in the control
group);
Measures: Use of illicit drugs and the delay of experimentation with
illicit drugs. Nonbehavioral measures included self-esteem and
attitudes toward drug use;
Prevention outcome: No statistically significant differences were found
between the intervention and control groups regarding the use of
marijuana and the delay of experimentation with illicit drugs, self
esteem, and attitudes toward drug use, at the 6-year follow-up.
Illinois Study:
Evaluation/date of article: 6. Assessing the Effects of School-Based
Drug Education: A Six-Year MultiLevel Analysis of Project DARE, 1998;
Location: Chicago, Illinois;
Sample description: A total of 1,798 students from 36 urban, suburban,
and rural schools in Illinois were surveyed each year from the sixth
through twelfth grade. Eighteen elementary schools received the DARE
intervention and the 18 elementary schools in the control group did
not;
Measures: The study measured past 30-day and any use of illicit drugs.
Nonbehavioral measures included attitudes towards drugs, peer pressure
resistance, and self-esteem;
Prevention outcome: No statistically significant differences were
observed between the intervention and control groups with regard to
recent or any use of illicit drugs 1 year after the intervention and
at the 6-year follow-up. The DARE students were more likely to report
stronger negative 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.
[End of table]
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.
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) [Footnote 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.
Table 2: Examples of Effective Substance Abuse Prevention Programs HHS
and Education Identified:
1. Life Skills Training Program (LST):
LST is a school-based substance abuse prevention program for children
ages 10-14. LST is designed to address a wide range of risk and
protective factors[A] to reduce illicit drug use by teaching general
personal and social skills in combination with drug resistance skills
and normative education.
2 Child Development Project (CDP):
CDP is a school improvement initiative designed to reduce the risk of
alcohol and 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 Program (SFP):
SFP targets families that are at risk for drug abuse. The
multicomponent, family-focused program provides prevention programming
for substance-abusing families with 6- to 10-year-old children.
5. Project STAR, known as the Midwestern Prevention Project (MPP):
MPP is a comprehensive, community-based drug abuse prevention program
that uses school, mass media, parent education, community organization,
and health 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.
[End of table]
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. [Footnote 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.
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.
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 [hyperlink, 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:
Signed by:
Marjorie E. Kanof:
Director, Health Care”Clinical and Military Health Care Issues:
Enclosures - 4:
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.
[End of Enclosure I]
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.
Table 3: Six Evaluations of the DARE Elementary School Curriculum GAO
Selected For Review:
Evaluation/date of article: Sensation Seeking as a Potential Mediating
Variable for School-Based Prevention Intervention: A Two-Year Follow-Up
of DARE, 1991; Location: Lexington, Kentucky;
Period evaluation covered (in years): 2;
Intervention and control groups: Yes;
Random assignment of study groups: Yes;
Pretest and posttest of study participants: Yes.
Evaluation/date of article: The Effectiveness of Drug Abuse Resistance
Education (Project DARE): 5-Year Follow-Up, 1996; Location: Lexington,
Kentucky;
Period evaluation covered (in years): 5
Intervention and control groups: Yes;
Random assignment of study groups: Yes;
Pretest and posttest of study participants: Yes.
Evaluation/date of article: Project DARE: No Effects at 10-Year Follow-
Up, 1999; Location: Lexington, Kentucky;
Period evaluation covered (in years): 10;
Intervention and control groups: Yes;
Random assignment of study groups: Yes;
Pretest and posttest of study participants: Yes.
Evaluation/date of article: Three-Year Follow-up of Drug Abuse
Resistance Education (DARE), 1996; Location: Colorado Springs,
Colorado;
Period evaluation covered (in years): 3
Intervention and control groups: Yes;
Random assignment of study groups: [A];
Pretest and posttest of study participants: Yes.
Evaluation/date of article: Long-Term Impact of Drug Abuse Resistance
Education (DARE): Results of a 6-Year Follow-Up, 1997: Location:
Colorado Springs, Colorado;
Period evaluation covered (in years): 6
Intervention and control groups: Yes;
Random assignment of study groups: [A];
Pretest and posttest of study participants: Yes.
