Research of Note for April 2003

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Sometimes research tells us what we already knew, sometimes it surprises us, and sometimes it misses the boat by not asking the right questions. This month’s Research Watch includes all three types as it reviews studies on trying to improve DARE, how being a witness to or victim of violence affects youth substance abuse, and the risk to adolescent girls of dating older boys and men.

Can DARE Be Fixed? Is There Reason to Try?

A Randomized Controlled Trial of the Middle and Junior High School D.A.R.E. and D.A.R.E. Plus Programs

Cheryl Perry, Ph.D., Keith Komro, Ph.D.,
Sara Veblen-Mortenson, MPH, MSW and colleagues
Archives in Pediatrics and Adolescent Medicine, Vol. 157, February 2003, pgs. 178-84.
Copies free from Perry at Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S. Second St, Suite 300, Minneapolis, MN 55454, or

It has long been established that the Drug Abuse Resistance Education (DARE) program, the most widely used drug prevention program in the country, usually does not work. A program called DARE Plus, which combined DARE with components such as peer-led parental involvement classes and youth-led extracurricular activities, was developed and implemented in Minnesota. A new study indicates that these additions “enhanced the effectiveness” of the DARE curriculum. But what does that mean?

It doesn’t take much to enhance the effectiveness of a program that doesn’t work. Does DARE Plus work because of the “Plus” part, or does the DARE curriculum actually add anything?

The study involved more than 6,000 seventh-graders in 24 Minnesota schools during the 1999-2000 academic year. Approximately one-third participated in DARE’s 10-session curriculum taught by police officers, one-third in DARE Plus, and one-third in a control group.

DARE Plus started with a classroom-based, peer-led parental involvement program entitled “On the VERGE,” implemented by trained teachers once a week for four weeks. The program included classroom activities as well as activities for the students and their parents. Students also participated in a theater production in their classrooms and received three postcards through the mail that focused on the tobacco industry’s targeting of youth. Ten more postcards were mailed to the parents every six to eight weeks with “short and relevant behavioral messages.”

DARE Plus also included youth action teams led by eight community organizers, helping the students choose extracurricular activities.

Although the “Plus components” are described in the article, it was difficult to understand exactly what they were talking about.
The results showed, again, that DARE did not prevent substance abuse or violence. However, compared with boys in the control group, boys in DARE Plus were less likely to use or intend to use alcohol, tobacco and multiple drugs, and less likely to increase their alcohol use and intentions, tobacco use and intentions, current frequency of smoking, or multidrug use behavior and intentions. They were also less likely to be victimized.

The differences between DARE and DARE Plus were similar to the differences between DARE Plus and the control group, but not as consistent. Compared with boys in DARE, boys in DARE Plus were less likely to increase tobacco use and intentions or violent behavior and intentions.

Girls showed almost no benefit. The only difference was that compared with girls in DARE, those in DARE Plus were less likely to report increases in ever having been drunk.

The authors were enthusiastic about DARE Plus for boys. I do not share that enthusiasm about the program results, or the way this study was conducted.

Since DARE is no more effective than no program at all, there is no good reason to enhance it. However, if it is desirable to do so (for political or other reasons) then researchers should include a group of youth who received the “Plus” components without the DARE curriculum. If the results then show that the “Plus” part works just as well as the DARE Plus combination, they could and should save time and resources by eliminating the DARE curriculum.

If, however, the combination is more effective than the Plus components alone, youth workers could consider whether the improvement justifies continuing to spend resources and time on DARE.

But if you don’t want to know whether the DARE curriculum has any value, why spend the resources to evaluate it?

Older Boyfriends and Adolescent Sex

Sexual Intercourse and the Age Difference Between Adolescent Females and Their Romantic Partners
Christine E. Kaestle, Donald Morisky and Dorothy Wiley
Perspectives on Sexual and Reproductive Health, Vol. 34, November/December 2002, pgs. 304-5.
Available free at or from Dorothy Wiley at if you send a stamped self-addressed envelope to Dr. Wiley, UCLA School of Nursing, 700 Tiverton Avenue, Los Angeles, CA 90095-6919.

Adolescent girls often date boys who are several years older than they are, and new research says that those girls are more likely to have sexual intercourse with older boys than with boys they date who are the same age.

The study analyzed responses from almost 2,000 girls in the National Longitudinal Study of Adolescent Health, a nationally representative sample of students who were in grades seven through 12 in 1994-95. Girls were selected for this study if they reported having a male romantic partner in the previous 18 months.

Most of the girls in the study were younger than 17 when they started the relationship and had a boyfriend who was one to five years older. The girls’ age at the start of the relationships ranged from 7 to 19 years, with a median of 15. (The term “romantic relationship” is defined by the girls, not the researchers.)

The male partners ranged from 8 to 44 years, and nearly 10 percent were 20 or older. Only 7 percent of the girls had a partner who was younger, usually by one year.

Forty-three percent of the girls reported having had sexual intercourse with their romantic partners, including 24 percent of those 13 or younger at the start of the relationship, 41 percent of those ages 14 to 15, and 59 percent of those 16 or older.

The boy’s age had the greatest influence on the sexual activities of the youngest girls: While 9 percent of the girls 13 or younger at the start of the relationship had intercourse with boys the same age or younger, 41 percent of girls in that age group reported having intercourse with partners at least four years older.

In contrast, 55 percent of girls 16 or older had intercourse with partners their own age, compared with 68 percent of 16-year-old girls dating boys at least four years older.

When the researchers focused only on the girls who were no longer dating the boyfriend in question, the likelihood of their having had sex was even greater. For example, 13-year-olds with ex-boyfriends at least six years older were 10 times as likely to have had sex with them than were 13-year-olds with ex-boyfriends that were their own age or younger. This may reflect more exploitative relationships, or longer relationships than the ones that the girls were currently involved in Age differences were not the only predictors of having sex. African-American girls were 70 percent more likely to have sexual intercourse than were white girls, and girls who did not live with a mother figure were more than twice as likely to have intercourse than those who did live with a mother figure. Girls whose mothers had graduated from college were 30 percent less likely to have had sexual intercourse than those whose mothers had not.

There are several possible explanations for why the difference in ages could influence sexual behavior, but the study did not examine those. The researchers speculate that older boys might have more power to persuade girls to engage in sex, and that older boys have longer relationships with girls than do younger boys, so those relationships might be more likely to progress to intercourse.

These are reasonable but unexplored, and there are other equally plausible explanations. The researchers did not mention that older boys and men probably have cars or apartments that offer more opportunity for sexual intercourse. The researchers did not try to determine whether girls who choose to date older boys are more interested in sex than are girls who do not.

The authors offer advice for parents, teachers, school psychologists and others who work with girls, such as asking them about the age of their boyfriends and how that affects the relationship. They suggest that sexuality and health education programs should help the girls identify their own interests and assert their own decisions, and that teachers should recognize that the boys in the programs may be substantially younger than the boys whom the girls are dating.

Although not mentioned in the article, youth workers can also consider the information from this study as they plan dances and other youth activities that might bring together youth of different ages. For example, organizers might want to restrict activities for girls to boys close to their own age.

Violence and Substance Abuse in Three Countries

Violence Exposure and Substance Use in Adolescents: Findings From Three Countries

Robert Vermeiren, M.D., Mary Schwab-Stone, M.D., Dirk Deboutte, M.D., Ph.D. and others
Pediatrics, Vol. 111, March 2003, pgs. 535-40.
Available free from Dr. Vermeiren at He can also be reached at Middelheimhospital, lindendreef 1, 2020 Antwerp, Belgium.

Drug abuse and exposure to community violence are thought of as American problems, but a new study conducted on youth in Antwerp, Belgium, Arkangelsk, Russia, and New Haven, Conn., found considerable exposure to drugs and violence and similar dysfunctional responses to it.

The study was based on more than 3,000 inner-city youth (ages 14 through 17). Victimization included being beaten or mugged, threatened with serious physical harm, shot at, attacked with a knife, chased by gangs or individuals or seriously wounded in a violent incident. Exposure to violence was measured as witnessing the same kinds of violence.

The rates of witnessing one or two events and experiencing moderate victimization were similar in the three countries. However, the teens in the United States were more than twice as likely to report witnessing more than two incidents (54 percent, compared with 24 percent in Belgium and 13 percent in Russia). Moderate victimization was similar in all three countries (between 26 and 30 percent), but severe victimization was considerably higher in the United States (18 percent compared with 8 percent in Belgium and 2 percent in Russia).

When age, sex and race are statistically controlled, smoking and alcohol use were higher in Belgium and the United States than in Russia. In all the countries, teens who witnessed more violence or were victims of violence tended to smoke, drink, and use marijuana more often and were more likely to use hard drugs. However, American adolescents who witnessed violence were less likely to use drugs and alcohol than were teens in other countries.

The results suggest that programs aiming to reduce substance abuse need to consider how teens “self-medicate” with alcohol or drugs to cope with fears and anger from witnessing or experiencing violence. Helping teens avoid violent experiences or find other ways to cope could reduce substance abuse.