Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations and
Federal Efforts to Identify Effective Programs (15-JAN-03,	 
GAO-03-172R).							 
                                                                 
This report contains information on (1) the results of		 
evaluations on the long-term effectiveness of the Drug Abuse	 
Resistance Education program (DARE) elementary school curriculum 
in preventing illicit drug use among children and (2) federal	 
efforts to identify programs that are effective in preventing	 
illicit drug use among children.				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-03-172R					        
    ACCNO:   A05881						        
  TITLE:     Youth Illicit Drug Use Prevention: DARE Long-Term	      
Evaluations and Federal Efforts to Identify Effective Programs	 
     DATE:   01/15/2003 
  SUBJECT:   Controlled substances				 
	     Drug abuse 					 
	     Education program evaluation			 
	     Program evaluation 				 
	     Schools						 
	     Students						 
	     Youth						 
	     Drugs						 
	     Drug Abuse Resistance Education Program		 

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GAO-03-172R

GAO- 03- 172R Youth Illicit Drug Use Prevention United States General
Accounting Office

Washington, DC 20548

January 15, 2003 The Honorable Richard J. Durbin United States Senate

Subject: Youth Illicit Drug Use Prevention: DARE Long- Term Evaluations
and Federal Efforts to Identify Effective Programs

Dear Senator Durbin: The use of illicit drugs, particularly marijuana, is
a problem among our nation*s youth. The adverse effects of illicit drug
use play a role in school failure, violence, and antisocial and self-
destructive behavior. A recent national survey 1 showed that for 1996
through 2002, more than 30 percent of tenth and twelfth grade students
reported using marijuana in the past year. Further, about 20 percent of
high school seniors reported using marijuana within the past 30 days. In
fiscal year 2000, the federal government spent over $2.1 billion on
illicit drug use prevention activities for youth, according to the Office
of National Drug Control Policy (ONDCP).

Many programs are designed to help prevent and reduce illicit drug use
among youth. Often, these programs also address the use of other
substances, such as alcohol and tobacco. Youth drug abuse prevention
programs are implemented in school, family, and community settings.
School- based prevention programs are the most prevalent because schools
provide easy access to children and adolescents. The most widely used
school- based substance abuse prevention program in the United States is
the Drug Abuse Resistance Education (DARE) program, 2 which is funded by a
variety of sources, including private, federal, and other public entities.
DARE*s primary mission is to provide children with the information and
skills they need to live drug- and violence- free lives through programs
at the elementary school, middle school, and high school levels. The DARE
program is usually introduced to children in the fifth or sixth grade.
According to research literature, concerns have been raised about the
effectiveness of the DARE fifth and sixth grade curriculum in preventing
illicit drug use among youth. As agreed with your staff, this report
contains information you requested on (1) the results of evaluations on
the long- term effectiveness of the

1 Lloyd D. Johnston, Patrick M. O*Malley, and Jerald G. Bachman,
Monitoring the Future National Results on Adolescent Drug Use: Overview of
Key Findings, 2001, NIH Publication No. 02- 5105 (Bethesda, Md.: National
Institute on Drug Abuse, 2002).

2 The DARE program is administered by DARE America* a nonprofit
foundation.

GAO- 03- 172R Youth Illicit Drug Use Prevention 2 DARE elementary school
curriculum in preventing illicit drug use among children

and (2) federal efforts to identify programs that are effective in
preventing illicit drug use among children.

To identify evaluations on the effectiveness of DARE at preventing illicit
drug use among children, we searched social science, business, and
education databases, which included the Department of Health and Human
Services* (HHS) National Institutes of Health*s (NIH) National Library of
Medicine, for evaluations of DARE published in professional journals. We
identified articles published in the 1990s on six evaluations of the DARE
elementary school curriculum that included illicit drug use

as an outcome measure and that also met key methodological criteria for
our review, such as a long- term evaluation design and the use of
intervention and control groups for comparisons. The six long- term
evaluations that we discuss in this report were conducted at different
times up to 10 years after student participants were initially surveyed.
The six evaluations are based on three separate studies in three states.
We reviewed each of the six evaluations and summarized the results of our
review. We also held discussions with the researchers who conducted the
evaluations. We did not independently validate the research designs or
verify the results of evaluations on the effectiveness of the DARE
program. (Enclosure I contains citations for the articles on evaluations
of the DARE elementary school curriculum that we reviewed and enclosure II
describes the methodology we used to select the evaluations).

To determine federal efforts to identify programs that are effective in
preventing youth illicit drug use, we interviewed federal officials and
reviewed documentation on efforts by HHS and the Department of Education
(Education) to recognize programs that demonstrate success in reducing
illicit drug use among children and adolescents. We did not independently
verify the results of prevention programs recognized by the federal
agencies. We conducted our work from January through December 2002 in
accordance with generally accepted government auditing standards.

In brief, the six long- term evaluations of the DARE elementary school
curriculum that we reviewed found no significant differences in illicit
drug use between students who received DARE in the fifth or sixth grade
(the intervention group) and students who did not (the control group).
Three of the evaluations reported that the control groups of students were
provided other drug use prevention education. All of the evaluations
suggested that DARE had no statistically significant long- term effect on
preventing youth illicit drug use. Of the six evaluations we reviewed,
five also reported on students* attitudes toward illicit drug use and
resistance to peer pressure and found no significant differences between
the intervention and control groups over the long term. Two of these
evaluations found that the DARE students showed stronger negative
attitudes about illicit drug use and improved social skills about illicit
drug use about 1 year after receiving the program. These positive effects
diminished over

time.

GAO- 03- 172R Youth Illicit Drug Use Prevention 3 HHS and Education have
identified several programs that show evidence of

effectiveness in preventing youth substance abuse and promoted their use
in schools and communities. The Substance Abuse and Mental Health Services
Administration (SAMHSA) within HHS and Education use expert panels to
review program information that the programs* developers or others submit
and rank the programs on several criteria, such as the scientific rigor of
their evaluations and the overall usefulness of their findings for
preventing substance abuse. Only those programs that produce a consistent
pattern of positive results that have been verified scientifically are
recognized as effective, according to SAMHSA. HHS has also identified
other programs supported by HHS- funded research, that show evidence of
effectiveness in preventing substance abuse among youth. Specifically,
within NIH, officials from the National Institute on Drug Abuse (NIDA) and
scientists who conduct NIDA- funded research identified effective drug use
prevention programs that were scientifically evaluated and have
demonstrated positive results over time. HHS and Education disseminate
descriptions of effective programs to practitioners, schools, and the
general public. In addition to the effective programs, each of the
agencies also has identified programs that, based on initial results, show
promise in preventing substance abuse among youth. However, the outcomes
of these programs either have not yet been verified scientifically or have
not consistently demonstrated positive results in preventing or reducing
substance use, according to the agencies. The agencies also disseminate
lists of these programs.

In response to HHS*s comments on a draft of this report, we revised the
report*s title to better reflect the scope of our work. HHS and Education
provided additional information about their efforts to identify effective
substance abuse prevention programs that we incorporated as appropriate.

Background

A major goal of drug abuse prevention programs is to prevent the use of
illicit and nonprescription legal drugs and other substances, such as
alcohol and tobacco. Two drug prevention approaches show promise in
reducing drug use and strengthening individuals* ability to resist illicit
drugs. The psychosocial approach emphasizes drug resistance skills,
generic problem solving/ decision- making training, and modification of
attitudes and normative beliefs that encourage drug use. The comprehensive
approach to prevention focuses on the setting in which programs are
implemented, which involves the use of schools, families, and the
community, working together. 3 Drug abuse prevention programs are
categorized by three different audiences for

which they are designed. Generally, the programs are designed for (1) the
general population, (2) individuals or subgroups that are at risk for drug
abuse because of certain conditions such as being children of drug users,
and (3) those individuals who are already experimenting with drugs or who
exhibit other risk- related behavior.

3 U. S. General Accounting Office, Drug Control: Observations on Elements
of the Federal Drug Control Strategy, GAO/ GGD- 97- 42 (Washington, D. C.:
Mar. 14, 1997).

GAO- 03- 172R Youth Illicit Drug Use Prevention 4 Established in 1983,
DARE operates in about 80 percent of all school districts across

the United States and in numerous foreign countries. 4 In addition to the
DARE elementary school curriculum, the DARE program also includes middle
school and high school curricula that reinforce lessons taught at the
elementary school level.

The elementary school curriculum consists of 17 lessons, taught by DARE-
trained uniformed police officers, that focus on providing students with
decision- making skills, showing them how to resist peer pressure, and
teaching alternatives to illicit drug use and violence. The majority of
studies evaluating DARE focus on the

elementary school curriculum in effect before 1994. According to
researchers, in 1994, modest changes were made to the elementary school
curriculum, including revisions to the content and sequencing of the DARE
lessons. 5 In fiscal year 2000, the Department of Justice*s Bureau of
Justice Assistance, which

supports various substance abuse prevention programs for youth, provided
about $2 million for DARE regional training centers to support the
training of new police officers that help deliver the DARE program
lessons. Also, in fiscal year 2000, Education provided states about $439
million in grants for schools and communities

under the Safe and Drug- Free Schools and Communities Act (SDFSCA) of
1994. 6 Some of the SDFSCA grant funds could have been used to support
DARE. However, Education has no estimate of the amount of SDFSCA fiscal
year 2000 state grant funds that were used for DARE.

4 Data obtained from the DARE America Web site at http:// www. DARE. com
(as of July 30, 2002) and information released by the University of Akron
Institute for Health and Social Policy. 5 The DARE middle and high school
program curricula are being revised and will be evaluated, under a Robert
Wood Johnson Foundation research grant, by researchers from the University
of Akron in

cooperation with DARE America Foundation officials. According to the Akron
researchers who are conducting the study, the revised middle school
curriculum places more emphasis on and devotes more time to three
prevention program areas (1) normative beliefs about drug use, (2)
consequences of drug and alcohol use, and (3) drug use resistance skills.
The curriculum also includes more interaction among students through small
group discussions and role- play. The study is experimenting

with using police officers as course facilitators rather than as
instructors. The purpose of these changes is to improve the effectiveness
of DARE. Revisions to the high school curriculum were not complete at the
time of our review. The researchers plan to complete their evaluation of
the revised DARE curricula in 2006.

6 Pub. L. No. 103- 382, S:101, 108 STAT. 3518, 3672- 3690 (classified to
20 U. S. C. S:S: 7101- 7144 (2000)).

GAO- 03- 172R Youth Illicit Drug Use Prevention 5

Evaluations of the DARE Elementary School Curriculum Show No Significant
Differences in Drug Use Between DARE and Non- DARE Students

The six evaluations that we reviewed of the long- term effectiveness of
the DARE elementary school curriculum found no statistically significant
differences in illicit drug use between students who received DARE lessons
in the fifth or sixth grade, referred to as intervention groups, and
students who did not* the control groups. 7 Three of the six evaluations
reported that the control groups of students that did not

receive DARE were provided other drug use prevention education. The six
evaluations we reviewed were based on three separate studies in three
states* Colorado, Kentucky, and Illinois. Table 1 summarizes the
information on the six evaluations that we reviewed. Each of the six
evaluations, conducted at intervals ranging from 2 to 10 years after the
fifth or sixth grade students were initially surveyed, suggested that DARE
had no statistically significant long- term effect on preventing illicit
drug use. Five evaluations also reported on students* attitudes about
illicit drug use and other nonbehavioral measures and found no significant
differences between the DARE and non- DARE students over the long term.

Table 1: Long- Term Evaluations on the Effectiveness of the DARE
Elementary School Curriculum in Preventing Illicit Drug Use a Evaluation/
date of

article Sample description Measures Prevention outcome Kentucky Studies

1. Sensation Seeking as a Potential Mediating Variable for SchoolBased
Prevention Intervention: A TwoYear Follow- Up of DARE, 1991

Location: Lexington, Kentucky

The initial sample included a total of 2,071 sixth graders from 31
elementary schools. Twenty- three schools and 1,550 students were assigned
to receive the DARE

intervention and 8 schools and 521 students were designated control groups
that received drug use prevention education provided under a standard

health curriculum. The sample size at the 2- year follow- up, when
students were in the eighth grade, was 1,207, or about 78 percent of the
baseline for the intervention group and 413,or about 79 percent for the
control group. Past year use of

marijuana. No statistically significant

differences were observed between the intervention and control schools on
students* past year marijuana use 2 years after the intervention.

7 The studies surveyed individuals about their lifetime, past year, and
past month marijuana, alcohol, or cigarette use. They were also asked
about their attitudes towards drugs, peer pressure resistance, and self-
esteem.

GAO- 03- 172R Youth Illicit Drug Use Prevention 6

Evaluation/ date of article Sample description Measures Prevention outcome

2. The Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-
Year FollowUp, 1996

Location: Lexington, Kentucky

In the 5- year follow- up to the 1991 study, students were surveyed each
year during the sixth through tenth grades.

The sample size at the 5- year follow- up, when students were in the tenth
grade, was 858, or about 55 percent of the

baseline for the intervention group and 285, or about 55 percent, for the
control group.

Past year use of illicit drugs. Nonbehavioral measures included attitudes
towards drugs, peer pressure resistance, and perceived peer substance use.
No statistically significant

differences were observed between intervention and control groups on
marijuana use 1 year after the intervention and at the 5- year follow- up.
Although, significant positive DARE effects were observed during the
seventh grade (about

1 year after the intervention) for measures of students* attitudes towards
drugs, capability to resist peer pressure, and perceived peer drug use,
these positive effects diminished over time and were not significant at
the 5- year follow- up. 3. Project DARE: No Effects at 10- Year Follow-
Up, 1999 Location:

Lexington, Kentucky Follow- up to the 1991 and

1996 studies. The final sample consisted of 1,002 young adults between the
ages of 19 and 21, who were in the original sixth grade sample of both
intervention and control groups. Seventy- six percent of the participants
had received

DARE lessons. Lifetime, past year, and past month use

of marijuana. Nonbehavioral measures included peer pressure resistance and
selfesteem. No statistically significant

differences were observed between the intervention and control groups for
illicit drug use, peer pressure resistance,

and self- esteem at the 10- year follow- up.

Colorado Studies

4. Three- Year Follow- up of Drug Abuse Resistance Education (DARE), 1996

Location: Colorado Springs, Colorado The initial sample included 38
elementary schools in

Colorado Springs, Colorado* 21 schools received the DARE intervention and
17 control

group schools did not. The 3- year follow- up sample consisted of 940
ninth grade survey respondents from the initial sample of elementary
school students. Excluding invalid responses, the final

sample consisted of 849 ninth grade students (497 students in the
intervention group and 352 in the control group). Use of illicit drugs

and the delay of experimentation with illicit drugs. Nonbehavioral
measures included self- esteem and resistance to peer pressure.

No statistically significant differences were found between the
intervention and control groups with regard to illicit drug use, delay of
experimentation with illicit drugs, self- esteem, or

resistance to peer pressure after 3 years.

5. Long- Term Impact of Drug Abuse Resistance Education (DARE): Results of
a 6- Year Follow- Up, 1997 Location:

Colorado Springs, Colorado Follow- up to the 1996 study.

The 6- year follow- up sample consisted of 676 twelfth grade survey
respondents from the initial sample of elementary school students.
Excluding invalid responses, the final

sample consisted of 620 twelfth grade students (356 students in the
intervention group and 264 students in the control group). Use of illicit
drugs

and the delay of experimentation with illicit drugs. Nonbehavioral
measures included self- esteem and attitudes toward drug use.

No statistically significant differences were found between the
intervention and control groups regarding the use of marijuana and the
delay of experimentation with illicit drugs, self esteem, and attitudes
toward drug use, at the 6- year follow- up.

GAO- 03- 172R Youth Illicit Drug Use Prevention 7

Evaluation/ date of article Sample description Measures Prevention outcome
Illinois Study 6. Assessing the Effects

of School- Based Drug Education: A Six- Year MultiLevel Analysis of
Project DARE, 1998

Location: Chicago, Illinois

A total of 1,798 students from 36 urban, suburban, and rural schools in
Illinois were surveyed each year from the sixth through twelfth grade.
Eighteen elementary schools received the DARE intervention and the 18
elementary schools in the control group did not.

The study measured past 30- day and any use of illicit drugs.
Nonbehavioral measures included attitudes towards drugs, peer pressure
resistance, and selfesteem. No statistically significant

differences were observed between the intervention and control groups with
regard to recent or any use of illicit drugs 1 year after the intervention
and

at the 6- year follow- up. The DARE students were more likely to report
stronger negative attitudes about drug use and improved social resistance
skills immediately after the intervention. However, these positive effects
eroded over time.

a These evaluations also measured the effects of DARE on other behavioral
outcomes such as preventing alcohol and tobacco use.

Source: GAO analysis of six evaluations. Two of the six evaluations
(Lexington, Kentucky, 1996 and Chicago, Illinois, 1998) also reported
information on the short- term effects of DARE. These evaluations found no
significant differences in illicit drug use between the intervention and
control groups within a year after completing the DARE lessons. They also
found that DARE students showed stronger negative attitudes about illicit
drug use and improved peer pressure resistance skills and self- esteem
about illicit drug use about 1 year after the intervention. These positive
effects diminished over time.

Federal Agencies* Efforts to Identify Effective Substance Abuse Prevention
Programs

HHS and Education have identified several programs that show evidence of
effectiveness in preventing or reducing the use of illicit drugs and other
substances, such as alcohol and tobacco, among youth. Each agency
identifies effective programs to recognize their success and promote their
use in schools and communities in the United States. HHS and Education
selected many of the effective prevention programs from among those
submitted by the program developers for review and recognition. According
to HHS and Education officials, the programs they selected through an
expert panel process do not include all programs that could potentially be
effective in preventing substance use among youth. Other effective
programs that HHS identified were selected from those whose development
was supported by HHSfunded research.

GAO- 03- 172R Youth Illicit Drug Use Prevention 8 Specifically, within
HHS, SAMHSA identified substance abuse prevention programs

that based on rigorous evaluation, consistently demonstrate positive
results. SAMHSA created the National Registry of Effective Prevention
Programs (NREPP) 8 to recognize many of these programs and help
policymakers and those working in the

field of substance abuse prevention learn more about science- based
prevention programs. Under the NREPP process, teams of scientists who are
expert in prevention research, review and assess information, such as
evaluation methodologies and evaluation results, on prevention programs.
Many of these programs are selected and submitted by the program
developers. The programs are scored using established criteria and ranked
on the scientific rigor of their evaluation and the overall usefulness of
their findings for preventing substance abuse. The criteria that programs
are evaluated on include factors such as design and implementation, data
collection and analysis, program outcomes, and replication and
dissemination capabilities. Only those programs that positively affect the
majority of the intended populations and produce a consistent pattern of
results are recognized as effective. HHS officials stated that the process
of having program developers select their programs for review tends to
encourage the submission of those programs that can be tested through
conventional, low- cost evaluation procedures but discourages the
submission of potentially effective interventions that result in broad
changes in school or community activities. As of October 2002, SAMHSA had
selected 41 effective programs from among 718 submissions. SAMHSA promotes
the use of these programs through dissemination, training, and
collaboration activities with other substance abuse prevention partners.
Table 2 contains examples of effective substance abuse prevention programs
recently identified. 8 NREPP incorporates the work of SAMHSA, Education,
NIH, and the Department of Justice, as well as the work of foundations and
other entities.

GAO- 03- 172R Youth Illicit Drug Use Prevention 9

Table 2: Examples of Effective Substance Abuse Prevention Programs HHS and
Education Identified 1. Life Skills Training Program (LST) LST is a
school- based substance abuse prevention program for children ages 1014.
LST is designed to address a wide range of risk and protective factors a
to

reduce illicit drug use by teaching general personal and social skills in
combination with drug resistance skills and normative education. 2 Child
Development Project (CDP) CDP is a school improvement initiative designed
to reduce the risk of alcohol and

illicit drug use and bolster protective factors among elementary school
children. 3. Project ALERT Project ALERT is a program that is provided to
middle school students. Its course

content focuses on establishing no- drug use norms, developing reasons not
to use illicit drugs, and resisting pro- drug pressures. 4. Strengthening
Families Program (SFP) SFP targets families that are at risk for drug
abuse. The multicomponent, familyfocused program provides prevention
programming for substance- abusing families with 6- to 10- year- old
children.

5. Project STAR, known as the Midwestern Prevention Project (MPP)

MPP is a comprehensive, community- based drug abuse prevention program
that uses school, mass media, parent education, community organization,
and health policy programming to prevent and reduce alcohol, tobacco, and
illicit drug abuse

among adolescents. Note: SAMHSA identified all five of the substance abuse
prevention programs in 1999. In 2001, Education identified all of the
programs except CDP and MPP. In 2002, NIDA identified all the programs
except MPP. a According to NIDA*s research- based guide, risk and
protective factors encompass psychological, behavioral,

family, and social characteristics. Risk factors, which include
ineffective parenting, failure in school performance, affiliations with
deviant peers, and aggressive behavior in the classroom, are associated
with greater potential for drug use. Protective factors, such as strong
family and community bonds, success in school performance, and adoption of
normative beliefs about drug use, reduce the potential for drug use.

Source: HHS and Education documents.

Also, within HHS, NIDA officials and scientists who conduct NIDA- funded
research, identify effective drug abuse prevention programs that have been
studied over time and achieved positive results. The development of these
programs is supported by NIDA. NIDA publishes a guide on preventing drug
use among children and adolescents that describes research- based concepts
for developing and implementing effective drug abuse prevention programs
and several research- based programs that NIDA and the scientists
identify. 9 Education established the Safe, Disciplined, and Drug- Free
Schools Expert Panel to

help identify programs effective in preventing and reducing substance
abuse and violent behavior among students. The panel consisted of teams of
experts in research, evaluation, and prevention programming. The expert
panel used a multilevel review process to identify effective programs
based on information submitted by entities or individuals applying for
program recognition. The programs

submitted for review must show evidence of effectiveness in reducing
substance use, violent behavior, or other conduct problems for a year or
longer based on at least one methodologically sound evaluation. Also, the
programs must obtain a certain rating based on other criteria, such as
whether the program*s content is appropriate for its target population and
whether the program provides the necessary information and guidance for
replication by others. Education officials stated that the programs
identified as effective and designated *exemplary,* showed statistically
significant

differences in outcomes that were sustained for at least 1 year beyond the
baseline. 9 NIDA is having the 2003 edition of its guide reviewed before
publication.

GAO- 03- 172R Youth Illicit Drug Use Prevention 10 The expert panel makes
recommendations to the Secretary of Education, who

announces those programs recognized as effective. Education began making a
list of these programs available to schools and others in 1999.

Education has also developed guidance, referred to as *Principles of
Effectiveness,* that identifies standards for state and local educational
agencies to use in implementing research- based prevention programs.
According to Education officials, SDFSCA funds can be used for programs
that meet these standards and the effective programs identified by the
expert panel process.

HHS and Education also identify programs that show promise in preventing
and reducing the use of illicit drugs and other substances among youth.
These programs have shown positive initial results that have not yet been
verified scientifically or have not consistently demonstrated a positive
effect on the prevention or reduction of substance use. Each agency also
publishes lists of the promising programs they identify to recognize the
programs* contributions, based on initial results, to preventing and
reducing the use of illicit drugs, alcohol, and tobacco among youth.

Comments from HHS and Education And Our Response

HHS and Education provided comments on a draft of this report. (See
enclosure III and enclosure IV, respectively.) Specifically, HHS commented
that the title of the draft report implied that the scope of our work was
broader than the report*s discussion. We revised the report title to
better reflect the content of the report. With regard to the DARE
elementary school curriculum that we reviewed, HHS commented that to
evaluate DARE on the basis of a portion of the program may be equivalent
to arbitrarily evaluating the effects of only 1 year of multiyear
interventions of programs, such as Project STAR and Life Skills Training.
We limited the scope of our work to reviewing published articles on long-
term evaluations of the effectiveness of the DARE elementary school
curriculum that included illicit drug use as an outcome measure because of
concerns that had been raised about the effectiveness of DARE in
preventing illicit drug use and because most of the research has focused
on the DARE elementary school fifth and sixth grade curriculum.

HHS also commented that the conclusions drawn in the draft report should
not necessarily be applied to the future DARE program and suggested that
we may want to incorporate more recent findings from the ongoing
evaluation of DARE that were released by the Robert Wood Johnson
Foundation. However, information from the ongoing evaluation of DARE that
was released by the Robert Wood Johnson Foundation did not contain any
interim findings on the effectiveness of the DARE program in preventing
illicit drug use among youth. Moreover, according to the University of
Akron researchers who are conducting this work, the focus of their study
is on revising and evaluating the DARE middle school and high school
curricula and not the elementary school curriculum that we discuss in this
report. The researchers expect to have the final results of their study in
2006.

GAO- 03- 172R Youth Illicit Drug Use Prevention 11 Education questioned
the accuracy and source of the statement in our draft report

that DARE operates in about 80 percent of school districts in the United
States. We obtained this information from the DARE America Web site and
information released by the University of Akron researchers related to
their current evaluation of the DARE middle school and high school
curricula. We added these sources of the data to the report. Education
also questioned the basis for the estimate in the draft report of SDFSCA
funds that the department made available to support DARE in fiscal year
2000. The estimate in the draft report was obtained from ONDCP. ONDCP and
Education staff developed the estimate using a formula that assumed a
certain percentage of SDFSCA state grant funds could be used to support
DARE. In response to Education*s comment, we contacted officials in
Education*s Budget Office and the Office of Elementary and Secondary
Education Safe and Drug- Free Schools Program, to discuss the estimate
that Education and ONDCP staff developed. According to Education
officials, the assumptions that were used to estimate the amount of SDFSCA
funds that could be used for DARE were hypothetical. Therefore, we deleted
the estimate from our report.

HHS and Education provided additional information about their efforts to
help identify effective substance abuse prevention programs. Where
appropriate, we made changes to the report to reflect the agencies*
comments, including technical changes that HHS provided.

- - - - - We are sending copies of this report to the Secretary of HHS,
the Secretary of Education, the Director of the Office of National Drug
Control Policy, and others who are interested. We will also make copies
available to others upon request. In addition, the report is available at
no charge on GAO*s Web site at http:// www. gao. gov. If you or your staff
have questions about this report, please contact me at (202) 512-

7119 or James O. McClyde at (202) 512- 7152. Darryl W. Joyce and David W.
Bieritz made key contributions to this report.

Sincerely yours, Marjorie E. Kanof Director, Health Care* Clinical

and Military Health Care Issues Enclosures - 4

Enclosure I Enclosure I 12 GAO- 03- 172R Youth Illicit Drug Use Prevention
Articles on Evaluations of the Effectiveness of the DARE Elementary School

Curriculum That GAO Reviewed

1. Clayton, Richard, R., Anne M. Cattarelo, and Katherine P. Walden.
*Sensation Seeking as a Potential Mediating Variable for School- Based
Prevention Intervention: A Two- Year Follow- Up of DARE.* Health
Communication (1991): 229- 239.

2. Clayton, Richard, R., Anne M. Cattarelo, and Bryan M. Johnstone. *The

Effectiveness of Drug Abuse Resistance Education (Project DARE): 5- Year
FollowUp Results.* Preventive Medicine Vol. 25, No. 3 (May 1996): 307-
318.

3. Dukes, Richard, L., Jodie B. Ullman, and Judith A. Stein. *Three- Year
Follow- Up of Drug Abuse Resistance Education (DARE).* Evaluation Review,
Vol. 20, No. 1 (February 1996): 49- 66.

4. Dukes, Richard, L., Judith A. Stein, and Jodie B. Ullman. *Long- Term
Impact of Drug Abuse Resistance Education (DARE): Results of a 6- Year
Follow- Up.* Evaluation Review, Vol. 21, No. 4 (August 1997): 483- 500. 5.
Lynam, Donald, R., Richard Milich and others. *Project DARE: No Effects At
10- Year Follow- Up.* Journal of Consulting and Clinical Psychology Vol.
67, No. 4 (August 1999): 590- 593.

6. Rosenbaum, Dennis, P. and Gordon S. Hanson. *Assessing the Effects of
SchoolBased Drug Education: A Six- Year MultiLevel Analysis of Project D.
A. R. E.* Journal of Research in Crime and Delinquency, Vol. 35, No. 4
(November 1998): 381- 412.

