Seven years after initially receiving a computer-based substance abuse prevention program, a sample of late-adolescent youths continued to realize material benefits. Youths who received intervention, regardless of whether their parents also received intervention, reported less alcohol use, binge drinking, and cigarette smoking, relative to control-arm youths. That youths involved in the prevention program also were better able to refuse drinking opportunities, reported less peer pressure to drink, had fewer friends who drink, and held lower intentions to drink, underscores the prevention program's value.
The concinnity of study findings lends credence to the value of intervening early with adolescents around substance use pressures toward reducing their risks of later problems with alcohol and other drugs. Reductions in binge drinking as well as in cigarette smoking show the long-term potential of early intervention efforts. Theoretically, once adolescents learn new ways of interacting with their peers and their environments, those new patterns will become ingrained as youths successfully try out their learned skills and are rewarded for their successes. The longitudinal nature of study data appears to support the transfer of youths' early learning through middle adolescence and into young adulthood. The relatively small investment needed to build and deliver the computerized prevention program may have borne considerable profit.
Study findings invite speculation about the mechanisms through which intervention-arm youths learned to reduce their substance use behavior. Starting with initial program delivery and continuing with booster sessions, youths acquired knowledge and skills associated with problem solving and the resistance of social influences on substance use behavior. Youths learned a sequenced model to understand and solve problems. And they observed and practiced behavioral skills for refusing peer pressure. Other intervention elements aimed to equip youths with the ability to analyze high-risk situations and to act accordingly toward lowering their substance use risks. Over time, youths' acquisition and use of new knowledge would have let them interact with their peers and environments in new and salubrious ways. These interactions in turn may have reinforced youths' learning, leading to additional and novel applications of skills acquired during initial and booster session intervention.
The absence of differences between youths who received the CD-ROM intervention only and those whose parents also received intervention materials deserves scrutiny. One explanation is that parental influences on children wane during adolescence. Parents in our study, moreover, received less intervention than their children received. Consequently, the CD and CDP arms shared more similarities than differences. Owing to the length of the randomized clinical trial, features of the prevention program that had salience for youths during the early adolescent years may have been less potent as youths matured. Quite possibly, parent involvement procedures were among these elements. Parental involvement procedures may have had less value as the developmental process progressed. Thus, the decision to include parents in prevention programs may rest largely on the age of youth participants. Parental involvement may prove useful when children are young. Once children leave home; however, inclusion of parents in prevention programming may not be cost-beneficial.
Another finding that invites speculation are differences in reported substance use between youths who completed follow-up measurement online and those who gave their reports by telephone. Notwithstanding that both methods of data collection assured youths of confidentiality, telephone responders reported higher rates of substance use than did online responders. Most youths (82%) reported online. Those who used the telephone, therefore, may have been in the minority of late adolescent youths who lack personal computers or Internet access. If true, these youths might have already been falling behind their peers in staying apace with technological advances and may otherwise not have enjoyed access to computers connected to the Internet. Whether youths who prefer the telephone response mode are at higher risk for substance use is a question for further research.
The rationale for recruiting study participants from community-based agencies warrants discussion. Whereas school-based research may capture the interest of motivated youths and parents, those who do not regard school as a rewarding experience may participate at lower rates or suffer frequent absences. Further, participation in a school-based intervention could be interpreted by youths as involving additional schoolwork and time at school—again perhaps not attractive possibilities to high-risk youths. Consequently, the study sample was potentially biased toward youth who are at higher risk for substance use and other problem behavior.
Baseline differences in the ethnic–racial composition of the sample are in part explained by the assignment of intact collaborating agency units to study arms. Because each collaborating community agency had a different demographic profile of youths served by the agency, ethnic–racial differences among arm assignments are unsurprising. Randomness can result in patterns.
Limitations to our study include reliance on a relatively small sample, the self-report nature of outcome data, which could have resulted in lower reports of substance use for program-arm youth than for control-arm youth due to the formers' receipt of prevention program materials, and participant loss to attrition. Moreover, only youths who assented to study participation and who had parental permission to participate were enrolled, introducing motivational bias into the sample. Computer-delivered programs are suitable only for youths and families with access to the necessary technology. The study, originally conceived simply to learn whether computer-delivered prevention programming was feasible, employed a perhaps overly simplistic design by not including an active control arm. The absence of outcome data on parental behavior is another study limitation.
Mindful of these limitations, we regard our results as adding longitudinal support to the impact of computer-delivered substance abuse prevention programming for urban youths. The future for computer-accessed interventions aimed at adolescents is bright. Because youths increasingly rely on new technologies for school and extracurricular purposes, giving them access to computerized prevention programming is logical, and as our data suggest, may prove efficacious. Original research needs to further explore such features as the fidelity of computerized program delivery, the verisimilitude of telephone and online self-reports, and the ability to track youths longitudinally through the Internet. The rapidity of technological advancements also begs for work on other new media venues for prevention program delivery and research, including social networking sites, text messaging, and similar brief, yet potentially influential means for reaching youths and changing their behavior. Modest findings reported here are certain to be followed by more sophisticated work on the use of computers to study and improve adolescent health.