Agenda packet — Los Gatos City Council, June 21, 2022 (part 7 of 8)

From: [email protected] <[email protected]>
Sent: Tuesday, March 29, 2022 6:45 PM
To: 'Joanne Rodgers' <[email protected]>; 'Joe Rodgers' <[email protected]>; '[email protected]' <[email protected]>; '[email protected]' <[email protected]>; '[email protected]' <[email protected]>; '[email protected]' <[email protected]>; '[email protected]' <[email protected]>; '[email protected]' <[email protected]>; '[email protected]' <[email protected]>
Cc: 'Karla Albright' <[email protected]>; 'Sue Anawalt' <[email protected]>; 'Don Arnaudo' <[email protected]>; 'Rose Arnaudo' <[email protected]>; Mary Badame <[email protected]>; 'Dru Barth' <[email protected]>; 'Jim Barth' <[email protected]>; 'Kathy Bays' <[email protected]>; 'Michael Bays' <[email protected]>; 'Celia Bell' <[email protected]>; 'Joanne Benjamin' <[email protected]>; 'Marty Berk' <[email protected]>; 'Toni Blackstock' <[email protected]>; 'Jeffrey P. Blum' <[email protected]>; 'Nancy Boesenberg' <[email protected]>; 'Diana Bond' <[email protected]>; 'Franklin Bondonno' <[email protected]>; 'Shannon Burnett' <[email protected]>; 'Susan Burnett' <[email protected]>; 'Kelly Campbell' <[email protected]>; 'Julio Casal' <[email protected]>; 'Faustine Comstock' <[email protected]>; 'Robert Cowan' <[email protected]>; 'Joan Cross' <[email protected]>; 'Don Erba' <[email protected]>; 'Lee Fagot' <[email protected]>; 'Leslie Finch' <[email protected]>; 'Karyn Gramling' <[email protected]>; 'R &L Hallinan' <[email protected]>; 'Mary Harvey' <[email protected]>; 'Stacey Hein' <[email protected]>; 'Nancy Hernandez' <[email protected]>; 'Margaret Hokeness' <[email protected]>; 'Garry Holst' <[email protected]>; 'Patti Hughes' <[email protected]>; 'Rupar Iyar' <[email protected]>; 'Jubie Jaramillo' <[email protected]>; 'Troy Jaramillo' <[email protected]>; 'Nancy Jobe' <[email protected]>; 'Sally Jones' <[email protected]>; 'Judy Peterson' <[email protected]>; 'Susan Kankel' <[email protected]>; 'Bonnie Knopf' <[email protected]>; 'Carrie Knopf' <[email protected]>; 'Phil Knopf' <[email protected]>; 'William Lasher' <[email protected]>; 'Theresa Leiker' <[email protected]>; 'Steve Leonardis' <[email protected]>; 'Celine Leroy' <[email protected]>; 'Barbara Mesa' <[email protected]>; 'Mike' <[email protected]>; 'Olga Montserratt' <[email protected]>; 'Pearl Norton' <[email protected]>; 'Sally Paolini' <[email protected]>; 'Judy Peckler' <[email protected]>; 'Gwen Pinkston' <[email protected]>; 'Diana Pleasant' <[email protected]>; 'Gladie Rabitz' <[email protected]>; 'Joe Rodgers' <[email protected]>; 'Travis Rodgers' <[email protected]>; 'Marshall Smith' <marshall@mbmsmith.com>; 'Doug Sporleder' <[email protected]>; 'Vicki Thorburn' <[email protected]>; 'Kirsten Trapani' <[email protected]>; 'Terri Trotter' <[email protected]>; 'Kathy Tumason' <[email protected]>; 'Susan Tuttle' <[email protected]>; 'Carol Wallace' <[email protected]>; 'Kim Wasserman' <[email protected]>; 'Lucy Wedemeyer' <[email protected]>; 'Dave Wilde' <[email protected]>; 'Kathy Winkelman'

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<[email protected]>
Subject: RE: alarming information regarding HDL requiring immediate action Dear Robert Schultz,
and Rob Rennie, Maria Ristow, Mary Badame, Matthew Hudes, Marico Sayoc, Laurel Prevetti My name is Lisa Harris and I have been a homeowner in Los Gatos for over 20 years. I am part of a growing collective group of concerned residents in Los Gatos called CAD, Community Against Dispensaries.

Recently we were made aware that the town of Los Gatos hired a Cannabis management company called HDL for initial consultation services.

I looked on the HDL website to learn more about the cannabis management company that The Town of Los Gatos gave $50,000 to. I want to quote what HDL said on their website regarding the companies “Regulation, Development, and Support services.”
“HDL, will help you develop cannabis regulations that maximize agency economic benefits while providing a framework for cannabis businesses to operate successfully. Services include fiscal analysis, land-use regulation development, regulatory and tax ordinance drafting, and ballot resolution preparation.” This is a biased for profit agency with regards to the cannabis industry. HDL plays a core part in orchestrating the approval of commercial cannabis businesses in towns.

Upon further research I discovered that essentially they are a full service company that has contracts with towns over the course of many years . HDL makes the bulk of their profits off of towns if they allow cannabis businesses to operate. They also will work with cannabis companies in a towns jurisdiction on an ongoing basis to make sure the town is receiving their taxes. HDL is essentially a biased pro- cannabis company. If we don’t allow cannabis in the town of Los Gatos, than HDL can’t provide billable services.

It’s in HDL’s best interest to convince the town of LG to allow cannabis businesses to operate. David Mc Pherson, Cannabis Compliance Director for HDL said in an interview with mjbizdaily.com, “ It makes no sense for this firm not to want cannabis businesses to succeed in the jurisdictions where it has contracts”
According to consulting.us, the town of San Bernadino originally had a 5 year $750,000 contract with HDL. HDL was going to audit and oversee regulations of the cannabis businesses in the town. San Bernadino shortened the contract to 1 year at $150,000 . Here’s the interesting part. It was reported in the consulting.us article that “The remaining 4 year contract($600,000) will be paid using fees collected from various Cannabis Businesses during the commercial licensing process.” So HDL also bills cannabis businesses for providing their services, in addition to billing towns. This contradicts what Andy Nickerson President of HDL wrote in the cover letter to Robert Schultz Town Attorney on January 24, 2022.

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Nickerson wrote , “HDL works solely with public agencies and has no private-sector clients in the cannabis industry”
In other words, HDL manages to still get paid by the local cannabis businesses even though a town might change their mind and not want a 5 year contract. No matter how you look at this, HDL’s sole fiscal survival is dependent upon towns allowing cannabis businesses.

In addition, HDL has no concern regarding for safety for the communities. In an interview by The Californian the question to David Mc Pherson was asked, “Is public concern common in communities?” Mc Pherson answered, “They keep bringing it back to schools and kids but look at the state law, and public safety, and law enforcement. It has so little concern of manufacturing ( growing operations) being an issue.” HDL looks for legal loopholes or rewrites the town ordinances to get the cannabis businesses in the towns anyway they can.

In the 1/24/22 proposal by HDL it said that the “Town Attorney held a series of 10 meetings with various community groups to gather input from the public. The majority of the public in attendance expressed an interest in allowing cannabis businesses within the town.” CAD is requesting information as to who attended those 10 meetings? This meeting ,to our knowledge, was never publicized within the community for the town to ”gather Input.” Furthermore, a survey was done recently by Surveymonkey asking if the town residents wanted dispensaries. Over %60 voted NO.
***CAD is asking Robert Shultz, Laurel Prevetti, or any member from the town council to please answer the following questions;
1) Why did the town council hire HDL knowing that it is a biased for-profit marijuana consultation company?
2) The town already did a survey on Surveymonkey and discovered that over 60% polled were against dispensaries in the town of Los Gatos. Your constituents have spoken. Why did the town hire HDL anyways?
3) In the future, How will you be communicating your intentions regarding allowing dispensaries in town?
4)Robert Schultz, Who were those 10 groups that you met with that expressed an interest in allowing cannabis businesses within the town?

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5) What is the long term financial commitment that the town expects to spend with HDL if dispensaries are allowed?
***CAD is making a formal request asking the town to terminate it’s contract with HDL and find an unbiased consultation firm that doesn’t have any financial stake in the outcome of the survey.

CAD is just getting started, this group has evolved and grown so quickly in spite of not advertising in our local communication resources or social media. We haven’t even gotten the word out to all of the parents in our local schools yet. I can guarantee you that there will be many concerned parents asking why does the town council and it’s leaders think having dispensaries in our town will enhance our quality of life.

Kind regards,
Lisa Harris
From: [email protected] <[email protected]>
Sent: Thursday, May 12, 2022 5:36 PM
To: 'Joanne Rodgers' <[email protected]>; 'Joe Rodgers' <[email protected]>; Rob Rennie <[email protected]>; Maria Ristow <[email protected]>; Mary Badame <[email protected]>; Matthew Hudes <[email protected]>; Marico Sayoc <[email protected]>; Robert Schultz <[email protected]>; Laurel Prevetti <[email protected]>; Cannabis <[email protected]> Cc: 'Karla Albright' <[email protected]>; 'Sue Anawalt' <[email protected]>; 'Don Arnaudo' <[email protected]>; 'Rose Arnaudo' <[email protected]>; Mary Badame <[email protected]>; 'Dru Barth' <[email protected]>; 'Jim Barth' <[email protected]>; 'Kathy Bays' <[email protected]>; 'Michael Bays' <[email protected]>; 'Celia Bell' <[email protected]>; 'Joanne Benjamin' <[email protected]>; 'Marty Berk' <[email protected]>; 'Toni Blackstock' <[email protected]>; 'Jeffrey P. Blum' <[email protected]>; 'Nancy Boesenberg' <[email protected]>; 'Diana Bond' <[email protected]>; 'Franklin Bondonno' <[email protected]>; 'Shannon Burnett' <[email protected]>; 'Susan Burnett' <[email protected]>; 'Kelly Campbell' <[email protected]>; 'Julio Casal' <[email protected]>; 'Faustine Comstock' <[email protected]>; 'Robert Cowan' <[email protected]>; 'Joan Cross' <[email protected]>; 'Don Erba' <[email protected]>; 'Lee Fagot' <[email protected]>; 'Leslie Finch' <[email protected]>; 'Karyn Gramling' <[email protected]>; 'R &L Hallinan' <[email protected]>; 'Mary Harvey' <[email protected]>; 'Stacey Hein'

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<[email protected]>; 'Nancy Hernandez' <[email protected]>; 'Margaret Hokeness' <[email protected]>; 'Garry Holst' <[email protected]>; 'Patti Hughes' <[email protected]>; 'Rupar Iyar' <[email protected]>; 'Jubie Jaramillo' <[email protected]>; 'Troy Jaramillo' <[email protected]>; 'Nancy Jobe' <[email protected]>; 'Sally Jones' <[email protected]>; 'Judy Peterson' <[email protected]>; 'Susan Kankel' <[email protected]>; 'Bonnie Knopf' <[email protected]>; 'Carrie Knopf' <[email protected]>; 'Phil Knopf' <[email protected]>; 'William Lasher' <[email protected]>; 'Theresa Leiker' <[email protected]>; 'Steve Leonardis' <[email protected]>; 'Celine Leroy' <[email protected]>; 'Barbara Mesa' <[email protected]>; 'Mike' <[email protected]>; 'Olga Montserratt' <[email protected]>; 'Pearl Norton' <[email protected]>; 'Sally Paolini' <[email protected]>; 'Judy Peckler' <[email protected]>; 'Gwen Pinkston' <[email protected]>; 'Diana Pleasant' <[email protected]>; 'Gladie Rabitz' <[email protected]>; 'Joe Rodgers' <[email protected]>; 'Travis Rodgers' <[email protected]>; 'Marshall Smith' <marshall@mbmsmith.com>; 'Doug Sporleder' <[email protected]>; 'Vicki Thorburn' <[email protected]>; 'Kirsten Trapani' <[email protected]>; 'Terri Trotter' <[email protected]>; 'Kathy Tumason' <[email protected]>; 'Susan Tuttle' <[email protected]>; 'Carol Wallace' <[email protected]>; 'Kim Wasserman' <[email protected]>; 'Lucy Wedemeyer' <[email protected]>; 'Dave Wilde' <[email protected]>; 'Kathy Winkelman' <[email protected]>
Subject: RE: NO dispensaries in Los Gatos

EXTERNAL SENDER
Dear Town Council members,
I am writing to express concern regarding the topic of dispensaries in our town. I have been very outspoken that I think dispensaries will be a detriment to our town. It normalizes marijuana use and makes it more accessible to our youth. According to the Cannabis Research Report July 2020 by the NIH, Marijuana is linked to other substance use disorders.

I would like to warn the council members to not be lulled in to a false sense of security when the dispensaries say that they check ID’s. Yes ,they check ID’s but I can tell you that black market fake ID’s have gotten very sophisticated and they are not only very convincing, but scannable. I know this because I have young adults in the house and I have spoken to many of their friends about this very topic. Some of the young adults have admitted to knowing people who have used their fake ID’s at Airfield and Caliva Dispensaries. Currently a trend in the Los Gatos High School is that students will gain access to alcohol in individual serving cans or bottles; beer, white claw, hard cider, etc. They then will sell them to other students. They are called “Alcohol Brokers”. If we have dispensaries in town, it will only make marijuana more accessible to our youth and a new branch of business called “Pot Brokers” will sprout in our high school. Oh, sorry, that’s already an existing business, they’re called drug dealers.

You will just increase the number of “ Pot Brokers” at Los Gatos High School.

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As our elected representatives of Los Gatos, you have a duty and responsibility to make Safe and Healthy choices for our beloved town and all of it’s members. It will be grossly negligent if you allow dispensaries in our town ,thus making marijuana more accessible to our youth. Simply deciding to allow dispensaries for the sake of money to the town is short sighted and irresponsible. Some of you will be moving on from your position, is this the legacy that you want to leave behind? There’s a price to pay for everything. Our youth depends on you to make the right decision. Vote NO on allowing dispensaries in town.

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<[email protected]>; 'William Lasher' <[email protected]>; 'Theresa Leiker' <[email protected]>; 'Steve Leonardis' <[email protected]>; 'Celine Leroy' <[email protected]>; 'Barbara Mesa' <[email protected]>; 'Mike' <[email protected]>; 'Olga Montserratt' <[email protected]>; 'Pearl Norton' <[email protected]>; 'Sally Paolini' <[email protected]>; 'Judy Peckler' <[email protected]>; 'Gwen Pinkston' <[email protected]>; 'Diana Pleasant' <[email protected]>; 'Gladie Rabitz' <[email protected]>; 'Joe Rodgers' <[email protected]>; 'Travis Rodgers' <[email protected]>; 'Marshall Smith' <marshall@mbmsmith.com>; 'Doug Sporleder' <[email protected]>; 'Vicki Thorburn' <[email protected]>; 'Kirsten Trapani' <[email protected]>; 'Terri Trotter' <[email protected]>; 'Kathy Tumason' <[email protected]>; 'Susan Tuttle' <[email protected]>; 'Carol Wallace' <[email protected]>; 'Kim Wasserman' <[email protected]>; 'Lucy Wedemeyer' <[email protected]>; 'Dave Wilde' <[email protected]>; 'Kathy Winkelman' <[email protected]>
Subject: RE: alarming information regarding HDL requiring immediate action Dear Robert Schultz,
and Rob Rennie, Maria Ristow, Mary Badame, Matthew Hudes, Marico Sayoc, Laurel Prevetti My name is Lisa Harris and I have been a homeowner in Los Gatos for over 20 years. I am part of a growing collective group of concerned residents in Los Gatos called CAD, Community Against Dispensaries.

Recently we were made aware that the town of Los Gatos hired a Cannabis management company called HDL for initial consultation services.

It’s in HDL’s best interest to convince the town of LG to allow cannabis businesses to operate. David Mc

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Pherson, Cannabis Compliance Director for HDL said in an interview with mjbizdaily.com, “ It makes no sense for this firm not to want cannabis businesses to succeed in the jurisdictions where it has contracts”
According to consulting.us, the town of San Bernadino originally had a 5 year $750,000 contract with HDL. HDL was going to audit and oversee regulations of the cannabis businesses in the town. San Bernadino shortened the contract to 1 year at $150,000 . Here’s the interesting part. It was reported in the consulting.us article that “The remaining 4 year contract($600,000) will be paid using fees collected from various Cannabis Businesses during the commercial licensing process.” So HDL also bills cannabis businesses for providing their services, in addition to billing towns. This contradicts what Andy Nickerson President of HDL wrote in the cover letter to Robert Schultz Town Attorney on January 24, 2022.

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1) Why did the town council hire HDL knowing that it is a biased for-profit marijuana consultation company?
2) The town already did a survey on Surveymonkey and discovered that over 60% polled were against dispensaries in the town of Los Gatos. Your constituents have spoken. Why did the town hire HDL anyways?
3) In the future, How will you be communicating your intentions regarding allowing dispensaries in town?
4)Robert Schultz, Who were those 10 groups that you met with that expressed an interest in allowing cannabis businesses within the town?
5) What is the long term financial commitment that the town expects to spend with HDL if dispensaries are allowed?
***CAD is making a formal request asking the town to terminate it’s contract with HDL and find an unbiased consultation firm that doesn’t have any financial stake in the outcome of the survey.

Kind regards,
Lisa Harris
From: Judy McCool <[email protected]>
Sent: Tuesday, May 17, 2022 4:39 PM
To: Cannabis <[email protected]>
Subject: Stores in town

EXTERNAL SENDER
This is ridiculous! I don’t want to live in a town that hosts stores that sell this product! There are plenty of other towns that already host these types of stores! Los Gatos has always been a family town! A town of community. A place where kids walk safely up and down the town streets buying ice cream and pizza.

Without worries from their parents. Because it’s safe- because it’s old fashioned Americana! Selling

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dope is not Americana- it’s stupid -it’s greedy- and it is disgusting that you are trying to normalize this type of business! You will not get my vote- and all who vote for this on our council- can guarantee they’ll be missing my vote for re- election!
Regards,
Judy McCool
Sent from my iPhone
From: Jaydon Barnett <[email protected]>
Sent: Wednesday, May 18, 2022 12:32 PM
To: Cannabis <[email protected]>
Subject: Cannabis and Los Gatos (a good idea)

EXTERNAL SENDER
I am emailing who it may concern regarding of the addition of cannabis business to Los Gatos. I think that this would be a lovely idea and would bring lots of money to the town. Don’t listen to the naysayers !
From: Mary Imig <[email protected]>
Sent: Friday, May 27, 2022 6:23 PM
To: Cannabis <[email protected]>
Subject: cannabis

EXTERNAL SENDER
I agree with allowing legal cannabis sales within Los Gatos From: Grasty, Kristina <[email protected]>
Sent: Wednesday, June 1, 2022 4:13 PM
To: Council <[email protected]>
Subject: A request

EXTERNAL SENDER
Dear Los Gatos Town Council Members,
I am writing to request that cannabis dispensaries not be allowed to operate in the Town of Los Gatos. It is important to be fiscally responsible in government decision-making and makes sense to examine ways to possibly increase revenues to the Town. However, in this case, I strongly believe that “the ends do not justify the means.” Additional revenue (and possible reductions in expenses) can be pursued in other ways than deriving it from cannabis retailers that you might be tempted to permit to operate in town.

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We face enough challenges as it is in trying to raise and educate our children in this community to develop into healthy, meaningfully-engaged young adults. Students are keenly sensitive to and influenced by decisions that adults make and the messages that come from those decisions. Currently, we are experiencing a time of crisis amongst our youth—a time of heightened mental health issues and increased drug overdoses, alongside impacts caused by the pandemic. With this context in mind, it particularly does not seem like the right move to allow cannabis retailers to operate in our town.

The local environment plays a critical role in the propensity for young people to use and abuse substances. Recent research conducted by Firth, et al. (2022) examined the effects of neighborhood contexts on adolescent substance use. They concluded that exposure to a cannabis retail environment, including the presence of a cannabis retailer near one’s school, is associated with influencing cannabis use and the use of manufactured cannabis products, as well as riskier use behaviors, amongst high school-age students.

I have attached some research including that mentioned in this letter as well as some slides showing statistics from recent administrations of the California Healthy Kids Survey revealing some of the challenging issues facing our students who are at statistically significant risk. Let’s work together to try to address these critical issues. Please make a decision in the best interest of our children.

Respectfully,
Kristi Grasty

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Health & Place 75 (2022) 102795
Available online 25 March 2022
1353-8292/© 2022 Elsevier Ltd. All rights reserved.

Retail cannabis environment and adolescent use: The role of advertising and retailers near home and school
Caislin L. Firth a,b,*, Beatriz Carlini a, Julia Dilley b, Katarina Guttmannova c, Anjum Hajat d a Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA b Program Design & Evaluation Services, Multnomah County Health Department & Oregon Public Health Division, Portland, OR, USA c Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, WA, USA d Epidemiology Department, University of Washington, Seattle, WA, USA

ARTICLE INFO
Keywords:

Adolescent substance use
Cannabis
School Environment
Multi-level modeling
Cannabis retailers

ABSTRACT
Youth cannabis use is influenced by overlapping environmental contexts. We examined the associations between proximity to cannabis retailers and seeing cannabis advertisements and cannabis use behaviors in Oregon, a state with adult cannabis legalization. We used 2017 anonymous survey data from 24,154 Oregon 8th and 11th grade students. After adjustments for student and school district characteristics, advertising for 8th graders and presence of a retailer within a mile from school for 11th graders were associated with cannabis use and perceived harm. Additional policy efforts may further reduce youth exposure to cannabis.

Role of funding source
Data collection efforts and work on this paper were supported by the National Institute on Drug Abuse (R01DA039293) awarded to Julia Dilley. In addition, Caislin Firth was supported by the Horowitz Foundation for Social Policy as a 2018 PhD Fellow.

Contributors
All authors contributed to the conceptualization and design of the study. Julia Dilley and Caislin Firth secured funding for the research.

Caislin Firth performed the statistical analysis, presentation of results, and drafted the manuscript. Beatriz Carlini, Julia Dilley, Katarina Guttmannova, and Anjum Hajat provided scientific revisions to the manuscript.

1. Introduction
More than one-third of the US population live in states with legalized production and retail sales of cannabis for adults (21+ years) as of November 2020 (Fertig and Zhang, 2020). There are concerns that the presence of cannabis retail outlets may influence youth by normalizing cannabis use, exposing them to pro-use messages, and increasing availability and variety of cannabis products. Nationally, adolescent treatment admission for cannabis have declined (Mennis, 2020), yet rates of cannabis use disorder among youth (12–17 years) have increased by 25% in states with adult use cannabis laws, despite no measurable increases in youth cannabis use, compared to changes in youth living in states without these laws (Cerda ´ et al., 2020). Disordered cannabis use during adolescence is linked to developing major depression and anxiety (Gobbi et al., 2019). These findings suggest that the modes and products youth are using in legalized states may be influencing increases in disordered use or addiction (Tormohlen et al., 2019).

Manufactured cannabis products such as edibles and concentrates, used for dabbing and vaping, account for a substantial and growing share of cannabis retail sales (Firth et al., 2020b). Adult cannabis consumers were more likely to consume edibles, use concentrates, particularly for vaping, and use these products more frequently if they lived in legalized states, compared to adults living in states without legal access (Hammond and Goodman, 2020). Manufactured cannabis products typically contain high doses of THC (Raber et al., 2015) which may lead to adverse experiences like panic attacks, anxiety, or acute psychotic episodes (Cao et al., 2016; Kim and Monte, 2016). Calls to U.S. poison centers for manufactured cannabis products are increasing (Dilley et al., 2021) and there is some evidence of increases in underage use of these products (Tormohlen et al., 2019). For adolescents, use of manufactured * Corresponding author.1107 NE 45th St Suite 120, Seattle, WA, 98105, USA.

E-mail addresses: [email protected] (C.L. Firth), [email protected] (B. Carlini), [email protected] (J. Dilley), [email protected] (K. Guttmannova), anjumh@ uw.edu (A. Hajat).

Contents lists available at ScienceDirect
Health and Place
journal homepage: www.elsevier.com/locate/healthplace
https://doi.org/10.1016/j.healthplace.2022.102795
Received 22 October 2021; Received in revised form 10 March 2022; Accepted 15 March 2022

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Health and Place 75 (2022) 102795
2 products creates specific concerns. In addition to general adverse effects of cannabis use in adolescence on cognitive, socio-emotional and physical health, high doses of THC may also amplify youth risk for developing psychotic and cannabis use disorders (van der Steur et al., 2020).

Environment plays a key role in adolescent substance use, including through exposure to retail outlets and advertising (Bostean et al., 2016; Cederbaum et al., 2015). Substance use behaviors often initiate during adolescence and are influenced by overlapping social and built environment contexts: where adolescents live, study, and socialize (Huang et al., 2020). Estimating the simultaneous effects of school and neighborhood contexts on adolescent substance use is a growing area of research (Huang et al., 2020). For example, liquor store density around adolescents’ homes has been correlated with binge drinking (Chen et al., 2010) and tobacco outlet density with cigarette use (Finan et al., 2019).

Similarly, retail outlet density around schools has also been correlated with substance use: having vaping stores near high schools was associated with adolescent e-cigarette use (Giovenco et al., 2016). In addition to their presence, advertising related to these markets may also influence underage product use and perceptions of harm (Giovenco et al., 2016). Consistent with studies that have examined the influence of tobacco and alcohol advertising exposure on behaviors (DiFranza et al., 2006; Finan et al., 2020), recent studies of retail cannabis advertising exposure, both online and on storefronts, have shown associations with adolescent cannabis use (Fiala et al., 2020) and intentions to use (Hust et al., 2020).

Oregon was one of the first states to legalize adult use and establish a retail cannabis market, where legal sales began in October 2015. Unincorporated counties and cities within Oregon can prohibit cannabis retailers and manufactures from operating in their jurisdictions. After the first year of licensed cannabis retailers, 96% percent of the Oregon state population lived in a county with at least one retailer (Dilley, 2022). To protect youth, Oregon requires cannabis retailers to be at least 1000 feet (i.e., 0.19 miles) from schools, and restricts advertisements that appeal to children (e.g., ads that feature cartoons or images of minors) (Fiala et al., 2020). Previous work has demonstrated that county-level density of cannabis retailers in Oregon was associated with adolescent cannabis use (Paschall and Grube, 2020) and more than half of Oregon’s 8th and 11th graders have seen cannabis advertising in the past month (Fiala et al., 2020). However, no study has simultaneously examined proximity of retailers from home and school environments and exposure to cannabis advertising as related to adolescent cannabis behaviors.

The present study is guided by developmental socio-ecological and life-course theories (e.g., Bronfenbrenner, 1977; Catalano and Hawkins, 1996; Elder, 1998) that recognize development is embedded in multiple interconnected contexts that may independently and jointly influence behaviors; moreover, the salience of these ecological contexts and the interactional associations among them and the developing individual can change over time. This theoretical framework has been used widely in the study of etiology of substance use behaviors (for review, see e.g., Nargiso et al., 2015; Trucco, 2020) as well as in the planning of prevention and intervention efforts aimed at reducing adolescent substance use and promoting adolescent health (e.g., (Catalano et al., 2012; Corbett, 2001; Hawkins et al., 1992). Regarding cannabis use, macro-level contexts that include societal forces such as state-level legalization of cannabis may influence other, more proximal, contexts such as schools and communities in which the lives of adolescents are embedded and which in turn may increase the risk of adolescent substance use (Catalano et al., 2018; Johnson and Guttmannova, 2019). For example, the commercialization of cannabis may influence adolescent use by increasing access to cannabis and variety of manufactured products near schools and their homes and also by promoting – through advertising – beliefs that cannabis use is safe and normative (D’Amico et al., 2015; Lipperman-Kreda and Grube, 2018). The objective of this study is to assess whether multidimensional cannabis environment measures are associated with youth cannabis use and perceptions of harm caused by cannabis. We hypothesize that 8th and 11th grade students who live or go to school near cannabis retailers and students who have reported seeing cannabis advertising on storefronts will be more likely to use manufactured cannabis products available in retail stores (e.g., edibles, vapes, concentrates) than students attending schools in different environments.

2. Methods

2.1. Data sources
This multi-level cross-sectional study drew from three existing data sources. First, Oregon Healthy Teens (OHT) is an anonymous, schoolbased survey administered to 8th and 11th grade students during oddnumbered school years (Oregon Health Authority, n.d.). Surveys are intended to monitor the health and well-being of Oregon youth and include questions specific to cannabis use. During the 2016–2017 school year, 84 Oregon school districts participated in the survey; representing 68% of the statewide population. When weighted, survey data are representative of all students in the state of Oregon. Our analysis used unweighted OHT data to understand how students’ exposures to cannabis environment, at the school and school district level, were associated with cannabis outcomes. Second, addresses for licensed cannabis retail outlets were obtained from the Oregon Liquor Control Commission (OLCC), a state agency that regulates the market, on June 16th, 2017 (Oregon Liquor Control Commission, 2017). Third, we obtained school building addresses from the Oregon Department of Education (ODE) and school district demographic data from ODE’s 2016–2017 School District Report Cards (Oregon Department of Education, 2019). This study was determined as exempt from review by the Oregon State Institutional Review Board.

2.2. Measures
We examined five cannabis-related outcomes: four modes of cannabis use (smoking, dabbing, eating (i.e., using edibles), and vaping) and perceived harm of cannabis use, which is a risk factor for future cannabis use. To assess modes of cannabis use, students who reported any cannabis use in the past 30 days were asked how they consumed cannabis (multiple responses were allowed so students could indicate all the ways they had used). We created a binary variable for each cannabis mode (1: used that mode 1+ times in the past 30 days, 0: did not use that mode in the past 30 days or did not use any cannabis in the past 30 days).

Our fifth outcome was perceived harm (1: moderate or great risk, 0:
slight or no risk), from responses to the question “How much do you think people risk harming themselves (physically or in other ways) if they use cannabis at least once or twice a week?” Dichotomizing the perceived harm outcomes aligns with reporting from the National Survey on Drug Use and Health (Mariani and Williams, 2021).

2.3. Cannabis retail environment measures
We developed two proximity-based measures–for school and community–and one advertising measure to capture different aspects of the Oregon retail cannabis environment in 2017. We relied on built environment, social ecology, and adolescent health research, including the roles of tobacco and cannabis retailers, to inform how we operationalized proximity to cannabis retailers from school and community. Prior work has used data-driven and contextual approaches to determine thresholds for calculating cannabis retailer exposure. Such methods include using percentiles to create cut points from the distribution of distances to outlets (e.g., categorized cannabis retailer access by ventiles (Everson et al., 2019)), counting the number of retailers at administrative spatial units (e.g. number of retailers within Portland, Oregon, neighborhoods (Firth et al., 2020a)), or proximity to a retailer by road C.L. Firth et al.

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3 network distance (e.g., at least one retailer within 1 or 2 km, 0.6 to 1.2 miles, from home (Rhew et al., 2022)). Beyond cannabis research, built environment features, such as recreational facilities, that are within 2 km of home were correlated with youth physical activity (Loh et al., 2019), and tobacco outlets within ¾ and 1 mile from home were associated with smoking frequency (Lipperman-Kreda et al., 2014). A walkable neighborhood includes amenities that are within a 1-mile or 20-min walk from home (Talen and Koschinsky, 2013). These studies were conducted in urban areas which may not be generalizable to youth living in rural communities. Data from the 2017 U.S. National Household Travel Survey points to differences in travel behaviors between youth living in urban and rural areas, such as, 29% of rural students walk to school when it’s within a mile compared to 22% of urban students (Kontou et al., 2020). Based on these studies, we operationalized proximity as having at least one cannabis retailer within 1 mile from school or at the community-level, using a dichotomized measure in analysis. We chose a 1-mile buffer, as opposed to a shorter threshold, because half of the Oregon school districts included in our study were in rural counties (40/82 districts), where population and road network density is lower than in metropolitan areas.

The school-based measure approximated exposure to retailers around students’ schools. Retailers’ distance from school buildings was calculated from the minimum Euclidean distance between edge of school campus and cannabis retailer. Addresses were geocoded in ArcGIS Pro, and the Near tool was used to calculate distance. Proximity to a school building was dichotomized as 1: <1 mile; 0: ≥1 miles. The school proximity measure was joined to OHT survey data by school.

The school district area (community) measure approximated exposure to retailers near students’ homes. School district areas are catchment areas for Oregon public schools. Community proximity was assessed as the minimum distance to a cannabis retailer, on average, at the school district area-level. This method has been used previously to calculate zip code-level proximity to cannabis retailers (Everson et al., 2019). Community proximity was created with three steps. First, a grid of 5000 square-foot cells was overlaid on the state of Oregon and the minimum distance between the center of each grid cell and geocoded cannabis retailer was calculated. We used a 5000 square-foot resolution to create aggregate measures for different administrative spatial scales (e.g., school districts, zip codes) that do not align with census-defined boundaries (e.g., census tracts). Then, we joined 2010 U.S. Census data to weigh each grid cell by population. Finally, these weighted measures were aggregated to the school district-level and represent the average proximity of all grid cells across the district. The final variable was dichotomized as 1: average proximity was <1 mile and 0: average proximity ≥1 mile and linked to OHT survey data by school district.

Exposure to cannabis storefront advertising was based on the OHT question: had students seen “advertisement for marijuana products or stores: on a storefront or on the sidewalk (like signs or people wearing/ waving signs)” in the past 30 days. Advertising exposure was coded ‘1’ for students who reported seeing storefront advertisements and ‘0’ for students who did not report seeing any advertisement or were unsure they had seen a relevant ad.

2.3.1. Socio-demographic characteristics
We adjusted for student gender (male, female, non-binary), race/ ethnicity (non-Latinx white, Asian, Native Hawaiian/Pacific Islander, Black/African American, American Indian/Alaska Native, and multiracial, and Latinx), socioeconomic status, and whether an adult used cannabis at home in our multi-level logistic regression models. Student socioeconomic status was measured with the Family Affluence scale (Currie et al., 2008) by aggregating responses from four questions:
whether the student’s family owns a car, traveled on vacation in the past year, how many computers they own, and whether the student has their own bedroom. The distribution of the family affluence scale was divided into tertiles: ranging from “least” to “most” affluence.

We used ODE data to adjust for school district-level characteristics that represent the environments where students lived, including proportion of students who are economically disadvantaged (i.e., students who are eligible for free or reduced lunch) and proportion of non-Latinx white students for each grade. We selected these two measures because cannabis retailers were more common in economically disadvantaged neighborhoods in Portland, Oregon (C. Firth et al., 2020), and students of color were more likely to receive exclusionary discipline compared to white students in Oregon (Burke and Nishioka, 2014) which may influence their willingness to respond to questions on substance use. In addition, we included a county density variable, based on whether the school district was within an urban or rural/frontier county, using the Oregon Office of Rural Health Geographic Definitions (Oregon Health & Science University, n.d.).

2.4. Statistical analysis
First, we described the socio-demographic characteristics of students using weighted data to be representative of students in the state. Then, we used unweighted survey data in multi-level logistic regression models to assess the relationships between cannabis retailer environment and our five cannabis outcomes. Survey weights are intended for statewide prevalence estimates and were not appropriate for our inferential analysis that examined individual-level cannabis outcomes within schools and school districts. We stratified our models by grade, because 8th grade students attended middle schools and 11th graders in high schools. In each model, we included the three cannabis retail environment measures and adjusted for individual-level socio-demographic (gender, race/ethnicity, socioeconomic status, adult used cannabis at home) and school district-level (% economically disadvantaged, % nonLatinx white, urban school district) covariates.

We included random intercepts at the school and school district levels to account for clustering between students within the same school and district and estimate the contextual effects of these environments.

The results of our fixed effects are reported as prevalence odds ratios (PORs) and interpreted as the prevalence of each cannabis outcome among students exposed to each retail environment measure compared to students who were not exposed. We presented the school and school district level random intercepts on the logit scale and as median odds ratios (MOR) (Merlo et al., 2006), which can be interpreted like an odds ratio, and correspond to the median value of school and school district level residuals for each outcome. It helps to understand variation in outcomes that were not explained by other model covariates. A MOR >1.0 suggests that different environments, such as schools where cannabis use is more common, is correlated with the probability that a student would adopt the behavior.

In addition, we conducted sensitivity analyses that considered proximity to retailers from schools and at the school-district level at ½ mile, ¾ mile, and 2 mile thresholds. All analyses were conducted in Stata/IC 15.1.

3. Results
Our study included 24,154 students who completed the 2016–2017 OHT survey and responded to question on cannabis use in the past 30 days (11.0% or 1628 8th graders and 8.1% or 965 11th graders skipped cannabis questions, see Supplemental Table 1 for analysis of missing survey data). Student demographic characteristics are summarized in Table 1.

Cannabis use in the past 30 days was more common among 11th grade students (20.3%) than 8th graders (6.5%). Smoking cannabis was the most common mode in both grades, 87.6% of 8th grade and 92.1% of 11th grade cannabis users smoked. Over 40% of cannabis users in either grade reported using manufactured products in the past 30 days (i.e., dabbing, using edibles, and/or vaping cannabis products, Table 2), and 86% of students who used manufactured cannabis products also smoked cannabis in the past month (data not shown). The most common C.L. Firth et al.

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4 manufactured products used were edibles by 8th graders and dabs by 11th graders. Most 8th grade students perceived cannabis use as harmful (62.7%), and about half of 11th graders (48.1%).

The average distance between a school and cannabis retailer in Oregon during 2017 was 8.7 miles (range: 0.3 miles to 159.6 miles, data not shown). Using the community proximity measure, students lived an average of 6.3 miles from a retailer (range: 0.5 miles to 117.6 miles, data not shown). There was no pattern in retail proximity by grade: 31.8% of 8th grade students and 32.1% of 11th graders had a cannabis retailer within 1 mile of their school, and about half as many lived in communities where cannabis retailers were within 1 mile of homes (15.3% among 8th grade and 12.1% among 11th grade students, Table 2).

Seeing storefront cannabis advertising was more common than living or going to school near a retailer; 35.9% of 8th grade students and 41.5% of 11th grade students reported seeing advertising in the past 30 days.

3.1. Associations for 8th grade students
None of the five cannabis outcomes were significantly associated with middle schools that had a cannabis retailer within 1 mile away (Table 3, full model results in Supplemental Table 2). Though, community proximity was associated with perceiving cannabis as less harmful (POR: 0.79, 95% CI: 0.66,0.94). Exposure to cannabis storefront advertising was associated with all five outcomes; the prevalence of using edibles, dabbing, or vaping cannabis was almost twice as high for students who reported seeing advertising compared to students who did not see advertising (used edibles POR: 1.80, 95% CI: 1.34,2.42; dabbed POR: 1.94, 95% CI: 1.40,2.69; vaped POR: 1.85, 95% CI: 1.23,2.78).

Advertising exposure was also associated with smoking cannabis (POR:

1.31, 95% CI: 1.11,1.55) and perceiving cannabis as less harmful (POR:

0.87, 95% CI: 0.80,0.95).

The residual heterogeneity between schools, as measured by MOR, was 1.83 in the edible model (Table 3) and can be interpreted as similar students may be nearly twice as likely to use edibles if they are in a school where edible use was more common. Similarly, school environment was associated with smoking, dabbing, and perception of harm, but not vaping.

3.2. Associations for 11th grade students
The prevalence of 11th grade students using edibles, dabbing, and smoking cannabis, but not vaping, were significantly associated with having a cannabis retailer within one mile of high school (Table 4, full Table 1
Demographic characteristics of Oregon 8th and 11th grade students who responded to cannabis questions on the Oregon Healthy Teens survey, 2016–2017.
8th grade students
N = 13,224
11th grade students
N = 10,930
Individual student
characteristics
Unweighted
count
Weighted
%
Unweighted
count
Weighted
%
Gender
Male 6111 45.9% 4945 45.4%
Female 6389 49.0% 5340 49.0%
Non binary/gender
nonconforming
665 5.1% 613 5.7%
Race/ethnicity
Non Latinx (NL)
American Indian/
Alaska Native
493 3.6% 224 2.2%
NL Asian 517 4.1% 412 3.7%
NL Black/African
American
280 2.2% 216 2.1%
NL Native
Hawaiian/Pacific
Islander
121 0.9% 92 0.9%
Latinx 3161 27.4% 2416 24.3%
NL Multiracial 520 4.1% 338 3.1%
NL White 7645 57.8% 6938 63.6%
Socio-economic status (Family Affluence Scale)
1: Least affluence 1305 10.6% 990 9.8%
2 4047 32.4% 3722 35.0%
3: Most affluence 7511 56.9% 6051 55.2%
Adult use cannabis
at home
2252 17.6% 2041 19.7%
Urban school
district
9626 77.6% 7516 76.7%
Student
characteristics
within School
Districts
median 25th –
75th
percentile
median 25th –
75th
percentile
% of non-Latinx
white students
64% (51%–
77%)
66% (54%–
78%)
% of students
enrolled in free
and reduced
meals programs
53% (42%–
66%)
45% (38%–
55%)
Note: Table 1 describes the student sample in the OHT 2016–2017 survey and uses state-level weights to report statewide prevalance estimates of each sociodemographic factor.

Table 2
Cannabis outcomes and cannabis retail environment measures, Oregon 8th and 11th grade students, 2016–17 school year.
8th grade 11th grade
Unweighted
count
Unweighted
%
Unweighted
count
Unweighted
%
Cannabis outcomes
Used any
cannabis in
the past 30
days
855 6.5% 2224 20.3%
Manufactured
cannabis
product use
(any)
375 2.8% 933 8.5%
Ate 237 1.8% 534 4.9%
Dabbed 202 1.5% 575 5.3%
Vaped 123 0.9% 246 2.3%
Smoked
cannabis
749 5.7% 2049 18.7%
Used 2+
cannabis
modes in past
30 days
314 2.4% 814 7.5%
Smoked +
manufactured
cannabis use
312 2.4% 809 7.5%
Used 2+
manufactured
cannabis
modes and did
not smoke
63 0.5% 124 1.1%
No cannabis use
in past 30 days
12,369 93.5% 8706 79.7%
Perceived
regular
cannabis use
as harmful
7763 62.7% 5054 48.1%
Cannabis retail environment exposures
School building
proximity: < 1
mile to retailer
4163 31.8% 3475 32.1%
School district
area
(community)
proximity: < 1
mile to retailer
2020 15.3% 1326 12.1%
Self reported
storefront
cannabis ad
exposure
4754 35.9% 4541 41.5%
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5 model results in Supplemental Table 3). Specifically, the prevalence of using edibles was 45% higher and dabbing and smoking cannabis were 43% higher among students who attended a high school within 1 mile from a cannabis retailer. Students also perceived cannabis as less harmful when there was a retailer within 1 mile from their high school (POR: 0.71, 95% CI: 0.61,0.83), although the opposite relationship was observed with community proximity (POR: 1.27, 95% CI: 1.01,1.60).

Exposure to storefront cannabis advertising was associated with using edibles, dabbing, and vaping cannabis (POR: 1.40, 95% CI: 1.15,1.70; POR: 1.39, 95% CI: 1.15,1.68; POR: 1.45, 95% CI: 1.10,1.92, respectively), but not smoking or perceptions of harm.

The MOR for schools exceeded 1 in all models, which suggested that normative school environments—schools where students were more likely to engage in cannabis outcomes or perceive cannabis as less harmful—could influence a student’s behavior, even after adjustment for measured cannabis retail environment factors.

3.3. Sensitivity analyses
Relationships between cannabis proximity measures, at the school and school district (community) level, and cannabis outcomes fluctuated with the addition of more restrictive (½ mile and ¾ mile) and less restrictive (2 mile) thresholds. There were 9 schools and 1 community with at least one retailer within ½ mile and 40 schools and 2 communities with a retailer within ¾ mile. Roughly, 60% of our student sample attended school or lived in a community within two miles from a retailer. There were no correlations between school or community level proximity and cannabis outcomes for 8th graders at the ½, ¾, or 2 mile thresholds, this is consistent with results using 1 mile threshold; except for a positive correlation between retailers within ½ mile of school and consuming edibles (POR: 2.63, 95% CI: 1.10,6.30) (Supplemental Table 4). For 11th graders, more restrictive buffers were generally consistent with using a 1-mile threshold; smoking cannabis and consuming edibles were positively correlated with school (at ½ and ¾ mile thresholds) and community proximity (at ½ mile threshold) (Supplemental Table 5). Though, the link between dabbing and school proximity at the 1-mile level was not observed in sensitivity analyses.

Perceived harm of cannabis was negatively correlated with community proximity at the ½ mile threshold and school proximity within ¾ and 2 miles.

4. Discussion
This is the first study to simultaneously consider the links between adolescent cannabis behaviors and various aspects of cannabis retail environment, namely exposure to storefront advertising and access to cannabis retailers at multiple spatial scales. We accounted for students living and attending school near cannabis retailers and examined how these relationships varied by student grade. Furthermore, this study examined use of manufactured cannabis products, which were made more common by the commercialized cannabis industry.

Different aspects of the cannabis retail environment were relevant at different grades. For younger students, community advertising may be a crucial factor. Cannabis use was uncommon among Oregon 8th graders but is slightly higher than national trends (using weighted data for 2017, 7% of Oregon 8th graders reported current cannabis use compared to 6% among 14 and 15 year olds, nationally)(Oregon Public Health Division, 2019; Substance Use and Mental Health Administration, 2019). The national average age for initiating cannabis use is 10th grade (Richmond-Rakerd et al., 2017), yet eighth graders were more likely to smoke, use edibles, dab, or vape cannabis if they had seen storefront advertising in the past month, but living or going to school near a cannabis retailer was not associated with any particular mode of cannabis use. The absence of associations between proximity to retailers and cannabis outcomes was unexpected, but it demonstrates that the presence of cannabis retailers, after adjustment for advertisement Table 3
Associations between cannabis outcomes and retail environment exposures, Oregon 8th grade students, 2016–2017a.

Consumed cannabis
edibles
Dabbed cannabis Vaped cannabis Smoked
cannabis
Moderate/great
risk
School building proximity: < 1 mile to retailer (POR) 1.00 (0.62–1.61) 0.87 (0.56–1.35) 1.21 (0.80–1.84) 0.86 (0.63–1.17) 0.98 (0.85–1.12) School district area (community) proximity: < 1 mile to retailer (POR)

1.30 (0.62–2.76) 1.40 (0.73–2.66) 0.98 (0.54–1.80) 1.44 (0.96–2.15) 0.79 (0.66–0.94) Self reported storefront cannabis ad exposure (POR) 1.80 (1.34–2.42) 1.94 (1.40–2.69)

1.85 (1.23–2.78)

1.31 (1.11–1.55)

0.87 (0.80–0.95)
School-level (MOR) b 1.83 (1.44–2.72) 1.53 (1.22–2.45) . 1.62 (1.45–1.85) 1.22 (1.15–1.31) Note: results of each model are presented as Prevalence Odds Ratio (POR) (95% Confidence Interval). Bold results indicate statistical significance (p-value <0.05). a Each model was adjusted for student covariates (gender, race/ethnicity, socio-economic status, adult used cannabis at home) and school-district covariates (% nonLatinx white students, % economically disadvantaged students, urban school district). Full models are in supplemental materials. b The median value of school-level residuals in each model is reported as the Median Odds Ratio (MOR) and is interpreted like an odds ratio that represent the probabiliy of a cannabis outcome attributed to the school environment.

Table 4
Associations between cannabis outcomes and retail environment exposures, Oregon 11th grade students, 2016–2017a.

Consumed cannabis
edibles
Dabbed cannabis Vaped cannabis Smoked
cannabis
Moderate/great
risk
School building proximity: < 1 mile to retailer (POR) 1.45 (1.05–1.98) 1.43 (1.11–1.83)

1.05 (0.73–1.52) 1.43
(1.14–1.78)

0.71 (0.61–0.83)
School district area (community) proximity: < 1 mile to retailer (POR)

0.71 (0.43–1.17) 0.75 (0.51–1.10) 1.09 (0.65–1.83) 0.87 (0.61–1.23) 1.27 (1.01–1.60) Self reported storefront cannabis ad exposure (POR) 1.40 (1.15–1.70) 1.39 (1.15–1.68)

1.45 (1.10–1.92)

1.09 (0.97–1.21) 1.06 (0.97–1.16)
School-level (MOR)b 1.55 (1.38–1.81) 1.27 (1.13–1.61) 1.37 (1.17–1.88) 1.42 (1.27–1.67) 1.24 (1.17–1.34) Note: results of each model are presented as Prevalence Odds Ratio (POR) (95% Confidence Interval). Bold results indicate statistical significance (p-value <0.05). a Each model was adjusted for student covariates (gender, race/ethnicity, socio-economic status, adult used cannabis at home) and school-district covariates (% nonLatinx white students, % economically disadvantaged students, urban school district). Full models are in supplemental materials. b The median value of school-level residuals in each model is reported as the Median Odds Ratio (MOR) and is interpreted like an odds ratio that represent the probabiliy of a cannabis outcome attributed to the school environment.

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6 exposure, may not influence 8th grade cannabis use. In addition, our sensitivity analyses supported these findings, with the exception that 8th graders who attended schools within ½ mile of a retailer had a higher prevalence of consuming edibles. This finding extends those from a study on medical marijuana advertising which showed that advertising exposure was associated with intentions to use and cannabis use among middle school students(D’Amico et al., 2015). In another study, retail cannabis advertising has been associated with adolescents (13–17 years old) intentions to use cannabis, particularly among adolescents who lived near a cannabis retailer (Hust et al., 2020).

In contrast, 11th graders who attended high school within 1 mile from a cannabis retailer were more likely to use edibles, dab, or smoke cannabis. These findings were consistent with our hypothesis, proximity to retailers would be associated with higher prevalence of cannabis outcomes. In sensitivity analysis, high schools that were within ½ or ¾ mile from retailers was also positively correlated with 11th graders consuming edibles and smoking cannabis. Cannabis advertising was not associated with smoking cannabis or perceived harm among 11th graders. Oregon law requires cannabis retailers to be ≥ 1000 feet from schools (Dilley et al., 2016), yet students still used edibles, dabbed and vaped cannabis which require concentrated products that are sold by cannabis retailers. Existing studies are mixed; evidence from Colorado showed no association between cannabis use and retailers within 2 miles of schools (Harpin et al., 2018) while a study in Los Angeles showed frequent use of concentrated cannabis products (e.g., waxes used for dabbing) even before cannabis retailers were legally operating (Barrington-Trimis et al., 2020). Of note, cannabis use among 11th grade Oregon students is substantially higher than national estimates, using weighted data from 2017, 21% of Oregon 11th graders reported using in the past 30 days compared to 13% among 16 and 17 year olds, nationally, which may affect the generalizability of our study findings outside of Oregon (Oregon Public Health Division, 2019; Substance Use and Mental Health Administration, 2019). Grade differences may be driven by changes in socializing over the course of adolescence that influence cannabis use (Guttmannova et al., 2019), but longitudinal studies are needed to disentangle how this relates to cannabis environment exposures and specific modes of cannabis use.

Having a retailer near home, as measured in our study, was not associated with any mode of cannabis use, except in sensitivity analyses of ½ mile, having a retailer near home was positively correlated with 11th grade edible use and smoking cannabis–exposure was rare, 3.2% of students lived with a retailer within ½ mile. It is possible that our community proximity measure did not adequately capture exposure near homes, or alternatively that it does not contribute meaningfully after inclusion of school proximity. Though, prior work has shown that having a retailer within 1-km, or 0.6 miles, of home was associated with perceived cannabis access and use among young adults living in Washington state (Rhew et al., 2022). However, 8th graders who lived near a cannabis retailer perceived cannabis as less harmful than students who lived farther from retailers (Lipari et al., 2016). This finding is supported by previous ecological studies which found that Oregon counties with licensed cannabis retailers had more students who used cannabis in the past 30 days (Paschall and Grube, 2020) and time-varying proximity to cannabis retailers at the zipcode-level was associated with increased adult cannabis use in Washington state after legalization (Everson et al., 2019).

Our study examined different dimensions of “risky behaviors” for youth rather than “any cannabis use” alone. We examined use of manufactured cannabis products because they are both increasingly available in legal cannabis outlets and pose potentially more health risks for adolescents than using dried cannabis flower due to higher THC concentration. Our finding that using these specific products increased with exposure to retail environments supports the concern that retail environments are influencing not only any underage cannabis use, but also riskier use behaviors. Though we did not assess how youth obtained different cannabis products, our findings suggest that legal efforts to curb youth exposure through land use and advertisement restrictions may not be enough to prevent youth from using cannabis products that are sold in licensed adult-use retailers. We also examined perceived harm because reductions in perception of harm from cannabis use are associated with future likelihood of use. In our study, community proximity to cannabis retailers was linked to reduced perceptions of risk among younger students, but increased perceptions of risk among older students. This paradox could be explained by education efforts targeted toward high school students in communities with cannabis markets, or it may be spurious. Future studies should examine consumption patterns in more detail (e.g., days used per month) to further inform understanding about how retail environments affect youths’ perceptions of risk and subsequent behavior choices.

Data collection for our study took place during the 2016-17 school year, one year after legal retail sales began in Oregon (October 2015).

Other studies have documented that reported exposure to cannabis marketing was very prevalent among young people at this time (Fiala et al., 2020). One consideration when interpreting our study’s findings is that data collection occurred when the market was still relatively “new”; thus, advertising from this nascent industry may be more noticeable.

The influence of cannabis retail markets on youth may change as the market becomes more established. Further study in different settings and over time is needed.

4.1. Limitations
Some limitations need to be considered when interpreting the findings of our study. First, the cross-sectional design limits the ability to infer a temporal relationship between cannabis retail environment and underage cannabis use and perceptions of harm. For example, students who already use cannabis may be more likely to notice cannabis advertising compared to students who do not use, or more cannabis retailers may be in areas with higher underage cannabis use. Second, licensed retailers are likely not the only source of cannabis for youth.

Despite efforts to eliminate prominent unlicensed cannabis retailers, illicit markets are difficult to monitor. In addition, Oregon allows for adults (21+ years) to grow cannabis at home and store useable product, which could be another unmeasured source for youth (Dilley et al., 2016). Influence of these other sources would likely have attenuated our findings. Third, we relied on students to self-report cannabis use, and students may be less forthcoming given that underage cannabis use is illegal. Using school-based survey data also limits the generalizability of findings. Youth who have dropped out of school or are institutionalized are excluded from the OHT survey and are also at higher risk of substance use (Tice, 2013). Last, modeling specific modes of cannabis use, particularly for rare outcomes like vaping (less than 2% of students reported vaping in the past 30 days), may have contributed to the wide confidence intervals of our estimates.

There is no ‘gold standard’ for calculating GIS-based cannabis retailer exposures or proximity measures. Different contexts, across places and populations, will likely require different distance-based thresholds. For example, larger buffers may be more relevant in studies among young adults because the size of activity spaces tend to decline with age (Morency et al., 2011). While car-dependent metropolitan areas may rely on thresholds derived from driving times, whereas areas with greater population and amenity density may use road network buffers, at relatively smaller spatial scales. Despite work in this area being heterogeneous, our study adds two contributions: 1) measuring proximity to cannabis retailers at two spatial scales, representing different environmental contexts that influence adolescent behaviors (Johnson and Guttmannova, 2019), and 2) including sensitivity analyses, using different distance-based thresholds, to assess the robustness of our findings.

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7 5. Conclusion
We found that exposure to Oregon’s cannabis retail environment was correlated with adolescent cannabis use and beliefs in 2017, including specifically use of manufactured cannabis products that are becoming common in a legal cannabis market. Younger student cannabis use was most often linked to cannabis advertising exposure, while older student cannabis use was more common among students who attended high schools within 1 mile from a cannabis retailer. These findings have direct implications for policy makers as they develop rules for where cannabis retailers operate and how they are allowed to advertise, while also protecting the health of youth. Furthermore, findings related to youths’ perception of harm suggest that prevention and intervention efforts should include education about the effects of cannabis use and specific products on adolescents.

Declaration of competing interest
The authors report no declarations of interest.

Acknowledgements
The authors wish to acknowledge Julie E. Maher, PhD, Director of Program Design & Evaluation Services (PDES), Multnomah County Health Department & Oregon Public Health Division for their critical review of the article. We would also like to thank Curtis E. Mack, Looking Glass Analytics, and Susan M Richardson, PDES, for assembling cannabis retailer data.

Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi. org/10.1016/j.healthplace.2022.102795.

References
Barrington-Trimis, J., Cho, J., Ewusi-Boisvert, E., Hasin, D., Unger, J.B., Miech, R.A., Adam, M., Leventhal, P., 2020. Risk of persistence and progression of use of 5 cannabis products after experimentation among adolescents. JAMA Netw. Open 3. https://doi.org/10.1001/jamanetworkopen.2019.19792.

Bostean, G., Crespi, C.M., Vorapharuek, P., McCarthy, W.J., 2016. E-cigarette use among students and e-cigarette specialty retailer presence near schools. Health Place 42, 129–136. https://doi.org/10.1016/j.healthplace.2016.09.012.

Bronfenbrenner, U., 1977. Toward an experimental ecology of human development. Am.

Psychol. 32.

Burke, A., Nishioka, V., 2014. Suspension and Expulsion Patterns in Six Oregon School Districts Key Findings.

Cao, D., Srisuma, S., Bronstein, A.C., Hoyte, C.O., 2016. Characterization of edible marijuana product exposures reported to United States poison centers. Clin. Toxicol. 54, 840–846. https://doi.org/10.1080/15563650.2016.1209761.

