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Journal of Consulting
and Clinical Psychology Selected Article August 1999, Vol. 67, No. 4, 590–593 ©1999 by the American
Psychological Association For personal use only—not for
distribution
Project DARE: No Effects at 10-Year
Follow-Up
Donald R. Lynam and Richard Milich Department of Psychology,
University of Kentucky
Rick Zimmerman and Scott P. Novak Department of Behavioral
Science, College of Medicine, University of Kentucky
T. K. Logan Center on Drug and Alcohol Research, University of
Kentucky
Catherine Martin Department of Psychiatry, University of
Kentucky
Carl Leukefeld Center on Drug and Alcohol Research, University
of Kentucky
Richard Clayton Center for Prevention Research, University of
Kentucky
ABSTRACT The
present study examined the impact of Project DARE (Drug Abuse Resistance
Education), a widespread drug-prevention program, 10 years after
administration. A total of 1,002 individuals who in 6th grade had either
received DARE or a standard drug-education curriculum, were reevaluated
at age 20. Few differences were found between the 2 groups in terms of
actual drug use, drug attitudes, or self-esteem, and in no case did the
DARE group have a more successful outcome than the comparison group.
Possible reasons why DARE remains so popular, despite the lack of
documented efficacy, are offered.
This research was supported by Grant DA05312-10 from the National
Institute on Drug Abuse and by General Clinical Research Center Grant M01
RR026202 from the National Institutes of Health.
Correspondence concerning this
article should be addressed to Donald R. Lynam, Department of Psychology,
University of Kentucky, Lexington, Kentucky 40506.
Email may be sent to
DLYNA1@POP.UKY.EDU.
Received March 12, 1998 Revision received November 10,
1998 Accepted November 12, 1998.
The use of illegal substances in childhood and adolescence occurs at an
alarming rate. In response to this problem, there has been a widespread
proliferation of schoolwide intervention programs designed to curb, if not
eliminate, substance use in this population. Project DARE (Drug Abuse
Resistance Education) is one of the most widely disseminated of these
programs ( Clayton, Cattarello, & Johnstone, 1996).
The widespread popularity of DARE is especially noteworthy, given the
lack of evidence for its efficacy. Although few long-term studies have
been conducted, the preponderance of evidence suggests that DARE has no
long-term effect on drug use ( Dukes, Ullman, & Stein, 1996; McNeal & Hansen, 1995; Rosenbaum, Flewelling, Bailey, Ringwalt, &
Wilkinson, 1994). For example, Clayton et al. (1996) examined the efficacy of DARE
among over 2,000 sixth-grade students in a city school system. The
students' attitudes toward drugs, as well as actual use, were assessed
before and after the intervention and then for the next 4 years through
10th grade. Although the DARE intervention produced a few initial
improvements in the students' attitudes toward drug use, these changes did
not persist over time. More importantly, there were no effects in actual
drug use initially or during the follow-up period. Further, results from
shorter term studies are no more encouraging; these studies suggest that
the short-term effects of DARE on drug use are, at best, small. In a
meta-analysis of eight evaluations of the short-term efficacy of DARE, Ennett, Tobler, Ringwalt, and Flewelling (1994)
found that the average effect size produced by DARE on drug use was .06,
an effect size that does not differ significantly from zero.
Given the continued popularity of DARE, the limited number of long-term
follow-ups, and the possibility of "sleeper effects" (effects showing up
years after program participation), it seems important to continue to
evaluate the long-term outcomes of DARE. The present study followed up the
Clayton et al. (1996) sample through the
age of 20. As far as we know, this 10-year follow-up is the longest
reported on the efficacy of DARE. The original study, although presenting
5-year follow-up data, assessed adolescents during a developmental period
when experimentation with drugs is quite prevalent and even considered
normative by some authors ( Moffitt, 1993; Shedler & Block, 1990). The
prevalence of minor drug use during this period may suppress the effects
of DARE. However, by the age of 20, experimentation with drugs has reached
its peak and begun to decline; it may be during this period that the
effects of DARE will become evident. In fact, Dukes, Stein, and Ullman (1997) reported a 6-year
follow-up that demonstrated an effect for DARE on the use of harder drugs
when participants were in the 12th grade; this effect was not present 3
years earlier.
Method
Participants
The initial sample for this study consisted of sixth graders in the
1987–1988 academic year in a Midwestern metropolitan area of 230,000. An
overwhelming majority of the sample came from urban or suburban areas.
With regard to socioeconomic status (SES), the area is considered one of
the more prosperous counties in a state known for its pockets of extreme
poverty. Although actual SES measures were not collected, given the size
and inclusiveness of the sample, the sample can be assumed to represent
all economic strata. Of the initial sample, 51% were male and 75% were
White.
Data were collected before and after the administration of DARE.
Follow-up questionnaire data were collected from the students over a
5-year period from 6th through 10th grade. Of the original participants,
completed questionnaires were obtained on at least three occasions (once
in 6th grade, once in 7th or 8th grade, and once in 9th or 10th grade) for
1,429 students. This became the sample targeted for the present young
adult follow-up study. Completed mailed surveys were received from 1,002
participants between the ages of 19 and 21.
The final sample of 1,002 consisted of 431 (43%) men and 571 (57%)
women. The average age of the participants was 20.1 (SD = 0.78
). The racial composition of the sample was as follows: 748 (75.1%)
were White, 204 (20.4%) were African American, and 44 (0.4%) were of other
race or ethnicity. Seventy-six percent of the final sample had received
DARE, which corresponds almost exactly to the 75% of sixth graders who
were originally exposed to DARE.
We conducted attrition analyses to determine whether the 1,002
participants differed from those 427 individuals who were eligible for the
mailed survey study but from whom no survey was obtained. A dummy variable
representing present–missing status was simultaneously regressed using a
pairwise correlation matrix onto 15 variables from the original
assessment: sex; ethnicity; age; DARE status; peer-pressure resistance;
self-esteem, and use of, and positive and negative expectancies toward,
cigarettes, alcohol, and marijuana. Missing status accounted for a small
but significant proportion of the variance in the linear combination of
the 15 study measures (R 2 = .06 ), F(15,
1339) = 6.08, p < .001, but only 3 variables were independently
linked to missing status. Participants who were missing completed surveys
tended to be older males who reported using cigarettes in the sixth grade.
In general, attrition seemed to have little effect on the results that are
reported here.
Procedures
Those individuals who could be located were sent a letter and a consent
form requesting their participation in a follow-up to their earlier
participation in the DARE evaluation. Those individuals who returned the
signed consent form were mailed a questionnaire that took approximately 30
to 45 min to complete. Of the available sample, 5 had died, 176 refused to
participate, 83 could not be located, and 163 were contacted but did not
return the survey. For their time and effort, participants were paid $15
to $50.
Measures
Similar to the earlier data collection, participants were asked
questions about their use of alcohol, tobacco, marijuana, and other
illegal drugs. For each drug category, participants were asked to report
how often they had used the substance in their lifetime, during the past
year, and during the past month. In addition, participants were asked a
variety of questions concerning their expectancies about drug use. For
each drug, respondents reported how likely they believed using that drug
would lead to five negative consequences (e.g., "get in trouble with the
law" and "do poorly at school or work") as well as how likely they
believed using that drug would lead to eight positive consequences (e.g.,
"feel good" and "get away from problems"). Negative and positive
expectancy scores were formed for each drug at each age. Two potential
mediators of the DARE intervention, peer-pressure resistance and
self-esteem, were also assessed. Participants responded to nine items
designed to assess the ability to resist negative peer pressure (e.g., "If
one of your best friends is skipping class or calling in sick to work,
would you skip too?"). Finally, participants responded to the 10-item
Rosenberg Self-Esteem Scale ( Rosenberg, 1965). All scale scores had
acceptable reliabilities (alphas ranged from .73 to .93, with an average
of .84).
Initial DARE Intervention
A complete description of the experimental and comparison interventions
is contained in the Clayton et al. (1996) study. Twenty-three
elementary schools were randomly assigned to receive the DARE
intervention, whereas the remaining 8 schools received a standard
drug-education curriculum. The DARE intervention was delivered by police
officers in 1-hr sessions over 17 weeks. The focus of the DARE curriculum
is on teaching students the skills needed to recognize and resist social
pressures to use drugs. Additionally, the curriculum focuses on providing
information about drugs, teaching decision-making skills, building
self-esteem, and choosing healthy alternatives to drug use. The control
condition was not a strict no-treatment condition but instead consisted of
whatever the health teachers decided to cover concerning drug education in
their classes. The drug education received by students in the control
condition cannot be described in detail because of the considerable
latitude on the part of teachers and schools in what was taught.
Nonetheless, in many instances, emphasis was placed on the identification
and harmful effects of drugs, peer pressure was frequently discussed, and
videos using scare tactics were often shown. These drug education units
lasted approximately 30 to 45 min over a period of 2 to 4
weeks.
Results and Discussion
Because the school, and not the individual, was the unit of
randomization in the present study, we used hierarchical linear modeling,
with its ability to model the effect of organizational context on
individual outcomes. For each of the substances (cigarettes, alcohol, and
marijuana), we constructed three hierarchical linear models (HLMs) that
examined amount of use, positive expectancies, and negative expectancies.
We conducted additional analyses on peer-pressure resistance, self-esteem,
and the variety of past-year illicit drug use. An HLM was used to model
the effect of DARE on the school mean of each dependent variable (drug use
and expectancies) while controlling for pre-DARE factors. This allowed for
the comparison of how each school mean varied with the effect of DARE. We
conducted preliminary analyses in which the effect of DARE was also
modeled on the relationship between pre-DARE baseline and the substantive
outcomes. Significant effects would suggest that DARE affected the
relation between pre- and post-DARE outcomes. These effects were not
significant and were thus fixed across schools. Respondents' sixth-grade
reports of lifetime use served as baseline measures, whereas age-20
reports of past-month use of cigarettes, alcohol, and marijuana served as
outcome measures. 1
The results of the full HLMs are presented in Table 1.
Cigarettes
Pre-DARE levels of use and negative expectancies about cigarette use
were significantly related to their counterparts 10 years later. There
were no relations between DARE status and cigarette use and expectancies,
suggesting that DARE had no effect on either student behavior or
expectancies.
Alcohol
Pre-DARE levels of lifetime alcohol use and positive and negative
expectancies about alcohol use were significantly related to their
counterparts 10 years later. DARE status was unrelated to alcohol use or
either kind of alcohol expectancy at age 20.
Marijuana
Pre-DARE levels of past-month marijuana use and negative expectancies
about use were significantly related to their counterparts 10 years later.
Similar to the findings for cigarettes, respondents' sixth-grade positive
expectancies about marijuana use were not significantly related to
marijuana expectancies at age 20. DARE status was unrelated to marijuana
use or either kind of marijuana expectancy at age
20.
Illicit Drug Use
Finally, the number of illicit drugs (except marijuana) used in the
past year was examined. Because no measures for these items were obtained
during the initial baseline measurement, we estimated a means-as-outcomes
HLM using no Level 1 predictors and only DARE status as a predictor at
Level 2. The results show that DARE had no statistically significant
effect on the variety of illicit drugs used.
Peer-Pressure Resistance
The results for peer-pressure resistance were similar to previous
results. Pre-DARE levels of peer-pressure resistance were significantly
related to peer-pressure resistance levels 10 years later, whereas DARE
status was unrelated to peer-pressure resistance
levels.
Self-Esteem
Finally, pre-DARE levels of self-esteem were significantly related to
self-esteem levels at age 20. Surprisingly, DARE status in the sixth grade
was negatively related to self-esteem at age 20, indicating that
individuals who were exposed to DARE in the sixth grade had lower levels
of self-esteem 10 years later. This result was clearly unexpected and
cannot be accounted for theoretically; as such, it would seem best to
regard this as a chance finding that is unlikely to be replicated.
Our results are consistent in documenting the absence of beneficial
effects associated with the DARE program. This was true whether the
outcome consisted of actual drug use or merely attitudes toward drug use.
In addition, we examined processes that are the focus of intervention and
purportedly mediate the impact of DARE (e.g., self-esteem and peer
resistance), and these also failed to differentiate DARE participants from
nonparticipants. Thus, consistent with the earlier Clayton et al. (1996) study, there appear to be no
reliable short-term, long-term, early adolescent, or young adult positive
outcomes associated with receiving the DARE intervention.
Although one can never prove the null hypothesis, the present study
appears to overcome some troublesome threats to internal validity (i.e.,
unreliable measures and low power). Specifically, the outcome measures
collected exhibited good internal consistencies at each age and
significant stability over the 10-year follow-up period. For all but two
measures (positive expectancies for cigarettes and marijuana),
measurements taken in sixth grade, before the administration of DARE, were
significantly related to measurements taken 10 years later, with
coefficients ranging from small ( b = 0.09 for
positive expectancies about alcohol) to moderate ( b = 0.24 for cigarette use). Second, it is extremely
unlikely that we failed to find effects for DARE that actually existed
because of a lack of power. Thus, it appears that one can be fairly
confident that DARE created no lasting changes in the outcomes examined
here.
Advocates of DARE may argue against our findings. First, they may argue
that we have evaluated an out-of-date version of the program and that a
newer version would have fared better. Admittedly, we evaluated the
original DARE curriculum, which was created 3 years before the beginning
of this study. This is an unavoidable difficulty in any long-term
follow-up study; the important question becomes, How much change has there
been? To the best of our knowledge, the goals (i.e., "to keep kids off
drugs") and foci of DARE (e.g., resisting peer pressure) have remained the
same across time as has the method of delivery (e.g., police officers). We
believe that any changes in DARE have been more cosmetic than substantive,
but this is difficult to evaluate until DARE America shares the current
content of the curriculum with the broader prevention community.
One could also argue that the officers responsible for delivering DARE
in the present study failed to execute the program as intended. This
alternative seems unlikely. DARE officers receive a structured, 80-hr
training course that covers a number of topics, including specific
knowledge about drug use and consequences of drug use, as well as teaching
techniques and classroom-management skills. Considerable emphasis is given
to practice teaching and to following the lesson plans. Although we did
not collect systematic data on treatment fidelity in the present study, a
process evaluation by Clayton, Cattarello, Day, and Walden (1991)
attested to the fidelity to the curriculum and to the quality of teaching
by the DARE officers.
Finally, advocates of DARE might correctly point out that the present
study did not compare DARE with a no-intervention condition but rather
with a control condition in which health teachers did their usual
drug-education programs. Thus, technically, we cannot say that DARE was
not efficacious but instead that it was no more efficacious than whatever
the teachers had been doing previously. Although this is a valid point, it
is unreasonable to argue that a more expensive and longer running
treatment (DARE) should be preferred over a less expensive and less
time-consuming one (health education) in the absence of differential
effectiveness ( Kazdin & Wilson, 1978).
This report adds to the accumulating literature on DARE's lack of
efficacy in preventing or reducing substance use. This lack of efficacy
has been noted by other investigators in other samples (e.g., Dukes et al., 1996; Ennett et al., 1994; Wysong, Aniskiewicz, & Wright,
1994). Yet DARE continues to be offered in a majority of the
nation's public schools at great cost to the public ( Clayton et al., 1996). This raises the obvious
question, why does DARE continue to be valued by parents and school
personnel ( Donnermeyer & Wurschmidt, 1997) despite its
lack of demonstrated efficacy? There appear to be at least two possible
answers to this question. First, teaching children to refrain from drug
use is a widely accepted approach with which few individuals would argue.
Thus, similar to other such interventions, such as the "good touch/bad
touch" programs to prevent sexual abuse ( Reppucci & Haugaard, 1989), these
"feel-good" programs are ones that everyone can support, and critical
examination of their effectiveness may not be perceived as necessary.
A second possible explanation for the popularity of programs such as
DARE is that they appear to work. Parents and supporters of DARE
may be engaging in an odd kind of normative comparison ( Kendall & Grove, 1988), comparing children who
go through DARE with children who do not. The adults rightly perceive that
most children who go through DARE do not engage in problematic drug use.
Unfortunately, these individuals may not realize that the vast majority of
children, even without any intervention, do not engage in problematic drug
use. In fact, even given the somewhat alarming rates of marijuana
experimentation in high school (e.g., 40%; Johnston, O'Malley, & Bachman, 1996), the
majority of students do not engage in any drug use. That is, adults
may believe that drug use among adolescents is much more frequent than it
actually is. When the children who go through DARE are compared with this
"normative" group of drug-using teens, DARE appears
effective.
References
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Table 1 Hierarchical Linear Models Examining the
Influence of Project DARE on Age-20 Levels of Drug Use, Drug Expectancies,
Peer-Pressure Resistance, and Self-Esteem
|
Variable |
Fixed effect a |
|
Frequency of past-month cigarette use |
|
|
Intercept ( g
0) |
-.076 |
|
Level 1: Pre-DARE lifetime cigarette use ( b 1) |
.240*** |
|
Level 2: DARE status ( g
1) |
.101 |
Negative expectancies toward cigarettes |
|
|
Intercept ( g
0) |
.108 |
|
Level 1: Pre-DARE expectancies ( b
1) |
.145*** |
|
Level 2: DARE status ( g
1) |
-.152 |
Positive expectancies toward cigarettes |
|
|
Intercept ( g
0) |
-.071 |
|
Level 1: Pre-DARE expectancies ( b
1) |
.009 |
|
Level 2: DARE status ( g
1) |
.053 |
Frequency of past-month alcohol use |
|
|
Intercept ( g
0) |
-.034 |
|
Level 1: Pre-DARE lifetime alcohol use ( b 1) |
.115** |
|
Level 2: DARE status ( g
1) |
-.018 |
Negative expectancies toward alcohol |
|
|
Intercept ( g
0) |
.075 |
|
Level 1: Pre-DARE expectancies ( b
1) |
.105** |
|
Level 2: DARE status ( g
1) |
-.034 |
Positive expectancies toward alcohol |
|
|
Intercept ( g
0) |
-.052 |
|
Level 1: Pre-DARE expectancies ( b
1) |
.085* |
|
Level 2: DARE status ( g
1) |
.048 |
Frequency of past-month marijuana use |
|
|
Intercept ( g
0) |
.033 |
|
Level 1: Pre-DARE lifetime marijuana use ( b 1) |
.098** |
|
Level 2: DARE status ( g
1) |
-.044 |
Negative expectancies toward marijuana |
|
|
Intercept ( g
0) |
-.013 |
|
Level 1: Pre-DARE expectancies ( b
1) |
.123*** |
|
Level 2: DARE status ( g
1) |
.039 |
Positive expectancies toward marijuana |
|
|
Intercept ( g
0) |
-.021 |
|
Level 1: Pre-DARE expectancies ( b
1) |
.045 |
|
Level 2: DARE status ( g
1) |
.011 |
Variety of illegal drugs used in past year
b |
|
|
Intercept ( g
0) |
-.081 |
|
Level 2: DARE status ( g
1) |
.080 |
Peer-pressure resistance |
|
|
Intercept ( g
0) |
.058 |
|
Level 1: Pre-DARE peer-pressure resistance ( b 1) |
.118** |
|
Level 2: DARE status ( g
1) |
-.139 |
Self-esteem |
|
|
Intercept ( g
0) |
.133 |
|
Level 1: Pre-DARE self-esteem ( b
1) |
.129** |
|
Level 2: DARE status ( g
1) |
-.181* |
|
Note. DARE status is coded 0 = control, 1 =
DARE intervention. |
a All beta coefficients presented are
group-mean-centered, standardized effect sizes. b There
were no baseline measures for this model; thus, a means-as-outcomes
model was estimated. |
* p < .05; ** p < .01; ***
p < .001. |
Footnote
1 Results were
unchanged when prevalence of use or heavy use, rather than frequency of
use, was used as the outcome variable. |
|
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