Alcohol Use and Misuse Prevention Strategies with Minors

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
Interventions designed to reach youth in

• Schools
• Families
• Communities

3
Interventions to be Discussed
Those that seek to change

• Psychological characteristics
• Sociological characteristics
• Immediate social environment

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 5th grade program plus a
  6th 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 7th 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 Educations effects were long-lasting
  but not permanent

10
Adolescent Alcohol Prevention Trial Results
11
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

12
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

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 12-14 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
• Mothers use of alcohol and drugs
• Quality of care of child
• Mothers adjustment

26
Nurse Home Visits Outcomes15-Year Follow-up

• Improved childrens 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 childs 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
Youth-centered interventions should

• 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