Alcohol and Tobacco Use Prevention

Life Skills Training
by National Institute of Health

Rates of drinking and smoking increase among high school students as they age. Therefore, prevention programs that target youth either before or during junior high school may help prevent alcohol, tobacco, and other drug (ATOD) use during high school. Life skills training is a school-based approach designed to prevent ATOD use among youth by influencing their knowledge and attitudes about ATODs, by teaching skills for resisting social pressures to use ATODs, and by helping students develop personal self-management and social skills. Researchers have studied this program's effectiveness in preventing use of various substances among varied populations.

Both alcohol and tobacco use are common among teenagers in the United States. According to results of a 1999 survey, 24 percent of 8th graders, 40 percent of 10th graders, and 51 percent of 12th graders reported drinking alcohol within the past month. In addition, 15 percent of 8th graders, 26 percent of 10th graders, and 31 percent of 12th graders reported engaging in binge drinking (having five or more drinks in a row) at least once during the 2 weeks before the survey was conducted. Compared with drinking, smoking is less prevalent among high school students. For example, according to the study's findings, 18 percent of 8th graders, 26 percent of 10th graders, and 35 percent of 12th graders reported smoking cigarettes during the month before the survey, and only 8 percent of 8th graders, 16 percent of 10th graders, and 23 percent of 12th graders reported smoking cigarettes on a daily basis.

These survey results indicate that the prevalence of both alcohol use and tobacco use increases with age. Therefore, prevention programs should target youth before or during junior high school. This article describes an approach to substance abuse prevention called life skills training and summarizes nearly two decades of research on the effectiveness of the LST program in varied populations.

The Life Skills Training Program

The LST program was designed as a school-based intervention to target a specific set of risk factors for alcohol, tobacco, and other drug use. Thus, LST is a primary prevention program. The ultimate goal of primary prevention programs, which target younger populations, such as junior high school students, is to reduce the prevalence of ATOD use and abuse among youth as they age.

Background and Rationale

Etiology research has identified several important risk factors for adolescent ATOD use as well as several protective factors that are important in countering the effects of these risks. As shown in the figure, factors contributing to the initiation of ATOD use can be clustered into several broad categories, including the following:

• Sociocultural (demographic factors, acculturation, and ethnic identity)
• Family factors (family management practices, discipline, monitoring, and parental ATOD use)
• Social environment factors (availability of ATODs, school bonding, media influences, and peer influences)
• Cognitive expectancies (attitudes and beliefs about ATOD use in general and ATOD use among peers [normative expectations])
• Personal and social competence skills (decisionmaking, anxiety management skills, communication skills, and assertiveness)
• Psychological factors (self-efficacy, self-esteem, and psychological well-being).

These etiologic factors have been incorporated into a comprehensive model of ATOD use initiation. In this model, ATOD use is conceptualized as the result of a dynamic interaction of environmental and individual factors in which peers, parents, and other social influences interact with individual psychosocial vulnerabilities to promote ATOD use. For example, some people may be influenced to use ATODs by media presentations that normalize or glamorize ATOD use, whereas other people may be influenced by family members or friends who use ATODs or hold attitudes and beliefs supportive of their use. These social influences are likely to have the strongest effect on people with pro-ATOD normative expectations, poor social and personal competence skills, and poor drugresistance skills. Social influences promoting ATOD use are also likely to have a greater effect on people with certain psychological vulnerabilities, such as social anxiety, low self-esteem, low self-efficacy, and psychological distress. The more risk factors that a person has, the greater is the likelihood that the person will use or abuse ATODs.

This theoretical framework contains key elements from several prominent etiological theories of ATOD use, including social learning theory; problem behavior theory; and self-derogation, persuasive communications, and peer cluster theories.

In addition to organizing key factors associated with initiation of ATOD use, the model in the figure helps conceptualize potential points of intervention for ATOD abuse prevention. For example, a prevention program that improves personal and social competence skills may have a beneficial effect on various psychological factors associated with reduced ATOD risk. This type of model, however, also has some inherent limitations. The model does not capture the dynamic and recursive nature of the mechanisms by which risk and protective factors act, nor does it contain an exhaustive list of etiological factors.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.