Prevention Science

, Volume 20, Issue 6, pp 852–862 | Cite as

Examining Intervention Component Dosage Effects on Substance Use Initiation in the Strengthening Families Program: for Parents and Youth Ages 10–14

  • Emily J. LoBraicoEmail author
  • Gregory M. Fosco
  • Daniel Max Crowley
  • Cleve Redmond
  • Richard L. Spoth
  • Mark E. Feinberg


Family-based prevention programs increasingly are being disseminated and can be effective for an array of adolescent problem behaviors, including substance use initiation. Yet, we continue to have little understanding of how and why these programs work. Increased specificity in our understanding of what components drive program effects can facilitate refinement of programs, with potential for greater impact at a lower cost. Using attendance data, previously coded intervention components, and a previously developed propensity model to adjust for potential bias, this study evaluated content component-specific dosage effects of the Strengthening Families Program: for Parents and Youth Ages 10–14 on three substance use initiation outcomes by grade 12. Results indicated that greater dosages of program content related to (a) parental monitoring and behavior management strategies and (b) promoting positive family relationships had potent and robust effects on reduction of risk for initiating drunkenness and marijuana use and (c) self-regulation and stress management had potent and robust effects on reduction of risk for initiating cigarette and marijuana use. Results indicate potential critical components within SFP 10–14 and offer a path forward for continuing work in efforts to optimize this widely disseminated program.


Family-based intervention Substance use prevention Propensity scores Component analysis 



This research was supported by grant R01-DA013709 from the National Institute on Drug Abuse and co-funded by the National Institute on Alcohol Abuse and Alcoholism. This project was supported by the Prevention and Methodology Training Program (T32 DA017629; PI: L.M. Collins) funded by the National Institute on Drug Abuse.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent/assent was obtained from all adolescents/parents included in the study.


