Program

Jul 06, 2012

OVERVIEW

The Adolescent Alcohol Prevention Trial (AAPT) is a school-based drug prevention program that uses several 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. NORM was also shown to help reduce the likelihood of subsequent substance use and abuse.  When evaluated for alcohol, marijuana and tobacco use, students receiving the combined NORM/RT or the NORM classes reported significantly lower incidence rates of substance use than did students not receiving some version of NORM.

DESCRIPTION OF PROGRAM

Target population: Students in 5th grade, middle school, and high school

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 skills for identifying and resisting pressure from peers or advertising to use drugs/alcohol. The second strategy is a Normative Education Strategy (NORM), which focuses on correcting false perceptions about the acceptability and prevalence of drug use among peers, while also establishing conservative norms for the school environment in terms of substance use.  Finally, the Information About Consequences of Use (ICU) strategy provides adolescents with information about the social and health consequences of drug use.  Each strategy is administered through lessons taught in the classroom.

EVALUATION(S) OF PROGRAM

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: Participants consisted of 3,077 fifth-grade students from 229 classrooms in 124 elementary schools in Los Angeles and San Diego County.  The sample was 47 percent male; 57 percent of students were 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.

Approach: Schools were divided into 48 independent units and then randomly assigned to one of four separate conditions.  Schools in the first condition received Information About Consequences of Use (ICU) only, which consisted of four, 45-minute lessons. The second condition received Resistance Skill Training (RT) (five lessons) and ICU.  The third condition received Normative Education Strategy (NORM) (five lessons) and ICU.  The fourth, combined condition (COMB) received RT, NORM ICU , three and one-half lessons of RT, three and one-half lessons of NORM, and ICU.

To measure the effectiveness of the program, data were collected on students’ reported alcohol, cigarette, and marijuana use, resistance skills, and their beliefs about the acceptability of alcohol and drug use.  Students’ beliefs about the prevalence (of offers) of alcohol, marijuana, and cigarettes at school were also measured.  The researchers measured outcomes at pre-test when students were in fifth grade, at post-test in seventh grade (when a booster program was administered), and at post-test in eighth grade.

Results: RT had a positive, statistically significant impact on students’ resistance skills at the individual, classroom, and school levels.  RT also had a statistically significant impact on beliefs about alcohol and drug use.  However it did not have an impact in reducing actual alcohol and drug use.

NORM had a statistically significant impact on resistance skills, perceived prevalence of offers, and perceived acceptability of use, at all three levels of analysis.  NORM also had a significant impact reducing the reported prevalence of drug and alcohol use.

COMB  (RT + NORM) was significantly related, at the individual and classroom levels, to perceived prevalence of offers.  Adolescents with the lowest prevalence estimates were those who received a combination of RT and NORM.

The study authors note several limitations to their findings.  First, only self-report was used to measure outcomes.  Second, students who missed the booster or failed to provide 8th-grade data were not included in analyses.  The external validity of the study is also limited, because probability sampling was not used to select schools and consequently it is unclear whether findings can be generalized to U.S. students or even to students in Los Angeles and San Diego Counties, where the study was conducted.

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 3,011 seventh-grade students in 12 junior high schools in Los Angeles and Orange Counties, California.

Approach: Participants were randomly assigned to one of four intervention groups, by classroom (conditions, design of programs, and number of lessons were as described in the preceding study).  The conditions consisted of ICU only (N=32 classrooms), RT+ICU (N=33), NORM+ICU (N=27), and RT+NORM+ICU (N=26).

To measure the effectiveness of the program, data were collected on students’ reported use of marijuana, alcohol, and cigarettes (lifetime use and recent/past 30 day use), and discipline problems and violent or destructive behavior in school, as a result of alcohol use (also self-reported).  Data were collected at baseline (pre-test), and at follow-up at the end of the program (during the students’ eighth-grade year).

Results: Participants who received a version of the NORM program reported significantly lower use of alcohol, marijuana, and cigarettes than participants who did not receive some version of NORM.  The NORM-and-RT combined intervention was most effective in preventing onset of marijuana and cigarette use.  Overall, there were no significant outcomes associated with RT only; in fact, RT was less effective at preventing onset of substance use than the ICU-only condition.  NORM was also shown to significantly reduce problem behavior associated with alcohol use.

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 7th-grade students who completed participation in 11th grade.  The sample was 47 percent white, 28 percent Hispanic, 16 percent Asian, and 2.5 percent black.  Proportions of males and females were nearly equal.

Approach: Students were randomly assigned by school to one of four combinations of program components (ICU, RT, NORM, COMB; conditions as described in the first study).  To measure the effectiveness of the program, data were collected on five self-reported drug-use variables: lifetime cigarette smoking, recent cigarette smoking, lifetime alcohol use, recent alcohol use, and lifetime drunkenness.  Data were collected at baseline (7th grade), and at 8th, 9th, 10th, and 11th grades.

Results: NORM had a beneficial effect on all five measures of drug use, and helped to slow the rate of growth in student reported drug use.  The NORM program also altered the trajectory of reported alcohol use, such that students maintained a lower, more stable rate of change throughout the study.  The RT and COMB programs were not found to have any significant impacts on students’ reported drug use.

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.

KEYWORDS: Children, Adolescents, Elementary, Middle School, Males and Females (Co-ed), School-based, Skills Training, Tobacco Use, Marijuana/Illicit/Prescription Drugs, Alcohol Use, Aggression, Other Behavior Problems

Program information last updated 7/6/12

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