Catalano, R.F., Fagan, A.A., Gavin, L.E., Greenberg, M.T., Irwin, C.E., Ross, D.A., Shek, D.

T., 2012. Worldwide application of prevention science in adolescent health. Lancet 379, 1653–1664. https://doi.org/10.1016/S0140-6736(12)60238-4.

Catalano, R.F., Hawkins, J.D., 1996. The social development model: a theory of antisocial behavior. In: Cambridge Criminology Series. Delinquency and Crime:

Current Theories. Cambridge University Press, pp. 149–197.

Catalano, R.F., Speaker, E.C., Skinner, M.L., Bailey, J.A., Hong, G., Haggerty, K.P., Guttmannova, K., Harrop, E.N., 2018. Risk factors for adolescent marijuana use. In:

Contemporary Health Issues on Marijuana. Oxford University Press, pp. 219–235. https://doi.org/10.1093/med-psych/9780190263072.003.0009.

Cederbaum, J.A., Petering, R., Katherine Hutchinson, M., He, A.S., Wilson, J.P., Jemmott, J.B., Sweet Jemmott, L., 2015. Alcohol outlet density and related use in an urban Black population in Philadelphia public housing communities. Health Place 31, 31–38. https://doi.org/10.1016/j.healthplace.2014.10.007.

Cerd´a, M., Mauro, C., Hamilton, A., Levy, N.S., Santaella-Tenorio, J., Hasin, D., Wall, M.

M., Keyes, K.M., Martins, S.S., 2020. Association between recreational marijuana legalization in the United States and changes in marijuana use and cannabis use disorder from 2008 to 2016. JAMA Psychiatr. 77, 165–171. https://doi.org/

10.1001/JAMAPSYCHIATRY.2019.3254.

Chen, M., Grube, J.W., Gruenewald, P.J., 2010. Community alcohol outlet density and underage drinking Meng-Jinn. Addiction 105, 270–278. https://doi.org/10.1111/ j.1360-0443.2009.02772.x.Community.

Corbett, K.K., 2001. Susceptibility of youth to tobacco: a social ecological framework for prevention. Respir. Physiol. 128, 103–118. https://doi.org/10.1016/S0034-5687 (01)00269-9.

Currie, C., Molcho, M., Boyce, W., Holstein, B., Torsheim, T., Richter, M., 2008.

Researching health inequalities in adolescents: the development of the health behaviour in school-aged children (HBSC) family affluence scale. Soc. Sci. Med. 66, 1429–1436. https://doi.org/10.1016/j.socscimed.2007.11.024.

D’Amico, E.J., Miles, J.N.V., Tucker, J.S., 2015. Gateway to curiosity: medical marijuana ads and intention and use during middle school. Psychol. Addict. Behav. 29, 613–619. https://doi.org/10.1037/adb0000094.

DiFranza, J.R., Wellman, R.J., Sargent, J.D., Weitzman, M., Hipple, B.J., Winickoff, J.P., 2006. Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality. Pediatrics. https://doi.org/10.1542/peds.2005–1817.

Dilley, J., 2022. From Gray Market to Green: Describing Changes in Cannabis Outlet Distribution between Washington State’s Unregulated Medical Market and Legal Retail Market.

Dilley, J., Fiala, S., Everson, E., Firth, C., Maher, J., 2016. Marijuana Report. OR, Portland.

Dilley, J.A., Graves, J.M., Brooks-Russell, A., Whitehill, J.M., Liebelt, E.L., 2021. Trends and characteristics of manufactured cannabis product and cannabis plant product exposures reported to US poison Control centers, 2017-2019. JAMA Netw. Open 4, e2110925. https://doi.org/10.1001/JAMANETWORKOPEN.2021.10925 e2110925.

Elder, G.H., 1998. The life course as developmental theory. Child Dev. 69, 1. https://doi. org/10.2307/1132065.

Everson, E.M., Dilley, J.A., Maher, J.E., Mack, C.E., 2019. Post-legalization opening of retail cannabis stores and adult cannabis use in Washington state, 2009-2016. Am. J.

Publ. Health 109, 1294–1301. https://doi.org/10.2105/AJPH.2019.305191.

Fertig, N., Zhang, M., 2020, 1 in 3 Americans now lives in a state where recreational marijuana is legal - POLITICO [WWW Document]. Politico. URL. https://www.politi co.com/news/2020/11/04/1-in-3-americans-lives-where-recreational-marijuanalegal-434004. (Accessed March 2020).

Fiala, S.C., Dilley, J.A., Everson, E.M., Firth, C.L., Maher, J.E., 2020. Youth exposure to marijuana advertising in Oregon’s legal retail marijuana market. Prev. Chronic Dis. https://doi.org/10.5888/PCD17.190206.

Finan, L.J., Lipperman-Kreda, S., Abadi, M., Grube, J.W., Kaner, E., Balassone, A., Gaidus, A., 2019. Tobacco outlet density and adolescents’ cigarette smoking: a metaanalysis. Tobac. Control 28, 27–33. https://doi.org/10.1136/tobaccocontrol-2017- 054065.

Finan, L.J., Lipperman-Kreda, S., Grube, J.W., Balassone, A., Kaner, E., 2020. Alcohol marketing and adolescent and young adult alcohol use behaviors: a systematic review of cross-sectional studies. J. Stud. Alcohol Drugs 42–56. https://doi.org/

10.15288/jsads.2020.s19.42. Supplement Sup. 19.

Firth, C., Carlini, B., Dilley, J., Hajat, A., 2020a. What about equity? Neighborhood deprivation and cannabis retailers in Portland, Oregon. Cannabis 3. https://doi.org/

10.26828/cannabis.2020.02.003.

Firth, C.L., Davenport, S., Smart, R., Dilley, J.A., 2020b. How high: differences in the developments of cannabis markets in two legalized states. Int. J. Drug Pol. 75 https://doi.org/10.1016/j.drugpo.2019.102611.

Giovenco, D.P., Casseus, M., Duncan, D.T., Coups, E.J., Lewis, M.J., Delnevo, C.D., 2016.

Association between electronic cigarette marketing near schools and E-cigarette use among youth. J. Adolesc. Health 59, 627–634. https://doi.org/10.1016/j. jadohealth.2016.08.007.

Gobbi, G., Atkin, T., Zytynski, T., Wang, S., Askari, S., Boruff, J., Ware, M., Marmorstein, N., Cipriani, A., Dendukuri, N., Mayo, N., 2019. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis. JAMA Psychiatr. 76, 426–434. https://doi.org/10.1001/JAMAPSYCHIATRY.2018.4500.

Guttmannova, K., Skinner, M.L., Oesterle, S., White, H.R., Catalano, R.F., Hawkins, J.D., 2019. The interplay between marijuana-specific risk factors and marijuana use over the course of adolescence. Prev. Sci. 20, 235–245.

Hammond, D., Goodman, S., 2020. Knowledge of Tetrahydrocannabinol and Cannabidiol Levels Among Cannabis Consumers in the United States and Canada. Cannabis and Cannabinoid Research. https://doi.org/10.1089/can.2020.0092.

Harpin, S.B., Brooks-Russell, A., Ma, M., James, K.A., Levinson, A.H., 2018. Adolescent marijuana use and perceived ease of access before and after recreational marijuana implementation in Colorado. Subst. Use Misuse 53. https://doi.org/10.1080/ 10826084.2017.1334069.

Hawkins, J.D., Catalano, R.F., Miller, J.Y., 1992. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychol. Bull. 112, 64–105. https://doi.org/10.1037/ 0033-2909.112.1.64.

Huang, Y., Edwards, J., Laurel-Wilson, M., 2020. The shadow of context: neighborhood and school socioeconomic disadvantage, perceived social integration, and the mental and behavioral health of adolescents. Health Place 66. https://doi.org/10.1016/j. healthplace.2020.102425.

Hust, S.J.T., Willoughby, J.F., Li, J., Couto, L., 2020. Youth’s proximity to marijuana retailers and advertisements: factors associated with Washington state adolescents’ intentions to use marijuana. J. Health Commun. https://doi.org/10.1080/ 10810730.2020.1825568.

Johnson, R.M., Guttmannova, K., 2019. Marijuana Use Among Adolescents and Emerging Adults in the Midst of Policy Change: Introduction to the Special Issue.

Prevention Science. https://doi.org/10.1007/s11121-019-0989-7.

Kim, H.S., Monte, A.A., 2016. Colorado cannabis legalization and its effect on emergency care. Ann. Emerg. Med. 68, 71–75. https://doi.org/10.1016/j. annemergmed.2016.01.004.

Kontou, E., McDonald, N.C., Brookshire, K., Pullen-Seufert, N.C., LaJeunesse, S., 2020. U.

S. active school travel in 2017: prevalence and correlates. Preventive Medicine Reports 17, 101024. https://doi.org/10.1016/J.PMEDR.2019.101024.

C.L. Firth et al.

Page 970 ends

Health and Place 75 (2022) 102795
8 Lipari, R.N., Williams, M.R., Copello, E.A.P., Pemberton, M.R., 2016. Risk and Protective Factors and Estimates of Substance Use Initiation: Results from the 2015 National Survey on Drug Use and Health. CBHSQ Data Review.

Lipperman-Kreda, S., Grube, J.W., 2018. Impacts of Marijuana Commercialization on Adolescents’ Marijuana Beliefs, Use, and Co-use with Other Substances. https://doi. org/10.1016/j.jadohealth.2018.05.003.

Lipperman-Kreda, S., Mair, C., Grube, J.W., Friend, K.B., Jackson, P., Watson, D., 2014.

Density and proximity of tobacco outlets to homes and schools: relations with youth cigarette smoking. Prev. Sci. 15, 738–744. https://doi.org/10.1007/S11121-013- 0442-2/TABLES/2.

Loh, V.H.Y., Veitch, J., Salmon, J., Cerin, E., Thornton, L., Mavoa, S., Villanueva, K., Timperio, A., 2019. Built environment and physical activity among adolescents: the moderating effects of neighborhood safety and social support. Int. J. Behav. Nutr.

Phys. Activ. 16, 1–8. https://doi.org/10.1186/S12966-019-0898-Y/FIGURES/1.

Mariani, A.C., Williams, A.R., 2021. Perceived risk of harm from monthly cannabis use among US adolescents: national Survey on drug Use and Health. Preventive Medicine Reports 23. https://doi.org/10.1016/j.pmedr.2021.101436, 2017.

Mennis, J., 2020. Trends in adolescent treatment admissions for marijuana in the United States, 2008–2017. Prev. Chronic Dis. 17 https://doi.org/10.5888/ pcd17.200156external icon.

Merlo, J., Chaix, B., Ohlsson, H., Beckman, A., Johnell, K., Hjerpe, P., Råstam, L., Larsen, K., 2006. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J. Epidemiol. Community Health 60, 290–297. https://doi.org/10.1136/jech.2004.029454.

Morency, C., Paez, A., Roorda, M.J., Mercado, R., Farber, S., 2011. Distance traveled in three Canadian cities: spatial analysis from the perspective of vulnerable population segments. J. Transport Geogr. 19 https://doi.org/10.1016/j.jtrangeo.2009.09.013.

Nargiso, J.E., Ballard, E.L., Skeer, M.R., 2015. A systematic review of risk and protective factors associated with nonmedical use of prescription drugs among youth in the United States: a social ecological perspective. J. Stud. Alcohol Drugs 76.

Oregon Department of Education, 2019. Media Page [WWW Document]. URL. https ://www.ode.state.or.us/data/reportcard/Media.aspx. (Accessed 4 September 2019).

Oregon Health & Science University. n.d. Oregon Office of rural health [WWW Document]. URL. https://www.ohsu.edu/xd/outreach/oregon-rural-health/abo ut-rural-frontier/index.cfm. (Accessed 17 January 2019).

Oregon Health Authority, n.d. Oregon Healthy Teen 2017 Results [WWW Document].

URL healthoregon.org/oht (accessed 5.20.18).

Oregon Liquor Control Commission, 2017. Active Marijuana Retail Licenses Approved as of 3/10/2017 [WWW Document]. URL. https://www.oregon.gov/olcc/marijuana/ Documents/Approved_Retail_Licenses.pdf. (Accessed 14 March 2017).

Oregon Public Health Division, 2019. Youth Marijuana Use, Attitudes and Related Behaviors in Oregon. Portland.

Paschall, M.J., Grube, J.W., 2020. Recreational marijuana availability in Oregon and use among adolescents. Am. J. Prev. Med. 58, e63–e69. https://doi.org/10.1016/j. amepre.2019.09.020.

Raber, J.C., Elzinga, S., Kaplan, C., 2015. Understanding dabs: contamination concerns of cannabis concentrates and cannabinoid transfer during the act of dabbing. J. Toxicol.

Sci. 40, 797–803. https://doi.org/10.2131/jts.40.797.

Rhew, I.C., Guttmannova, K., Kilmer, J.R., Fleming, C.B., Hultgren, B.A., Hurvitz, P.M., Dilley, J.A., Larimer, M.E., 2022. Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State. Drug Alcohol Depend. 232, 109332. https://doi. org/10.1016/J.DRUGALCDEP.2022.109332.

Richmond-Rakerd, L.S., Slutske, W.S., Wood, P.K., 2017. Age of initiation and substance use progression: a multivariate latent growth analysis. Psychol. Addict. Behav. 31 https://doi.org/10.1037/adb0000304.

Substance Use and Mental Health Administration, 2019. Results from the 2017 National Survey on Drug Use and Health: Detailed Tables [WWW Document].

Talen, E., Koschinsky, J., 2013. The walkable neighborhood: a literature review.

International Journal of Sustainable Land Use and Urban Planning 1. https://doi. org/10.24102/ijslup.v1i1.211.

Tice, P., 2013. Substance use among 12th grade Aged youths by dropout status. The CBHSQ Report 1–10.

Tormohlen, K.N., Schneider, K.E., Johnson, R.M., Ma, M., Levinson, A.H., BrooksRussell, A., 2019. Changes in prevalence of marijuana consumption modes among Colorado high school students from 2015 to 2017. JAMA Pediatr. https://doi.org/

10.1001/jamapediatrics.2019.2627.

Trucco, E.M., 2020. A review of psychosocial factors linked to adolescent substance use.

Pharmacol. Biochem. Behav. 196.
van der Steur, S.J., Batalla, A., Bossong, M.G., 2020. Factors moderating the association between cannabis use and psychosis risk: a systematic review. Brain Sci. 10, 97. https://doi.org/10.3390/brainsci10020097.

C.L. Firth et al.

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Preventing Drug Use among Children and Adolescents
Karen L. Bierman, Ph.D.

Pennsylvania State University
C. Hendricks Brown, Ph.D.

University of South Florida
Richard R. Clayton, Ph.D.

University of Kentucky
Thomas J. Dishion, Ph.D.

University of Oregon
E. Michael Foster, Ph.D.

Pennsylvania State University
Meyer D. Glantz, Ph.D.

National Institute on Drug Abuse
Mark T. Greenberg, Ph.D.

Pennsylvania State University
Hyman Hops, Ph.D.

Oregon Research Institute
Eugene R. Oetting, Ph.D.

Colorado State University
Zili Sloboda, Sc.D.

University of Akron
Richard Spoth, Ph.D.

Iowa State University
John B. Reid, Ph.D.

Oregon Social Learning Center
Thomas A. Wills, Ph.D.

Albert Einstein College of Medicine
NIDA also would like to thank the Community Anti-Drug Coalitions of America for helping organize a focus group of community leaders in reviewing this publication.

This publication was written by Elizabeth B. Robertson, Ph.D., Susan L. David, M.P.H. (retired), and Suman A. Rao, Ph.D., National Institute on Drug Abuse.

All materials in this volume are in the public domain and may be used or reproduced without permission from NIDA or the authors. Citation of the source is appreciated.

The U.S. government does not endorse or favor any specific commercial product or company.

Trade, proprietary, or company names appearing in the publication are used only because they are considered essential in the context of the studies described here.

NIH Publication No. 04-4212(A)
Printed 1997
Reprinted 1997, 1999, 2001
Second Edition October 2003
NIDA wishes to thank the following individuals for their guidance and comments during the development and review of this publication:

Acknowledgments
ii

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National Institute on Drug Abuse
Acknowledgments ii
Preface v
Introduction 1
Prevention Principles 2
Chapter 1: Risk Factors and Protective Factors 6
What are risk factors and protective factors? 6
What are the early signs of risk that may predict later drug abuse? 8 What are the highest risk periods for drug abuse among youth? 9 When and how does drug abuse start and progress? 10
Chapter 2: Planning for Drug Abuse Prevention in the Community 12 How can the community develop a plan for research-based prevention? 12 How can the community use the prevention principles in prevention planning? 12 How can the community assess the level of risk for drug abuse? 14 Is the community ready for prevention? 15
How can the community be motivated to implement research-based prevention programs? 16 How can the community assess the effectiveness of current prevention efforts? 17 Chapter 3: Applying Prevention Principles to Drug Abuse Prevention Programs 18 How are risk and protective factors addressed in prevention programs? 18 What are the core elements of effective research-based prevention programs? 21 How can the community implement and sustain effective prevention programs? 24 How can the community evaluate the impact of its program on drug abuse? 24 What are the cost-benefits of community prevention programs? 25 Contents
iii Page 975
iv Preventing Drug Use among Children and Adolescents
Chapter 4: Examples of Research-Based Drug Abuse Prevention Programs 26 Universal Programs 26
Elementary School
• Caring School Community Program
• Classroom-Centered (CC) and Family-School Partnership (FSP) Intervention • Promoting Alternative Thinking Strategies (PATHS)
• Skills, Opportunity, And Recognition (SOAR)
Middle School
• Guiding Good Choices
• Life Skills Training (LST) Program
• Lions-Quest Skills for Adolescence (SFA)
• Project ALERT
• Project STAR
• The Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14) High School
• Life Skills Training: Booster Program
• Lions-Quest Skills for Adolescence
• Project ALERT Plus
• The Strengthening Families Program: For Parents and Youth 10–14 Selective Programs 31
Elementary School
• Focus on Families (FOF)
• The Strengthening Families Program (SFP)
Middle School
• Coping Power
High School
• Adolescents Training and Learning to Avoid Steroids (ATLAS) Indicated Programs 33
High School
• Project Towards No Drug Abuse (Project TND)
• Reconnecting Youth Program (RY)
Tiered Programs 34
Elementary School
• Early Risers “Skills for Success” Risk Prevention Program • Fast Track Prevention Trial for Conduct Problems
Middle School
• Adolescent Transitions Program (ATP)
Chapter 5: Selected Resources and References 36
Selected Resources 36
Selected References 38

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National Institute on Drug Abuse
Preface
v
Today’s youth face many risks, including drug abuse,
violence, and HIV/AIDS. Responding to these risks
before they become problems can be difficult. One
of the goals of the National Institute on Drug Abuse
(NIDA) is to help the public understand the causes
of drug abuse and to prevent its onset. Drug abuse
has serious consequences in our homes, schools,
and communities. From NIDA’s perspective, the
use of all illicit drugs and the inappropriate use of
licit drugs is considered drug abuse.

Prevention science has made great progress in recent
years. Many prevention interventions are being tested
in “real-world” settings so they can be more easily
adapted for community use. Scientists are studying
a broader range of populations and topics. They
have identified, for example, effective interventions
with younger populations to help prevent risk
behaviors before drug abuse occurs.

Researchers are also studying older teens who
are already using drugs to find ways to prevent
further abuse or addiction. Practical issues, such as
cost-benefit analyses, are being studied. Presenting
these findings to the public is one of NIDA’s most
important responsibilities.

We are pleased to offer our newest edition of the
publication, Preventing Drug Use among Children
and Adolescents: A Research-Based Guide for Parents,
Educators, and Community Leaders, Second Edition.

This edition includes updated principles, new questions and answers, new program information, and expanded
references and resources. We also invite you to
visit our Web site at www.drugabuse.gov where
this publication and other materials related to the
consequences, prevention, and treatment of drug
abuse are offered. We hope that you will find the
guide useful and helpful to your work.

Nora D. Volkow, M.D.

Director
National Institute on Drug Abuse

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National Institute on Drug Abuse
In 1997, the National Institute on Drug Abuse (NIDA)
published the first edition of Preventing Drug Use
among Children and Adolescents: A Research-Based
Guide to share the latest NIDA-funded prevention
research findings with parents, educators, and
community leaders. The guide introduced the concept
of “research-based prevention” with questions and
answers on risk and protective factors, community
planning and implementation, and 14 prevention
principles derived from effective drug abuse prevention research. Examples of research-tested prevention
programs were also featured. The purpose was to help
prevention practitioners use the results of prevention
research to address drug abuse among children and
adolescents in communities across the country.

Since then, NIDA’s prevention research program has
more than doubled in size and scope to address all
stages of child development, a mix of audiences and
settings, and the delivery of effective services at the community level. The Institute now focuses on risks
for drug abuse and other problem behaviors that
occur throughout a child’s development. Prevention
interventions designed and tested to address risks can
help children at every step along their developmental
path. Working more broadly with families, schools,
and communities, scientists have found effective ways
to help people gain the skills and approaches to stop
problem behaviors before they occur. Research funded
by NIDA and other Federal research organizations—
such as the National Institute of Mental Health and
the Centers for Disease Control and Prevention—
shows that early intervention can prevent many
adolescent risk behaviors.

This second edition, reflecting NIDA’s expanded
research program and knowledge base, is more than
double the size of the first edition. The prevention
principles have been expanded to provide more
understanding about the latest research, and principles relevant to each chapter accompany the discussion.

Additional questions and answers, a new chapter
on community planning, and more information
on the core elements in research-based prevention
programs have been added. Each chapter ends with
a “Community Action Box” for primary readers—
parents, educators, and community leaders. As in the
first edition, the descriptions of prevention programs
are presented as examples of research-based
programs currently available.

The expanded Selected Resources section offers Web
sites, sponsored by Federal and private-sector agencies.

Some feature registries of effective prevention
programs with agency-specific selection criteria
and other resources for community planning. The
Selected References section includes up-to-date books
and journal articles that provide more information
on prevention research. NIDA hopes that this revised
guide is helpful to drug abuse prevention efforts among children and adolescents in homes, schools, and
communities nationwide.

Introduction
1 Page 979
Prevention Principles
These revised prevention principles have emerged from research studies funded by NIDA on the origins of drug abuse behaviors and the common elements found in research on effective prevention programs. Parents, educators, and community leaders can use these principles to help guide their thinking, planning, selection, and delivery of drug abuse prevention programs at the community level. The references following each principle are representative of current research.

Risk Factors and Protective Factors
Prevention programs should
enhance protective factors and reverse or reduce
risk factors (Hawkins et al. 2002).
• The risk of becoming a drug abuser involves the
relationship among the number and type of
risk factors (e.g., deviant attitudes and behaviors)
and protective factors (e.g., parental support)
(Wills and McNamara et al. 1996).
• The potential impact of specific risk and
protective factors changes with age. For
example, risk factors within the family have
greater impact on a younger child, while
association with drug-abusing peers may be a
more significant risk factor for an adolescent
(Gerstein and Green 1993; Kumpfer et al. 1998).
• Early intervention with risk factors (e.g.,
aggressive behavior and poor self-control)
often has a greater impact than later
intervention by changing a child’s life path
(trajectory) away from problems and toward
positive behaviors (Ialongo et al. 2001).
• While risk and protective factors can affect
people of all groups, these factors can have
a different effect depending on a person’s age,
gender, ethnicity, culture, and environment
(Beauvais et al. 1996; Moon et al. 1999).

Prevention programs should address
all forms of drug abuse, alone or in combination,
including the underage use of legal drugs (e.g.,
tobacco or alcohol); the use of illegal drugs (e.g.,
marijuana or heroin); and the inappropriate use
of legally obtained substances (e.g., inhalants),
prescription medications, or over-the-counter
drugs (Johnston et al. 2002).

Prevention programs should
address the type of drug abuse problem in the
local community, target modifiable risk factors,
and strengthen identified protective factors
(Hawkins et al. 2002).

Prevention programs should be
tailored to address risks specific to population
or audience characteristics, such as age, gender,
and ethnicity, to improve program effectiveness
(Oetting et al. 1997).
2 Preventing Drug Use among Children and Adolescents
PRINCIPLE 1
PRINCIPLE 2
PRINCIPLE 3
PRINCIPLE 4

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National Institute on Drug Abuse 3
Prevention Planning
Family Programs
Family-based prevention programs
should enhance family bonding and relationships
and include parenting skills; practice in developing,
discussing, and enforcing family policies on
substance abuse; and training in drug education
and information (Ashery et al. 1998).

Family bonding is the bedrock of the relationship
between parents and children. Bonding can
be strengthened through skills training on
parent supportiveness of children, parent-child
communication, and parental involvement
(Kosterman et al. 1997).
• Parental monitoring and supervision are
critical for drug abuse prevention. These skills
can be enhanced with training on rule-setting;
techniques for monitoring activities; praise
for appropriate behavior; and moderate,
consistent discipline that enforces defined
family rules (Kosterman et al. 2001).
• Drug education and information for parents
or caregivers reinforces what children
are learning about the harmful effects of
drugs and opens opportunities for family
discussions about the abuse of legal and
illegal substances (Bauman et al. 2001).
• Brief, family-focused interventions for the
general population can positively change
specific parenting behavior that can reduce
later risks of drug abuse (Spoth et al. 2002b).

School Programs
Prevention programs can be
designed to intervene as early as preschool
to address risk factors for drug abuse, such
as aggressive behavior, poor social skills, and
academic difficulties (Webster-Stratton 1998;
Webster-Stratton et al. 2001).

Prevention programs for elementary
school children should target improving academic
and social-emotional learning to address risk
factors for drug abuse, such as early aggression,
academic failure, and school dropout. Education
should focus on the following skills (Ialongo
et al. 2001; Conduct Problems Prevention Work
Group 2002b):
• self-control;
• emotional awareness;
• communication;
• social problem-solving; and
• academic support, especially in reading.

Prevention programs for middle or
junior high and high school students should increase
academic and social competence with the following
skills (Botvin et al.1995; Scheier et al. 1999):
• study habits and academic support;
• communication;
• peer relationships;
• self-efficacy and assertiveness;
• drug resistance skills;
• reinforcement of antidrug attitudes; and
• strengthening of personal commitments
against drug abuse.

PRINCIPLE 5
PRINCIPLE 6
PRINCIPLE 7
PRINCIPLE 8

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Preventing Drug Use among Children and Adolescents
Community Programs
Prevention programs aimed at
general populations at key transition points, such
as the transition to middle school, can produce
beneficial effects even among high-risk families
and children. Such interventions do not single
out risk populations and, therefore, reduce labeling
and promote bonding to school and community
(Botvin et al. 1995; Dishion et al. 2002).

Community prevention programs
that combine two or more effective programs,
such as family-based and school-based
programs, can be more effective than a single
program alone (Battistich et al. 1997).

Community prevention programs
reaching populations in multiple settings—for
example, schools, clubs, faith-based organizations,
and the media—are most effective when they
present consistent, community-wide messages
in each setting (Chou et al. 1998).

Prevention Program Delivery
When communities adapt programs
to match their needs, community norms, or
differing cultural requirements, they should retain
core elements of the original research-based
intervention (Spoth et al. 2002b), which include:
• Structure (how the program is organized
and constructed);
• Content (the information, skills, and strategies
of the program); and
• Delivery (how the program is adapted,
implemented, and evaluated).

Prevention programs should be
long-term with repeated interventions (i.e.,
booster programs) to reinforce the original
prevention goals. Research shows that the
benefits from middle school prevention programs
diminish without followup programs in high
school (Scheier et al. 1999).

PRINCIPLE 10
4 PRINCIPLE 9
PRINCIPLE 11
PRINCIPLE 12
PRINCIPLE 13

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National Institute on Drug Abuse 5
Prevention programs should include
teacher training on good classroom management
practices, such as rewarding appropriate student
behavior. Such techniques help to foster students’
positive behavior, achievement, academic motivation,
and school bonding (Ialongo et al. 2001).

Prevention programs are most
effective when they employ interactive techniques,
such as peer discussion groups and parent
role-playing, that allow for active involvement in
learning about drug abuse and reinforcing skills
(Botvin et al. 1995).

Research-based prevention programs
can be cost-effective. Similar to earlier research,
recent research shows that for each dollar invested
in prevention, a savings of up to $10 in treatment
for alcohol or other substance abuse can be seen
(Pentz 1998; Hawkins 1999; Aos et al. 2001;
Spoth et al. 2002a).

PRINCIPLE 14
PRINCIPLE 15
PRINCIPLE 16

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6 Preventing Drug Use among Children and Adolescents
Chapter 1: Risk Factors and Protective Factors
This chapter describes how risk and protective factors influence drug abuse behaviors, the early signs of risk, transitions as high-risk periods, and general patterns of drug abuse among children and adolescents. A major focus is how prevention programs can strengthen protection or intervene to reduce risks.

What are risk factors
and protective factors?
Studies over the past two decades have tried to
determine the origins and pathways of drug abuse
and addiction—how the problem starts and how it
progresses. Many factors have been identified that
help differentiate those more likely to abuse drugs
from those less vulnerable to drug abuse. Factors
associated with greater potential for drug abuse are
called “risk” factors, while those associated with
reduced potential for abuse are called “protective”
factors. Please note, however, that most individuals
at risk for drug abuse do not start using drugs or
become addicted. Also, a risk factor for one person
may not be for another.

As discussed in the Introduction, risk and protective
factors can affect children in a developmental risk
trajectory, or path. This path captures how risks
become evident at different stages of a child’s life.

For example, early risks, such as out-of-control
aggressive behavior, may be seen in a very young
child. If not addressed through positive parental
actions, this behavior can lead to additional risks
when the child enters school. Aggressive behavior
in school can lead to rejection by peers, punishment
by teachers, and academic failure. Again, if not
addressed through preventive interventions, these
risks can lead to the most immediate behaviors that
put a child at risk for drug abuse, such as skipping
school and associating with peers who abuse drugs. In
focusing on the risk path, research-based prevention
programs can intervene early in a child’s development
to strengthen protective factors and reduce risks long
before problem behaviors develop.

The table below provides a framework for
characterizing risk and protective factors in five
domains, or settings. These domains can then serve
as a focus for prevention. As the first two examples
suggest, some risk and protective factors are mutually
exclusive—the presence of one means the absence
of the other. For example, in the Individual domain,
early aggressive behavior, a risk factor, indicates the absence of impulse control, a key protective factor.

Helping a young child learn to control impulsive
behavior is a focus of some prevention programs.

Early Aggressive Behavior Individual Impulse Control
Lack of Parental Supervision Family Parental Monitoring Substance Abuse Peer Academic Competence
Drug Availability School Antidrug Use Policies
Poverty Community Strong Neighborhood Attachment
Risk Factors Domain Protective Factors

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National Institute on Drug Abuse 7
Other risk and protective factors are independent of
each other, as demonstrated in the table as examples
in the peer, school, and community domains. For
example, in the school domain, drugs may be
available, even though the school has “antidrug
policies.” An intervention may be to strengthen
enforcement so that school policies create the
intended school environment.

Risk factors for drug abuse represent challenges
to an individual’s emotional, social, and academic
development. These risk factors can produce different
effects, depending on the individual’s personality
traits, phase of development, and environment.

For instance, many serious risks, such as early
aggressive behavior and poor academic achievement,
may indicate that a young child is on a negative
developmental path headed toward problem behavior.

Early intervention, however, can help reduce or reverse these risks and change that child’s developmental path.

For young children already exhibiting
serious risk factors, delaying intervention
until adolescence will likely make it more
difficult to overcome risks. By adolescence,
children’s attitudes and behaviors are well
established and not easily changed.

Risk factors can influence drug abuse in several
ways. They may be additive: The more risks a
child is exposed to, the more likely the child will
abuse drugs. Some risk factors are particularly
potent, yet may not influence drug abuse unless
certain conditions prevail. Having a family history
of substance abuse, for example, puts a child at
risk for drug abuse. However, in an environment
with no drug-abusing peers and strong antidrug
norms, that child is less likely to become a drug
abuser. And the presence of many protective
factors can lessen the impact of a few risk factors.

For example, strong protection—such as parental
support and involvement—can reduce the influence
of strong risks, such as having substance-abusing
peers. An important goal of prevention, then,
is to change the balance between risk and
protective factors so that protective factors
outweigh risk factors.

Chapter 1 Principles
Risk Factors and
Protective Factors
Prevention programs should enhance
protective factors and reverse or reduce risk factors.
• The risk of becoming a drug abuser involves the
relationship among the number and type of risk factors
(e.g., deviant attitudes and behaviors) and protective
factors (e.g., parental support).
• The potential impact of specific risk and protective
factors changes with age. For example, risk factors
within the family have greater impact on a younger
child, while association with drug-abusing peers may
be a more significant risk factor for an adolescent.
• Early intervention with risk factors (e.g., aggressive behavior and poor self-control) often has a greater
impact than later intervention by changing a child’s
life path (trajectory) away from problems and toward
positive behaviors.
• While risk and protective factors can affect people of all groups, these factors can have a different effect
depending on a person’s age, gender, ethnicity, culture, and environment.

Prevention programs should address all
forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs.

Prevention programs should address the
type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified
protective factors.

Prevention programs should be tailored
to address risks specific to population or audience
characteristics, such as age, gender, and ethnicity,
to improve program effectiveness.

PRINCIPLE 1
PRINCIPLE 2
PRINCIPLE 3
PRINCIPLE 4

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8 Preventing Drug Use among Children and Adolescents
Gender may also determine how an individual
responds to risk factors. Research on relationships
within the family shows that adolescent girls respond
positively to parental support and discipline, while
adolescent boys sometimes respond negatively.

Research on early risk behaviors in the school setting
shows that aggressive behavior in boys and learning
difficulties in girls are the primary causes of poor peer relationships. These poor relationships, in turn, can
lead to social rejection, a negative school experience, and problem behaviors including drug abuse.

What are the early signs of risk that
may predict later drug abuse?
Some signs of risk can be seen as early as infancy.

Children’s personality traits or temperament can
place them at increased risk for later drug abuse.

Withdrawn and aggressive boys, for example, often
exhibit problem behaviors in interactions with their
families, peers, and others they encounter in social
settings. If these behaviors continue, they will likely lead to other risks. These risks can include academic
failure, early peer rejection, and later affiliation with deviant peers, often the most immediate risk for drug
abuse in adolescence. Studies have shown that children
with poor academic performance and inappropriate
social behavior at ages 7 to 9 are more likely to be
involved with substance abuse by age 14 or 15.

In the Family
Children’s earliest interactions occur within the
family and can be positive or negative. For this
reason, factors that affect early development in the
family are probably the most crucial. Children are
more likely to experience risk when there is:
• lack of mutual attachment and nurturing
by parents or caregivers;
• ineffective parenting;
• a chaotic home environment;
• lack of a significant relationship with
a caring adult; and
• a caregiver who abuses substances, suffers from
mental illness, or engages in criminal behavior.

These experiences, especially the abuse of drugs and
other substances by parents and other caregivers, can
impede bonding to the family and threaten feelings of
security that children need for healthy development.

On the other hand, families can serve a protective
function when there is:
• a strong bond between children and their families;
• parental involvement in a child’s life;
• supportive parenting that meets financial,
emotional, cognitive, and social needs; and
• clear limits and consistent enforcement of discipline.

Finally, critical or sensitive periods in development
may heighten the importance of risk or protective
factors. For example, mutual attachment and bonding
between parents and children usually occurs in infancy
and early childhood. If it fails to occur during those
developmental stages, it is unlikely that a strong positive attachment will develop later in the child’s life.

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National Institute on Drug Abuse 9
Outside the Family
Other risk factors relate to the quality of children’s
relationships in settings outside the family, such as
in their schools, with their peers, teachers, and in
the community. Difficulties in these settings can be
crucial to a child’s emotional, cognitive, and social
development. Some of these risk factors are:
• inappropriate classroom behavior, such
as aggression and impulsivity;
• academic failure;
• poor social coping skills;
• association with peers with problem behaviors,
including drug abuse; and
• misperceptions of the extent and acceptability
of drug-abusing behaviors in school, peer, and
community environments.

Association with drug-abusing peers is often the
most immediate risk for exposing adolescents to
drug abuse and delinquent behavior. Research has
shown, however, that addressing such behavior in
interventions can be challenging. For example, a
recent study (Dishion et al. 2002) found that placing
high-risk youth in a peer group intervention resulted
in negative outcomes. Current research is exploring
the role that adults and positive peers can play in
helping to avoid such outcomes in future interventions.

Other factors—such as drug availability, drug
trafficking patterns, and beliefs that drug abuse is
generally tolerated—are also risks that can influence
young people to start to abuse drugs.

Family has an important role in providing protection
for children when they are involved in activities
outside the family. When children are outside the
family setting, the most salient protective factors are:
• age-appropriate parental monitoring of social
behavior, including establishing curfews, ensuring
adult supervision of activities outside the home,
knowing the child’s friends, and enforcing
household rules;
• success in academics and involvement
in extracurricular activities;
• strong bonds with prosocial institutions, such
as school and religious institutions; and
• acceptance of conventional norms against
drug abuse.

What are the highest risk periods
for drug abuse among youth?
Research has shown that the key risk periods
for drug abuse occur during major transitions in
children’s lives. These transitions include significant changes in physical development (for example,
puberty) or social situations (such as moving
or parents divorcing) when children experience
heightened vulnerability for problem behaviors.

The first big transition for children is when they leave the security of the family and enter school. Later,
when they advance from elementary school to middle
or junior high school, they often experience new
academic and social situations, such as learning to
get along with a wider group of peers and having
greater expectations for academic performance. It
is at this stage—early adolescence—that children
are likely to encounter drug abuse for the first time.

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10 Preventing Drug Use among Children and Adolescents
Then, when they enter high school, young people face
additional social, psychological, and educational
challenges. At the same time, they may be exposed
to greater availability of drugs, drug abusers, and
social engagements involving drugs. These challenges
can increase the risk that they will abuse alcohol,
tobacco, and other drugs.

A particularly challenging situation in late adolescence is moving away from home for the first time without
parental supervision, perhaps to attend college or
other schooling. Substance abuse, particularly of
alcohol, remains a major public health problem for
college populations.

When young adults enter the workforce or marry,
they again confront new challenges and stressors
that may place them at risk for alcohol and other
drug abuse in their adult environments. But these
challenges can also be protective when they present
opportunities for young people to grow and pursue
future goals and interests. Research has shown that
these new lifestyles can serve as protective factors
as the new roles become more important than being
involved with drugs.

Risks appear at every transition from early
childhood through young adulthood; therefore,
prevention planners need to consider their
target audiences and implement programs
that provide support appropriate for each
developmental stage. They also need to
consider how the protective factors involved
in these transitions can be strengthened.

When and how does drug abuse
start and progress?
Studies such as the National Survey on Drug Use
and Health, formerly called the National Household
Survey on Drug Abuse, reported by the Substance
Abuse and Mental Health Services Administration,
indicate that some children are already abusing
drugs by age 12 or 13, which likely means that some
may begin even earlier. Early abuse includes such
drugs as tobacco, alcohol, inhalants, marijuana,
and psychotherapeutic drugs. If drug abuse persists
into later adolescence, abusers typically become
more involved with marijuana and then advance
to other illegal drugs, while continuing their abuse
of tobacco and alcohol. Studies have also shown
that early initiation of drug abuse is associated
with greater drug involvement, whether with the
same or different drugs. Note, however, that both
one-time and long-term surveys indicate that most
youth do not progress to abusing other drugs. But
among those who do progress, their drug abuse
history can vary by neighborhood drug availability,
demographic groups, and other characteristics of the
abuser population. In general, the pattern of abuse is
associated with levels of social disapproval, perceived risk, and the availability of drugs in the community.

Scientists have proposed several hypotheses as to
why individuals first become involved with drugs
and then escalate to abuse. One explanation is a
biological cause, such as having a family history
of drug or alcohol abuse, which may genetically
predispose a person to drug abuse. Another
explanation is that starting to abuse a drug may
lead to affiliation with more drug-abusing peers
which, in turn, exposes the individual to other
drugs. Indeed, many factors may be involved.

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National Institute on Drug Abuse 11
Parents can use information on risk and
protection to help them develop positive
preventive actions (e.g. talking about family
rules) before problems occur.

Educators can strengthen learning and bonding to
school by addressing aggressive behaviors and
poor concentration—risks associated with later
onset of drug abuse and related problems.

Community Leaders can assess community
risk and protective factors associated with
drug problems to best target prevention services.

COMMUNITY ACTION BOX Different patterns of drug initiation have been identified based on gender, race or ethnicity, and
geographic location. For example, research has found
that the circumstances in which young people are
offered drugs can depend on gender. Boys generally
receive more drug offers and at younger ages. Initial
drug abuse can also be influenced by where drugs
are offered, such as parks, streets, schools, homes,
or parties. Additionally, drugs may be offered by
different people including, for example, siblings,
friends, or even parents.

While most youth do not progress beyond initial
use, a small percentage rapidly escalate their
substance abuse. Researchers have found that these
youth are the most likely to have experienced a
combination of high levels of risk factors with low
levels of protective factors. These adolescents were
characterized by high stress, low parental support,
and low academic competence.

However, there are protective factors that can
suppress the escalation to substance abuse. These
factors include self-control, which tends to inhibit
problem behavior and often increases naturally as
children mature during adolescence. In addition,
protective family structure, individual personality,
and environmental variables can reduce the impact
of serious risks of drug abuse. Preventive interventions can provide skills and support to high-risk youth
to enhance levels of protective factors and prevent
escalation to drug abuse.

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12 Preventing Drug Use among Children and Adolescents
Chapter 2: Planning for Drug Abuse Prevention
in the Community
This chapter presents a process to help communities as they plan to implement research-based prevention programs. It provides guidance on applying the prevention principles, assessing needs and community readiness, motivating the community to take action, and evaluating the impact of the programs implemented. Additional planning resources are highlighted in Selected Resources and References.

How can the community develop a plan
for research-based prevention?
Prevention research suggests that a well-constructed
community plan incorporates the characteristics
outlined in the following box.

Planning Process
Planning usually starts with an assessment of drug
abuse and other child and adolescent problems,
which includes measuring the level of substance
abuse in the community as well as examining the
level of other community risk factors (e.g., poverty)
[see section on “How can the community assess
the level of risk for drug abuse?” for more details].

The results of the assessment can be used to raise
community awareness of the nature and seriousness
of the problem and guide the selection of programs
most relevant to the community’s needs. This is an
important process, whether a community is selecting
a school-based prevention curriculum or planning
multiple interventions that cut across the
entire community.

Next, an assessment of the community’s readiness
for prevention can help determine additional steps
that are needed to educate the community before
beginning the prevention effort. Then, a review
of existing programs is needed to determine gaps
in addressing community needs and identifying
additional resources.

Finally, community planning can benefit from
contributions of community organizations that
provide services to youth. Convening a meeting
of leaders of youth-serving organizations can aid in
coordinating ideas, resources, and expertise to help
implement and sustain research-based programs.

Planning for implementation and sustainability requires resource development for staffing and management,
long-term funding commitments, and linkages with
existing delivery systems.

How can the community use the
prevention principles in
prevention planning?
Several prevention principles provide a framework
for effective prevention planning and programming
by presenting key concepts in implementing research-

THE COMMUNITY PLAN
• Identifies the specific drugs and other child
and adolescent problems in a community;
• Builds on existing resources (e.g., current drug abuse prevention programs);
• Develops short-term goals relevant to implementation
of research-based prevention programs;
• Projects long-term objectives so that plans and
resources are available for the future; and
• Incorporates ongoing assessments to evaluate the
effectiveness of prevention strategies.

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National Institute on Drug Abuse 13
based prevention. Consider, for example, Principle 3:
“Prevention programs should address the type of
drug abuse problem in the local community, target
modifiable risk factors, and strengthen identified
protective factors.” This principle describes how the
plan should reflect the reality of the drug problem in
that community and, importantly, what needs to be
done to address it.

Community-wide efforts also can be guided by
Principle 9: “Prevention programs aimed at general
populations at key transition points . . . can produce
beneficial effects, even among high-risk families and
children.” With carefully structured programs, the
community can provide services to all populations,
including those at high risk, without labeling or
stigmatizing them.

In implementing a more specific program, such as
a family program within the educational system,
the principles address some of the required content
areas. For instance, Principle 5 states, “Family-based
prevention programs should enhance family bonding
and relationships and include parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education
and information.”
The principles offer guidance for selecting or adapting effective programs that meet specific community needs.

It is important to recognize, however, that
not every program that seems consistent with
these research-based prevention principles is
necessarily effective. To be effective, programs
need to incorporate the core elements identified in
research (see Chapter 3). These include appropriate
structure and content, adequate resources for training
and materials, and other implementation requirements.

For more information on resources to help communities
in prevention planning and the research underlying
the prevention principles, see Selected Resources
and References.

Principles for Prevention Planning
Prevention programs should address all
forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs.

Prevention programs should address the
type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified
protective factors.

Prevention programs should be tailored
to address risks specific to population or audience
characteristics, such as age, gender, and ethnicity,
to improve program effectiveness.

Prevention programs aimed at general
populations at key transition points, such as the transition to middle school, can produce beneficial effects even
among high-risk families and children. Such interventions do not single out risk populations and, therefore, reduce labeling and promote bonding to school and community.

Community prevention programs that
combine two or more effective programs, such as familybased and school-based programs, can be more effective than a single program alone.

Community prevention programs reaching
populations in multiple settings—for example, schools,
clubs, faith-based organizations, and the media—are most effective when they present consistent, community-wide
messages in each setting.

Chapter 2 Principles
PRINCIPLE 2
PRINCIPLE 3
PRINCIPLE 4
PRINCIPLE 9
PRINCIPLE 10
PRINCIPLE 11

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14 Preventing Drug Use among Children and Adolescents
How can the community assess the
level of risk for drug abuse?
To assess the level of risk of youth engaging in drug
abuse, it is important to:
• measure the nature and extent of drug abuse
patterns and trends;
• collect data on the risk and protective factors
throughout the community;
• understand the community’s culture and how that
culture affects and is affected by drug abuse;
• consult with community leaders working in drug
abuse prevention, treatment, law enforcement,
mental health, and related areas;
• assess community awareness of the problem; and
• identify existing prevention efforts already under
way to address the problem.

Researchers have developed many tools to assess
the extent of a community’s drug problem. Most of
these tools assess the nature of the problem—what
drugs are available and who is abusing them. Some
of them assess the extent of abuse by estimating
how many people are abusing drugs. Others assess
factors associated with abuse, such as juvenile
delinquency, school absenteeism, and school dropout
rates. Researchers have also developed instruments
that assess individual risk status. It is important
when beginning the assessment process to collect
sufficient information to help local planners target
the intervention by population and geographic area.

As an example, the Communities That Care prevention
operating system, developed by Hawkins and colleagues
at the University of Washington (Hawkins et al. 2002),
is based on epidemiological methods. An assessment
is conducted to collect data on the distribution of risk and protective factors at the community level. This
approach helps local planners identify geographic
areas with the highest levels of risk and the lowest
levels of protective resources. This analysis tool
assists planners in selecting the most effective
prevention interventions to address the specific
risks of neighborhoods.

Other data sources and measurement instruments
(such as questionnaires) that can help in community
planning include the following resources.
• Public access data. Several large national
surveys provide data to help local communities
understand how their drug problems relate to
the national picture. These include the National
Survey on Drug Use and Health, Monitoring the
Future Study, and Youth Behavior Risk Study.

Information on accessing these data is provided
in Selected Resources and References.
• Public access questionnaires. The studies listed
above and many other federally sponsored data sets
make the data collection instruments available for
adaptation and use by the public. Communities
can conduct local studies using these instruments
to collect uniform data that can often be compared
with national findings.
• Archival data. Data from public access files
from school systems, health departments, hospital
emergency rooms, law enforcement agencies, and
drug abuse treatment facilities can be analyzed to
identify the nature of the local drug problem and
other youth problems.

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National Institute on Drug Abuse 15
• Ethnographic studies. Ethnographic approaches
use systematic, observational processes to describe
behaviors in natural settings, such as studying the
abuse of drugs by youth gangs, and documenting
the individual perspectives of those under observation. • Other qualitative methods. Other qualitative
methods, such as convening focus groups of
representatives of drug-abusing subpopulations
or key interviews with community officials, can
be used to gain a greater understanding of the
local drug abuse problem.

As each of these methods has advantages and
disadvantages, it is advisable, permitting resources,
to use multiple strategies to assess community risk
to provide the best information possible.

The Community Epidemiology Work Group (CEWG),
another data source pioneered in the early 1970s by
NIDA and communities nationwide, is composed
of researchers from 21 U.S. cities who collect or use
archival data to characterize the nature of the drug
problem in their locations. CEWG representatives
meet with NIDA biannually to inform the Institute
and fellow CEWG members of changing drug trends
in their cities. The work group has developed a
Guide for Community Epidemiology Surveillance
Networks on Drug Abuse to help other communities
use this approach to provide up-to-date information
on local drug abuse problems.

Using information obtained through these many
sources can help community leaders make sound
decisions about programs and policies. Analyzing
these data before implementing new programs can
also help establish a baseline for evaluating results.

To be most informative, periodic assessments need
to be made routinely.

For more information on how communities can
assess the level or risk of drug abuse in their
community, see Selected Resources and References.

Is the community ready for prevention?
Identifying a serious level of risk in a community
does not always translate into community readiness
to take action. Based on studies of many small
communities, researchers have identified nine stages
of readiness that can guide prevention planning
(Plested et al. 1999). Applying measures to assess
readiness, prevention planners can then identify the
critical steps needed to implement programs (see
table on page 20). Although much of the research
on the stages of community readiness has examined
small communities, large communities find that
these stages provide a structure to describe levels
of awareness of drug issues in their community
and readiness to embrace a prevention program.

Awareness is assessed at two levels: that of the public (by examining the nature and level of drug coverage
in the news) and that of officials (by determining
if they have taken a position on drug abuse
in the community).

Community leaders can begin assessing their
community’s readiness by interviewing key
informants in their community. Additional
planning and program sources can be found in
Selected Resources and References. Web sites,
contact information, and publications offer further
information to guide community efforts.

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16 Preventing Drug Use among Children and Adolescents
How can the community be motivated
to implement research-based
prevention programs?
The methods needed to motivate a community to
act depend on the particular community’s stage of
readiness. At lower stages of readiness, individual
and small group meetings may be needed to attract
support from those with great influence in the
community. At higher levels of readiness, it may be
possible to establish a community board or coalition
of key leaders from public- and private-sector
organizations. This can provide the impetus for action.

Community coalitions can and do hold communitywide meetings, develop public education campaigns, present data that support the need for research-based
prevention programming, and attract sponsors for
comprehensive drug abuse prevention strategies.

But care is needed in organizing a community-level
coalition to ensure that its programming incorporates
research-tested strategies and programs—at the
individual, school, and community levels. Having a
supportive infrastructure that includes representatives across the community can reinforce prevention
messages, provide resources, and sustain prevention
programming. Introducing a school-based curriculum,
however, requires less community involvement, but is
still a focused preventive effort.

Research has shown that prevention programs
can use the media to raise public awareness
of the seriousness of a community’s drug
problem and prevent drug abuse among
specific populations. Using local data and speakers
from the community demonstrates that the drug
problem is real and that action is needed. Providing
some of the examples of research-based programs
described in Chapter 4 can help mobilize the
community for change.

ASSESSING READINESS* COMMUNITY ACTION
Community Response
Relative tolerance of drug abuse
Not happening here, can’t do
anything about it
Awareness, but no motivation
Leaders aware, some motivation
Active energetic leadership
and decisionmaking
Data used to support
prevention actions
Community generally supports
existing program
Decisionmakers support improving
or expanding programs
Knowledgeable of community drug
problem; expect effective solutions
Ideas
Create motivation. Meet with community
leaders involved with drug abuse prevention;
use the media to identify and talk about the
problem; encourage the community to see
how it relates to community issues; begin
preplanning.

Work together. Develop plans for prevention
programming through coalitions and other
community groups.

Identify and implement research-based programs.

Evaluate and improve ongoing programs.

Institutionalize and expand programs to reach
more populations.

Put multicomponent programs in place for
all audiences.
* Plested et al. 1999.

Readiness Stage

1. No awareness

2. Denial

3. Vague awareness

4. Preplanning

5. Preparation

6. Initiation

7. Stabilization

8. Confirmation/

9. Professionalization
Expansion

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National Institute on Drug Abuse 17
How can the community assess
the effectiveness of current
prevention efforts?
Assessing prevention efforts can be challenging for
a community, given limited resources and limited
access to expertise in program evaluation. Many
communities begin the process with a structured
review of current prevention programs to determine:
aWhat programs are currently in place
in the community?
aWere strict scientific standards used to test
the programs during their development?
aDo the programs match community needs?
aAre the programs being carried out as designed?
aWhat percentage of at-risk youth is being
reached by the program?
Another evaluation approach is to track existing
data over time on drug abuse among students in
school, rates of truancy, school suspensions, drugabuse arrests, and drug-related emergency room admissions. The use of the information obtained in
the initial community drug abuse assessment can
serve as a baseline for measuring change in longterm trends. Because the nature and extent of drug abuse problems can change with time, it is wise to
periodically assess community risk and protective
factors to help ensure that the programs in place
appropriately address current community needs.

Communities may wish to consult with State and
county prevention authorities for assistance in planning and implementation efforts. Also, federally supported
publications and other resources are available,
as noted in Selected Resources and References.

In assessing the impact of individual programs, it is
important for communities to document how well
the program is delivered and the level of intervention
participants receive. For example, in assessing a
school-based prevention program, key questions
to be asked include:
aHave the teachers mastered the content and
interactive teaching strategies needed for the
selected curriculum?
aHow much exposure have the students had
to each content area?
aIs there an assessment component?
The community plan should guide actions for prevention
over time. Once communities are mobilized, program
implementation and sustainability require clear,
measurable goals, long-term resources, sustained
leadership, and community support to maintain
momentum for preventive change. Continuing
evaluations keep the community informed and
allow for periodic reassessment of needs and goals.

Parents can work with others in their community
to increase awareness about the local drug
abuse problem and the need for research-based
prevention programs.

Educators can work with others in their school
and school system to review current programs,
and identify research-based prevention
interventions appropriate for students.

Community Leaders can organize a community
group to develop a community prevention plan,
coordinate resources and activities, and support
research-based prevention in all sectors
of the community.

COMMUNITY ACTION BOX

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18 Preventing Drug Use among Children and Adolescents
Chapter 3: Applying Prevention Principles to
Drug Abuse Prevention Programs
This chapter describes how the prevention principles have been applied to create effective family, school, and community programs. It offers information on working with risk and protective factors, adapting programs while maintaining fidelity to core elements, implementing and evaluating programs, and understanding the cost-benefits of research-based prevention. The goal is to help communities implement research-based prevention programs.

How are risk and protective factors
addressed in prevention programs?
Risk and protective factors are the primary targets
of effective prevention programs used in the family,
school, and community settings. Prevention programs
are usually designed to reach specific populations
in their primary settings, such as reaching children
at school or through recreational or after-school
programs. However, in recent years it has become
more common to find programs for any given target
group in a variety of settings, such as holding a
family-based program in a school or a church. The
goal of these programs is to build new and strengthen
existing protective factors and reverse or reduce
modifiable risk factors in youth.

Prevention programs can be described by the audience
or intervention level for which they are designed:
• Universal programs are designed for the general
population, such as all students in a school.
• Selective programs target groups at risk, or subsets
of the general population such as children of drug
abusers or poor school achievers.
• Indicated programs are designed for people who
are already experimenting with drugs.

Tiered programs, such as the Adolescent Transitions
Program, incorporate all three levels of intervention.

Others, such as Early Risers “Skills for Success”
Prevention Program, may have only two levels
of intervention.

Details of the programs used as examples in the
following sections are provided in Chapter 4.

In the Family
Prevention programs can strengthen protective factors
among young children by teaching parents better
family communication skills, developmentally
appropriate discipline styles, firm and consistent rule enforcement, and other family management skills.

Parents also can be taught how to increase their
emotional, social, cognitive, and material support,
which includes, for example, meeting their children’s
financial, transportation, health care, and homework
needs. Research confirms the benefit of parents taking
a more active role in their children’s lives, by talking with them about drugs, monitoring their activities,
getting to know their friends, understanding their
problems and concerns, providing consistent rules
and discipline, and being involved in their learning
and education. The importance of the parent-child
relationship continues through adolescence and beyond.

An example of a universal family-based program is
the Strengthening Families Program For Parents and
Youth, 10–14, which provides rural parents guidance
on family management skills, communication,

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National Institute on Drug Abuse 19
academic support, and parent-child relationships.

Recognizing that it can be difficult to attract
parents to this program, the researchers encourage
participation through flexibility in scheduling and
location. Offering conveniences such as babysitting,
transportation, and meals make participation more
practical for many rural parents, while enhancing
the program’s success in reaching its goals.

Another type of family program operates within a
school setting. The Adolescent Transitions Program,
for example, is a tiered intervention family program.

All families can get involved with the universal
intervention, which makes available a Family Resource
Room where information on parenting is provided.

The Family Check-Up, the selective level of this
program, is an assessment process to identify and
help families at greater risk by providing them with
information and interventions specific to their needs.

Families already engaged in problem behaviors and
identified as needing an indicated intervention are
provided more intense assistance and information
tailored to their problem. Such assistance might
include, for example, individual or family therapy,
intensive parent coaching, therapeutic foster care, or
other family-specific interventions. The uniqueness
of the tiered approach is that the whole school
participates in the program and all individuals or
families receive the appropriate level of help without
being labeled in the process.

In School
Prevention programs in schools focus on children’s
social and academic skills, including enhancing
peer relationships, self-control, coping skills, social behaviors, and drug offer refusal skills. School-based
prevention programs should be integrated within
the school’s own goal of enhanced academic
performance. Evidence is emerging that a major risk
for school failure is a child’s inability to read by the third and fourth grades (Barrera et al. 2002), and
school failure is strongly associated with drug abuse.

Integrated programs strengthen students’ bonding
to school and reduce their likelihood of dropping
out. Most prevention curricula include a normative
education component designed to correct the
misperception that many students are abusing drugs.

Principles for Programs
Family-based prevention programs should
enhance family bonding and relationships and include
parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education and information.

Prevention programs can be designed to
intervene as early as preschool to address risk factors for drug abuse, such as aggressive behavior, poor social skills, and academic difficulties.

Prevention programs for elementary school
children should target improving academic and socialemotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and
school dropout.

Prevention programs for middle or junior
high and high school students should increase academic
and social competence.

Community prevention programs that
combine two or more effective programs, such as familybased and school-based programs, can be more effective than a single program alone.

Community prevention programs reaching
populations in multiple settings—for example, schools,
clubs, faith-based organizations, and the media—are most effective when they present consistent, community-wide
messages in each setting.

Chapter 3 Principles
PRINCIPLE 5
PRINCIPLE 6
PRINCIPLE 7
PRINCIPLE 8
PRINCIPLE 9
PRINCIPLE 10
PRINCIPLE 11

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20 Preventing Drug Use among Children and Adolescents
Chapter 3 Principles
Principles for Program Delivery
When communities adapt programs to
match their needs, community norms, or differing cultural requirements, they should retain core elements of the
original research-based intervention.

Prevention programs should be long-term
with repeated interventions (i.e., booster programs) to reinforce the original prevention goals. Research shows that the benefits from middle school prevention programs diminish without followup programs in high school.

Prevention programs should include
teacher training in good classroom management practices, such as rewarding appropriate student behavior. Such
techniques help to foster student’s positive behavior,
achievement, academic motivation, and school bonding.

Prevention programs are most effective
when they employ interactive techniques, such as peer
discussion groups and parent role-playing, that allow
for active involvement in learning about drug abuse and reinforcing skills.

Research-based prevention programs
can be cost-effective. Similar to earlier research, recent research shows that for each dollar invested in prevention, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen.

Most research-based prevention interventions in
schools include curricula that teach many of the
behavioral and social skills described above. The
Life Skills Training Program exemplifies universal
classroom programs that are provided to middleschoolers. The program teaches drug resistance, self-management, and general social skills in a
3-year curriculum, with the third year a booster
session offered when students enter high school.

The Caring School Community Program is another
type of school-based intervention. This universal
elementary school program focuses on establishing
a “sense of community” among the classroom, school,
and family settings. The community support that
results helps children succeed in school and cope
with stress and other problems when they occur.

An indicated intervention that reaches high school
students, Project Towards No Drug Abuse focuses on
students who have failed to succeed in school and are
engaged in drug abuse and other problem behaviors.

The program seeks to rebuild students’ interest in
school and their future, correct their misperceptions
about drug abuse, and strengthen protective factors,
including positive decisionmaking and commitment.

Recent research suggests caution when
grouping high-risk teens in peer group
interventions for drug abuse prevention.

Such groups have been shown to produce
negative effects, as participants appear to
reinforce substance abuse behaviors over time
(Dishion et al. 2002). Research is examining
how to prevent such effects, with a particular
focus on the role of adults and positive peers.

In the Community
Prevention programs work at the community level
with civic, religious, law enforcement, and other
government organizations to enhance antidrug
norms and prosocial behaviors. Strategies to change
key aspects of the environment are often employed
at the community level. These can involve instituting
new policies, such as the drug-free school concept,
or strengthening community practices, such as asking
for proof of age to buy cigarettes.

PRINCIPLE 12
PRINCIPLE 13
PRINCIPLE 14
PRINCIPLE 15
PRINCIPLE 16

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National Institute on Drug Abuse 21
Many programs coordinate prevention efforts
across settings to communicate consistent messages
through school, work, religious institutions, and the
media. Research has shown that programs that reach
youth through multiple sources can strongly impact
community norms (Chou et al. 1998). Communitybased programs also typically include development of policies or enforcement of regulations, mass media
efforts, and community-wide awareness programs.

Examples include establishing youth curfew, having
advertising restrictions, reducing the density of alcohol outlets in the community, raising cigarette prices,
and creating drug-free school zones. Some carefully
structured and targeted media interventions have
proven to be very effective in reducing drug abuse.

For example, a mass media campaign targeting
sensation-seeking youth reduced marijuana abuse
by 27 percent among high sensation-seeking youth
(Palmgreen et al. 2001).

Project STAR is an example of a multicomponent
drug abuse prevention program for the community.

This project tested whether a coordinated effort
that encompassed schools, parents, community
organizations, health policies, and the media could
make a difference in preventing drug abuse among
youth. Project STAR reached all children and
families in the community. The middle school
curriculum was the core of the program and was
reinforced by homework and other activities of the
parent component. Health policies and mass media
components were incorporated as well. Long-term
followup studies have shown significant impacts in
reducing substance abuse, with benefits lasting well
into participants’ adult years.

What are the core elements of effective
research-based prevention programs?
In recent years, many research-based prevention
programs have proven effective. These programs
were tested with rigorous designs in diverse
communities in a wide variety of settings, and with
a variety of populations. The most rigorous design
tests the program’s effects on a group that receives
the intervention (i.e., “experimental group”) and
compares results to a second group that did not
receive the intervention (i.e., “control group”).

As communities review prevention programs to
determine which best fit their needs, the following
core elements of effective research-based programs
should be considered.
• Structure—how each program is organized
and constructed;
• Content—how the information, skills, and
strategies are presented; and
• Delivery—how the program is selected or adapted
and implemented, as well as how it is evaluated
in a specific community.

When adapting programs to match community
characteristics, it is important to retain these core
elements to ensure that the most effective aspects of
the program remain intact. Core elements help build
effective research-based prevention programs.

Each core element contains descriptive features, which
are presented in the following sections. Tables are
included in each section to provide examples of
how these features fit together in programs.

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22 Preventing Drug Use among Children and Adolescents
Content of Prevention Programs
Program Types
Community
School
Family
Information
Drug Trends
Drug Effects
Drug Abuse
Symptoms
Skills Development
Social Skills
Resistance Skills
Parenting Skills
Methods
Tolerance Policies
Norms Change
Home Drug-Testing;
Curfew
Services
Drug-Free Zones
School Counseling and
Assistance
Family Therapy
The setting describes where the program takes place.

Prevention programs are usually designed to reach
target populations in their primary setting, such as
reaching children at school. It is becoming more
common, however, for effective programs to be
conducted in settings other than their primary
setting—for example, holding a family-based
program in a school or a school-based program
in a youth organization such as Boys/Girls Clubs.

Multicomponent programs reach populations
in a variety of settings.

Content
Content is composed of information, skills
development, methods, and services. Information
can include facts about drugs and their effects, as
well as drug laws and policies. Drug information
alone, however, has not been found to be effective in
deterring drug abuse. Combining information with
skills, methods, and services produces more effective
results. Programs include skills development training
to build and improve behaviors in important areas,
such as communication within the family, social
and emotional development, academic and social
competence in children, and peer resistance
strategies in adolescents.

Methods are oriented toward structural change,
such as establishing and enforcing school rules on
substance abuse, or enforcing existing laws, such
as those on tobacco sales to minors. Services could
include school counseling and assistance, peer
counseling, family therapy, and health care. These
content areas are designed to reduce modifiable risk
factors and strengthen protective factors.

The table below describes the type of content
included in programs.

Structure
Structure addresses program type, audience, and
setting. Several program types have been shown
to be effective in preventing drug abuse. Schoolbased programs, the first to be fully developed and tested, have become the primary approach
for reaching all children. Family-based programs
have proven effective in reaching both children
and their parents in a variety of settings. Media
and computer technology programs are beginning
to demonstrate effectiveness in reaching people at
the community level as well as the individual level.

Research also shows that combining two or
more effective programs, such as family and
school programs, can be even more effective
than a single program alone. These are called
multicomponent programs.

The following examples illustrate program structure:

Within these categories, programs have been designed
to specifically target the needs of a particular audience, such as an indicated prevention program for highrisk boys. Examples of other subcategories would include urban or rural populations, racial and ethnic
minorities, and different age groups. Researchers are
testing how to modify effective programs to best
address such audience differences.

Structure of Prevention Programs
Program Type Audience Setting
Community
(Universal)
School
(Selective)
Family (Indicated)
All Youth
Middle School
Students
High-RiskYouth
and Their Families
Billboards
After-School
Clinic

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National Institute on Drug Abuse 23
Delivery
Delivery includes program selection or adaptation
and implementation. The following table describes
various delivery approaches.

During the selection process, communities match
effective research-based programs to their community
needs. In Chapter 2, it was suggested that communities
conduct a structured review of existing programs to
determine what gaps remain, given risk and protective
factors in the community and the community’s drug
problems and needs. This information can then be
incorporated into the community plan, which guides
the selection of new research-based programs.

For initial guidance to aid the selection process,
communities can refer to the description of programs
in several categories found in Chapter 4. Additional
planning and program resources can be found in
Selected Resources and References, which offers Web
sites, contact information, and publications to guide
community efforts.

Adaptation involves shaping a program to fit the
needs of a specific population in various settings.

Scientists have been exploring how best to culturally
adapt effective programs to a specific environment
(such as a rural environment) and population (only
boys, for example). In the process of adaptation, the
program’s core elements are maintained to ensure the
effectiveness of the intervention, while addressing the community’s needs. Several research-based adapted
programs are now available, such as the Life Skills
Training Program for inner-city minority youth.

For programs that have not yet been adapted and
studied in a research protocol, it is best to implement the program as designed to ensure the most effective
outcomes. Implementation refers to how the program
is delivered, including the number of sessions,
methods used, and program followup. Research
has found that how a program is implemented can
determine its effectiveness in preventing drug abuse.

Use of interactive methods and appropriate
booster sessions helps to reinforce earlier
program content and skills to maintain
program benefits.

Delivery of Prevention Programs
Program
Type
Community
School
Family
Program Selection
or Adaptation
Spanish-Speaking
Population
Gender
Rural
Implementation
Features
Consistent
Multimedia
Messages
Booster Sessions
Recruitment/
Retention

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24 Preventing Drug Use among Children and Adolescents
How can the community evaluate the
impact of its program on drug abuse?
Conducting evaluations of community prevention
programs can be challenging. Many community
leaders have consulted with university faculty members
and other local and State evaluation experts to assist
in designing and implementing evaluation procedures.

Ensuring appropriate evaluation design is important
because errors can result in findings that do not show
a clear relationship between the program and the
outcomes. Were the results truly attributable to the
program’s effects and not some other source, such
as other community events or the maturation
of the target groups?
An evaluation should identify what was accomplished
in the program, how it was carried out, and its effects.

To ensure a thorough evaluation, the program
implementer and staff should assess ongoing
adherence to program elements. Keeping records
of content delivered, session attendance, content
feedback quizzes, and independent observations
of implementation fidelity can help monitor the
effectiveness of program implementation and
provide key information on why a program
is or is not achieving its intended effects.

How can the community implement and
sustain effective prevention programs?
After considering risk and protective factors
within the community and selecting and adapting
prevention programs to address those risks, the
community must begin to implement those programs.

In many communities, coalitions formed during the
community planning process remain involved in
overseeing program implementation. They continue
to review progress toward goals and objectives set
out in the community plan. Responsibility for actual
implementation, however, generally resides within the
local public or private community-based organization
in the educational, social service, or other local system implementing the programs.

To ensure effective implementation, research-based
school and family programs often require extensive
human and financial resources and a serious
commitment to training and technical assistance.

In addition to resources, special attention is needed
to attract and keep program participants interested
and involved in the programs. This is especially
important when involving families in rural and poverty
settings. Research has shown that extra effort in
providing incentives, maximal schedule flexibility,
minimal time demands, free meals, transportation,
baby-sitting, personal contact, and endorsement from
important community leaders all help to attract and
retain program participants. In short, how a program
is delivered to specific audiences is critical to its success.

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National Institute on Drug Abuse 25
Parents can work with others in the community
to use the prevention principles in selecting drug
abuse programs.

Educators can incorporate research-based
content and delivery into their regular
classroom curricula.

Community Leaders can work with evaluation
experts to evaluate program progress and
develop improvements in outcomes.

COMMUNITY ACTION BOX
Evaluation pitfalls can be avoided by consulting with
experts who can guide the evaluation design by:
• using tested data-collection instruments;
• obtaining good baseline, or preintervention,
information;
• using control or comparison groups who did not
receive the intervention, but whose characteristics
are similar to those who did receive it;
• monitoring the quality of program implementation;
• ensuring that postintervention followup includes
a large percentage of the target population; and
• using appropriate statistical methods to analyze
the data.

In addition to assessing program impact, evaluation
is an ongoing process that can provide guidance on
maintaining the program’s responsiveness to changing
community needs.

The evaluation process needs to answer questions
about the program and its outcomes, including:
aWhat was accomplished in the program?
aHow was the program carried out?
aWho participated in it?
aHow much of the program was received
by participants?
aIs there a connection between the amount
of program received and outcomes?
aWas the program implemented as intended?
aDid the program achieve what was expected
in the short term?
aDid the program produce the desired
long-term effects?
What are the cost-benefits of
community prevention programs?
Research has demonstrated that preventing substance
abuse and other problem behaviors can have a
net benefit after accounting for costs. In a recent
study, Spoth and associates (2002a) performed
cost-effectiveness and benefit-cost analyses on data
from two long-term interventions already shown
to be effective in preventing substance abuse: Iowa
Strengthening Families Program (ISFP; now called
The Strengthening Families Program: For Parents
and Youth 10–14), and Preparing for the Drug-Free
Years (PDFY; now called Guiding Good Choices).

Both interventions were found to have net benefits
by preventing adult cases of alcohol abuse and thus
saving future costs for alcohol abuse treatment.

Benefit-to-cost ratios were $9.60 for each dollar
invested in prevention for the ISFP group, and $5.85
per dollar invested in prevention for the PDFY group.

For each family in the ISFP condition, there was a
benefit of $5,923; and the PDFY condition resulted
in a benefit of $2,697 per family. In addition, an
analysis of the Skills, Opportunity, And Recognition
(SOAR) program had a benefit-to-cost ratio of $4.25
for every dollar spent (Hawkins et al. 1999; Aos et
al. 2001). An earlier study (Pentz 1998) found that
for every dollar spent on drug abuse prevention,
communities could save from $4 to $5 in costs
for drug abuse treatment and counseling.

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26 Preventing Drug Use among Children and Adolescents
Universal Programs
Elementary School
Caring School Community Program (Formerly, Child
Development Project) (Battistich et al. 1997; U.S.

Department of Education 2001). This is a universal
family-plus-school program to reduce risk and bolster
protective factors among elementary school children.

The program focuses on strengthening students’
“sense of community,” or connection, to school.

Research has shown that this sense of community
has been pivotal to reducing drug use, violence,
and mental health problems, while promoting
academic motivation and achievement. The program
consists of a set of mutually reinforcing classroom,
school, and family involvement approaches. These
promote positive peer, teacher-student, and homeschool relationships and the development of social, emotional, and character-related skills. The program
provides detailed instructional and implementation
materials and accompanying staff development.

Contact for Materials and Research:

Eric Schaps, Ph.D.

Caring School Community Program
Developmental Studies Center
2000 Embarcadero, Suite 305
Oakland, CA 94606-5300
Phone: 510-533-0213
Fax: 510-464-3670
E-mail: [email protected]
Web site: www.devstu.org
Chapter 4: Examples of Research-Based
Drug Abuse Prevention Programs
To help those working in drug abuse prevention,
NIDA, in cooperation with prevention scientists,
presents the following examples of research-based
programs that use a variety of strategies proven
effective in preventing drug abuse. Each program
was developed as part of a research protocol in which
an intervention group and a comparison group were
matched on important characteristics, such as age,
grade in school, parents’ level of education, family
income, community size, and risk and protective
factors. The interventions were tested in a family,
school, or community setting, all with positive results.

Prevention research continues to identify effective
programs and strategies, thus this list is not meant
to be exhaustive.

Many of these research-based programs include
approaches to identifying early risk factors and
addressing them long before a child encounters
substance abuse. Whether the intervention focuses on
improving teachers’ skills in classroom management
and academic support or on parents’ communication
skills, early positive support can reduce risks and
increase protection. Also, recent research is focused
on adapting interventions to address specific risks by
gender, ethnic or racial identification, and geographic settings to improve the effectiveness of programs for
specific audiences.

The programs are presented within their audience
category (universal, selective, indicated, or tiered)
and for whom they are designed (elementary, middle,
or high school students). Since these programs are
only examples, community planners may wish to
explore additional programs and planning resources,
which are highlighted in Selected Resources and
References. With NIDA’s continued support of
research on effective prevention strategies at all levels of prevention, new research-based programs will
continue to be made available in the future.

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National Institute on Drug Abuse 27
Classroom-Centered (CC) and Family-School
Partnership (FSP) Intervention (Ialongo et al. 2001).

The CC and FSP interventions are multicomponent,
universal first-grade interventions to reduce later onset of violence and aggressive behavior and to improve
academic performance. The CC intervention combines
two effective classroom programs, the “Good Behavior
Game” and “Mastery Learning,” and includes
classroom management and organizational strategies,
as well as reading and mathematics curricula. The
CC intervention also focuses on enhancing teachers’
behavior management and instructional skills. The
FSP intervention targets the same risk factors of
aggression and learning problems, but directly
involves parents. It seeks to improve parent-teacher
communication, parental teaching, and children’s
behavior management strategies in the home.

Findings show that sixth-graders exposed to the
CC intervention in first grade had significantly
reduced their aggressive behavior, as compared
with control students.

Contact for Materials and Research:

Nicholas Ialongo, Ph.D.

Department of Mental Health
Johns Hopkins Bloomberg
School of Public Health
Johns Hopkins University
624 N. Broadway
Baltimore, MD 21205
Phone: 410-550-3441
Fax: 410-550-3461
E-mail: [email protected]
Promoting Alternative Thinking Strategies
(PATHS) (Greenberg and Kusché 1998). PATHS is
a comprehensive program for promoting emotional
health and social competencies and reducing aggression
and behavior problems in elementary school children,
while enhancing the educational process in the
classroom. This K–5 curriculum is designed for use
by educators and counselors in a multiyear, universal
prevention model. Although primarily for use in
school and classrooms, information and activities
are also included for use with parents. PATHS has
been shown to improve protective factors and
reduce behavioral risk factors that impact youth
problem behaviors. Studies report reduced aggressive
behaviors, increased self-control, and an improved
ability to tolerate frustration and use conflictresolution strategies.

Contact for Materials:

Channing Bete Company
One Community Place
South Deerfield, MA 01373-0200
Phone: 877-896-8532
Fax: 800-499-6464
E-mail: [email protected]
Web site: www.channing-bete.com
Contact for Research:

Mark T. Greenberg, Ph.D.

Prevention Research Center
Pennsylvania State University
110 Henderson Building-South
University Park, PA 16802-6504
Phone: 814-863-0112
Fax: 814-865-2530
E-mail: [email protected]
Web site: www.prevention.psu.edu/PATHS
Contact for Training:

PATHS Training, LLC
Carol A. Kusché, Ph.D.
927 10th Avenue E.

Seattle, WA 98102
Phone and Fax: 206-323-6688
E-mail: [email protected]
Skills, Opportunity, And Recognition (SOAR)
(Formerly, Seattle Social Development Program)
(Lonczak et al. 2002; U.S. Department of Education
2001; Hawkins et al. 1999). This universal schoolbased intervention for grades one through six seeks to reduce childhood risks for delinquency and
drug abuse by enhancing protective factors. The
multicomponent intervention combines training
for teachers, parents, and children during the
elementary grades to promote children’s bonding
to school, positive school behavior, and academic
achievement. These strategies are designed to enhance
opportunities, skills, and rewards for children’s
prosocial involvement in school and their families.

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28 Preventing Drug Use among Children and Adolescents
Long-term followup results show positive outcomes
for participants, including reduced antisocial behavior, misbehavior, alienation and teen pregnancy, and
improved academic skills, commitment to school,
and positive relationships with people.

Contact for Materials:

Channing Bete Company
One Community Place
South Deerfield, MA 01373-0200
Phone: 877-896-8532
Fax: 800-499-6464
E-mail: [email protected]
Web site: www.channing-bete.com
Contact for Research:

J. David Hawkins, Ph.D.

Social Development Research Group
University of Washington
9725 Third Avenue NE, Suite 401
Seattle, WA 98115
Phone: 206-543-7655
Fax: 206-543-4507
E-mail: [email protected]
Web site: www.depts.washington.edu/sdrg
Middle School
Guiding Good Choices (GGC) (Formerly, Preparing
for the Drug-Free Years) (Hawkins et al. 1999;
Kosterman et al. 1997; U.S. Department of Education
2001; Spoth et al. 2002b). This curriculum was first
researched as part of the Seattle Social Development
Project at the University of Washington to educate
parents on how to reduce risk factors and strengthen
bonding in their families. In five 2-hour sessions,
parents are shown how to (1) create age-appropriate
opportunities for family involvement and interaction;
(2) set clear expectations, monitor children, and apply discipline; (3) teach their children peer coping strategies; (4) adopt family conflict management approaches;
and (5) express positive feelings to enhance family
bonding. Dr. Richard Spoth of Iowa State University
independently tested this intervention for rural
parents and found the program to be effective in
inhibiting alcohol and marijuana use. Special efforts
were made to ensure recruitment and retention
of study participants.

Contact for Research:

J. David Hawkins, Ph.D.

Channing Bete Company
One Community Place
South Deerfield, MA 01373-0200
Phone: 877-896-8532
Fax: 800-499-6464
E-mail: [email protected]
Web site: www.channing-bete.com
Life Skills Training (LST) Program (Botvin et al.
1995, 1997, 2003; U.S. Department of Education
2001). LST is designed to address a wide range of risk
and protective factors by teaching general personal
and social skills, along with drug resistance skills
and normative education. This universal program
consists of a 3-year prevention curriculum for students in middle or junior high school. LST contains 15
sessions during the first year, 10 booster sessions
during the second, and 5 sessions during the third
year. The program can be taught either in grades 6, 7,
and 8 (for middle school) or grades 7, 8, and 9 (for
junior high schools). LST covers three major content
areas: (1) drug resistance skills and information,
(2) self-management skills, and (3) general social
skills. The program has been extensively tested over
the past 20 years and found to reduce the prevalence
of tobacco, alcohol, and illicit drug use relative to
controls by 50 to 87 percent. When combined with
booster sessions, LST was shown to reduce the
prevalence of substance abuse long term by as much
as 66 percent, with benefits still in place beyond
the high school years. Although LST was originally
tested predominantly with White youth, several studies
have shown that the LST program is also effective

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National Institute on Drug Abuse 29
with inner-city minority youth. Moreover, an
age-appropriate version of the LST program for upper
elementary school students was recently developed
and shown to reduce tobacco and alcohol use (Botvin
et al. 2003). It contains 24 classes (8 classes per year) to be taught during either grades 3 to 5 or 4 to 6.

Contact for Materials and Training:

National Health Promotion Associates, Inc.

Life Skills Training
711 Westchester Avenue
White Plains, NY 10604
Phone: 914-421-2525
Fax: 914-683-6998
E-mail: [email protected]
Web site: www.lifeskillstraining.com
Contact for Research:

Gilbert Botvin, Ph.D.

Institute for Prevention Research
Weill Medical College of Cornell University
411 East 69th Street, Room 203
New York, NY 10021
Phone: 212-746-1270
Fax: 212-746-8390
E-mail: [email protected]
Lions-Quest Skills for Adolescence (SFA) (Eisen et al.
2002; U.S. Department of Education 2001). SFA is a
commercially available, universal, life skills education program in use in schools nationwide. A rigorous
school-based trial of SFA funded by a NIDA research
grant compared the effectiveness of SFA delivered
in sixth grade with “standard” drug prevention
programs in preventing or delaying the onset of
students’ tobacco, alcohol, and illegal substance use
through middle school. The 40-session version of SFA
tested includes social influence and social cognitive
approaches to teaching cognitive-behavioral skills
for building self-esteem and personal responsibility,
communicating effectively, making better decisions,
resisting social influences and asserting rights, and
increasing drug use knowledge and consequences
(Quest International, 3rd edition 1992.) Some of
the results after 1 year indicate that exposure to the
program can help deter initiation of regular cigarette
smoking and marijuana use; these results held across
all racial/ethnic groups studied. Additional findings
after 2 years indicate lower initiation and regular
marijuana use across all groups, as well as lower
binge drinking rates among Hispanic students.

Contact for Materials:

Greg Long
Lions-Quest
1984-B Coffman Road
Newark, OH 43055
Phone: 740-522-6405 or 800-446-2700
Fax: 740-522-6580
E-mail: [email protected]
Web site: www.lions-quest.org
Contact for Research:

Marvin Eisen, Ph.D.

Population Studies Center
The Urban Institute
2100 M Street, NW
Washington, DC 20037
Phone: 202-261-5858
Fax: 202-452-1840
E-mail: [email protected]
Project ALERT (U.S. Department of Education 2001).

This drug prevention curriculum is a 2-year, universal
program for middle school students that reduces the
onset and regular use of substances among youth.

The 14-lesson program is designed to prevent drug
use initiation and the transition to regular use. It
focuses on substances that adolescents typically use
first and most widely—alcohol, tobacco, marijuana,
and inhalants. Project ALERT uses participatory
activities and videos to help students establish nondrug norms, develop reasons not to use, and resist prodrug
pressures. The program has prevented marijuana use
initiation, decreased current and heavy smoking, curbed alcohol misuse, reduced prodrug attitudes and beliefs,
and helped smokers quit. The program has proven
successful with high- and low-risk youth from
a variety of communities.

Contact for Materials:

G. Bridget Ryan
Project ALERT
725 S. Figueroa Street, Suite 970
Los Angeles, CA 90017
Phone: 800-253-7810
Fax: 213-623-0585
E-mail: [email protected]
Web site: www.projectalert.best.org

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30 Preventing Drug Use among Children and Adolescents
Contact for Research:

Phyllis L. Ellickson, Ph.D.

Director, Center for Research on
Maternal, Child, and Adolescent Health
The RAND Corporation
1700 Main Street
P.O. Box 2138
Santa Monica, CA 90407-2138
Phone: 310-393-0411
Fax: 310-451-7062
E-mail: [email protected]
Web site: www.rand.org
Project STAR (Chou et al. 1998; U.S. Department of
Education 2001). Project STAR is a comprehensive
drug abuse prevention community program with
components for schools, parents, community
organizations, and health policymakers. An additional
component targets mass media to encourage publicizing
positive efforts for drug prevention. The middle
school component is a social influence curriculum
that is incorporated into classroom instruction by
trained teachers over a 2-year timetable. In the
parent program, parents work with children on
homework, learn family communication skills, and
get involved in community action. Strategies range
from individual-level change, such as teaching youth
drug resistance skills, to school and community-change, including limiting youth access to alcohol or drugs.

Long-term followup studies showed significant
reductions in drug use among participants, when
compared with adolescents in the community who
had not received prevention intervention.

Contact for Materials and Research:

Karen Bernstein, M.P.H.

University of Southern California
Institute for Prevention Research
1000 S. Fremont Avenue, Unit #8
Alhambra, CA 91803
Phone: 626-457-6687
Fax: 626-457-6695
E-mail: [email protected]
The Strengthening Families Program: For Parents
and Youth 10–14 (SFP 10–4) (Formerly, the Iowa
Strengthening Families Program) (Spoth, Redmond,
and Shin 2000, 2001). This program offers seven
sessions, each attended by youth and their parents.

Program implementation and evaluation have been
conducted through partnerships that include state
university researchers, Cooperative Extension System
staff, local schools, and community implementers.

Longitudinal study of comparisons with control
group families showed positive effects on parents’
child management practices (for example, setting
standards, monitoring children, and applying
consistent discipline) and on parent-child affective
quality. In addition, a recent evaluation found
delayed initiation of substance use at the 6-year
followup. Other findings showed improved youth
resistance to peer pressure to use alcohol, reduced
affiliation with antisocial peers, and reduced levels of problem behaviors. Importantly, conservative benefitcost calculations indicate returns of $9.60 per dollar invested in SFP.

