Making effective alcohol education interventions for high schools.

According to the Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control and Prevention (CDC) among high school students, in 2003, 74.9 ([+ or -] 2.7) percent of the high school students had at least one drink of alcohol on one or more days during their life (CDC, 2004). Current alcohol use or high school students who had one or more drinks in the past 30 days was found to be 44.9 ([+ or -] 2.4) percent (CDC, 2004). Percentage of high school students who had five or more drinks of alcohol in a row (binge drinking) on one or more of the past 30 days was 28.3 ([+ or -] 2.0) (CDC, 2004). With regard to specific subpopulations of high school students also data is available. For example, in 2001, the Bureau of Indian Affairs (BIA) conducted the Youth Risk Behavior Survey (YRBS) among 8,511 students in grades 9-12 attending schools funded by BIA and found that 83% female students and 78% male students reported life time alcohol use (CDC, 2003). This group shows greater prevalence than the national data. It has been found that African Americans and Asian Americans are less likely to misuse alcohol than whites and Hispanic Americans (Ellickson, McGuigan, Adams, Bell, & Hays, 1996).

A survey was done about health education in schools in 1996 that found that a median of 87.6% of the states and 75.8% of the cities included in the survey taught a separate health education course in grades 6-12 and knowledge-based coverage about alcohol and other drugs ranged from 97-100% schools (Grunbaum, Kann, Williams, Kinchen, Collins, & Kolbe, 1998). While this appears quite impressive, it is well known that the amount of time given for health education in schools, and more so in high schools, is quite insufficient. There are several subjects that need to be taught and health education does not get enough attention. Furthermore, it has been found that knowledge-based curricula are necessary but often insufficient for behavior change for a majority of students. Hence, there is a need for effective alcohol education programs in high schools.

A cross-sectional survey was done with 1,236 high school students in Canada to determine alcohol use beliefs and behaviors (Feldman, Harvey, Holowaty, & Short-t, 1999). In this study sample 24% of students reported never having tasted alcohol, 22% reported having tasted alcohol but did not currently drink, 39% were current moderate drinkers, 11% were current heavy drinkers (five or more drinks on one occasion at least once a month), and 5% did not answer the question. The most common reason given for not drinking was because it was "bad for health" and due to the "upbringing" they had received. The most common reasons given for drinking were cited as: "enjoy it" and "to get in a party mood."

Several specialized interventions have been implemented in high schools for primary prevention of alcohol use. Clearly there is a need for more alcohol education in high schools that is either dovetailed with existing health education curricula or is in addition to the existing health education curricula. An Israeli intervention aimed at reducing abuse of alcohol among adolescents that was based on Botvin's social skills theory was implemented in seven high schools (Peleg, Neumann, Friger, Peleg, & Sperber, 2001). The results of the intervention showed that at one and two year follow-up the rates of alcohol consumption did not change in the intervention group (p > 0.05) but rose significantly in the control group (p < 0.001) thus indicating the effectiveness of the intervention. Such theory-based interventions are needed in our high schools.

Another component that has been found useful in high school interventions is peer support groups. It has been found that peer support groups are an economical and well-accepted method for early recognition and management of emotional and behavioral problems in high schools (Wassef, Mason, Collins, O'Boyle, & Ingham, 1996). In this study by Wasef and colleagues (1996) it was found that half of the alcohol and substance users reduced their intake as a result of participating in a program utilizing peer support group.

Ideally, interventions for primary prevention of alcohol use in high school students must start in middle school or junior high school because the behavior is beginning to get started at that time. In a drug abuse prevention program that began in middle school with boosters in high school, it was demonstrated that alcohol, drug, and poly-drug use rates were lowered (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995). In addition to utilizing booster sessions in high school, the program utilized building combination of social resistance skills and general life skills. Another important aspect for these interventions must be the focus on skill building.

Perry and Kolder (1992) in a review article have suggested that prevention programs are most effective when the target behavior has received increasing societal disapproval, the programs utilize multiple years of behavioral health education, community-wide involvement and mass media complements the school-based peer-led program. Hence, to summarize, in order to make primary prevention programs for alcohol prevention more effective these must (1) start in middle school and continue in high schools; (2) be added to existing health education curricula or be designed as complementary programs; (3) explicitly utilize a robust behavioral theory that aims at influencing behavior rather than mere knowledge building; (4) utilize peer support groups; (5) build specific resistance and general life skills; (6) aim for building societal disapproval regarding alcohol consumption; (7) must involve community support; and (8) utilize active mass media component.

References

Botvin, G.J, Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. JAMA, 273, 1106-1112.

Centers for Disease Control and Prevention (2004). Youth Online: Comprehensive Results [Data file]. Retrieved November 7, 2005 from http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar= CI&cat=3&quest=Q3 9&loc=XX&year=2003.

Centers for Disease Control and Prevention (2003). Tobacco, alcohol, and other drug use among high school students in Bureau of Indian Affairs-funded schools--United States, 2001. MMWR Morbidity and Mortality Weekly Report, 52, 1070-1072.

Ellickson, P. L., McGuigan, K. A., Adams, V., Bell, R. M., & Hays, R. D. (1996). Teenagers and alcohol misuse in the United States: By any definition, it's a big problem. Addiction, 91, 1489-1503.

Feldman, L., Harvey, B., Holowaty, P., & Shortt, L. (1999). Alcohol use beliefs and behaviors among high school students. Journal of Adolescent Health, 24, 48-58.

Grunbaum, J. A., Kann, L., Williams, B. I., Kinchen, S. A., Collins, J. L., & Kolbe, L. J. (1998). Characteristics of health education among secondary schools--school health education profiles, 1996. MMWR CDC Surveillance Summary, 47(4), 1-31.

Peleg, A., Neumann, L., Friger, M., Peleg, R., & Sperber, A. D. (2001). Outcomes of a brief alcohol abuse prevention program for Israeli high school students. Journal of Adolescent Health, 28, 263-269.

Perry, C. L. & Kelder, S. H. (1992). Models for effective prevention. Journal of Adolescent Health, 13, 355-363.

Wassef, A., Mason, G., Collins, M. L., O'Boyle, M., & Ingham, D. (1996). In search of effective programs to address students' emotional distress and behavioral problems part 111: Student assessment of school-based support groups. Adolescence, 31, 1-16.

Manoj Sharma, MBBS, CHES, Ph.D.

Editor, Journal of Alcohol & Drug Education

University of Cincinnati

526 Teachers College, PO Box 210002

Cincinnati, OH 45221-0002