This article reports findings from a national longitudinal cross-site evaluation of high-risk youth to clarify the relationships between risk and protective factors and substance use. Using structural equation modeling, baseline data on 10,473 youth between the ages of 9 and 18 in 48 high-risk communities around the nation are analyzed. Youth were assessed on substance use (cigarette, alcohol, and marijuana use), external risk factors including family, school, peer and neighborhood influences, and individual risk and protective factors including self-control, family connectedness, and school connectedness. Findings indicate strong direct relationships between peer and parental substance use norms and substance use. Individual protective factors, particularly family and school connectedness were strong mediators of individual substance use. These findings suggest that multi-dimensional prevention programming stressing the fostering of conventional anti-substance use attitudes among parents and peers, the importance of parental supervision, and development of strong connections between youth and their family, peers, and school may be most effective in preventing and reducing substance use patterns among high-risk youth.

Research regarding prevention strategies for Hispanic youth stress the importance of family interventions because of the particular importance of family as a protective factor within the Hispanic community. Starting in 1995, the Center for Substance Abuse Prevention conducted the National Cross-Site Evaluation of High Risk Youth Programs, a 5-year drug and alcohol prevention study with a sample of approximately 10,500 youth, including nearly 3,000 Hispanic youth. Youth were surveyed regarding their alcohol use patterns and risk and protective factors, with several measures of family relationships, including family connectedness, family supervision, and parental attitudes toward their child's alcohol use. Analyses indicate that family factors are highly linked to alcohol use among Hispanics, particularly among Hispanic females. Longitudinal growth curve analyses indicate that improving the connections that young Hispanic females have to their parents can have positive long-term effects on delaying or reducing their alcohol use.

In a 46-site, 5-year high-risk youth substance abuse prevention evaluation, effect sizes were adjusted using a meta-analytic regression technique to project potential effectiveness under more optimal research and implementation conditions. Adjusting effect size estimates to control for the impact of comparison group prevention exposure, service intensity, and coherent program implementation raised the mean effectiveness estimate from near zero (.02, SD = .21) to .24 (SD = .18). This finding suggests that adolescent prevention programs can have significant positive effects under optimal, yet obtainable conditions. EDITORS' STRATEGIC IMPLICATIONS: The authors present a meta-analytic technique that promises to be an important tool for understanding what works in multi-site community-based prevention settings. Researchers will find this to be a creative approach to model the "noise'' in implementation that may often overshadow the potential impact of prevention programs.

This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.

Suicide in Missouri is a significant public health issue that has taken the lives of 8351 individuals over the last decade. The recognition of suicide as an imminent concern has led to the development of evidence-based prevention programs to decrease suicide-related mortality. One program, question, persuade, refer (QPR), has become the most widely-distributed gatekeeper training program in the world. This article presents both immediate and 2-year follow-up analyses of QPR trainees who work with youth, specifically examining changes in knowledge, self-efficacy, and help-giving behaviors. Results indicate both short- and long-term positive outcomes in knowledge and self-efficacy, supporting use of QPR.

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This study adds to the limited research on the potential importance of the quality of the relationship between adult prevention service providers and youth participants in enhancing social skills and strengthening prevention outcomes. Study subjects were drawn from seven prevention programs funded under a Youth Mentoring Initiative by the Center for Substance Abuse Prevention in the Substance Abuse and Mental Health Services Administration. These programs maintain a relationship-based service focus but use a variety of one-on-one, group, volunteer, and paid staff service formats. Study results showed that youth who perceived a higher level of trust, mutuality and empathy in their relationship with providers experienced significantly greater improvements in social skills (i.e., cooperation, self-control, assertiveness, and empathy) than program participants who perceived a lower quality relationship with adult providers. These findings underscore the importance of recruitment, training and supervisory practices that promote staff and volunteer skills in achieving high quality relationships with youth participants regardless of the specific intervention strategy. Editors' Strategic Implications: Practitioners and policymakers should review the authors' findings about the importance of individual adult skills in building protective mentoring relationships. The impact of relationship quality, rather than setting, suggests that the scope of effective prevention practice can be broadened beyond the confines of formal prevention programming to any place in which caring and skilled adults interact with youth.

The effectiveness of a school-based truancy court intervention in four middle schools in a midsized school district was evaluated. Cumulative data from 185 youth attending a truancy court from 2004 through 2008 were included in the analyses. Results indicated a differential impact of the truancy court intervention depending on truancy severity at baseline. The intervention was most successful in increasing attendance for students with severe truancy, but had limited impact on students with moderate truancy, and no impact on mild truancy. The intervention did not result in improved school attachment or grade point averages, nor did it signiÞcantly reduce discipline offenses. Furthermore, the aftercare intervention, consisting of regular meetings with an authority Þgure (e.g., a juvenile ofÞcer), was only effective at maintaining truancy court attendance gains for students with severe truancy at baseline, although it was associated with a substantial decrease in discipline offenses for all groups. These results suggest that truancy courts similar to the one described here may have an impact on truancy for severely truant students, but may have a limited effect on students with mild or moderate truancy. C 2009 Wiley Periodicals, Inc.