Evaluation/date of article: Assessing the Effects of School-Based Drug
Education: A Six Year MultiLevel Analysis of Project DARE, 1998;
Location: Chicago, Illinois;
Period evaluation covered (in years): 6
Intervention and control groups: Yes;
Random assignment of study groups: Yes;
Pretest and posttest of study participants: Yes.
[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.
[End of table]
[End of Enclosure II]
Enclosure III: Comments from the Department of Health and Human
Services:
Department of Health & Human Services:
Office of Inspector General:
Washington, DC 20201:
October 30, 2002:
Ms. Marjorie E. Kanof:
Director, Health Care - Clinical and Military Health Care Issues:
United States General Accounting Office:
Washington, D.C. 20548:
Dear Ms. Kanof:
Enclosed are the department's comments on your draft report entitled,
"Substance Abuse: Programs to Prevent Illicit Drug Use Among Youth."
The comments represent the tentative position of the department and are
subject to reevaluation when the final version of this report is
received.
The department also provided several technical comments directly to
your staff.
The department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Janet Rehnquist:
Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the department's
response to this draft report in our capacity as the department's
designated focal point and coordinator for General Accounting Office
reports. The OIG has not conducted an independent assessment of these
comments and therefore expresses no opinion on them.
General Comments of the Department of Health and Human Services on the
General Accounting Office's Draft Report. "Substance Abuse: Programs to
Prevent Illicit Drug Use Among Youth" (GAO-03-172R):
General Comments:
The Department of Health and Human Services (the department)
appreciates the opportunity to comment on this draft report. The GAO
report entitled "Substance Abuse: Programs to Prevent Illicit Drug Use
Among Youth" presents a detailed discussion of the lack of significant
findings of the Drug Abuse Resistance Education (DARE) program but only
a limited discussion of other effective prevention programs. The
department's Substance Abuse and Mental Health Services Administration
(SAMHSA) is concerned that the report's title implies that it provides
an overall assessment of the effectiveness of substance abuse
prevention programs, when it actually provides a comprehensive
evaluation of an early iteration of the DARE model and a brief
reference to federal efforts to identify programs that are effective in
preventing illicit drug use among children.
Therefore, we suggest that either separate reports be developed to
reflect the two objectives ("the results of evaluations on the long-
term effectiveness of the DARE elementary school core curriculum in
preventing illicit drug use among children" and "federal efforts to
identify programs that are effective in preventing illicit drug use
among children") requested by Congress or that the report be retitled
to clearly indicate its scope. In either case, SAMHSA would urge the
GAO to expand its discussion of SAMHSA's National Registry of Effective
Prevention Programs (NREPP).
The following suggestions to more clearly describe the NRREP program
build upon the language already in the GAO Report (heading: Federal
Agencies Identify Effective Substance Abuse Prevention Programs, text
following Table 2):
Within the department, SAMHSA created NREPP to identify on an ongoing
basis substance abuse prevention programs that, based on rigorous
evaluation, consistently demonstrate positive results. The NREPP is a
key component of a national system that is accessible to all and
incorporates not just the work of SAMHSA, but of other federal, state,
foundation, and private entities, including the National Institute of
Health (NIH), the Department of Justice, and the Department of
Education. Teams of scientists who are expert in prevention research
use a set of 15 scientifically-rigorous criteria to assess various
programs that may be implemented by states and communities across the
country. 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. Only those programs
that positively affect the majority of the intended populations and
produce a consistent pattern of results are recognized as effective. To
date, 41 effective model programs and 32 promising programs have been
selected from 718 submissions. In addition to enhancing protective
factors and minimizing risk, these programs have demonstrated a
significant impact on drug and alcohol use (25% average reduction), and
may have also demonstrated a positive effective effect on other related
behaviors including school achievement, prevention and reduction of
violence, and enhanced family functioning.
Once programs are identified by NREPP, SAMHSA's National Dissemination
Initiative is responsible for promoting these programs through the
active dissemination of written materials, a strong Training of
Trainers approach, the use of innovative web-based technology, and
collaboration with a set of national partners, including the National
Association of Elementary School Principals, the National Mental Health
Association, and the Community Anti-Drug Coalitions of America. Many of
these programs are being implemented through the State Incentive Grant
(SIG) Program (over 1,858 SIG-supported programs are science-based),
the SAMHSA Substance Abuse Block Grants, and other federal and state
funding mechanisms, and by a number of agencies including the
Department of Education, the Department of Justice, etc.
With regard to the section of the draft report dealing with the
evaluation of the DARE program, it should be clear that the SAMHSA
neither supports nor disputes the effectiveness of DARE. SAMHSA's
prevention scientists are aware that DARE America currently is testing
the effectiveness of a major revision of the DARE program, conducted
under the direction of a former official of NIH's National Institute on
Drug Abuse (NIDA). This revised DARE program has not yet been submitted
for review to the NREPP, and SAMHSA is not in a position to officially
comment on the effectiveness of this curriculum.
Also, we offer the following comments about several questionable
statements within the draft report on the GAO's assessment of DARE.
1. "The core of the DARE program is its fifth and sixth grade
curriculum."
It is accurate to report that the 5th/6th grade curriculum was the
first curriculum developed by DARE and that it is the most widely-used
component. DARE America, however, does not describe this as a "core"
curriculum and advocates that the most effective use of DARE requires
sequential use of curricula for elementary school and secondary school.
More importantly, to evaluate DARE on the basis of a portion of the
program may be equivalent to arbitrarily evaluating the effects of only
one year of the multi-year interventions of Project STAR, Life Skills
Training, or other programs. The department has identified "prevention
principles" that emphasize the importance of multi year interventions.
The NIDA publication Preventing Drug Use Among Children and
Adolescents: A Research-Based Guide (NIH Publication No. 97-4212), for
example, states:
"Prevention programs should be long-term, over the school career with
repeat interventions to reinforce the original prevention goals. For
example, school-based efforts directed at elementary and middle school
students should include booster sessions to help with critical
transitions from middle to high school."
2. "HHS and Education have identified programs that show evidence of
effectiveness in preventing or reducing the use of illicit drugs and
other substances among youth.... HHS and Education select these
programs based on expert panel reviews of research-based evidence of
program effectiveness."
Rather than proactively identifying prevention programs, the department
and the Department of Education invite the developers of programs to
submit programs or curricula for review. To the best of this agency's
knowledge, the Department of Education encouraged DARE to complete and
test the current revision of the DARE program prior to submission to
Education's expert review panel.
The self-selection process generally favors submission of curricula
with an easily-defined "dosage" that can be tested through
conventional, low-cost evaluation procedures. It tends to discourage
consideration of potentially effective interventions involving broad
changes in the school or community environment (e.g. changes in the
procedures and policies of law enforcement authorities, increased youth
participation in structured after school activities, etc.).
3. "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.
The six evaluations we reviewed were based on three separate studies in
three states."
The studies evaluate the DARE program as implemented in the late 1980s
and early 1990s. The program has since been refined and subsequent
iterations have been developed. The conclusions that are drawn in the
GAO report should not necessarily be applied to the future DARE
program. It is our understanding that a report of the evaluation of the
revised DARE curriculum is scheduled to be released at the end of
October by the Robert Wood Johnson Foundation. The GAO report may want
to incorporate these more recent findings into the report's assessment
of DARE.
[End of Enclosure III]
Enclosure IV: Comments from the Department of Education:
United States Department Of Education:
The Under Secretary:
400 Maryland Ave., S.W.,
WASHINGTON, D.C. 20202
[hyperlink, http://www.ed.gov]
"Our mission is to ensure equal access to education and to promote
educational excellence throughout the Nation."
October 29, 2002
Ms. Marjorie E. Kanof:
Director, Health Care - Clinical and Military Health Care Issues:
General Accounting Office:
441 G Street, N.W.
Washington, DC 20548:
Dear Ms. Kanof:
Thank you for the opportunity to review your draft report, "Substance
Abuse Programs to Prevent Illicit Drug Use Among Youth." In the
introduction of your report to Senator Richard J. Durbin, you state
that the report contains information on Federal efforts to identify
programs that are effective in preventing illicit drug use among
children. We have concerns about the accuracy of some of the
information included in the report and regret that we did not have the
opportunity to be formally involved in the development of the report.
The U.S. Department of Education (Department) established the Safe,
Disciplined and Drug-Free Schools Expert Panel (Expert Panel) to
identify exemplary programs that are effective in preventing and
reducing substance abuse and violent behavior among students. The
discussion in your report about the Expert Panel does not fully
describe the Expert Panel process and, we believe, may contribute to
misunderstanding about the Expert Panel's role. Specifically, the
discussion on page 11 of the draft report omits important aspects of
the Expert Panel review process and implies that the programs
identified by the Expert Panel process are the only prevention programs
that are effective.
The Expert Panel used a multilevel review process comprising teams of
experts in research, evaluation, and prevention programming.
Submissions were reviewed for evidence of effectiveness based on
methodologically sound evaluations, and for evidence of high quality
programming, including educational significance and replicability.
Programs designated as exemplary showed statistically significant
differences in outcomes that were sustained at least one year or longer
beyond baseline. We recommend that you revise your discussion to
incorporate this information.
In 1998, the Department developed the Principles of Effectiveness to
guide State and local educational agencies in their decisions to
implement prevention programs based on research. Following the
enactment of the No Child Left Behind Act in 2001, State and local
educational agencies must use the Principles of Effectiveness to
design, implement, and evaluate programs funded under the Safe and Drug-
Free Schools and Communities Act (SDFSCA). Because of these
requirements, there has been some confusion among grantees concerning
the Expert Panel's "list" of exemplary programs. Some grantees
mistakenly believe that the programs identified as exemplary are the
only programs that can be funded under the SDFSCA. In a letter to
Governors and Chief State Schools Officers dated May 6, 1999, the
Department provided guidance on the Expert Panel process as it related
to programs that could be supported with SDFSCA funds. While the
Department would expect to accept programs identified by this process
as meeting the standard established by the SDFSCA Principles of
Effectiveness, the programs identified by this process by no means
constitute an official or exhaustive list of programs that meet the
standard established by the Principles of Effectiveness, and grantees
will continue to have flexibility in selecting prevention programs as
long as they meet the standard established in the No Child Left Behind
Act. Therefore, we recommend that you revise your discussion to
incorporate this information.
We also are concerned about the accuracy of some of the statements
about the Drug Abuse Resistance Education (DARE) program contained in
the draft report. On page 4 of the report, the auditors state that DARE
operates in 80 percent of all the school districts across the United
States. You have not provided a source for this information. To our
knowledge, there has not been any sound survey to determine exactly how
many schools have implemented DARE programs. Therefore, we recommend
that you either delete or identify the statistical source of the
information.
On page 5 of the report, the auditors state that the Office of National
Drug Control Policy (ONDCP) estimates that in FY 2000, the Department
made available about $41 million to support DARE activities in schools.
We question the basis for this figure. We assume this reference is to
the Safe and Drug-Free Schools and Communities Act funds spent under
the Governor's Program, because State and local educational agencies
are not required to implement DARE activities. For FY 2000, the amount
of funds awarded, nationally, to the Governor's program was
approximately $86 million. We do not agree that almost 50 percent of
the Governor's funds were used to support DARE. Although not required
in the current authorization of the SDFSCA, in FY 2000 Governors were
required to use not less than 10 percent of funds for Law Enforcement
Education Partnership (LEEP) programs. In other words, the SDFSCA only
required that $8.6 million in FY 2000 SDFSCA funds be used to support
LEEP programs. Further, under the SDFSCA, allowable LEEP programs
included, but were not limited to, programs such as Project DARE. We
recommend that you either delete the $41 million estimate included in
the draft, or provide supporting documentation about the amount of
SDFSCA funds spent on DARE activities.
Again, thank you for providing a copy of this draft report for our
review. If you have any questions, please feel free to contact William
Modzeleski, Director, Safe and Drug-Free Schools Program, at (202) 260-
3954.
Sincerely,
Signed by:
Eugene W. Hickok:
[End of enclosure IV]
Footnotes:
[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.
[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).
[4] Data obtained from the DARE America Web site at [hyperlink,
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)).
[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.
[8] NREPP incorporates the work of SAMHSA, Education, NIH, and the
Department of Justice, as well as the work of foundations and other
entities.
[9] NIDA is having the 2003 edition of its guide reviewed before
publication.
[End of section]
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