Enclosure II Enclosure II 13 GAO- 03- 172R Youth Illicit Drug Use
Prevention

Methodology GAO Used to Select Evaluations of the Effectiveness of the
DARE Elementary School Curriculum at Preventing Illicit Drug Use Among

Youth

To identify evaluations of the effectiveness of the DARE elementary school
curriculum at preventing illicit drug use among children, we searched
social science, business, and education databases, which included NIH*s
National Library of Medicine, within HHS, for evaluations of DARE
published in professional journals. The majority of the published articles
on evaluations of the effectiveness of DARE focused on the program*s fifth
and sixth grade elementary school curriculum. We identified 27 articles on
evaluations of the DARE elementary school curriculum that included illicit
drug use as an outcome measure. Of these articles, we selected for review
those evaluations that used at least three of the following four criteria
for methodological design: (1) long- term study design (study period of 2
years or longer), (2) intervention and control groups for comparisons, (3)
random assignment of study groups, and (4) pretest and post- test or
surveys of study participants. These criteria are among the ones suggested
by researchers as key components of rigorous experimental research design.
Six evaluations met at least three of these criteria (see table 3). The
six evaluations were based on three separate studies of the DARE
elementary school program in three different states* Colorado, Kentucky,
and Illinois.

We reviewed the sample design, research results, and conclusions for each
of the six evaluations and summarized the results of our review. We did
not independently validate the research design or verify the results of
evaluations on the effectiveness of the DARE elementary school curriculum.

Enclosure II Enclosure II

GAO- 03- 172R Youth Illicit Drug Use Prevention 14

Table 3: Six Evaluations of the DARE Elementary School Curriculum GAO
Selected For Review Evaluation/ date of article Period evaluation

covered (in years) Intervention and

control groups Random assignment of

study groups Pretest and posttest of study

participants

Sensation Seeking as a Potential Mediating Variable for School- Based
Prevention Intervention: A

Two- Year Follow- Up of DARE, 1991

Location: Lexington, Kentucky 2 Yes Yes Yes The Effectiveness of Drug
Abuse Resistance Education (Project DARE): 5- Year Follow- Up, 1996

Location: Lexington, Kentucky 5 Yes Yes Yes Project DARE: No Effects at
10- Year Follow- Up, 1999

Location: Lexington, Kentucky 10 Yes Yes Yes Three- Year Follow- up of
Drug Abuse Resistance Education (DARE), 1996

Location: Colorado Springs, Colorado 3 Yes a Yes Long- Term Impact of Drug

Abuse Resistance Education (DARE): Results of a 6- Year Follow- Up, 1997

Location: Colorado Springs, Colorado 6 Yes a Yes Assessing the Effects of

School- Based Drug Education: A Six Year MultiLevel Analysis of Project
DARE, 1998

Location: Chicago, Illinois 6 Yes Yes Yes

a Evaluation did not have initial random assignment of intervention and
control groups. Random assignment allows for the development of
experimental and control groups that are equivalent on all known and
unknown variables. Instead of random assignment, the evaluation included
periodic random tests that included checks of students* demographic
characteristics such as, age, gender, and ethnicity and students*
attitudes toward alcohol, tobacco, and other drugs to ensure equivalency
among the groups. No statistically significant differences were found
between the two study groups on those variables tested. Source: GAO
analysis of six evaluations

Enclosure III Enclosure III 15 GAO- 03- 172R Youth Illicit Drug Use
Prevention

Comments from the Department of Health and Human Services

Enclosure III Enclosure III

GAO- 03- 172R Youth Illicit Drug Use Prevention 16

Enclosure III Enclosure III

GAO- 03- 172R Youth Illicit Drug Use Prevention 17

Enclosure III Enclosure III

GAO- 03- 172R Youth Illicit Drug Use Prevention 18

Enclosure IV Enclosure IV 19 GAO- 03- 172R Youth Illicit Drug Use
Prevention

Comments from the Department of Education

Enclosure IV Enclosure IV

GAO- 03- 172R Youth Illicit Drug Use Prevention 20 (290165)
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