Meta-Analysis of Family-Based Prevention Programs for Adolescent Substance Abuse

描述（由申请人提供）：使用物质（即烟草、酒精、大麻和“硬性毒品”，如可卡因、吸入剂等）对青少年的健康和福祉有严重影响。研究一直将以家庭为基础的因素（如父母监督和亲子关系）与青少年药物使用的开始和升级联系起来，并且已经制定了许多以家庭为基础的预防计划，通过解决家庭系统内的潜在问题来减少青少年药物使用。虽然这些计划被广泛认为是成功的，但在文献中有几个潜在的弱点。首先，总结该领域发现的研究通常是基于对文献的传统叙述评论，这本质上是主观的，因此无法在控制可能影响结果的因素（如样本特征、研究设计、参与率和测量工具）的同时，提供经验、客观、可量化的项目有效性评估。其次，缺乏调查以家庭为基础的预防项目成功的确切原因的研究，该领域的许多作者呼吁对这些项目的各个组成部分及其附加或协同效应进行更多的研究。第三，最近的研究质疑以家庭为基础的因素是否会在整个青春期产生类似的影响（例如，父母的监督可能在青春期早期而不是青春期晚期更有效地阻止物质使用）。因此，这个R03项目的第一个目标是使用荟萃分析技术来评估以家庭为基础的青少年药物使用预防项目，以确定哪些项目组成部分与成功减少药物使用和/或改善养育方式最密切相关。具体来说，我们将使用项目设计、课程设置和交付方法来预测育儿和青少年行为测量的效应大小。第二个目的是评估以家庭为基础的青少年药物使用预防计划的组成部分是否表现出附加或协同效应。具体而言，我们将研究单个成分是否预测结果的唯一方差（即，加性效应），或者它们是否表现出显著的相互作用（即，协同效应）。第三个目标是评估不同样本（如青年年龄和性别）和研究因素（如研究设计、人员流失）在多大程度上缓和了项目组成部分与结果之间的联系（如父母监督方面的培训可能与减少药物使用有关，但在青少年早期更为强烈）。这个R03项目将提供许多好处。首先，荟萃分析使我们能够将研究结果结合起来，产生更大的统计能力，并获得受任何给定研究固有偏差影响较小的结果。其次，我们的项目将提供对这些项目如何运作的更深入的了解，并将为未来针对青少年药物使用的预防工作提供信息。最后，我们的项目将为给定的人口和环境确定最有利的组件平衡，从而使设计师能够优化程序设计。

DESCRIPTION (provided by applicant): Use of substances (i.e., tobacco, alcohol, marijuana, and "hard drugs" such as cocaine, inhalants, etc.) has serious implications for adolescent health and well-being. Research has consistently linked family-based factors such as parental monitoring and parent-youth relationships with the initiation and escalation of substance use in adolescence, and numerous family-based prevention programs have been developed to reduce adolescent substance use by addressing the underlying issues within the family system. Although these programs are widely seen as successful, there are several underlying weaknesses in the literature. First, the research that summarizes the findings from the field has often been based upon conventional narrative reviews of the literature, which are essentially subjective and thus cannot provide an empirical, objective, quantifiable evaluation of program effectiveness while controlling for factors that can influence outcomes, such as sample characteristics, study design, rate of engagement, and measurement tools. Second, there is a lack of research that investigates exactly why family-based prevention programs have been successful, and numerous authors in the field have called for more research on the individual components of these programs and their additive or synergistic effects. Third, recent research has questioned whether family-based factors exert similar effects across the entirety of adolescence (e.g., parental monitoring may be a more effective deterrent of substance use in early rather than late adolescence). Thus, the first aim of this R03 project is to use meta-analyti techniques to evaluate family-based prevention programs for adolescent substance use to determine which program components are most strongly linked to success in reducing substance use and/or improving parenting. Specifically, we will use program design, curricula, and delivery methods to predict effect sizes on measures of parenting and adolescent behavior. The second aim is to evaluate whether components of family-based prevention programs for adolescent substance use exhibit additive or synergistic effects. Specifically, we will examine whether individual components predict unique variance in outcomes (i.e., additive effects) or whether they exhibit significant interactions with one another (i.e., synergistic effects). The thid aim is to evaluate the degree to which various sample (i.e., youth age and gender) and study factors (e.g., research design, attrition) moderate the link between program components and outcomes (e.g., training in parental monitoring may be associated with reduced substance use, but more strongly in early adolescence). This R03 project will provide many benefits. First, meta-analysis allows us to combine findings across studies, generate greater statistical power, and obtain results less affected by biases inherent in any given study. Second, our project will provide a stronger understanding of how these programs work and will inform future prevention efforts targeting adolescent substance use. Finally, our project will identify the most favorable balance of components for given populations and circumstances and thus enable designers to optimize program design. PUBLIC HEALTH RELEVANCE: Use of substances (i.e., tobacco, alcohol, marijuana, and "hard drugs" such as cocaine, inhalants, etc.) has serious implications for adolescent health and well-being, and numerous family-based prevention programs have been developed to reduce adolescent substance use by addressing the underlying issues within the family. We will use meta-analytic techniques to evaluate family-based programs for adolescent substance use to determine which program components are most strongly linked to success in reducing substance use and/or improving parenting. We will also evaluate whether components of family-based programs exhibit additive or synergistic effects, and whether various sample and study factors moderate the link between components and study outcomes. Meta-analysis will provide results less affected by researcher and study biases, and our results will enable researchers to optimize program design for specific populations and circumstances.