1 Alcohol Use and Misuse Prevention Strategies with Minors William B. Hansen Linda Dusenbury Tanglewood Research Prepared for the Institute of Medicine Workshop on Underage Drinking October, 2002

2 Focus Schools Families Communities Interventions designed to reach youth in:

3 Interventions to be Discussed Psychological characteristics Sociological characteristics Immediate social environment Those that seek to change:

4 School-Based Programs

5 Large Scale Alcohol-Specific School-Based Studies Alcohol Misuse Prevention Trial AMPS (Dielman et al.; University of Michigan) Adolescent Alcohol Prevention Trial AAPT (Hansen et al.; University of Southern California and Tanglewood Research) Project Northland (Perry et al.; University of Minnesota)

6 AMPS Intervention Two trials (original and enhanced) Focused on teaching students to refuse peer pressure to use alcohol Intervention included a 5 th grade program plus a 6 th grade booster

7 AMPS Outcomes Program effects were not observed for non-drinking students Program effects were observed for students who had previously used alcohol Mediating variable analysis revealed no effect for resistance skills increase but an effect for normative beliefs

8 AAPT Interventions Four groups –Information only –Resistance Skills Training –Normative Education –Combined (Resistance Skills plus Normative Education Targeted 7 th grade students

9 AAPT Outcomes Resistance Skills Training and Information only were not effective in reducing alcohol use Normative Education was effective in reducing alcohol use Normative Education’s effects were long-lasting but not permanent

10 Adolescent Alcohol Prevention Trial Results

11 Project Northland Intervention Intervention for 6 th, 7 th, and 8 th grades Create a non-drinking norm for teens Provide positive role models Decrease opportunities to get alcohol Self-efficacy to resist social influences Reinforce value of non-drinking

12 Project Northland Outcomes By 8 th grade, students participating in Project Northland reduced –Weekly alcohol consumption –Monthly alcohol consumption –Their tendency to drink Effects disappeared by 10 th grade

13 Project Northland Drinking Prevalence Outcomes

14 Norms Refers to two concepts: –How common a behavior is –How acceptable a behavior is Can be applied: –To an entire society –To generational, cultural, religious, ethnic, and friendship sub-groups within society

15 How Do Different Groups of Drinkers Estimate Prevalence?

16 School-Based Norm Setting Approaches Correct erroneous perceptions of the norm among individuals Build positive norms among the peer group Reinforce positive norms within the community

17 Family-Based Approaches

18 Family-Based Studies Family Matters (Bauman et al.; University of North Carolina) Preparing for the Drug Free Years (Hawkins et al.; University of Washington) Project Northland (Perry et al.; University of Minnesota) Nurse Home Visits (Olds et al.; University of Houston)

19 Family Matters Families with year olds Four booklets with follow-up phone calls –Parental monitoring –Parent-child communication –Family policies –Conflict resolution –Resistance skills training

20 Family Matters Outcomes Reductions in tobacco and alcohol use in the 12 months following the program Increased rule setting in families about tobacco and alcohol use

21 Project Northland Informational packets and homework activities to be completed by parents and children together. Focus on: –Family policies –Family meetings –Communicating with teens

22 Project Northland Outcomes By 6th grade, more parents had spoken to students about drinking By 8th grade, more families had rules about drinking

23 Preparing for the Drug Free Years Five session program for parents of children 8-14 Focuses on risk and protective factors Communication Family management skills Resistance skills

24 Preparing for the Drug Free Years Outcomes Increased communication between parents and children Improved quality of parent-child relationship Improved parents’ norms concerning alcohol Reduced the onset of alcohol use Savings of $5.85 in alcohol-use disorder costs for every dollar spent

25 Nurse Home Visits Targets low-income women Addresses: –Maternal health –Child development and parenting –Support by family and friends –Linkages to services Focuses on: –Mother’s use of alcohol and drugs –Quality of care of child –Mother’s adjustment

26 Nurse Home Visits Outcomes 15-Year Follow-up Improved children’s I.Q. scores. Reduced risk for substance use by children and parents. –79% fewer incidents of child abuse or neglect –69% fewer arrests of the mother –44% reduction in behavioral problems due to alcohol and drug abuse

27 Family Factors that Reduce Alcohol Use and Misuse Parental monitoring Parental support of child’s involvement in positive alternatives Positive family norms Clear family policies and rules

28 Community-Based Approaches

29 Large Scale Community-Based Studies Project Northland (Perry et al., University of Minnesota) Community Trials Intervention (Holder et al., PIRE)

30 Project Northland Mobilized community-wide task forces Promoted awareness and provided alcohol-free recreational activities Peer participation program (T.E.E.N.S.) students planned alcohol-free activities

31 Project Northland Outcomes 16% of students participated in planning an activity for their peers 50% attended at least one activity Student planners reduced their levels of alcohol use in 7th grade Five alcohol-related ordinances and three resolutions were passed Local ordinances required responsible beverage service training

32 Community Trials Intervention Three pairs of communities in California and South Carolina. Focuses on: –Organization & mobilization –Responsible beverages service –Drinking and driving –Availability to underage drinkers –Zoning and municipal control.

33 Community Trials Interventions Youth Outcomes Reduced sales to minors Off-premises outlets were half as likely to sell to underage drinkers Greater adoption of responsible serving policies Institutionalization

34 Community-Based Approaches Build coalitions and partnerships that have the goal of establishing positive norms Limit access to alcohol Provide positive alternatives

35 Conclusions Be multi-component and integrated Be sufficient in dose and follow-up Promote positive norms Promote parental monitoring Limit access to alcohol Be interactive Be implemented with fidelity Youth-centered interventions should: