Schools need to get serious about underage drinking prevention efforts. Why? Because, as we noted on Day 2, the risk factors that influence underage drinking also impact academic performance and social interactions. Historically, communities and organizations have explored different ideas to reduce underage drinking. Most have not been terribly effective to date. Those that have had measurable impact have some elements in common. One of those common elements is a comprehensive approach that includes individuals, parents, schools, and the community (Reducing Underage Drinking, p.2).

Ineffective Programs

According to Reducing Underage Drinking, "programs relying on provision of information alone, fear tactics, or messages about not drinking until one is 'old enough' have consistently been found to be ineffective in reducing alcohol use and, in some cases, produce boomerang effects" -- an increased use of alcohol (Botvin, 1995; Swisher et al., 1971). These studies speculate that this may occur because the information provided increased the youths' curiosity about alcohol, or because teens believe many other young people drink (Cialdini et al., 1990).

In addition, programs that focus on strategies to only resist peer pressure have been ineffective. That is in part because peer influence is usually subtle and does not take the form of direct pressure, which these strategies focus on (Donaldson, 1995). Another ineffective approach is to identify youth who are drinking alcohol and engaging in other risky behaviors and put them in groups with similar adolescents. There have been mixed results from this approach. Some research has indicated that high-risk behaviors actually increase in these groups, which again highlights the boomerang effect (Paglia and Room, 1999), and this is consistent with research on the harmful effects of some group interventions (Dishion et al., 1999).

Effective School Programs/Effective School Components

In general, current research indicates effective prevention programs should be designed with a focus on the risk protective factors we looked at in Day 2. The National Highway Traffic Safety Administration Community How to Guide on Prevention sums it up best: "Prevention programs no longer focus only on reaching individuals and providing knowledge about alcohol and drugs. Newer efforts emphasize programs and policies that shape knowledge, beliefs and behavior by changing the environment in which the target audience lives . . . the community, school, family, and cultural environments." That means providing support to young people to enhance their risk protective factors. Strengthening families, improving parenting skills, and helping families to establish strong, consistent norms about alcohol and other drug use can help prevent substance abuse, including underage drinking, as well as violence and other related problems.

The Substance Abuse and Mental Health Services Administration (SAMHSA) promotes these three strategies for prevention, which readily incorporate the risk and protective factors:

• Universal -- As the name implies, universal interventions are districtwide, schoolwide, and classroomwide interventions for every child in the district, school, or class. Universal interventions prevent risk factors from developing or intensifying and build a foundation that supports the efficiency and effectiveness of early and intensive interventions (Osher et al., p. 9). Universal programs:

  • Address the entire population with messages, skills and programs designed to prevent or delay the use and abuse of alcohol, tobacco, and other drugs.

  • Vary in type, design, structure, and delivery mechanisms. They can include school, family, and community-based programs.

  • Primarily reflect environmental influences such as community values, economic, and employment stability, school support and other issues.

• Selective -- Selective programs target specific, defined groups of people who are at risk for severe academic or behavioral difficulties:

  • Target subgroups of the population such as a fraternity or sorority on a college/ university campus or parents who belong to the PTA.

  • Recipients are recruited to participate, and program activities are generally more involved in the daily lives of the participants.

  • Risk factors only predict the increased likelihood of a poor outcome for members of a group. When targeting groups, it is important to avoid stigmatizing the groups or all members of the groups.

• Indicated -- Indicated programs target specific individuals and families, rather than entire groups. These programs target individuals who are already experiencing early signs of substance abuse such as youth who have been cited for an underage drinking offense or those who are exhibiting problems in school.

  • Focus more on the individual than on factors in the community and address issues such as alienation from parents, school and peers and various conduct disorders.

  • Individuals are specifically recruited based on an assessment of the individual's personal risk or related problem behaviors, rather than relying on membership in a subgroup (SAMHSA, SAMHSA Model Programs: IOM Classifications).

Click here to see examples of universal, selective, and indicated approaches in reducing underage drinking.

On Day 4 we'll take a look at how your needs assessment will guide your choice of key strategies as you begin to develop your prevention plan.

Effective Programs Engage the Community

Comprehensive prevention programs involve all segments of the community and infuse prevention into the community, family, and social environment. Alan Leshner, Director of the National Institute on Drug Abuse, underscored this point in his plenary address to the National Conference on Drug Abuse Prevention Research:

John Bunker, president of New Futures, a nonprofit, nonpartisan organization seeking to reduce underage alcohol problems and increase access to treatment, has worked in schools for 25 years. In a recent interview, Bunker recommends that schools take some key steps in addressing the problem of underage drinking.

First, he says schools need to have a comprehensive plan for addressing the problems. To do so, they need to know the scope of the problem of alcohol and other drug use and the consequences of such use. Consequences can include tardiness, juvenile arrests, drunk driving, etc. He recommends that schools conduct needs assessments to learn more about the problems and people's perceptions of alcohol and other drug issues. Once they have that information, school officials need to put policies in place and enforce them fairly.

"What happens in a lot of places is that the jocks get treated differently," Bunker said. "If the captain of the football team gets busted for drinking, he plays the next day. Any other kid would get suspended" (Bunker, personal communication).

Bunker and other practitioners say that it is critical to work with parents as well. Some parents believe that drinking is a rite of passage and even supply their children with alcohol. Research shows that parents are a key influence in when youth decide to drink. Parents need information to educate them and help guide their children. Students are also a critical component of any work.

"Kids have to be part of the solution," Bunker said. "Invite them to help. What can we do to create alcohol or drug free activities at school?" If it's only faculty or staff driven its not going to have a lot of staying power."

Finally, the community must be involved. That means reminding merchants about not selling to underage youth, working with police to develop solutions to drinking and driving and planning ways that the community sends a message against underage drinking. Most communities have coalitions against alcohol and drug abuse. The school should be part of that coalition, Bunker said.

Community How To Guides

The National Highway Traffic Safety and Administration (NHTSA) developed a series of Community How To Guides on Underage Drinking Prevention. The Prevention and Education Guide discusses the importance of preventing underage drinking and provides an overview of recent advances in prevention planning. Universal, selective and indicated prevention strategies are discussed within the framework of risk and protective factors to assist communities in developing successful programs. These are the strategies NHTSA recommends at each level of prevention and intervention:

Approaches That Schools Can Take

So, what does work in schools? Meta-analyses of school-based interventions show that they vary widely in their ability to affect alcohol-related outcomes. Positive effects are, in statistical terms, small to modest (e.g., Gottfredson and Wilson, 2003). Here's a quick summary of what research tells us works in school-based programs.

Effective Programs Schools Can Adopt

There are a great many programs being conducted in schools throughout the United States that are effectively impacting underage drinking. How do you know which to implement in your school? Based on the findings of your needs assessment, you will be able to identify problem areas in your school and community, and the probable risk factors behind those problems. To be effective, the program you select for your school needs to target those specific risk factors. "Change must be more than cosmetic. . . school community members and other stakeholders must ensure that improvements are deep and systemic, changing both the structure and the culture of the school" (Osher et al. p. 6).

Safe, Supportive, and Successful Schools has an extensive program matrix that analyzes these programs on four criteria: targeted grade level, level of intervention, environment of program implementation, and the targeted areas (Osher et al., pp.132-134). We're going to highlight a few of those programs here.

• Project Northland- Project Northland has been recognized as an outstanding program model by several agencies: Model Program -- Substance Abuse and Mental Health Services Administration; Exemplary Program -- U.S. Department of Education; Rated "A" -- Drug Strategies, Making the Grade.

