HEALTH EDUCATION RESEARCH
Theory & Practice
Vol.19 no.5 2004
Pages 501–513
Teaching a coherent theory of drug action
to elementary school children
Carol K. Sigelman1,2, Cheryl S. Rinehart1, Alberto G. Sorongon1,
Lisa J. Bridges1 and Philip W. Wirtz1
Abstract
This study examined whether two versions of
a drug and alcohol curriculum explaining how
substances affect behavior and health, one
version more causally coherent than the other,
were more effective than a control curriculum
on disease in changing school-age children’s
(N 5 327) beliefs and attitudes regarding cocaine and alcohol. Few differences were found
between the two drug and alcohol curricula.
Compared to children receiving the control
curriculum, however, both treatment groups
demonstrated greater understanding of the
circulation of alcohol and cocaine throughout
the body, the true long-term effects of these
substances, and the stimulant effects of cocaine.
Moreover, they had less positive attitudes and
intentions toward cocaine. Several differences
were evident at both a 3-month post-test and
a 1-year follow-up, pointing to the potential
value of applying an intuitive theories perspective in designing drug prevention and other
health education programs.
Introduction
Experts agree that efforts to prevent drug and
alcohol abuse must begin early in childhood,
although consensus regarding the best approach
1
Department of Psychology, George Washington
University, Washington, DC 20052, USA
2
Correspondence to: C. K. Sigelman;
E-mail: [email protected]
has yet to be reached (Stoil and Hill, 1996; Drug
Strategies, 1999). Regardless of approach, an
essential element of nearly all drug prevention
programs designed for children has been an
educational component conveying information
about the effects of drugs and alcohol on behavior
and health (Hansen, 1992). However, little research
has focused on how best to optimize children’s
learning of such information.
Our review of drug education curricula for
elementary school-age children suggests that they
often present discrete facts about drugs and alcohol
(e.g. names, nicknames, physical properties), but
little in-depth information about their behavioral and
health effects, and even less about how these effects
come about. Recent educational and developmental
research suggests, however, that children attempt
from an early age to understand the world around
them by formulating intuitive theories (Wellman and
Gelman, 1992). The current investigation builds
upon this literature by examining (1) whether
school-age children as young as 8 can learn a theory
of drug action that explains the brain’s role in
mediating drug effects, and (2) whether a causally
coherent version of the curriculum is more effective
than a less coherent one in changing knowledge and
beliefs about alcohol and drug effects, attitudes and
intentions toward drug and alcohol use, and actual
alcohol use over a year’s time.
The rationale for providing children with an
explanation of drug effects derives from the
intuitive theories perspective on cognitive development [see (Wellman and Gelman, 1992; Inagaki
and Hatano, 2002)]. According to this perspective,
children’s knowledge in any domain is best
characterized as theory-like in nature, organized
Health Education Research Vol.19 no.5, Ó Oxford University Press 2004; All rights reserved
doi:10.1093/her/cyg058
C. K. Sigelman et al.
around core causal ideas. Wellman and Gelman
propose that an intuitive theory defines a domain of
entities (e.g. living things), describes causal processes involving these entities (e.g. mechanisms of
heredity or contagion) and organizes knowledge in
the domain. Children are viewed as theorists
seeking to explain phenomena, e.g. why drinking
alcohol might make someone stagger.
Researchers have begun to demonstrate that
education guided by an intuitive theories model of
cognitive development can be effective (Novak and
Musonda, 1991; Muthukrishna et al., 1993; Au and
Romo, 1996; Sigelman et al., 1996). For example,
Sigelman et al. (Sigelman et al., 1996) demonstrated that an AIDS curriculum explaining how
people get HIV and how it affects their health was
effective in modifying beliefs about transmission
and attitudes toward people with HIV among
elementary school children. In addition, Slusher
and Anderson (Slusher and Anderson, 1996) found
that causal persuasive arguments that HIV is not
transmissible through casual contact were more
effective in changing college students’ beliefs than
were presentations of statistical evidence that did
not include causal explanations.
Research also demonstrates that presentations in
which each piece of information is related to the next
in a causal path that follows a logical temporal order
from beginning to end, with many causal connectors, enhance learning and memory [e.g. (Trabasso
and van den Broek, 1985; O’Brien and Myers, 1987;
Linderholm et al., 2000). By inference, a drug
education curriculum that integrates drug facts into
a coherent, temporally logical explanation should be
better understood and more memorable than a less
causally coherent curriculum.
Drug education programs typically have not
attempted to teach elementary school children
much about the effects of drugs and how they
come about physiologically. This may be due to an
untested assumption that children are not cognitively ready to assimilate such information (Meltzer
et al., 1984) or to fear of arousing their curiosity
about, or increasing their tolerance of, substance
use (Paglia and Room, 1999). Indeed, there may be
grounds for concern—in one study, one of two
502
programs designed to alter expectancies about the
effects of alcohol among second to fourth graders
unexpectedly backfired, making their expectancies
more positive rather than more negative (Kraus
et al., 1994).
Drug education programs also tend to have
more impact on knowledge than on attitudes and
intentions, possibly because children’s orientations
toward drugs are highly negative to start with
(Bangert-Drowns, 1988; Hansen, 1992). However,
attitudes should be targeted for change nonetheless.
Children’s expectancies concerning the behavioral
effects of tobacco, alcohol and other substances
normally become more positive with age, starting in
mid-elementary school, as do their attitudes toward
substance use (Huetteman et al., 1992; Johnson
and Johnson, 1995; Dunn and Goldman, 1996,
1998, 2000). Further, children and adolescents who
believe that drugs have many positive effects and
few negative ones are at risk to use substances
(Dinh et al., 1995; Grube et al., 1995). Finally,
children’s beliefs about drugs and their effects are
modifiable [e.g. (Flynn et al., 1994; Shope et al.,
1994)].
The present study seeks to reinforce children’s
negative orientations toward drugs in the midelementary school years by teaching them how
alcohol and drugs can alter brain functioning, and in
turn result in a loss of control over body and
behavior, as well as in long-term damage to health.
It assumes that children who have been taught
a meaningful scientific theory of drug action, and
who organize their knowledge about the effects
of drugs around it, may process new information
about drugs differently than other children and may
be better able to resist pressure to use drugs because
their attitudes rest on a more solid cognitive
foundation. In addition, we compared the effectiveness of two versions of the drug education
curriculum. One version, designed to simplify the
learner’s task, presents information in logical
temporal order with many causal connections,
whereas the other places more burden on the
learner to order information sequentially and
connect it causally. Alcohol and cocaine were
targeted because they are different (e.g. alcohol is
Teaching a coherent theory of drug action
more familiar and socially accepted than cocaine;
alcohol is a central nervous system depressant,
whereas cocaine is a stimulant).
Children exposed to either drug curriculum were
expected to outperform children who received
a control curriculum on an irrelevant topic,
diseases. Our foremost goal was to determine
whether children can in fact learn how drug effects
come about—and can do so without any unintended
consequences such as more positive attitudes
toward drugs. Thus, it was predicted that children
exposed to the drug curriculum would, at 3 and 12
months following administration: (1) outperform
recipients of the disease curriculum on measures
of understanding of drug action, (2) display more
negative expectancies about the behavioral effects
of drugs and more accurate knowledge of their
long-term effects, (3) express more strongly antidrug attitudes and intentions, and (4) be less likely
to report use of alcohol. Further, it was predicted
that children exposed to the causally coherent
version of the drug curriculum would benefit more
than those exposed to the less coherent version.
Both knowledge of the effects of drugs and
alcohol [e.g. (Huetteman et al., 1992; Sigelman
et al., 2000)] and the complexity of children’s
thinking about the effects of substances [e.g.
(Meltzer et al., 1984; Lieberman et al., 1992;
Sigelman et al., 1999)] increase with age. As a result,
the degree of causal coherence of a curriculum may
be more critical for younger than for older learners.
In support of this hypothesis, less-skilled readers
appear to benefit more from causally coherent text
than do more skilled readers (Linderholm et al.,
2000). Possible differences in the effectiveness of
the curricula with boys and girls, and with white
and minority children, were also explored, but no
specific predictions were made due to a lack of
relevant research.
Method
Participants
Participants were 327 Grade 3–6 students drawn
from 17 classrooms in three Catholic schools in an
ethnically diverse metropolitan area. Participating
schools were chosen on the basis of their socioeconomic and racial diversity. The children studied had
not received any systematic drug education at
school. Approximately 55% were female; 47%
were white (non-Hispanic), 30% were AfricanAmerican, 10% were Hispanic and 12% were of
other backgrounds. For purposes of analysis, the
sample was divided into two age groups: Grade 3/4
(7–10 years, M = 8.67) and Grade 5/6 (9–12 years,
M = 10.69).
Mothers had a mean of 14.91 years of education
(SD = 2.29) and fathers had a mean of 15.02 years
(SD = 2.80), the equivalent of some college or
technical training. Socioeconomic index (SEI)
scores based on average education levels and
incomes of parents’ jobs were calculated (Nakao
and Treas, 1994). SEI scores could range from
a low of 17 for some types of machine operators to
a high of 97 for physicians. The actual range for
employed parents in this sample was 21–97. The
mean family SEI score, based on the parent with
the highest SEI score, was 62.59 (SD = 18.13).
Occupations with SEI codes near this mean include
a variety of managerial and administration occupations, engineering technicians, and police officers.
Overview of procedures
All students in Grades 3–6 in the target schools (N =
469) were given a consent package to take home to
their parents. Parent consent was obtained for
70.8% of the students (N = 332). Prior to pretesting, students were told that participation was
voluntary and were asked to sign their own assent
forms. Five children with parental consent declined
to participate, resulting in a total of 327 participants, 268 of whom completed all three testings
(pre-test, post-test and follow-up).
Testing and curriculum administration were
conducted in classrooms. A total of four Grade 3,
five Grade 3, three Grade 5 and four Grade 6
classrooms participated. At pre-test, between 14
and 26 participants (Mdn = 22.5) per classroom had
the 1-hour pre-test questionnaire read aloud to them
and wrote their responses confidentially on individual answer sheets. Order of presentation of the
503
C. K. Sigelman et al.
alcohol and cocaine sections of the questionnaire
was counterbalanced within grade. Approximately
2 weeks later, the curricula were administered.
Children were randomly assigned to three small,
mixed-sex groups within each classroom and one
researcher was assigned to oversee each group. The
median group size was seven students, with a range
of four to 10 depending upon the number of participants in the classroom.
Each group received one of the three curricula
developed for this project. Two curricula concerned
alcohol and cocaine, and were administered to 110
students each, while the third, a control curriculum
about diseases, was administered to 107 children.