  1. Brody, G. H., Murry, V. M., Gerrard, M., Gibbons, F. X., Molgaard, V., McNair, L., … Neubaum-Carlan, E. (2004). The Strong African American Families Program: Translating research into prevention programming. Child Development, 73, 900–917.Google Scholar
  2. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18. Scholar
  3. Chassin, L. (2008). Juvenile justice and substance use. Future of Children, 18, 165–183.CrossRefPubMedGoogle Scholar
  4. Coffman, D. L., & Zhong, W. (2012). Assessing mediation using marginal structural models in the presence of confounding and moderation. Psychological Methods, 17, 642–664.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1, 98–101. Scholar
  6. Collins, L. M., Murphy, S. A., Nair, V. N., & Strecher, V. J. (2005). A strategy for optimizing and evaluating behavioral interventions. Annals of Behavioral Medicine, 30, 65–73.CrossRefPubMedGoogle Scholar
  7. Conger, K. J., Williams, S. T., Little, W. M., Masyn, K. E., & Shebloski, B. (2009). Development of mastery during adolescence: The role of family problem-solving. Journal of Health and Social Behavior, 50, 99–114. Scholar
  8. Cordova, D., Heinze, J., Mistry, R., Hsieh, H., Stoddard, S., Salas-Wright, C., & Zimmerman, M. (2014). Family functioning and parent support trajectories and substance use and misuse among minority urban adolescents: A latent class growth analysis. Substance Use & Misuse, 49, 1908–1919. Scholar
  9. Crowley, D. M., Coffman, D. L., Feinberg, M. E., Greenberg, M. T., & Spoth, R. L. (2014). Evaluating the impact of implementation factors on family-based prevention programming: Methods for strengthening causal inference. Prevention Science, 15, 246–255. Scholar
  10. D’Agostino, R., & Rubin, D. B. (2000). Estimating and using propensity scores with partially missing data. Journal of the American Statistical Associationcal Association, 95, 749–759.CrossRefGoogle Scholar
  11. De Martini-Scully, D., Bray, M. A., & Kehle, T. J. (2000). A packaged intervention to reduce disruptive behaviors in general education students. Psychology in the Schools, 37, 149–156.<149::AID-PITS6>3.0.CO;2-K.CrossRefGoogle Scholar
  12. Degenhardt, L., Stockings, E., Patton, G., Hall, W. D., & Lynskey, M. (2016). The increasing global health priority of substance use in young people. The Lancet Psychiatry, 3, 251–264. Scholar
  13. DeWit, D. J., Adlaf, E. M., Offord, D. R., & Ogborne, A. C. (2000). Age at first alcohol use: A risk factor for the development of alcohol disorders. The American Journal of Psychiatry, 157, 745–750. Scholar
  14. Dishion, T. J., & Patterson, G. R. (1999). Model building in developmental psychopathology: A pragmatic approach to understanding and intervention. Journal of Clinical Child & Adolescent Psychology, 28, 502–512. Scholar
  15. Dumas, J. E., Moreland, A. D., Gitter, A. H., Pearl, A. M., & Nordstrom, A. H. (2008). Engaging parents in preventive parenting groups: Do ethnic, socioeconomic, and belief match between parents and group leaders matter? Health Education & Behavior, 35, 619–633. Scholar
  16. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology.Google Scholar
  17. Eiden, R. D., Lessard, J., Colder, C. R., Livingston, J., Casey, M., & Leonard, K. E. (2016). Developmental cascade model for adolescent substance use from infancy to late adolescence. Developmental Psychology, 52, 1619–1633.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Fairchild, A. J., & Mackinnon, D. P. (2014). Factors affecting implementation: Cultural adaptation and training. In Z. Sloboda & H. Petras (Eds.), Defining prevention science (pp. 315–334). New York: Springer Science + Business Media.Google Scholar
  19. Fleming, C. B., Mason, W. A., Haggerty, K. P., Thompson, R. W., Fernandez, K., Casey-Goldstein, M., & Oats, R. G. (2015). Predictors of participation in parenting workshops for improving adolescent behavioral and mental health: Results from the common sense parenting trial. Journal of Primary Prevention, 36, 105–118.CrossRefPubMedGoogle Scholar
  20. Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2005). Evaluating fidelity: Predictive validity for a measure of competent adherence to the Oregon model of parent management training. Behavior Therapy, 36, 3–13. Scholar
  21. Fosco, G. M., Caruthers, A. S., & Dishion, T. J. (2012a). A six-year predictive test of adolescent family relationship quality and effortful control pathways to emerging adult social and emotional health. Journal of Family Psychology, 26, 565–575.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Fosco, G. M., Stormshak, E. A., Dishion, T. J., & Winter, C. E. (2012b). Family relationships and parental monitoring during middle school as predictors of early adolescent problem behavior. Journal of Clinical Child and Adolescent Psychology, 41, 202–213.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Fosco, G. M., Frank, J. L., Stormshak, E. A., & Dishion, T. J. (2013). Opening the “Black box”: Family check-up intervention effects on self-regulation that prevents growth in problem behavior and substance use. Journal of School Psychology, 51, 455–468.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Fosco, G. M., Seeley, J. R., Dishion, T. J., Smolkowski, K., Stormshak, E. A., Downey-McCarthy, R., … Strycker, L. A. (2014). Lessons learned from scaling up the ecological approach to family interventions and treatment programs in middle schools. In M. Weist, N. Lever, C. Bradshaw, & J. Owens (Eds.), Handbook of school mental health (pp. 237–251). Boston, MA: Springer.Google Scholar
  25. Franks, R., & Schroeder, J. (2013). Applying implementation science in early childhood programs and systems. In T. Halle, A. Metz, & I. Martinez-Beck (Eds.), Applying implementation science to early care and education programs and systems: Exploring a new frontier (pp. 5–19). Baltimore: Paul H. Brookes.Google Scholar
  26. Gardner, T. W., Dishion, T. J., & Connell, A. M. (2008). Adolescent self-regulation as resilience: Resistance to antisocial behavior within the deviant peer context. Journal of Abnormal Child Psychology, 36, 273–284. Scholar
  27. Gottfredson, D. C., Cook, T. D., Gardner, F. E. M., Gorman-Smith, D., Howe, G. W., Sandler, I. N., & Zafft, K. M. (2015). Standards of evidence for efficacy, effectiveness, and scale-up research in prevention science: Next generation. Prevention Science, 16, 893–926.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Gross, D., Julion, W., & Fogg, L. (2001). What motivates participation and dropout among low-income urban families of color in a prevention intervention? Family Relations, 50, 246–254. Scholar
