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Alcohol Use and Misuse Prevention Strategies with
Minors
William B. HansenLinda Dusenbury
Tanglewood Research
Prepared for the Institute of MedicineWorkshop on Underage Drinking
October, 2002
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Focus
• Schools• Families• Communities
Interventions designed to reach youth in:
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Interventions to be Discussed
• Psychological characteristics• Sociological characteristics• Immediate social environment
Those that seek to change:
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School-Based Programs
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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)
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AMPS Intervention
• Two trials (original and enhanced)
• Focused on teaching students to refuse peer pressure to use alcohol
• Intervention included a 5th grade program plus a 6th grade booster
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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
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AAPT Interventions
• Four groups– Information only– Resistance Skills Training– Normative Education– Combined (Resistance Skills plus
Normative Education
• Targeted 7th grade students
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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
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Adolescent Alcohol Prevention Trial Results
Effect of Programs on Drunkenness
0%
5%
10%
15%
20%
25%
30%
7 8
Grade
Information
Resistance Skill
Norm Setting
Combined
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Project Northland Intervention
• Intervention for 6th, 7th, and 8th 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
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Project Northland Outcomes
• By 8th grade, students participating in Project Northland reduced– Weekly alcohol consumption– Monthly alcohol consumption– Their tendency to drink
• Effects disappeared by 10th grade
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Project Northland Drinking Prevalence
Outcomes
0%
5%
10%
15%
20%
25%
30%
Past Week Past Month
Northland Control
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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
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How Do Different Groups of Drinkers Estimate Prevalence?
Estimates of Peer Group Prevalence
0%10%20%30%40%50%60%70%80%90%
100%
6 7 8 9 10 11 12Grade
Non Drinkers Light Drinkers Heavy Drinkers
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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
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Family-Based Approaches
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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)
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Family Matters• Families with 12-14 year olds
• Four booklets with follow-up phone calls
– Parental monitoring
– Parent-child communication
– Family policies
– Conflict resolution
– Resistance skills training
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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
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Project Northland
• Informational packets and homework activities to be completed by parents and children together.
• Focus on:– Family policies– Family meetings– Communicating with teens
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Project Northland Outcomes
• By 6th grade, more parents had spoken to students about drinking
• By 8th grade, more families had rules about drinking
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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
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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
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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
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Nurse Home Visits Outcomes15-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
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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
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Community-Based Approaches
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Large Scale Community-Based Studies
• Project Northland (Perry et al., University of Minnesota)
• Community Trials Intervention (Holder et al., PIRE)
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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
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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
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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.
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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
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Community-Based Approaches
• Build coalitions and partnerships that have the goal of establishing positive norms
• Limit access to alcohol• Provide positive alternatives
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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: