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HEALTH EDUCATION RESEARCH

Vol.23 no.4 2008 Pages 621–632 Advance Access publication 25 September 2007

The role of life skills promotion in substance abuse prevention: a mediation analysis
Downloaded from http://her.oxfordjournals.org at University Library of Tromsø on September 1, 2010

Anneke Bu ¨ hler1*, Elke Schro ¨ der2 and Rainer K. Silbereisen2
Abstract
Research has shown that life skills programs are the most effective single activity in schoolbased substance abuse prevention. However, little is known about the processes through which they are effective. This study examines whether an evidence-based prevention program targeting general competence is effective through the promotion of knowledge about life skills and enhanced related behaviors. Based on a sample of 442 fifth graders participating in a quasi-experimental prevention study, as expected, mediation analyses revealed that increased knowledge about life skills paralleled an increase in students’ distant attitudes toward alcohol and nicotine use. Unexpectedly, behaviors manifesting enhanced life skills were found not only among program participants who remained experimental/non-smokers or stopped smoking but also among smokers. In general, findings suggest that favorable prevention outcomes may be influenced through building knowledge about general life skills. The notion of uniform mechanisms of effectiveness in prevention programs is discussed.

Introduction
Although cigarette, alcohol and other substance use is a major risk factor for serious illnesses and mortality, they are behaviors practiced all over the world, and Germany is no exception. Among young people aged 12–25 years, ;35% reported regular smoking and binge drinking during the last month prior to testing [1], and every fourth had tried illegal substances, mostly cannabis. As early regular substance use has been shown to be a risk factor for later substance-related problems of adjustment [2], these figures are alarming. Efforts to prevent substance abuse among adolescents can be effective, especially if socially interactive methods are used [3]. Interactive methods, which assign a facilitating role to the program mediator and stimulate exchange among program participants through work in small groups or roleplay, are used by the life skills approach. Life skills programs aim to prevent problem behavior by promoting ‘abilities for adaptive and positive behavior, that enable us to deal effectively with the demands and challenges of everyday life’ [4, p. 1]. In this regard, they represent the notion of promoting positive development rather than relying on avoiding risks [5]. Most life skills programs consist of a general competence enhancement part (e.g. training in communication and interrelationship skills, critical and creative thinking, decision making and problem solving, self-awareness and empathy and coping with stress and emotions) and a part focusing on problem behavior (information about substances, value clarification, norm education, etc.).

¨ r Therapieforschung, Parzivalstrasse 25, IFT Institut fu 80804 Munich, Germany and 2Department of Developmental Psychology, Friedrich Schiller University, Am Steiger 3, 07743 Jena, Germany ¨ hler. *Correspondence to: A. Bu E-mail: buehler@ift.de

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doi:10.1093/her/cym039

With regard to universal prevention. however. implemented in smaller projects. introspective methods. it is clear that additional research is needed in Downloaded from http://her. They resulted in a smaller percentage of students who smoked and a lower rate of drunkenness compared with the control condition [e. 11]. surpassed only by system-wide approaches [3].) regarded as necessary ingredients of successful substance abuse prevention [17]. Mediation analyses were rarely conducted in substance abuse prevention 622 [3. In contrast to results found in North America. higher intensity (>3 h week) and coherent concept and implementation. Taken together. The life skills approach is seen as a powerful tool in universal and selective prevention. metaanalysis of Tobler et al. Finally the mediation analysis approach tests whether change in mediating variables targeted by the intervention is due to program participation and whether this in turn can be related to change in substance use behavior [12].oxfordjournals. (ii) the leader (peerled or adult-led) may constitute one of several characteristics which determine effectiveness and (iii) effects of school programs can be increased when community components are added. problem solving. He concludes that (i) booster sessions may be beneficial depending on other program characteristics. The life skills approach has been found to be the most effective single activity in school-based substance abuse prevention. Encouraged by the US experience. perceived peer approval of drug use. unspecific variables were found to be mediators of preventive effects—less tendency to risk-taking behavior in a school-based life skills program and improved parent–child communication in a family-oriented program (although results are inconsistent across studies [15]). Cuijpers [11] found only seven studies examining this issue. acceptability of drugs. intensity. universal prevention through life skills programs affected substance use primarily in younger samples (Grades 1–6) rather than among older students. Only two distal.g. [3] shows that programs using interactive methods. 14] implemented their program with samples of students at high risk for substance use but could not test the mediating role of enhanced life skills because they found no program effects on the skills they measured. with health professionals as program facilitators. etc. knowledge about substances and prevalence of use. Concerning selective prevention Springer et al.A. Twenty-one studies that directly compare prevention programs with and without possible core ingredients of effective substance abuse prevention were reviewed by Cuijpers [11]. beliefs about substances and commitment or intention not to use.g. were also promoted through program participation [18–22]. 2010 . Bu ¨ hler et al. Botvin et al. Whether promotion of these life skills actually mediated the preventive effects. has not been proven up to now. The only two studies that attempted to conduct a mediational analysis including life skills measures were inconclusive. Other substance-unspecific variables (e. meanwhile another four papers were published [13–16]. communication skills. [10] identified five aspects which were associated with positive outcomes: life skills-related content. targeting younger and older students (<7th grade or >10th grade) achieve higher effect sizes. [23. see [6]). with a certain length (11–30 sessions). size of project) and conceptualization (theoretical approach. 7–9]. program effects have rather been related to change in proximal substance-specific variables than to generic life skills enhancement. Knowing that a prevention program is effective leads to the question of why and how the program worked. Thus ‘While the research conducted thus far examining the impact of the LST [life skills training] program on hypothesized mediators and attempts to identify specific mediating mechanisms are important first steps. connection-building methods. The mediating variables identified were rather proximal and substancespecific risk factors such as. These characteristics concern implementation (length. interactive methods). In these studies. prevention research has revealed several characteristics that are associated with effective substance abuse prevention outcomes. interpersonal and decision-making skills. implement and evaluate school-based life skills programs at the beginning of the 1990s (for a review. German researchers started to develop. although up to now.org at University Library of Tromsø on September 1.

Gender was distributed equally (49. Project staff administered questionnaires to students following a standardized protocol emphasizing confidentiality of participant reports. very good to 5. Teachers were trained during a 2-day workshop and were supervised throughout the intervention. This random sample consisted of experimental and control students who had completed questionnaires at post-test only. A bogus pipeline procedure [25] was used to increase the validity of selfreport substance use data. Power analysis revealed that given an alpha level of 0. i.org/index. (ii) Enhancement of life skills knowledge and behaviors due to program participation mediates the program effects toward lower substance affinity and fewer cases of substance abuse among students. failed). compared with controls. Classrooms were randomly assigned to the Solomonfour-groups design. This retention rate of 69. 9. Data analysis is based on the reports of 448 students who completed questionnaires at all measurement points (treatment group n = 256. As shown in Table I.11 (small effect size). Our hypotheses were as follows: (i) Participation in a substance abuse prevention program targeting general competence results in enhanced life skills knowledge and life skills behaviors as well as lower substance affinity and fewer cases of substance abuse. 29]. Measures In order to assess ‘program implementation’.8 and a number of three predictors in a regression model. we wanted to test whether a program aimed at general competence enhancement is effective due to its promotion of life skills. Thus. The program was implemented mid-year in fifth grade.g.7% is similar to other German school-based evaluation studies [e. an anticipated effect size of 0. to the experimental or control condition and to the pre-test or no pre-test condition.05. 2010 Methods Design and procedures A pre-and post-test study with a treatment and control condition was conducted in schools. control group n = 192). Downloaded from http://her. 226]. a minimum sample size of 103 is required (http:// statpages. after every program session teachers reported the number of program elements implemented and rated their quality of teaching on a five-point scale. Following the Solomon-four-groups-design [27]. they reported the share of attentive and actively participating students. 28. Against this backdrop. In addition. tions. the factor ‘pre-testing’ indicates whether it is testing rather than the intervention that has an effect and the interaction factor ‘pre-testing 3 treatment’ indicates whether treatment in combination with a pretest has a different effect than without pre-test. Respondents were asked whether they had ever used tobacco or alcohol (response format: ‘yes. Baseline and post-test data (12 months later) were collected during a regular 45-min classroom period. Schools showed interest in school-based substance abuse prevention and agreed to participate in the study. 9].html#Power). The 195 missing cases were absent at one measurement point.org at University Library of Tromsø on September 1. a desired statistical power level of 0. The population of fifth graders in Realschulen in the region we studied was 1505 [26]. ‘Substance use’ was measured using items that were developed by consensus in several German prevention research groups [8. a type of noncollege bound school typically leading students into professions not requiring university-level qualifica- .8 years. comparing the outcome variable of all four groups.Life skills promotion in substance abuse prevention this area’ [24. Passive informed consent of participation was given by parents.8% girls) and the mean school mark reported was slightly >3 (marks range from 1. p. 623 Sample The sample comprised 643 fifth graders from 22 classes of seven ‘Realschulen’.e. data of a comparable additional sample (n = 110) were used to investigate testing effects that could threaten internal validity.oxfordjournals. several times’. mean age of study participants was 10.

