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PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors

  • R. Spoth (a1), C. Redmond (a1), C. Shin (a1), M. T. Greenberg (a2), M. E. Feinberg (a2) and L. Trudeau (a1)...



Substance misuse and associated health-risking behaviors are prevalent in emerging adulthood. There is a knowledge gap concerning the post-high school effects of community-based delivery systems for universal preventive interventions implemented during young adolescence. This study reports effects of the PROSPER delivery system through age 19, 7.5 years past baseline.


A cohort sequential design included 28 public school districts randomly assigned to the PROSPER partnership delivery system or usual-programming conditions. PROSPER community teams implemented a family-focused intervention in 6th grade and a school-based intervention in 7th grade. Outcomes for the age 19, post-high school report included lifetime, current, and frequency of substance misuse, as well as antisocial and health-risking sexual behaviors. Intent-to-treat, multi-level analyses of covariance of point-in-time outcomes were conducted, along with analyses of risk-related moderation of intervention effects.


Results showed emerging adults from PROSPER communities reported significantly lower substance misuse across a range of types of substances, with relative reduction rates of up to 41.0%. No significant findings were observed for associated antisocial and health-risking sexual behavior indices; or for lifetime rates of sexually transmitted infections. Risk-related moderation effects were non-significant, suggesting generally comparable outcomes across higher- and lower-risk subgroups of emerging adults.


The PROSPER delivery system for brief universal preventive interventions has potential for public health impact by reducing long-term substance misuse, with positive results extending beyond high school.


Corresponding author

* Address for correspondence: R. Spoth, Ph.D., Partnerships in Prevention Science Institute, Iowa State University, 2625 N. Loop Drive, Suite 2400, Ames, IA 50010, USA. (Email:


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Anthony, J (2003, August 1). Selected issued pertinent to epidemiology of adolescent drug use and dependence. Invited presentation to the Annenberg Commission on Adolescent Substance Abuse meeting. Philadelphia, PA.
Blanchard, KA, Morgenstern, J, Morgan, TJ, Lobouvie, EW, Bux, DA (2013). Assessing consequences of substance use: psychometric properties of the inventory of drug use consequences. Psychology of Addictive Behaviors 17, 328331.
Botvin, GJ (1996). Life Skills Training: Promoting Health and Personal Devlopment. Princeton, NJ: Princeton Health Press.
Botvin, GJ (2000). Life Skills Training. Princeton Health Press: Princeton, NJ.
Botvin, GJ, Griffin, KW (2014 a). Life skills training: preventing substance misuse by enhancing individual and social competence. New Directions for Youth Development 141, 5765.
Botvin, GJ, Griffin, KW (2014 b). Toward the development of preventive interventions to reduce HRSB, HIV/AIDS, and multiple problem behaviors. Prevention Science 15(S1), S81S83.
Chen, C-Y, Dormitzer, CM, Gutierrez, U, Vittetoe, K, Gonzalez, GB, Anthony, JC (2004). The adolescent behavioral repertoire as a context for drug exposure: behavioral autarcesis at play. Addiction 99, 897906.
Coffey, C, Patton, G (2016). Cannabis use in adolescence and young adulthood: a review of findings from the Victorian Adolescent Health Cohort Study. Canadian Journal of Psychiatry-Revue 61, 318327.
Crowley, DM, Jones, DE, Greenberg, MT, Feinberg, ME, Spoth, RL (2012). Resource consumption of a dissemination model for prevention programs: The PROSPER delivery system. Journal of Adolescent Health 50, 256263.
Degenhardt, L, Chiu, W-T, Sampson, N, Kessler, RC, Anthony, JC, Angermeyer, M, Bruffaerts, R, de Girolamo, G, Gureje, O, Huang, Y, Karam, A, Kostyuchenko, S, Lepine, JP, Mora, ME, Neumark, Y, Ormel, JH, Pinto-Meza, A, Posada-Villa, J, Stein, DJ, Takeshima, T, Wells, JE (2008) Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Medicine 5, e141.
Elliott, DS, Huizinga, D, Ageton, SS (1985). Explaining Delinquency and Drug use. Beverly Hills: Sage.
Fergusson, DM, Boden, JM (2008). Cannabis use and later life outcomes. Addiction 103, 969976.
Fischer, JA, Clavarino, AM, Plotnikova, M, Najman, JM (2015). Cannabis use and quality of life of adolescents and young adults: findings from an Australian birth cohort. Journal of Psychoactive Drugs 47, 107116.
Grant, BF, Dawson, DA (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the national longitudinal alcohol epidemiologic survey. Journal of Substance Abuse 10, 163173.
Grant, BF, Stinson, FS, Harford, TC (2001). Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. Journal of Substance Abuse 13, 493504.
Grumbach, K, Mold, JW (2009). A health care cooperative extension service: transforming primary care and community health. Journal of the American Medical Association 301, 25892591.
Hansen, WB (1996). Pilot test results comparing the All Stars program with seventh grade D.A.R.E. program integrity and mediating variable analysis. Substance Use and Misuse 31, 13591377.
Hawkins, JD, Catalano, RF Jr., and Associates (1992). Communities that Care: Action for Drug Abuse Prevention, 1st edn. Jossey-Bass: San Francisco.
Hawkins, JD, Catalano, RF, Arthur, MW, Egan, E, Brown, EC, Abbott, RD, Murray, DM (2008 a). Testing communities that care: the rationale, design and behavioral baseline equivalence of the community youth development study. Prevention Science 9, 178190.
Hawkins, JD, Kosterman, R, Catalano, RF, Hill, KG, Abbott, RD (2005). Promoting positive adult functioning through social development intervention in childhood: long term effects from the Seattle Social Development Project. Archives of Pediatrics and Adolescent Medicine 159, 2531.
Hawkins, JD, Kosterman, R, Catalano, RF, Hill, KG, Abbott, RD (2008 b). Effects of social development intervention in childhood fifteen years later. Archives of Pediatrics and Adolescent Medicine 162, 11331141.
Hawkins, JD, Oesterle, S, Brown, EC, Monahan, KC, Abbott, RD, Arthur, MW (2012). Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial. Archives of Pediatrics & Adolescent Medicine 166, 141148.
Johnston, LD, O'Malley, PM, Bachman, JG, Schulenberg, JE, Miech, RA (2015 a). Monitoring the Future National Survey Results on Drug use, 1975–2104: Volume 2, College Students and Adults ages 19–55 . Institute for Social Research, The University of Michigan: Ann Arbor.
Johnston, LD, O'Malley, PM, Bachman, JG, Schulenberg, JE, Patrick, ME, Miech, RA (2015 b). HIV/AIDS: Risk & Protective Behaviors among Adults Ages 21 to 40 in the U.S., 2004–2014 . Institute for Social Research, The University of Michigan: Ann Arbor.
Kellam, SG, Wang, W, Mackenzie, AC, Brown, CH, Ompad, DC, Or, F, Ialongo, NS, Poduska, JM, Windham, A (2014). The impact of the Good Behavior Game, a universal classroom-based preventive intervention in first and second grades, on high-risk sexual behaviors and drug abuse and dependence disorders into young adulthood. Prevention Science 15(S1), S6S18.
Loeber, R, Farrington, DP, Stouthamer-Loeber, M, White, HR (2008). Violence and Serious Theft: Development and Prediction from Childhood to Adulthood. Lawrence Erlbaum: Mahwah, NJ.
Molgaard, VM, Kumpfer, KK, Fleming, E (1997). Strengthening Families Program for Parents and Youth 10-14: A Video-Based Curriculum. Institute for Social and Behavioral Research: Ames, IA.
Murray, DM, O'Connell, CM, Schmid, LA, Perry, CI (1987). The validity of smoking self-reports by adolescents: a reexamination of the bogus pipeline procedure. Addictive Behavior 12, 715.
Murray, J, Farrington, DP (2010). Risk factors for conduct disorder and delinquency: key findings from longitudinal studies. Canadian Journal of Psychiatry 55, 633642.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Center for Disease Control and Prevention. ( Accessed 24 December 2016.
National Institute on Drug Abuse (February, 2016 a). Abuse of prescription (Rx) drugs affects young adults most ( Accessed 24 February 2016.
National Institute on Drug Abuse (February, 2016 b). Trends & Statistics. ( Accessed 24 February 2016.
National Research Council and Institute of Medicine (2009). Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities (ed. O'Connell, M. E., Boat, T. and Warner, K. E.). Committee on the prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults; Research Advances and Promising Interventions; Board on Children, Youth and Families, Division of Behavioral and Social Sciences and Education. The National Academies Press: Washington, DC. ( Accessed 5 May 2016.
Oesterle, S, Hawkins, JD, Kuklinski, MR, Fagan, AA, Fleming, C, Rhew, IC, Brown, EC Abbott, RD, Catalano, RF (2015). Effects of Communities That Care on males’ and females’ drug use and delinquency 9 years after baseline in a community-randomized trial. American Journal of Community Psychology 56, 217228.
Offord, DR, Bennett, KJ (2002). Prevention. In Child and Adolescent Psychiatry, 4th edn. (ed. Rutter, M. and Taylor, E.), pp. 881889. Blackwell Scientific: Oxford, England.
Osgood, DW, Feinberg, ME, Gest, SD, Moody, J, Ragan, DT, Spoth, R, Greenberg, M, Redmond, C (2013). Effects of PROSPER on the influence potential of prosocial versus antisocial youth in adolescent friendship networks. Journal of Adolescent Health 53, 174179.
Perrino, T, Pantin, H, Huang, S, Brincks, A, Brown, CH, Prado, G (2016). Reducing the risk of internalizing symptoms among high-risk Hispanic youth through a family intervention: a randomized controlled trial. Family Process 55, 91106.
Piquero, AF, Farrington, D, Blumstein, A (2007). Key Issues in Criminal Career Research. Cambridge University Press: New York.
Poduska, JM, Kellam, SG, Wang, W, Brown, CH, Ialongo, NS, Toyinbo, P (2008). 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 95, S29S44.
Redmond, C, Spoth, RL, Shin, C, Schainker, L, Greenberg, M, Feinberg, M (2009). Long-term protective factor outcomes of evidence-based interventions implemented by community teams through a community-university partnership. Journal of Primary Prevention 30, 513530.
Rehm, J (2011). The risks associated with alcohol use and alcoholism. Alcohol Research & Health 34, 135143.
Riggs, N, Chou, C, Pentz, M (2009) Preventing growth in amphetamine use: long term effects of the Midwestern Prevention Project (MPP) from early adolescence to early adulthood. Addiction 104, 16911699.
Rosenstock, IM, Strecher, VJ, Becker, MH (1988). Social learning theory and the Health Belief Model. Health Education Quarterly 88, 175183.
Sameroff, AJ, Peck, SC, Eccles, JS (2004). Changing econolgical determinants of conduct problems from early adolescence to early adulthood. Development and Psychopathology 16, 873896.
Smith, GT, McCarthy, DM, Goldman, MS (1995). Self-reported drinking and alcohol-related problems among early adolescents: dimensionality and validity over 24 months. Journal of Studies on Alcohol and Drugs 36, 383394.
Spoth, R, Clair, S, Trudeau, L (2014 a). Universal family-focused intervention with young adolescents: effects on health-risking sexual behaviors and STDs among young adults. Prevention Science 15, S47S58.
Spoth, R, Clair, S, Greenberg, M, Redmond, C, Shin, C (2007 a). Toward dissemination of evidence-based family interventions: maintenance of community-based partnership recruitment results and associated factors. Journal of Family Psychology 21, 137146.
Spoth, R, Greenberg, M (2011). Impact challenges in community science-with-practice: lessons from PROSPER on transformative practitioner-scientist partnerships and prevention infrastructure development. American Journal of Community Psychology 48, 106119.
Spoth, R, Greenberg, M, Bierman, K, Redmond, C (2004). PROSPER community-university partnership model for public education systems: capacity-building for evidence-based, competence-building prevention. Prevention Science 5, 3139.
Spoth, R, Guyll, M, Lillehoj, CJ, Redmond, C, Greenberg, M (2007 b). PROSPER study of evidence-based intervention implementation quality by community-university partnerships. Journal of Community Psychology 35, 981999.
Spoth, R, Guyll, M, Shin, C (2009 a). Universal intervention as a protective shield against exposure to substance use: long-term outcomes and public health significance. American Journal of Public Health 99, 20262033.
Spoth, R, Redmond, C, Clair, S, Shin, C, Greenberg, M, Feinberg, M (2011). Preventing substance misuse through community-university partnerships: randomized controlled trial outcomes 4.5 years past baseline. American Journal of Preventive Medicine 40, 440447.
Spoth, R, Redmond, C, Shin, C (2001). Randomized trial of brief family interventions for general populations: adolescent substance use outcomes four years following baseline. Journal of Consulting and Clinical Psychology 69, 627642.
Spoth, R, Redmond, C, Shin, C, Greenberg, M, Clair, S, Feinberg, M (2007 c). Substance use outcomes at 18 months past baseline: the PROSPER community-university partnership trial. American Journal of Preventive Medicine 32, 395402.
Spoth, R, Redmond, C, Shin, C, Greenberg, M, Feinberg, M, Schainker, L (2013 a). PROSPER community-university partnership delivery system effects on substance misuse through 6½ years past baseline from a cluster randomized controlled intervention trial. Preventive Medicine 56, 190196.
Spoth, R, Trudeau, L, Guyll, M, Shin, C, Redmond, C (2009 b). Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology 77, 620632.
Spoth, R, Trudeau, L, Redmond, C, Shin, C (2014 b). Replication RCT of early universal prevention effects on young adult substance misuse. Journal of Consulting and Clinical Psychology 82, 949963.
Spoth, R, Trudeau, L, Redmond, C, Shin, C (2016). Replicating and extending a model of effects of universal preventive intervention during early adolescence on young adult substance misuse. Journal of Consulting and Clinical Psychology 84, 913921.
Spoth, R, Trudeau, L, Shin, C, Ralston, E, Redmond, C, Greenberg, M, Feinberg, M (2013 b). Longitudinal effects of universal preventive intervention on prescription drug misuse: three randomized controlled trials with late adolescents and young adults. American Journal of Public Health 103, 665672.
Spoth, RL, Trudeau, LS, Redmond, C, Shin, C, Greenberg, MT, Feinberg, ME, Hyun, GH (2015). PROSPER partnership delivery system: effects on conduct problem behavior outcomes through 6.5 years past baseline. Journal of Adolescence 45, 4455.
Stone, AL, Becker, LG, Huber, AM, Catalano, RF (2012). Review of risk and protective factors of substance use and problem use in emerging adulthood. Addictive Behaviors 37, 747775.
Sussman, S (2013). A lifespan developmental-stage approach to tobacco and other drug abuse prevention. ISRN Addiction, vol. 2013, Article ID 745783. ( Accessed 5 May 2016.
Swendsen, J, Conway, KP, Degenhardt, L, Glantz, M, Jin, R, Merikangas, KR, Sampson, N, Kessler, RC (2010). Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 105, 11171128.
Trudeau, L, Spoth, R, Mason, WA, Randall, GK, Redmond, C, Schainker, L (2016). Effects of an adolescent universal substance misuse preventive intervention on young adult depression symptoms: mediational modeling. Journal of Abnormal Child Psychology 44, 257268.
Trudeau, L, Spoth, R, Randall, K, Mason, WA, Shin, C (2012). Internalizing symptoms: effects of a preventive intervention on developmental pathways from early adolescence to young adulthood. Journal of Youth & Adolescence 41, 788801.
US Department of Justice, Drug Enforcement Administration (May, 2014). The dangers and consequences of marijuana abuse. ( Accessed 24 February 2016.
US Department of Health and Human Services (HHS), Office of the Surgeon General (2016). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. HHS: Washington, DC.
Van Ryzin, MJ, Johnson, AB, Leve, LD, Kim, HK (2011). The number of sexual partners and health-risking sexual behavior: prediction from high school entry to high school exit. Archives of Sexual Behavior, 40, 939949.
Volkow, ND, Compton, WM, Weiss, SRB (2014). Adverse health effects of marijuana use REPLY. New England Journal of Medicine 371, 879879.
Welsh, J, Chilenski, SM, Johnson, L, Greenberg, MT, Spoth, RL (2016). Pathways to sustainability: 8-year outcomes from the PROSPER project. Journal of Primary Prevention 37, 263286.


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PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors

  • R. Spoth (a1), C. Redmond (a1), C. Shin (a1), M. T. Greenberg (a2), M. E. Feinberg (a2) and L. Trudeau (a1)...


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