All curricula were administered simultaneously via
audiocassettes played on personal cassette players
with headphones, in order to enhance interest,
standardize administration and ensure that children
heard only their assigned curriculum. While
listening, children completed workbooks that
illustrated the taped material with photographs
and drawings, and included quizzes and activities
designed to promote active learning (e.g. one in
which participants were asked to explain why
a teenager who drank alcohol could not play his
guitar well). Each curriculum was presented in three
sections during 1-hour sessions on 3 consecutive
days. After the last segment, each group reviewed
the material, discussing their answers to workbook
quizzes, explaining their answers and resolving any
confusion.
Approximately 3 months later, the pre-test
questionnaire was re-administered as a post-test
using identical procedures. Students received the
same version (i.e. alcohol questions first or cocaine
questions first) as they received at pre-test. A
follow-up administration of the questionnaire was
conducted approximately 1 year following curriculum presentation.
Curricula
All curricula were reviewed by several parents and
teachers for developmental appropriateness and
cultural sensitivity. The three curricula, all of
approximately equal length, were (1) the causally
coherent drug and alcohol curriculum, (2) the less
504
coherent drug and alcohol curriculum, and (3) the
disease control curriculum.
Coherent curriculum
This curriculum was designed to teach the elements
of a scientific, brain-mediated theory of drug effects
in a causally coherent sequence. After an introduction describing what drugs are, it outlined,
through drawings and text, a causal sequence
in which beer passes through the mouth, throat,
stomach and intestines, through their walls and into
the bloodstream, throughout the body and, ultimately, to the brain. It then introduced the
circulatory and nervous systems, especially the
brain’s role in controlling behavior, and described
how alcohol, a depressant, slows the brain and,
through its effects on the brain, causes slow signals
to the muscles and, in turn, the behavioral effects
associated with alcohol (e.g. staggering). Multiple
examples of the brain’s mediating role were
provided. Hangovers, overdosing, addiction and
the longer-term health consequences of alcohol use
were then discussed.
A similar brain-mediated theory was then
presented to describe how cocaine, as a stimulant,
arouses the brain and, in turn, alters behavior, with
emphasis on the distinction between depressants
and stimulants. Where appropriate, the mediating
role of the brain in health outcomes was discussed
(e.g. cocaine overdose can disrupt brain signals that
regulate heart rate, possibly causing a heart attack).
To illustrate the dangers of drug and alcohol abuse,
real-life examples of cocaine- and alcohol-related
deaths were used.
Less coherent curriculum
This version of the drug curriculum presented
information identical to that in the coherent version.
However, sections of the text were reordered so
that the consequences of drug use for health and
behavior were discussed before the drug’s effects
on the body and brain. Thus, while the coherent
curriculum treated each substance’s effects on the
brain as the mechanism through which use alters
behavior, the less coherent curriculum treated each
drug’s effects on the brain as just one of several
Teaching a coherent theory of drug action
consequences of its use. In addition, the less
coherent curriculum omitted explicit causal linkages present in the coherent curriculum, leaving
more theory-construction work to the child. For
example, the italicized causal phrases in this
passage from the coherent curriculum were
omitted:
When Barry drinks too much alcohol, important
messages from Barry’s eyes and ears and body
don’t get through to his brain. That’s because his
brain is working too slowly to keep up with
everything that’s happening. And then his brain
sends out fewer messages to his body, so Barry’s
heart beats more slowly and his body moves
more slowly.
Disease control
This curriculum provided information about flu,
chicken pox and strep throat transmission, prevention and treatment. It was designed to parallel
the structure, conceptual complexity and length of
the drug curricula, and to provide an interesting,
meaningful activity and attention from a researcher
to students in the control group.
Measures and scale construction
Parallel alcohol and cocaine scales were created to
tap drug theory knowledge, expectancies regarding
behavioral effects, beliefs about long-term effects,
attitudes toward use, and intentions to use alcohol
and cocaine. Scale construction was guided by our
previous work with similar measures, as well as by
factor analyses involving pre-test and post-test data
from the current study. Cronbach’s as were computed to assess reliability. In addition, test–re-test
reliabilities were computed using pre-test and
post-test data (collected approximately 14 weeks
apart) from the disease control group children
(n = 107).
Theory knowledge
Three scales were constructed to tap children’s
intuitions regarding the mechanisms through which
alcohol and cocaine influence behavior. Items were
scored either 1 (correct) or 0 (incorrect) and were
averaged to form scale scores that represent the
proportion of items answered correctly.
(1) Drug goes everywhere. This scale was the
mean of four yes/no items asking whether the
drug goes to the heart, blood, brain and feet.
Alpha ranged from 0.42 for the alcohol pre-test
to 0.52 for the cocaine pre-test. The test–re-test
correlations were 0.32 for alcohol and 0.37 for
cocaine (both P < 0.01).
(2) Causal understanding. This scale was composed of eight two-option multiple-choice
items gauging children’s theoretical understanding that behavioral effects of drugs result
from the blood carrying the drug to the brain
and altering the brain and the messages it sends
to the peripheral body parts. The scale included
questions such as, ‘Is [a teenager who just
drank lots of alcohol] having trouble walking
mostly (a) because alcohol got into her brain or
(b) because alcohol got into her legs?’. Alphas
ranged from 0.63 at pre-test for both drugs to
0.68 at follow-up for both drugs. Test–re-test
correlations were 0.56 for alcohol and 0.68 for
cocaine (both P < 0.0001).
(3) Drug has stimulant/depressant effects. Six twoor three-option items, subsequently recorded as
correct or incorrect, measured whether children
understand that the drug speeds up (cocaine) or
slows down (alcohol) brain cells, brain signals
and the heart. Alphas ranged from 0.70 at
pre-test for both drugs to 0.84 for the alcohol
post-test. Test–re-test correlations were 0.50 for
alcohol and 0.49 for cocaine (both P < 0.0001).
Behavioral expectancies
Items tapping expectancies that substance use
results in loss of control, positive affect, pathological effects and stimulant/depressant effects were
based on measures developed for a previous study
and existing expectancy scales [e.g. (Bauman,
1986; Young and Knight, 1985; Morrison et al.,
1996; Dunn and Goldman, 1996)]. A four-point
response scale ranging from 0 (‘definitely no’) to 3
(‘definitely yes’) was used to assess the belief that
each effect will occur. Exploratory factor analyses
505
C. K. Sigelman et al.
using oblique rotation of 23 items resulted in our
using 19 to create four behavioral expectancy scales
for each substance:
(1) Loss of control. Eight items measured the
expectancy that a teenager who drank lots of
alcohol (took some cocaine) one night would
lose control of motor and cognitive functions
(e.g. he would stagger around, say words funny,
have trouble thinking). Alphas ranged from
0.77 for alcohol at post-test to 0.83 for alcohol
at pre-test. Test–re-test reliabilities were 0.56
(P < 0.0001) for both alcohol and cocaine.
(2) Depressant effects. This three-item scale concerning behavioral depressant effects (e.g. he
would get really relaxed, think thoughts slowly)
had alphas ranging from 0.53 for alcohol at
post-test to 0.67 for alcohol at follow-up. Test–
re-test reliabilities were 0.49 for alcohol and
0.50 for cocaine (both P < 0.0001).
(3) Stimulant effects. Four items tapped behavioral
stimulant effects (e.g. he would get full of
energy, feel excited). Alphas ranged from 0.74
for alcohol pre-test to 0.82 for alcohol followup. Test–re-test reliabilities were 0.50 for
alcohol and 0.49 for cocaine (both P < 0.0001).
(4) Positive Affect. Four items assessed affective
outcomes (e.g. he would get in a good mood,
feel happy for a while). Alphas ranged from
0.74 for alcohol at post-test to 0.81 for cocaine
at follow-up. Test–re-test reliabilities were 0.55
for alcohol and 0.52 for cocaine (Ps < 0.0001).
Long-term effects
Twelve items for each substance assessed long-term
health and social effects of alcohol and cocaine
abuse. Three items described long-term health
effects of alcohol abuse (damage to brain, liver and
memory), three health effects of cocaine abuse (heart
attack, nose damage and blood vessel damage), three
health effects of tobacco use (lung cancer, cough and
trouble breathing) and three social effects of longterm substance abuse (job loss, trouble with the
police and others’ anger). Three scales were created
for each substance: a true long-term health effects
scale (i.e. the three true alcohol effects for alcohol,
506
the three true cocaine effects for cocaine), a false
long-term health effects scale with the six health
effects not associated with long-term abuse of
the substance (i.e. cocaine and tobacco items for
alcohol, alcohol and tobacco items for cocaine) and
a social effects scale (the three social effects items).
Scores on each scale were means of items scored
from 0 (definitely no) to 3 (definitely yes). The
median a for the 18 resulting measures (3 scales 3 2
drugs 3 3 points of assessment) was 0.69 (range
0.41–0.82). The median test–re-test correlation was
0.41 (range 0.20–0.55).
Attitudes
Attitudes toward use of each drug were assessed by
asking whether five adult behaviors were good or
bad ideas given the options very bad, kind of bad,
kind of okay and very okay. These items, in order
from most to least extreme, concerned getting really
drunk or high, having a drink or some cocaine most
nights, using a little on the weekends, using a little
at a special party and trying a tiny bit of the drug
just once to see what it is like. Scores could range
from 0 (very bad) to 3 (very okay). Alphas ranged
from 0.73 for alcohol at pre-test to 0.85 for cocaine
at follow-up. Test–re-test reliabilities were 0.60 for
alcohol and 0.57 for cocaine (both P < 0.0001).
Intentions
The measure of intentions to use drugs was parallel
in item content and ordering to the Attitudes scale
but used the stem, ‘When you are an adult, do you
think you will ever...’. Mean item scores could range
from 0 (definitely no) to 3 (definitely yes). Both the
attitudes and intentions scales focused on adulthood because even alcohol use is illegal for minors
and children were expected to be less rigidly antidrug with regard to adult behavior than child
behavior. Alphas ranged from 0.77 for alcohol at
pre-test to 0.85 for cocaine at follow-up. Test–retest correlations were 0.68 for alcohol and 0.70 for
cocaine (both P < 0.0001).
Personal alcohol use
Finally, children were asked whether they had ever
had a sip of alcohol, had most of a drink, had most of
Teaching a coherent theory of drug action
a drink in the past month (4 weeks) and gotten drunk.
Response options were (1) ‘No, never’, (2) ‘Yes, with
my parent’s permission’ and (3) ‘Yes, without my
parent’s knowing’. Because ‘yes’ frequencies were
low for all four items, a dichotomous scale was
constructed (0 = no use, 1 = any use). Approximately
95% of children’s responses were logically consistent
within a single assessment and across time.