Contact for Materials and Research:

Virginia Molgaard, Ph.D.

Prevention Program Development
The Strengthening Families Program:

For Parents and Youth 10–14
Institute for Social and Behavioral Research
Iowa State University
2625 North Loop Drive, Suite 500
Ames, IA 50010-8296
Phone: 515-294-8762
Fax: 515-294-3613
E-mail: [email protected]
Web site: www.extension.iastate.edu/sfp/
Contact for Research and Evaluation Information:

Richard Spoth, Ph.D.
c/o Pandora Lamar
Institute for Social and Behavioral Research
Iowa State University
2625 North Loop Drive, Suite 500
Ames, IA 50010-8296
Phone: 515-294-5383
Fax: 515-294-3613
E-mail: [email protected]; cc: [email protected]
Web site: www.projectfamily.isbr.iastate.edu

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National Institute on Drug Abuse 31
High School
Life Skills Training: Booster Program. The 3-year
LST universal classroom program contains 15 booster
sessions during the first year, 10 during the second,
and 5 during the third year. See the Life Skills
Training description above for background and
contact information.

Lions-Quest Skills for Adolescence. (Eisen 2002; U.S.

Department of Education 2001). See description
above for background and contact information.

Project ALERT Plus. An enhanced version of Project
ALERT has been added as a high school component
and is being tested in 45 rural communities. See the
Project ALERT description above for background
and contact information.

The Strengthening Families Program: For Parents
and Youth 10–14. (Formerly, the Iowa Strengthening
Families Program). See description above for
background and contact information.

Selective Programs
Elementary School
Focus on Families (FOF) (Catalano et al. 1999,
2002). A selective program for parents receiving
methadone treatment and their children, FOF seeks
to reduce parents’ use of illegal drugs by teaching
them skills for relapse prevention and coping. Parents
are also taught how to better manage their families
to reduce their children’s risk for future drug abuse.

The parent training consists of a 5-hour family
retreat and 32 parent training sessions of 1.5 hours
each. Children attend 12 of the sessions to practice
developmentally appropriate skills with their parents.

Results from an experimental evaluation of FOF
found positive program effects on parents at the 1-year followup, especially in parenting skills, rule-setting, domestic conflict, drug refusal skills, and drug use.

At the 1-year assessment, significantly fewer children
in the experimental condition reported having stolen
something in the previous 6 months. After 2 years
of family skills training, positive effects were still
evident in parents’ drug refusal skills, and positive
effects had emerged in parent problemsolving skills
in general situations. No statistically significant
differences in drug use were found between those in
experimental versus control conditions, although the
direction of difference still favored experimental participants. Importantly, the strength of program effects on children was substantially stronger at the 2-year
followup. Note that the direction of differences on
all primary child outcome measures were stronger
at the second-year assessment than at the end of the
first year. These findings suggest that interventions to prevent relapse among parents and substance abuse
among their children may produce immediate, as well
as delayed, or “sleeper” effects on targeted risk and
protective factors and substance use. The promise of
the FOF program is evident in the early reduction
in family-related risk factors—particularly for very
high-risk families—with an overall trend toward
positive program effects on child outcomes.

Contact for Materials and Research:

Richard F. Catalano, Ph.D.

Social Development Research Group
9725 Third Avenue, NE, Suite 401
University of Washington
Seattle, WA 98115
Phone: 206-543-6382
Fax: 206-543-4507
E-mail: [email protected]
Web site: depts.washington.edu/sdrg

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32 Preventing Drug Use among Children and Adolescents
The Strengthening Families Program (SFP) (Kumpfer
et al. 1996, 2002). SFP, a universal and selective
multicomponent, family-focused prevention program,
provides support for families with 6- to 11-year-olds.

The program began as an effort to help drug-abusing
parents improve their parenting skills and reduce
their children’s risk for subsequent problems.

It has shown success in elementary schools and
communities. Strengthening Families has three
components: a behavioral parent training program,
children’s skills training program, and family skills
training program. In each of the 14 weekly sessions,
parents and children are trained separately in the first hour. During the second hour, parents and children
come together in the family skills training portion.

The session begins with families sharing dinner.

Barriers to attendance are reduced by providing
child care, transportation, and small incentives. This
approach has been evaluated in a variety of settings
and with several racial and ethnic groups. Spanishlanguage manuals are available. Primary outcomes include reduced family conflict, youth conduct
disorders, aggressiveness, and substance abuse, as
well as improved youth social skills, parenting skills, and family communication and organization.

Contact for Materials and Research:

Karol Kumpfer, Ph.D.

University of Utah
Department of Health Promotion
300 S. 1850 E. Room 215
Salt Lake City, UT 84112-0920
Phone: 801-581-7718
Fax: 801-581-5872
E-mail: [email protected]
Web site: www.strengtheningfamiliesprogram.org
Contact for Training:

Henry O. Whiteside, Ph.D.

Lutragroup
5215 Pioneer Fork Road
Salt Lake City, UT 84108-1678
Phone: 801-583-4601
Fax: 801-583-7979
E-mail: [email protected]
Middle School
Coping Power (Lochman and Wells 2002). Coping
Power is a multicomponent child and parent preventive
intervention directed at preadolescent children at
high risk for aggressiveness and later drug abuse
and delinquency. The child component is derived
from an anger coping program, primarily tested
with highly aggressive boys and shown to reduce
substance use. The Coping Power Child Component
is a 16-month program for fifth- and sixth-graders.

Group sessions usually occur before or after school
or during nonacademic periods. Training focuses
on teaching children how to identify and cope with
anxiety and anger; controlling impulsiveness; and
developing social, academic, and problemsolving
skills at school and home. Parents are also provided
training throughout the program. Results indicate
that the intervention produced relatively lower rates
of substance use at postintervention than seen among
the controls. Also, children of families receiving
the Coping Power child and parent components
significantly reduced aggressive behavior, as rated
by parents and teachers.

Contact for Materials and Research:

John E. Lochman, Ph.D.

Department of Psychology
University of Alabama
P.O. Box 870348
Tuscaloosa, AL 35487
Phone: 205-348-7678
Fax: 205-348-8648
E-mail: [email protected]

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National Institute on Drug Abuse 33
High School
Adolescents Training and Learning to Avoid Steroids
(ATLAS) (Goldberg et al. 2000). ATLAS is a
multicomponent selective program for male high
school athletes, designed to reduce risk factors for
use of anabolic steroids and other drugs, while
providing healthy sports nutrition and strength-training alternatives to illicit use of athletic-enhancing
substances. Coaches and peer teammates facilitate
curriculum delivery with scripted manuals in small
cooperative learning groups, taking advantage of an
influential coaching staff and the team atmosphere
where peers share common goals. Seven 45-minute
classroom sessions and seven physical training periods
involve role-playing, student-created campaigns,
and educational games. Instructional aids include
pocket-sized food and exercise guides and easy-tofollow student workbooks. Parents are involved through parent-student homework and are given
the booklet, Family Guide to Sports Nutrition.

Attitudes and alcohol and illicit drug use, as well as
nutrition behaviors and exercise self-efficacy, remained significantly healthier among ATLAS program
participants at a 1-year followup.

Contact for Materials:

Division of Health Promotion
and Sports Medicine
Oregon Health & Science University
Phone: 503-494-7900
Web site: www.ohsu.edu/som-hpsm/atlas.html
Contact for Research:

Linn Goldberg, M.D., FACSM
Division of Health Promotion
and Sports Medicine
Oregon Health & Science University
3181 SW Sam Jackson Park Road
Portland, OR 97201-3098
Phone: 503-494-8051
Fax: 503-494-1310
E-mail: [email protected]
Web site: www.atlasprogram.com
Indicated Programs
High School
Project Towards No Drug Abuse (Project TND)
(Sussman et al. 2002). This indicated prevention
intervention targets high school age youth who
attend alternative or traditional high schools. The
goal is to prevent the transition from drug use to
drug abuse, considering the developmental issues
faced by older teens, particularly those at risk for
drug abuse. At the core of Project TND is a set of
12 in-class sessions that provide motivation and
cognitive misperception correction, social and selfcontrol skills, and decisionmaking material targeting the use of cigarettes, alcohol, marijuana, and hard
drugs and violence-related behavior, such as carrying
a weapon. The classroom program has been found
to be effective at 1-year followup across three true
experimental field trials. The 12-session version is
effective across outcome variables, and many effects
are maintained at 2-year followup.

Contact for Materials and Research:

Steve Sussman, Ph.D., FAAHB
Institute for Health Promotion
and Disease Prevention Research
Departments of Preventive Medicine
and Psychology
University of Southern California
1000 S. Fremont Avenue, Unit 8
Building A-4, Room 4124
Alhambra, CA 91803
Phone: 626-457-6635
Fax: 626-457-4012
E-mail: [email protected]
Reconnecting Youth Program (RY) (Eggert et al.
1995, 2001; Thompson et al. 1997). RY is a schoolbased indicated prevention program for high school students with poor school achievement and potential
for dropping out. Participants may also show signs
of multiple problem behaviors, such as substance
abuse, depression, aggression, or suicidal behaviors.

Students are screened for eligibility and then invited
to participate in the program. The program goals are
to increase school performance, reduce drug use, and

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34 Preventing Drug Use among Children and Adolescents
learn skills to manage mood and emotions. RY blends
small group work (10–12 students per class) to foster
positive peer bonding, with social skills training in
a daily, semester-long class. RY skills, taught by an
RY specially trained teacher or group leader, include
self-esteem enhancement, decisionmaking, personal
control, and interpersonal communication. Early
experiments have shown that participation in RY
improved school performance (20-percent increase
in GPA), decreased school dropout, reduced hard
drug use (by 60 percent), and decreased drug use
control problems, such as adverse consequences and
progression to heavier drug use. Recent studies of a
refined RY program model (with skills training on
depression and anger management and increased
monitoring of drug use) have found greater decreases
in hard drug use, depression, perceived stress, and
anger control problems.

Contact for Materials:

Reconnecting Youth: A Peer Group Approach
to Building Life Skills (Revised Edition)
National Educational Service
304 West Kirkwood Avenue, Suite 2
Bloomington, IN 47404
Phone: 800-733-6786 or 812-336-7790
Fax: 812-336-7790
E-mail: [email protected]
Web site: www.nesonline.com
Contact for Research and Program Evaluation:

Jerald R. Herting, Ph.D.

Reconnecting Youth Prevention
Research Program
Psychosocial and Community Health
University of Washington School of Nursing
9709 Third Avenue NE, Suite 510
Seattle, WA 98115
Phone: 206-543-3810 or 206-616-6478
Fax: 206-221-3674
E-mail: [email protected]
Web site: www.son.washington.edu/department/pch/ry
Contact for Training:

Leona L. Eggert or Liela J. Nicholas,
Program Developers
Reconnecting Youth Prevention Programs
Phone: 425-861-1177
Fax: 425-861-8071
E-mail: [email protected]
Tiered Programs
Elementary School
Early Risers “Skills for Success” Risk Prevention
Program (August et al. 2001; August et al. 2002;
August et al., in press). Early Risers is a selective,
multicomponent, preventive intervention for children
at heightened risk for early onset of serious conduct
problems, including licit and illicit drug use. The
program’s focus is on elementary school children
with early aggressive behavior. It is designed to deflect children from the “early starter” developmental
pathway toward normal development by effecting
positive change in academic competence, behavioral
self-regulation, social competence, and parent
investment in the child. Early Risers has two
broad components: CORE, a set of child-focused
intervention components delivered continuously
in school and over the summer for 2 or 3 years,
implemented in tandem with FLEX, a family
support and empowerment component tailored to
meet family-specific needs and delivery through
home visits. Recent findings reveal that program
participants showed greater gains in social skills, peer reputation, prosocial friendship selection, academic
achievement, and parent discipline than did controls.

Contact for Materials and Research:

Gerald J. August, Ph.D.

Division of Child and Adolescent Psychiatry
University of Minnesota Medical School
P256/2B West, 2450 Riverside Avenue
Minneapolis, MN 55454-1495
Phone: 612-273-9711
Fax: 612-273-9779
E-mail: [email protected]
Fast Track Prevention Trial for Conduct Problems
(Conduct Problems Prevention Research Group 2002c).

Fast Track is a comprehensive preventive intervention
for young children at high risk for long-term antisocial behavior. Based on a developmental model, the
intervention includes a universal classroom program
(adapted from the PATHS curriculum) for high-risk
children selected in kindergarten; it also includes
training for parents. Children receive social skills
training, academic tutoring, and home visits to improve

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National Institute on Drug Abuse 35
academic and social competencies and reduce
problems. In first grade, the classroom intervention
builds skills in (1) emotional understanding and
communication, (2) friendship, (3) self-control, and
(4) social problemsolving. The selective intervention
reaches parents and children at higher risk for
conduct problems. Parenting strategies provide
skills to support school adjustment, improve the
child’s behavior, build parents’ self-control, promote
appropriate expectations for the child’s behavior, and
improve parent-child interaction. By the end of third
grade, 37 percent of the intervention group were free of serious conduct problems, compared with 27 percent
of the control group.

Contact for Materials and Research:

Conduct Problems Prevention
Research Group
Karen L. Bierman, Ph.D.

Pennsylvania State University
Prevention Research Center
110 Henderson-Building South
University Park, PA 16802-6504
Phone: 814-865-3879
Fax: 814-865-3246
E-mail: [email protected]
Middle School
Adolescent Transitions Program (ATP) (Dishion et al.
2002). ATP is a school-based program that uses a
tiered approach to provide prevention services to
students in middle and junior high school and their
parents. The universal intervention level, directed
to parents of all students in a school, establishes a
Family Resource Room to engage parents, establish
norms for parenting practices, and disseminate
information about risks for problem behavior and
substance use. The selective intervention level, the
Family Check-Up, offers family assessment and
professional support to identify families at risk for
problem behavior and substance use. The indicated
level, the Parent Focus curriculum, provides direct
professional support to parents to make the changes
indicated by the Family Check-Up. Services may
include behavioral family therapy, parenting groups,
or case management services.

Contact for Materials and Research:

Thomas J. Dishion, Ph.D.

University of Oregon
Child and Family Center
195 West 12th Avenue
Eugene, OR 97401
Phone: 541-346-4805
Fax: 541-346-4858

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36 Preventing Drug Use among Children and Adolescents
Chapter 5: Selected Resources and References
Below are resources relevant to drug abuse prevention. Information on NIDA’s Web site is followed by Web sites for other Federal agencies and private organizations. These resources and the selected references that follow are excellent sources of information in helping communities plan and implement research-based drug prevention programs.

Selected Resources
National Institute on Drug Abuse (NIDA)
National Institutes of Health (NIH)
U.S. Department of Health and
Human Services (DHHS)
NIDA’s Web site (www.drugabuse.gov) provides
factual information on all aspects of drug abuse,
particularly the effects of drugs on the brain and
body, the prevention of drug abuse among children
and adolescents, the latest research on treatment
for addiction, and statistics on the extent of drug
abuse in the United States. The Web site allows
visitors to print or order publications, public service announcements and posters, science education
curricula, research reports and fact sheets on specific drugs or classes of drugs, and the NIDA NOTES
newsletter. The site also links to related Web sites
in the public and private sector.

Other Federal Resources
Center for Substance Abuse Prevention (CSAP)
Substance Abuse and Mental Health Services
Administration (SAMHSA), DHHS
5600 Fishers Lane
Rockwall 2, 9th Floor, Suite 900
Rockville, MD 20857
Phone: 301-443-9110
www.prevention.samhsa.gov
Centers for Disease Control and Prevention (CDC), DHHS
1600 Clifton Road
Atlanta, GA 30333
Phone: 404-639-3534
Phone: 800-311-3435 (toll-free)
www.cdc.gov
Safe and Drug-Free Schools Program
U.S. Department of Education (DoE)
400 Maryland Avenue, SW
Washington, DC 20202
Phone: 800-872-5327 (toll-free)
www.ed.gov
Drug Enforcement Administration (DEA)
U.S. Department of Justice (DOJ)
2401 Jefferson Davis Highway
Alexandria, VA 22301
Phone: 202-307-1000
www.dea.gov
Knowledge Exchange Network, SAMHSA, DHHS
P.O. Box 42490
Washington, DC 20015
Phone: 800-789-2647 (toll-free)
www.mentalhealth.org

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National Institute on Drug Abuse 37
National Clearinghouse for Alcohol and
Drug Information (NCADI), SAMHSA, DHHS
Phone: 800-729-6686 (toll-free)
www.ncadi.samhsa.gov
National Institute on Alcohol Abuse and Alcoholism
(NIAAA), NIH, DHHS
6000 Executive Boulevard, Willco Building
Bethesda, MD 20892
Phone: 301-443-3860
www.niaaa.nih.gov
National Institute of Mental Health (NIMH), NIH, DHHS
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892
Phone: 301-443-4513
www.nimh.nih.gov
National Institutes of Health (NIH), DHHS
9000 Rockville Pike
Bethesda, MD 20892
Phone: 301-496-4000
www.nih.gov
National Library of Medicine (NLM), NIH, DHHS
8600 Rockville Pike
Bethesda, MD 20894
Phone: 301-594-5983
Phone: 888-346-3656 (toll-free)
www.nlm.nih.gov
Office of Juvenile Justice and Delinquency Prevention
(OJJDP), DOJ
810 Seventh Street
Washington, DC 20531
Phone: 202-307-5911
www.ojjdp.ncjrs.org/pubs/substance.html
Office of National Drug Control Policy (ONDCP)
P.O. Box 6000
Rockville, MD 20849
Phone: 800-666-3332 (toll-free)
www.whitehousedrugpolicy.gov
Substance Abuse and Mental Health Services Administration (SAMHSA), DHHS
5600 Fishers Lane
Rockville, MD 20857
Phone: 301-443-8956
www.samhsa.gov
Other Selected Resources
American Academy of Child and Adolescent Psychiatry
(AACAP)
3615 Wisconsin Avenue, NW
Washington, DC 20016
Phone: 202-966-7300
www.aacap.org
American Academy of Family Physicians (AAFP): KidsHealth 11400 Tomahawk Creek Parkway
Leawood, KS 66211
www.familydoctor.org
American Academy of Pediatrics (AAP)
141 Northwest Point Boulevard
Elk Grove, IL 60007-1098
Phone: 847-434-4000
www.aap.org
American Psychological Association (APA)
750 First Street, NE
Washington, DC 20002
Phone: 800-374-2121 (toll-free)
Phone: 202-336-5510
www.apa.org
American Society of Addiction Medicine (ASAM)
4601 North Park Avenue, Arcade Suite 101
Chevy Chase, MD 20815
Phone: 301-656-3920
www.asam.org
Blueprints for Violence Prevention, Center for the Study and Prevention of Violence
Institute on Behavioral Science
University of Colorado at Boulder
900 28th Street, Suite 107
439 UCB
Boulder, CO 80309
Phone: 303-492-1032
www.colorado.edu/cspv/blueprints/
Center on Addiction and Substance Abuse (CASA)
at Columbia University
633 Third Avenue, 19th Floor
New York, NY 10017
Phone: 212-841-5200
www.casacolumbia.org

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38 Preventing Drug Use among Children and Adolescents
Community Anti-Drug Coalitions of America (CADCA)
901 North Pitt Street, Suite 300
Alexandria, VA 22314
Phone: 800-542-2322 (toll-free)
www.cadca.org
Drug Strategies, Inc.
1150 Connecticut Avenue, NW, Suite 800
Washington, DC 20036
Phone: 202-289-9070
www.drugstrategies.org
Join Together
One Appleton Street, 4th Floor
Boston, MA 02116
Phone: 617-437-1500
www.jointogether.org
Latino Behavioral Health Institute
P.O. Box 1008
Thousand Oaks, CA 91360
Phone: 213-738-2882
www.lbhi.org
National Asian Pacific American Families Against
Substance Abuse (NAPAFASA)
340 East Second Street, Suite 409
Los Angeles, CA 90012
Phone: 213-625-5795
www.napafasa.org
National Criminal Justice Reference Service (NCJRS)
P.O. Box 6000
Rockville, MD 20849
Phone: 800-851-3420 (toll-free)
Phone: 301-519-5500
www.ncjrs.org
National Families in Action (NFIA)
2957 Clairmont Road, NE, Suite 150
Atlanta, GA 30329
Phone: 404-248-9676
www.nationalfamilies.org
National Hispanic Science Network (NHSN)
Center for Family Studies
Department of Psychiatry & Behavioral Sciences
University of Miami School of Medicine
1425 NW 10th Avenue, 3rd Floor
Miami, FL 33136-1024
Phone: 305-243-2340
www.hispanicscience.org
National Prevention Network (NPN)
808 17th Street, NW, Suite 410
Washington, DC 20006
Phone: 202-293-0090
www.nasadad.org/Departments/Prevention/prevhme1.htm
Partnership for a Drug-Free America
405 Lexington Avenue, Suite 1601
New York, NY 10174
Phone: 212-922-1560
www.drugfreeamerica.org
Society for Prevention Research (SPR)
1300 I Street, NW, Suite 250 West
Washington, DC 20005
Phone: 202-216-9670
www.preventionresearch.org
Selected References
The following references have been selected as
either summaries of the literature of the past several
years or as the latest findings on specific aspects of
prevention research, which have been cited in this
publication. For a more comprehensive list of research
citations, please consult the NIDA Web site at
www.drugabuse.gov.

Aos, S.; Phipps, P.; Barnoski, R.; and Lieb, R. The Comparative Costs and Benefits of Programs to Reduce Crime. Vol. 4 (1-05-1201).

Olympia, WA: Washington State Institute for Public Policy, May 2001.

Ashery, R.S.; Robertson, E.B.; and Kumpfer K.L.; eds. Drug Abuse Prevention Through Family Interventions. NIDA Research Monograph No. 177. Washington, DC: U.S. Government Printing Office, 1998.

August, G.J.; Realmuto, G.M.; Hektner, J.M.; and Bloomquist, M.L.

An integrated components preventive intervention for aggressive elementary school children: The Early Risers Program. Journal of Consulting and Clinical Psychology 69(4):614–626, 2001.

August, G.J.; Hektner, J.M.; Egan, E.A.; Realmuto, G.M.; and Bloomquist, M.L. The Early Risers longitudinal trial: Examination of 3-year outcomes in aggressive children with intent-to-treat and as-intended analyses. Psychology of Addictive Behaviors 16(43):827–839, 2002.

August, G.J.; Lee, S.S.; Bloomquist, M.L.; Realmuto, G.M.; and Hektner, J.M. Dissemination of an evidence-based prevention innovation for aggressive children living in a culturally diverse, urban neighborhood: The Early Risers effectiveness study.

Prevention Science, in press.

Page 1016 ends

National Institute on Drug Abuse 39
Barrera, M.; Biglan, A.; Taylor, T.K.; Gunn, B.K.; Smolkowski, K.; Black, C.; Ary, D.V.; and Fowler, R.C. Early elementary school intervention to reduce conduct problems: A randomized trial with Hispanic and non-Hispanic children. Prevention Science
3(2):83–94, June 2002.

Battistich, V.; Solomon, D.; Watson, M.; and Schaps, E. Caring school communities. Educational Psychologist 32(3):137–151, 1997.

Bauman, K.E.; Foshee, V.A.; Ennett, S.T.; Pemberton, M.; Hicks, K.A.; King, T.S.; and Koch, G.G. The influence of a family program on adolescent tobacco and alcohol. American Journal of Public Health 91(4):604–610, 2001.

Beauvais, F.; Chavez, E.; Oetting, E.; Deffenbacher, J.; and Cornell, G. Drug use, violence, and victimization among White American, Mexican American, and American Indian dropouts, students with academic problems, and students in good academic standing. Journal of Counseling Psychology 43:292–299, 1996.

Botvin, G.; Baker, E.; Dusenbury, L.; Botvin, E.; and Diaz, T.

Long-term follow-up results of a randomized drug-abuse prevention trial in a white middle class population. Journal of the American Medical Association 273:1106–1112, 1995.

Botvin, G.; Epstein, J.; Baker, E.; Diaz, T.; and Ifill-Williams, M.

School-based drug abuse prevention with inner-city minority youth.

Journal of Child and Adolescent Substance Abuse 6:5–19, 1997.

Botvin, G.; Griffin, K.; Diaz, T.; Miller, N.; and Ifill-Williams, M.

Smoking initiation and escalation in early adolescent girls:

One-year follow-up of a school based prevention intervention for minority youth. Journal of American Medical
Women’s Association 54:139–143, 152, 1999.

Botvin, G.; Griffin, K.W.; Paul, E.; and Macaulay, A.P. Preventing tobacco and alcohol use among elementary school students through Life Skills Training. Journal of Child and Adolescent Substance Abuse 12(4):1–18, 2003.

Catalano, R.F.; Gainey, R.R.; Fleming, C.B.; Haggerty, K.P.; and Johnson, N.O. An experimental intervention with families of substance abusers: One-year follow-up of the Focus on Families Project. Addiction 94(2):241–254, 1999.

Catalano, R.F.; Haggerty, K.P.; Fleming, C.B.; Brewer, D.D.; and Gainey, R.R. Children of substance abusing parents: Current findings from the Focus on Families project. In: McMahon, R.J., and Peters, R.D., eds. The Effects of Parental Dysfunction on Children. New York: Kluwer Academic Press/Plenum Publishers, pp.179–204, 2002.

Chou, C.; Montgomery, S.; Pentz, M.; Rohrbach, L.; Johnson, C.; Flay, B.; and Mackinnon, D. Effects of a community-based prevention program in decreasing drug use in high-risk adolescents.

American Journal of Public Health 88:944–948, 1998.

Conduct Problems Prevention Research Group. Evaluation of the first three years of the Fast Track Prevention Trial with children at high risk for adolescent conduct problems. Journal of Abnormal Child Psychology 30(1):19–35, 2002a.

Conduct Problems Prevention Research Group. Predictor variables associated with positive Fast Track outcomes at the end of third grade. Journal of Abnormal Child Psychology 30(1):37–52, 2002b.

Conduct Problems Prevention Research Group. The implementation of the Fast Track Program: An example of a large-scale prevention science efficacy trial. Journal of Abnormal Child Psychology 30(1):1–17, 2002c.

Dishion, T.; McCord, J.; and Poulin, F. When interventions harm:

Peer groups and problem behavior. American Psychologist 54:755–764, 1999.

Dishion, T. and Kavanagh, K.A. multilevel approach to family-centered prevention in schools: Process and outcome.

Addictive Behaviors 25:899–911, 2000.

Dishion, T.; Kavanagh, K.; Schneiger, A.K.J.; Nelson, S.; and Kaufman, N. Preventing early adolescent substance use: A family centered strategy for the public middle school.

Prevention Science 3(3):191–202, 2002.

Eggert, L.L.; Thompson, E.A.; Herting, J.R.; Nicholas, L.J.; and Dicker, B. Preventing adolescent drug abuse and high school dropout through an intensive school-based social network development program. American Journal of Health Promotion 8:201–215, 1994.

Eggert, L.L.; Thompson, E.A.; Herting, J.R.; and Nicholas, L.J.

Reducing suicide potential among high-risk youth: Tests of a school-based prevention program. Suicide & Life-Threatening Behavior 25(2):276–296, 1995.

Eggert, L.L.; Herting, J.; and Thompson, E. The drug involvement scale for adolescents (DISA). Journal of Drug Education 26:101–130, 1996.

Eggert, L.L.; Thompson, E.A.; Herting, J.R.; and Randall, B.P.

Reconnecting youth to prevent drug abuse, school dropout, and suicidal behaviors among high-risk youth. In Wagner, E., and Waldron, H.B., eds. Innovations in Adolescent Substance Abuse Intervention. Oxford: Elsevier Science, pp. 51–84, 2001.

Eisen, M.; Zellman, G.L.; Massett, H.A.; and Murray, D.M.

Evaluating the Lions-Quest “Skills for Adolescence” drug education program: First-year behavior outcomes.

Addictive Behaviors 27(4):619–632, 2002.

Eisen, M.; Zellman, G.L.; and Murray, D.M. Evaluating the Lions-Quest “Skills for Adolescence” drug education program:

Second-year behavior outcomes. Addictive Behaviors
28(5):883–897, 2003.

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40 Preventing Drug Use among Children and Adolescents
Gerstein, D.R., and Green, L.W., eds. Preventing Drug Abuse: What Do We Know? Washington, DC: National Academy Press, 1993.

Goldberg, L.; MacKinnon, D.P.; Elliot, D.L.; Moe, E.L.; Clarke, G.; and Cheong, J.W. The Adolescents Training and Learning to Avoid Steroids Program. Preventing drug use and promoting health behaviors. Archives of Pediatric and Adolescent Medicine 154:332–338, April 2000.

