Intervention Summary

Reality Tour

Reality Tour is a volunteer-driven substance abuse prevention program that is presented to parents and their children (ages 10-17) in a community setting over the course of one approximately 3-hour session. The goal of the program is to increase children's negative attitudes toward alcohol, tobacco, marijuana, and other illicit drugs, as well as their perceived risk of harm from use of these substances. Reality Tour provides participants with testimonies from individuals with a history of addiction, an address by law enforcement personnel, and the opportunity to pose questions to these speakers. The session also includes dramatic narratives (provided on CD) that precede brief reenactments of emergency room and funeral home scenes involving a young person who has overdosed on drugs, as well as the portrayal of an arrest and imprisonment (or the viewing of an arrest and imprisonment on DVD). Reality Tour participants are given information on coping and refusal skills, as well as guidance in assessing their own coping skills. Each child receives printed profiles of abused drugs, a form that includes a contact list for community resources, and a personal photograph that has been digitally altered to show how the child's appearance might change negatively from substance use. Children also are encouraged to sign a banner pledging to remain drug free. Parents receive printed drug education materials and resources for accessing electronic materials, as well as the opportunity to sign up for newsletters delivered via email.

Reality Tour, which is grounded in part in protection motivation theory, attempts to modify children's attitudes, perceptions, and ultimately behavior by highlighting children's vulnerability to the potential harm from substance use and motivating them to learn about the problems of substance use. The program employs interactive teaching methods, and the developer recommends small audiences so participants have a more personal experience. In addition, child-parent interaction is encouraged, with the expectation that the children and their parents will develop shared attitudes and perceptions.

A community can be organized and ready to implement Reality Tour in about 2 months. Approximately 24 volunteers must be recruited to present the program, and they are trained through multiple DVDs over four to six meetings. Volunteers should include individuals in law enforcement, civic and faith-based groups, youth groups, and the recovery community, as well as youth and adults from the community at large, health care providers, and educators. Two civic-minded persons also are needed to serve as program directors.

Descriptive Information

Areas of Interest	Substance use disorder prevention
Outcomes	1: Attitudes toward use of alcohol, cigarettes, and marijuana 2: Perceived risk of harm from drinking alcohol and smoking marijuana
Outcome Categories	Alcohol Drugs Tobacco
Ages	6-12 (Childhood) 13-17 (Adolescent)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Black or African American White Race/ethnicity unspecified
Settings	Other community settings
Geographic Locations	Suburban
Implementation History	Reality Tour was first implemented in Butler, Pennsylvania, with 24 volunteers, and it was presented three times as a summer program. Reality Tour program model was established, and the 501(c)(3) nonprofit CANDLE, Inc. (Community Action Network for Drug-Free Lifestyle Empowerment), was formed. More than 5,000 Butler residents had attended a Reality Tour program. Outside of Butler, Reality Tour has been implemented in 22 sites throughout Pennsylvania and in 1 site in Montana, New Jersey, New York, Ohio, Oregon, Vermont, and West Virginia. Across Pennsylvania, over 15,000 youth and parents have participated in the program. Butler is the only community in which Reality Tour has been evaluated.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Pringle, J., & Melczak, M. Evaluation of the Reality Tour, an innovative drug and alcohol awareness education program. Pittsburgh, PA: School of Pharmacy, Department of Pharmacy and Therapeutics, University of Pittsburgh.

Outcomes

Outcome 1: Attitudes toward use of alcohol, cigarettes, and marijuana
Description of Measures	Attitudes toward the use of alcohol, cigarettes, and marijuana were measured using 3 items from the Favorable Attitudes Toward Use Scale, which were taken from SAMHSA's National Outcome Measures (NOMs): "How wrong do you think it is for someone your age to drink beer, wine or hard liquor (for example, vodka, whiskey or gin) regularly?" "How wrong do you think it is for someone your age to smoke cigarettes?" "How wrong do you think it is for someone your age to smoke marijuana?" Youth participants rated each item on a 4-point Likert scale (1 = not wrong at all, 2 = a little bit wrong, 3 = wrong, and 4 = very wrong), with higher scores indicating a less favorable attitude toward use of the substance.
Key Findings	From pre- to posttest, mean scores increased for attitudes toward use of alcohol (3.63 to 3.80; p = .001), cigarettes (3.60 to 3.74; p = .001), and marijuana (3.81 to 3.91; p = .023). From pretest to follow-up, mean scores increased for attitudes toward use of alcohol (3.63 to 3.78; p = .009) and attitudes toward use of marijuana (3.82 to 3.95; p = .006).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 2: Perceived risk of harm from drinking alcohol and smoking marijuana
Description of Measures	Perceived risk of harm from drinking alcohol and smoking marijuana was measured using 3 items on the Perceived Risk of Harm Scale, which were taken from SAMHSA's NOMs: "How much do you think people risk harming themselves (physically or in other ways) if they take one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day?" "How much do you think people risk harming themselves (physically or in other ways) if they try marijuana once or twice?" "How much do you think people risk harming themselves (physically or in other ways) if they smoke marijuana regularly?" Youth participants rated each item on a 4-point Likert scale (1 = no risk, 2 = slight risk, 3 = moderate risk, and 4 = great risk), with higher scores indicating a greater perceived risk of harm from use of the substance.
Key Findings	From pre- to posttest, mean scores increased for perceived risk of harm from drinking alcohol (3.44 to 3.76; p = .001), smoking marijuana once or twice (3.50 to 3.78; p < .001), and smoking marijuana regularly (3.83 to 3.90; p = .012). From pretest to follow-up, mean scores increased for perceived risk of harm from drinking alcohol (3.44 to 3.68; p = .001), smoking marijuana once or twice (3.50 to 3.68; p < .017), and smoking marijuana regularly (3.83 to 3.93; p = .032).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood) 13-17 (Adolescent)	59.8% Male 40.2% Female	94.3% White 2.5% Black or African American 2.5% Race/ethnicity unspecified 0.8% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Attitudes toward use of alcohol, cigarettes, and marijuana	3.5	3.5	2.0	0.5	1.0	1.5	2.0
2: Perceived risk of harm from drinking alcohol and smoking marijuana	3.5	3.5	2.0	0.5	1.0	1.5	2.0