Results
Preliminary analyses
Preliminary analyses tested for differences among the
three curriculum groups in demographic variables.
Chi-square analyses indicated no significant differences in child gender, grade or ethnicity, and one-way
ANOVAs indicated no differences in family SEI and
mother’s education. Moreover, one-way ANOVAs
to determine whether the three curriculum groups
differed at pre-test on the substantive measures
revealed only one significant version effect, a number
that does not exceed that expected by chance.
Analysis strategy
The effectiveness of the drug education program
was assessed using a multivariate analysis of
covariance (MANCOVA) approach. Grade, curriculum version and the Grade 3 Version interaction
were used to predict post-test and follow-up scores,
controlling for pre-test score and gender. Gender
was included because of a confound between
gender and grade; relatively few of the participating
fifth graders were boys. Based on preliminary analyses, the grade variable in these analyses was a
dichotomous contrast between younger (Grade 3/4)
and older (Grade 5/6) students.
Four a priori comparisons were included in each
MANCOVA. The first (drug versus disease control)
compared the two drug curriculum groups pooled
to the disease control group; the second (coherent
versus less coherent) compared the coherent to the
less coherent drug curriculum group. Given our
directional hypotheses, one-tailed t-tests (P < 0.05)
were used to determine whether any significant
effects were significant at post-test and follow-up
separately. The final two planned comparisons
involved Grade 3 Curriculum interactions, each
reflecting the product of grade (3/4 versus 5/6) and
one of the two curriculum version contrasts above,
to determine whether the curricula affected younger
and older children differentially.
Post-test and follow-up mean scores and standard
deviations for the two drug curriculum groups and
the disease control group are presented in Tables I
(alcohol) and II (cocaine).
Curriculum effects for alcohol
Alcohol theory knowledge
MANCOVA results indicated that there was an
overall curriculum version effect for knowledge that
alcohol circulates throughout the body, F(4, 506) =
5.95, P < 0.001. Specifically, t-tests indicated that
drug curricula participants, compared to disease
curriculum participants, had significantly greater
knowledge at post-test that alcohol circulates
throughout the body, t(260) = 4.77, P < 0.0001.
The difference was not significant at follow-up.
MANCOVAs testing curriculum version main
effects and Grade 3 Curriculum interaction effects
for causal understanding and stimulant and depressant effects were not significant.
Since this scale’s reliability was low, a logistic
regression with the same predictors as in the
MANCOVA was conducted for each item. Only
the drug versus disease curriculum comparison was
reliably significant. Drug curriculum recipients
were more likely than control group participants
to know that alcohol goes to the heart at post-test,
0.78 versus 0.60, Wald v2 = 9.61, P < 0.01; that it
goes into the blood at post-test, 0.93 versus 0.76,
Wald v2 = 9.91, P < 0.01; and that it goes to the feet
at both post-test, 0.55 versus 0.32, Wald v2 = 13.45,
P < 0.001, and follow-up, 0.45 versus 0.29, Wald
v2 = 6.37, P < 0.05. Over 90% knew that it goes
to the brain even at pre-test.
Alcohol behavioral expectancies
MANCOVAs for the four expectancies scales did
not reveal any significant curriculum main effects
or Grade 3 Curriculum interaction effects.
507
C. K. Sigelman et al.
Table I. Alcohol post-test and follow-up scale means (SD) by curriculum group
Variable
Drug curriculum
Disease control curriculum
Coherent
Theory knowledge
drug goes everywhere
causal understanding
depressant/stimulant effects
Behavioral expectancies
loss of control
depressant effects
stimulant effects
positive affect
Long-term effects
true effects
false effects
social effects
Attitudes, intentions and alcohol use
attitudes
intentions
alcohol use
Less coherent
Post-test
Follow-up
Post-test
Follow-up
Post-test
Follow-up
0.82 (0.21)
0.82 (0.18)
0.67 (0.34)
0.73 (0.25)
0.87 (0.18)
0.61 (0.37)
0.77 (0.23)
0.79 (0.22)
0.60 (0.36)
0.74 (0.26)
0.87 (0.20)
0.61 (0.36)
0.66 (0.26)d
0.82 (0.21)
0.74 (0.31)
0.68 (0.24)
0.89 (0.17)
0.70 (0.30)
2.54
1.74
1.23
1.38
2.50
1.67
1.45
1.47
2.47
1.77
1.40
1.54
2.45
1.66
1.55
1.57
2.49
1.75
1.31
1.43
2.46
1.65
1.39
1.46
(0.39)
(0.76)
(0.89)
(0.72)
(0.49)
(0.81)
(0.87)
(0.79)
(0.43)
(0.75)
(0.93)
(0.77)
(0.42)
(0.86)
(1.00)
(0.73)
(0.42)
(0.72)
(0.79)
(0.66)
(0.38)
(0.71)
(0.78)
(0.62)
2.28 (0.54)
1.58 (0.64)
2.20 (0.75)
2.23 (0.58)
1.37 (0.55)
2.17 (0.83)
2.37 (0.49)
1.55 (0.66)
2.23 (0.64)
2.23 (0.54)
1.37 (0.63)
2.28 (0.70)
2.15 (0.60)b
1.43 (0.56)
2.28 (0.71)
2.07 (0.47)b
1.31 (0.57)
2.24 (0.63)
1.35 (0.56)
1.05 (0.68)
0.60 (0.49)
1.47 (0.59)
1.29 (0.68)
0.70 (0.46)
1.31 (0.58)
0.97 (0.71)
0.66 (0.48)
1.50 (0.55)
1.21 (0.69)
0.74 (0.44)
1.37 (0.61)
1.05 (0.69)
0.64 (0.48)
1.54 (0.58)
1.31 (0.66)
0.75 (0.43)
Scores for alcohol use and the three theory knowledge scales range from 0 to 1. For all other scales, scores range from 0 to 3.
Superscripts next to a disease control post-test or follow-up mean indicate a significant drug (coherent and less coherent groups
combined) versus disease control curriculum group difference for that variable: aP < 0.05; bP < 0.01; cP < 0.001; dP < 0.0001.
Alcohol long-term effects
A significant main effect of curriculum version
emerged in the MANCOVA for true long-term
effects of alcohol, F(4, 506) = 2.90, P < 0.05. At
both post-test and follow-up, knowledge of the true
long-term effects of alcohol was greater for the drug
curriculum groups combined than for the disease
control curriculum group, t(261) = 2.42, P < 0.01 at
post-test and t(261) = 2.43, P < 0.01 at follow-up.
However, the curricula did not have differential
effects on beliefs about false long-term effects or
social long-term effects.
Alcohol attitudes, intentions and use
No significant main effects of version or interaction effects of version and grade were found in the
MANCOVAs for attitudes, intentions toward
alcohol use and personal alcohol use.
Finally, the planned comparison of the coherent
and less coherent drug curricula was not significant
for any of the alcohol variables.
508
Curriculum effects for cocaine
Cocaine theory knowledge
MANCOVA results indicated a significant main
effect of version on children’s understanding that
cocaine circulates throughout the body, F(4, 506) =
6.02, P < 0.001. Results of t-tests indicated that
drug curricula participants, compared to disease
curriculum participants, had significantly greater
knowledge at post-test that cocaine circulates
throughout the body, t(261) = 4.83, P < 0.0001.
This difference was not significant at follow-up.
Item-by-item logistic regressions, like those for
alcohol, demonstrated a drug versus disease
curriculum effect on knowledge that cocaine goes
to the heart at post-test, 0.77 versus 0.61, Wald v2 =
6.83, P < 0.01, and knowledge that it goes to the
feet at post-test, 0.53 versus 0.28, Wald v2 = 16.48,
P < 0.0001, and at follow-up, 0.44 versus 0.29,
P < 0.05. Knowledge that cocaine goes to the blood
and brain, already substantial at pre-test, was not
affected.
Teaching a coherent theory of drug action
Table II. Cocaine post-test and follow-up scale means (SD) by curriculum group
Variable
Drug curriculum
Disease control curriculum
Coherent
Theory knowledge
drug goes everywhere
causal understanding
depressant/stimulant effects
Behavioral expectancies
loss of control
depressant effects
stimulant effects
positive affect
Long-term effects
true effects
false effects
social effects
Attitudes, intentions and alcohol use
attitudes
intentions
Less coherent
Post-test
Follow-up
Post-test
Follow-up
Post-test
Follow-up
0.80 (0.22)
0.82 (0.19)
0.51 (0.37)
0.72 (0.26)
0.85 (0.20)
0.48 (0.36)
0.79 (0.22)
0.79 (0.23)
0.55 (0.53)
0.72 (0.25)
0.86 (0.18)
0.35 (0.36)
0.64 (0.28)d
0.83 (0.21)
0.30 (0.30)d
0.66 (0.26)
0.89 (0.17)
0.35 (0.33)b
2.45
1.37
1.65
1.52
2.38
1.40
1.75
1.54
2.37
1.34
1.91
1.54
2.38
1.37
1.80
1.58
2.45
1.60
1.39
1.33
2.37
1.44
1.52
1.46
(0.54)
(0.88)
(0.85)
(0.73)
(0.49)
(0.78)
(0.79)
(0.83)
(0.51)
(0.81)
(0.80)
(0.84)
(0.48)
(0.77)
(0.75)
(0.71)
(0.43)
(0.67)
(0.77)d
(0.73)
(0.51)
(0.72)
(0.80)b
(0.63)
2.01 (0.66)
1.90 (0.48)
2.36 (0.66)
1.93 (0.60)
1.83 (0.50)
2.30 (0.75)
2.06 (0.60)
1.86 (0.54)
2.46 (0.57)
2.07 (0.58)
1.84 (0.52)
2.48 (0.52)
1.61 (0.56)d
1.79 (0.48)
2.30 (0.71)a
1.70 (0.58)c
1.75 (0.47)
2.40 (0.56)
0.51 (0.59)
0.22 (0.38)
0.62 (0.62)
0.39 (0.57)
0.52 (0.60)
0.18 (0.41)
0.50 (0.57)
0.22 (0.40)
0.68 (0.58)a
0.35 (0.51)c
0.79 (0.71)b
0.42 (0.53)a
Scores for the three theory knowledge scales range from 0 to 1. For all other scales, scores range from 0 to 3. Superscripts next to
a disease control post-test or follow-up mean indicate a significant drug (coherent and less coherent groups combined) versus
disease control curriculum group difference for that variable: aP < 0.05; bP < 0.01; cP < 0.001; dP < 0.0001.