Project Northland is a community-wide intervention designed to reduce alcohol use. The program spans seven academic years and involves students, parents, peers, community members businesses and organizations. The most intense intervention is in the first phase, which covers grades six through eight. In the second phase, which covers ninth and tenth grades, there are minimal interventions. Finally, the third phase, which covers eleventh and twelfth grades, resumes its intensity in programming.

The program components are:

• Classroom curricula.
• Parent Involvement and Education.
• Peer Leadership and Participation.
• Community Task Forces.
  

Field staff for Project Northland also recruited community-wide task forces. The task forces, whose members represented a cross-section of the community, concentrated on areas including: (1) promoting awareness of alcohol issues among teens; (2) the organization and implementation of alcohol-free recreational activities for adolescents; (3) discussions with local alcohol merchants about their alcohol-related policies concerning young people; and (4) distribution of materials that support policies such as ID checks and legal consequences for selling alcohol to minors.

The most dramatic effects of the program occurred at the end of Phase I. The eighth-grade intervention group showed a 29 percent reduction on past week drinking and a 19 percent reduction in past month use. Researchers attributed the reductions primarily to changes in peer norms, peer drinking behavior, parent-child communication that reinforced abstention, increase negative perceptions about the consequences of alcohol use and increase resistance skills, according to students' survey responses.

However, during the phase in ninth and tenth grade when interventions were minimal, there were no statistically significant differences between students in the intervention and control communities on any alcohol use measures. When the program resumed its intensity in grades 11 and 12, there some statistical differences in alcohol use, but not at the level of the first phase.

"The failure of the project to maintain its effectiveness during the interim phase demonstrates the importance of intervention throughout adolescence, and it also points to the significance of community-level policy and other actions that change community norms around youthful drinking," write the authors in the IOM report Reducing Underage Drinking: A Collective Responsibility. "The Project Northland team has increased their focus on community-level change in a replication of the program that is currently under way in 61 schools and communities in the Chicago area" (Reducing Underage Drinking, p. 221).

• Linking the Interests of Families and Teachers (LIFT) -- LIFT targets first and fifth grade children and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. LIFT is based on the developmental model of behavior. It focuses on how the interactions of children with parents, peers, and school staff contribute to or exacerbate conduct problems (Patterson, Reid, & Dishion, 1992).

LIFT is a ten-week program that combines classroom activities with parent training, a playground behavioral program, and systematic communication between teachers and parents. The focus is on changing specific behaviors of the children (opposition, defiance, and social ineptitude) and the parents' reactions to their behavior (discipline and monitoring of the children.)

Short term evaluations showed positive results: decreased aggression on the playground, and decreased aversive behavior in mothers. Three years later these children exhibited fewer increases in attention deficit disorder behaviors (inattentiveness, impulsivity, and hyperactivity). By fifth-grade, these students had fewer associations with delinquent peers and were less likely to initiate patterned alcohol use (Osher et al., p. 171).

Classroom instructors, school staff, and playground staff will require some training. A high level of parent involvement and strong parent commitment is essential to the successful implementation of this program.

• Project STAR: Students Taught Awareness and Resistance -- Project STAR is a community-based, multifaceted program for adolescent drug abuse prevention. Primarily a classroom initiative, STAR does extend to the family and the community.

STAR targets peer use of drugs and peer approval of drugs and drug use. The program helps youth about to enter middle school or junior high recognize the "tremendous social pressures to use drugs and provides training skills in how to avoid drug use and drug situations" (Osher et al., p. 206). In the first year of the program, teachers present 10-13 sessions on resistance skills. There are five additional sessions in the second year to bolster that message. These lessons employ student peer leaders and active social learning techniques including modeling, role playing, and discussions. Parents and other family members are involved through homework assignments. The parental program also involves a parent-principal committee which reviews school drug policy and parent-child communications training.

