Youth programs designed to prevent drug use and delinquency and support healthy development can reap lasting benefits not only for participants, but also for their future kids, according to a decades-long study by the University of Colorado and the 91探花.

The research focuses on a program called Raising Healthy Children, which the UW鈥檚 monitored in several Seattle elementary schools in the 1980s. The program was among the first to test the idea that problem behaviors could be prevented with specialized training for teachers, parents and young children.

Lead author , a professor of psychology and neuroscience at CU Boulder and director of the , first got involved with the study while a professor at the UW.

鈥淭his is the first published study to show that a broadly implemented, early childhood prevention program can have positive effects on the next generation,鈥� said Hill. 聽“Previous studies have shown that childhood interventions can demonstrate benefits well into adulthood. These results show that benefits may extend into the next generation as well.”

The , part of a longitudinal study known as the Seattle Social Development Project, is published June 8 in JAMA Pediatrics.

For the study, researchers assessed children whose parents had participated in , created by 91探花social work professors聽听补苍诲听, founders of the Social Development Research Group. 聽聽The lessons, for use by parents and teachers, focused on enhancing children鈥檚 opportunities for forming healthy bonds in grades 1 through 6 and providing them with social skills and reinforcements.聽Set in 18 public elementary schools in Seattle, the program was among the first to test the idea that problem behaviors could be prevented with specialized training for teachers, parents and young children.

鈥淭eachers were taught how to better manage their classrooms, parents were taught to better manage their families, and kids were taught how to better manage their emotions and decision making,鈥� said Hill.

Previous studies have shown that by age 18 those who had gone through the program demonstrated better academic achievement than non-participants and were less likely to engage in violence, substance use or unsafe sex. By their 30s, they had gone further in school, tended to be better off financially, and scored better on mental health assessments.

Beginning in 2002, the researchers started following the first-born children of program participants via questionnaires for their teachers and parents. Beginning when the children were 6 years old, they also conducted annual interviews.

A total of 182 kids were studied for the new paper, including 72 whose parents had gone through the program and 110 whose parents had not.

Those whose parents had participated in Raising Healthy Children had fewer developmental delays in the first five years of life, fewer behavior problems, fewer symptoms of attention deficit hyperactivity disorder 鈥� or ADHD 鈥� and better cognitive, academic and emotional maturity in the classroom. They were also significantly less likely to report using drugs or alcohol as a teenager.

鈥淲e already know that if you can prevent kids from getting involved in the criminal justice system, engaging in underage drinking and drug use, and experiencing depression and anxiety, you can save governments and families a lot of money,鈥� said co-author , assistant director of the Social Development Research Group at the UW. 鈥淥ur results suggest these programs, by delivering cross-generational effects, may be working even better than we thought.鈥�

Children whose parents had gone through the program in the 1980s also showed less 鈥渙ppositional defiance鈥� and 鈥渆xternalizing behaviors鈥� 鈥� two common precursors to serious violence later in life 鈥� said Hill. This suggests such interventions could play a role in stemming the tide of school violence.

The researchers caution that the study was a non-randomized controlled trial conducted in only one region of the country, and needs to be replicated before broad conclusions can be drawn. But amid a pandemic, when youth depression and anxiety are on the rise while budgets are being slashed and lawmakers may have a tendency to place prevention at a lower priority, Hill hopes the findings send a message.

鈥淏y investing in kids now and continuing to invest in them, we could be making generations to come more resilient for when the next national emergency comes around,鈥� said Hill.

The study was funded by the National Institute on Drug Abuse. In addition to Hawkins and Catalano, co-authors from the 91探花Social Development Research Group are principal investigator and project director . Additional authors were , an emeritus professor in the 91探花College of Education, and Christine Steeger of the University of Colorado.

For more information, contact Bailey at jabailey@uw.edu or Hill at karl.hill@colorado.edu.

Adapted from a University of Colorado news release.

What defines a 鈥済ood life鈥� in your 30s?

The exact answer probably depends on the person, but most people could agree on some general themes: good physical and mental health, solid relationships, and a steady job or good education. Being financially responsible and involvement in your community or civic life also help make life better.

Now 91探花 researchers have found that that 鈥済ood life鈥� in adulthood can start in grade school, by teaching parents and teachers to build stronger bonds with their children, and to help children form greater attachments to family and school. In a study of more than 800 adults throughout their 30s 鈥� a group the researchers have followed since they were fifth-graders at Seattle elementary schools in 1985 鈥� the people who reported better health and socioeconomic status were, consistently, those whose parents and teachers had received lessons aimed at building stronger bonds with their children decades ago.

The researchers know of no other study of a program provided during elementary school that has followed participants for this long. Participants in the longitudinal study, known as the Seattle Social Development Project, have responded to surveys over the years about health, , even the . Such research requires participants who will stick with a study over a big stretch of their lives, and nearly 90% of them have done just that.聽The sample has about equal numbers of males and females, half are racial minorities, and about half had experienced poverty in childhood.

The latest study involved coming up with broad measures of health and functioning in adulthood, surveying participants on specific issues related to those measures, and comparing participants whose teachers and parents received the bonding interventions during elementary school with those who didn’t.

鈥淭hese early elementary-school interventions seek to make kids鈥� current lives better both in and out of school,鈥� said , a principal investigator with the Social Development Research Group, part of the 91探花School of Social Work. 鈥淏ut can we actually get kids on a different life trajectory that lasts beyond elementary school? In fact, we found enduring effects, where they鈥檙e having an overall better experience in adulthood.鈥�

The prevention curriculum, called , was created by 91探花social work professors and . The lessons, for use by parents and teachers, focused on enhancing children’s opportunities for forming healthy bonds in grades 1 through 6 and providing them with social skills and reinforcements. Teachers and parents of children in some classrooms of the 18 participating Seattle elementary schools used the curriculum in the 1980s, while those in other classrooms did not have access to it.

Many of the concepts are teaching tools and parenting tips that are well-known today: reinforcing positive behaviors; setting expectations for making responsible choices; and promoting positive social interaction at school through group projects and seating arrangements. Table groups in the classroom facilitate cooperation and learning from one another, for example, while at home, parents can 鈥渃atch鈥� their child being good and offer praise. With older children, parents can discuss issues such as smoking so that standards for healthy behavior are established before the teen years.

For the published in late spring in Prevention Science, Kosterman devised a list of nine measurable aspects of life for people in their 30s: physical health; mental health; health maintenance behaviors (such as exercise and sleep); low sex-risk behavior; low rates of substance abuse; friendships and relationships; socioeconomic status (income, education, homeownership); responsibility (employment, managing finances); and civic engagement. The team then used surveys and in-person physical evaluations to determine participants鈥� health and successful functioning in adult life.

In a comprehensive test of effects that combined all nine indicators of a healthy and successful adult life, those from intervention classrooms when in elementary school reported significantly better outcomes than those from comparison classrooms through their 30s. Specific areas of significant improvement included fewer symptoms of mental health disorders, more engagement in health maintenance behaviors, and overall better health and socioeconomic success. On the remaining measures, the intervention group scored better on each one, though not as dramatically, compared with the control group.

It鈥檚 hard to attribute results that manifest decades later directly to the curriculum, said Hawkins, a co-author on the new study. But the changed behaviors of their teachers and parents during the elementary grades likely had a snowball effect, leading to positive relationships and responsible decision-making in adulthood.

鈥淲e worked to build healthier relationships 鈥� we call it social bonding 鈥� between teachers and students, and parents and children. The larger question was, if we do all these things, will it turn into a prosocial, healthy lifestyle?鈥� Hawkins said. 鈥淲e didn鈥檛 know we would see these results so much later in life.鈥�

In analyzing the data, researchers examined factors that tend to negatively affect health outcomes: whether a child grew up in poverty, was raised by a single parent, or born to a teenager. Participants who were born to a mother under age 20 were found to have a substantially lower quality of life on several of the measures, especially in the areas of socioeconomic status, physical health and substance abuse. The intervention effects the researchers found persisted even after controlling for these effects of being born to a teen mother.

鈥淭he most important thing we鈥檝e learned is to provide opportunities for kids to have positive social involvement,鈥� Hawkins said.聽 鈥淢ake sure your kids have the opportunity to engage with you as a parent. Play with them, hold them; don鈥檛 just sit on your phone when you鈥檙e with them.

鈥淲hen kids feel bonded to you, they鈥檙e less likely to violate your expectations. And you are likely to be setting them up to have better lives long into the future.鈥�

Kosterman and his team have applied for funding to conduct further research on the group, now in their mid-40s, in midlife. “More studies are needed that test childhood interventions and follow participants through the 30s and beyond,” Kosterman added, “but we are encouraged that these findings suggest that lasting change for important outcomes is possible.”

The study was funded by the National Institute on Drug Abuse. In addition to Catalano, other co-authors on the study were of the 91探花Social Development Research Group; , emeritus professor in the 91探花College of Education; and of the University of Colorado, Boulder.

For more information, contact Kosterman at rickk@uw.edu or 206-543-4546.

Grant numbers: R01DA033956, 1R01DA024411, 1R01DA09679

Want to prevent kids from using drugs and make it stick into young adulthood? Get the community involved and intervene before they鈥檙e teens, say researchers from the 91探花.

A new, longitudinal study from the 91探花 shows that young adults who grew up in communities that used a coordinated, science-based approach to prevention were more likely to have abstained from substance use, violence and other antisocial behaviors through age 21.

Researchers at the group, part of the 91探花School of Social Work, examined a decade鈥檚 worth of participant data across seven states as they evaluated the effectiveness of the (CTC) prevention system. Their was published online in April in the American Journal of Public Health.

鈥淭his study is significant because we show that we have these long-term effects through age 21,鈥� said , lead author and assistant director of the Social Development Research Group. 鈥淭he youth we have been following weren鈥檛 exposed to prevention-oriented programs after middle school, so that suggests that whatever happened by middle school, they carried [those influences] with them, and it鈥檚 made such a lasting impact on their lives.鈥�

91探花social work professors and created Communities That Care, an approach that helps communities organize around prevention, choose programs that are appropriate for their populations, and collect information on young people鈥檚 experiences with alcohol, drug and tobacco use, and delinquency. The idea, they say, is to give children, parents, teachers and community members the opportunities and tools to adopt and sustain healthy behaviors. Today, hundreds of cities and towns nationwide use the program.

The study was conducted among 4,400 youth participants in 24 rural communities in Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington. Towns were randomly assigned as 鈥渃ontrol鈥� communities or as intervention communities. Control communities maintained whatever prevention programming was in place, while intervention communities used the CTC system to select evidence-based, prevention-oriented programs according to the risk factors that were found to be higher among their youth. Communities were asked to focus on grades five to nine.

Many intervention communities opted for three to five programs over time, such as classroom-based lessons in life skills, after-school activities like Big Brothers Big Sisters or parent-support classes. Training began in 2003, and selected programs were launched in 2004, when the children were in sixth grade. Monitoring of the participants’ behavior continued for a decade through surveys.

For many of the measured behaviors, participants from intervention communities were more likely to have abstained through age 21 than those in the control group. Among those who had never used substances or engaged in antisocial behavior at the beginning of the study, incidence rates were still generally lower among participants from intervention communities compared to those from control communities.

Results showed:

• The likelihood of abstaining from a 鈥済ateway drug鈥� (alcohol, tobacco, or marijuana) through age 21 was 49 percent higher among participants from Communities That Care towns.
• CTC participants were 18 percent more likely to abstain through age 21 from criminal behavior, such as vandalism, theft and illegal use of weapons.
• Among males, participants from intervention communities were significantly more likely to abstain through age 21 from cigarette smoking, marijuana and inhalant use, as well as from antisocial behavior and violence. These differences were smaller among females.
• Although more participants from intervention communities never engaged in these behaviors, the proportion who used drugs or engaged in criminal and violent behavior in the past year did not differ between control and intervention communities.

The gender differences need more study to be fully explained, Oesterle said. One theory is that the risk factors targeted by the prevention programs may be more relevant for boys than girls. Perhaps the kinds of behaviors or 鈥減rotective factors鈥� that would be more meaningful to girls weren鈥檛 emphasized as much in the chosen programs.

In 2004, when the study launched, states had not yet begun legalizing recreational marijuana. Plans for the next phase of the study, pending funding, call for a focus on whether that new access has affected marijuana use for young adults in the study, Oesterle said.

For now, this study reveals broader implications for public health, she said. Communities often want to tackle a problem behavior or head one off, but they don鈥檛 always know where to start.

鈥淚t shows that if a community invests in a coordinated and data-driven prevention planning system, you have this long-term effect that gets sustained,鈥� Oesterle said. 鈥淚f a community adopts CTC, they own the process, based on their local culture and values. With Communities That Care, you鈥檙e not just focusing on the most high-risk kids; you鈥檙e trying to prevent the beginning of problems for everyone.鈥�

Along with Oesterle and Hawkins, other authors of the study were and of the Social Development Research Group and and of the 91探花Department of Psychiatry and Behavioral Sciences.

The study was supported by a research grant from the National Institute on Drug Abuse, with additional funding from the National Cancer Institute, the National Institute of Child Health and Human Development, the National Institute of Mental Health, the Center for Substance Abuse Prevention and the National Institute on Alcohol Abuse and Alcoholism.

###

For more information, contact Oesterle at soe@uw.edu or 206-221-4917.

Grant number: R01 DA015183

And their proposal rests on one simple principle: prevention.

The group鈥檚 recently published on the National Academy of Medicine website, recommends implementing evidence-based prevention programs on a national scale to reduce a host of problems ranging from drinking to delinquent behavior, anxiety and risky driving.聽It notes that treatment, lost productivity and crime related to behavioral health problems among young people cost an estimated a year.

Lead author , founding director of the , an organization within the 91探花School of Social Work, said the typical approach to addressing behavioral health problems among young people has been to step in only after they take hold.

鈥淪o much of what we do is to wait until there are big problems, then we start intervening,鈥� he said. 鈥淎s consumers of programs that are costing public money, we need to ask, 鈥榃hat鈥檚 the scientific evidence that this works?鈥欌��

Hawkins has seen that evidence firsthand. , the community-level prevention system developed by Hawkins and Social Development Research Group co-founder , a co-author on the paper, has been to cut smoking and alcohol use among young people by more than 30 percent, and overall juvenile crime by 25 percent. The paper highlights other prevention initiatives that have helped prevent sexual behavior, self-injury, anxiety, unwanted pregnancy, violence and other youth problems.

The paper sets two overarching goals: to cut behavioral health problems among young people by 20 percent in the next decade, and also reduce the disproportionately higher rates of those problems among disadvantaged youth by the same amount. It lays out seven steps for achieving those targets, ranging from investing 10 percent of all public funds spent on young people in effective prevention programs to creating strategies to develop a new cadre of prevention workers.

The coalition, which has more than 60 members from a range of disciplines, has started forming committees to address the seven goals. One group, for example, is putting together curricula to train prevention workers, while another is working with state leaders to develop systems to promote and implement effective prevention programs.

Hawkins acknowledges that the success of the effort will rely on buy-in from states and organizations across the country. He hopes the initiative can garner endorsement from a few high-profile leaders, and ideally, a foundation or corporation that could help cover implementation costs.

鈥淲hat we鈥檙e trying to do is build interest and enthusiasm,鈥� he said. 鈥淲e鈥檙e saying, 鈥楲ook, we need to work together across disciplines and organizations to really take these things to scale.鈥�

The paper鈥檚 19 authors 鈥� which also include ,聽director of the Social Development Research Group, and , an associate professor of social work at the 91探花 Tacoma聽鈥� are experts from some of the nation鈥檚 leading social work, medical and research institutions. Their聽paper is part of the inaugural , a project that was by the 91探花School of Social Work and is overseen聽by the American Academy of Social Work & Social Welfare.

The initiative aims to engage practitioners in coming up with 鈥渁mbitious yet achievable鈥� goals for addressing social issues. The 12 preliminary selected by the academy focus on topics including ending racial injustice, reducing mass incarceration and stopping family violence.

The roots of the coalition鈥檚 paper can be traced back to 1980, when one of Hawkins鈥� 91探花social work colleagues decided to see how many randomized experiments there had been in the U.S. aimed at preventing delinquent behavior. There were just nine, he discovered, and none had proven that delinquency could be curbed. Back then, Hawkins said, efforts to address problem behaviors in young people primarily involved 鈥減eople sitting around a table鈥� thinking about what might work, then doing it.

鈥淭here was no evidence that you could prevent delinquency in America before kids get involved with the justice system,鈥� he said.

That began to change in the 1980s and 鈥�90s, Catalano said, as prevention science emerged along with an increase in randomized, controlled trials of prevention programs. An run by the University of Colorado Boulder now lists more than 50 evidence-based youth development programs aimed at promoting positive behaviors and discouraging negatives ones, and the Obama administration has invested in programs focused on preventing y and providing for first-time, high-risk mothers.

Organizations have started commercializing effective interventions and making them more available to providers, Catalano said, and a focus on evidence-based programs is increasing at various levels of government and in philanthropy.

鈥淭he market is starting to grow up,鈥� he said. 鈥淭he purveyor organizations are coming online, and federal and state agencies are starting to say, 鈥榃e want evidence-based programs.鈥欌��

There has been progress in reducing problems such as teen pregnancy and youth violence, Hawkins said, but in other areas such as infant mortality, children living in poverty and mental disorders among young people, the U.S. lags behind other countries. Proven prevention programs are the most effective way to improve those statistics, Hawkins said.

鈥淚 don鈥檛 think the general public really knows we have this knowledge that would allow us to say we could reduce rates of these problems by 20 percent in a 10-year period of time,鈥� he said. 鈥淭hat鈥檚 a pretty bold statement.鈥�

91探花 researchers have found that joining a gang in adolescence has significant consequences in adulthood beyond criminal behavior, even after a person leaves the gang. The research is published in the .

“It turns out that, like violence, gang membership is as much a public health problem as a criminal justice problem,” said , study co-author and research associate professor in the School of Social Work. “Joining a gang in the teens had enduring consequences on health and well-being.”

The , which was founded by study co-author , followed 808 fifth-grade students from 18 elementary schools serving high-crime neighborhoods in Seattle, beginning in 1985. More than half of the students came from low-income families. Participants were interviewed every year until the age of 18, then every three years until the age of 33.

According to lead author , a doctoral candidate in the School of Social Work, joining a gang served as a turning point, creating consequences that cascaded into other areas of life for years afterward.

“Very few of them reported still being in a gang at age 27. The vast majority had left a long time ago, but the consequences stuck with them long-term,” Gilman said.

Researchers used 23 risk factors to calculate a child’s propensity for joining a gang, and then compared 173 youth who had joined a gang with 173 who did not but showed a similar propensity for doing so, so that the only difference between the two groups was gang membership. The average age of joining a gang was just under 15 years old. No one in this study reported joining a gang after the age of 19, and the majority (60 percent) were in a gang for three years or less.

The 23 variables used to match the groups included individual factors such as antisocial beliefs, alcohol and marijuana use, violent behavior and hyperactivity; family factors such as poverty, family structure, sibling behavior and parent pro-violent attitudes; school factors such as academic aspiration and achievement; neighborhood factors such as the availability of marijuana and neighborhood kids in trouble; and whether the child associated with friends who engaged in problem behaviors. Researchers measured three areas of adult functioning at age 33: illegal behavior, education and occupational attainment, and physical and mental health.

Those who joined a gang in adolescence were nearly three times more likely between ages 27 and 33 to report committing a crime, more than three times more likely to receive income from illegal sources, and more than twice as likely to have been incarcerated in the previous year.

Former gang members also were nearly three times more likely to have drug-abuse issues, were almost twice as likely to say they were in poor health, and twice as likely to be receiving public assistance. They were also half as likely to graduate from high school.

