Alcohol and Tobacco Use Prevention

Program Overview
by National Institute of Health

(Page 2 of 6)

The LST program was designed to influence factors at the individual level, as shown in the figure below, through the development of three components: 1. to influence ATODrelated knowledge, attitudes, and norms; 2. to teach skills for resisting social influences to use ATODs; and 3. to promote the development of personal self-management and social skills. Following is a brief description of each of these components:

ATOD-related information and skills. This component is designed to influence ATOD-related knowledge and attitudes, normative expectations, and skills for resisting media and peer influences to use ATODs. The material examines 1. both the short- and long-term consequences of ATOD use, 2. the actual levels of ATOD use among adults and adolescents (to correct normative expectations about ATOD use), and 3. the declining social acceptability of smoking and other ATOD use. In addition, this component includes information and class exercises demonstrating the immediate physiological effects of smoking; presents material concerning media pressures to smoke, drink, or use other drugs; examines techniques used by cigarette and alcoholic beverage advertisers; and teaches skills for resisting alcohol and tobacco advertising as well as peer pressure to smoke, drink, or use other drugs.

Personal self-management skills. This component is designed to 1. improve decisionmaking and problemsolving ability; 2. teach skills for identifying, analyzing, interpreting, and resisting media influences; 3. teach skills for coping with anxiety, anger, and frustration; and 4. provide students with the basic principles of personal behavior change and self-improvement (goal-setting, self-monitoring, and self-reinforcement).

Social skills. This component is designed to influence several important social skills (communication, initiating social interactions, conversation, complimenting, skills related to male-female relationships, and verbal and nonverbal assertive skills) and to improve students' general social competence.

Program Implementation

The LST program consists of 15 class periods and is intended for middle or junior high school students. In addition to the initial year of intervention in seventh grade, the LST approach continues for 2 additional years. These booster interventions are designed to reinforce the material covered during the first year. There are 10 booster sessions in eighth grade and 5 in ninth grade. For school districts with a middle school, the LST program can be implemented in the sixth, seventh, and eighth grades.

Program Delivery Methods

The methods used to deliver the content of an effective prevention program may be as important as the content itself. Thus, in developing effective interventions, attention must be given to both the content of the intervention and the delivery methods. A variety of intervention methods have been used in the LST program, including traditional didactic teaching methods, facilitation and group discussion, classroom demonstrations, and cognitive-behavioral skills training. Although lecturing and conventional didactic teaching methods are appropriate for some of the material taught in the LST program, the material can be most effectively taught by facilitating group discussion and focusing on skills training. Because a major emphasis of the LST program is on teaching personal self-management skills, social skills, and skills for resisting social influences to use ATODs, the central role of intervention providers is that of skills trainer or coach. Skills are taught using a combination of the following techniques:

Instruction and demonstration. The first step in the skills training process, instruction and demonstration, consists of explaining how and when to use the skill and then showing students how to perform the skill. The program provider, actors on videotape, or a member of the class can demonstrate the skill.

Behavioral rehearsal. Once the skill has been explained and demonstrated, students practice it using role-playing exercises either at the front of the classroom or in small groups. Role-playing scenarios are clearly described by the provider and are brief to ensure that as many students as possible can participate.

Feedback. After the students practice the skills being taught, the provider "critiques" the strengths and weaknesses of each student's skills "performance." This information is provided in a gentle and supportive manner so that students understand which aspects of the skill they performed well, which aspects need improvement, and how to improve.

Social reinforcement. The teacher or program provider reinforces or praises each student for one or two positive elements of his or her skills performance. Because the goal of skills training is to improve both the target skills and the self-efficacy of each student, each participant's improvement is assessed individually.

Extended practice. The final step in the skills training process is extended practice in which students receive behavioral "homework" assignments, such as saying "hello" to one new person each day, practicing a technique for coping with anxiety once per day, and responding assertively in three different situations. In addition to providing opportunities for practice in general, extended practice is intended to facilitate the use of learned skills in situations outside the classroom, promote application to different situations, and encourage students to use the skills as part of their everyday lives. Program providers can further facilitate the skills training process by continuing to provide feedback and reinforcement, as appropriate, outside the classroom.

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.