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Programs that Work

SPORT


Program Info
Program Overview
Program Participants
Evaluation Methods
Key Evaluation Findings
Probable Implementers
Funding
Implementation Detail
Issues to Consider
Example Sites
Contact Information
Available Resources
Bibliography
Last Reviewed

 

Program Info

Outcome Areas
Healthy and Safe Children

Indicators
Youths not using alcohol, tobacco, or illegal drugs
Children experiencing good physical health

Topic Areas

     Age of Child
       Middle Childhood (9-12)
       Adolescence (13-18)
     Type of Setting
       Middle School
       High School
       Out of School Time
     Type of Service
       Health Education
     Type of Outcome Addressed
       Physical Health
       Substance Use and Dependence

Evidence Level  (What does this mean?)
Promising

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Program Overview

SPORT aims to integrate physical activity and other health-enhancing habits with substance abuse prevention topics in order to appeal to adolescents by linking alcohol avoidance with attractive images of active and healthy adolescents. SPORT includes a health behavior screen, a health consultation, and a take-home fitness prescription, all of which integrate alcohol avoidance and other topics. The program design draws on several theories. The predominant one is the Integrative Behavior-Image Model (BIM) (Werch, 2007), which emphasizes normative youth development, promoting positive goals, and healthy behavior along with awareness of health risks of negative behaviors. SPORT applies this concept by linking images of physical activity and other health habits, such as healthy eating and sleep habits, to alcohol prevention. For example, one message emphasized through SPORT is that alcohol use does not correspond to an active lifestyle (Werch et al., 2005).

The health behavior screen assesses six different types of health behaviors, including sport and physical activity, exercise, physical activity norms, breakfast and nutrition, sleep and rest, and alcohol initiation and use. The health consultation includes scripted messages about normative behaviors and risks associated with risky behaviors, tailored to the individual’s circumstances. The take-home fitness prescription includes goals for youth to improve their health-related behaviors based on their individual circumstances (Werch et al., 2005).

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Program Participants

SPORT was designed for use among adolescents.

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Evaluation Methods

There is a large body of research on the effectiveness of SPORT. One study utilized an experimental design that compared outcomes for intervention group participants with those of control group participants (Werch et al., 2005). Other studies compared SPORT to modified versions of the intervention without a control group or were conducted as process evaluations. Only the results of the study that meets Promising Practices Network (PPN) criteria and uses an experimental design — Werch et al., 2005 — are presented here.

Werch et al. (2005) conducted an evaluation of SPORT among students in ninth and eleventh grades at a suburban high school in northeast Florida between fall 2002 and fall 2003. Students were recruited through classroom presentations, announcements from teachers and staff, and schoolwide announcements. A total of 604 students participated: 335 ninth grade students and 269 eleventh grade students. Students were randomly assigned within grade levels to receive SPORT (intervention group) or to be in the control group. Students in the control group were seated in a quiet place and given pamphlets about alcohol prevention and health promotion to read. One week after this reading session, the control group students were mailed a pamphlet on health and fitness. For both intervention and control groups, the procedures were scheduled so as not to last longer than one class period. Despite random assignment, participants in the control group were significantly more likely than intervention group participants to have a family drug or alcohol problem (42.7 percent versus 34.9 percent). There were no other significant differences between the two groups at baseline, including no differences in alcohol or drug consumption or physical activity. Baseline assessments were conducted for all participants in fall 2002 prior to the intervention. Post-intervention assessments were conducted at three and 12 months after baseline. At the three time points, participants completed the Youth Alcohol and Health Survey (Werch et al., 2005), which assesses alcohol and drug use, risk factors and protective factors associated with alcohol and drug use, and exercise habits. The survey asked about alcohol, marijuana, and cigarette consumption (self-reported 30 day frequency and quantity), stage of initiation of alcohol, marijuana, and cigarette use (ranging from will never try substance to using substance for longer than six months), episodes of moderate physical activity in a seven-day period (self-report of at least 30 minutes of activity with no sweating or breathing hard), and episodes of vigorous physical activity in a seven-day period (at least 20 minutes of activity with sweating and breathing hard).

At the 12-month follow up, 85 percent of the original sample was retained, and there were approximately equal frequencies of attrition across both the intervention and control groups. More participants who dropped out of the control group had mothers who drank a minimum of a few times a year than participants who dropped out of the intervention group. There were no other significant differences between the participants who dropped out of the control and intervention groups based on baseline data.

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Key Evaluation Findings

At the three-month post-intervention assessment conducted by Werch et al. (2005), the following results were found:

  • Alcohol behaviors improved significantly more for intervention students than for control students, as measured by 30-day alcohol frequency, 30-day alcohol quantity, 30-day heavy use of alcohol, and alcohol problems.

  • Students in the intervention group were significantly less likely to initiate alcohol use than students in the control group, as measured by stage of alcohol initiation and length of alcohol use.

  • A significantly higher frequency of alcohol protective factors was seen among intervention students than among control group students, as measured by negative expectancy beliefs, behavioral capability, resistance self-efficacy, self-control, value incompatibility, perceived susceptibility, parental monitoring, parent-child communication, and positive parent-child relationship.

  • Students in the intervention group were at less risk for alcohol use than control group students, as measured by positive expectancy beliefs, subjective norms, intentions to drink the in the future, alcohol attitudes, perceived peer prevalence, and ability to be influenced by peers.

  • Intervention group students were more likely to engage in physical activity than control group students, as measured by moderate and vigorous physical activity.

  • Students in the intervention group used cigarettes and marijuana less frequently than students in the control group, as measured by 30-day cigarette frequency and 30-day marijuana frequency.

  • There were no significant differences in drug initiation, as measured by stage of cigarette initiation and stage of marijuana initiation.

At the 12-month post-intervention assessment conducted by Werch et al. (2005), the following results were found:
  • The three-month finding for alcohol protective measures was maintained at 12 months. A significantly higher frequency of alcohol protective factors was seen among intervention students than among control group students, as measured by negative expectancy beliefs, behavioral capability, resistance self-efficacy, self-control, value incompatibility, perceived susceptibility, parental monitoring, parent-child communication, and positive parent-child relationship.

  • The three-month finding for alcohol risk factor measures was also maintained. Students in the intervention group were at less risk for alcohol use than control group students, as measured by positive expectancy beliefs, subjective norms, intentions to drink the in the future, alcohol attitudes, perceived peer prevalence, and ability to be influenced.

  • Likewise, the three-month finding for drug use was maintained at 12 months. Students in the intervention group used cigarettes and marijuana less than students in the control group, as measured by 30-day cigarette frequency and 30-day marijuana frequency.

  • While there was no significant difference in drug initiation at three months, intervention group students were significantly less likely to initiate drug use at 12 months, as measured by stage of cigarette initiation and stage of marijuana initiation.

  • The significant differences in alcohol behaviors, alcohol initiation, and engagement in physical activity found at three months were not maintained at 12 months.
Werch et al. (2005) also assessed outcomes trends over baseline, three months, and at the 12-month follow-up and found the following results:
  • There was a significant positive trend over time for the intervention group participants compared with control group participants for alcohol behaviors, as measured by 30-day alcohol frequency, 30-day alcohol quantity, 30-day heavy use of alcohol, and alcohol problems.

  • At the three- and 12-month follow-up there were significant positive trends for intervention group participants compared with control group participants for alcohol initiation, as measured by length of alcohol use and stage of alcohol initiation.

  • There were also significant positive trends over time for intervention group participants compared with control group participants for alcohol protective factors, as measured by negative expectancy beliefs, behavioral capability, resistance self-efficacy, self-control, value incompatibility, perceived susceptibility, parental monitoring, parent-child communication, and positive parent-child relationship.

  • Likewise, there were significant positive trends over time for intervention group participants compared with control group participants for alcohol risk factors, as measured by positive expectancy beliefs, subjective norms, intentions to drink the in the future, alcohol attitudes, perceived peer prevalence, and ability to be influenced.

  • Intervention group participants demonstrated significant positive trends over time compared with control group participants for drug initiation, as measured by stage of cigarette initiation and stage of marijuana initiation.

  • There were no significant trends over time in drug behaviors or engagement in physical activity.

This evaluation (Werch et al., 2005) also assessed the interaction between self-reported cigarette and/or marijuana use and intervention exposure. Where there is a significant positive interaction effect between self-reported drug use and intervention exposure, this indicates that the effect of the intervention was stronger for drug users than for non-drug users. At baseline, there were 53 drug users in the intervention group and 65 drug users in the control group. Based on this analysis, the following results were found:
  • At three months, there was a significant positive interaction effect between drug use and intervention exposure for alcohol behaviors. This finding was not maintained at 12 months.

  • At three months, there was also a significant positive interaction effect between drug use and intervention exposure for drug behaviors. This finding was maintained at 12 months.

  • At three months, there was a significant positive interaction effect between drug users and intervention exposure for drug initiation. This finding was not maintained at 12 months.

  • There were no differences in alcohol initiation at three months or 12 months.

  • At three months, there were no significant differences in participation in physical activity. At 12 months, however, there was a significant positive interaction effect between drug user and intervention exposure for engagement in physical activity.

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Probable Implementers

High school and middle school health and physical education teachers, school counselors and nurses, after school teachers, community prevention and behavioral mental health providers, youth organizations, faith-based organizations, sporting groups and agencies, primary health care and health clinic providers, and others working with adolescents.

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Funding

Possible sources of funding to support SPORT implementation include the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Free Communities Program. In addition, implementation of SPORT may be eligible for reimbursement by Medicaid and commercial health insurance in clinical and primary care settings as a Screening and Brief Intervention (SBI).

More information regarding funding can be obtained through the Brief Programs for Health website: http://www.briefhealthprograms.com/index.php/programs-training/funding-resources

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Implementation Detail

Program Design

Adolescents participating in SPORT receive an in-person health behavior screen and a one-on-one consultation with a fitness specialist to promote an active lifestyle and to discuss the risks of alcohol consumption and the impact of alcohol on an active lifestyle. The adolescents then receive a fitness prescription, including personalized goals for sleep, nutrition, physical activity, and alcohol use. One week after the fitness specialist consultation, the participants are mailed a flyer reiterating the messages conveyed during the consultation.

Staffing

A SPORT fitness consultant administers the fitness consultation. Fitness specialists are health care professionals, including nurses and certified health education specialists. All fitness specialists need to undergo a training programing prior to administering consultations (Werch et al., 2005).

Curriculum

Werch (2007) explains the Behavior-Image Model (BIM) as a framework that links a positive health image to a health risk behavior, with the aim of increasing the positive health behavior and decreasing the health risk behavior through one intervention. The underlying theory to the BIM is that two positive health behaviors can be coupled to reinforce each other, whereas a positive health behavior and a negative health behavior can be coupled to oppose each other. This opposition occurs by educating individuals to the negative correlation between a positive health state and a negative health behavior. In the context of SPORT, the intervention aims to create images of physical health for participants and to demonstrate that substance use does not fit with this image (Werch et al., 2005).

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Issues to Consider

This program has been given a "promising" rating. The evaluation conducted by Werch et al. (2005) was a randomized evaluation of SPORT that included participants from one high school in a suburban neighborhood of northeast Florida. Also, participants in the control group were significantly more likely than intervention group participants to have a family drug or alcohol problem, and this difference was not controlled for in the analysis. There were no other significant differences between intervention and control participants at baseline. Note also that Dr. Werch, lead author on the evaluations cited, is the program developer.

Werch et al. (2003) conducted an evaluation of SPORT compared with SPORT plus an alcohol consultation (SPORT Plus) and compared with SPORT plus an alcohol consultation and materials on alcohol prevention mailed to parents (SPORT Plus Parent) among 465 eighth grade students in three northeast Florida schools. This study did not use a control group that did not receive SPORT and therefore did not meet PPN evidence criteria. Nonetheless, the findings of this study are of interest because students in all programs showed reductions in alcohol consumption and problems, and increases in physical activity. SPORT had the larger positive impact among those participants who were substance users at baseline. SPORT Plus Parent was effective in increasing parent-child alcohol communication and in increasing alcohol use self-control.

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Example Sites

SPORT was implemented in one high school in a suburban neighborhood of northeast Florida.

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Contact Information

Chudley Edward Werch, PhD
PreventionPLUSWellness
3595 Forest Bend Terrace
Jacksonville, FL 32224
(904) 472-5022
cwerch@preventionpluswellness.com
http://preventionpluswellness.com

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Available Resources

Webinar or workshop training options are available to certify SPORT implementers. Training includes all reproducible program materials needed to implement and evaluate SPORT, as well as re-implement the program as a booster or follow-up. 30-day program support and technical assistance by phone and email are also included with purchase.
www.briefhealthprograms.com

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Bibliography

Werch, Chudley (Chad), "The Behavior-Image Model: A Paradigm for Integrating Prevention and Health Promotion in Brief Interventions,"  Health Education Research,  Vol. 22, No. 5, 2007, pp. 677-690. 

Werch, Chudley (Chad), Michele J. Moore, Carlo C. DiClemente, Rhonda Bledsore, and Edessa Jobli, "A Multihealth Behavior Intervention Integrating Physical Activity and Substance Use Prevention for Adolescents,"  Prevention Science,  Vol. 6, No. 3, 2005, pp. 213-226. 

Werch, Chudley (Chad), Michele Moore, Carlo C. DiClemente, Deborah M. Owen, Edessa Jobli, and Rhonda Bledsoe,   Journal of School Health,  Vol. 73, No. 10, 2003, pp. 380-388. 

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Last Reviewed

September 2012

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