Program

Apr 01, 2009

OVERVIEW

The Dartmouth Prevention Project
aimed to reduce tobacco and alcohol use and increase safety among elementary
school-aged youth by using the family pediatrician to communicate messages to
the parents and children. Twelve pediatric practices were paired. One in each
pair was randomly assigned to deliver a treatment to prevent alcohol and tobacco
use. The other was assigned to deliver a treatment to address gun safety, and
use of bicycle helmets and seat belts. An evaluation of the program found an
increase in bicycle helmet use, but no significant impacts on smoking, alcohol
use, seatbelt use, or gun storage.

DESCRIPTION OF PROGRAM

Target population: Families
with children in elementary school

The Dartmouth Prevention Project
utilizes the pediatric primary care clinician to deliver facts and engage the
parent and child in discussion about alcohol and tobacco use or bicycle helmet
and seatbelt use, and safe gun storage. Clinicians and families sign contracts
pledging that the family will talk about these issues and family policies will
be developed. The office staff also repeats these messages during interactions
with the families. Program staff supports the information with site visits,
telephone calls, newsletters, and other informational materials delivered to the
clinical site and mailed to families. Ten days after signing the contract,
families receive a letter from their clinician reinforcing the agreement with a
magnet with which to attach the contract. The clinician continues to provide
the family with new risk behavior information at each visit for 36 months.
Families also receive reinforcement through 24 newsletter mailings over 36
months. Parent newsletters contain information on communication skills, risk
factor data, family activities, and website and book reviews. Child newsletters
contain communication strategies, risk-factor data, games, puzzles, and quizzes.

Pediatricians and nurse
practitioners are trained in a three-hour on-site session. Training includes a
presentation on rationale behind the program’s components and data on risk
behaviors. Clinicians participate in role-playing exercises to practice
increasing parent awareness of risk behaviors and gaining family commitment.

EVALUATION(S) OF PROGRAM

Stevens,
M. M., Olson, A. L., Gaffney, C. A., Tosteson, T. D., Mott, L. A., & Starr, P.
(2002). A pediatric, practice-based, radomized trial of drinking and smoking
prevention and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics, 109, 490-497.

Evaluated
Population: 
3,145 families with a child in fifth or
sixth grade from 12 pediatric primary care practices in Massachusetts, New
Hampshire, and Vermont completed baseline assessments. The mean child age was
11 years. Approximately 58% of the families had an income of over $50,000, and
approximately 16% of families had an income below $30,000. 84 percent of the
families were married-couple families.

Approach: Families were recruited by pediatric
clinicians. Families were eligible for the study if they had a child in fifth
or sixth grade and parents had to accompany the child to their appointment.
Pediatric practices were randomly assigned to receive the safety portion of the
intervention or the alcohol/tobacco portion of the intervention. Thus, there
was not a no-treatment control group.

Children were assessed, through a self-administered survey, on alcohol and
tobacco use, bicycle helmet and seatbelt use, and gun access and use. The
parent survey assessed parent and spouse alcohol and tobacco use, perception of
child’s alcohol and tobacco use, bicycle and seatbelt use, gun storage in the
home, parenting style, and child’s behavior problems.

Results:
At 24 and 36 months, there was a
non-significant increase in child alcohol use among the children who received
the alcohol/tobacco intervention. At 36 months, there was a significant
increase in bicycle helmet use among the children receiving the safety
intervention compared with children receiving the alcohol/tobacco intervention.
There were no significant impacts for smoking, smokeless tobacco, seatbelt use,
or gun storage at any follow-up.

SOURCES FOR MORE INFORMATION

References:

Stevens, M. M., Olson, A. L., Gaffney, C. A., Tosteson, T. D., Mott, L. A., &
Starr, P. (2002). A pediatric, practice-based, radomized trial of drinking and
smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics, 109, 490-497.

KEYWORDS: Middle
Childhood (6-11), Clinic-based, Children (3-11), Alcohol Use, Tobacco Use,
Elementary, Seat Belt Use, Helmet Use

Program
information last updated on 4/1/09.

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