State-level education standards for substance use prevention programs in schools: a systematic content analysis.

PURPOSE Three fourths of public schools in the United States maintain instructional programs to discourage alcohol, tobacco, and other drug (ATOD) use. State-sanctioned instructional standards attempt to direct this ATOD preventive education. No existing research, however, systematically codes these standards across all grades and states. We performed such an analysis. METHODS We retrieved ATOD standards information from all 50 states and the District of Columbia from multiple sources, including the National Association of State Boards of Education's State School Health Policy Web site. Three independent researchers classified and cross-validated ATOD standards (inter-rater agreement = 98%) based on recommended content domains and pedagogic delivery methods. RESULTS We find substantial grade-level variation in standards. Elementary schools emphasize generic social skills and affective skills, whereas middle and high school standards focus on knowledge about biological and behavioral consequences of ATOD use. States also vary widely in their content and coverage of standards. Two thirds of states do not include standards in all content areas considered "evidence-based." CONCLUSIONS The ATOD curricular agenda for the majority of states falls well below recommended content and delivery benchmarks. We intend for our harmonized data set-the first of its kind-to promote research that examines the relation among state ATOD standards, actual classroom instruction, and adolescent ATOD use.