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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: