Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years
Introduction
Childhood disruptive behavior problems (DBP) are linked to a large number of serious negative outcomes. Besides outcomes more directly linked with the behavior problems, such as delinquency and associated mental health diagnoses such as conduct disorder or antisocial personality disorder, childhood disruptive behavior problems are often associated with early onset substance use problems (Elkins et al., 2007, Ernst et al., 2006, Fothergill and Ensminger, 2006, Hu et al., 2008, Kuperman et al., 2005, Patton et al., 2006). Early onset substance use may imply an increase in risk for future substance use. For instance, early onset smoking has been found to predict progression to daily and dependent patterns of tobacco (Costello et al., 1999, Patton et al., 2006) alcohol (Clark, 2004) and illicit drug use (Korhonen et al., 2008) at later ages.
Various prevention programs, developed to prevent the onset or further development of childhood disruptive problems have been found effective in reducing such problems (for an overview, see Greenberg et al., 2001). Given the link between childhood disruptive behavior problems and substance use, such programs have also been reported to impact substance use. The aim of this study is to explore the impact of the Good Behavior Game (GBG) intervention (Barrish et al., 1969, Dolan et al., 1989) on the development of tobacco and alcohol use in children from age 10 to 13 years. The GBG focuses on preventing early elementary school children's aggressive, opposition and ADHD symptoms. In various randomized controlled trials, the program has been shown effective in reducing such problem behaviors (Ialongo et al., 2001, Ialongo et al., 1999, Kellam et al., 1994, Rebok et al., 1996, van Lier et al., 2004, van Lier et al., 2005). The long-term impact of the program on adolescent and adult psychopathology has also been reported. For instance, reduced levels of anxiety and depressive problems in adolescence, which was explained by the fact that GBG children were less likely than controls to be a victim of aggressive behavior in elementary school, were found (Vuijk et al., 2007). Moreover, reduced levels of antisocial personality disorder (Kellam et al., 2008, Petras et al., 2008) suicide ideation (Wilcox et al., 2008), and mental health service use (Poduska et al., 2008) in young adulthood were reported. In addition to reduced levels of psychopathology, the GBG has been associated with lower risk of initiating tobacco use in late childhood and adolescence (Furr-Holden et al., 2004, Kellam and Anthony, 1998, Storr et al., 2002). This reduced rate of tobacco use persisted into young adulthood in which a significant lower proportion of 6% of GBG children, versus 14% of control children reported regular smoking (defined as ≥10 cigarettes per day; Kellam et al., 2008).
Besides replicating the earlier findings in the Baltimore based GBG trials (Kellam et al., 1991) this study, which used data from the Dutch GBG trial which was initiated by the third author (Crijnen et al., 1997), aims to address the impact of the intervention on tobacco and alcohol use from age 10 years onwards, as various studies have shown that both tobacco and alcohol experimentation start at around this age (Clark, 2004, Monshouwer et al., 2004, Verdurmen et al., 2005). This study thus aims to explore the effect of the program on the onset and course of tobacco and alcohol use from age 10 to 13 years, as distal outcomes of a randomized controlled intervention trial that started at age 7 years.
Section snippets
Participants
Children from 13 elementary schools in Rotterdam and Amsterdam, the Netherlands, were recruited in 1999. Initially, 744 children were eligible for inclusion, and for 666 children informed consent by parents or parent substitutes was obtained (90% participation rate). The mean age of these children was 6.9 years (SD = 0.6) at baseline. For more details of the sample, see van Lier et al. (2004). After baseline assessments in first grade, classes were randomly assigned to the GBG or to a control
Descriptive statistics
The percentages of children reporting having smoked less than one cigarette per week or more was 5.7, 9.5, 13.2, and 15.1 at ages 10–13 years respectively. These percentages are in accordance with the general Dutch population (Monshouwer et al., 2004). For alcohol use, 25.2%, 28.5%, 31.6%, and 36.8% at ages 10–13 years respectively reported having drunk alcohol over the past year. Overall 54% of the children reported having used alcohol over the ages of 10–13 years which is in accordance with
Discussion
This study aimed to add to the initial reports of lower rates of substance use among children who had received the GBG intervention (Furr-Holden et al., 2004, Kellam and Anthony, 1998, Kellam et al., 2008, Storr et al., 2002) by exploring the impact of the program in preventing tobacco and alcohol use in childhood/early adolescence. With respect to tobacco use, we found, in accordance with the prior reports that GBG children had a lower probability of onset of tobacco use from age 10 to 13
Conflict of interest
None of the authors have a conflict of interest to disclose.
Acknowledgements
Role of funding source: Funding for this study was provided by grants 242 and 364 from the Sophia. Foundation for Medical Research and by the Ministry of Justice, the Netherlands; the granting agencies had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors: Author Crijnen initiated the GBG intervention study in the Netherlands and was PI of the project
References (56)
- et al.
Lifetime parental smoking history and cessation and early adolescent smoking behavior
Preventive Medicine
(2004) - et al.
Childhood and adolescent antecedents of drug and alcohol problems: a longitudinal study
Drug and Alcohol Dependence
(2006) - et al.
Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial
Drug and Alcohol Dependence
(2004) - et al.
Developmental trajectories of criteria of nicotine dependence in adolescence
Drug and Alcohol Dependence
(2008) - et al.
Maternal recall of alcohol, cocaine, and marijuana use during pregnancy
Neurotoxicology and Teratology
(1991) - et al.
Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes
Drug and Alcohol Dependence
(2008) - et al.
Role of individual, peer and family factors in the use of cannabis and other illicit drugs: a longitudinal analysis among Finnish adolescent twins
Drug and Alcohol Dependence
(2008) - et al.
Teen smokers reach their mid twenties
Journal of Adolescent Health
(2006) - et al.
Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms
Drug and Alcohol Dependence
(2008) - et al.
Impact of the Good Behavior Game, a universal classroom-based behavior intervention, on young adult service use for problems with emotions, behavior, or drugs or alcohol
Drug and Alcohol Dependence
(2008)
Effect of concentration problems on the malleability of children's aggressive and shy behaviors
Journal of the American Academy of Child and Adolescent Psychiatry
Tobacco smoking trajectory and associated ethnic differences among adolescent smokers seeking cessation treatment
Journal of Adolescent Health
A randomized controlled trial of two primary school intervention strategies to prevent early onset tobacco smoking
Drug and Alcohol Dependence
Testing sex-specific pathways from peer victimization to anxiety and depression in early adolescents through a randomized intervention trial
Journal of Affective Disorders
The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts
Drug and Alcohol Dependence
Manual for the Teacher's Report Form and 1991 Profile
Manual for the ASEBA school-age Forms and Profiles
Good Behavior Game: effects of individual contingencies for group consequences and disruptive behavior in the classroom
Journal of Applied Behavior Analysis
Developmental trajectories of externalizing behaviors in childhood and adolescence
Child Development
Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study
Developmental Psychology
Adolescent substance use outcomes in the Raising Healthy Children project: a two-part latent growth curve analysis
Journal of Consulting and Clinical Psychology
The natural history of adolescent alcohol use disorders
Addiction
Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex
Journal of Clinical Child Psychology
The Good Behavior Game Manual
Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse
Archives of General Psychiatry
Cited by (26)
Drugs, Illicit - Primary Prevention Strategies
2016, International Encyclopedia of Public HealthLiving in an urban environment and non-communicable disease risk in Thailand: Does timing matter?
2015, Health and PlaceCitation Excerpt :For Thailand, targeting children in urban areas may be useful for behavioral and physiological risk factors as early life urban exposure (compared to early life rural exposure) was associated with increase odds of heavy alcohol drinking (OR 2.20, 95% CI 1.34–3.59) and higher systolic blood pressure (2.53 mmHg, 95% CI 0.16–4.90) in adulthood despite adjusting for proportion of urban life years. Trials have shown that childhood interventions can be effective measures to prevent and combat substance use, obesity and elevated blood pressure (Van Lier et al., 2009; Cai et al., 2014; Flynn et al., 2006). To effectively decrease biological risk factors, it may be important to integrate public health interventions in adulthood.
Fostering healthy mental, emotional, and behavioral development in children and youth
2020, Fostering Healthy Mental, Emotional, and Behavioral Development in Children and YouthSame-Sex Friendship, School Gender Composition, and Substance Use: A Social Network Study of 50 European Schools
2018, Substance Use and Misuse