Health Education Research, Vol. 14, No. 1, 85-97,
February 1999
© 1999 Oxford University Press
Drug education practice: results of an observational study
Tanglewood Research, PO Box 1772, Clemmons, NC 27012 and Department of Sociology, University of Connecticut, Storrs, CT 06269, USA
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Understanding normative practice in drug education is a key to identifying means of improving preventive intervention outcomes. In this paper, we report findings of an observational study in which drug education in multiple periods of 146 middle school classes was categorized minute-by-minute according to the type of instruction provided to students. Results indicate that nearly half of all drug education focused on providing students with knowledge. Alternative methods, particularly those that have shown programmatic effectiveness, and those that address risk and protective factors known to be highly predictive of drug use onset, were relatively ignored. Further, teachers showed relatively low consistency in understanding concepts other than knowledge based on comparisons of their ratings of intended instructions with those of trained observers. Nonetheless, there is evidence that some teachers systematically attempted to address drug prevention from either a social influence or an affective education perspective. These findings suggest that if improvements in the effectiveness of drug education are to be seen in the future, a relatively radical transformation of approaches to teaching will be needed.
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Introduction |
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In 1987, the US Congress passed the Omnibus Anti-Drug Act. This significant public investment was intended to solve the nation's drug problems through interdiction, intervention, treatment and prevention. The Drug-Free Schools and Communities program provided funds that were intended to foster effective prevention in schools. Unfortunately, recent data (Johnston et al., 1996
) indicate that drug use among teens is on the rise, suggesting that educational efforts have been ineffective. However, it must be remembered that specific programs and instructional approaches remain unevaluated. Even though there have been significant advances in our understanding of what constitutes effective prevention programs (Hansen, 1992; Tobler, 1994), research on the normative practices of teachers who have been given the responsibility for completing drug education is lacking. This paper presents findings of a recent research project that was designed to assess the normative practices of middle school teachers. Because of the overall failure of initial efforts to produce long-term changes in drug use, standard practices must now be dramatically improved. Models are clearly needed to bolster confidence that effective preventive practices can be identified, adopted, implemented, confirmed and sustained. Truly effective drug abuse prevention methods which are adopted and maintained at a significant level should be expected to meaningfully suppress all measures of drug prevalence.
A growing body of research has focused on the efficacy and effectiveness of specific programs (Tobler, 1986; Bangert-Drowns, 1988; Hansen, 1992; Dusenbury and Falco, 1995; Tobler and Stratton, 1998). Much of this literature has focused on evaluating the effectiveness of research-generated programs. Less attention has been paid to commercially marketed programs (Hopkins et al., 1987) and, in contrast to both research-generated and commercial programs, normative prevention practice has not been intensively studied.
The ability of programs to reduce the onset of drug experimentation has increased as models that target mediating processes that account for drug use have been developed and refined (MacKinnon et al., 1991). It is now widely accepted that programs produce their effects by changing risk or protective factors that account for drug use (Hawkins et al., 1992; Hansen and McNeal, 1996). One likely reason for failure may be that programs rely on strategies that have little chance for success by virtue of the fact that they either do not target appropriate mediating mechanisms or fail to have sufficient impact on correctly targeted mediators (Hansen and McNeal, 1997).
Hawkins et al. (1992) discuss several risk and protective factors that education may address. Important risk factors that might be the target of education include building appropriate normative beliefs and developing appropriate attitudes toward drug use. Bonding to prosocial institutions may be of equal importance as a mediator that might be successfully targeted by intervention (Hawkins et al., 1992). Programs that have addressed mediating variables that statistically account for changes in behavior have shown promise (Botvin et al., 1990; MacKinnon et al., 1991; MacKinnon and Dwyer, 1993).
The adoption of research-generated methods frequently lags behind the research that has produced those methods. In the case of drug education practice there is not yet evidence that findings widely published in the research literature have produced any significant shift in practice. One reason for this may be that decision makers are simply uninformed about effective methods. It is possible that there are competing interests which may serve as serious barriers to the adoption and implementation of effective programs. For example, Perhats et al. (1996) found that those who have the most say in deciding about policies and practices regarding drug education are the least likely to be informed about methods for achieving program efficacy. Without appropriate administrative support, effective programs are not likely to be adopted.
It is likely that teaching as practiced will follow overall trends in what has been emphasized in drug education. Meta-analyses of research-based programs suggest that programs cluster into knowledge, social influence and affective approaches (Hansen, 1992; Tobler, 1994). It is quite possible that the selection of programmatic approaches is likely to be limited by the paradigm of the user. To date, however, there is no empirical evidence that teachers adopt a specific paradigm when they select program approaches.
Research is needed to understand how drug education is practiced. Understanding normative practices is an important first step toward developing and implementing effective programs. Studies conducted to date have relied solely on teacher and administrator self-report to determine the standards of practice (Bosworth and Cueto, 1994). This study used trained observers to assess educational practice and addressed three questions. First, what evidence exists that concepts driving effective prevention practices are understood by teachers who are called on to deliver drug education curricula? Second, what programmatic content do teachers typically address in drug education? Third, what styles of drug education are observed in teaching?
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Subjects and setting
Teachers in 12 middle schools in Forsyth County were solicited to participate in this study. All teachers who taught drug education were invited to inform project staff about planned drug education. Project staff encouraged teachers through direct appeals and through the establishment of paid coordinators at each site to participate. Teachers who volunteered were offered a $5 incentive for each class of drug education that project staff were allowed to observe.
Procedures
Project staff were scheduled to visit teachers' classrooms based on the communication of future plans to teach drug education. Classrooms were identified by school, course and section number. In combination with the date, this created a unique identification number that was used to identify each observed class.
Staff were instructed to occupy a place in the back of the classroom. Staff were briefly introduced to students by the teacher if they were visiting for the first time. Their presence was explained as being in class to observe that day's teaching. In as much as possible, staff were to not interact with the teacher or the students.
During their visits, staff completed three forms for each classroom that was observed. The first form required staff to judge which of 12 concepts postulated to serve as drug-prevention mediators (Hansen, 1992) were addressed in teaching on a minute-by-minute basis. Teaching was categorized into the following: norm setting, commitment building, values clarification, knowledge (beliefs about consequences and facts about drugs), resistance skills training, self-esteem building, goal-setting skills training, decision skills training, alternatives, stress management training, assistance skills training and social skills training. A separate category was provided if teaching addressed drug-related topics that fit with none of these concepts. Observers were encouraged to categorize instruction into at least one category if possible. Observers had the option of marking multiple categories of instruction if this reflected the teaching that occurred during that minute. There was also an option to note that no drug education of any sort was observed. Prior to participating in observations, project staff were trained in characteristics that defined each of the 12 concepts and how forms were to be completed. This form also required staff to note every 5 min which substances had been discussed during that 5 min period. Substances that were listed included alcohol, tobacco, marijuana, cocaine, heroin (opiates), inhalants, amphetamines, hallucinogens, steroids and other drugs.
The second form requested staff to make written comments, and a qualitative description of teaching and class activities. This form was completed concurrently with the rating form. This form was used as a memory aid in post-session debriefings about observations.
The final form required staff to make overall judgments about which content areas had been addressed during the class. This form required observers to rank the overall emphasis placed on each concept. Mediators that were addressed were ranked. Mediators that were not addressed were left blank. For analysis purposes, ranked categories were also scored as 1's and non-ranked categories were scored as 0's.
After each class, staff asked teachers to complete the third form and provide an overall assessment of what content areas they believed they had addressed in teaching. Teacher ratings were completed independently. Brief descriptions (operational definitions) of the meaning of each content area were available to teachers if they requested them. The teacher overall form and the staff overall form were identical in structure.
As often as resources would permit, staff were sent in pairs. Paired observations were completed without communication between staff except for coordinating time and identifying information. Upon completion of the observation, paired observers worked together to complete consensus minute-by-minute and overall forms. Individual forms were not changed retrospectively.
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Results |
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Observational database
During the 1992–93 and 1993–94 school years, a total of 1839 class sessions were observed. The frequency of observation varied greatly across teachers. The data include several teachers whose entire sequence of drug education was observed as well as teachers who were observed sporadically and infrequently. To remove any distortion in the findings due to over-representation of the more frequently observed teachers, observations were averaged by class period. After aggregation, the number of unique class periods totaled 232 (69 in 1992–93 and 163 in 1993–94). Of these, 86 class periods were deleted because the data collection was undertaken in large school-wide or grade-wide assemblies. The primary analysis reported in this manuscript represents these 146 class periods.
It should be noted that few sessions observed consisted of the delivery of a program in the sense that prevention researchers use this term. In one school, the middle school version of DARE was observed. However, in nearly every other case, the lessons taught had either been invented by teachers or had been liberally adapted from source materials. Other than traditional health textbooks, there were no standardized materials available to teachers from the district. There was also no standardization imposed by the district on what or how teachers could teach. Indeed, most of them had no knowledge of any official plan or curriculum from which they were expected to teach. Thus, the observed sessions represent what is likely to be observed when drug education is promoted but not managed or directed.
Agreement about observed constructs
We were able to observe 2828 min of instruction in which two data collectors both recorded ratings about the concepts taught in drug education. In addition, there were 981 class sections in which the data collector and teacher both provided overall rankings of program content. Table I presents 
coefficients for the paired observer–observer minute-by-minute categorizations, the paired observer–observer overall categorizations (from dichotomous scoring) and the observer–teacher overall categorizations.
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There was good overall agreement between observers in analyses of both the paired observer–observer minute-by-minute categorizations (average
= 0.870) and the paired observer–observer overall categorizations (average = 0.869). There was perfect agreement for teaching that addressed building commitments. However, this is based on only 4 min of teaching about commitment. Other agreement scores were generally based on more observed minutes of teaching that addressed each topic. High in general agreement among observers were ratings of teaching that addressed goal-setting training, stress management training, the dissemination of facts about drugs and the consequences of drug use, and teaching that was intended to build self-esteem. The lowest agreement using the minute-by-minute ratings was observed for instruction that involved values clarification, normative education, and training in how to get and give assistance. The latter category had relatively good agreement when viewed as an overall focus of instruction as did values clarification; none of the minute-by-minute coefficients were below 0.750. Normative education received the lowest agreement on the overall form (0.725). Except agreement about decision making (0.790), all other coefficients were above 0.800. These findings indicate good agreement among observers. In contrast to the observer–observer findings, the observer–teacher results about teaching content revealed an overall pattern of low agreement. The highest agreement was seen for teaching stress management skills, teaching about self-esteem, and giving information about drugs and the consequences of drug use. The lowest agreement was observed for teaching that stressed normative education, building commitment, teaching skills for getting and giving assistance, teaching about alternatives, teaching social skills, and teaching values clarification. The discrepancy between observer–observer agreement and observer–teacher agreement suggests that teachers often did not understand the concepts or the words and descriptions commonly associated with concepts that have been the focus of drug education.
Teaching emphasis by program content
We examined the distribution of effort given to each of the 12 drug-prevention concept areas. Three sets of analyses were completed. The first analysis assessed whether there had been any occurrence of a topic during the observations of any class. Thus, in classes that were observed on multiple occasions, any single occurrence of the concept would cause students in that class to be classified as having been exposed to the concept. In essence, this analysis describes the likelihood of students in any observed class ever having been exposed to a given concept. The second analysis assessed the total overall time devoted to addressing each content area. This number includes all observed minutes as its denominator. Thus, the result represents the percentage of time spent on each concept averaged across all class periods. This analysis describes the typical exposure to each concept that classes of students received. The final analysis represents a measure of intensity. If a given topic had been noted during any given observation, this analysis reflects the relative amount of time that was devoted to that topic during class sessions in which it was observed.
As can be seen in Table II, instruction that addressed knowledge about drugs and the consequences of drug use was the single most common component of drug education for all three analyses. Some level of knowledge focused intervention was seen in nearly all observed classes. On average, knowledge was the focus of drug education 45.9% of the time. Overall, the time on task devoted to programming designed to enhance knowledge comprised nearly half of all drug education that was observed. This was clearly the emphasis of most drug education. In some classes, drug education was nearly all devoted to teaching knowledge. For example, in one class unit, 95% of all observed time was focused on teaching about facts related to drugs and drug use consequences.
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Resistance skills training programs were the next most commonly observed program elements. Some form of resistance skill training was noted in four of every five observed classes. While this represents a relatively frequent mention of this topic, resistance skills training accounted for only 8.2% of all drug education teaching time. Even in sessions in which resistance training was observed, it accounted for less than 10% of the total teaching time. Thus, while resistance training was observed relatively frequently, when it occurred it was of brief duration and low intensity. However, it should be noted that there was variability among classes. In one class, for instance, resistance skills training accounted for 53.3% of all observed drug education.
The next most commonly observed drug education strategy (defined by whether or not students were ever exposed to instruction in this topic) was assistance skills training. Approximately two-thirds of classes were exposed to some mention of getting or giving assistance. It is apparent from the extremely low percent of time devoted to this topic, however, that teachers focused on this concept almost in passing. This mostly consisted simply of admonishing students to get help if they develop a drug problem or give help if they know of someone else who has a drug problem. Similar findings were observed for values clarification and norm-setting methods. There appeared to be some exposure to the concept in the majority of classes. However, the amount of time spent on each topic and the intensity of instruction when the topic emerged was minimal at best. Indeed, the most intensely involved class that addressed norm setting spent only 25% of time addressing this topic.
Programming designed to build self-esteem was noted in about half of the observed classes. Overall, self-esteem building activities received less than 10% of the attention given to drug education. When addressed, self-esteem activities consumed just more than 10% of the class time. However, it should be noted that this was the second most intensively covered topic observed. That is, when teachers addressed self-esteem issues, they focused a relatively considerable effort to addressing self-esteem-related activities. As with resistance skills training, classes and schools differed in the extent of inclusion of self-esteem; the class that emphasized self-esteem enhancement the most devoted 62.1% of drug education time to this topic.
Social skills development training activities were observed in about half of the classes. Overall, social skills training accounted for just less than 3% of the time that was observed. Even when it was a part of the focus of class instruction, it was not addressed with meaningful intensely. However, in one class, social skills development accounted for 46.7% of the total time that was devoted to drug education.
Decision-making skills training activities were not observed frequently, with decision-making training being included in a third of all classes. Overall, not much time was given to teaching decision-making skills. However, when decision-making training was observed, it occupied a relatively important niche, being the fourth most intensely taught subject. Indeed, one class focused 85.8% of their total time to decision-making training.
Teaching students to manage stress and set goals, and encouraging students to think about alternatives to drug use and make personal commitments to not use substances was observed only rarely. Like decision-making training, stress management training was relatively intense when it occurred, being the third most intensely taught subject when it was included. Nonetheless, overall, these strategies account for very little of the drug education we observed.
Teaching emphasis by target drug
Drug use was analyzed in a similar fashion to concepts, with three analyses performed for each observed substance. Unlike concepts that were rated minute-by-minute, drug use was rated every 5 min. Therefore the denominator in each case reflected a 5 min block.
Alcohol was the most frequently discussed substance in drug education classes, being discussed in nearly all observed classes (see Table III). Overall, alcohol was the focus of instruction just less than half of the time.
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Tobacco, marijuana and cocaine were next most frequently discussed. All were very similar in the frequency with which they were included. Most drug education classes sooner or later addressed these drugs. However, they were much less likely than alcohol to be the focus of education, being given less overall attention when discussed and being dealt with less intensely than alcohol. Still, significant attention was given to each of these substances, reflecting a relatively high inclusion of drug-specific content in education.
The majority of classes were exposed to instruction that addressed hallucinogens, heroin, inhalants and amphetamines. However, much less time was spent discussing these substances. Not only were these substances mentioned in fewer observations, they tended to be given less attention when they were included. On average, these substances were all included in instruction about 10% of the time or less.
Anabolic steroids used illicitly for building muscle mass were included only rarely. When included, they were not the focus of discussion. Overall, there was very little emphasis on this topic of substance use.
Teaching approaches
The pattern of focus on the different drugs that constitute society's concern is, in many respects, what might be expected for drug education. There was a heavy emphasis on alcohol, tobacco, marijuana and cocaine, with less emphasis on other drugs. Similarly, the heavy emphasis on communicating basic knowledge about drugs and their effects is also not surprising. However, there are interesting differences in approaches to teaching that simply noting the frequency and intensity of instruction do not capture.
The variability observed among classes in their emphasis on both constructs and substances suggested that there may be several patterns of teaching related to drug use that might be definable through factor analysis. Our approach to analysis was to include the 13 concept variables and nine drug variables in a principal components factor analysis using a Varimax rotation procedure. Table IV presents our findings. Our experience with factor analysis in the past is that with 22 variables, the analysis could reasonably be expected to result in a relatively few number of factors (three or four). This should be especially true given the degree to which the variables are theoretically related to each other and the underlying process. However, our analysis yielded eight factors with eigenvalues greater than 1.0; the scree plot indicated that there were only five salient factors. Therefore, we present the loadings for these five factors. Factors not presented in tabular form include loadings for resistance skills and assistance skills, decision skills, and alternatives.
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The factors that emerge identify distinctive approaches of teaching about drugs. The first factor included an emphasis in teaching about cocaine, heroin and marijuana, and stressed disseminating knowledge about drugs and their consequences. Thus, those who concentrate on knowledge also tend to focus on a specific set of illicit hard drugs. The loadings for inhalants, steroids, amphetamines, hallucinogens, alcohol and tobacco do not suggest these topics are specifically avoided; they are just not emphasized. Depending on the teacher, this suggests these other drugs may or may not be discussed. The core set of items for this approach of drug education teaching is to focus on cocaine, heroin and marijuana—drugs that have relatively high visibility as being illicit.
The second factor included teaching that focused on inhalants, steroids, amphetamines and hallucinogens. No conceptual issues from our set of 12 mediator-focused teaching methods was associated with this form of instruction. This suggests that teachers who emphasized these substances used multiple approaches to address this topic. Clearly, simply providing knowledge was not the only strategy employed.
The third factor included an emphasis on teaching about alcohol and tobacco. Programs that emphasized these most common and legal substances tended to emphasize norm-setting methods. The negative loadings on self-esteem and social skills training suggests that this teaching approach not only emphasizes alcohol and tobacco from a largely normative perspective, but that self-esteem and social skills were specifically avoided.
Stress management, goal-setting training and values clarification approaches made up the fourth factor. This factor includes methods that have been associated with affective education in the past. Self-esteem, often thought of as the quintessential affective education component, loaded on this factor, but not with sufficient strength to allow us to identify it as an element of teachers who use this approach.
The final factor included teaching that attempted to build commitment as well as our eclectic other category. The inclusion of commitment is easiest to interpret. However, this suggests that there may be more active approaches to drug education than prior research suggests.
The fact that teaching about how to give and get assistance, resistance skills training, decision-making training, and alternative training did not load on one specific factor suggests that these methods may have actually been used randomly in combination with other methods and may have been applied at random to substances. Resistance skills training was somewhat associated with the norm-setting (not self-esteem or social skills training) factor, although the association was not strong.
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Discussion |
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Conceptual understanding
Results of this project provide clear insights to the field about how drug education is normally practiced. Researchers and program developers have given significant effort to creating a diverse repertoire of strategies for preventing drug use through education. Drug education as practiced, however, appears to be faced with many challenges. First and foremost among these appears to be a general lack of understanding about the concepts that serve as a basis for existing drug-prevention approaches. There was high agreement among trained observers about the implementation of the 12 approaches we were scheduled to observe. Teachers in the field, in contrast, demonstrated low agreement with observers about the teaching strategy they employed. Teachers have often been trained in very different methods than those employed in drug education and such differences are to be understood rather than criticized. The discrepancy in understanding, however, does serve as a potential barrier to the adoption and delivery of effective drug education. In addition to providing teachers with better programs, a major emphasis may be needed to train teachers in the concepts that underlie prevention approaches. Of particular importance may be training that helps teachers distinguish from among approaches that may, at this point in time, seem very similar on both intent and method. Even though the 12 terms were understood at some level by the teachers we observed, it is likely that the terms themselves require extensive further elaboration to make them understandable.
Strategy focus
We observed that drug education is focused primarily on one strategy—teaching students what drugs are and what the potential consequences of use will be. Indeed, in terms of the overall time spent and focus of instruction when addressed, teaching about drug use facts and consequences occupies nearly half of what was observed as drug education. It should be noted from the descriptions captured during observation that most of this education focused on health consequences associated with drug use. Data exist that do suggest perceived harm is correlated with the prevalence of drug use (Bachman et al., 1988). However, it is not clear that beliefs about health consequences predict the onset of drug use (Hansen et al., 1993). It is more likely that beliefs about health consequences are adopted after behavior has been initiated reflecting adjustments predicted by classical social psychological theories that predict adjustments in beliefs to reduce cognitive dissonance (Festinger, 1957).
Several of the remaining strategies, notably resistance skills training, training in getting and giving assistance, values clarification, and norm setting, were touched upon by a majority of teachers in their classes. However, in contrast to knowledge, these approaches received slight attention. Resistance skills training—teaching students to identify and resist peer and other social pressures to use drugs—became a popular focus of drug education on a national scale during the 1980s. This strategies has been the focal element of many of the research-based efforts that have been shown to be effective (Hansen et al., 1988; Botvin et al., 1990) Yet, even with its popularity, less than 10% of instruction we observed directly addressed this strategy.
Other analyses completed as part of this project have demonstrated that the mediators most likely to have a payoff in instruction include such approaches as norm setting, commitment building and values clarification (McNeal and Hansen, 1995; Hansen, 1996a,b; Hansen and McNeal, 1997; Hansen et al., unpublished). Collectively, these three approaches accounted for only 4.6% of the overall drug education time observed. Based on the assumption that time on task is expected to be an important marker of the potential of programs to alter mediating variables that account for drug use, there is little hope for drug education as practiced to achieve its overall goal—the reduction of drug use prevalence. To the extent that these findings are typical of other school systems, it is no wonder that drug education efforts have not been effective at stemming the recent increase in drug use (Johnston et al., 1996).
There was a trend among all strategies, other than knowledge, for instruction to be relatively brief. In class periods in which these other strategies were observed, the time on task given to the topic averaged less than 10%. The one exception to this was for instruction about self-esteem. However, even here, attention to the topic was not intense, averaging 12.8% in those sessions we observed. In a 45 min class period, this means that when self-esteem was addressed by a teacher, on average less than 6 min was devoted to the topic. It is likely that teachers who tried other-than-knowledge methods were well intended, but that they lacked programmatic resources that would allow them to implement the approaches they desired to the depth needed to create changes in postulated mediators. That is, once many teachers got beyond the initial steps associated with a novel method of drug education, they may have simply run out of resources and fell back to addressing knowledge-based subjects. Simply having the appropriate concept in mind may be insufficient without an extensive arsenal of methods that can effectively be used to address that concept.