Gilman hopes the study will motivate schools and communities to develop and implement research-based strategies to prevent children from joining gangs, in the hopes of not only reducing crime, but increasing graduation rates and reducing physical and mental health costs.

Hill said everyone can be involved in gang prevention in their own way, by reducing the 23 variables shown to be risk factors. “If you’re a parent, manage your family well. If you’re a community member, be involved in kids’ lives. If you’re a teacher, engage your kids and recognize good work. We can’t solve all of the risks kids are exposed to alone, but we can if we work together,” he said.

# # #

Gilman can be reached at abg5@uw.edu. Hill can be reached at khill@uw.edu or 206-685-3859.

This research was supported by the National Institute on Drug Abuse (grant numbers R01DA003721, R01DA009679 and R01DA024411-03-04), the Robert Wood Johnson Foundation (grant 21548), and the National Institute on Mental Health (grant 5 T32 MH20010).

A 91探花 study found that the positive influence of this community-led system was sustained through high school.

“These towns are safer now, because there are significantly fewer teens fighting, stealing or doing things under the influence that they’d regret later,” said , lead author and founding director of the , affiliated with the .

The results also suggest that teens growing up in Communities That Care towns will go on to have healthier lives.

“Kids who don’t try alcohol until after age 18 are much less likely to become addicted,” Hawkins said. And, “kids who refrain from smoking or crime before age 18 are very unlikely to start either later.”

The findings are published in the Dec. 9 issue of the Journal of the American Medical Association Pediatrics.

Communities That Care was developed by Hawkins with co-author , director of the UW鈥檚 Social Development Research Group. The prevention system is led by a coalition of diverse stakeholders in each community who use surveys of young people to identify that are widespread in their town and protective factors that need strengthening.

Choosing from a list of prevention approaches proven to work, the local coalitions implement policies and programs that best address their communities’ needs.

Since 2003, the 91探花team has tracked the effectiveness of this strategy by measuring experiences and聽 behaviors among a sample of about 4,500 fifth-grade students living in 24 small- to moderate-size towns (between 1,500 and 50,000 residents) in seven states: Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington. Half of the towns participated in Communities That Care, and the other towns served as a control group and did not receive training to use the Communities That Care system.

The new study followed those fifth graders through high school and found that by the end of 12^th grade, the rates of never engaging in violence, delinquency, drinking and smoking in the sample in Communities That Care towns were significantly lower than in communities 聽that did not receive training to 聽use the system.

By the end of high school, 32 percent of teens from Communities That Care towns had never had an alcoholic drink compared with 23 percent of teens from the control towns.

That 10 percentage point is a shift in peer culture, Hawkins said. “Now you’re one in three 鈥� not one in four 鈥� who hasn’t tried alcohol. Abstaining from alcohol appears more popular.”

Fewer Communities That Care teens tried smoking cigarettes by the end of high school: half of teens in the program had avoided smoking compared with 43 percent of the control group.

Delinquency 鈥� including fighting, vandalism, shoplifting, carrying a handgun and being arrested 鈥� also diminished with the program. Fifty-eight percent of Communities That Care teenagers reported involvement in delinquent acts by the end of 12^th grade, compared with 67 percent of their peers in control communities.

A previous benefit-cost analysis showed $5.30 saved in future costs to society for every $1 spent on Communities That Care based on earlier reported results on the prevention of smoking and delinquency.

“We’re learning that communities that initiate this science-based approach to reducing risk and strengthening protection in the middle school years can have lasting effects on whether kids start to engage in risky behaviors all the way through high school. That change will bring future benefits both to those young people and their communities,” Hawkins said.

Other co-authors from the 91探花School of Social Work are , research associate professor, and , research assistant professor. , a 91探花professor of educational psychology, is also a co-author.

The study was funded by the National Institute on Drug Abuse, the National Cancer Institute, the National Institute of Child Health and Human Development, the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism and the Center for Substance Abuse Prevention.

###

For more information, contact Hawkins at 206-543-7655 or jdh@uw.edu.