Alcohol Prevention Programs Research Articles

Extramedical Use of Prescription Pain Relievers by Youth Aged 12 to 21 Years in the United States

OBJECTIVE To identify when youth are most likely to start using prescription pain relievers to get high or for other unapproved indications outside the boundaries of what a prescribing physician might intend (ie, extramedical use). DESIGN Cross-sectional surveys of adolescent cohorts, 2004 to 2008. SETTING The United States. PARTICIPANTS Large nationally representative samples of youth in the United States who had been assessed for the 2004 through 2008 National Survey on Drug Use and Health, yielding data from 138729 participants aged 12 to 21 years. MAIN OUTCOME MEASURES Estimated age-specific risk of starting extramedical use of prescription pain relievers, year by year, and confirmation of age at peak risk by tracing the experience of individual cohorts during this period. RESULTS The estimated peak risk of starting extramedical use of prescription pain relievers occurs in midadolescence, well before the college years. The age at peak risk is 16 years, when an estimated 2% to 3% become newly incident users. Smaller risk estimates are observed at age 12 to 14 years and at age 19 to 21 years. CONCLUSIONS For initiatives to prevent youth from using prescription pain relievers to get high or for other unapproved indications, a focus on the last year of high school and the post-secondary school years may be too little too late. Practice-based approaches are needed in addition to public health interventions based on effective alcohol and tobacco prevention programs during the earlier adolescent years.

Federal structures of the prevention of alcohol misuse among children and youths.

Health political background Hazardous alcohol consumption of children, adolescents and young adults has been increasing for several years in Germany. Alcohol prevention programs are intended to stop this development. For the review of the efficacy of these programs the German Institute for Medical Documentation and Information (DIMDI) has commissioned a health technology assessment (HTA) which has given an international overview of the efficacy of alcohol prevention measures. German alcohol prevention measures are insufficiently included in scientific electronic data bases. This report has therefore the aim to find out the efficacy of German alcohol prevention programs and the federal structures of funding bodies.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15 to 20 years with a low educational background: study protocol for a randomized controlled trial

BackgroundThe serious negative health consequences of heavy drinking among adolescents is cause for concern, especially among adolescents aged 15 to 20 years with a low educational background. In the Netherlands, there is a lack of alcohol prevention programs directed to the drinking patterns of this specific target group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that aims to reduce alcohol use among heavy drinking adolescents aged 15 to 20 years with a low educational background.Methods/designThe effectiveness of the What Do You Drink (WDYD) web-based brief alcohol intervention will be tested among 750 low-educated, heavy drinking adolescents. It will use a two-arm parallel group cluster randomized controlled trial. Classes of adolescents from educational institutions will be randomly assigned to either the experimental (n = 375: web-based brief alcohol intervention) or control condition (n = 375: no intervention). Primary outcomes measures will be: 1) the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking, 2) reductions in mean weekly alcohol consumption, and 3) frequency of binge drinking. The secondary outcome measures include the alcohol-related cognitions, attitudes, self-efficacy, and subjective norms, which will be measured at baseline and at one and six months after the intervention.DiscussionThis study protocol presents the study design of a two-arm parallel-group randomized controlled trial to evaluate the effectiveness of the WDYD web-based brief alcohol intervention. We hypothesized a reduction in mean weekly alcohol consumption and in the frequency of binge drinking in the experimental condition, resulting from the web-based brief alcohol intervention, compared to the control condition.Trial registrationNetherlands Trial Register NTR2971

Magnitude of the Problem of Drinking Alcohol on College Campuses, Commentary on “Structuring a College Alcohol Prevention Program on the Low Level of Response to Alcohol Model: A Pilot Model”

The objective of this commentary is to discuss the significance of the study entitled, "Structuring a College Alcohol Prevention Program on the Low Level of Response to Alcohol Model: A Pilot Model" by Schuckit and colleagues (2012) published in this issue of the Alcoholism: Clinical and Experimental Research. The work by Schuckit and colleagues emphasizes the importance of personalizing an alcohol prevention program for college students. This pilot model is the result of over 30 years of clinical translational research on an individual's level of response to alcohol. The prevention program is efficient, simple, safe, cost-effective and self-directed. The results indicate the computerized intervention was associated with decreases in drinking overall and students with a low level of response to alcohol showed greater decreases when the prevention program is personalized to focus on how level of response is affected by peer influence, alcohol expectancies, and stress management. It concludes that college students with a low level of response to alcohol will benefit from a prevention program that is personalized to this well documented endophenotype. The findings provide the foundation for developing future longitudinal studies of the proposed prevention program with a larger sample size on diverse campuses. In addition, as mentioned in the Discussion section, future studies could also evaluate the effectiveness of other easily measured clinical endophenotypes known to be associated with alcohol use such as impulsivity, negative effect, and maximum number of drinks per occasion.

A Comparison of Maternal Outcomes From an Alcohol, Tobacco, and Other Drug Prevention Program for Mothers Choosing an Intervention Versus Being Randomized

Self-determination theory and substantial research findings suggest that more desirable outcomes may occur when participants are able to choose their prevention or treatment interventions, as having a choice may lead to greater motivation and feelings of self-efficacy. The present study examined the influence of having a choice of family-based prevention programs for youth alcohol, tobacco, and other drug use on mothers' communication outcomes. Families (N = 496) were those with an 11- to 12-year-old enrolled in Kaiser Permanente medical centers at one of four locations. Results from multivariate repeated measures analyses supported the importance of having a choice for improved communication outcomes. As compared with families who were randomly assigned to a program, those allowed to choose showed improved tobacco-specific and peer pressure communication, with marginally improved alcohol communication. No differences were found between the groups for general communication. Results suggest that allowing mothers to participate in decisions about health-related interventions for their teens may lead to better outcomes.

An Assessment of Community Capacity to Prevent Adolescent Alcohol Consumption

To effectively address the issue of youth alcohol use, communities need to have sufficient infrastructure and capacity in place to operate effective prevention programs. This study evaluates community capacity in the state of Hawai'i, using the Capacity Assessment Survey administered to stakeholders in the youth alcohol prevention system. Capacity is quantified with gap scores, which measure the discrepancy between an agency's performance of an attribute and the attribute's relative importance. Six assessment areas, termed capacity domains, are defined. Results are given for each county and the state overall. Based on these results, communities need to prioritize capacity-building efforts specifically in the domains of effectiveness, funding/resource availability, and sustainability. Organization, workforce skills/knowledge, and cultural competency were categorized as relative strengths in comparison, but gap scores are nevertheless significantly greater than 0 ("ideal"; p < .001), indicating these areas need improvement as well. Suggestions for improvement in each capacity domain are given. This assessment is the first step in a five-step planning process to implement youth alcohol prevention programs in communities in Hawai'i.

Stereotypic information about drinkers and students’ observed alcohol intake: An experimental study on prototype–behavior relations in males and females in a naturalistic drinking context

BackgroundCross-sectional and longitudinal research has shown that favorable drinker prototypes (i.e., perceptions about the typical drinker) are related to higher levels of alcohol consumption in adolescents and college students. So far, few studies have experimentally tested the causality of this relationship and it is not clear what type of manipulation affects drinker prototypes and drinking levels. MethodsIn an experimental 1-factor design with two levels, we tested the short-term effects of exposing students to either positive or negative stereotypic information about drinkers on their drinker prototypes and actual drinking behaviors. We exposed 192 male and female college students to positive drinker prototype information (drinkers in general were presented as being attractive, sociable and successful), or to negative information (unattractive, unsociable and unsuccessful). Subsequently, participants’ levels of alcohol consumption were observed unobtrusively while they were interacting with peers in a naturalistic drinking context, namely a bar lab. ResultsParticipants exposed to positive stereotypic information about drinkers reported more favorable drinker prototypes than participants exposed to negative stereotypic information. Multilevel analyses revealed that men's subsequent alcohol consumption in the bar lab was higher in the positive prototype condition than in the negative prototype condition. For women, no prototype effects on alcohol use were found. ConclusionsThese findings underline that drinker prototypes affect actual alcohol use in men and suggest that changing perceptions of drinkers may be a useful tool in alcohol prevention programs.

Structuring a College Alcohol Prevention Program on the Low Level of Response to Alcohol Model: A Pilot Study

New approaches are needed to bolster the modest effects of campus drinking prevention programs. However, more definitive research on new paradigms is very expensive, and in the current economic climate, progress can be made by evaluating smaller pilot studies. This study describes one such approach. A sample of 18-year-old or older, healthy, drinking freshmen at our university was assigned to 2 groups stratified to be similar on demography, drinking histories, and their level of response (LR) to alcohol. In the spring quarter of the school year, the 32 subjects in each of 2 groups viewed four 45-minute Internet-based videotapes as part of 4 prevention sessions. All 8 modules were based on the same techniques and general content, but the 4 videos for the first group were structured around the validated model of how a low LR affects heavy drinking (the low level of response-based [LRB] Group), with partial mediation by heavier drinking peers, positive alcohol expectancies, and drinking to cope with stress. Videos for the state-of-the-art (SOTA) comparison group did not place the similar prevention messages into the low LR framework. Changes in drinking were evaluated at 3 times: before Module 1, before Module 4, and 1month after Module 4. Usual and maximum drinks per occasion decreased over time for both high and low LR subjects in both LRB and SOTA groups. As predicted, the low LR students showed greater decreases in the LRB Group, while high LR students showed greater decreases in the more generic SOTA Group. The results support the hypothesis that tailoring prevention efforts to address specific predisposing factors, such as a low LR, may be associated with beneficial effects on drinking quantity. We hope that these data will encourage additional efforts to validate the low LR-based prevention paradigm and test other interventions that are targeted toward predisposing phenotypes such as impulsivity and negative affect.

Differential Impact of a Dutch Alcohol Prevention Program Targeting Adolescents and Parents Separately and Simultaneously: Low Self-Control and Lenient Parenting at Baseline Predict Effectiveness

To test whether baseline levels of the factors accountable for the impact of the Prevention of Alcohol use in Students (PAS) intervention (self-control, perceived rules about alcohol and parental attitudes about alcohol), moderate the effect of the intervention. A cluster randomized trial including 3,490 Dutch early adolescents (M age = 12.66, SD = 0.49) and their parents randomized over four conditions: 1) parent intervention, 2) student intervention, 3) combined intervention and 4) control group. Moderators at baseline were used to examine the differential effects of the interventions on onset of (heavy) weekly drinking at 34-month follow-up. The combined intervention was only effective in preventing weekly drinking among those adolescents who reported to have lower self-control and more lenient parents at baseline. No differential effect was found for the onset of heavy weekly drinking. No moderating roles of self-control and lenient parenting were found for the separate student and parent interventions regarding the onset of drinking. The combined intervention is more effective among adolescents with low-self control and lenient parents at baseline, both factors that were a specific target of the intervention. The relevance of targeting self-control in adolescents and restrictive parenting is underlined.

“They must be 18 years old ... really”. Alcohol debut discourses at parent meetings within alcohol prevention programmes in school

Aims This article analyses how parents discuss norms of youth alcohol debut at meetings of alcohol prevention programmes in schools. The focus is on how different ways of argumentation can help to deal with dilemmas between what parents perceive to be the right age of debut, what they describe as common, and what they consider is possible to realise. Methods and Data The data mainly consists of audio recordings of conversations at parent meetings arranged by an alcohol prevention programme in the eighth grade at four schools in four different locations in Norway. The study takes its inspiration from discourse analysis. Results The analysis identifies three different patterns of parent discussions about alcohol debut. This information is used to construct three discourses of norms for alcohol debut, namely, a traditional discourse, a discourse of modern upbringing and a discourse of legalisation. Both the traditional opinions, which centre on the significance of the confirmation age, and the modern individualised norms are challenged by arguments for an 18-year limit in these discussions. Conclusion The legal age limit of 18 years seemed implicitly or explicitly to be a strong resource of argumentation for formulating common norms for alcohol debut. In the parents’ discussions, too, the consensus seems to be moving towards the 18-year age limit.

Parent and child characteristics related to chosen adolescent alcohol and drug prevention program

Parent and child characteristics related to chosen adolescent alcohol and drug prevention program

Developing a school-based drug prevention program to overcome barriers to effective program implementation: The CLIMATE schools: Alcohol module

Although effective school-based alcohol prevention programs do exist, the overall efficacy of these programs has been compromised by implementation failure. The CLIMATE Schools: Alcohol Module was developed to overcome some of the obstacles to high fidelity program implementation. This paper details this development of the CLIMATE Schools: Alcohol Module. The development involved two stages, both of which were considered essential. The first stage, involved reviewing the literature to ensure the program was based on the most effecttive pedagogy and health promotion practice and the second stage involved collaborating with teachers, students and specialists in the area of alcohol and other drugs, to ensure these goals were realised. The final CLIMATE Schools: Alcohol Module consists of computer-driven harm minimisation program which is based on a social influence approach. The program consists of six lessons, each with two components. The first component involves students completing an interactive computer-based program, with the second consisting of a variety of individual, small group and class-based activities. This program was developed to provide an innovative new platform for the delivery of drug education and has proven to be both feasible and effective in the school environment. The success of this program is considered to be testament to this collaborative development approach.

Binge Drinking Among Underage College Students: Role of Impulsivity and the Transtheoretical Model

A major public health problem facing American colleges is binge drinking by students with adverse effects on academic achievement and self-fulfillment. The short-term negative consequences of binge drinking include memory loss, hangovers, and blackouts. Binge drinking has been related to campus problems, suicides, violence, sexually transmitted diseases (STDs), heightened aggression, automobile accidents, property damage, and academic failure. This study investigated the relationship of impulsivity to readiness to change binge drinking behavior among college students attending a 4-year university. The theoretical formulation for the study was based on Prochaska and DiClemente's transtheoretical model. Participants were volunteer undergraduate college students from a state-supported Southeastern University. The students were recruited from undergraduate classrooms, fraternities, and sororities. The volunteer participants were 248 undergraduate college students enrolled in a 4-year university in the southeastern United States. This study consists of a subgroup, 131 of the 248 participants which were 93 binge drinkers and 38 nondrinkers. Three surveys were administered: the Student Alcohol Questionnaire (SAQ), Barratt's Impulsivity Scale (BIS-11), and the Brief Readiness to Change Questionnaire (BRCQ). Impulsivity was significantly correlated with binge drinking and the transtheoretical stages of change. Impulsivity can result in a lack of inhibitory control, which is a risk factor for binge drinking. The results of this study suggest that impulsivity may interfere with intentional behavioral change. This study may have valuable implications for the current and future design of alcohol prevention programs at institutions of higher education.

Parent and child characteristics related to chosen adolescent alcohol and drug prevention program

Mothers were allowed to choose between two different family-based adolescent alcohol-drug prevention strategies and the choice was examined in relation to parent and teen characteristics. Under real world conditions, parents are making choices regarding health promotion strategies for their adolescents and little is known about how parent and teen characteristics interact with programs chosen. The two programs were: Family Matters (FM) (Bauman KE, Foshee VA, Ennett ST et al. Family Matters: a family-directed program designed to prevent adolescent tobacco and alcohol use. Health Promot Pract 2001; 2: 81-96) and Strengthening Families Program (SFP) 10-14 (Spoth R, Redmond C, Lepper H. Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study. J Stud Alcohol Suppl 1999; 13: 103-11). A total of 272 families with an 11-12 years old enrolled in health care centers were in the choice condition of the larger study. SFP requires group meetings at specified times and thus demanded more specific time commitments from families. In contrast, FM is self-directed through booklets and is delivered in the home at a time chosen by the families. Mothers were significantly more likely to choose SFP when the adolescent had more problem behaviors. Mothers with greater education were more likely to choose FM. Findings may provide more real-world understanding of how some families are more likely to engage in one type of intervention over another. This understanding offers practical information for developing health promotion systems to service the diversity of families in the community.

Effectiveness of the home-based alcohol prevention program "In control: no alcohol!": study protocol of a randomized controlled trial.

BackgroundIn the Netherlands, children start to drink at an early age; of the Dutch 12-year olds, 40% reports lifetime alcohol use, while 9.7% reports last-month drinking. Starting to drink at an early age puts youth at risk of developing several alcohol-related problems later in life. Recently, a home-based prevention program called "In control: No alcohol!" was developed to delay the age of alcohol onset in children. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of the program.Methods/DesignThe prevention program will be tested with an RCT among mothers and their 6 grade primary school children (11-12 years old), randomly assigned to the prevention or control condition. The program consists of five printed magazines and an activity book designed to improve parental alcohol-specific socialization. Parent-child dyads in the control group receive a factsheet information brochure, which is the standard alcohol brochure of the Trimbos Institute (the Netherlands Institute for Mental Health and Addiction).Outcome measures are initiation of alcohol use (have been drinking at least one glass of alcohol), alcohol-specific parenting, susceptibility to drinking alcohol, alcohol expectancies, self-efficacy, and frequency and intensity of child alcohol use. Questionnaires will be administered online on secured Internet webpages, with personal login codes for both mothers and children. Mothers and children in both the experimental and control condition will be surveyed at baseline and after 6, 12, and 18 months (follow-ups).DiscussionThe present study protocol presents the design of an RCT evaluating the effectiveness of the home-based "In control: No alcohol!" program for 6 grade primary school children (11-12 years old). It is hypothesized that children in the prevention condition will be less likely to have their first glass of alcohol, compared to the control condition. When the prevention appears to be effective, it can easily and relatively quickly be implemented as a standard alcohol prevention program on a large scale.Trial registrationNederlands Trial Register NTR2564

Culture and Context: Buffering the Relationship Between Stressful Life Events and Risky Behaviors in American Indian Youth

The Sacred Mountain Youth Project was conducted to investigate risk and protective factors related to alcohol and drug use among American Indian youth. Findings indicated that stressful life events were positively associated with depressed mood, substance use, and risky behavior; cultural identity had no direct effects, but a secondary model showed that social support and protective family and peer influences were related to cultural identity. These findings suggest that the relationships between stressors and their negative sequelae are complex. Emphasis on protective processes that are culturally specific to American Indian youth may lead to effective alcohol and drug use prevention programs.

Alcohol Prevention and Evaluation in the Era of Evidence Based Practice – the Need for a Systematic Approach to Evaluation

AIMS This article focuses on the shortcomings of experimental outcome evaluations. MATERIAL The study uses two studies of the alcohol prevention program Prime for Life (PFL) to illustrate problems associated with a ‘one dimensional’ goal focus and how implementation may affect the efficiency of an intervention. Results As evidence based practice often fails to acknowledge the importance of context and implementation quality in its quest to find ‘what works’, it is argued in the article that a wider perspective on efficiency is needed in evaluations of alcohol prevention. CONSLUSIONS To be able to find out what works and during what circumstances, evaluators need to look for a wider set of traits that constitute effective interventions.

Targeting young drinkers online: the effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among college students: study protocol of a two-arm parallel group randomized controlled trial

BackgroundThe prevalence of heavy drinking among college students and its associated health related consequences highlights an urgent need for alcohol prevention programs targeting 18 to 24 year olds. Nevertheless, current alcohol prevention programs in the Netherlands pay surprisingly little attention to the drinking patterns of this specific age group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that is aimed at reducing alcohol use among heavy drinking college students aged 18 to 24 years old.Methods/DesignThe effectiveness of the What Do You Drink web-based brief alcohol intervention will be tested among 908 heavy drinking college students in a two-arm parallel group randomized controlled trial. Participants will be allocated at random to either the experimental (N = 454: web-based brief alcohol intervention) or control condition (N = 454: no intervention). The primary outcome measure will be the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking. These limits specify that, for heavy alcohol use, the mean consumption cannot exceed 14 or 21 glasses of standard alcohol units per week for females and males, respectively, while for binge drinking, the consumption cannot exceed five or more glasses of standard alcohol units on one drinking occasion at least once per week within one month and six months after the intervention. Reductions in mean weekly alcohol consumption and frequency of binge drinking are also primary outcome measures. Weekly Ecological Momentary Assessment will measure alcohol-related cognitions, that is, attitudes, self-efficacy, subjective norms and alcohol expectancies, which will be included as the secondary outcome measures.DiscussionThis study protocol describes the two-arm parallel group randomized controlled trial developed to evaluate the effectiveness of a web-based brief alcohol intervention. We expect a reduction of mean weekly alcohol consumption and frequency of binge drinking in the experimental condition compared to the control condition as a direct result of the intervention. If the website is effective, it will be implemented in alcohol prevention initiatives, which will facilitate the implementation of the protocol.Trial registrationNetherlands Trial Register NTR2665.

A research strategy case study of alcohol and drug prevention by non-governmental organizations in Sweden 2003-2009.

BackgroundAlcohol and drug prevention is high on the public health agenda in many countries. An increasing trend is the call for evidence-based practice. In Sweden in 2002 an innovative project portfolio including an integrated research and competence-building strategy for non-governmental organisations (NGOs) was designed by the National Board of Health and Welfare (NBHW). This research strategy case study is based on this initiative.MethodsThe embedded case study includes 135 projects in 69 organisations and 14 in-depth process or effect studies. The data in the case study has been compiled using multiple methods - administrative data; interviews and questionnaires to project leaders; focus group discussions and seminars; direct and participatory observations, interviews, and documentation of implementation; consultations with the NBHW and the NGOs; and a literature review. Annual reports have been submitted each year and three bi-national conferences Reflections on preventions have been held.ResultsA broad range of organisations have been included in the NBHW project portfolio. A minority of the project were run by Alcohol or drug organisations, while a majority has children or adolescents as target groups. In order to develop a trustful partnership between practitioners, national agencies and researchers a series of measures were developed and implemented: meeting with project leaders, project dialogues and consultations, competence strengthening, support to documentation, in-depth studies and national conferences. A common element was that the projects were program-driven and not research-driven interventions. The role of researchers-as-technical advisors was suitable for the fostering of a trustful partnership for research and development. The independence of the NGOs was regarded as important for the momentum in the project implementation. The research strategy also includes elements of participatory research.ConclusionsThis research strategy case study shows that it is possible to integrate research into alcohol and drug prevention programs run by NGOs, and thereby contribute to a more evidence-based practice. A core element is developing a trustful partnership between the researchers and the organisations. Moreover, the funding agency must acknowledge the importance of knowledge development and allocating resources to research groups that is capable of cooperating with practitioners and NGOs.

Evaluating a selective prevention programme for binge drinking among young adolescents: study protocol of a randomized controlled trial.

BackgroundIn comparison to other Europe countries, Dutch adolescents are at the top in drinking frequency and binge drinking. A total of 75% of the Dutch 12 to 16 year olds who drink alcohol also engage in binge drinking. A prevention programme called Preventure was developed in Canada to prevent adolescents from binge drinking. This article describes a study that aims to assess the effects of this selective school-based prevention programme in the Netherlands.MethodsA randomized controlled trial is being conducted among 13 to 15-year-old adolescents in secondary schools. Schools were randomly assigned to the intervention and control conditions. The intervention condition consisted of two 90 minute group sessions, carried out at the participants' schools and provided by a qualified counsellor and a co-facilitator. The intervention targeted young adolescents who demonstrated personality risk for alcohol abuse. The group sessions were adapted to four personality profiles. The control condition received no further intervention above the standard substance use education sessions provided in the Dutch national curriculum. The primary outcomes will be the percentage reduction in binge drinking, weekly drinking and drinking-related problems after three specified time periods. A screening survey collected data by means of an Internet questionnaire. Students have completed, or will complete, a post-treatment survey after 2, 6, and 12 months, also by means of an online questionnaire.DiscussionThis study protocol presents the design and current implementation of a randomized controlled trial to evaluate the effectiveness of a selective alcohol prevention programme. We expect that a significantly lower number of adolescents will binge drink, drink weekly, and have drinking-related problems in the intervention condition compared to the control condition, as a result of this intervention.Trial registrationThis trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR1920.