Project Northland, an ongoing community trial aimed at reducing alcohol use and alcoholrelated problems among adolescents, is nearing completion. The project combines individualbased strategies to encourage adolescents not to use alcohol with community-based strategies to both reduce alcohol availability and modify community attitudes concerning youth drinking. Project Northland has developed prevention programs and followed the same group of adolescents from sixth grade to high school graduation. This article discusses the rationale for this type of program, elements of the adolescents' social environment targeted for change, the unique challenges of working with high school students compared with younger adolescents, and areas for future research. KEY WORDS: community based prevention; prevention program; prevention strategy; adolescent; AOD availability; attitude toward AOD; prevention of AODR (alcohol and other drug related) problems; underage drinker; socioenvironmental factors; junior high school student; high school student; youth culture; harm reduction policy; literature review
Throughout the history of the United States, public opinion concerning alcohol use has oscillated from toleration to disapproval, and the average annual consumption of alcohol has risen and fallen in accordance with this pattern. Current annual per person alcohol consumption among adults in the United States is only about one-third of what it was in the early 19th century (Musto 1996). Along with other indications, a 15-percent drop in adult alcohol consumption since its most recent peak around 1980 (Musto 1996) suggests that a third era of temperance may be under way. Additional evidence to support this shift in American attitudes toward alcohol includes the reinstatement of age 21 as the legal drinking age in all States by the mid1980s and ongoing public activism, beginning in the mid-1970s, supporting tougher drunk-driving laws.
Despite overall lower alcohol consumption in the United States, American youth drink more at younger ages. One study found that only 9 percent of respondents born between 1919 and 1929 reported first using alcohol (i.e., "you first had a glass of beer or wine, or a drink of liquor such as whiskey, gin, scotch, etc.") at age 15 or younger, compared with 33 percent of those surveyed who were born between 1971 and 1975 (Johnson and Gerstein 1998). Many youth drink alcohol regularly. In a 1995 survey, 25 percent of 8th graders, 39 percent of 10th graders, 51 percent of 12th graders, and 68 percent of college students reported drinking at least once during the 30 days prior to being surveyed (Johnston et al. 1996). In addition, the survey results suggest that many young drinkers consume multiple drinks per drinking occasion. Fifteen percent of 8th graders, 24 percent of 10th graders, 30 percent of 12th graders, and 40 percent of college students reported consuming five or more drinks in a row at least once in the 2 weeks before the survey (Johnston et al. 1996).
The widespread and often heavy alcohol use by adolescents are associated with significant morbidity and mortality (e.g., Chassin and DeLucia 1996) that are not confined to the group of more extreme users. In fact, because the general population includes more light and moderate drinkers than heavy drinkers, the former experience more alcohol-related problems as a group, even though as individuals they are at less risk than heavier drinkers (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1994). This finding has tended to shift the focus of prevention efforts away from the identification of problem drinkers toward the prevention of alcohol use during adolescence (Wagenaar and Perry 1995).
Project Northland is the largest community trial in the United States to focus on the prevention of alcohol use and alcohol-related problems among adolescents. Using the example of Project Northland, this article describes a comprehensive approach that combines individual-based strategies to encourage adolescents not to use alcohol with community-based strategies to both reduce alcohol availability and modify community attitudes regarding underage drinking. …