Substance focus
Teachers tended to emphasize gateway drugs in their instruction. Alcohol was almost universally included in classes we observed and was mentioned in nearly half of all 5 min time periods we observed. Tobacco and marijuana was included by many teachers in their instruction, but occupied less time in class. Forsyth County is the home of R. J. Reynolds Tobacco Company. Tobacco may have been discussed less frequently in drug education in local schools than might otherwise be expected because of this company's presence.
Cocaine was discussed about 20% of the time. Prevalence studies show that cocaine use is actually quite low among students (Johnston et al., 1996). In Forsyth County, the prevalence of lifetime cocaine use among high school seniors has been around 7%. Students are more likely to use amphetamines and inhalants. The fact that cocaine may be discussed more than these other substances may reflect both the coverage of cocaine in the media as well as a lack of understanding about gateway processes and prevalence estimates. It is not necessarily the case that less attention should be given to cocaine. However, given the recent increase in inhalant use (Edwards, 1993; Hansen and Rose, 1995) and meth-amphetamine use (Johnston et al., 1996), it may be wise to encourage drug education that includes a stronger emphasis on these drugs.
Teaching approach
The general findings discussed above need to be tempered by the fact that there was significant variation from teacher to teacher in the specific sets of strategies and substances they discussed. We found that there were several distinctive approaches to drug education that teachers tended to take. Based on the factor analysis summarized in Table IV
, there were some teachers (Factor 1) who tended to gave extra attention to illicit drugs—cocaine, heroin and marijuana. These teachers also tended to give greater than normal attention to teaching about drug facts and consequences. There was a subset of teachers (Factor 2) who paid attention to less frequently mentioned drugs—inhalants, steroids, amphetamines and hallucinogens. These teachers did not seem to have a preferred strategy for teaching, although there was a slight de-emphasis on norm setting. It is possible that these teachers were simply more aware of or interested in the diversity of substances that might be addressed in instruction and that they adjusted their teaching to accommodate this awareness.
One group of teachers (Factor 3) tended be those who were most likely to emphasize alcohol and tobacco, the gateway substances most prevalent among the target age group. These teachers placed increased emphasis on norm-setting methods. Such methods often point out the discrepancy between estimated and actual prevalence of substance use (Sussman et al., 1988; Hansen and Graham, 1991). There may also be an attempt to focus attention on social acceptability (Hansen, 1996b). It is of interest that teachers who adopted this approach tended to de-emphasize self-esteem instruction and social skills training. Thus, this approach to teaching not only reflects a heightened reliance on one specific method, but the avoidance of other methods. It is worth noting that these teachers also tended to evidence a slight increase in emphasis in the teaching about resistance skills (0.38), drug use facts and consequences (0.31), and included marijuana slightly more often (0.25). This pattern of findings suggests that these teachers have adopted either programs or philosophies that are based on a rationale that goes beyond intuitive thinking that appears to be common with much of the drug education that is practiced. This group was most closely aligned to what has been suggested based on drug-prevention research.
One set of teachers (Factor 4) placed a great deal of emphasis on stress management, goal setting and values clarification. These topics are common to an approach of drug education known as `affective education'. It is interesting that the next largest positive loading observed on this factor was for self-esteem (0.35). It is also interesting that there was a slight negative loading on this factor for teaching about drug use and its consequences (–0.36). This pattern of values all fit with the affective education approach and provides evidence that there are teachers who are actively and systematically attempting to utilize this approach in prevention. In light of this, it is interesting that teaching decision-making skills did not load on the factor (0.00). Perhaps decision skills training is associated with multiple methods and is not viewed as an exclusive method associated with affective education.
The final factor we observed (Factor 5) included teaching that addressed building commitment to avoid drug use as well as the group of methods that were not categorized a priori. It is not surprising that there are drug education methods other than those listed that have emerged as part of drug education. It is of interest that these approaches loaded with building commitment. Our method was to include any teaching method that did not fit within the 12 predefined concepts into this category. Therefore, these other methods are not expected to reflect a singular strategy. However, it is possible that one specific, as yet unidentified approach was commonly observed. These data may reflect instances of this approach. Given that there was a high association between the other category and building commitment, it may be that one approach to drug education focuses on building personal responsibility, a recent theme of character education which has become popular with teachers (Lickona, 1991).
