Adolescent Alcohol Prevention Trial

Adolescent Alcohol Prevention Trial

OVERVIEW

The Adolescent Alcohol Prevention Trial (AAPT) is a school-based drug prevention program that uses different social psychology-based strategies. The program gives students behavioral skills and knowledge to prevent the onset of substance use. Two of the strategies incorporated in the program were particularly successful. The Resistance Skills Training (RT) and the Normative Education Strategy (NORM) are reported to impact students’ beliefs about alcohol and drugs as well as their knowledge of resistance skills. The Normative Education Strategy was also proven to predict and help reduce subsequent substance use and abuse. When evaluating for alcohol, marijuana and tobacco use, those students receiving the combined NORM/RT and the NORM classes reported significantly lower incidence rates of substance use.

DESCRIPTION OF PROGRAM

Target population: The program is administered in fifth grade, and a booster program is given in the seventh grade.

AAPT incorporates several social psychology-based strategies to prevent the onset of drug use in adolescents. One of these strategies is Resistance Skills Training (RT). RT teaches adolescents behavioral skills for refusing drug offers. The second strategy is a Normative Education Strategy (NORM), which focuses on correcting false perceptions about the prevalence of drug use. Finally, the Information About Consequences of Use (ICU) component provides adolescents information about the social and health consequences on drug use. Each strategy uses lessons taught in the classroom.

EVALUATION(S) OF PROGRAM

STUDY 1: Donaldson, S.I., Graham, J.W., & Hansen, W.B. (1994). Testing the generalizability of intervening mechanism theories: Understanding the effects of adolescent drug use prevention interventions. Journal of Behavioral Medicine, 17(2), 195-216.

Evaluated population: Evaluated participants consisted of 124 elementary schools in Los Angeles and San Diego County. In total, there were 229 classrooms and 3,077 fifth-grade students involved at pre-test. The sample was 47 percent male and 53 percent female; 57 percent white, 27 percent Hispanic, 10 percent Asian, 3 percent African-American, and 4 percent other ethnic groups; 62 percent attended public schools and 38 percent attended private schools. Schools were randomly assigned into one of four conditions. This evaluation of AAPT examined specific strategies.

Approach: The strategies/conditions were as follows: The first condition received Resistance Skill Training (RT) and Information About Consequences of Use (ICU). The second condition received Normative Education Strategy (NORM) and Information About Consequences of Use. The third condition received Resistance Skill Training, Normative Education Strategy, and Information About Consequences of Use. The fourth condition received Information About Consequences of Use only

The researchers hypothesized that students who receive RT will have better outcomes than students who do not. They also hypothesized that students who receive NORM will have lower drug use than students who do not. Finally the researchers hypothesized that students who received NORM will believe that drug use is less acceptable and consequently participation will be predictive of actual drug use.

The researchers measured outcomes at pre-test when students were in fifth grade, at post-test in seventh grade, and at post-test in eighth grade. Outcomes were measured using a variety of instruments. To measure drug use, alcohol use, cigarette use, and marijuana use indices were used asking students to report their level of use. Resistance skills were measured using a behavioral assessment, where the student was observed and rated by peers, adults, and self on his or her response to a role-play of a persistent offer of alcohol. Finally, beliefs about alcohol and drug use were measured using questionnaires and written scenarios.

Results: Results of the study indicate that Resistance Skill Training (RT) impacts beliefs about alcohol and drug use and resistance skills, however it did not have an impact in reducing actual alcohol and drug use. NORM had an impact on beliefs about alcohol and drugs, resistance skills, as well as alcohol, smoking, and marijuana use. NORM was also found to predict subsequent adolescent substance use. Overall, RT was effective at increasing resistance skills and NORM was effective at strengthening beliefs about alcohol and drug use and reducing the prevalence of drug and alcohol use. Adolescents with the lowest prevalence estimates were those who received a combination of Resistance Skills Training and Normative Education. The researchers stated that teaching resistance skills along with changing beliefs about alcohol and drug use was an effective method of reducing drug use.

The evaluation notes several limitations to its findings. The first limitation is that only self-report was used to measure outcomes. The second limitation which is noted is that students who missed the booster or failed to provide 8^th grade data were not included in analyses. The final admitted limitation is that the external validity of the study is questionable because probability sampling was not used to select schools and consequently it is unclear if findings can be generalized to American adolescents or even adolescents in Los Angeles and San Diego Counties, where the study was conducted.

STUDY 2: Hansen, W.B., & Graham, J.W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20, 414-430.

