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Voluntary, Randomized, Student Drug-Testing

May 28, 2008

By Barrington, Kyle

Abstract Illegal drug use and abuse by the nation’s secondary school students is a continuing public health issue and this is especially true for students living in rural, low-income areas where access to intervention and treatment services is often limited. To address this issue, some school districts have implemented voluntary, randomized, student drug-testing (VRSDT) programs. The quantitative findings of this quasi-experimental study revealed that VRSDT had no significant impact on students’ self-reported rates of illegal drug use. However, the study’s qualitative results indicated that a VRSDT program may be more than just a primary prevention program. Because of this, school administrators interviewed during this study indicated they felt VRSDT of students was still worth the costs and efforts to implement.

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INTRODUCTION

Since 2001, the Department of Education has provided nearly $3.45 billion to state and local agencies to help ensure schools are safe and drug free (Cooper, 2005). These resources have been allocated, in part, because of research that documents alcohol and illicit substance use among adolescents is a major public health concern (Johnson, O’Malley, Bachman, Schulenberg, 2005). Researchers have found that illegal drug use interferes with students’ ability to think clearly, reduces academic achievement, reduces motivation and self-discipline, and negatively impacts school climate (National Commission on Drug-Free Schools, 1990; Steinberg, 1996). Further, research has documented that excessive alcohol use by adolescents has a direct and negative impact on brain development and behavioral control (Caldwell, Schweinsburg, Nagel, Barlett, Brown, & Tapert, 2005).

Geographic location plays a role in adolescent substance use. The National Survey of Drug Use noted that illicit drug use in rural communities was exceeding that of larger urban centers (Maxwell, Tackett-Gibson, & Dyer, 2006; National Center on Addiction and Substance Abuse, 2000). According to the work of Shears, Edwards and Stanley (2006), adolescent use rates in rural communities are equal to or greater than urban use rates for all illicit drugs except ecstasy and marijuana. The reasons for this disparity are not definitively known; however, the fact that urban school districts have more full-time substance abuse prevention counselors (Falck, Wang, Carlson, & Siegal, 2002), more mental health services (Slade, 2003) and more treatment services does play a part (Hutchison & Blakely, 2003; Maxwell et al., 2006).

Drug use and abuse is clearly a major public health concern for local, state and federal authorities. In 2004, President George W. Bush dedicated millions of dollars in federal funding to help schools implement VRSDT programs. To date, however, the effectiveness and efficacy of VRSDT programs has not been fully determined due to two main factors: 1) school districts just recently started to implement VRSDT; and 2) many researchers have assumed that all drug-testing programs are similar.

Recent United States Supreme Court decisions have empowered many school districts to consider VRSDT programs as part of a comprehensive drug abuse prevention effort. Prior to the Supreme Court’s Vernonia (1995) decision, “fewer than 20 schools in the country tested students for drugs and alcohol” (DuPont, Campbell, & Mazza, 2002, p. 3). However, by 2002 “as many as 1000 school districts in at least 38 states and Puerto Rico instituted student drug testing programs” (DuPont et al., 2002, p. 3). Vemonia and a 2002 decision (i.e., Board of Education of Independent School District No. 92 of Pottawatomic County v. Earls) brought about a significant interest in using VRSDT for students taking part in after-school activities, including school athletics. This rapid increase, which was driven by the belief that reducing substance use within this group of students, who were perceived by some to have a heightened social status, would translate into reduced substance use by all students (Goldberg et al., 2003), has occurred “despite the absence of efficacy studies” (Goldberg et al, p. 17).

VRSDT programs remain in doubt, however, because they are weakly defined and have been studied by many researchers who have assumed that all student drug-testing programs are equivalent. This is a false assumption. There is “no ‘one size fits all’ approach to student drug testing programs” (Office of the National Drug Control Policy , 2004, p. 13).

According to the ONDCP (2002), student drug-testing programs (SDTP) can be implemented using a number of strategies. Prior to Vernonia, many school districts with SDTP only tested, with the intent of imposing legal consequences, those under suspicion of violating a school rule or being under the influence of a banned substance. That is not the approach or philosophy of VRSDT programs as advocated by the ONDCP (2004). VRSDT programs are designed to be part of a comprehensive substance-abuse prevention program where the intent is to provide both a deterrence to substance use and a means of helping students who test positive by referring them to school and community services. The two clearest distinctions between SDTP and VRSDT programs are that VRSDT programs utilize suspicionless drug testing of students and do not refer students who test positive to law enforcement agencies.

However, at this time, too little is known about the efficacy of VRSDT programs, especially those being implemented in rural, low- income communities. Further, little is known about how school administrators’ perceptions of the efficacy of VRSDT change once quantitative VRSDT results are obtained. Despite these deficiencies, many school systems utilize VRSDT as part of their drug prevention efforts (Office of National Drug Control Policy, 2004).

METHODS

School Recruitment

This study involved two rural, low-income, public secondary school districts. Both districts recruited for this study successfully implemented the Pride Survey (see Instruments, below) in 2003 and continued administering the Pride Survey through 2007. The intervention district was selected because it has implemented a locally funded VRSDT policy and program; the comparison district because it served a similar demographic in the same geographic area.

Participant Consent

The School Superintendents of the two districts granted permission for this study’s researcher to retrieve their 2005 and 2006 Pride Survey results and to collect the 2007 results in the spring of 2007, using their standard survey administrative procedures. All teachers and staff involved in the surveys’ administration became the trained Pride Survey Administrators. Since the surveys contain confidential information, the protection of confidentiality was of vital concern. Both districts have a defined, annual, multi-step process for approving the use of substance abuse surveys and that process was utilized for all of this study’s surveys. The process included: 1) providing parents with a method to decline their children’s participation; 2) informing students that participation was completely voluntary; and 3) ensuring all data collected was anonymous (i.e., the survey did not provide a place for a student name or other identifier).

The school administrators interviewed in this study were provided with informed consent documentation that identified the interview process and noted that the interviews would be audio taped, that transcripts would be made, and that confidentiality could not be assured.

Instruments

The Pride Survey is a nationally known, self-reported, student survey that measures alcohol, tobacco, and other drugs use, and assists in collecting data on the incidence of violence and on the attitudes and perceptions of students regarding drug use. It is anonymous and was first used in 1982. In 1992 federal action designated it as an official measurement of adolescent drug use. It has been found valid and reliable nationwide (Metze, 2000), has ten sections that each contains various items ranging from family demographics to drug use, and has been used by more than seven million students since its creation in 1982 (Metze). The survey contains questions about tobacco (e.g., cigarettes, smokeless tobacco, cigars, etc.), alcohol (e.g., beer, wine coolers, liquor, etc.), marijuana, cocaine, stimulants (uppers), depressants (downers), inhalants, hallucinogens, heroin, anabolic steroids, designer drugs (e.g., ecstasy, etc.), prescription drugs, and crystal methamphetamines (e.g., ice, crank, etc.). Other questions derive information about students’ attitudes and behaviors that related to substance abuse issues, violence, and family relations. It uses a Likert eight-point scale for responses to a series of past- year, drug-use questions, ranging from “did not use” to used “every day.”

This study’s Pride Surveys were administered in the spring of 2005, 2006, and 2007. The spring of 2005 (i.e., school year 2004- 2005) was selected as the study’s starting point because it was the year prior to the VRSDT policy and program implementation in the intervention district. This study utilized a mixed-methods sequential explanatory research design which called for semi- structured interviews with the school administrators (i.e., High School Principal and District Superintendent from each school district). A total of four, individual and private, interviews were conducted to determine how the results of the study’s quantitative analysis impacted the administrators’ perception of the efficacy of VRSDT programs.

Drug Testing Program

In the fall of 2005, this study’s intervention district implemented, for all secondary school students (i.e., 6-12th graders) participating in school-sponsored extracurricular activities, a VRSDT policy and program that required that all participating students be drug and alcohol tested at the beginning of, and randomly during, each school year. All participating students had to ascent to the drug testing, and active parental consent was obtained. Informational, mandatory parent, student, and community VRSDT meetings were held and non-attending students were not allowed to participate in extracurricular activities.

Once the ascents and consents where obtained, a contracted, certified, drug-testing laboratory began drug testing – testing at least 10% but no more than 90% of the eligible students on any given day while utilizing a random selection procedure, with no prior notice of date or time. Participating students were eligible to be selected for testing at any point during the school year, not just during their respective sport or extracurricular season(s).

Consequence of a Positive Drug Test Result

In the study’s VTSDT program, any non-negative drug test was confirmed by a second test on the same test specimen before being reported as a positive drug test. A positive test required that the student, the student’s parents if the student was a minor, and authorized school district personnel be notified and meet as a group that included the coach or sponsor of the extracurricular activity. If no medical explanation was ascertained within two days of the group meeting, an initial offense resulted in a ten-day suspension from any extracurricular activity and in the student and parents being notified of local area drug and alcohol abuse prevention resources. A second offense resulted in suspension from extracurricular activities for 30 school days. A third offense resulted in suspension for the remainder of the school year.

Data Analysis

This study’s research questions pertaining to the impact of the VRSDT program on the use of alcohol, tobacco, and illicit drugs were tested using 2-way Analysis of Variance (ANOVA), with one 2-way ANOVA for each research question. In each test, the dependent variable was the frequency of substance use and there were three main effects (i.e., independent variables): 1) effect due to year; 2) effect due to drug-testing status; and 3) the interaction effect between year and drug-testing status. The interaction effect was of primary importance because it directly addressed the research questions. That is, if the interaction effect between year and drug- testing status was statistically significant, then the null hypothesis was rejected and it was concluded that the difference in the average frequency of usage between the three years was different for the two school districts. If the difference between the two districts showed a reduction in the “VRSDT program present” group (i.e., intervention district) and no change in the “VRSDT program not present” group (i.e., comparison district), that was supportive of the hypothesis that a drug-testing program was effective at reducing substance abuse. If the F-test for the interaction effect was statistically significant, then post-hoc Bonferroni adjusted two- sample t-tests were performed, separately, for each district to determine which years were different from which.

Qualitative data was used to analyze school administrators’ perception of efficacy about VRSDT programs. This data was gathered during personal interviews and was analyzed using principles of interpretational analysis as described by Gall, Gall & Borg (2003). Responses were organized around the key survey questions and reported in narrative form. Constructs, patterns, and themes were used to describe and explain the information studied.

RESULTS

Demographics

This study, which was designed to compare the self-reported, student drug use of a rural, low-income public school district utilizing VRSDT to a comparable district not utilizing VRSDT, included a longitudinal analysis of drug use over three school years (i.e., 2004-2005, 2005-2006, and 2006-2007). The intent was to measure the students’ drug use prior to and after the 2005-2006 school year implementation of VRSDT. The study’s subjects were all of the 6th through 12th graders, not excluded from participation by their parents, in the two selected school districts. Table 1 provides a summary of the study’s actual population demographics.

Participation was voluntary, required parental permission, and was completely anonymous. A total of 1,048 students participated, with 245 (23.4%) from the intervention district and 803 (76.6%) from the comparison district. The percentage of each district’s total student population participating in the study was approximately equal: 64.3% in intervention and 66.6% in comparison. The participants by school year were also fairly consistent: 368 (35.1%) in 2004-2005, 317 (30.3%) in 2005-2006, and 363 (34.6%) in 2006- 2007. The frequency distribution of participants by academic grade level was also fairly equal: 162 (15.4%) 6th graders, 160 (15.3%) 7th graders, 154 (14.7%) 8th graders, 133 (12.7%) 9th graders, 143 (13.6%) 10th graders, 151 (14.4%) 11th graders, and 137 (13.1%) 12th graders. A total of eight (0.8%) students failed to indicate an academic grade level. Significantly, 96.7% and 89.1% of the intervention and comparison partici-…

Quantitative Results

The dependent variable for Research Question 1 (Alcohol Use) was derived by calculating the maximum of the three Alcohol Use variables – beer, wine coolers and liquor. Results (Figure 1) showed a distinct decreasing trend in the comparison district and a slight increasing trend in the intervention district. However, the interaction between Year and District was not statistically significant [F(2,1040) = 1.84, p = .16] and, thus, the null hypothesis was not rejected and it was concluded that there was no evidence to suggest the change in alcohol use over the three-year period was different for the two districts. Thus, there was no statistically significant evidence to suggest that VRSDT intervention had an effect on Alcohol Use.

