What are the most important factors to consider for developing effective drug use prevention programs? Many current programs for adolescents focus on elements including peer and family relationships, school connection, and youth's self-confidence and self-assertion. However, a new study from the University of Illinois suggests another factor may be equally -- or even more -- influential: whether the youth believes drug use is wrong.

"Inherent to the success of drug use prevention programs is ensuring activities are targeting those risks and protective factors that are most influential and salient for youth substance use," says Allen Barton, assistant professor and Extension specialist in the Department of Human Development and Family Studies at U of I and lead author on the study.

"As we aim to develop more effective drug use prevention programming, we have to ask whether any pertinent factors have been overlooked."

Barton and his colleagues found individual beliefs that drug use is wrong had twice the magnitude of impact compared to other risk and protective factors examined in the study. Thus, influencing adolescents' beliefs about drug use may be an important, but relatively underemphasized, key to modifying their behavior.

The researchers based their work on cognitive dissonance theory, which has not been used commonly to inform drug prevention efforts.

"The basic idea of cognitive dissonance theory is that individuals strive for harmony or agreement between their beliefs and their behavior. When there's a disconnect or dissonance, they try to reconcile either by changing their behavior to match their beliefs, or by changing their beliefs to allow for their behavior," Barton explains.

The researchers analyzed information from the 2018 Illinois Youth Survey, which measured risk behaviors among middle and high school students. The study included more than 128,000 youths in grades 8, 10, and 12 from schools across Illinois. Respondents noted whether, and how frequently, they had used alcohol, cannabis, or tobacco in the past year. They also answered a range of questions about their attitudes, school, family, and health.

"It is not surprising that drug use beliefs are linked to behavior; we certainly would expect a correlation between them. What's most noticeable is the magnitude of the effect, particularly in comparison to more established factors included in the analyses," Barton states.

In the survey, youth were asked how wrong they think it is for someone their age to consume alcohol or drugs, ranking from "not wrong at all" to "very wrong" on a four-point scale. For each unit increase in response, the likelihood of past-year drug abstinence increased by 39% for 8th graders, 50% for 10th graders, and 53% for 12th graders.

Beliefs not only correlated strongly with past usage, but also with frequency of use.

"Even among individuals who used drugs in the past year, individual beliefs that drug use is wrong were associated with less frequent use," Barton says.

The researchers found parents' beliefs also had a protective effect, albeit smaller than individual beliefs, while peer acceptance of drug usage was a risk factor. Perhaps more surprisingly, parental communication about drugs was associated with higher usage.

"These conversations may be happening because parents are already suspicious that youth are using drugs or trying to experiment," Barton notes. He suggests parents might want to speak with their kids about drugs at an earlier age, perhaps during the middle school years, rather than wait until they perceive a problem.

The study's findings can inform research and prevention efforts in various ways, the scientists say. First steps are to investigate how youths' beliefs about drug use are formed and influenced. Practitioners might also consider how they can support parents and caregivers in transmitting their beliefs to youth.

"Our work suggests this is a construct that warrants more attention in both the research and practice communities as it demonstrates a strong protective effect when it comes to drug use," Barton says. "As we are trying to improve drug use prevention programming for youth, these results suggest it may be useful to think about how educators, mentors, and parents can help instill the belief that drug use is wrong."

The Illinois Youth Survey is administered every other year to schools across Illinois. Reports are available at the Illinois Youth Survey website. Schools can also register online for participation.

The article, "Adolescent substance use and individual beliefs that drug use is wrong: A statewide epidemiological study" is published in Substance Use & Misuse. Authors include Allen Barton, Qiujie Gong, Naya Sutton, Jordan Davis, and Doug Smith.

Funding was provided by the Illinois Department of Human Services.