Significant effects of the drug curricula on
knowledge that cocaine has stimulant rather than
depressant effects on the brain and heart were also
evident, F(4, 506) = 5.37, P < 0.001. The drug
versus control curriculum comparison was significant at both post-test, t(261) = 4.49, P < 0.0001,
and follow-up, t(261) = 2.90, P < 0.01. Most
children thought cocaine was a depressant at pretest. As for alcohol, causal understanding scores
were high at pre-test and were unaffected by the
curricula.
Cocaine behavioral expectancies
There was also a significant version effect for
beliefs that cocaine has stimulant effects on
behavior, F(4, 506) = 4.85, P < 0.001. At both
post-test and follow-up, those who received the
drug curricula endorsed expectancies of stimulant
behavioral effects of cocaine use more strongly than
did those in the control curriculum group, t(261) =
4.06, P < 0.0001 at post-test and t(261) = 2.54,
P < 0.01 at follow-up. MANCOVA results for the
loss of control, positive affect, and depressant
expectancies scales were non-significant.
Cocaine long-term effects
There were significant version effects for both true
long-term effects knowledge, F(4, 506) = 6.95, P <
0.001, and beliefs about social long-term effects,
F(4, 506) = 2.57, P < 0.05, but not for false long-term
effects beliefs. At both post-test and follow-up,
knowledge of the true long-term health effects of
cocaine was greater for the drug curriculum groups
than for the disease control curriculum group,
t(261) = 4.77, P < 0.0001 at post-test and t(261) =
3.53, P < 0.001 at follow-up. Awareness of the longterm negative social effects of cocaine was significantly greater for the drug curricula participants
than for the disease control curriculum participants
at post-test only, t(261) = 2.33, P < 0.05.
Cocaine attitudes and intentions
Finally, the drug curricula significantly altered
both attitudes and intentions toward cocaine use,
509
C. K. Sigelman et al.
F(4, 506) = 3.21, P < 0.05 for attitudes, F(4, 506) =
4.06, P < 0.01 for intentions. Participants in the
drug curriculum groups had significantly more
negative attitudes toward cocaine use than did
disease curriculum participants at both post-test,
t(261) = ÿ2.28, P < 0.05, and follow-up, t(261) =
ÿ2.96, P < 0.01. Similarly, children receiving the
drug curricula had significantly weaker intentions
to use cocaine at both post-test, t(261) = ÿ3.20, P <
0.001, and follow-up, t(261) = ÿ2.13, P < 0.05.
As for alcohol, none of the comparisons of the
coherent and the less coherent versions of the drug
curriculum were significant, nor were non-significant differences consistent in direction. Finally,
although a few Grade 3 Version interaction effects
were nearly significant (P < 0.10), the findings generally indicated that (1) younger children gained as
much as older children from the drug curricula and
(2) younger children benefited no more or less from
the more casually coherent of the two versions of the
drug curriculum relative to the less coherent version.
Ethnic group and gender differences
in curriculum effects
In order to assess in a preliminary manner whether
children of different ethnicities responded differentially to the drug education program, MANCOVAs
were conducted paralleling those examining grade
differences, but replacing the grade contrast with an
ethnicity (white versus minority, primarily AfricanAmerican) contrast. The effect of interest was the
interaction between ethnicity and curriculum version. Only three significant Ethnicity 3 Version
interaction effects were found and follow-up
analyses indicated in each case that the curriculum
version effect was not significant for either white or
minority children considered separately.
A similar set of MANCOVAs was conducted
to test for gender differences in responsiveness to
the curriculum, with grade included as a covariate.
Only two significant Gender 3 Version interactions were detected. For one involving expectancies
of stimulant behavioral effects of alcohol use,
follow-up ANCOVAs indicated that the version
effect was not significant for either gender. Finally,
the MANCOVA predicting knowledge that cocaine
510
use results in stimulant effects on the brain and
heart revealed a significant gender by coherent
versus less coherent curriculum interaction at
post-test, t(261) = ÿ2.51, P < 0.05. Contrary to
expectation, the less coherent curriculum produced
higher scores than the coherent curriculum among
the boys [LSM = 0.61 versus 0.46; F(1, 82) = 4.08,
P < 0.05], but not girls.
Discussion
This study indicates that a scientifically based drug
and alcohol education curriculum guided by the
intuitive theories perspective on cognitive development can teach children as young as age 8 about
the behavioral and health effects of alcohol and
cocaine use, and how they come about physiologically. Although more and less causally coherent
versions of the curriculum did not differ in
effectiveness as expected, both had effects evident
not only at the three-month post-test, but a full year
later, especially for cocaine. Specifically, compared
to children exposed to a disease curriculum,
children who received the two drug and alcohol
curricula demonstrated greater understanding that
alcohol and cocaine travel throughout the body
once ingested, greater knowledge of the true longterm health effects of both substances, and greater
understanding of cocaine’s stimulant effects on
both physiology and behavior and long-term
negative social effects. Of particular note were
findings that students who received either of the
drug curricula had less positive attitudes toward
cocaine and lower intentions to use cocaine as
adults even 1 year later than did students who
received the control curriculum. Positive attitudes
and intentions toward drugs and alcohol predict use
(Dinh et al., 1995; Grube et al., 1995), but have
proven difficult to modify through knowledgebased drug prevention programs (Bangert-Drowns,
1988; Hansen, 1992). The rarity of interactions of
curriculum version with grade, gender and ethnicity
suggests that younger and older, male and female,
and white and minority children generally benefited
equally from the program.
Teaching a coherent theory of drug action
Contrary to expectation, the drug and alcohol
curricula generally did not increase causal understanding of the roles of the bloodstream and
brain in mediating drug effects, most likely because
scores on the causal understanding scales were
already high at pre-test. Except for teaching children
that cocaine, unlike alcohol, is arousing, the program also did little to alter expectancies regarding
the behavioral effects of the two substances,
although this was not its primary intent, given that
children’s expectancies are highly negative already.
Finally, the fact that the curriculum increased
knowledge of the true health effects of alcohol and
cocaine, but did nothing to eliminate common
misconceptions about their health effects, points to
the need to confront misconceptions explicitly if one
wishes to dispel them. Importantly, though, the
curriculum did nothing to create or strengthen
misconceptions or to soften attitudes toward alcohol
or drug use—reassurance to those who fear that drug
education during elementary school may do more
harm than good (Paglia and Room, 1999).
There are a number of possible reasons for the
stronger influence of the program on cocainerelated than on alcohol-related knowledge, beliefs
and orientations. Cocaine was a relatively unfamiliar substance to most children in this study,
whereas children gain considerable exposure to
alcohol through both direct contact with drinkers
and media portrayals. Since elementary school
children incorrectly attribute the effects of familiar
substances such as tobacco and alcohol to unfamiliar drugs such as cocaine [e.g. (Sigelman
et al., 2000; Bridges et al., 2003)], there was more
potential for gaining knowledge and understanding
of cocaine than of alcohol. Further, children’s
attitudes and intentions toward alcohol are likely to
have been influenced by family, peer and community norms, and may therefore have been less
modifiable than their relatively unformulated attitudes and intentions toward cocaine.
This study also evaluated the extent to which the
degree of causal coherence of a drug and alcohol
curriculum affects children’s ability to learn and
remember its material, but failed to find significant
differences between the more and less causally
coherent drug curricula. Because the curriculum
was carefully designed to be comprehensible to
third graders, both versions of it may have been
sufficiently simple for these Grade 3–6 students that
the additional causal links and the temporally
ordered presentation of the more coherent version
added only marginally to the comprehensibility of
the material. Consistent with this interpretation,
Linderholm et al. (Linderholm et al., 2000) reported
that text modifications designed to increase causal
coherence improve text recall more for difficult
than for easy textual material.
In addition, the two drug curricula were not
radically different. Both included supports for learning that are generally unavailable in other studies of
texts that vary in causal coherence, which have
generally used short passages presented in a single
sitting [e.g. (Linderholm et al., 2000)]. The two
curricula included the same activities and questions
interspersed throughout the text, and all children
participated in an interactive review session. Moreover, the less coherent curriculum was not incoherent; it gave children the information needed to
learn many of the aspects of knowledge tested and to
construct a theory of how the effects of substance use
come about. Indeed, if it was somewhat more
cognitively challenging, it may even have stimulated
deeper processing of the information.
Finally, although the measures relied on the types
of forced-choice questions most often used in
intuitive theories research [see (Inagaki and Hatano,
2002)], the drug knowledge scales may not have
been sufficiently discriminating to detect differences
in comprehension between the two drug curriculum
groups. Had children been required to construct and
then articulate their own explanations, for example,
those exposed to the causally coherent curriculum
might have demonstrated more sophisticated understanding. (Note, however, that analysis of an
exercise in the workbook requiring children to write
a theoretical explanation of alcohol’s effect on guitar
playing revealed no such difference; possibly active
theory construction needed to be a more substantial
part of the curriculum.)
Among other limitations of this study was the
relatively short length of the program (three 1-hour
511
C. K. Sigelman et al.
sessions over 3 days). Stronger effects may have
been realized had it been longer, and asked children
to theorize about more examples of alcohol and
cocaine effects. Second, because students within
classrooms were randomly assigned to curriculum
conditions, contamination effects may have operated, although experimenters were not aware of
information sharing across conditions and control
children did not demonstrate knowledge gains.
Thirdly, the generalizability of findings beyond
Catholic parochial school children is unknown.
Given the generalizability of curriculum effects
across children of different races and genders,
however, we have little reason to believe that public
school children would respond differently.
Despite these limitations, health education curricula for children are only rarely evaluated for their
longer-term effects, and it is impressive that a 3-day
program had positive effects on some aspects of
knowledge and on attitudes toward and intentions to
use cocaine a full year after the intervention—with
no adverse effects. More work is needed to determine the circumstances under which children
benefit from receiving a theoretically meaningful
and coherent explanation of how the negative effects
of substance abuse and other health risk behaviors
come about. Similarly, more needs to be done to
understand when in childhood the informational
component of drug prevention interventions is best
introduced and how it can best contribute to the
overall effectiveness of more comprehensive interventions, given the fact that information alone is
likely insufficient to change attitudes and behavior
(Hansen, 1992; Paglia and Room, 1999). In short, it
remains to be seen whether a solid understanding of
the effects of alcohol and drugs on brain, behavior
and health will help protect children from the
influences that will later lead some of them to use
or abuse these substances.
Acknowledgements
The authors thank the students and staff of the
participating schools for their cooperation, and
Diane B. Leach, Keisha L. Mack, Albert B.
512
Brewster, Richard Wengler, Paige Danyliu, Aviele
Kaufman and Karen D’Angelo for their contributions. This work was partially supported by
National Institute on Drug Abuse grant R01
DA10578.
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Received on February 4, 2003; accepted on September 8, 2003
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