Understanding the approaches to drug education that teachers adopt may be helpful to the field. Knowing that teachers tend to approach drug education from different perspectives (knowledge, social influence process, affective education process and character education process) may assist program trainers. Training to state-of-the-art strategies requires both changes in conceptual understanding and methods. Trainers can expect resistance to both if a paradigm other than what is being trained to has been adopted. For example, teaching about social influence process concepts to teachers who come from a primarily knowledge or affective education focus may need to be specifically designed to overcome or transform an allegiance to these other paradigms. Thus, teachers may need to unlearn as much as they may need to learn. Such training can be expected to be considerably more difficult than has been anticipated in the past.
Perhaps one method that might be explored might be to develop a pre-test measure of what teachers view as their adopted method of instruction, including an assessment of the role they are to play as teachers. Not only will teachers apparently tend to identify with one approach or another, it is likely that there will be variability among teachers' strength of affiliation. Teachers who are less vested in alternative approaches or who are highly vested in the approach that matches proposed training might be systematically selected to participate above teachers who are most heavily vested in approaches that may be in conflict with new training.
We postulate that approaches to teaching drug education are primarily the result of past efforts and practices. That is, what has become known as affective education (stress management training, goal-setting training, values clarification and, to some extent, self-esteem building) has emerged because program designers have created programs and training that reflects this specific combination of concepts. Similarly, the social influence approach has traditionally come to include resistance skills training, norm setting and teaching about short-term health consequences. Other patterns may emerge in the future based on how program developers design programs and how widely those approaches are disseminated. Thus, even though the factor structure we observed is instructive, it reflects rather than defines practice. If more effective approaches that combine different concepts are developed and adopted, the factor structure observed might be expected to change.
Policy implications
Throughout the field of drug education, success hinges on the confluence of three attributes, access to appropriate information, selection of materials, and quality of teaching and implementation. This study, because of its observational nature, does not speak directly to the larger issues decision makers must address as they consider how drug education can be improved. Nonetheless, the overall implication of these findings is that the selection of program materials and implementation of interventions all need improvement. There is also a likely need for access to relevant information. Methods for achieving improvements in all three areas are needed.
Several recent publications (Dusenbury and Falco, 1995; NIDA, 1997) have outlined principles that underlie drug abuse prevention program effectiveness. There may be examples of schools that do well either because they have adopted and effectively implemented programs or because they have created their own programs that embody these principles. We expect these schools to be the exception rather than the rule. In contrast, we expect most schools to be similar to those we observed. The gap between recommended and actual practice is large, and will require significant effort and resources to bridge.
There is now evidence that national and state agencies are actively promoting consideration of science-based and research-based programs. It is not yet known whether this will result in an increase in the adoption of researched and evaluated programs. It is further not know whether this policy change will increase the quality of teaching and increase focus on changing mediators that account for drug use onset. Practitioners and policy makers alike must face, understand and address this challenge. Researchers should investigate the outcomes that any such changes in policy produce.
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Conclusion |
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In conclusion, normative drug education practice needs to be understood as part of a national effort to improve the effectiveness of drug education. Results of this study suggest that significant effort has been expended on behalf of drug education. Future efforts should focus on: (1) increasing teachers' conceptual understanding of concepts relevant to drug use prevention, (2) increasing teachers' understanding about the distribution of drug use behavior and the normal pattern of drug use onset and experimentation, (3) increasing training effectiveness for building an allegiance to research-based strategies for prevention, and (4) training specifically geared to emphasize the execution of methods associated with changing mediating variables associated with drug use including the large-scale adoption of proven research-based programs.
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Acknowledgments |
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This research was supported in part by a grant from the National Institute on Drug Abuse, grant no. 1-R01-DA07030.
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References |
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Received on July 11, 1997; accepted on February 2, 1998
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