The dependent variable for Research Question 2 (Tobacco Use) was derived by calculating the maximum of the three Tobacco Use variables – cigarettes, smokeless tobacco, and cigars. Results (Figure 1) showed little evidence that Tobacco Use over time was different for the two districts. The interaction between Year and District was not statistically significant [F(2,1040) = .23. p = .79] and, thus, the null hypothesis was not rejected and it was concluded that there was no evidence to suggest the change in Tobacco Use over the three-year period was different for the two districts. Therefore, there is no statistically significant evidence to suggest that VRSDT intervention had an effect on Tobacco Use.

The dependent variable for Research Question 3 (Illicit Drug Use) was derived by calculating the maximum of two Illicit Drug Use variables – marijuana and cocaine. Results (Figure 1) showed a distinct decreasing trend in the comparison district and a less apparent downward trend in the intervention district. However, the interaction between Year and District was not statistically significant [F(2,1038) = .46, p = .20] and, thus, the null hypothesis was not rejected and it was concluded that there was no evidence to suggest the change in Illicit Drug Use over the three- year period was different for the two districts. Therefore, there was no statistically significant evidence to suggest that VRSDT intervention had an effect on Illicit Drug Use.

Qualitative Results

Intervention school district. The quantitative portions of this study indicated that VRSDT did not have a statistically significant impact on students’ illegal substance use rates. However, there remained a question as to how administrators in the intervention district would perceive the VRSDT after results of this study were made available. Once the study’s data analyses were completed, the results were presented, during individual, private interviews, to the intervention district’s Superintendent and High School Principal. To help ensure confidentiality, the interviewees were identified as Respondent One and Respondent Two. Both respondents were employed in their current positions at the time the school district opted to implement VRSDT, and remained in their respective positions at the end of the 2006-2007 school year.

Addressing the effectiveness of VRSDT, both respondents were satisfied and relieved to know that the overall rates of substance use were going down in their district. When made aware that the study revealed no statistically significant reduction, their reactions were also similar. Respondent One noted, “You’re dealing with such small numbers here that one student can cause this to change.” Respondent Two noted, “The numbers can be skewed a little bit based on the number of kids that you survey. You know, when you have only a few kids to survey then your percentages aren’t going to be very great.” After reviewing the quantitative results of this research study, both respondents stated that they still believed that VRSDT was effective.

To further explore this issue, another question was posed. “If there was a definitive study that came out that concluded VRSDT does not, in and of itself, reduce students’ self-reported use of drugs would you still be supportive of VRSDT?” Respondent Two stated, “Yes, I would.” When asked to explain why, Respondent Two stated: The main reason would be because it gives the child an option. It gives them an avenue to have a defense against peer pressure and I think that’s important. I think you do need to provide as many options for kids and have an option to choose so they can have that support behind them. That’s what it is; it’s a support more than it is for drug testing. It’s a support for children to make good decisions.

Respondent One, in response to the same question, noted that VRSDT was more than a prevention option. When discussing the efficacy of VRSDT, Respondent One noted that the drug-testing program helps the district identify students who might have “fallen between the cracks. Those students that show up to school and do well but who are also addicted are hard to identify.” Respondent One was of the opinion that VRSDT helps identify students in need of treatment. Thus, when asked if he would still support VRSDT if a definitive study was conducted and found it did not reduce substance abuse rates, Respondent One stated, “Yes, because if you save one child you’ve accomplished something. I would like to see any student that is using drugs, that we could get help to them.”

In addition, both respondents noted VRSDT advantages other than reducing drug use or identifying students that need treatment. Respondent One noted that since implementing VRSDT he has felt a difference in how the students perceive their school, especially in terms of safety. Citing a specific incident, Respondent One noted that students were more open to letting administration know when kids are carrying drugs on school grounds and that he has experienced an increase in the number of students reporting when another student brings drugs to school. Specifically, since VRSDT Respondent One stated:

It’s a very positive situation. I’ve been here 13 years and we have never had any drugs on campus that we’ve been able to catch. Since we implemented our drug-testing policy we have had students quickly come to the office and alert us that we had a person carrying some illegal substances here.

Respondent Two stated that since VRSDT, he has seen an increase in school pride.

I think it (i.e., VRSDT) just created an awareness overall. I think it heightens the positive within our school because our district was known to be socially and economically poor – not a good school. We are the stepchild in the county when it comes to some of the other school districts. And to see so few kids using drugs versus the expectations, or what the speculation was, it made a world of difference because we are a very clean school compared to even what I thought we were.