Evaluated Population: Participants consisted of 2,416 seventh grade students in 12 junior high schools in Los Angeles and Orange counties; FL. Participants were randomly assigned into one of four intervention groups. One group received ICU. A second group received RT. A third group received NORM and a final group received NORM, ICU, and RT.

Approach: Participants were pre-tested prior to the start of the program in seventh grade and then post-tested after the end of the program in eighth grade (the 1987 and 1988 school years). Measures consisted of a questionnaire that assessed participants use of marijuana, alcohol, and cigarettes in their life and recently (e.g., last 30 days, last 7 days). The questionnaire also asked about whether participants had discipline problems at school or had engaged in violent/destructive behavior in the past month.

Results: Results of the study indicate that participants in the NORM group reported significantly lower use of alcohol, marijuana, and cigarettes than participants who did not receive NORM. For example, at pretest the reported prevalence of weekly alcohol use among students was 4.5 percent. Students receiving the NORM program reported an increase in weekly alcohol use of 2.8 percent versus a 5.1 percent increase among those not receiving NORM. Rates of reported marijuana use were similar. NORM classes reported a 2.2 percent increase in rates of marijuana use between pre and posttest whereas non-NORM classes reported an increase as high as 6.2 percent. Cigarette consumption also followed this trend with NORM students reporting consistently lower smoking rates than those who did not receive NORM classes. The NORM and RT combined intervention was most effective in preventing onset of marijuana and cigarette use. Overall, there were no significant outcomes when using only Resistance Skill Training only. The researchers concluded that it is important to establish conservative behavioral norms in preventing drug use.

STUDY 3: Taylor, B. J., Graham, J. W., Cumsille, P., & Hansen, W. B. (2000). Modeling prevention program effects on growth in substance use: Analysis of five years of data from the adolescent alcohol prevention trial. Prevention Science, 1(4), 183-197.

Evaluated Population: Participants consisted of 3,027 Los Angeles area 7^th grade students that completed participation in 11^th grade. The sample was included 47 percent white, 28 percent Hispanic, 16 percent Asian, and 2.5 percent black. Males and females were nearly equal.

Approach: Students were randomly assigned by school to one of four combinations of AART program components (ICU, RT, Norm, COMB). The ICU group acted as the control. The groups were as follows: The first group received Information About Consequences of Use (ICU), which taught the social and health consequences of using alcohol and drugs. The second group received Resistance Skill Training (RT), which provided the information lessons plus strategies to resist pressure to use illicit substances. The third group, Normative Education Strategy (NORM), received the information lessons and lessons that corrected misperceptions about the prevalence and acceptability of alcohol and drug use. The fourth group (COMB) combined resistance training and normative education plus the information group. The study examined five drug use variables: lifetime cigarette smoking, recent cigarette smoking, lifetime alcohol use, recent alcohol use, and lifetime drunkenness.

Results: NORM had a beneficial effect on all five drug use variables, and helped to slow the rate of growth in student drug use. The rate of growth is important at this period of life (11^th grade), because it may indicate “normal” versus “abnormal” development, and seventh graders who are on a steeper onset trajectory may be at greater risk for drug-related problems later in life. The Norm program also altered the trajectory of alcohol use, and students maintained a lower, more stable rate of change throughout the study. The COMB program, unfortunately, was not found to have any significant effects on students.

SOURCES FOR MORE INFORMATION

References

Donaldson, S.I., Graham, J.W., & Hansen, W.B. (1994). Testing the generalizability of intervening mechanism theories: Understanding the effects of adolescent drug use prevention interventions. Journal of Behavioral Medicine, 17(2), 195-216.

Hansen, W.B., & Graham, J.W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20, 414-430.

Taylor, B. J., Graham, J. W., Cumsille, P., & Hansen, W. B. (2000). Modeling prevention program effects on growth in substance use: Analysis of five years of data from the adolescent alcohol prevention trial. Prevention Science, 1(4), 183-197.

Program categorized in this guide according to the following:

Evaluated participant ages: Fifth grade students at pre-test/ Program age ranges in the Guide: 6-11, 12-14

Program components: school-based

Measured outcomes: physical health, behavioral problems, life skills

KEYWORDS: Substance Use, Illicit Drugs, Adolescent, Elementary, Middle Childhood, Alcohol, Cigarettes, Marijuana, School-based, Hispanic or Latino, Asian, Black or African American, White or Caucasian, Middle School, Community-Based, Adolescents, High School.

Program information last updated 5/12/2008.

		© Child Trends 2003