Greenberg, M.T., and Kusche, C.A. Preventive interventions for school-age deaf children: The PATHS curriculum. Journal of Deaf Studies & Deaf Education 3(1):49–63, 1998.

Greenberg, M.T. and Kusche, C.A. Promoting Alternative Thinking Strategies. In Blueprint for Violence Prevention (Book 10).

Institute of Behavioral Sciences, University of Colorado, 1998.

Hansen, W.B.; Giles, S.M.; and Fearnow-Kenney, M.D. Improving Prevention Effectiveness. Greensboro, NC: Tanglewood
Research, 2000.

Hawkins, J.D. and Catalano, R.F. Communities That Care: Action for Drug Abuse Prevention. San Francisco, CA: Jossey-Bass, 1992.

Hawkins, J.D.; Catalano, R.F.; Kosterman, R.; Abbott, R.; and Hill, K.G. Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatric and Adolescent Medicine 153:226–234, 1999.

Hawkins, J.D.; Catalano, R.F.; and Arthur, M. Promoting sciencebased prevention in communities. Addictive Behaviors 90(5):1–26, 2002.

Hecht, M.; Trost, M.; Bator, R.; and MacKinnon, D. Ethnicity and sex similarities and differences in drug resistance. Journal of Applied Communication Research 25:75–97, 1997.

Ialongo, N.; Werthamer, L.; Kellam, S.; Brown, C.; Wang, S.; and Lin, Y. Proximal impact of two first-grade preventive
interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior. American Journal
of Community Psychology 27:599–641, 1999.

Ialongo, N.; Poduska, J.; Werthamer, L.; and Kellam, S. The distal impact of two first-grade preventive interventions on
conduct problems and disorder in early adolescence. Journal of Emotional and Behavioral Disorders 9:146–160, 2001.

Johnston, L.D.; O’Malley, P.M.; and Bachman, J.G. Monitoring the Future National Survey Results on Drug Use, 1975–2002.

Volume 1: Secondary School Students. Bethesda, MD: National Institute on Drug Abuse, 2002.

Kosterman, R.; Hawkins, J.D.; Spoth, R.; Haggerty, K.P.; and Zhu, K. Effects of a preventive parent-training intervention on observed family interactions: proximal outcomes from Preparing for the Drug Free Years. Journal of Community Psychology 25(4):337–352, 1997.

Kosterman, R.; Hawkins, J.D.; Haggerty, K.P.; Spoth, R.; and Redmond, C. Preparing for the Drug Free Years: Session-specific effects of a universal parent-training intervention with rural families. Journal of Drug Education 31(1):47–68, 2001.

Kumpfer, K.L.; Molgaard, V.; and Spoth, R. The “Strengthening Families Program” for the prevention of delinquency and drug abuse. In: Peters, R.D., and McMahon, R.J., eds. Preventing Childhood Disorders, Substance Abuse, and Delinquency.

Newbury Park, CA: Sage, 1996.

Kumpfer, K.L.; Olds, D.L.; Alexander, J.F.; Zucker, R.A.; and Gary, L.E. Family etiology of youth problems. In: Ashery, R.S.; Robertson, E.B.; and Kumpfer K.L.; eds. Drug Abuse Prevention Through Family Interventions. NIDA Research Monograph No. 177. Washington, DC: U.S. Government Printing Office,
pp. 42–77, 1998.

Kumpfer, K.L.; Alvarado, R.; Smith, P.; and Bellamy, N. Cultural sensitivity in universal family-based prevention interventions.

Prevention Science 3(3):241–246, 2002.

Kumpfer, K.L.; Alvarado, R.; Tait, C.; and Turner, C. Effectiveness of school-based family and children’s skills training for substance abuse prevention among 6-8 year old rural children.

Psychology of Addictive Behaviors 16(4S):S65–S71, 2002.

Lochman, J.E. and Wells, K.C. The Coping Power Program at the middle-school transition: Universal and indicated prevention effects. Psychology of Addictive Behaviors 16(45):S40–S54, 2002.

Lonczak, H.S., Abbott, R.D., Hawkins, J.D., Kosterman, R., and Catalano, R.F. Effects of the Seattle Social Development Project on sexual behavior, pregnancy, birth, and sexually transmitted disease outcomes at age 21 years. Archives of Pediatric and Adolescent Medicine 156:438–447, May 2002.

Moon, D.; Hecht, M.; Jackson, K.; and Spellers, R. Ethnic and gender differences and similarities in adolescent drug use and refusals of drug offers. Substance Use and Misuse
34(8):1059–1083, 1999.

National Institute on Drug Abuse. National Conference on Drug Abuse Prevention Research: Presentations, Papers, and Recommendations. Bethesda, MD: National Institute on Drug Abuse, 1998.

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National Institute on Drug Abuse 41
O’Donnell, J.; Hawkins, J.; Catalano, R.; Abbott, R.; and Day, L.

Preventing school failure, delinquency among low-income children: Long-term intervention in elementary schools.

American Journal of Orthopsychiatry 65:87–100, 1995.

Oetting, E.; Edwards, R.; Kelly, K.; and Beauvais, F. Risk and protective factors for drug use among rural American youth.

In: Robertson, E.B.; Sloboda, Z.; Boyd, G.M.; Beatty, L.; and Kozel, N.J., eds. Rural Substance Abuse: State of Knowledge and Issues. NIDA Research Monograph No. 168. Washington, DC:

U.S. Government Printing Office, pp. 90–130, 1997.

Palmgreen, P.; Donohew, L.; Lorch, E.P.; Hoyle, R.H.; and Stephenson, M.T. Television campaigns and adolescent marijuana use: Tests of sensation seeking targeting. American Journal of Public Health 91(2):292–296, 2001.

Palmgreen, P.; Donohew, L.; Lorch, E.P.; Hoyle, R.H.; and Stephenson, M.T. Television campaigns and sensation seeking targeting of adolescent marijuana use: A controlled time series approach. In: Hornik, R.C, ed. Public Health Communication:

Evidence for Behavior Change. Mahwah, NJ: Lawrence Erlbaum, pp. 35–56, 2002.

Pentz, M.A. Costs, benefits, and cost-effectiveness of comprehensive drug abuse prevention. In: Bukoski, W.J., and Evans, R.I., eds. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph No. 176. Washington, DC:

U.S. Government Printing Office, pp. 111–129,1998.

Plested, B.; Smitham, D.; Jumper-Thurman, P., Oetting, E., and Edwards, R. Readiness for drug use prevention in rural minority communities. Substance Use And Misuse 34(4 and 5):521–544, 1999.

Scheier, L.; Botvin, G.; Diaz, T.; and Griffin, K. Social skills, competence, and drug refusal efficacy as predictors of adolescent alcohol use. Journal of Drug Education 29(3): 251–278, 1999.

Spoth, R.; Redmond, C.; and Shin, C. Reducing adolescents’ aggressive and hostile behaviors: Randomized trial effects of a brief family intervention four years past baseline. Archives of Pediatrics and Adolescent Medicine 154(12):1248–1257, 2000.

Spoth, R.; Redmond, C.; and Shin, C. Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes four years following baseline. Journal of Consulting and Clinical Psychology 69(4):627–642, 2001.

Spoth, R.; Guyull, M.; and Day, S. 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, 2002a.

Spoth, R.L.; Redmond, D.; Trudeau, L.; and Shin, C. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors 16(2):129–134, 2002b.

Sussman, S.; Dent, C.W.; and Stacy, A.W. Project Toward No Drug Abuse: A review of the findings and future directions.

American Journal of Health Behavior 26(5):354–365, 2002.

Thompson, E.; Horn, M.; Herting, J.; and Eggert, L. Enhancing outcomes in an indicated drug prevention program for high-risk youth. Journal of Drug Education 27(1):19–41, 1997.

Thornton, T.N., et al., eds. Best Practices of Youth Violence Prevention: A Sourcebook for Community Action. Atlanta, GA:

Centers for Disease Control and Prevention, September 2000.

U.S. Department of Education, Office of Special Education Research and Improvement, Office of Reform Assistance
and Dissemination, Safe, Disciplined, and Drug-Free Schools Programs, Washington, DC, 2001.

Webster-Stratton, C. Preventing conduct problems in Head Start children: Strengthening parenting competencies. Journal of Consulting and Clinical Psychology 66:715–730, 1998.

Webster-Stratton, C.; Reid, J.; and Hammond, M. Preventing conduct problems, promoting social competence: A parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology 30:282–302, 2001.

Wills, T. and Cleary, S. How are social support effects mediated? A test with parental support and adolescent substance use.

Journal of Personality and Social Psychology 71:937–952, 1996.

Wills, T.; McNamara, G.; Vaccaro, D.; and Hirky, A. Escalated substance use: A longitudinal grouping analysis from early to middle adolescence. Journal of Abnormal Psychology
105:166–180, 1996.

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California Healthy Kids Survey
LGSUHSD 2020-21 & 2018-19
Results and Comparisons

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What is the California Healthy Kids Survey?
The California Healthy Kids Survey (CHKS) is the largest statewide survey of resiliency, protective factors, and risk behaviors in the nation.

Across California, the CHKS has led to a better understanding of the relationship between students' health behaviors and academic performance, and is frequently cited by state policymakers and the media as a critical component of school improvement efforts to help guide the development of more effective health, prevention, and youth development programs. It provides a means to confidentially obtain data on student knowledge, attitudes, and perceptions about the topics it covers.

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California Healthy Kids Survey
Comparable Districts & Administration Years
● Los Gatos High School
○ 2018/19 and 2020/21
● Saratoga High School
○ 2018/19 and 2020/21
● Palo Alto Unified School District
○ 2019/20
● Mountain View-Los Altos Union High School District
○ 2019/20
● Statewide Secondary Data

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○ 2015-17
California Healthy Kids Survey
Survey Participant Sizes

LGHS SHS
2018/19 2020/21 2018/19 2020/21
9th 488 446 325 287
11th 420 406 310 310
2018/19 - Survey administered in February 2018
2020/21 - Survey administered in December 2020

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Important Points about Context

1. No community is without problems that need to be identified and addressed.

2. Drug use, violence and other health risks are not just school issues; they are social, community, and family issues.

3. Schools are often safe havens in their communities.

4. The CHKS results help districts focus resources and develop programs. To address any problem, you first need to identify and understand it.

5. Reducing risk behaviors and promoting positive youth development are key efforts to improve schools and promote academic success among all students.

6. Our goal is to determine what we can do to support and help our community’s youth lead healthy, satisfying, and productive lives.

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Interpreting the Data
● Data is accurate - the standard error of the mean ranges from 0.011 to 0.014 ● Data is reliable - The 95% confidence intervals are (~0.05 for developmental supports and ~0.03 for current drug use items). That means that if the survey was given 100 times, the results would be within less than one point difference 95 times.

How do we know if there was a significant difference between administration years?
● + 4% indicates a significant increase or decrease between administration years. For LGHS and SHS, those items are marked with a on subsequent

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What does statistically significant mean?
● A statistically significant result is a result that's not attributed to chance.
● When something is statistically significant, we believe the difference is larger than can reasonably be explained as a chance occurrence.
● As a general rule, the significance level is commonly set to 0.05, meaning that the probability of observing the differences seen in your data by chance is just 5%.

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Protective Factors vs. Risk Factors
Protective Factor
● a characteristic at the biological, psychological, family, or community (including peers and culture) level that is associated with a lower likelihood of problem outcomes or that reduces the negative impact of a risk factor on problem outcomes
Risk Factor
● a characteristic at the biological, psychological, family, community, or cultural level that precedes and is associated with a higher likelihood of problem outcomes

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School Performance,
Supports and Engagement

Page 1029 ends

At my school there is a teacher or some other adult who really cares about me. (Pretty much true to Very much true)
9th Grade
Statistically Significant Pre-Covid
53% state avg.

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At my school there is a teacher or some other adult who really cares about me. (Pretty much true to Very much true)
11th Grade
60% state avg.

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I feel close to people at this school.
(Agree to Strongly Agree)
9th Grade
*No 20/21 data available due to remote learning
62% state avg.

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I feel close to people at this school.
(Agree to Strongly Agree)
11th Grade
57% state avg.

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I am happy to be at this school.
(Agree to Strongly Agree)
9th Grade
*No 20/21 data available due to remote learning
61% state avg.

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I am happy to be at this school.
(Agree to Strongly Agree)
11th Grade
54% state avg.

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I feel like I am part of this school.
(Agree to Strongly Agree)
9th Grade
*No 20/21 data available due to remote learning
52% state avg.

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I feel like I am part of this school.
(Agree to Strongly Agree)
11th Grade
49% state avg.

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I feel safe in my school.
(Agree to Strongly Agree)
9th Grade
*No 20/21 data available due to remote learning
57% state avg.

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I feel safe in my school.
(Agree to Strongly Agree)
11th Grade
59% state avg.

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School Violence,
Victimization, and Safety

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During the past 12 months, how many times on school property were you harassed or bullied for your race, ethnicity, or national origin? (2 or more times)
9th Grade
*No 20/21 data available due to remote learning
8% state avg.

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During the past 12 months, how many times on school property were you harassed or bullied for your race, ethnicity, or national origin? (2 or more times)
11th Grade
8% state avg.

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During the past 12 months, how many times on school property were you harassed or bullied because you are gay or lesbian or someone thought you were? (2 or more times)
9th Grade
*No 20/21 data available due to remote learning
5% state avg.

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During the past 12 months, how many times on school property were you harassed or bullied because you are gay or lesbian or someone thought you were? (2 or more times)
11th Grade
4% state avg.

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During the past 12 months, how many times on school property have you been offered, sold, or given an illegal drug?
(2 or more times)
9th Grade
*No 20/21 data available due to remote learning
11% state avg.

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During the past 12 months, how many times on school property have you been offered, sold, or given an illegal drug?
(2 or more times)
11th Grade
14% state avg.

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Alcohol and Other Drug Use

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During the past 30 days, did you have one or more drinks of alcohol? 9th Grade
15% state avg.

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During the past 30 days, did you have one or more drinks of alcohol? 11th Grade
23% state avg.

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During the past 30 Days, have you engaged in binge drinking? (5 or more drinks in a row)
9th Grade
6% state avg.

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During the past 30 Days, have you engaged in binge drinking? (5 or more drinks in a row)
11th Grade
12% state avg.

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During the past 30 days, have you used marijuana?
(smoke, vape, eat, or drink)
9th Grade
10% state avg.

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During the past 30 days, have you used marijuana?
(smoke, vape, eat, or drink)
11th Grade
17% state avg.

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During the past 30 days, have you used electronic cigarettes or other vaping device? (cigarettes for past data)
9th Grade
8% state avg.

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During the past 30 days, have you used electronic cigarettes or other vaping device? (cigarettes for past data)
11th Grade
10% state avg.

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Other Physical and
Mental Health Risks

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During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more that you stopped doing usual activities? 9th Grade
30% state avg.

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During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more that you stopped doing usual activities? 11th Grade
32% state avg.

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During the past 12 months, did you ever seriously consider attempting suicide? 9th Grade
16% state avg.

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During the past 12 months, did you ever seriously consider attempting suicide? 11th Grade
16% state avg.

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From: Toni Blackstock <[email protected]>
Sent: Saturday, June 4, 2022 8:32 PM
To: Cannabis <[email protected]>
Subject: Scientific Community Survey

EXTERNAL SENDER
Has this survey been sent to the 300 households? If so, when should the results be made public? Toni Blackstock
From: [email protected] <[email protected]>
Sent: Tuesday, June 7, 2022 2:15 PM
To: Council <[email protected]>
Subject: Retail Cannabis

EXTERNAL SENDER
I believe the more we do to promote cannabis in our Town, it will increase the desirability to our youth.

The promotion of cigarettes caused lifetime damage to lungs. Cannabis can cause lifelong damage to developing brains Sent from my iPhone
From: Lee Fagot <[email protected]>
Sent: Wednesday, June 08, 2022 2:49 PM
To: Rob Rennie <[email protected]>; Maria Ristow <[email protected]>; Mary Badame <[email protected]>; Matthew Hudes <[email protected]>; Marico Sayoc <[email protected]>; Laurel Prevetti <[email protected]> Cc: Jamie Field <[email protected]>; Arn Andrews <[email protected]> Subject: Cannabis Retail Sales in Town

EXTERNAL SENDER
Honorable Mayor, Council Members and Town Manager,
Following last nights Council meeting where I spoke against opening any retail cannabis sales in Town, I am enclosing my letter to you with the references that were requested, based on the data I quoted.

Please let me know if you have any further questions or comments as I am happy to work with you all on this issue and want to be clear I am focusing on the facts relevant to our community.

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Thank you all, and keep up the good work on our citizens’ behalf.

Lee Fagot
Retail Cannabis Sales in Los Gatos
June 8, 2022
Dear Mayor, Council Members, Town Manager and Town Staff, True, LG needs new revenue (and possible expenditure reductions) to overcome the shortfalls projected against spending going forward in our Town’s Budget. However, full analysis of both the costs and potential revenue must be completed before a final decision to take to the voters is made for the potential recreational cannabis (MJ) retail sales to be allowed in Town. And, the social impacts and their costs must be part of that analysis as well.

All MJ is still illegal under Federal Law, and LG citizens have OVERWHELMINGLY stated they do not want retail sales in Town for recreational MJ. Medical MJ is available thru recognized retail outlets now, and recreational is available for home delivery and other retail outlets within a few miles outside of Town.

For example, Airfield Supply, in San Jose, reports that approx. 2000 LG residents shop annually with about an $85 avg. per visit purchase. The Council’s interest in considering allowing retail site or sites in Town for new tax revenue must be considered with the following information -- The Town’s contracted consultant’s report estimated that for one retail outlet in Town there would be an estimated $320K new sales tax revenue source (see Community Outreach Report below). However, when I asked the Chief of Police and the Mayor if a study was completed to determine the increased costs for police and community services based on recreational MJ sales in Town, no such study was requested. Most recently when more folks pushed for this study to be done, our Town Manager requested the study and it is just now underway. The study should be specifically comparing Los Gatos to other communities that also added rec MJ so as to measure what increased police and other direct gov’t costs they incurred. The estimate to be used in the consultant’s report includes 2 additional sworn officers as their only direct cost analysis, but with NO value in this cost reported. This may be a zero net gain after not just salaries, but when all benefits and pension costs are also calculated for the Town.

However, we all need to wait for Chief’s report to inform the Council and citizens once they have more data. But, for a more relevant set of information to help make a truly informed decision, the other indirect expenses outside Town salaries must also be calculated. (More on other cities actions after some localized MJ retail sales on the next pages.)
But, just focusing on the direct financial numbers for now, please review this report from the Los Gatos Town’s recent “Community Outreach Report” on Cannabis in Town, page 31:

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Annual Retail Tax Revenue Estimates*:
 (4%): $320,000 - Plus $90,000 in local sales tax. Total $410,000

 (5%): $400,000 - Plus $90,000 in local sales tax. Total $490,000

 (6%): $480,000 - Plus $90,000 in local sales tax. Total $570,000.

*Assumes 2 storefront retailers with an average of $4M in gross receipts each.

EG:$4M sales x 4%
sales tax = $160,000 x 2 stores = $320,000 sales tax for 2 stores.

Using the data in the presentation by Airfield at our recent LG Democracy Tent session, to get $8m in sales with 2 outlets and an approximate $85 avg. transaction value (as currently at Airfield), would require about 95,000 transactions per year. Now, we have to calculate the impacts of traffic, parking, etc. for 95,000 visits per year; with only 2000 current LG resident purchasers reported by Airfield, this would require all 2000 Airfield Supply LG customers to make almost weekly purchases. But, most likely thousands of non-townsfolk, plus some LG residents who currently shop elsewhere, (perhaps up to 700 folks (According to the attached report only 13.5% of the total California population used cannabis in the past month (page 13) which suggests that there would be 2,700 users in Los Gatos (#) who would then travel to LG’s 2 retailers in Town which is a retailer’s goal, that is to get more customers, and legal retailers can only survive if they can also get the number of legal users to increase from 13.5% of the Towns population to 25% or new customers coming into Town.

And, consider where the sites would even be allowed as retailers have to be located in areas of Town with mandatory parking and set backs (min of 600 ft.) from schools, health and social services, etc. Don’t forget that an out of town customer would require more travel miles in Town - VMT. On the other hand, deliveries to users in town might be a more efficient way to get the MJ to the end users because the delivery service could transport multiple purchases in one vehicle (like Amazon, etc.) ( Note, I am NOT advocating any cannabis sales in Town, just reporting the facts here). Airfield Supply states it currently is providing about 1 hour delivery time to customers who order for delivery. And, the argument local MJ retail would bring new visitors who may spend on dining, etc. in Town has NO basis in fact as the other retailers in the news article below (NPR) have reported shops and restaurants near them have closed due to burglaries and drug use on or very near their sites with increased street MJ sales.

Further, the cost with all the taxes for legal purchases will drive more illegal street sales of NONcontrolled products as the street drugs will be cheaper, since obtained from non-legal sources, and are most likely adulterated and easily sold to minors as reported on several news outlets. Folks will not know what additives will be included in street drugs.

NPR, KQED news media, on Dec 6, 2021, also reported that burglaries of retail cannabis outlets in SF last year generated a reported $5M loss for retailers and the city of SF decided to stop the sales tax on

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cannabis so the stores could be more competitive with street drugs. Watsonville, for the same reasons, recently cut their taxes on cannabis by half.

And, one of the biggest concerns expressed by many of our Town groups, our Kiwanis, Lions clubs, CASA, etc., is the social/emotional impact particularly to the youth in our Town. This is based on the mixed message that its ok for adults to use such drugs, but not youth, or maybe it is ok for youth to also imbibe since adults do it. Watching adults in their homes doing drugs, smoking, vaping, etc., is then challenging kids to do the same. And, they will be sneaking drugs from the parent’s stash, buying on the street (most likely tainted and addictive formulas) and sharing with their friends.

Importantly, note that the 2020/2021 school year “California Healthy Kids Survey” conducted at LGHS and released this year provided some concerning data: Over the prior 30 days 28% of Juniors consumed an alcoholic drink, including 5% admitting binge drinking, and 22% had used marijuana and vaping. All data is above the state average in the same survey. And, 15% LGHS juniors admitted thinking of suicide in the fall of last school year (perhaps tied to drugs?).

A June 7, 2022 Wall Street Journal article (Pg A15) reported on a study that shows MJ is 4 times as potent now as in 1995. Its more powerful than when today’s adults grew up, making it easier for today’s kids to get hooked, and with 1 in 6 kids developing an addiction. Another national report published in “Health and Place” (##), 75 (2022) 102795, Pg 5 “..the prevalence of using edibles was 45% higher and dabbing and smoking cannabis were 43% higher among students who attended a high school within 1 mile from a cannabis retailer. Students also perceived cannabis as less harmful when there was a retailer within 1 mile from their high school.“ There is not just a financial impact of increased costs to the Town for police, but additional costs dealing with the need for more social and emotional services for citizens of all ages. This cost will continue to increase. Please consider this when determining the feasibility of even allowing sales in Town. Cannabis retail sales in Town changes not just the character of our Town, because it so negatively impacts the wellbeing of all our citizens.

The business model for cannabis sales in our Town – does not work.

Our community CANNOT afford cannabis sales. Please review the facts, listen to our citizens and their concerns, and let’s work together on truly achieving budgeting solutions. Let this proposal for retail cannabis sales in Town to die a natural death.

Respectfully,
Lee Fagot
845 Lilac Way

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95032
(#) The Reason Foundation, ”The Impact of California Cannabis Taxes on Participation Within The Legal Market” by Geoff Lawrence, May 2022.
(##)https://www.sciencedirect.com/science/article/abs/pii/S1353829222000569?via%3Dihub From: Alyce Parsons <[email protected]>
Sent: Thursday, June 9, 2022 8:53 PM
To: Council <[email protected]>
Subject: Proposed cannabis stores in Los Gatos

EXTERNAL SENDER
Town Council of Los Gatos,
I would like to state our objection to the selling of cannabis in the town of Los Gatos. Please refer to the article in the Wall Street Journal Tuesday, June 7. The article clearly stated the objections that we have.

Smoking marijuana is dangerous to young people. It has been proven that it affects their brain end it can interfere with their mental health and ability to learn. It also can lead to the use of more dangerous drugs. By establishing outlets in our town we are tacitly approving its use. Thank you for your consideration of our objection.

Respectfully,
Dr. And Mrs Mike Parsons
Monte Sereno, Ca. 95030
From: claire leclair <[email protected]>
Sent: Friday, June 10, 2022 4:13 PM
To: Cannabis <[email protected]>
Subject: Future Cannabis Store

EXTERNAL SENDER
I am not in favor of having a Cannabis store in LG. There are other ways to increase revenues for our town. Claire Leclair

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From: Susan Tuttle <[email protected]>
Sent: Sunday, June 12, 2022 4:27 PM
To: Cannabis <[email protected]>
Subject: Cannabis Stores in Los Gatos - NO

EXTERNAL SENDER
I am strongly against having Cannabis sales in Los Gatos as I believe it will change the personality and tenor of our town and send the wrong message to everyone, especially kids.

Susan Tuttle
From: Kennan Kuehn <[email protected]>
Sent: Sunday, June 12, 2022 1:44 PM
To: Cannabis <[email protected]>
Subject: Cannabis

EXTERNAL SENDER
I think that cannabis in Los Gatos would be a great idea.

From: Buchanan, Kevin <[email protected]>
Sent: Monday, June 13, 2022 3:35 PM
To: Council <[email protected]>
Subject: Cannabis Dispensaries - my two cents

EXTERNAL SENDER
Dear Los Gatos Town Council Members,
As the principal of Los Gatos High School and one who battles daily the normalization and social acceptance of marijuana use among our youth, I am writing to share my grave concern that cannabis dispensaries may be allowed to operate in Los Gatos. Research strongly suggests that regular use during adolescence is associated with severe and persistent negative outcomes and that the adolescent brain may be particularly vulnerable to the effects of cannabis exposure, and that "prolonged use during adolescence results in a disruption in the normative neuromaturational processes that occur during this period" (1) Marijuana is the second most widely used intoxicant in adolescence, and teens who engage in heavy marijuana use often show disadvantages in neurocognitive performance, macrostructural and microstructural brain development, and alterations in brain functioning. (2) "The data provides compelling longitudinal evidence suggesting that repeated exposure to cannabis during adolescence may have detrimental effects on brain functional connectivity, intelligence, and cognitive function." (3) The challenges we confront as we try to educate our children are already complicated, given our increased focus on mental wellness and the arrested social and emotional development exacerbated by the COVID 19 pandemic. I realize that the financial benefits from allowing dispensaries to operate in town are tempting, but I have to ask each one of you if you are willing to sacrifice the healthy development of our youth to

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supplement the town coffers. I would hope not, and would like you to consider that such an action would make our jobs only more difficult than they already are, and put our children at greater risk of cognitive impairment.

Please consider the best interests of our children when you make this important decision.

Respectfully,
Kevin Buchanan
Principal
Los Gatos High School

1. Cannabis and adolescent brain development:
https://www.sciencedirect.com/science/article/abs/pii/S0163725814002095

2. Effects of Cannabis on the Adolescent Brain
https://www.ingentaconnect.com/content/ben/cpd/2014/00000020/00000013/art00009

3. Adverse Effects of Cannabis on Adolescent Brain Development https://academic.oup.com/cercor/article/27/3/1922/3056289?login=true

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From: Alexis Dulin <[email protected]>
Sent: Tuesday, June 14, 2022 3:03 PM
Subject: Cannabis Retail in Los Gatos

Please make the right choice here people!!!! It's going to bring more revenue to the town too.

Thank you,
Alexis Dulin
From: Michaela Matulich <[email protected]> Sent: Tuesday, June 14, 2022 11:21 AM
To: Council <[email protected]>; Town Manager <[email protected]> Subject: Yes for Cannabis in LG

EXTERNAL SENDER
Dear Los Gatos Town Council,
I am writing in support of allowing retail cannabis in the Town of Los Gatos and feel that it is entirely long past due that the Town move towards having safe and reliable access to cannabis. Having grown up in Los Gatos, it feels that cannabis is the next move to keep Los Gatos on a progressive and up to date status with other surrounding towns.

Thank you for your time.

Michaela Matulich
From: Midori Portillo <[email protected]>
Sent: Tuesday, June 14, 2022 3:35 PM
To: Council <[email protected]>
Subject: Cannabis Retail Tax Support

EXTERNAL SENDER
Dear Town Council,
I am in total support of the town’s potential move to allow and regulate the cannabis retail.

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From: Toni Blackstock <[email protected]>
Sent: Thursday, June 16, 2022 10:30 AM
To: Council <[email protected]>
Subject: Cannabis dispensary

EXTERNAL SENDER
I strongly OPPOSE allowing any type of cannabis dispensary in Los Gatos.

Toni Blackstock
[email protected] 408 497 2402
From: Barry Cheskin <[email protected]>
Sent: Thursday, June 16, 2022 10:52 AM
To: Council <[email protected]>
Subject: Dispensaries

EXTERNAL SENDER
Members of the Town Council,
My wife and I strongly object to having marijuana dispensaries in our town. I believe it will adversely affect our family friendly "hometown" vibe and character.

This is a very very bad idea for Los Gatos.

Barry Cheskin
Citizen and Vice-Chair, Historic Preservation Committee.

Barry Cheskin
650-245-8551 Cell
[email protected]

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From: Lydia Norcia <[email protected]>
Sent: Monday, June 6, 2022 6:38 PM
To: Council <[email protected]>
Subject: Please be advised that I am opposed to having any Marijuana dispensaries in Los Gatos Ca - See the articles below and the number of dispensaries near Los Gatos.

EXTERNAL SENDER
https://www.yellowpages.com/los-gatos-ca/marijuana-dispensary https://www.verywellmind.com/why-do-teens-use-marijuana-63543 https://www.sciencedaily.com/releases/2019/02/190218094005.htm https://www.sciencedaily.com/releases/2019/02/190218094005.htm Lydia Norcia
102 Escobar Court
Los Gatos, CA 95032
408-757-6336
From: Mitch Kraemer <[email protected]>
Sent: Tuesday, June 14, 2022 10:14 AM
To: Cannabis <[email protected]>
Subject: Email update list

EXTERNAL SENDER
Hello, if it is possible can I be placed on a list for updates from the city on a potential cannabis program?- -
Mitch Kraemer - Market Research Analyst
Cannabis Real Estate Consultants
6440 Lusk Blvd STE D201
San Diego, CA 92121
Direct: (858) 699-0218
Office: (866) 810-2022
[email protected]
www.CannabisRealEstateConsultants.com

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Trusted Commercial Real Estate Experts in the Cannabis Industry From: william kane <[email protected]>
Sent: Wednesday, June 15, 2022 5:07 AM
To: Cannabis <[email protected]>
Subject: Pot club

EXTERNAL SENDER
Good morning I messaged your address yesterday,and my message was received but was blocked could you please explain why?I thought the address was advertised to be a site to make my input a public response available to the town board to review in response to the possibility of a pot club being established in our town which my husband and I would like to see approved,We have been residents in Los Gatos and have lived here for forty one years,I would appreciate your reply in this matter,I thought in lieu of having to attend the town meeting that was scheduled I figured that my response that I sent yesterday would have been noted/recorded and read by any council member as being a resident/residents in favor of the establishment of a dispensary in our town,thank you for your time.

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Reviewed by: Town Manager, Assistant Town Manager, Town Attorney, and Finance Director 110 E. Main Street Los Gatos, CA 95030 ● (408) 354-6832 www.losgatosca.gov

TOWN OF LOS GATOS

COUNCIL AGENDA REPORT
MEETING DATE: 06/21/2022
ITEM NO: 23

ADDENDUM
DATE: June 17, 2022
TO: Mayor and Town Council
FROM: Laurel Prevetti, Town Manager
SUBJECT: Maintain a Ban on Cannabis Businesses in Los Gatos and Consider a Ballot Measure to Tax Cannabis Businesses
REMARKS:

Attachment 4 contains public comments received between 11:00 a.m., Thursday, June 16, 2022, and 11:01 a.m., Friday, June 17, 2022.

Attachments Previously Received with the Staff Report:

1. Consultant Study

2. Map of State Buffer Areas

3. Public Comment
Attachments Received with this Addendum:

4. Public Comment received between received between 11:00 a.m., Thursday, June 16, 2022, and 11:01 a.m., Friday, June 17, 2022.

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From: Jonathan G. Hanhan
To: Cannabis; Hanhan Commercial Group
Subject: W Main Street & E Main Street
Date: Thursday, June 16, 2022 3:00:30 PM

EXTERNAL SENDER
Hi there,
We represent the ownership groups of two buildings in Downtown Los Gatos (addresses below). We have begun to receive inquiries from cannabis-related retail operators and would like to learn if we should be having these conversations or not.

Are either of these sites anticipated to be within the cannabis zoning region? I believe 32 E Main is too close to LGHS. Appreciate any thoughts and insights. We plan to attend the meeting on June 21st.

Main Street
Main Street
Cheers,
Jonathan G. Hanhan
Sr. Vice President
Silicon Valley Commercial Division

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From: Joan Cross
To: Council
Cc: Joanne Rodgers
Subject: Dispensaries
Date: Thursday, June 16, 2022 11:53:24 AM

EXTERNAL SENDER
Dear Council Members,
Los Gatos has long been a family friendly, community oriented town. This, and the good, well supported schools, was why we moved here 34 years ago and why we stay. Allowing storefront marijuana dispensaries in Los Gatos completely negates the efforts that our town has upheld for those years. I understand the need for additional tax revenue, but please, do not use this avenue as an income stream. It WILL be detrimental to our children. Kids have been finding ways around the laws & rules that keep them safe for years & they will easily get past ID scanners, etc to access the marijuana before the legal age. I expect they are doing so even now, with the dispensaries outside of Los Gatos. Having those storefronts in our town makes it that much easier for our kids to access & also sends a message that Los Gatos thinks it’s ok.

It’s NOT ok!! Find another way to make the revenue. Our children are our future, and this money making idea is putting them at risk.

Sincerely,
Joan Y Cross, CPM
Los Gatos and
Coronado

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From: Denise Dulin
To: Council; Town Manager
Cc: DENISE DULIN
Subject: Support of Cannabis Retail in Town
Date: Friday, June 17, 2022 7:08:04 AM

EXTERNAL SENDER
Dear Los Gatos Town Council,
I am writing to let you know that I am in favor of moving forward with regulations for commercial cannabis dispensaries and a proposed general or special sales tax. Cannabis is legal and it should be regulated and taxed. It would help our citizens by providing a safe environment for purchasing the product and it would help our city by providing much needed revenue. This is a much better option than purchasing it from people “on the streets”.

Thank you,
Denise Dulin

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From: Ann Mirizzi
To: Council
Subject: Vote No on Marijuana Dispensaries in Los Gatos Date: Friday, June 17, 2022 9:00:22 AM

EXTERNAL SENDER
My husband and I live in Los Gatos and DO NOT want Marijuana Dispensaries in our town. We vote NO on all fronts!
Ann and Raymond Mirizzi. Old Orchard Dr. Los Gatos, Ca 95032 Sent from Ann's iPhone
ATTACHMENT 4

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Reviewed by: Town Manager, Assistant Town Manager, Town Attorney, and Finance Director 110 E. Main Street Los Gatos, CA 95030 ● (408) 354-6832 www.losgatosca.gov

TOWN OF LOS GATOS

COUNCIL AGENDA REPORT
MEETING DATE: 06/21/2022
ITEM NO: 23

ADDENDUM B
DATE: June 20, 2022
TO: Mayor and Town Council
FROM: Laurel Prevetti, Town Manager
SUBJECT: Maintain a Ban on Cannabis Businesses in Los Gatos and Consider a Ballot Measure to Tax Cannabis Businesses
REMARKS:

Attachment 5 contains public comments received beginning at 11:00 a.m., Friday, June 17, 2022, through 11:00 a.m., Monday, June 20, 2022.

Attachments Previously Received with the Staff Report:

1. Consultant Study

2. Map of State Buffer Areas

3. Public Comment
Attachments Received with Previous Addendum:

4. Public comment received between 11:00 a.m., Thursday, June 16, 2022, and 11:01 a.m., Friday, June 17, 2022.

Attachments Received with this Addendum B:

5. Public comment received beginning at 11:00 a.m., Friday, June 17, 2022, through 11:00 a.m., Monday, June 20, 2022.

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ATTACHMENT 5
From: Jack Balletto <[email protected]>
Sent: Friday, June 17, 2022 4:29 PM
To: Council <[email protected]>
Subject: Legalize Cannabis

EXTERNAL SENDER
Dear Los Gatos Town Council,
I have heard the arguments regarding the pros and cons of allowing commercial cannabis in Los Gatos. I want you to know that I support the commercial cannabis grows and dispensaries and a proposed general or special sales tax. It is the only way we can control the sale of cannabis and it would help Los Gatos’ financial problems. Please continue moving forward on this issue.

John (Jack) Balletto
36 Peralta Ave
Los Gatos,ca
From: William Bowman <[email protected]>
Sent: Friday, June 17, 2022 10:05 PM
To: Town Manager <[email protected]>
Subject: Cannabis dispensary in Los Gatos

EXTERNAL SENDER
Town Council of Los Gatos:

I believe that it is in the best interests of the citizens of the town to approve the application for cannabis dispensaries in our town.

It make fiscal sense and does not pose a threat to public safety; in fact,objective analysis shows the opposite.

Thank You
William Bowman
16641 Kennedy Rd
95032
From: Yahoo <[email protected]>
Sent: Saturday, June 18, 2022 1:01 PM
To: Council <[email protected]>
Cc: Town Manager <[email protected]>
Subject: Cannibis

EXTERNAL SENDER
Dear Los Gatos town council I am writing in support of allowing retail cannabis in our town and feel that it is entirely long past due that the town move towards having safe and reliable access to cannibis.

Thank you Sent from my iPhone

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ATTACHMENT 5
From: Esther Kruse <[email protected]>
Sent: Saturday, June 18, 2022 4:34 PM
To: Council <[email protected]>; Town Manager <[email protected]> Subject: Fwd: Cannibis

EXTERNAL SENDER
Cannibis
Dear Los Gatos town council I am writing in support of allowing retail cannabis in our town and feel that it is entirely long past due that the town move towards having safe and reliable access to cannibis.

Thank you
Thank you,
Esther Kruse
From: Kristina Taroni <[email protected]>
Sent: Saturday, June 18, 2022 1:10 PM
To: Council <[email protected]>
Subject: Cannibus tax

Sent from my iPhone
From: Kathy Mlinarich <[email protected]>
Sent: Sunday, June 19, 2022 9:20 AM
To: Council <[email protected]>; Town Manager <[email protected]> Subject: Cannabis dispensary in LG

EXTERNAL SENDER
I have heard the arguments regarding the pros and cons of allowing commercial cannabis in Los Gatos. I support the commercial cannabis growers and dispensaries and a proposed general or special sales tax. I know many seniors that rely on cannibals for medical reasons, such as helping with nausea during chemo. The location of the shop is important as we have traffic issues. On the outer areas of LG would be preferable.

Sent from my iPad

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ATTACHMENT 5
From: Jess B. Guy <[email protected]>
Sent: Saturday, June 18, 2022 8:57 AM
To: Cannabis <[email protected]>
Subject: Marijuana Dispensary

EXTERNAL SENDER
Not a good idea. Los Gatos is surrounded by cities selling marijuana. A simple observation of the numerous outlets already in existence begs the question, why?
If this proposal is only to gain tax revenue it seems shortsighted to establish licensing, fees, locations (zoning), code enforcement, etc., for the taxes collected.

There's enough pot for users to get elsewhere. Lets keep Los Gatos smoke free!
Jess B. Guy
408-460-2805
From: Scott Cooley <[email protected]>
Sent: Saturday, June 18, 2022 1:06 PM
To: Cannabis <[email protected]>
Subject: No on Cannabis

EXTERNAL SENDER
My biggest reasons to not support cannabis sales in Los Gatos:

1. Every addicted drug user, which causes homelessness, started their addiction with cannabis. It is a gateway drug.

2. New evidence shows use of cannabis, over longer periods of time, do decrease brain function and reduces intelligence.

3. My own personal experience is that every young adult involved with cannabis has significant motivation issues. Ambition is the first casualty.

I urge the town to not allow the selling of such an awful product.

Scott Cooley
15900 Kennedy Rd.

Los Gatos, CA 95032
Cell/Text: 408-829-4130

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Reviewed by: Town Manager, Assistant Town Manager, Town Attorney, and Finance Director 110 E. Main Street Los Gatos, CA 95030 ● (408) 354-6832 www.losgatosca.gov

TOWN OF LOS GATOS

COUNCIL AGENDA REPORT
MEETING DATE: 06/21/2022
ITEM NO: 23

DESK ITEM
DATE: June 21, 2022
TO: Mayor and Town Council
FROM: Laurel Prevetti, Town Manager
SUBJECT: Maintain a Ban on Cannabis Businesses in Los Gatos and Consider a Ballot Measure to Tax Cannabis Businesses
REMARKS:

Since the initial publication of the report, staff has learned that Revenue and Taxation Code Section 34011(f) currently precludes cities from taxing medicinal marijuana sales when a customer provides a valid state-issued Medical Cannabis Identification Card and governmentissued identification. Staff will continue to monitor the law in this area.

This means that if Senate Bill 1186 passes, the Town would not be able to tax medical cannabis delivery businesses. With this additional information, it may not be worthwhile to pursue a ballot measure for a tax on cannabis businesses.

Attachment 6 contains public comments received beginning 11:00 a.m., Monday, June 20, 2022 through 11:00 a.m., Tuesday, June 21, 2022.

Attachment 7 contains the scientific cannabis community survey results.

Attachments Previously Received with the Staff Report:

1. Consultant Study

2. Map of State Buffer Areas

3. Public Comment
Attachments Received with Previous Addendum:

4. Public comment received between 11:00 a.m., Thursday, June 16, 2022, and 11:01 a.m., Friday, June 17, 2022.

Page 1085 ends

PAGE 2 OF 2
SUBJECT: Maintain a Ban on Cannabis Businesses in Los Gatos and Consider a Ballot Measure to Tax Cannabis Businesses
DATE: June 21, 2022
Attachments Received with Previous Addendum B:

5. Public comment received beginning at 11:00 a.m., Friday, June 17, 2022, through 11:00 a.m., Monday, June 20, 2022.

Attachments Received with this Desk Item:

6. Public comment received beginning 11:00 a.m., Monday, June 20, 2022 through 11:00 a.m., Tuesday, June 21, 2022.

7. Scientific Cannabis Community Survey Results

Page 1086 ends

From: Nancy Boesenberg <[email protected]>
Sent: Monday, June 20, 2022 4:35 PM
To: Council <[email protected]>
Subject: Vote NO on allowing marijuana dispensaries in Los Gators.

EXTERNAL SENDER
Dear Council,
I oppose allowing marijuana dispensaries in Los Gatos. It is a déstructuré addictive drug that can ruin lives and destroys developing brains.

The non-scientific propaganda spewed by pro- marijuana activists is only to acquire revenue.

Please save Los Gatos but more importantly, save lives. Vote NO! Thank you,
Nancy Boesenberg
Sent from my iPhone
From: Rob Gelphman <[email protected]>
Sent: Monday, June 20, 2022 6:01 PM
To: Council <[email protected]>; Town Manager <[email protected]> Subject: I SUPPORT A CANNABIS DISPENSARY IN LOS GATOS

EXTERNAL SENDER
Dear Los Gatos Town Council
I would like to express my support for the decision to allow Cannabis related businesses to operate locally. Adding tax revenue, providing safe access and eliminating the black market by allowing legitimate business seems like an obvious choice. Cannabis is not addictive and no one has died—ever— from an overdose of pot. There is no such thing. It is impossible. Yet we legalize alcohol, coffee and tobacco all of which are habit forming.

As to unfounded objections regarding the attraction of unsavory elements, that is pure nonsense. Have you ever been to a dispensary? Everyone there—customers and employees--is professional and well behaved. And of all age groups including seniors who are looking for some pain relief from worn out body parts without the addictive qualities of prescription drugs.

Cannabis is a growth industry, is not habit forming, employs lots of people and must fall into all state and local laws. Anyone who says different is uninformed and obviously biased, and thus rendered irrelevant.

The ancient Hebrews were using cannabis in their sacrificial and religious rituals more than two millennium ago. The Chinese were chronicling the medicinal value of marijuana two thousand years ago.

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As City Council and Manager, you are obligated to follow the will of the people. Authorize a dispensary NOW.

Rob Gelphman
1-408-838-7458
[email protected]
From: Christopher Lane <[email protected]>
Sent: Monday, June 20, 2022 12:19 PM
To: Council <[email protected]>; Town Manager <[email protected]> Subject: Cannabis Retail on June 21st, Thank You for Your Engagement

EXTERNAL SENDER
Hi Council,
Chris Lane, CMO of Airfield Supply Company here, thanks for all of your conversations. I have had the chance to speak with many of you over the last several months and just wanted to briefly write a note prior to the June 21st meeting to summarize a few key points that have come up during our discussion in your process.

First, there seems to be a pervasive theme developing of wanting to understand the costs. I had a chance to read the staff report and HDL work on the topic and while it's mentioned in there, it's worth clarifying that in basically all cases the retailers cover the cost of a program. Between annual fees and supplementary items, it's a pretty cut and dry situation. We even reached out to San Jose, the most relevant geographic and household income municipality to offer their conversation with their Cannabis Regulatory Program, who are more than happy to meet with you as we have mentioned to explain cost recovery.

Second, youth influence, diversion or access seems to be a major topic of concern in town. This is completely understandable and frankly refershing to hear how much focus on youth there is, but just as a reminder - cannabis is for adults and everything that happens around it should be targeted to only adults. There are laws on where a retail store could be safely located, what a retail could look like, where it could advertise, how it is secured and monitored and every other aspect. Cannabis retail is as uninterested in youth as the town is, and works hard to not appeal to anyone under the age as we completely agree that it isn't appropriate. As an Airfield anecdote, we can't tell you how many people

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live and work in the area for years and often say on their first visit that they never knew what that retail location was until they researched finding one. It's not an accident.

Third, general operational insight seems like something that the community could do well for more insight on and conversation around. From customer traffic to how products are licensed and approved to cash handling and storage, we have had many questions that are important to understand how this really is just like most other businesses in town. That being said, regulation means more planning, and every retailer takes this just as seriously as you do to ensure successful operations. Opening up retail means the chance to find the best operator that fits Los Gatos perfectly, and it's important to not forget Council's vital role in a process like that if it was to move forward at some time.

As we have reiterated many times, Airfield views Los Gatos as something of our emotional home. Many of us have families here, friends made here and futures to plan here. This is a place for long term decisions and lifelong commitments to the best for this town, this decision should be viewed no different simply because it's "new" to many. From learning more about security, safety, or youth prevention to economic impact, community engagement and retail operations - it doesn't go without saying that there is usually a merited answer for most questions and concerns. It often just takes asking the question.

In closing, I just want to commend the Council's willingness and leadership to show interest, ask questions, raise concerns and learn from the industry and local businesses. We have had the chance to tour some members, speak with others and even help with community events where town staff and council have attended. In all cases, there feels to be a true sense of fact finding and a quest for knowledge that shows commitment to finding the right answer for Los Gatos, whatever that is.

Best,
Chris Lane
--
Chris Lane
CMO
Airfield Supply Company
Phone: 408-458-6100

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From: Karen Mautich <[email protected]>
Sent: Monday, June 20, 2022 11:01 AM
To: Council <[email protected]>; Town Manager <[email protected]> Subject: We support cannabis retail

EXTERNAL SENDER
Hi Town Council,
My name is Karen Matulich and my husband Paul and I have been residents of Los Gatos since 1978 and owned Steamer's Grillhouse in Los Gatos since 1979. We raised our two children in Los Gatos, have been in the business community for over four decades and we strongly support opening up cannabis retail in Los Gatos.

As you likely know, my son founded Airfield Supply Company in 2010, and over the last twelve years has created a business that has employed hundreds, if not thousands of individuals - many of them Los Gatos residents - contributed tens of millions in tax revenue to San Jose and engaged in countless community service activities. While this decision is not about what - or even if right away a store could open - I am compelled to say that our family knows Los Gatos better than most and knows that cannabis retail would never disrupt a town. Retailers are modern, secure, positively-community engaged and offer significant career opportunities.

I can't tell you how many people have told me their stories about the positive impact cannabis has had for them, be it for sleep, relaxation, pain management, stress relief or others. It is a substance for adults, and it needs proper engagement, frameworks and discussion. Our town needs education and honesty about the world today and how to best create a community around it that we can all be proud of, not to bury our heads in the sand and hope it doesn't exist. Let's improve our parks, roads, and city with something people alreadfy spend money on and we get no benefit from as of now.

Please move forward and let's continue to make a Los Gatos we are all proud to live in.

Best,
Karen and Paul Matulich
From: Phil Koen <[email protected]>
Sent: Tuesday, June 21, 2022 8:02 AM

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To: Rob Rennie <[email protected]>; Matthew Hudes <[email protected]>; Mary Badame <[email protected]>; Marico Sayoc <[email protected]>; Maria Ristow <[email protected]>; Shelley Neis <[email protected]> Cc: [email protected]; Rick Van Hoesen ([email protected]) <[email protected]>; Lee Fagot <[email protected]>; Laurel Prevetti <[email protected]>; Arn Andrews <[email protected]>
Subject: HDL Analysis - Agenda Item #23

EXTERNAL SENDER
Dear Honorable Mayor and Town Council Members,
I am pleased the Staff has recommended continuing the ban on store front cannabis retail sales. I believe this is the correct answer especially after doing a realistic analysis of potential retail tax revenue less all costs that potentially could be incurred by the Town for additional safety and administration personal resulting from store front sales of cannabis. It is highly probable that on a net revenue basis retail sales of cannabis would be financially breakeven at best and more likely than not generate a net revenue loss. I arrive at this conclusion using a more likely tax revenue estimate of $264,000 and assuming that at least two additional sworn police officers and 1 administration headcount will be needed to support the retail program. Unfortunately, the Hdl analysis does not include a financial feasibility study and only focused on projecting potential revenue and tax collection projections. This represented only one half of the required analysis.

I want to point out there are obvious errors and questionable assumptions in the HDL revenue projection. It is necessary that the Town Council have the benefit of a different perspective during your deliberation. HdL’s business model depends on local jurisdictions allowing retail sales of cannabis. The firm makes substantial money on providing additional consulting services including drafting regulations, cannabis compliance, policy development, etc. It is in their best interest that every local jurisdiction in the State allow retail cannabis sales. What could possibly go wrong with a revenue forecast prepared by HdL? I can think of no better advocate for allowing retail cannabis sales than HdL.

1. The numbers reported by the State for Santa Clara County per capita retail sales of cannabis for Q1 2022 were $24.13. per capita (see attached). Per capita sale is the best number to use in forecasting cannabis retail sales since it avoids introducing a forecasting error driven by estimating the percentage of the population that uses cannabis. For the State of California, it is widely reported that the 13.5% of the population has used cannabis within the past month.

Obviously, that can change at the local jurisdiction level but there are no good reporting mechanisms to capture local percentage usage rates. $24.13 per capita for Q1 2022 compares to

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$29.26 for the same quarter last year. This represents a 17.5% decrease in per capita sales year over year. If you annualize Q1 2022 actual, the projected per capita retail sales would be $96.52.

The HdL report stated that the sales per capita for Santa Clara County (1.9m population) over the last 12 months was $114 person. Using the more recent data, total annual sales for 2022 in Santa Clara County would be approximately $183m as compared to HdL’s reported number of $220 million. That is a material reduction which is not reported in the HdL study. The analysis should at least reflect the most recent actual results.

2. Why isn’t the most likely answer for projected retail sales in Los Gatos simply $96.52 (most recent per capita sales based on Santa Clara County actuals) x 33,529 (Los Gatos population) which yields $3.3m total sales? Applying a 4% tax rate, the projected tax revenue for the Town would be only $129,450. This seems to be the most reasonable forecast based on actual data.

The HdL “best” estimate is $16m in sales and using a 4% tax rate, the projected tax revenue would be $641,332. By using a per capital methodology in forecasting total sales, one avoids having to make numerous assumptions (most of which have no factual data to support the assumption), which introduce forecasting error and bias. For example, assumptions regarding average transaction amount ($73), transaction frequency (2x per month), leakage to black market (50%) and leakage to other licensed retailers (20%) can all be avoided. Each of these individual assumptions in the HdL analysis has a wide distribution of various outcomes at the local jurisdiction level. As a result, the summation of all forecasting errors makes the “most” likely estimate a very poor predictor of actual results because of the wide variation of possible outcomes. A good analogy is having one hand in boiling water and another hand in a bucket of ice water. The average is fine, but you can’t say the same about each hand!

3. To believe the Hdl revenue forecast of $16,033,046 for Los Gatos, you have to also believe that for every local Los Gatos resident that purchases cannabis at a local store front, there are 7 individuals living outside of Los Gatos, driving to the Los Gatos to make a purchase. Please reflect on that – 7 driving from outside the Town to purchase. Is that good public policy for the Town and does it even pass the reasonableness test since presumably these individuals are already buying cannabis at an existing retail store front? Here is the supporting math - based on 13% of the population using cannabis that means there are 4,358 local individuals purchasing at retail stores. The HdL analysis is based on an unsupported assumption that the total cannabis user base served by Los Gatos is 30,504 buying locally. The additional 26,146 are coming from outside the Town and this assumption drives the vast majority of the estimated revenue for the Town. Unfortunately, the HdL analysis offers no supporting data that would serve as substantiating evidence. What if that number is only 4,358, which means for every local purchase there is only one purchase from the surrounding area? The revenue projection would be $6.6m and not $16m. $6.6m in total sales will generate using a 4% tax rate $264,000.

In closing, the HdL analysis is extremely problematic. It would be interesting to ask HdL if they have actual tax revenue collection data for a local jurisdiction that is similar in size and socio-economic make up as the Town. Since this was not included in their report, I am assuming they don’t have the data.

What we do know, there is a common theme around forecasting tax revenues vs. actual outcomes.

Many local jurisdictions are now discovering (and this includes the State) that the cannabis tax revenue projections were widely optimistic and actual results were materially less.

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There are other errors in the analysis such as, the leakage to licensed retailers claims to be 30% in the schedule, but the math indicates it is only 20%. The estimate leakage to the black-market claims to be 30% but the math suggests it is 50%. If HdL is to be believed, the average transaction amount of $73 per person and $16m in sales equates to 219,630 transactions per year – the vast majority originating from individuals living outside of Los Gatos. That is a ton of cars coming into the Town to purchase cannabis.

The Town Council started down this path based on the assumption that allowing retain storefront sales would be a good fiscal decision. There has been no objective data that supports this will actually happen and more likely than not will be fiscally negative. Given this lack of data, the Staff has reached the prudent and correct decision, which is to continue the ban of retail cannabis sales. Please support the Staff’s recommendation.

Thank you.

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Analysis of Cannabis Market
in California and Case Study
Cities
Prepared by:

Applied Development Economics, Inc.
3527 Mt. Diablo Boulevard, CA 94549 925.934.8712
www.adeusa.com
August 6, 2020

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Applied Development Economics | Page 4

ANALYSIS OF CALIFORNIA

CANNABIS MARKET

INTRODUCTION
On November 6, 2016, voters in California passed Proposition 64, the Adult Use of Marijuana Act (“AUMA”). The initiative legalized recreational cannabis in the state and provided a broad framework from which cannabis businesses would be licensed, taxed, and regulated.

Since its adoption, the legal cannabis market in California has grown steadily and currently supports over $2 billion in legal sales. Between 2018 and 2019, taxable cannabis sales increased by 62 percent.

In addition to direct cannabis sales, the retail cannabis industry in California also generates taxable revenues from accessories and point-of-sale items that increase the overall retail sales associated with cannabis sales to about $2.7 billion.

While these represent positive signs that the uptake for legal cannabis has created an emerging industry in California with the potential to generate significant employment opportunities and revenue to the State, comparisons with other states indicate that California’s legal cannabis market continues to underperform by a wide margin.

The implementation of Proposition 64 has seen inconsistencies between different jurisdictions. These inconsistencies range from land use regulations to tax rate and licensing procedures. While some jurisdictions have proactively sought to attract and develop local cannabis businesses, others have taken steps to block cannabis businesses from opening. Because retail cannabis licensing and sales still fall short of potential consumer demand, the illicit cannabis market continues to meet a large majority of this demand.

This study will provide some context to the current status of California’s legal cannabis market. The report compiles together the updated revenue and market information about the legal adult use cannabis market in California, and benchmarks it against other states that also have legal cannabis markets. In addition, the study includes case studies for three different California jurisdictions that identify the market potential for legal cannabis and local tax revenues for those jurisdictions.

CALIFORNIA CANNABIS MARKET FINDINGS
The state of the California cannabis market has shown decidedly mixed results. As the state moves forward with implementation of Proposition 64, the Adult Use of Marijuana Act of 2016 (“AUMA”), California sees growing legal cannabis sales, but also difficulties with sales and tax revenues that fall well short of projections.

EXISTING CONDITIONS
According to a 2019 study by Arcview Market Research and BDS Analytics, California’s projected annual recreational cannabis sales totaled $3.1 billion (CDTFA estimates taxable sales of $2.1 billion

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Los Gatos City CouncilJune 21, 2022

Los Gatos City Council
June 21, 2022