The Role of Program Implementation Quality in Family-Focused Substance-Use Prevention for Youth with Multiple Risks: PROSPER Project.

Programming to prevent behavioral problems can effectively build youth skills and enhance bonding to parents and prosocial peers to delay substance use for adolescents, an important challenge for adolescents given the links between early adolescent experimentation and the chance of developing problems related to substance use as an adult. For youth at higher risk, the effective delivery of such programs could be particularly critical. This study examined the impact of implementation outcomes of family-focused evidence-based prevention programming in sixth grade on substance use in ninth grade based on youths' initial levels of risk. Three implementation outcomes were assessed: (1) adherence, (2) facilitation quality, and (3) participant responsiveness. Using multi-level analysis of data from two cohorts across 14 school districts, we examined whether community-level implementation quality moderated the relationship between individual-level baseline risk and later substance use. Results showed higher implementation quality, particularly facilitation quality and participant responsiveness, was significantly associated with lower substance use among high-risk youth. Notably, high implementation quality was significantly associated with lower substance initiation index scores for high-risk students (p < 0.05). Similar results were also found for the initiation of marijuana and cigarette use, as well as for alcohol consumption in the past month.