Another clear point made during the interviews was that VRSDT was not the only prevention program being implemented by the school district. In fact, both respondents noted that “drug testing is just one part of our prevention approach.” Both identified in-school prevention programs using prevention curriculums, in-school lectures, presentations made by a local drug-free community organization, and their district’s Red Ribbon Week activities. Significantly, when asked when students in the district were first introduced to substance abuse prevention activities, both respondents stated “by second grade.”

Comparison school district. To determine what, if any, impact the results of this research study had on the comparison district’s administrators, this study’s researcher interviewed the district’s Superintendent and High School Principal. To help ensure confidentiality, the interviewees were identified as Respondent Three and Respondent Four. Both respondents were employed in their current position in the 2005-2006 school year and remained in their respective positions at the end of the 2006-2007 school year.

Addressing the question of the efficacy of VRSDT, both respondents acknowledged that they had heard of VRSDT. Respondent Three acknowledged that he did not know if “drug testing was found to be effective” but that he had heard some positive Slings about such an approach from other districts. Respondent Four stated that he felt “anything that can give me more information so I can help my students I am in favor of.” Further, when asked if they would ever consider implementing a VRSDT program, Respondent Three noted, “That is one approach and one our district would consider if the desire was expressed by the community.” Respondent Four stated, “Yes, I would support and approve that approach.” When asked why the district had not implemented such a program Respondent Three noted, “The request needs to come from the community not the School Board.” Further, Respondent Three noted that thus far “no one has come to the school board and asked for it.” Respondent Four stated that he would like to see the policy implemented so that he would “have that option.”

Before the results of this study were presented, the respondents were asked about their perceptions of their district’s use rates. Both respondents acknowledged that they knew that some students at their school engage in illegal drug use. However, when asked, “Has the problem gotten better or worse over the course of the past three years?” the responses were contradictory. Respondent Three stated he felt “there was pretty consistent use over that time period.” Respondent Four thought there was “growing use.”

When the results were revealed that their district’s students were reporting less illegal drug use over the course of the past three years both respondents were pleased. Respondent Four acknowledged that, “In my capacity I only see the problems so it is nice to see a decrease in drug use.” Respondent Three noted that he felt the results showed that the district’s approach to improving facilities “creates a positive environment for students to want to learn.”

When the quantitative results of this study were presented, the respondents were asked if they impacted their perception of the effectiveness of VRSDT. Respondent Three noted that he felt that “drug testing is just one element of a drug prevention program.” Further, he stated that he did not feel any one program or service would, in and of itself, “significantly reduce students’ illegal drug use.” Respondent Four stated that he still felt that VRSDT would be beneficial as “drug testing would still allow us to identify kids in need more accurately.”

When asked about their district’s current drug prevention programs, both respondents were able to identify significant programs. Respondent Four stated that the district had increased their counselors, formed a drug-free community organization, and been involved with the county’s Safe Schools/Healthy Student Consortium, which secured grant funds for drug abuse prevention programs. Further, Respondent Four noted that he had implemented a personal goal of knowing every student on campus. He stated, “Building positive relationships between administration and students is important, and needed, to keep students away from drugs.” Respondent Three stated that the district has a “Safe Schools Program, an elementary school Counseling Program, and an Advanced Placement program that gives students hope. Also, we are providing a clean, safe environment for students to learn.” When asked if a VRSDT program could eliminate any existing district prevention program, both respondents stated “no.”

Finally, when asked, “Assume someone provided you all the money you needed to implement one additional substance abuse prevention program, what would it be?” Respondent Three stated “more tutoring and counseling” and Respondent Four stated “after-school programming, especially on weekends, and more counselors.”

DISCUSSION

According to the ONDPC (2004), there is a growing interest in VRSDT among public school administrators. Further, President Bush (2004) has dedicated millions of dollars to help school districts implement VRSDT programs. Despite the interest and the increased federal funding, there has been very little empirical evidence that VRSDT is effective at reducing illegal drug use among school students. The quantitative research results for this study add to a small but growing number of studies that have found that drug testing, in any number of forms, has no significant impact on students’ illegal drug use. Because of the money and time required to implement a VRSDT program, the quantitative research results of this study reinforces the idea that school districts might be best served by investing their time and resources into other strategies and programs. Clearly, this study’s lack of statistically significant results related to reducing drug use can be used by organizations and individuals opposed to VRSDT.

Though there are numerous studies documenting the success of curriculum-based substance abuse programs (Tobler, 2000), this study’s lack of statistical significance seems to replicate the findings of other studies that report substance abuse prevention programs, of various types, produce little, if any, impact on illegal drug usage rates (Steinberg, 2004; Skiba, Monroe, & Wodarski, 2004). Importantly, however, this study’s qualitative results indicate that there are at least two identified reasons to spend time and resources in implementing a VRSDT program:

1. VRSDT helped the school administrators identify students needing more intensive substance abuse services; and

2. VRSDT is believed to have increased school bonding and connectedness.

According to the administrators from the intervention district, VRSDT is not just a prevention program with an aim at preventing students from using illegal drugs; but, because VRSDT can be used to identify substance-abusing or addicted students, it allows a school district to positively identify students who may need additional and more intensive substance abuse services, including interventions or treatment services. Specifically, these administrators reported that their VRSDT program had helped their school district to positively identify at least three students who would have gone untreated, or at least had treatment delayed, had it not been for the program. Interestingly, during the interviews in the comparison district, the administrators stated one of the reasons they would still consider VRSDT is that it would help them identify substance-abusing and already addicted students. This consideration is important as rural area adolescents have equal or greater drug use rates compared to urban areas but have less intervention and treatment services (Shears et al. 2006; Hutchinson & Blakely, 2003). According to the administrators in the intervention district, VRSDT also seems to have increased school bonding and connectedness. Students feel more empowered and are more willing to inform administrators when other students bring drugs into or onto school facilities or grounds, meaning the perception of school safety has increased with VRSDT implementation.

Another interesting finding of this study was that one of the reasons the intervention district had implemented VRSDT was to counter community perceptions that the school district had a significant drug problem. The administrators indicated that they were pleasantly surprised to find such a low number of students testing positive, and indicated they use that information (i.e., that the vast majority of students tested negative) when addressing community stakeholders and leaders to help improve the public perceptions of their school district.

This study had several limitations: 1) the scope was limited to two rural, low-income, public school districts located in southcentral Texas – one that utilized a VRSDT program and one that did not; 2) though experimental and comparison school districts were utilized, they were self-selected, not randomly selected; 3) there were unequal sample sizes between the intervention and the comparison districts; and 4) only those substances that more than five percent of the students in the selected districts reported using during the 2004-2005 school year were included.

The findings of this study leads to several recommendations. First, this study used anonymous student surveys that were collected over the course of three years; however, individual participants could not be identified from one year to the next. Further, the small sample size in the experimental group reduced the power of the study’s findings. Thus, there is a compelling need for a more in depth and larger longitudinal study that can track individual students over the course of several years. second, the impact of VRSDT on students’ and faculties’ perceptions of school safety should be more fully explored since school administrators who have implemented VRSDT reported an increase in their perception of school safety. Third, the experimental school district, on average, tested 5% of all students in the drug-testing program each month. This data introduces the question of whether the results would have been different had the school district selected a larger number of students to test each month. A fourth recommendation is to study the outcome of students enrolled in a VRSDT program who test positive for illegal drugs and are referred to intervention or treatment services to help determine if positive results from a VRSDT improves intervention and treatment outcomes.

The clearest conclusion reached by this study is that school administrators from rural, low-income communities, looking to implement a single and universal substance abuse prevention program, should not implement VRSDT as a stand-alone program. The study’s results suggest that VRSDT does not, by itself, significantly reduce substance use among secondary school students. They do indicate, however, that VRSDT does offer some significant, identifiable benefits which add value if VRSDT is part of a comprehensive substance abuse prevention program. First, VRSDT appears to be an effective tool to identify addicted and substance-abusing students. Second, VRSDT is reported to be responsible for increasing students’ feeling of empowerment, leading to increased school bonding and connectedness, which increase school district administrators’ perceptions of school safety and, perhaps, the public perception of the school district.

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Kyle Barrington, Ph.D.

Zajonc Corp.

Correspondence concerning this article should be addressed to: Kyle D. Barrington, Ph.D., Zajonc Corp., 2112 Chippendale St., College Station, TX 77845; phone: (979) 696-6373; email: kyle.barrington@zajonc-corp.com.

Copyright American Alcohol and Drug Information Foundation Apr 2008

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