Risk and Protective Factors by Domain
One legacy of the widespread drug use and rebellion among youth in the mid-1960s was a vast body of research on the causes and correlates of youthful problem behavior. As a result, the literature on risk factors is more extensive than for protective factors and resilience. Further, risk and protective factors may vary considerably according to an individual’s age, psychosocial development, ethnic/cultural identity, and environment. What follows, therefore, is a brief summary of the literature that presents a current consensus on risk and protective factors that are generally considered to be among the most important for substance abuse prevention policy and programming. This consensus, in turn, has guided the development of the HRY grant programs reviewed in the following chapter.
Risk Factors
Knowledge about specific risk factors, as noted by Hawkins, Catalano, & Miller (1992), is crucial in preventing substance abuse and related problem behaviors. Hawkins emphasizes, however, that risks exist in multiple domains and preventionists should work to reduce risks across domains. In addition, common risk factors predict diverse behavior problems. When a particular risk factor is reduced, according to Hawkins, it may affect a diverse set of problems in the community. Further, although levels of risk may vary from one community and ethnic/cultural group to another, effects of risk factors are fairly consistent across races, cultures, and social classes.
Personal/individual
Many of the most important risk factors affecting substance use and abuse can be categorized as uncontrollable variables. Foremost among these are genetic predispositions toward alcohol use (CSAP, 1993a, p. 8). Age and gender are also important. Individuals are considered to be most vulnerable to substance use during the period from early adolescence through young adulthood. The earlier the age at onset of drug use, the greater the risk for later substance-related problems (Kandel, 1982).
More amenable to change are personal attitudes and predispositions related to drug use. Highly correlated with use or nonuse of drugs, for example, is an individual’s perception of risk (Brounstein, Altschuler, Hatry, & Blair, 1989). Within recent years, an increase in youthful drug use has been associated with decreased perceptions of risk (Johnston, O’Malley, & Bachman, 1995). Other predispositions include increased levels of impulsivity, hostility, or disinhibition; increased alienation from the dominant values of society; and greater levels of rebelliousness (CSAP, 1993a, p. 7).
Substance abuse prevention programs often aim at correcting or overcoming deficits in social skills. Principal among these are early aggressive behavior (Hawkins, Catalano, & Miller, 1988) and alienation (CSAP, 1993a, p. 9). Also closely linked with substance use and abuse among youth are related problem behaviors such as juvenile delinquency, violence, teen pregnancy, and dropping out of school (Hawkins, Catalano, & Miller, 1992).
Family
From the prenatal stage through late childhood, the family—parents, caregivers or parent surrogates, siblings, and close relatives—is the main influence in the development of children and youth, and it is also the crucible in which problem behaviors and all their antecedents are shaped. Kumpfer (1993) has observed, for example, that remaining in an abusive or conflict-ridden family is far more detrimental to children than divorce. Kumpfer also notes that, according to research, marital discord is a stronger predictor of delinquency than family structure (such as a single-parent family). Other major family risk factors include economic deprivation; reduced supervision, formal controls, and social supports; living in impoverished neighborhoods characterized by high crime rates and alienation; differential family acculturation; and poor family management, discipline, and problem-solving practices (Kumpfer, 1993; Hawkins, Catalano, & Miller, 1992). Also important in predicting substance use among youth is parental use of alcohol and drugs and both parental permissiveness and positive attitudes toward alcohol and drugs (Hawkins, Catalano, & Miller, 1988).
School
One of the strongest predictors of substance use and related problem behavior is school failure (CSAP, 1993a, p. 11; Hawkins, Catalano, & Miller, 1988). Although to a great extent school failure is shaped by an individual’s experiences in early childhood, within the family setting, and during the preschool years, some school-related factors are believed to exacerbate preexisting problems and dispositions. Principal among these are a negative, disorderly, and unsafe school climate and low teacher expectations of student achievement (cf. Hawkins, Catalano, & Associates, 1992). Closely associated with an unsafe and disorderly school climate, and also predictive of school-related substance abuse problems, is a lack of clear school policies regarding drug use (cf. Hawkins, Catalano, & Associates, 1992).
Peer group
The negative influence of peers is well established as one of the most important factors in the onset of drug and alcohol use among youth, and it continues to be important through young adulthood (Swisher, 1992). Nevertheless, all young people are not equally susceptible to real or perceived peer pressure. According to Swisher (1992, p. 11), adolescents who are strongly peer-oriented hold “more negative views of themselves, see themselves as less dependable, more hostile, more likely to disobey adults, less interested in academics, and less future-oriented.” Another factor noted by Swisher (1992, p. 12) is weak bonds with traditionally positive norms such as those espoused by the family, community, or religion. Further, peer influence increases in importance as young people move into adolescence. One or more of the preceding vulnerabilities to peer influence can lead to the surest predictor of substance use among youth, involvement with peers who use alcohol and drugs and engage in other forms of problem behavior (Hawkins, Catalano, & Miller, 1988).
Community
In a review of research related to community risk factors for substance abuse, Emshoff, Erickson, and Thompson (1992) identified seven that appear to have a direct influence:
- Community norms that promote or permit substance use. Mosher (1990) has noted that community norms may favor inappropriate alcohol use among adults while discouraging youthful drinking, thus creating a conflicting message for youth.
- Poverty/lack of empowerment.
- Lack of community bonding and community disorganization—strongly related to poverty and lack of empowerment.
- Cultural disenfranchisement—i.e., a perception among youth that the dominant/mainstream culture is not relevant to them; that they are discriminated against because of their culture, race, or ethnicity; or that little value is attached to their ethnicity and culture.
- Policies that encourage or fail to discourage substance use—e.g., tolerance of sales of tobacco and alcohol to minors.
- Pro-use messages in the general media—e.g., television shows and popular music.
- Pro-use messages specifically in advertising (as distinct from other media)—e.g., youth-oriented cigarette advertising has been consistently linked with the onset of smoking.
Society
Societal-level risks are relevant because all of the previously mentioned systems (i.e., individuals, peer groups, families, schools, and communities) exist within the larger society. Societal-level risk factors relate to national economic and employment conditions, discrimination, and marginalization of groups. Impoverishment, employment and underemployment, and discrimination contribute to a society that may marginalize groups of individuals, increasing their risk for substance use and abuse.
Protective Factors
The literature on protective factors and resilience is more diffuse than that for risk factors, and there is less clarity about which factors are most important in the pre ven tion of substance abuse. Nevertheless, a growing consensus exists that in the major domains of youth development, certain protective factors are critically important.
Personal/individual
CSAP’s review of the individual domain (CSAP, 1993a, p. 13) identifies three primary categories of protective factors:
- Positive temperament characteristics, which include social skills and social responsiveness, cooperativeness, emotional stability, positive sense of self, flexibility, problem-solving skills, and low levels of defensiveness.
- An emotionally supportive parental/family milieu, including parental attention to children’s interests, attachment to parents, orderly and structured parent-child relationships, and parent involvement in homework and school-related activities.
- Supportive societal institutions that reinforce the child’s coping efforts, elements of which include parental identification and satisfaction, commitment to school, regular involvement in church, and belief in society’s values.
Less easily definable, but perhaps just as important, is social competence, including having good communication skills, responsiveness, empathy, caring, a sense of humor, and an inclination toward prosocial behavior (Elias, Zins, & Weissberg, 1997). Social competence also includes problem-solving skills, a strong sense of autonomy and independence, and a sense of purpose and of the future, e.g., goal-directedness.
Family
Perhaps the single most important family-related protective factor is positive bonding within the family setting. As Werner (1990) has observed, “despite the burden of parental psychopathology, family discord, or chronic poverty, most children identified as resilient have had the opportunity to establish a close bond with at least one person [not necessarily the mother or father] who provided them with stable care and from whom they received adequate and appropriate attention during the first year of life” (quoted in Benard, 1991, p. 6). Other key family protective factors include:
- High levels of warmth and an absence of severe criticism (Rutter, 1979).
- A sense of basic trust (Erickson, 1950/ 1985).
- High parental expectations (Benard, 1990).
- Clear rules and expectations for children, including children’s participation in family chores and responsibilities (Hawkins, Catalano, & Miller, 1992).
School
Key protective factors within the school setting are similar to those for the family. Principal among these are caring and support; high expectations; clear standards and rules for appropriate behavior; and youth participation, involvement, and responsibility in school tasks and decisions (Elias et al., 1997).
Peer group
Given the crucial importance of the peer group in adolescence, one of the most important factors in young people’s ability to resist negative peer influences is involvement with positive peer group activities and norms (Swisher, 1992). Also helping young people resist negative peer influences are such social competencies as decision-making skills, assertiveness, and interpersonal communication (Swisher, 1992).
Community
Protective factors within the community and society are similar to those within the family and school in helping to support and develop individual traits of social competence, self-responsibility, and resilience. Elements found in caring communities include:
- Caring and support—social networks and support systems that can promote and sustain social cohesion within the community (Battistich et al., 1996).
- High expectations of youth—cultural norms that set high standards of behavior for young people, including clear norms regarding the use of alcohol and drugs, and that also value youth as community members.
- Opportunities for participation—ways for youth to function as active and contributing members of the community and participate in cooperative learning and shared decision making (Battistich et al., 1996).
Society
Societal-level characteristics or policies can also work to protect youth from initiating substance use. Messages promoting substance use via media channels may lose their impact if children are taught to become media literate or if these same media channels also carry counteradvertising messages describing the harmful effects of substance use. Understanding and reinterpreting media messages may reduce their negative impact on individual attitudes and, perhaps, behavior (Lewit, Coate, & Grossman, 1981; Wallack & De Jong, 1995). Additionally, decreasing substance accessibility can also protect youth from initiating use. Substance accessibility can be reduced through a variety of prevention strategies, such as increased prices through taxation, increased purchasing age with enforcement, and stricter driving laws.
An emphasis on protective factors, in short, is consistent with the basic mission of substance abuse prevention programs today, particularly the HRY Demonstration Grant Program. Such an emphasis promotes the healthy development of children, youth, families, and communities. When all the domains of a young person’s life support healthy development and promote resilience, young people are more likely to withstand the negative influences and risks to which they will inevitably be exposed.
Assessing the Impact of the HRY Grants
CSAP was established at a time of intense public concern about the drug problem. The highly publicized drug-related deaths of several celebrities had created a sense of urgency and crisis. As a result, in its early years CSAP’s emphasis was primarily on addressing the problem through delivery of direct services. The first 130 HRY grants were awarded in 1987 in 42 States; their purpose was to develop innovative programming tailored to meet the needs of identified subpopulations of youth in high-risk environments.
Increasingly, however, it became apparent that CSAP’s demonstration programs needed to place more emphasis on rigorously evaluating their impacts and outcomes. Every year the Federal Government promotes prevention efforts through several different agencies and departments, including CSAP, the Center for Mental Health Services, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the Department of Education, the Department of Defense, the Department of Justice, and others. All have experienced a move toward greater accountability and identification of prevention program outcomes. Initial legislation providing funding for the earliest grants did not require evaluation; however, CSAP later required that grantees use a portion of their monies for evaluation purposes (Sambrano, Springer, & Hermann, 1997). By the second round of grants, of which 48 were awarded in 1989, CSAP required that a significant percentage of each grant be used for evaluation.
Compiling and disseminating the results of HRY program evaluations is now viewed as an important next step for CSAP, both to promote the effectiveness of substance abuse prevention programming and to disseminate the models and intervention strategies that proved most successful.
Advances in Knowledge: The HRY DataBank
Recognizing the need for a sustained effort to organize the mass of information originating among CSAP grantees, and to present findings and other pertinent information in a form that would be useful in assessing both program effectiveness and scientific acceptability, CSAP launched a new initiative, the High Risk Populations HRY DataBank, in the fall of 1994. This document describes the process used to organize, extract, and code information; the structure and contents of the DataBank; and findings from the best implemented and evaluated grants in the DataBank.
The HRY DataBank is an evaluation-oriented information system with a comprehensive unifying framework. It consists of four primary information components:
- Descriptive information (e.g., administrative characteristics including location, number, and types of sites; setting; and targeted population demographics);
- Compilations of specific CSAP demonstration program interventions (prevention strategies);
- Formal characterization of the evaluation methods used; and
- Objective ratings of both strength (direction and magnitude) and credibility of findings.
Procedures for Rating DataBank Findings
For each grant, Proposals, Final Reports, Findings Papers, and annual Evaluation Status Reports were reviewed and coded to extract descriptive information regarding the implementation, population, and administrative characteristics of the program as well as to describe the evaluation methods including sample characteristics, measures used, attrition, and findings. In addition, each report presenting research from an evaluation study measuring change over time against a standard was subjected to expert review. The purpose of this expert review was to rate level of confidence in each finding based upon the characteristics and quality of implementation of the research design. Pairs of trained external evaluators rated each research finding for magnitude and confidence that the data were meaningful. In addition, ratings of confidence, magnitude, and direction were generated across all findings in each outcome domain, resulting in ratings for both individual findings and for the overall domain. Details of the rating procedures are presented in Appendix A.
Subsequent to this round of reviews, another set of reviews was undertaken. Here, those programs identified as providing data in which the analysts had at least moderate confidence were again subjected to review by two outside evaluation experts. In this review, the research was evaluated on the basis of quality of program intervention implementation, evaluation research rigor, and the positivity and consistency of findings. Again, details of the review process are presented in Appendix A. Appendix B includes information about how effectiveness ratings were derived and a list of the criteria used by reviewers to be applied to programs.
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Last Updated: March 4, 2002