  29. Hanisch, C., Hautmann, C., Pluck, J., Eichelberger, I., & Dopfner, M. (2014). The prevention program for externalizing problem behavior (PEP) improves child behavior by reducing negative parenting: Analysis of mediating processes in a randomized controlled trial. Journal of Child Psychology and Psychiatry, 55.
  30. Henderson, C. E., Rowe, C. L., Dakof, G. A., Hawes, S. W., & Liddle, H. A. (2009). Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. The American Journal of Drug and Alcohol Abuse, 35, 220–226.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Hukkelberg, S. S., & Ogden, T. (2013). Working alliance and treatment fidelity as predictors of externalizing problem behaviors in parent management training. Journal of Consulting and Clinical Psychology, 81, 1010–1020. Scholar
  32. Kang, J. D. Y., & Schafer, J. L. (2007). Demystifying double robustness: A comparison of alternative strategies for estimating a population mean from incomplete data. Statistical Science, 22, 523–539. Scholar
  33. Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. Scholar
  34. Kumpfer, K. L., Molgaard, V., & Spoth, R. L. (1996). The Strengthening Families Program for the prevention of delinquency and drug use. In R. D. Peters & R. J. McMahon (Eds.), Preventing childhood disorders, substance abuse, and delinquency (pp. 241–267). Thousand Oaks, C.A.: Sage.CrossRefGoogle Scholar
  35. Liddle, H. A. (2004). Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs. Addiction, 99, 76–92.CrossRefGoogle Scholar
  36. Lunceford, J. K., & Davidian, M. (2004). Stratification and weighting via the propensity score in estimation of causal treatment effects: A comparative study. Statistics in Medicine, 23, 2937–2960. Scholar
  37. McGue, M., & Iacono, W. G. (2005). The association of early adolescent problem behavior with adult psychopathology. The American Journal of Psychiatry, 162, 1118–1124.CrossRefPubMedGoogle Scholar
  38. Odgers, C. L., Caspi, A., Nagin, D. S., Piquero, A. R., Slutske, W. S., Milne, B. J., … Moffitt, T. E. (2008). Is it important to prevent early exposure to drugs and alcohol among adolescents? Psychological Science, 19, 1037–1044.Google Scholar
  39. Patel, C. C., Fairchild, A. J., & Prinz, R. J. (2017). Potential mediators in parenting and family intervention: Quality of mediation analyses. Clinical Child and Family Psychology Review, 20, 127–145. Scholar
  40. Pokhrel, P., Herzog, T. A., Black, D. S., Zaman, A., Riggs, N. R., & Sussman, S. (2013). Adolescent neurocognitive development, self-regulation, and school-based drug use prevention. Prevention Science, 14, 218–228. Scholar
  41. R Core Team. (2016). R: A language and environment for statiscal computing. Vienna, Austria. Retrieved from
  42. Redmond, C., Spoth, R., Shin, C., Schainker, L. M., Greenberg, M. T., & 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, 513–530. Scholar
  43. Robins, J. M., Hernán, M. A., & Brumback, B. (2000). Marginal structural models and causal inference in epidemiology. Epidemiology, 11, 550–560.CrossRefGoogle Scholar
  44. Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrica, 70, 41–55.CrossRefGoogle Scholar
  45. Sandler, I. N., Schoenfelder, E. N., Wolchik, S. A., & Mackinnon, D. P. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299–320.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Spoth, R., & Redmond, C. (1995). Parent motivation to enroll in parenting skills programs: A model of family context and health belief predictors. Journal of Family Psychology, 9, 294–310. Scholar
  47. Spoth, R., Guyll, M., & Day, S. X. (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63, 219–228.CrossRefPubMedGoogle Scholar
  48. Spoth, R., Clair, S., Greenberg, M., Redmond, C., & Shin, C. (2007). Toward dissemination of evidence-based family interventions: Maintenance of community-based partnership recruitment results and associated factors. Journal of Family Psychology, 21, 137–146.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77, 620–632.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Spoth, R., Redmond, C., Shin, C., Greenberg, M., Feinberg, M., & Schainker, L. (2013). PROSPER community-university partnership delivery system effects on substance misuse through 6 1/2 years past baseline from a cluster randomized controlled intervention trial. Preventive Medicine, 56, 190–196. Scholar
  51. Spoth, R., Redmond, C., Mason, W. A., Schainker, L., & Borduin, L. (2015). Research on the Strengthening Families Program for Parents and Youth Ages 10–14: Long-term effects, mechanisms, translation to public health, prosper partnership scale up. In L. M. Scheier (Ed.), Handbook of adolescent drug use prevention: Research, intervention strategies, and practice (2nd ed., pp. 267–292). Washington, D.C.: American Psychological Association.CrossRefGoogle Scholar
  52. Trentacosta, C. J., & Shaw, D. S. (2009). Emotional self-regulation, peer rejection, and antisocial behavior: Developmental associations from early childhood to early adolescence. Journal of Applied Developmental Psychology.
  53. van Buuren, S. & Groothuis-Oudshoorn, K. (2011). Mice: Multiple imputation by chained equations in R. Journal of Statistical Software, 45.
  54. Van Ryzin, M. J., & Fosco, G. M. (2016). Family-based approaches to prevention. In M. J. Van Ryzin, K. L. Kumpfer, G. M. Fosco, & M. T. Greenberg (Eds.), Family-based prevention programs for children and adolescents (1st ed., pp. 1–20). Psychology Press.Google Scholar
  55. Van Ryzin, M. J., Roseth, C. J., Fosco, G. M., Lee, Y., & Chen, I.-C. (2016). A component-centered meta-analysis of family-based prevention programs for adolescent substance use. Clinical Psychology Review, 45, 72–80.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Varvil-Weld, L., Crowley, D. M., Turrisi, R., Greenberg, M. T., & Mallett, K. A. (2014). Hurting, helping, or neutral? The effects of parental permissiveness toward adolescent drinking on college student alcohol use and problems. Prevention Science, 15, 716–724.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  1. 1.Department of Human Development and Family StudiesPennsylvania State UniversityUniversity ParkUSA
  2. 2.Prevention Research CenterPennsylvania State UniversityUniversity ParkUSA
  3. 3.Partnerships in Prevention Science InstituteIowa State UniversityAmesUSA

Personalised recommendations