Alcohol and Tobacco Use Prevention

Summary
by National Institute of Health

(Page 6 of 6)

Followup data collected 2 years later at the end of the ninth grade found significant effects for both prevention approaches. Students in both skillstraining conditions drank alcohol less often, became drunk less often, drank less alcohol per drinking occasion, and had lower intentions to use alcohol in the future, relative to students in the control group. These data also showed that the culturally focused intervention produced significantly stronger effects than the generic LST approach. Therefore, the followup study findings suggest that although it may be possible to develop an effective preventive intervention for a relatively broad range of students, tailoring interventions to specific populations can increase effectiveness with inner-city minority populations.

From Research to Action

For many years the challenges facing prevention researchers and public health professionals have been to identify promising approaches, carefully test them, and provide evidence of their effectiveness. That challenge has largely been met. Much is known at this point about the causes of ATOD abuse and how to prevent it. Although more work is needed to refine existing approaches and develop even more effective ones, the challenge facing us now concerns bridging the gap between research and practice. Recognizing this, efforts are underway to disseminate information about effective ATOD abuse prevention approaches and to move from research to action. During the past few years, national conferences conducted by the National Institute on Drug Abuse, the U.S. Department of Education, and the Justice Department's Office of Juvenile Justice and Delinquency Prevention have focused on communicating research results indicating that a small group of prevention approaches, such as the LST program, have worked. Speakers at these conferences have exhorted practitioners to use researchbased approaches.

One issue that needs to be addressed is cost. Although most prevention programs are inexpensive, schools and communities must be willing to allocate resources to cover the cost of prevention materials and training. The LST program costs range from $5 to $10 per student per year including the cost of materials and training. When several schools in a State or region can coordinate training and the purchase of curriculum materials, the costs can remain closer to $5 per student. Researchers have developed a formal economic analysis of the cost benefit or cost effectiveness of the LST program, but no analysis has been conducted to date. Compared with the expense of treatment or imprisonment, however, which can exceed $30,000 per person per year, the cost of a prevention program like LST is extremely inexpensive.

The etiology of ATOD abuse is complex, involving multiple determinants and numerous developmental pathways. To be effective, prevention approaches should target these determinants as comprehensively as possible. Approaches that focus on ATOD-related knowledge or attitudes have not been found to be effective. Similarly, the use of prevention approaches relying on scare tactics or approaches promoting affective development have failed to influence ATOD use. The most effective prevention approaches have focused on teaching social resistance skills either alone or in combination with general life skills.

LST is currently the most extensively evaluated schoolbased prevention approach available. More than two decades of research have demonstrated prevention effects with respect to tobacco, alcohol, and marijuana use; multiple substance use; and illicit drug use; as well as hypothesized mediating variables. The magnitude of the reported effects typically has been large, with most studies demonstrating initial reductions of 50 percent or more relative to the control groups. These studies have generally produced reductions in both occasional (experimental) ATOD use and more serious levels of substance use. Studies of the LST approach have tested its short-term effectiveness, its longterm durability, and the use of different delivery methods as well as the effectiveness of booster sessions, its effectiveness when conducted by different program providers, and its effectiveness with different populations. These studies have ranged from small-scale pilot studies involving two schools and a few hundred adolescents to large-scale, multisite, randomized field trials involving more than 50 schools and several thousand adolescents.

Although considerable progress has been made in the past decade, further research is needed. To this end, additional research is underway in order to better understand the mechanisms through which the LST approach prevents ATOD use; to understand the LST program's effectiveness with different populations (particularly minority youth); and to determine the program's generalizability to other empirically and theoretically related behaviors, such as violence. One obvious limitation of this type of prevention approach is that it addresses a limited set of etiological factors within school settings. More research is therefore needed either to extend this approach to other intervention modalities (approaches targeting the family or community) or to integrate it within a more comprehensive intervention strategy targeting a broader array 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.