Study Strengths

The study's measures are widely used, valid, and reliable. Training and, if requested, technical assistance were provided before implementation of the intervention. Program materials for implementation, training, and technical assistance helped to standardize implementation. The sample size was adequate for testing primary hypotheses.

Study Weaknesses

Although the choice of measures was good, assessment conditions were not carefully controlled; participants were given surveys for all three time points (i.e., pretest, posttest, follow-up) at pretest, and both pre- and posttest surveys were collected together after the program was implemented. It also is unclear whether children's responses were influenced by parents, who may have been present during the assessment and who may have mailed the children's 30-day follow-up survey. The assessment of fidelity did not involve any objective evaluation or indices. No information was provided on program attendees who were not included in the analysis because they did not complete surveys for all three time points, and no attrition analyses were performed. Because there was no control group, potential confounds cannot be ruled out. A number of confounding variables, such as bias in survey completers versus noncompleters, may have accounted for the outcomes of the evaluation. Researchers did not explain why data from parents were not analyzed. The analyses included no correction for multiple comparisons. The distributions of scores for the scales were extremely negatively skewed, and nonparametric tests were not conducted.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

CANDLE, Inc. Reality Tour program disc set [DVDs/CD-ROM]. Butler, PA: Author.

CANDLE, Inc. Reality Tour program manual. Butler, PA: Author.

Reality Tour Copyright Compliance Packet

Reality Tour Fidelity Checklist

Reality Tour Needs/Value Acceptance Assessment

Reality Tour Volunteer Recruiting Poster

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.5	3.5	2.5	3.2

Dissemination Strengths

The preimplementation presentation, program manual, and Web site clearly define program components and are accompanied by DVDs and a CD-ROM to support implementation. Training is presented through DVDs that directly align with the content of the program manual. Training, which can be customized to fit the needs of each site, includes the principles and theories that guide the program's design. The required licensing agreement contributes to program fidelity. Pre- and posttest surveys for both youth and adults are provided to support outcome monitoring.

Dissemination Weaknesses

Although the program components are clearly defined, little detailed guidance is provided on determining the appropriate sequence of activities, making the program manual difficult to follow. No print materials specifically tracking activities within the training DVDs are provided to support implementation. No specific fidelity measures are provided to assist implementers in ensuring adherence to the model over time.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Initial licensing agreement and program materials (including manual, training and implementation DVDs, CD-ROM, and quality assurance materials)	$3,500 per site	Yes
Annual license renewal	$500	Yes
Vinyl "I Promise" banner (one per 400 attendees)	About $150 each	Yes
Stakeholder meeting documents	Free	No
Media kit	Free	No
Two-sided, 9 inch by 4 inch promotional cards	$250 for 1,000	No
Electronic newsletter and blog access	Free	No
E-Workbook: Reality Tour 12 Community Sectors/7 Environmental Strategies	Free	No
Online introductory training offered monthly via the program Web site	Free for up to 20 participants (i.e., potential implementers)	No
Ongoing online education for program directors	Free	No
On-site developer consultation	$500 per day plus travel expenses	No
Detailed phone consultation with developer	$75 per hour	No
Response to occasional site questions by phone or email	Free	No

Additional Information

Start-up costs may range up to $1,000, depending on the level of community involvement and whether any program supplies are donated (or obtained through in-kind donations). Ongoing costs include photocopying expenses, which are estimated at no more than $20 per session. Reality Tour requires two program directors, who may need to be compensated if they are not participating on a voluntary basis. Each director will need to dedicate 2 hours of preparation time and 4 hours of direct time for each session.