Original article
Long-Term Effects of Drug Prevention on Risky Sexual Behavior Among Young Adults

https://doi.org/10.1016/j.jadohealth.2008.12.022Get rights and content

Abstract

Objective

This study assesses the impact of a school-based drug prevention program, called Project ALERT, on risky sexual behavior among 1901 nonmarried, sexually active young adults who participated in one of two program variations as adolescents. It also tests for differences in program effect depending on program duration (middle school only vs. a combined middle school and high school program) and participants’ gender.

Methods

Using survey data from a randomized controlled experiment conducted in 45 midwestern communities (55 schools), we assessed program effects on risky sexual behavior at age 21 with three measures—having unprotected sex because of drug use plus engaging in inconsistent condom use and having sex with multiple partners.

Results

Compared to control, Project ALERT reduced the likelihood of all risky sex outcomes except inconsistent condom use among these sexually active young adults, effects that occurred 5 and 7 years after program exposure. Program effects were partially mediated by reductions in alcohol and drug abuse. There were no significant differences in program effects by gender or by program duration compared to control. Implications for future prevention programs and research are discussed.

Section snippets

Participants

To assess Project ALERT's long-term effects on risky sexual behavior, we used data from 1901 21-year-olds who were sexually active but not married at the time of data administration and had participated in an experimental trial of the two drug prevention programs that took place in 55 schools from 45 South Dakota communities. We focused on unmarried young adults because lack of condom use among married persons frequently reflects a decision to have children and thus is considerably less likely

Results

Risky sexual behavior was common in our sample of unmarried, sexually active young adults. Seventy-one percent of the control group reported inconsistent condom use, 50% had multiple sex partners in the last year, and 32% said they had engaged in unprotected sex because of using alcohol or other drugs.

Table 2 shows program effects on risky sexual behavior for young adults who were exposed to Project ALERT (either the core or the expanded version) compared to the control group. Young adults who

Discussion

These results show that a drug prevention program for adolescents can have long-term effects on risky sexual behavior, reducing its prevalence among young adults 5 to 7 years after exposure to the curriculum. Compared to their counterparts in the control condition, youth exposed to Project ALERT were significantly less likely as young adults to engage in sex with multiple partners and to have unprotected sex because of using alcohol or other drugs. Although the effects are modest, they indicate

Financial Disclosure

The authors have no financial relationships relevant to this article to disclose.

References (40)

  • M.J. Rotheram-Borus et al.

    Prevention of HIV among adolescents

    Prev Sci

    (2000)
  • D.W. Brook et al.

    Drug use and the risk of major depressive disorder, alcohol dependence and substance use disorders

    Arch Gen Psychiatry

    (2002)
  • E.J. D'Amico et al.

    Processes linking adolescent problems to substance-use problems in late young adulthood

    J Stud Alcohol

    (2005)
  • H.R. White et al.

    Problem drinking and intimate partner violence

    J Stud Alcohol

    (2002)
  • G.J. Botvin et al.

    Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population

    J Am Med Assoc

    (1995)
  • P.L. Ellickson et al.

    New inroads in preventing adolescent drug use: results from a large-scale trial of Project ALERT in middle schools

    Am J Public Health

    (2003)
  • R.L. Spoth et al.

    Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline

    J Consult Clin Psychol

    (2001)
  • R. Jessor et al.

    Problem Behavior and Psychosocial Development

    (1977)
  • T.K. MacDonald et al.

    Alcohol and intentions to engage in risky health-related behaviors: experimental evidence for a causal relationship

  • J.S. Tucker et al.

    Temporal associations of cigarette smoking with social influences, academic performance and delinquency: a four-wave longitudinal study from age 13 to 23

    Psychol Addict Behav

    (2008)
  • Cited by (30)

    • The use of the Risky Sex Scale among adolescents receiving treatment services for substance use problems: Factor structure and predictive validity

      2012, Journal of Substance Abuse Treatment
      Citation Excerpt :

      Efforts to prevent young people from using alcohol or other substances or engaging in unplanned, unprotected, or impulsive sexual intercourse remain a daunting challenge. Some evidence supports the efficacy of brief cognitive–behavioral interventions designed to reduce sexual risk behaviors and substance use among multiproblem youth (e.g., Schmiege, Broaddus, Levin, & Bryan, 2009), and school-based primary prevention strategies have demonstrated promising, yet modest, results in reducing risk related to substance use and sexual behaviors over time (e.g., Ellickson, McCaffrey, & Klein, 2009). Achieving significant reductions in targeted risk behavior outcomes via primary and secondary prevention efforts is likely to be even more difficult among youth manifesting co-occurring psychiatric and behavioral disorders.

    • Strategies for characterizing complex phenotypes and environments: General and specific family environmental predictors of young adult tobacco dependence, alcohol use disorder, and co-occurring problems

      2011, Drug and Alcohol Dependence
      Citation Excerpt :

      Results suggest that prevention programs addressing general family functioning can have beneficial effects on several young adult problem behaviors, including tobacco and alcohol use disorders. A growing number of drug prevention and positive youth development programs have found beneficial effects on other problem behaviors, including risky sexual behavior, STI acquisition, teen pregnancy, drug and alcohol use, violent delinquency, and school misbehavior (Ellickson et al., 2009; Gavin et al., 2010; Hawkins et al., 1999). Knowledge about environmental influences that affect multiple problem behaviors, such as general adolescent family environment, aids in the targeting of preventive and treatment interventions.

    • Exploring the protective effects of Judaism on risky behaviors in college students: A pilot study

      2019, Journal of Pediatric Nursing
      Citation Excerpt :

      Ellickson, McCaffrey, and Klein's longitudinal study tracked students through an alcohol and drug prevention program in middle school and high school years and their actual alcohol and drug use in college, as well as sexual behaviors in college (2009). They found that young adults who participated in the Project ALERT drug prevention program were significantly less likely than their peers to report having unprotected sex because of drug use as well as less likely to have multiple partners (Ellickson et al., 2009). In addition to examining middle and high school prevention programs, researchers efforts to examine and reduce risky behaviors in college students focus both on individual level characteristics such as personality, as well as larger system level characteristics including campus culture.

    View all citing articles on Scopus

    Data collection and analysis were supported by the National Institute on Drug Abuse (grant R01DA11246). The BEST Foundation provided funds for teacher materials and training. The Conrad N. Hilton Foundation supported the original program's development, evaluation and revision.

    View full text