Project STAR has demonstrated considerable success in reducing drug use and abuse, and those gains have been maintained throughout high school and, in some cases, beyond:

• up to a 40 percent reduction in marijuana use and smaller reductions in alcohol use;
• effect on daily smoking, heavy marijuana use, and some hard drug use;
• increased parent-child communications about drug use;
• facilitated development of prevention programs, activities, and services among community leaders (Osher et al., p. 207).

• SOAR, The Seattle Social Development Project -- SOAR promotes the healthy development of young people by increasing opportunities for active involvement in family and school, improving skills for successful participation in family, school, peer groups, and community (Osher et al., p. 225).

SOAR targets several specific risk factors: lack of commitment to school, poor family management, family conflict, favorable parental attitudes towards drugs, alienation, friends who use drugs, early initiation of drug use, and early antisocial behaviors. SOAR also enhances protective factors, and sets healthy beliefs and standards for behavior.

Staff development is a major component of SOAR. Instructional improvement workshops and classroom coaching sessions is aimed at improving the students' academic achievement and bonding to the school. The parent component enhances parents' skills in helping their children succeed academically. The third component provides children with social and citizenship skills and allows them to practice social and emotional skills in the classroom.

Program outcomes to date have been very positive and extend over a long period of time. At age 18, for example, "fewer full-intervention students had engaged in violent . . . acts, heavy drinking, sexual activity. . . fewer SOAR students had become pregnant or had caused pregnancies" (Osher et al., p. 226). Academic achievement was markedly improved, and aggressive and self-destructive behaviors were reduced.

• Reach Out Now: Talk to Your Fifth Graders about Underage Drinking

Reach Out Now started as a collaboration between the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, and Scholastic, Inc., Now in its fourth year, the "Reach Out Now" program provides SAMHSA materials to fifth and sixth grade teachers to educate youngsters before they become teens about the dangers to young bodies associated with alcohol. The program provides classroom teachers with a set of underage drinking-related materials.

The classroom teaching packet includes:

• Understanding the effects of alcohol on the developing child
• A science experiment in which students observe the effects of pouring alcohol on an egg
• A unit on making healthy decisions by using critical-thinking skills and finding alternative activities to drinking

The take home packet includes:

• A Family Resource Guide filled with activities to help parents:
  • Maintain good lines of communication
  • Get involved in the child's life
  • Make and enforce clear and consistent rules
  • Serve as a positive role model for their child
  • Help a child know how to choose friends wisely
  • Be aware of the child's activities
  • Parents are also encouraged to create a family calendar to keep track of the activities of all the family members so that the parent is more involved in the child's life.

The materials are based on research supported by SAMHSA and the National Institute on Alcohol Abuse and Alcoholism at the National Institute of Health.

References for Day 3materials:

BEST Foundation. Project ALERT. Available: http://www.projectalert.best.org/

Bonnie, Richard J., and O'Connell, Mary Ellen. (Eds.) (2004). Reducing Underage Drinking: A Collective Responsibility. Washington: National Research Council, Institute of Medicine, The National Academies Press. Available: http://www.nap.edu/books/0309089352/html/

Botvin, G.J., Baker, E. Dusenbury, L. Botvin, E.M., and Diaz, T. (1995). Long-term followup results of a randomized drug abuse prevention trial in a white middle-class population. Journal of the American Medical Association, 273(14), 1106-1112.

Botvin, G.J., Botvin, E.M., Ruchlin, H. (1998). School-Based Approaches to Drug Abuse Prevention: Evidence for Effectiveness and Suggestions for Determining Cost-Effectiveness. In: Bukoski, W.J., editor. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph No. 176 59-82. Washington, DC: U.S. Department of Health and Human Services. Available: http://www.drugabuse.gov/pdf/monographs/
monograph176/059-082_Botvin.pdf

Bunker, John. (August 2005). Personal Communication.

Center for the Study and Prevention of Violence. Linking the Interests of Families and Teachers (LIFT). Available: http://www.colorado.edu/cspv/blueprints/promising/
programs/BPP09.html

Cialdini, R.B., Reno, R.R., and Kallgren, C.A. (1990). A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places. Journal of Personality and Social Psychology, 58, 1015-1026.

Dishion, T.J., McCord, J., and Poulin, F. (1999), When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755-764. Available: http://www.prevention.psu.edu/events/documents/
Dishionetal1999_WhenInterventionsHarm.pdf

Donaldson, S.I., Graham, J.W., Piccinin, A.M., and Hansen, W.B. (1995). Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools. Health Psychology, 14(4), 291-300.

Dusenbury, L. (2000). Family-based drug abuse prevention programs: A review. Journal of Primary Prevention, 20, 337-352.

Gottfredson, D.C., and Wilson, D.B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4(1), 23-38.

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

Hazelden Foundation. Project Northland. Available: http://www.hazelden.org/servlet/hazelden/cms/ptt/
hazl_7030_shade.html?sh=t&sf=t&page_id=27170

Holder, H.D., Gruenewald, P.J., Ponicki, W.R., Grube, J.W., Saltz, R.F., Voas, R.B., Reynolds, R., Davis, J., Sanchez, L., Gaumont, G., Roeper, P., and Treno, A.J. (200). Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of Studies on Alcohol, 54, 23-26.

Kersten, K. (September 17, 1997). Commentary: Is DARE Doing Kids More Harm? Star Tribune, Minneapolis, MN. Available: http://www.amexp.org/Publications/Archives/Kersten/kersten091797.htm

Komro, K.A., Perry, C.L., Beblen-Mortenson, S., and Williams, C.L. (1994). Peer participation in Project Northland: A community-wide alcohol use prevention project. Journal of School Health, 64, 318-322.

Leshner, Alan I., Ph.D. (1996). Plenary address: From the prevention research lab to the community. National Institute on Drug Abuse. Available: http://www.drugabuse.gov/MeetSum/CODA/Prevention.html

National Highway Traffic Safety and Administration. (2001). Community How to Guide on Education and Prevention. Available: http://www.nhtsa.dot.gov/people/injury/alcohol/
Community%20Guides%20HTML/Book4_Prevention.html

Osher, David, Dwyer, Kevin, & Jackson, Stephanie. (2004). Safe, Supportive, and Successful Schools Step by Step. Colorado: Sopris West.

Paglia, A., and Room, R. (1999). Preventing substance use problems among youth: A literature review and recommendations. Journal of Primary Prevention, 20(1), 3-50.

Patterson, G.R., Reid, J.B., and Dishion, T. J. (1992). Antisocial boys: A social interactional approach. Eugene, OR: Castalia Publishing.

Rohrbach, L.A., Johnson, C.A., Mansergh, G., Fishkin, S.A., and Neumann, F.B. (1997). Alcohol-related outcomes of the day one community partnership. Evaluation and Program Planning, 20(3), 315-322.

Swisher, J.D., and Hoffman, A. (1975). Information: The irrelevant variable in drug education. In B.W. Corder, R.A. Smith, and J.D. Swisher (Eds.), Drug Abuse prevention: Perspectives and approaches for educators. Dubuque, IA: William C. Brown.

Tobler, N. S., and Stratton, H.H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of research. Journal of Primary Prevention, 18, 71-128.

University of Southern California. Project Star: Students Taught Awareness and Resistance. Available: http://www.projectstar.info

University of Washington. SOAR, The Seattle Social Development Project. Available: http://depts.washington.edu/ssdp/

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (n.d.). SAMHSA model programs. Rockville, MD: Author. Available: http://modelprograms.samhsa.gov/template.cfm?page=IOMClass

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2002). SAMHSA's reach out now. Rockville, MD: Author. Available: http://www.teachin.samhsa.gov/

Vicary, J.R., Snyder, A.R., and Henry, L.L. (2000). The effects of family variables and personal competencies on the initiation of alcohol use by rural seventh grade students. Adolescent and Family Health, 1(1), 11-20.