Alcohol and Tobacco Use Prevention

Intervention Providers
by National Institute of Health

(Page 3 of 6)

Several different types of providers have successfully implemented the LST program, including health professionals from outside the school, older peer leaders and regular classroom teachers. However, the most natural and logical provider for a school-based prevention program is a classroom teacher. Teachers are readily available and generally have more teaching experience and better classroom management skills than other potential intervention providers. Peer leaders (students who are either the same age or older than the students in training) can assist teachers in implementing the curriculum and serve as positive role models for the kinds of skills and behaviors being taught. Although the LST program has proven to be effective when taught by health professionals, teachers, and peer leaders, the results of one study suggest that peer leaders may produce somewhat stronger prevention effects than do teachers.

Provider training can be conducted in 1 or 2-day training workshops or by videotape. The purpose of training is to familiarize intervention providers with the program, its rationale, and the results of prior studies as well as give providers an opportunity to learn and practice the skills needed to implement the program successfully. Peer leader training consists of one half-day workshop in which the prospective peer leaders receive a general orientation to the program as well as an overview of the responsibilities, information, and skills needed to implement the program successfully. In addition, teachers meet with the peer leaders before each session to debrief them on the past session and prepare them for the upcoming one.

Evidence of Effectiveness

The most serious challenge to the field of ATOD abuse prevention has been in proving that prevention works. Whereas some prevention approaches have been shown to influence knowledge (and, in some cases, attitudes) in a direction consistent with decreased ATOD abuse risk, the gold standard of whether a preventive intervention works is the extent to which it influences ATOD use. Until the late 1970s and early 1980s, little credible evidence existed that prevention efforts worked to reduce ATOD use. Since then, considerable research has been conducted, leading to several promising prevention approaches, including the LST program.

From the 1980s to the present, researchers have conducted a series of studies to test the effectiveness of ATOD abuse prevention approaches based on the LST model. These studies have been conducted in a logical sequence intended to facilitate the development of a prevention approach that is effective with a variety of problem behaviors when implemented by various types of providers and with various populations. Early LST research focused on cigarette smoking and involved predominantly white, middle-class populations. More recent studies, however, have extended this research to other problem behaviors, including the use of alcohol, marijuana and, in one study, other illicit drugs, and have increasingly tested the LST approach among inner-city, minority populations. Furthermore, this research has assessed the long-term durability of the LST prevention model, its impact on hypothesized mediating variables, its implementation fidelity (the extent to which the intervention is implemented as designed), and methods of improving implementation fidelity. These studies are briefly described in the following sections, along with the key findings, which are expressed by the percent reductions in ATOD use based on a comparison of ATOD rates among students who received the program versus those who did not.

Preventing Tobacco Use

The LST program was initially developed as a smoking prevention program. An early study examined the short-term effectiveness of the LST approach for preventing cigarette smoking among 281 students in the 8th, 9th, and 10th grades. Students at one school received the 10-session prevention program, whereas students at a comparable school served as a control group. Health professionals who were members of the project staff conducted the program. Study results showed a 75-percent reduction in the number of new cigarette smokers at the initial posttest (comparing the posttest smoking rate for the LST group relative to the posttest smoking rate for members of the control group - 0.04 vs. 0.16) and a 67-percent reduction in new smoking at the 3-month followup.

In a second study, older peer leaders served as intervention providers for 7th graders. To emphasize the immediate physical effects of cigarette smoking, a unit was added in which a biofeedback apparatus, such as a heart rate monitor or a tremor tester for assessing hand steadiness, was used in class experiments. This equipment demonstrated the immediate physical effects of smoking on the heart and nervous system among volunteer smokers by showing before and after differences in heart rate and hand steadiness. A methodological improvement (collecting saliva for analysis before collecting self-report data) was introduced to enhance the validity of self-report smoking data and to provide an objective measure of smoking status. Posttest results indicated that the experimental group included significantly fewer new smokers. These results were corroborated by the results of the saliva thiocyanate analysis, which showed a significant increase in smoking among control group students but did not show any increase among experimental group students. In addition, findings indicated a 58-percent reduction in new smoking at the initial posttest and a 56-percent reduction in regular smoking at the 1-year followup. The experimental group also demonstrated significant changes on several hypothesized mediating variables, including smoking knowledge, psychosocial and advertising knowledge, social anxiety, and susceptibility to influence.

A third study examined several important prevention issues, including the efficacy of this approach when implemented by regular teachers, the evaluation of two different implementation schedules, and the efficacy of booster sessions for preserving the initial prevention effects. Seventh-grade students from seven suburban New York schools were randomly assigned to three conditions: 1. a treatment condition in which students were exposed to the prevention program once per week for 15 weeks; 2. a treatment condition in which students were exposed to the program several times per week for approximately 5 weeks; and 3. a control condition. As in the previous study, saliva samples were collected to ensure high-quality self-report data.

Significant treatment effects were found at the initial posttest using the measure of monthly smoking. The weekly intervention format and the intensive minicourse format were equally effective in preventing the onset of new smoking. Significant intervention effects for monthly, weekly, and daily smoking were found at the 1-year followup. Groups receiving additional booster sessions had one-half as many regular smokers as groups not receiving booster sessions. Followup conducted one-and-one-half years after the conclusion of the program showed reduced smoking onset rates for monthly, weekly, and daily smoking. These findings provided additional empirical support for the efficacy of the LST prevention program and for its efficacy when conducted by regular classroom teachers. The findings also indicate that LST is effective when implemented according to two different schedules. Perhaps the most important finding of this study, however, is in demonstrating the potential of booster sessions for maintaining and even enhancing the effects of the LST program.

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.