Refusal and Resistance Skills for Children and Adolescents: A Selected Review

Abstract

The authors review the literature on refusal and resistance skill (RRS) training implemented with children and adolescents. RRS training is critically evaluated across different target behaviors and outcomes. RRS efficacy is considered for tobacco use, includingE very year millions of dollars are provided to school systems across the United States to implement prevention and intervention programs, most of which are funded through the U.S. Department of Education (Dryfoos, 1993), the Department of Health and Human Services (e.g., the Substance Abuse and Mental Health Services Administration, the Center for Disease Control and Prevention), the juvenile justice system, and various state programs in the attempt to effect prosocial change in children and adolescents. In recent years, programs that teach refusal and resistance skills (RRS) have emerged as widely popular strategies, and funding is continually sought for the development and sustainment of such programs. But amid the variation of programs that exist, what do we really know about their efficacy? Do RRS programs produce substantive treatment effects? Is the literature uniformly supportive across different RRS programs?Like other prevention efforts, RRS strategies vary considerably in their content and the way they are applied, making comparisons across programs inherently difficult. Sussman et al. (1993) differentiated between normative influence RRS programs (those that target pressure applied by a peer group) and informational influence RRS programs (those that target more covert pressures designed to influence behavior, such as media advertising). To complicate matters further, risky behaviors to which RRS are applied also vary considerably, but most frequently include smoking, alcohol use, illegal substance abuse, and sexual activity. Because RRS are often embedded as single segments within larger programs designed to address specific risk behaviors, conclusively identifying RRS components as either effective or ineffective is arduous. Nevertheless, RRS training has remained consistently popular among counselors, educators, and prevention specialists, and considerable research has examined RRS merits. Thus, the question is posed: "What general conclusions can be drawn from this literature?"The purpose of this article is to provide a selective yet integrative review of the research literature regarding RRS programs. We hope to provide a meaningful summary for counselors, psychologists, educators, and others who develop and implement such programs with young people. In this review we assess process and outcome research from various RRS studies, including those that use RRS in conjunction with other prevention strategies, as well as those that present RRS as isolated "stand-alone" prevention efforts. Although other reviews have compared prevention strategies on the basis of how well they affect a single target behavior (e.g., Hansen's [1992] review of substance abuse prevention curricula), we take an alternative course by assessing the effectiveness of one...

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