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Program Profile: Midwestern Prevention Project (MPP)

Evidence Rating: Effective - More than one study Effective - More than one study

Date: This profile was posted on May 31, 2012

Program Summary

A school-based comprehensive program intended to promote an antidrug message throughout communities and prevent substance use (alcohol, tobacco, and marijuana) among middle school students. The program is rated Effective. The program significantly reduced cigarette smoking prevalence among treatment youths relative to the control group. There was no significant sustained effect for alcohol or marijuana use at follow-up.

Program Description

Program Goals
The Midwestern Prevention Project (MPP) was a comprehensive, community-based, multifaceted program intended to prevent or reduce gateway substance use (alcohol, tobacco, and marijuana) during adolescence. The program strived to help youths recognize the social pressures to use drugs and to provide them with assertiveness skills to help refuse peer pressure and avoid drug use. MPP was designed to eliminate gateway substance use in middle school students and to reduce the risk of delinquency along the lifespan.

Target Population/Eligibility
The program was targeted at youths in the transitory period from early adolescence to middle adolescence, as this age presents a high risk for gateway drug use. The program was intended for use in a school-based setting for middle school students, specifically, sixth and seventh graders.

Program Components
MPP disseminated an antidrug message to students through a system of coordinated, communitywide strategies that involved various areas that influence a middle school student’s life, including school, community, family, and mass media.
  • School. The central component for drug prevention programming is the school. The school component used active social learning techniques (modeling, role playing, and discussion, with student peer leaders assisting teachers). It was included in teachers’ curricula for middle school students and included homework that requires participation from parents in assignments.
  • Community/policy. A consistent message supporting a non–drug use norm was delivered through community organization and training, as well as through changes in local health policy regarding tobacco, alcohol, and other drugs. This component entailed training community leaders and government officials to plan prevention goals and strategies for implementation.
  • Parent. The parent education and organization component involved a parent–principal committee that met to review school drug policy and parent–child communications training, and was designed to occur within the school and the school neighborhood. This component was intended to motivate parents to participate in the furtherance of program goals.
  • Mass media. The mass media component was intended to promote the program’s antidrug message through various media, such as television, radio, and newspaper. Mass media programming was used to support the other components by introducing the program’s concepts to the entire community.
These components were introduced to the community in sequence at a rate of one a year, with the mass media component occurring throughout all the years. All components involved regular meetings of respective deliverers (for example, community leaders for organization) to review and refine programs. Overall, the interrelated components were intended to promote a comprehensive curriculum that disseminated a zero-tolerance attitude toward substance use.

Key Personnel
While the MPP was mainly school based, the program was designed to elicit participation from the community, schools, and family to promote a comprehensive approach to drug prevention. Therefore, proper implementation of the MPP curriculum required collaboration and effective communication between members from teachers, parents, principals, and student leaders.

Program Theory
The MPP used a preventive approach to drug abuse, concentrating on the pressure that adolescents face regarding substance use. The program addressed the fact that adolescents ages 10 to 14 are highly susceptible to experimentation and peer pressure to use drugs and cigarettes, and that cigarette use during formative years can serve as a gateway to further drug use and delinquency. Also taking into account that school transition provides a critical risk period for smoking and risk behavior in youths, the program adopted a comprehensive school-based curriculum to prevent and reduce substance use in middle school students.

Evaluation Outcomes

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Study 1
Smoking Prevalence Rates

The results of the study by Pentz and colleagues (1989) provided evidence that the Midwestern Prevention Program (MPP) significantly reduced cigarette smoking prevalence among treatment youths relative to control youths. Analyses indicated that, at 2-year follow-up, program schools had approximately 13 percent fewer cigarette users in the last month than would be expected without MPP intervention. The 13 percent net decrease in smoking in program schools translates to a 30 percent rate of decline in program schools relative to control schools.

Study 2
Cigarette Use

The results of the study by Chou and colleagues (1998) provided evidence that the MPP significantly reduced cigarette use among treatment youths relative to control youths. However, such effects were present only at the initial 6-month follow-up, and significant effects were not sustained throughout the remaining follow-up assessments.

Alcohol Use
The results of the study indicated significant reductions in alcohol use among treatment youth at the first two follow-ups—that is, up to 1½ years, relative to the control group. Significant effects were not sustained throughout the remaining follow-up assessments.

Marijuana Use
The results of the study did not indicate sufficient evidence of a significant reduction in marijuana use among treatment youths relative to control youths during any of the four follow-up assessments.
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Evaluation Methodology

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Study 1
Pentz and colleagues (1989) conducted a randomized control trial of the Midwestern Prevention Project (MPP) in Kansas City, Missouri, a longitudinal study that spanned 6 years. The experiment began in fall 1984, and the study concentrated on providing an evaluation of the program’s impact on cigarette use prevalence among middle school students. Schools were assigned to either a program group—which received school, booster, parent, and mass media program components—or a control group that received regular health education programming in school as usual. As there was no realistic way to prevent access to the mass media component, the control group was assumed to have access to this component of the intervention. The sample included eight schools, totaling 1,122 sixth and seventh grade students. The sample was 50 percent male and 82 percent white, 14 percent African American, and 4 percent other races. To evaluate the effectiveness of MPP, the program’s impact on smoking prevalence rates was analyzed. Smoking prevalence rates were measured through an analysis of self-reported cigarette use, supplemented with a biochemical analysis of monoxide in students’ breath. Both measures were combined to determine an overall impact on smoking prevalence rates.

Self-reported cigarette use among students was measured through the administration of a questionnaire regarding smoking behavior. Students completed a self-administered questionnaire about 1½ months before the intervention, between early November 1984 and early January 1985, to provide baseline data. Three follow-ups were conducted to monitor the progress of the intervention’s effects; these occurred at 6 months, after 1 year, and after 2 years. The questionnaire included items regarding smoking behaviors, drug use, and psychological factors related to drug use, and four categories of questions were used as indicators of program effects: lifetime use, last-month use, last-week use, and current use of cigarettes.

A biochemical measure of smoking was used to enhance the accuracy of the data collected from the survey results, which entailed the collection and analysis of carbon monoxide in students’ breath. During this procedure, each student was instructed to inhale deeply and hold his or her breath for 10 seconds. Students then exhaled through a straw to blow up the balloon, after which indicator readings were recorded. The instrument was calibrated before its use, to account for levels of carbon monoxide in the air that could be from heating systems or other sources. These recordings were used to estimate the concentration of carbon monoxide in expired air from the lungs, to estimate whether cigarette use was evident.

Study 2
Chou and colleagues (1998) conducted a randomized controlled trial of MPP in Indianapolis, Indiana, beginning in fall 1987. The evaluation concentrated on the impact MPP made in reducing tobacco, alcohol, and marijuana use among middle school students. A cohort of adolescents from 57 schools in 12 school districts was identified for inclusion in the study, and schools were randomly assigned to either a treatment condition or control condition. Thirty-two schools were placed in the treatment condition and used all components of the MPP curriculum. Twenty-five schools were placed in the control group and were assigned to a health-education-as-usual condition. To be eligible for participation in the study, adolescents must have reported use of cigarettes, alcohol, or marijuana in the month before baseline data collection. The number of students included in the study totaled 3,412, with 1,904 in the treatment group and 1,508 in the control group. Students were tracked for four follow-ups at 6 months, 1½ years, 2½ years, and 3½ years after baseline data collection.

The study used the administration of a self-report questionnaire regarding students’ recent substance use. The questionnaire consisted of 100 items that measured substance abuse behavior as well as demographic characteristics, attitudes, and social influences related to substance abuse. Responses regarding cigarette, alcohol, and marijuana use were evaluated separately to determine the potential impact of MPP on each behavior.
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The cost to implement the Midwestern Prevention Program (MPP) over a 3-year period is estimated at $175,000, which includes the costs of teacher, parent, and community leader training and curriculum materials for the school-based program. This calculation is based on a minimum of 20 teachers trained in one group for the school program, 20 parent group members trained in one group for the parent program (about 3 or 4 principals, 4 student peer leader, 12 parents), and 1,000 participating middle school students. Beyond this threshold, costs increase to approximately $4,000 per additional group trained on the same day or trip, $100–$125 per additional trainer manual, and $7 per additional student workbook.
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Implementation Information

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To facilitate successful implementation of the Midwestern Prevention Program (MPP), the community frequently donated available resources such as office space, technical support, media coverage, or other various materials. Additionally, strong support from parents and school principals helped to bolster implementation of the family and school components of the program. It was important that all participants put forth necessary effort, as trainers and leaders were required to make a 2- to 2½-year commitment to the program.

Training of all participants facilitated proper implementation of MPP. Teachers were required to participate in a 2-day training session before implementation of the school component, and were also required to attend yearly ½-day refinement sessions. It was recommended that program implementation occurred within 2 weeks of training, or teachers could forget techniques and information from training sessions. Community leaders and school superintendents were also required to complete a series of training sessions to facilitate effective implementation of the program. Initial sessions included familiarizing leaders with effective prevention techniques, and setting general goals for the task force or council. Later sessions entailed the review of prevention and intervention research to guide further direction of program goals. Finally, the parent program component involved a 1-day training that included discussion and collaboration between parents and principals. During this session, groups conducted a policy needs assessment that was tailored to the needs of specific schools to plan long-term prevention efforts.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Pentz, Mary Ann, David P. MacKinnon, Brian R. Flay, William B. Hansen, C. Anderson Johnson, and James H. Dwyer. 1989. “Primary Prevention of Chronic Diseases in Adolescence: Effects of the Midwestern Prevention Project on Tobacco Use.” American Journal of Epidemiology 130(4):713–24.

Study 2
Chou, Chih–Ping, Susanne Montgomery, Mary Ann Pentz, Louise Ann Rohrbach, C. Anderson Johnson, Brian R. Flay, and David P. MacKinnon. 1998. “Effects of a Community-Based Prevention Program on Decreasing Drug Use in High-Risk Adolescents.” American Journal of Public Health 88(6):944–48.
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Additional References

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These sources were used in the development of the program profile:

MacKinnon, David P., C. Anderson Johnson, Mary Ann Pentz, James H. Dwyer, William B. Hansen, Brian R. Flay, and Eric Yu I. Wang. 1991. “Mediating Mechanisms in a School-Based Drug Prevention Program: 1-Year Effects of the Midwestern Prevention Project.” Health Psychology 10(3):164–72.

Pentz, Mary Ann, James H. Dwyer, David P. MacKinnon, Brian R. Flay, William B. Hansen, Eric Yu I. Wang, and C. Anderson Johnson. 1989. “A Multicommunity Trial for Primary Prevention of Adolescent Drug Abuse: Effects on Drug Use Prevalence.” Journal of the American Medical Association 261:3259–66.

Pentz, Mary Ann, Sharon F. Mihalic, and Jennifer K. Grotpeter. 1998. Blueprints for Violence Prevention, Book 1: The Midwestern Prevention Project. Boulder, Colo.: Center for the Study and Prevention of Violence.
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Program Snapshot

Age: 10 - 14

Gender: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): School, Other Community Setting

Program Type: Classroom Curricula, Community Awareness/Mobilization, School/Classroom Environment, Alcohol and Drug Prevention

Current Program Status: Not Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices, Blueprints for Healthy Youth Development (formerly Blueprints for Violence Prevention)

Chih–Ping Chou
Professor, Preventive Medicine
Joint Appointment in Social Work, University of Southern California
Soto Street Building, SSB, 2001 N. Soto Street, Room 302X, MC 9239
Los Angeles CA 90032–3628
Phone: 323.442.8239