Sunday, December 17, 2006

Just Say No (to D.A.R.E.): The Nation’s Most Widespread Drug Prevention Program Fails to Incorporate Basic Social Science Theories - Laura Wulach

D.A.R.E. (Drug Abuse Resistance Education) is the most widespread drug prevention program in the United States, reaching up to 26 million students nationally each year and being implemented in over 75% of the nation’s school districts [1]. The curriculum is based upon four core areas: providing knowledge about drugs and alcohol, teaching effective decision-making skills, offering children alternatives to substance use, and teaching children how to deal with overt and subtle peer pressures [1]. D.A.R.E. uses the same curriculum throughout the United States, which is taught by police officers who participate in an 80 to 120 hour training. D.A.R.E. is traditionally presented in fifth or sixth grade during 17 lessons. Its most popular slogan is “Just Say No,” which represents its most basic principal that refraining completely from using substances is the most effective way to prevent abuse.

Arguably, the greatest advantage of D.A.R.E. is the network it has created to disseminate information, since over three-fourths of the nation’s school districts receive the D.A.R.E. curriculum each year. D.A.R.E. also benefits from extensive community and school-based support, both of which give it the potential to be a powerful medium to reach students [2]. Unfortunately, there are many studies that show that D.A.R.E.’s curriculum is ineffective [3, 4, 5], and in some cases, that it has increased the use of various drugs among certain groups of students [6]. In fact, the United States General Accounting Office wrote a report on the conclusive evidence that D.A.R.E. is ineffective in preventing drug and alcohol use [7].

While almost all studies have shown that D.A.R.E. is ineffective, virtually none have examined central social science theories that could help explain some basic flaws in the program. Once these social science theories are identified and incorporated into the program, D.A.R.E. could become extremely effective, offering widespread dissemination, community support, and a practical social science curriculum that would make D.A.R.E. a success and help reduce drug and alcohol use among adolescents. This paper will critique D.A.R.E.’s understanding of the ability to resist peer pressure, the effectiveness of police officers as teachers of the D.A.R.E. curriculum, and the “Just Say No” slogan. It will do so by examining theories from the social sciences that demonstrate why these aspects of D.A.R.E. are ineffective, and it will suggest that if these theories were incorporated into the D.A.R.E. program, D.A.R.E. would be considerably more effective.

One of D.A.R.E.’s primary aims is to teach students how to recognize and resist peer pressure, and thus avoid the pressures that often lead to experimenting with drugs and alcohol. While there exists a lot of research that shows that peer pressure is a significant factor in an adolescent’s experimentation with drugs and alcohol [8], there are many variables that contribute to one’s ability to resist peer pressure. D.A.R.E. believes that students can be taught to resist it; however, D.A.R.E. ignores the larger forces that play into the ability to resist peer pressure, such as the family. According to psychological evidence, “Research has shown that most young people who abuse alcohol or other drugs were first encouraged to do so by their peers and that the ability to resist such peer pressure is directly related to the strength and cohesiveness of family ties” [9]. Thus, D.A.R.E. is ineffective because it does not deal with the most important factors in determining whether a student will resist peer pressure.

Moreover, a family’s strength and cohesiveness is influenced by many larger societal forces, such as neighborhood safety, socioeconomic status, discrimination, and racial residential segregation [10, 11, 12, 13]. Since family cohesiveness can greatly impact the ability to which a child is able to resist peer pressure, it follows that increasing family cohesiveness would improve a child’s ability to resist peer pressure. Unfortunately, D.A.R.E. does not address this central issue at all, rather focusing solely on different refusal strategies for resisting various types of peer pressure [6]. While this strategy might be important, and peer pressure can lead to drug and alcohol use, ignoring the deeper factors that affect the ability to resist peer pressure results in an intervention that deals with peer pressure only on its most superficial level. Until D.A.R.E. attempts an intervention to improve family strength and cohesiveness, and thus increase the ability of children to resist peer pressure, D.A.R.E. will remain ineffective.

Furthermore, as D.A.R.E. strives to teach students how to resist peer pressure, it fails to ask the people who understand this issue the best: students themselves. Students face peer pressure on a daily basis, and while they struggle with it, most find ways to deal with it and get by. Students who use drugs and alcohol could provide invaluable information as to why they chose to use these substances and how they reacted to peer pressure, and students who do not use substances could explain their reasons for not using them and could explain how they reacted to peer pressure. By ignoring the first hand experiences and opinions of the people to whom the intervention is aimed, D.A.R.E. is not effective, as it does not create an intervention that incorporates the perspective of adolescents. While different in many ways, Siegel demonstrates how the failure of public health practitioners to incorporate the views of gay men into campaigns to prevent HIV has lead to a crisis among this population. Regarding the HIV prevention campaigns geared towards gay men, Siegel states, “… Our current efforts to understand the target audience are woefully inadequate and often lead to prevention programs that conflict with the audience’s core values” [14]. D.A.R.E.’s curriculum might not conflict with its audience’s core values, but it does fail to incorporate them into its prevention efforts. D.A.R.E. will remain ineffective until it asks students their opinions and experiences and incorporates them into the D.A.R.E. curriculum.

Another reason why D.A.R.E. is ineffective is because of its firm belief that police officers are the most effective teachers of drug resistance methods. D.A.R.E. is an initiative that originates from the Los Angeles Police Department, and thus is a program that is created by and for police officers. However, D.A.R.E. ignores one of the most basic psychological theories: that most adolescents rebel against their parents and parental figures. As children enter adolescence, they tend to rely on peers for clues as to how to behave and for emotional support. At the same time, adolescents rebel against the immediate controls of their parents [15]. Adolescents are more likely to view police officers as parental figures than as peers, and thus are more likely to rebel against what police officers teach. While D.A.R.E. views police officers teaching as its finest point, it might be exactly this fact that causes D.A.R.E. to be ineffective.

A third reason why D.A.R.E. is ineffective is because of its core method of teaching resistance: “Just Say No.” This message is ineffective because it is negative, unrealistic, and inconsistent with teens’ experiences. D.A.R.E. tells students to “say no” to all types and quantities of substances. However, adolescents quickly learn that it is possible to enjoy certain substances in small quantities, as they see their parents, relatives, and peers responsibly enjoying one beer or a glass of wine, and not experiencing any adverse effects. While it is true that drinking alcohol is as illegal for teens as is using drugs, it is still important that adolescents are taught the truth about how to responsibly drink alcohol, so that when they are legally able to drink it, they can do so responsibly.

It is essential that adolescents are taught in school the same messages that they see in other parts of their lives. When adolescents are taught that any use of any substance is bad, and then see in their lives that this is not true, they are more likely to reject the entire message. According to a communications theory, consistent messages need to come from a variety of sources and over a long period of time in order for adolescents to truly learn the message [16]. Austin argues that the media, family, and peers need to reliably offer the same message about substances for many years so that what adolescents learn in a classroom or on TV, they also experience in their day-to-day lives [16]. Thus, in order for D.A.R.E. to be effective, it would have to teach the complicated truth about substances, in a manner that is consistent with children’s reality.

Another problem with “Just Say No” is that it is an unrealistic goal. It implies that a person must never try any substance, which is not realistic or socially normal. Additionally, since it is a negative message, using the strong word “no,” it associates only negative feelings with substances. When some adolescents do decide to experiment with a substance, and feel the initial positive effects, they might be more likely to reject the message, as it once again is not consistent with the world in which they live. Thus, D.A.R.E. is ineffective because its central message is not consistent with a communication theory that emphasizes teaching adolescents the complicated truth.

Based on the social science theories discussed above, it is clear that D.A.R.E. needs to change its methods in order to become effective. First of all, in order to truly impact a student’s ability to resist peer pressure, and thus drugs and alcohol, D.A.R.E. needs to address the deeper social causes that play into resisting peer pressure. Since family cohesiveness affects the ability to resist peer pressure, D.A.R.E. needs to improve family strength and cohesiveness within each community. It could do so by involving parents in the entire process of drug resistance education. D.A.R.E. could create programs where police officers and teachers educate parents, from pregnancy onwards, teaching good parenting skills, with role playing, resources for further ideas and help, anger management techniques, and eventually information about how to teach children the truth about drugs. In order for this method to work, D.A.R.E. officers would need to include active community members in the process, so that the community accepts the D.A.R.E. officers and the messages they teach about parenting. D.A.R.E. would need to ensure that it was reaching all parents, and not just those who are more likely to be involved in their children’s lives. D.A.R.E. would also need to be willing to alter its parents program slightly depending on the specific community it is working with, in order to include cultural and social differences. By teaching good parenting skills from before a child is born, and using community members as fellow teachers, there is a chance that more children will be brought up in families that are more emotionally cohesive. These families would thus be more likely to have strong family ties, providing the skills and emotional environment that improve a child’s ability to resist peer pressure, and thus drugs and alcohol.

Unfortunately, in order to ensure that all children are raised in such families, changes would need to be made on a much larger scale, and would potentially reach beyond the capabilities of D.A.R.E. However, D.A.R.E., being organized and run by police officers, could take a stand on some of the larger issues at hand. For example, D.A.R.E. could actively support government policy changes that would improve neighborhoods, increase minimum wage, improve all school systems, decrease racial residential segregation, and create free job preparation courses. D.A.R.E. would need to be careful to advocate for positive policy changes without supporting a particular political party, as one of the beneficial aspects of D.A.R.E. is its wide-based support group, and supporting a particular political party could isolate people who have different political ideas. However, as long as D.A.R.E. was aware of this and was careful to not support a particular party line, D.A.R.E. could avoid losing its wide support base. As Williams and Collins suggest, interventions need to happen in geographic contexts, which D.A.R.E. could help establish by supporting changes on a larger, governmental level [13]. Since the police force is so crucial to the functioning of the United States, if they organized and focused in part on supporting policy change, they could have a huge impact on some of the structural barriers to improving family strength. Once some of these structural barriers are eliminated or at least diminished, the strength and cohesiveness of many families would improve, and they would be able to provide an environment in which children would be more likely to resist peer pressure, and not experiment with drugs and alcohol.

Another suggestion to improve D.A.R.E. is to ask the target audience what they want and need, as Siegel suggests be done for public health campaigns aimed towards preventing the spread of HIV among gay men [14]. D.A.R.E. could administer peer-lead focus groups and questionnaires where students who have participated in D.A.R.E. could express their comments, concerns, and suggestions. D.A.R.E. could ask students why they chose to use or to not use substances, and what factors they consider to be important in their ability to resist peer pressure. D.A.R.E. might be surprised how much it could learn from the adolescents who are facing peer pressure and who decide, despite what D.A.R.E. teaches them, to experiment with drugs. D.A.R.E. could learn equally as much from the students who choose not to use drugs, as they could help identify what skills, family influences, and decisions aid in staying away from drugs. After all, learning why adolescents decide to experiment or not with drugs could lead to important lessons that D.A.R.E. could incorporate in its program. Understanding peer pressure from the adolescent’s perspective and including this in its curriculum could result in a much more effective D.A.R.E. program.

Furthermore, in order to engage adolescents and improve the likelihood that they will listen to the messages being taught, D.A.R.E. needs to change who is teaching the message. As shown earlier, adolescents tend to rely on peers for cues as to how to act, and tend to rebel against parents and parental figures. Thus, if D.A.R.E. officers taught some students the D.A.R.E. messages, so that these students could then go into classrooms and teach their peers, it is likely that more students would pay attention to the messages, as they would be coming from peers. While this might be seen as risky, adolescents are likely to act more maturely when given responsibility. In fact, Kassebaum has shown that “Inviting at-risk teenagers to help another, such as a younger sibling, rather than just portraying them as victims or problems, can instill purpose, hope, and self-confidence” [17]. Thus, training as many youths as possible, and not just the best students or student leaders, to teach other students these important ideas could not only be more effective for the students who are learning, but also for the students who are teaching. Clearly, D.A.R.E. would not initially support this idea, as it would significantly limit the amount of D.A.R.E. officers in classrooms. However, D.A.R.E. officers would still be needed in order to teach the peer teachers the lessons. Additionally, the D.A.R.E. officers could then spend time in other areas of the community, such as D.A.R.E. sponsored after school programs, policy advocacy, and parental education. This approach would make D.A.R.E. much more effective, as students would be more likely to listen to and follow the messages that D.A.R.E. wants to teach.

Finally, in order to ensure that the message that the peer teachers are sharing is effective, D.A.R.E. would need to change the message from “Just Say No” to something more positive and honest. D.A.R.E. would need to take the time to create a curriculum that included a more in-depth look at the differences between substances, and how some can potentially be used in a responsible manner. In fact, STAR (Students Taught Awareness and Resistance), one of the most effective drug prevention programs, encourages students to discuss both the seemingly positive and negative effects of substances [18]. In this way, students are able to address and deal with their curiosity, and learn that while substances may have some positive initial effects, the negative effects outweigh them. Students would thus be taught a more complex, truthful message, and be more likely to see this same message over and over again in their daily lives. This is consistent with communication theories, which emphasize the importance of teaching adolescents consistent messages in all aspects of their lives, and in ensuring that the messages they hear are the same as what they experience in their lives. Thus, D.A.R.E. would be more effective, as the message it would teach would be more positive, realistic, and consistent.

Interestingly, D.A.R.E. recently updated its curriculum based on social science theories. The University of Akron, sponsored by the Robert Wood Johnson Foundation, is in its fourth year of a five year evaluating of the new D.A.R.E. program. It appears that they are making some positive changes by incorporating some ideas from the social sciences [19]. However, there is much criticism from many social scientists, who attended a meeting with D.A.R.E. officials to give their advice on how to make D.A.R.E. more effective, but were not included in the process of creating the new D.A.R.E. program [4].

One change that D.A.R.E. has made is to include a parental education component. This is a step in the right direction, as it involves parents in the process of preventing substance use. As shown above, one key way that D.A.R.E. could become more effective is by improving family cohesiveness among the families in each community, and this is one small way to begin to do that. Involving parents directly in their children’s education and teaching parents additional skills related to helping their children resist peer pressure is important. Unfortunately, parents that are already very involved in their children’s lives might be more likely to attend these D.A.R.E. sessions, and thus these programs will miss part of the target audience. Moreover, while these sessions might help a few parents improve their relationships with their children and thus potentially improve their family’s cohesiveness, there needs to be more research done to see whether a short term intervention that is offered when the child is in middle school could actually improve the strength of a family. It is likely that a much larger, societal level intervention would be necessary to improve family cohesiveness on a large scale basis by generally improving the socioeconomic levels of neighborhoods. If such a change were to happen, then these parental sessions could be useful in reinforcing certain ideas and in engaging the parents more in their children’s education. However, without changing the socioeconomic disparities that currently exist, it is difficult to imagine that these new parental sessions will improve family cohesiveness enough to impact the ability of children to resist peer pressure and thus not use drugs and alcohol. The addition of these sessions, while acknowledging that parents do play a key role in helping children resist drugs and alcohol, fail to really include social science theory and thus will not make D.A.R.E. more effective.

Another change that D.A.R.E. has made is to alter their core message from “Just Say No” to “Take Charge of Your Life,” which is a much more encouraging message that gives adolescents more of a sense of control in their lives. Contrary to its previous message, this message is positive, realistic, and consistent with what adolescents experience in their daily lives. “Take Charge of Your Life” gives adolescents more control over what choices they make and is more consistent with the reality they experience is, as this message implies that there are choices in life. Adolescents are less likely to reject this message outright, as it does not associate only negative feelings with substances, and as it does not indicate that avoiding substances is as easy as saying “No”. In fact, Zili Sloboda, who is the head of the research study about the new D.A.R.E. at the University of Akron, states that, “Students today are very sophisticated, and we have to be current with how we approach them… Obviously, they can't ‘just say no.’ We need to give them skills they can use, and then reinforce those skills” [20]. This is a constructive change that D.A.R.E. has made, and one that is based on communication theories. In this sense, D.A.R.E. has a chance at becoming more effective, as it is basing its central message on sound social science theory.

Another change that D.A.R.E. has made is to create a Youth Advisory Board (YAB). The YAB was created in 2000, and is composed of 50 students, one from each state who has graduated the D.A.R.E. program. According to the official D.A.R.E. website, “The YAB gives D.A.R.E. graduates an opportunity to speak to issues impacting the national and worldwide D.A.R.E. program and to advise D.A.R.E. America and local D.A.R.E. programs, government and community leaders on drug and violence prevention strategies beneficial to our youth” [21]. While this is an excellent idea, and supports social science theory that indicates how crucial it is to ask the target audience for their opinions and experiences, this is a very limited effort. Asking 50 students nation-wide for their ideas is helpful; however, when D.A.R.E. reaches over 75% of school districts in the nation, these 50 chosen students are not very representative. These children, as part of the YAB Mission Statement, must promise to remain drug and alcohol free [21]. Thus, D.A.R.E. is only including the perspectives of students who choose not to use substances, rather than getting a broader understanding of the complex issues of peer pressure by also including students who experiment with substances and students who abuse substances. By creating the YAB, D.A.R.E. is moving in the right direction by listening to social science theory, but is not going far enough to really get a broad sample of adolescents’ ideas and opinions regarding peer pressure and substance use.

D.A.R.E. is ineffective because it fails to base its program on social science theories. The new D.A.R.E. has incorporated psychology and communication theories into its curriculum, giving it the potential to be slightly more effective. However, the influence of D.A.R.E. will remain minimal until significant changes are made on a societal level that effect neighborhood safety, socioeconomic status, discrimination, and racial residential segregation. Until these issues are dealt with, many children will continue to be brought up in families that lack cohesiveness. The economic, emotional, and physical stresses that these issues place on families and communities jeopardize many efforts to reduce substance use among adolescents, as it is extremely difficult for families dealing with these issues to create strong family ties. All families need the opportunity to live in areas that are safe, that are not plagued by massive unemployment and poverty, and that offer good school systems and job opportunities. Economic and social policies need to be made on the national level that would address these issues and hopefully provide the opportunity for families to live in safer neighborhoods, improve their socioeconomic status, and not have to deal with discrimination or racial residential segregation. Realistically, it is not feasible that D.A.R.E. alone would be able to bring about these large scale changes, as they would require massive efforts by youth, parents, teachers, police officers, and politicians. However, once these policies are created and enforced, and once D.A.R.E. relies more heavily on social science theories, D.A.R.E. will be in a much better position to effectively influence adolescents. In the meantime, D.A.R.E. must incorporate more social science theories to improve its program so that it can become more effective and disseminate valuable messages that will impact adolescents and reduce drug and alcohol use.


References

1. About D.A.R.E.: New D.A.R.E.. (n.d.). Retrieved September 30, 2006, from http://www.dare.org/home/about_dare.asp
2. Perry, C. L., Komro, K. A., Veblen-Mortenson, S., Bosma, L., Munson, K., Stigler, M., Lytle, L. A., Forster, J. L., & Welles, S.L. (2000, March). The Minnesota DARE PLUS project: creating community partnerships to prevent drug use and violence. Journal of School Health, 70(3), 84-88. Retrieved November 5, 2006, from Health Reference Center Academic database (A61822581).
3. Drug education programs fail in Houston. (1999, January-February). Society, 36(2), 3-5. Retrieved November 5, 2006, from Expanded Academic ASAP database (A61822581).
4. Miller, D. W. (2001, October). DARE Reinvents Itself—With Help From Its Social-Scientist Critics. The Chronicle of Higher Education, 48(8), NA. Retrieved November 5, 2006 from Health Reference Center Academic database (A146948720).
5. Perry, C.L. (2003, February). A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. Plus programs. Archives of Pediatrics & Adolescent Medicine, 157, 178-84. Retrieved November 5, 2006 from Health Reference Center Academic database (A105929633).
6. Rosenbaum, D. (1998, November). Assessing the effects of school-based drug education: a six-year multilevel analysis of project D.A.R.E. Journal of Research in Crime and Delinquency, 35(4), 381-412. Retrieved November 5, 2006, from Expanded Academic ASAP database (A21255328).
7. U.S. General Accounting Office. (2003, January). Youth illicit drug use prevention: DARE long-term evaluations and federal efforts to identify effective programs. GAO-03-172R. Retrieved November 1, 2006 from http://www.gao.gov/new.items/d03172r.pdf
8. U.S. Department of Health and Human Services: National Institute on Drug Abuse. (2003, October). Preventing drug use among children and adolescents: a research-based guide for parents, educators, and community leaders (2nd ed.). 04-4212(B). Retrieved October 12, 2006 from http://www.drugabuse.gov/pdf/prevention/InBrief.pdf
9. Gray, P. (1999). Psychology (3rd ed.), (p. 627). New York: Worth Publishers.
10. Haan, M., Kaplan, G., & Camacho, T. (1987). Poverty and health: prospective evidence from the Alameda County Study. American Journal of Epidemiology, 125, 989-998.
11. Lu, N., Samuels, M., & Wilson, R. (2004). Socioeconomic differences in health: how much do health behaviors and health insurance coverage account for? Journal of Health Care for the Poor and Underserved, 15, 618-630.
12. Krieger, N. & Sidney, S. (1996). Racial discrimination and blood pressure: the CARDIA study of young black and white adults. American Journal of Public Health, 86, 1370-1378.
13. Williams, D. R. & Collins, C. (2001). Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Reports, 116, 404-416.
14. Siegel, M. (2004). The importance of formative research in public health campaigns: an example from the area of HIV prevention among gay men (Appendix 3-A, pp. 66-69). In Siegel, M., Doner, L., Marketing public health: strategies to promote social change. Sudbury, MA: Jones and Bartlett Publishers.
15. Gray, P. (1999). Psychology (3rd ed.), (p. 468). New York: Worth Publishers.
16. Austin, E. W. (1995). Reaching young audiences: developmental considerations in designing health messages. In Mailbach, E., & Parrot, R. L. (Eds.), Designing health messages: approaches from communication theory and public health practice (p. 124). Thousand Oaks, CA: Sage Publications.
17. Austin, E. W. (1995). Reaching young audiences: developmental considerations in designing health messages. In Mailbach, E., & Parrot, R. L. (Eds.), Designing health messages: approaches from communication theory and public health practice (p. 131). Thousand Oaks, CA: Sage Publications.
18. Austin, E. W. (1995). Reaching young audiences: developmental considerations in designing health messages. In Mailbach, E., & Parrot, R. L. (Eds.), Designing health messages: approaches from communication theory and public health practice (p. 116). Thousand Oaks, CA: Sage Publications.
19. A longitudinal evaluation of the new curricula for the D.A.R.E. middle (7th grade) and high school (9th grade) programs: take charge of your life—year four progress report. (2006, March). Retrieved September 30, 2006, from http://www.dare.org/home/Resources/documents/DAREMarch06ProgressReport.pdf
20. Maltin, L. J. (2001, February). D.A.R.E. program will test new approach. Retrieved October 12, 2006 from http://www.dare.com/new_site/curriculum/DARE_program_test.htm
21. D.A.R.E. America Youth Advisory Board (n.d.). Retrieved October 12, 2006 from http://www.dare.com/youthadvisoryboardmission.asp

6 Comments:

Anonymous Anonymous said...

Excellent stuff. I am pleased to know that D.A.R.E. is finally getting its act together. Have you ever thought about sending your critique to your local police department? Who knows- they might be receptive!

10:13 AM  
Anonymous Anonymous said...

Ooops! Last comment was from me.-Heidi

10:14 AM  
Anonymous Stephanie said...

Hi Laura-
I think your paper is excellent. I liked your discussion on the role of the family in helping a child deal with the peer pressure that leads to drug use. I know of someone very close to me that had become addicted to drugs, and I can't help but think that the divorce of his parents at an early age was a contributing factor in him experimenting with drugs in the first place. Keeping the lines of communication and support open to your children when going through a divorce is paramount (although quite hard to do during such a tumultuous time).
Your comment that having a parental, authoritive figure delivering this anti-drug message is an ineffective approach is right on. Kids are definitely more likely to listen to a message delivered by their peers rather than by someone they spend their adolescent life rebelling against. I am happy to hear D.A.R.E has changed it's slogan to TAKE CHARGE OF YOUR LIFE- this message will be much more effective, as it gives control and power back to the child, and also gives them a sense of autonomy at the same time (core values of the audience).
I agree with Heidi- you should submit this paper to D.A.R.E and to local police departments. I bet it would be very well receive and certainly very helpful.

Awesome job!

Steph

7:23 PM  
Anonymous Anonymous said...

Very interesting and thoughtful paper...I too agree that local police departments might be receptive to this.

4:11 PM  
Anonymous Anonymous said...

Very interesting and thoughtful. Too bad a critique such as this can't easily effect policy changes.

4:15 PM  
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