School-Based Programs to Prevent and Reduce Alcohol Use among Youth

By Stigler, Melissa H.; Neusel, Emily et al. | Alcohol Research, Fall 2011 | Go to article overview

School-Based Programs to Prevent and Reduce Alcohol Use among Youth


Stigler, Melissa H., Neusel, Emily, Perry, Cheryl L., Alcohol Research


Because alcohol use typically begins during adolescence (Office of the Surgeon General 2006) and because no other community institution has as much continuous and intensive contact with underage youth, schools can be an important setting for intervention. This article describes school-based approaches to alcohol prevention, highlighting evidence-based examples of this method of intervention, and suggests directions for future research. This summary primarily is based on several recent reviews focusing on alcohol prevention among underage youth conducted by Foxcroft and colleagues (2002), Komro and Toomey (2002), and--the most comprehensive and critical review of this field to date--Spoth and colleagues (2008, 2009). Although these previous reviews addressed interventions in a variety of contexts (e.g., families, schools, and communities), the present article highlights key findings specific to school-based interventions.

CHARACTERISTICS OF SCHOOL-BASED ALCOHOL PREVENTION PROGRAMS

Rates of initiation of drinking rise rapidly starting at age 10 (i.e., grades 4 and 5) and peak between ages 13 and 14 (i.e., grades 8 and 9). At that point, more than 50 percent of adolescents report ever having consumed alcohol in their lifetime (Kosterman et al. 2000). Given this natural history of alcohol use in adolescence, most school-based programs have been developed for and delivered in middle schools; programs aimed at elementary schools (especially grades 3 to 5) and high schools are less common (Spoth et al. 2008, 2009). Of particular concern to contemporary research with underage youth is heavy drinking, including harmful behaviors, such as binge drinking and drunkenness.

The primary goal of school-based alcohol prevention programs is to prevent or delay the onset of alcohol use, although some programs also seek to reduce the overall prevalence of alcohol use. Interventions earlier in life (i.e., during elementary school) target risk factors for later alcohol use (e.g., early aggression) because alcohol use itself is not yet relevant to this age group (Spoth et al. 2008, 2009). Any reduction in alcohol-related behavior is assumed to lead to subsequent reductions in alcohol-related problems (e.g., injuries or alcohol dependence), although the latter often are not measured in primary prevention studies (Foxcroft et al. 2002).

School-based alcohol interventions are designed to reduce risk factors for early alcohol use primarily at the individual level (e.g., by enhancing student's knowledge and skills), although the most successful school-based programs address social and environmental risk factors (e.g., alcohol-related norms) as well. Some school-based programs focus on the general population of adolescents (i.e., are universal programs), whereas others target adolescents who are particularly at risk (i.e., are selective or indicated programs). The research literature on the efficacy of school-based alcohol prevention programs is large, encompassing several decades of study (Foxcroft et al. 2002; Komro and Toomey 2002; Spoth et al. 2008, 2009). The most recent review by Spoth and colleagues (2008, 2009) provides several examples of effective school-based programs, which will be discussed in detail below. Not all school-based alcohol prevention programs for youth are effective, however. The review by Foxcroft and colleagues (2002), especially, emphasizes this point with regard to long-term (3 years or more) outcomes of primary prevention efforts such as school-based programs.

EXAMPLES OF EVIDENCE-BASED, SCHOOL-BASED ALCOHOL PREVENTION PROGRAMS

The review by Spoth and colleagues (2008, 2009) provides support for the efficacy of school-based programs, at least in the short term (defined as at least 6 months after the intervention was implemented). This review considered alcohol prevention interventions across three developmental periods (i.e., younger than age 10 years, age 10 to 15 years, and age 16 years or older), aligned with reviews of other etiologic work during the same developmental stages (Masten et al. …

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