82) 0.8 (0.ift. Scales consist of five items each.7 (0. data were dichotomized into ‘abuse’ and ‘no use/experimental use’.9 (5. e.15) 0. If respondents disagree with this item.8 (7) 14. ‘Affinity toward tobacco and alcohol’ was measured with two scales developed for prevention studies where their use predicted later substance use behavior (Tobacco and Alcohol Distance) [28. creative and critical thinking. bSignificant difference between treatment and control group (P < 0. M (SD) School achievement: M (SD) Substance use Nicotine abuse: % (n) Alcohol abuse: % (n) Tobacco distance: M (SD) Alcohol distance: M (SD) Life skills Knowledge skilled behavior: M (SD) Knowledge unskilled behavior: M (SD) Resources: M (SD) Deficits: M (SD) 50.05).8 (0. 91–110].9 (53) 1. 2010 M = mean. Table I.61) 2. ‘Passive smoking is harmless’.1) Total (n = 448) 49.9 (0.25)a 34.15) 0.php?id=211 for full questionnaire).64) 1. Respondents reported how often they showed the behavior in question (1 = seldom. Three items assess knowledge about tobacco/alcohol. Thirty-three items were formulated following the World Health Organization definition of each skill [4..65)b 2.5 (95) 10. The amount of alcohol use per occasion was reported in a free format.56 (0. middledistance adolescents (2 points) and low-distance adolescents (0 and 1 point). pp.org at University Library of Tromsø on September 1. 3 = most of the .81) 0. a Significant difference between retention and dropout sample (P < 0.8 (5. 29]. was classified as substance abuse.91 (0. The fourth item assesses the affective aspect of affinity: ‘Adolescent smokers/drinkers are posers’. Points are summed to classify high-distance adolescents (3 points).84)a 4.e.7 (5.8 (0. the intentional aspect of affinity is measured by a fifth item ‘I do intend to smoke/drink regularly in the next 12 months’.50 (0.82) 0.9 (0.0 (128) 10.7 (0.7 (0.15) 0.8 (223) 10.8 (0.2)a 14. decision making and problem solving and coping with stress and emotions (see http:// www.7 (0. Finally. another distance point is assigned. The ‘life skills behavior’ scales reflect the five main life skills areas defined by prevention experts [4]: self-awareness and empathy.62) 3.05). If this item 624 is supported.90 (0.1 (0.63) 2.5) 16. If two of three knowledge items are correctly answered by the respondent.1 (11. I tried’ and ‘no’) and whether they had used it recently (in the past 30 days).16) 0.4)a Downloaded from http://her.de/index.7 (11.55 (0. ‘yes.2 (5. i.6 (16) 11.1) Control (n = 192) 49. 2f].89 (0. Sample and dropout characteristics Retention sample Treatment (n = 256) Gender: % girls (n) Age: years.8 (0. This definition is rooted in a developmentally oriented perspective on adolescent substance use that classifies any use beyond experimenting in this age group as abuse [30.8 (0. a ‘distance point’ is assigned. ‘consumed several times during lifetime’ or ‘current use of more than one cigarette during the last week or more than a sip of alcohol per occasion’.9 (75)a 10. Bu ¨ hler et al.8 (11.71) 3.7 (0.71) 1.4 (20) 1.24) 37.70) 1.7 (7) 10.83) 0. communication and interpersonal relationships.5 (9) 13.oxfordjournals. SD = standard deviation. Due to the lack of established life skills assessment scales. p.25) 37.5) 15.5 (21) 1.24) 36.1) Dropouts Total (n = 195) 38.5) 16. a third possible distance point is assigned. Subsequently. 2 = more often. 31].68) 1.7 (0. items capturing life skills behavior and knowledge were developed by the authors.9 (0. Three additional items indicating refusal assertiveness were taken from Botvin’s questionnaire [32.A.1 (33) 1. Current users reported frequency of use during the past 30 days and amount of use per occasion.91 (0. Any use beyond trying.70)b 3.54 (0.68) 3.3 (12.g.

71 0. Due to other research questions in our project.Life skills promotion in substance abuse prevention time).73) was computed. T2: 0. ‘Life skills knowledge’ items reflect facts about life skills taught in the program. communication (six items.g. i.7%). middle distance.e.g. A sum score for resource items (Cronbach’s a at T1: 0. e. I don’t look for alternatives but act the way that comes into my mind first’. middle distance. Two mean scores according to the factor solution were computed. I solve it step by step’. 2010 Table II. of items Outcome variables Substance use Nicotine abuse Alcohol abuse Tobacco affinity Alcohol affinity Mediator variables Life skills Knowledge skilled behavior Cronbach’s a (T2) Score range Abuser versus non-user/experimental user Abuser versus non-user/experimental user Low distance. e.oxfordjournals. high distance 1 1 5 5 — — — — 1/0 1/0 1–3 1–3 One should show a friend that one is listening by nodding or 6 looking at him Knowledge unskilled behavior One should talk until somebody interrupts 7 Resources If a problem occurs. We expected life skills knowledge to be positively associated with resources in the life skill domain and negatively associated with deficits in skilled behavior. high distance Low distance. Sixteen items assessed knowledge about assertiveness (three items. T2: 0. With regard to validity of the developed measures. Measurement of the outcome variables and potential mediators No. problem solving: ‘If a problem occurs. Exploratory factor analysis with Varimax rotation resulted in a life skills resources factor (23 items.org at University Library of Tromsø on September 1.86) and for deficits items (Cronbach’s a at T1: 0.70 0. both instruments were divided into two scales. Cronbach’s a at T1: 0.86. ‘One should show a friend that one is listening by nodding or looking at him/her’) and problem solving (seven items. e. ‘One should always solve problems without the help of others’. As assertiveness variables loaded on one factor at T1 and on the other at T2. even if previously I had a different opinion’). coping with emotions: ‘I try to cheer myself up when I’m down’.71) and knowledge about unskilled problem solving and communication (seven items.7% at T2: 33. namely. assertive communication: ‘I’m not afraid to say my opinion’. they were not included in the sum scores.70. Factors reflected knowledge about problem solving and communication (six items. a short version of the Problem Questionnaire [33] and of the Coping Across Situations Questionnaire [33]. a scale concerning intrapersonal and a scale concerning interpersonal problems or situations. Cronbach’s a at T1: 0. Table III shows cross-sectional and longitudinal correlations between potential mediators and other life skills relevant instruments used in our study.53. inverted). Based on research on stress and coping [32]. Table II summarizes the measurements of the outcome variables and potential mediators.g.g. I solve it step by step 23 Deficits I find it hard to start a conversation with someone I don’t know 13 0. problem solving: ‘If a problem occurs. stressful interand intrapersonal problems were hypothesized to relate negatively to resources and knowledge about Downloaded from http://her.g.45. critical thinking: ‘Other people can easily persuade me.73 1–3 1–3 1–4 1–4 625 .86 0. T2: 0. Exploratory factor analysis with Varimax rotation suggested a two-factor solution (variance explained at T1: 23. T2: 0. interpersonal skills: ‘I find it hard to start a conversation with someone I don’t know’. e. ‘Talking loud and clear is assertive’).70). e. self-awareness: ‘I think about my strengths’) and a life skills deficits factor (13 items.

1) is represented by the path from the program through the mediating variables (life skills) to the outcome. Bu ¨ hler et al. in some classrooms.A. correlations between active and socially oriented coping behavior and resources or life skills knowledge should be positive whereas correlations between this coping style and deficits should be negative.04 À0.12* (1) 0.49** 0. 2010 0.09 0. The mediator effect is equal to ab. problem solving.11* 0.01 0.16** 0.07 (À) À0.13* 0.02 À0.24** Knowledge skilled 1 0.01 À0.06 2 0.13* 0.46** À0.04 0.25** 0.49** 0.03 (À) À0.07 À0.04 0.06 0.04 0.01 (1) 0.22** Knowledge unskilled 1 0.14* 0.14* expected direction of correlation coefficients negative (italics) or positive (bold).40*** 1 0. normative education.20** 0. coping with stress and emotions) and four sessions on substance use-related issues (information about immediate effects of nicotine and alcohol use and short-term and long-term negative consequences.07 À0.04 (1)a 0.11* À0.06 0.01.12* 0.00 À0. In contrast. Thus.19** 0.00 À0.13* À0.21** 0.11 À0.02 À0. life skills and positively to reporting deficits.09 À0.14* À0.01 0. critical thinking.oxfordjournals.08 À0.08 À0.09 0.11* 0.02 0. uses interactive methods and emphasizes reference to the personal daily life of students. Other effects in the model include the direct effect.02 0.02 À0.05 (À) À0. the coefficients are rather low and one of the expected relations is not significant at all (resources and stress).24** 0.01 0.01 0. Table III.12* 0.12* 2 0. The program 626 Data analysis strategy The process of mediation (see Fig. self-awareness.12* 0.07 À0. Mediation regression analysis was conducted according to MacKinnon’s recommendations [12] using the statistical procedures described in MacKinnon and Dwyer [35]. discussion about motivation to smoke and drink.14** À0. *** p < . all significant coefficients point to the direction expected. Intervention and control condition ‘Allgemeine Lebenskompetenzen und Fertigkeiten (ALF)’ (general life competencies and skills) is a life skills program for fifth graders consisting of eight sessions on general life skills training (communication.05 À0. s’.25** 0. Cross-sectional and longitudinal correlations between potential mediators and other life skills relevant measures Resources Time Resources Deficits Knowledge skilled Knowledge unskilled Interpersonal stress Intrapersonal stress Interpersonal coping Intrapersonal coping a Deficits 2 0.06 À0.00 (À) À0. and the total effect s = ab + s’.org at University Library of Tromsø on September 1.04 À0.02 0. social competence was trained as part of the routine school curriculum and drugs were sometimes discussed in cases where substance use had been observed among students.06 À0.03 (1) 0.20* 0. Three types of regression models provided the parameter estimates and the standard errors needed to establish the presence or absence of mediation between one mediating .15** 0. media and social influences on use.05.17** 0. * p < . ** p < .12* À0.00 0.13* 2 0. As shown. Control classrooms did not receive any systematic drug prevention activity. resistance skills training) [34].19* 0.08 0.09 À0.16** 1 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Downloaded from http://her.16** À0.01 0.20** 0.13* 0.001.22** 0.09 À0.12* À0.23** 0.04 0.21** À0.06 À0.14** 0. However.17** 0.07 0. interpersonal relationships. However. the control condition is considered a treatment-as-usual control group.

Life skills promotion in substance abuse prevention correspond to the unit of analysis (individual level). a linear or logistic regression was computed. The first regression model tested and estimated the effect of the program on the outcome variables (s). dropouts also reported fewer deficits in life skills. Fig. The standard error of the mediated effect (rab) was derived using the multivariate 2 2 delta method [square root of (a2 a2 b +b aa )] [12]. there were no significant differences in substance abuse or substance affinity between the retained and the dropout sample. dropouts had less life skills knowledge at baseline and reported less life skills resources than the remaining respondents. Unexpectedly. Concerning possible ‘testing effects’ [27]. a measure of the extent that is mediated. Due to the directed nature of the hypothesis. ‘Implementation check’ results showed that the mean percentage of implemented elements per program session was . Teachers reported . The mean number of sessions in which a student participated was 10. program implementation was deemed satisfying. 1. The second regression model tested and estimated the effect of the program on the hypothesized mediating variable (a). In sum. the percent of the total effect that is mediated [ab/(ab + s’)] [12]. onetailed tests were employed to examine the significance of the estimated parameters.90% (range 80–100%).7 out of 12 sessions. Baseline measures of the outcome variables and the mediator variables were used as covariates in the analyses.50 to 75% participated actively. teachers rated their own behavior between 2 and 3 on a scale of 1–5 (5 = very bad). no further analyses were conducted with that variable. To avoid this bias.oxfordjournals. 2010 Results Preliminary analyses variable and the outcome variable [36]. a software program that takes intraclass correlation into account through adjustment of the standard estimate error of regression coefficients. there were no differences in substance-related and life skills outcome variables between the samples with and without a pre-test. If the program did not have at least a marginally significant effect (P < 0. In addition. Significant ‘baseline differences’ between experimental and control students in the study were limited to age and school achievement: the mean age was slightly higher and the mean mark slightly better in the control than in the experimental group (see Table I). The magnitude of the mediated effect was calculated by multiplying the latter two regression coefficients (ab).e. In contrast. i. inferential tests were computed with SUDAAN [37]. Downloaded from http://her. Depending on whether the criteria was assessed on interval level or was dichotomous. Note that the unit of randomization (classroom level) does not ‘Attrition’ was more prominent among boys and for students with lower school achievement (see Table I). 627 . The mediated effect for the dichotomous outcome variable (nicotine abuse) was calculated by comparing the total program effect and the direct program effect (s – s’) because of its categorical property (see [34]). was calculated for each mediator. and consequently intraclass correlation may bias results of inferential statistics.org at University Library of Tromsø on September 1.60 to 85% of students were attentive during the sessions and that .10) on the mediator hypothesized. Mediation model. The statistical test for significance was calculated using a Z statistic. In addition. The third regression model tested and estimated the effect of the mediating variable on the outcome variable after adjusting for the effect of the program (b). in one-way analyses of variance (ANOVAs) for continuous outcome variables and in logistic regression for dichotomous outcome variables the factor ‘pre-testing’ and the factor ‘pre-testing 3 treatment’ was not significant. Concerning the quality of implementation.

01. there were statistically significant program effects on the mediator variables knowledge about skilled behavior (P < 0.1) 2.3% (P < 0.88 (0.0 (5.s.8 (0.01) and life skill resources (P < 0.4%.59 (0. Program effects on substance use and life skills (n = 448) T1 ALF Substance use Nicotine abuse % (n) Alcohol abuse % (n) Tobacco affinity M (SD) Alcohol affinity M (SD) Life skills Knowledge skilled behavior M (SD) Knowledge unskilled behavior M (SD) Resources M (SD) Deficits M (SD) Control T2 ALF Control Program effects s rs Z value 3.4 (20) 1. **P < 0.8) 15.A.30*** n.4) 6. nicotine abuse increased from 3.511 0. M = mean.80 (0. In contrast.7 (12. Concerning tobacco and alcohol affinity. Bu ¨ hler et al.7 (5.01) and alcohol affinity (P < 0. 3.05 ra 0.30) 37. 628 .6) 16.5) 16. As expected.90 (0.7 (11. testing as a threat to internal validity can be ruled out.7 to 6.5 (5.org at University Library of Tromsø on September 1.05.8 (5.s. Nicotine abuse decreased in the intervention group from 3.81 (0.24) 37. All models are adjusted for baseline substance use and baseline measures of the mediators.001). This study replicated significant effects on all outcome variables of interest except alcohol abuse. students’ affinity to smoking did not change.21) 0. including nicotine abuse (P < 0.1) 3. Program effects Elsewhere we reported significant effects of the prevention program concerning delaying the onset of smoking and heavy drinking [8].65 (0.14 (0.70) ALF 0.. whereas in the control group. and use.64) 1. no mediation analyses were conducted on these variables.g.70) Control 0. 2010 Mediating effects The mediating effects of the program on abuse and affinity toward smoking and alcohol drinking are presented in Table V. did not significantly mediate program effects on tobacco and alcohol affinity.5 to 2.65) 1.69) 1. As hypothesized.8 (11.16) 0. but there was evidence for an ‘inconsistent mediating effect’ [38] on nicotine abuse (P < 0.5 (20) 1.01* n. Thus. ***P < 0.56 (0.26*** Z value 2.oxfordjournals. students participating in the intervention program developed a more critical view against smoking and alcohol consumption after the program (P < 0.1 (33) 1.06 3.25) 36.93 (0. e.5 (9) 13.28) 34.313 a 0.9 (11. Although intervention students were less likely to smoke and were more likely to use life skills (see Table IV). *P < 0.83 (0.59 (0. In the control group.5) 15.71) 1.05).s. 3. enhanced life skills Table IV.91 (0.05 0. their affinity to drinking alcohol became more critical but did not reach the distant level of the intervention group (see Table IV). Participants gained from the program by enhancing their knowledge Downloaded from http://her.67) Control 0. No program effects were found concerning knowledge about unskilled behavior and life skill deficits. SD = standard deviation.5 1.15) 0.85 (0.2) 1.4 (6) 10.001). in contrast to the controls.15) 0. and consequently.02 2. enhanced life skills paralleled less nicotine abuse and an increasingly distant attitude toward legal substances. life skills resources.88*** 6. in effective problem solving and communicating with others.7 (7) 10.001).10). tobacco affinity (P < 0.74) ALF 0.194 0.50** n.03 0.01).54 (0.98 (0.8 (27) 2.3 (12) 10. Knowledge about skilled behavior significantly mediated the effect of the program ALF on all outcome variables.001.05 0.

***P < 0.05].074 (0. 629 . Learning techniques to manage the demands and challenges of everyday life successfully (e. Downloaded from http://her. the inconsistent mediating effect of life skills resources on nicotine abuse is shown.001. communicating) helped students to develop a critical view on substance use and to reduce nicotine abuse.51** n.230 (0.s. Mediation effects of the program on substance use Mediated effect (ab) or (s – s’)a Nicotine abuse (s – s’) Z value Percent mediated (ab/ab + s’) Discussion So far. Fig. ** P < 0. 2010 Table V.s.83*** 13. However.30** n.8 5.Life skills promotion in substance abuse prevention do not seem to represent the cause for their nonsmoking behavior. problem solving. Inconsistent mediating effect.01.055) 1.060) 3. (ii) students who remained non-smokers at T1 and T2 and (iii) students who changed smoking status from smoker at T1 to non-smoker at T2. In addition.015 (0. 2. The ‘inconsistent mediating effect’ arises because a higher increase of life skills resources can be observed among smokers than among remaining experimental or non-smokers. process evaluation revealed that the program elements were successfully implemented in the intervention classes and a testing Knowledge skilled 0.049) 2. To clarify this issue further.6 behavior Resources À0. Mean differences between the three groups are significant as an ANOVA revealed [F (2.oxfordjournals. Changes in life skills resources are shown for three different groups of ALF students: (i) students who started heavier smoking between T1 and T2 (onset of nicotine abuse).019 (0.034) 2. preventionists have not fully understood the mechanisms through which life skills programs are effective. +P < 0. the negative score of the mediating effect indicates that enhanced life skills parallel onset of nicotine abuse.0 All models are adjusted for baseline substance use and baseline measures of the mediators. the highest increase of life skills resources was reported by Alf students who stopped smoking. On the contrary. 201) = 3.75. 2. in Fig. 14.34+ Tobacco affinity Knowledge skilled behavior Resources Alcohol affinity Knowledge skilled behavior Resources (ab) 0.1. (ab) 0. P < 0. a Parameter estimation depending on whether outcome variable is continous or dichotomous (see [28]). The findings of the current mediation analyses suggest that the prevention program ALF achieved its results of lowering the rate of nicotine abuse and fostering a critical attitude toward substance use among students in Grade 5 by increasing knowledge and use of general life skills.org at University Library of Tromsø on September 1.g.

This may be seen as an alarming message for preventionists favoring the life skills prevention approach. cognitive changes concerning life skills presumably led to cognitive and behavioral changes in the substance use domain. Bu ¨ hler et al. the US studies targeted a minority sample [23. Thus.e.g. ALF students who smoked after the intervention did so because they improved in life skills. Our findings confirm that life skills promotion is related to favorable prevention outcomes and as such represents a promising way in substance abuse prevention. i. 14]. the population examined in our study is a general population sample. reveals that the situation is more complex. we chose a global measurement with which to analyze the mediation role of general life skills in substance prevention. could not be tested in this study design. Our findings concerning the mediating effect of life skills resources on nicotine abuse are to be interpreted as an inconsistent mediating effect [38]. however. Unlike tobacco or alcohol affinity. 2. The fact that life skills resources and knowledge about skilled behavior were influenced rather than life skills deficits and knowledge about unskilled behavior may reflect the conceptual basis of the prevention program implemented: ALF was designed to focus on protective factors rather than on risk factors [39]. Secondly.A. First.g. Our results point to the fact that changes in cognitions about general competence skills are also an important agent in successful substance use prevention. Other researchers [23. acceptability of drugs. 2010 . Contrary to our expectations. although. It may be that life skills promotion is a mediating condition in a non-select population rather than in at risk groups. problem solving) was followed by a more distant attitude toward tobacco and alcohol and fewer cases of nicotine abuse after the intervention. 14] tried to explain the underlying mechanisms of effective life skills programs by testing the mediating role of isolated life skills (e.org at University Library of Tromsø on September 1. life skills programs are characterized by general competence enhancement. We would like to emphasize that in contrast to other evaluation studies. effect [27] could be ruled out through the analysis of an additional sample. a reduction of substance abuse in adolescence and adulthood. Our results show that increasing knowledge about life skills (communication. Thus. Knowing why an activity is preventive as well as knowing the limits of its effectiveness is helpful in optimizing substance abuse prevention activities [12]. Three aspects may explain why mediating effects were evident in our study. on the conceptual basis of general competence enhancement. This study indicates the importance of substanceunspecific life skills promotion in preventing substance abuse.2% [14]. Indeed. The program emphasized building up a skilled behavioral repertoire rather than correcting maladjusted behavior or restructuring maladjusted cognitions. The mean number of program points covered in one US study as observed by project staff was 630 48. our outcome variable tobacco use goes beyond experimental smoking behavior and indicates what from a developmental perspective [28. ALF Downloaded from http://her. perceived peer approval of drug use. Although observation and self-report data may be not comparable with regard to validity. In comparison to other prevention approaches like resistance skills programs or substance-specific information sessions. a more conservative and theoretically sound effectiveness criterion was applied. knowledge about the prevalence of use.90% of program elements. an issue that had not been proven up to now. The ALF program can be regarded as effective in the sense that enhanced protective factors led to a reduction of substance abuse. A closer look at Fig. behavioral changes do not seem to play a role in the development of substance-related cognitions. obviously. 29] can be classified as nicotine abuse. teachers in our study reported to have implemented . decision making). The importance of cognitive changes in substance-specific constructs for successful prevention (e. intention not to use) has been demonstrated [11]. the final goal of substance abuse prevention. this difference may point to the fact that life skills training needs to be comprehensively implemented with a high proportion of attentive and active students in order to influence favorable prevention outcomes.oxfordjournals. Finally.

for the majority of ‘non-problematic’ adolescents training in general life skills was not the core mediating process in order to remain nonsmokers. our results point to the possibility that rather differential than uniform mechanisms of effectiveness operate in prevention programs. 2005. Federal Centre for Health Education. Germany: Bundeszentrale fu ¨ r gesundheitliche Aufkla ¨ rung.org at University Library of Tromsø on September 1. the highest increase of life skills resources was observed among those ALF students who stopped abuse. Cologne. Follow-up data are needed to determine whether the ultimate goal of substance use prevention—less substance abuse in adolescence and adulthood—can be accomplished through the prevention program. because of small group size. The present study has several strengths and weaknesses. established data collection protocols. J Prim Prev 2000. Bloomfield K. Kraus L. substancespecific variables) may have been the agent in this group. Finally. whereas dimensions of social assertiveness and dating assertiveness were positively associated with substance use [40]. Addiction 2000. this differential role of life skills promotion may support the notion of different pathways of substance use behavior [41. Geneva. Prevalence of alcohol use and the association between onset of use and alcohol-related problems in a general population sample in Germany. problem-specific coping skills. In contrast. Life Skills Education in Schools. 3. 4. 2002.Life skills promotion in substance abuse prevention students who started to smoke showed a higher increase in life skills resources than ALF students who remained experimental or non-smoker. 5. 2010 Funding The German Science Foundation (grant DFG 296/ 31-1) and by a stipend of the German National Academic Foundation. Strengths include the random assignment. Pathways to Positive Development among Diverse Youth. 1994. Drug Affinity of Adolescents in the Federal Republic of Germany 2004. Ko ¨ ln. Future investigation considering more than one plausible mediating mechanism would help to decide ‘what works’ and thus help to optimize established school-based prevention programs. 2. [Health Promotion through Life Skills Programs in Germany. Lerner RM. Nevertheless. San Francisco. Ochshorn P et al. although still needed to be replicated. Augustin R et al. Thus. Thus. World Health Organiszation (WHO). Germany: Federal Centre for Health Education. Change in other mediating variables (e.]. Taylor CS. Heppekausen K. School-based adolescent drug prevention programs: 1998 meta-analysis.g. Validity of these results is limited. References 1. 6. Limitations of the study include the fact that the data are constrained to assessments 1 year after baseline measurement. 28] responding to different elements of prevention. CA: Jossey-Bass. our results suggest that in this age group. 95: 1389–401. Tobler N. control of testing effect and statistical analyses that control for intraclass correlations. Gesundheitsfo ¨ rderung durch Lebenskompetenzprogramme in Deutschland. This is reminiscent of research findings showing that only substance-specific assertiveness was inversely associated with substance use. von Eye A. Bu ¨ hler A. Downloaded from http://her.oxfordjournals. 631 . 20: 275–336. Roona M. Switzerland: WHO. the fact that we focused on life skills promotion does not rule out the possibility of alternative mediating processes of effectiveness such as group processes on the classroom level or substancespecific cognitive mechanisms. Acknowledgements We gratefully thank all participating schools. a group of adolescents with more persistent problem behavior from childhood to adulthood [41]. Conflicts of interest statement None declared. Students who started smoking heavily before fifth grade may be ‘early starters’. a sound theoretical definition of substance abuse. Although speculative. implementation check. They may have benefited from general life skills training in order to stop nicotine abuse. 2005. enhanced general life skills may be less important for maintaining one’s status as experimental or non-smoker than for giving up already developed heavier smoking behavior. however.

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