The effectiveness of peer-led FAS/FAE prevention presentations in middle and high schools.

Abstract

Pregnant women and women who might become pregnant, including middle school- and high school-age adolescents, continue to consume alcohol, placing themselves at risk of having a child with the effects of prenatal alcohol exposure. However, most prevention programs that attempt to increase public awareness and knowledge of FAS and related disorders have had limited success and are inappropriate for 11 through 17-year-old youth. This study assessed the effectiveness of a pilot multimedia presentation that was implemented by peers and slightly older college students and incorporated into the middle school and high school health education programs. Posttests and follow-up assessments were compared to pretest scores to measure change in knowledge related to the effects of prenatal alcohol exposure and understanding of the overall purpose of the program. In general, students' overall knowledge of presentation content increased from pretest to posttest. Overall follow-up scores showed that students 'retention of the presentation information had increased since the posttest. The findings suggest that FAS/FAE presentations led by peers and utilizing a multimedia-discussion format effectively increase middle school and high school students' knowledge of the effects of alcohol consumption during pregnancy.

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On February 21, 2005, the U.S. Surgeon General released an advisory on alcohol use during pregnancy warning that pregnant women and women who may become pregnant to abstain from consuming alcohol during pregnancy in order to eliminate the risk of having a child with fetal alcohol syndrome or other disorders caused by prenatal alcohol exposure (Office of the Surgeon General, 2005). However, despite this announcement and considerable public awareness initiatives informing women of the reasons drinking alcohol is unsafe during pregnancy, pregnant women and adult and adolescent women who could become pregnant continue to consume alcohol, placing themselves at risk of having a child with problems associated with prenatal alcohol exposure. Since alcohol is the most widely used drug by U.S. adolescents (Ma, Toubbeh, Cline & Chisholm, 1998b), it has become increasingly important to develop more effective, age-appropriate programs that educate adolescents of the effects of alcohol consumption during pregnancy.

Fetal alcohol syndrome (FAS) was defined in 1973 as a medical condition in the United States associated with alcohol consumption during pregnancy (Jones & Smith, 1973). Experts now consider FAS one end of the spectrum of fetal alcohol spectrum disorders (FASD), an umbrella term that includes a range of lifelong disabilities that result from all levels of prenatal exposure to alcohol (Substance Abuse and Mental Health Services Administration [SAMHSA], 2002). Another condition within the spectrum is Fetal alcohol effects (FAE), which describes children who display problems associated with prenatal alcohol exposure but do not demonstrate all the symptoms of classic FAS. Although some research still uses the term FAE, the Institute of Medicine has coined more specific terms. These include prenatal alcohol effects (PAE), alcohol-related birth defects (ARBD) and alcohol-related neurodevelopmental disorder (ARND) (Sokol, Delaney-Black, & Nordstrom, 2003).

FAS and FASD are significant public health problems. FASD occurs in about 10 per 1,000 live births, or about 40,000 babies per year and 1% of all births (May & Gossage, 2001).

FASDs are also completely preventable as long as the pregnancy is alcohol-free. There are substantial challenges, however, in eliminating this spectrum of disorders, particularly among adolescents. One reason is the rate of alcohol use by middle school and high school youth. Alcohol use by adolescents in the United States has long been recognized as a significant problem with far-reaching public health implications (Center for Disease Control [CDC], 2000, 2006; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1993). The findings of the 2005 Youth Risk Behavior Surveillance (YRBS) Survey of high school students in the United States revealed that 43.3% of students were currently consuming alcohol (36.2% were 9th graders), 25.5 % were heavy drinkers, and 25.6% had drunk alcohol (more than a few sips) for the first time before they were 13 years of age. A report by Greene, Weimer and Ringwalt (1997) indicated that 60% of North Carolina middle school students (grades 6-8) and 76% of high schools students consumed alcohol. Between grades 6 and 9, the rate of substance use steadily increased.

Moreover, sexual activity has become a public health concern among adolescents in the United States due to the higher pregnancy rates and birthrates compared to other Western countries (CDC, 2006). Nationwide, 46.8% of students had had sexual intercourse and 33.9% of students were currently sexually active. A total of 6.2% of students had had intercourse for the first time before 13 years of age and this prevalence rate appeared to be increasing with age. The rate was higher among 9th grade students (8.7%) than all other high school grades, and higher among 9th grade females (5.4%) than all other high school females. Among the 33.9% of currently sexually active students nationwide, 23.3% admitted to having consumed alcohol or used drugs before their last sexual intercourse. Another recent study (SAMHSA, 2004) reported that 9.8% of pregnant women aged 15-44 used alcohol and 4.1% reported binge drinking, suggesting that some pregnant girls are continuing to consume alcohol during their pregnancy.

Caution should be taken in interpreting the data from these reports due to the limitations of studies using surveys that measure self-reported behavior. However, the data reveal pervasive and increasing prevalence rates of at risk behaviors that are associated with fetal alcohol exposure among middle school and high school students. Although sufficient data is lacking regarding the percent of FASD-affected infants born to adolescent women, the statistics indicate that some adolescent women who have been drinking become pregnant and are at risk for having a child with FASD. Moreover, if these teen girls choose to have an abortion, they are adding another psychological trauma to the shock of an unwanted pregnancy.

A second reason why eliminating fetal alcohol spectrum disorders is particularly challenging is the lack of effective FAS prevention programs in the United States (Ma, Toubbeh, Cline & Chisholm, 1998a; NIAAA, 2000). Previous efforts to educate the public about the risks of drinking during pregnancy included public awareness campaigns using publications and television ads, labeling alcoholic beverage containers with the surgeon general's warning statement, pamphlets, and media announcements. Some of the prevention or intervention programs that employed these measures reported some success in reducing the prevalence of maternal drinking during pregnancy and fetal alcohol syndrome (Astley, 2004) and in increasing public knowledge and awareness of FAS (Hankin, 2002; Livey & Castro, 2001; Ryan & Ferguson, 2006; Walker, Darling, Sherman, Wybrecht, & Kyndely, 2005).

Most reports, however, question the success of universal interventions to increase the general knowledge of FAS and prevent prenatal alcohol exposure. Sokol et al. (2003) reported that data recorded since 1989 when the warning labels were introduced, through 1994, revealed that there was no significant association between exposure to warning label messages and drinking patterns during pregnancy. Other studies reported that pregnant women (Kaskutas, 2000), women of childbearing age (Branco & Kaskutas, 2001; Hankin, 2002) and middle school adolescents (Ma, Toubbeh, Cline, & Chisholm, 1998b, 1998c) still lacked knowledge about the nature, symptoms and causes of FAS, the types of disorders that could result from alcohol exposure during pregnancy, and the alcohol-level equivalency of beer, wine, wine coolers and spirits. Thus, previous prevention efforts to educate adolescents about the effects of drinking during pregnancy, or the dangers of drinking without using some form of birth control while being sexually active, have been minimally effective (Kulaga, 2005). Above all, the data suggesting that early prevention is critical and that middle and high school students still lack knowledge about FAS or the relationship between FAS and alcohol underline the need for new and more effective ways to reach middle and high school students by devising messages that will change their behavior (Hankin, 2002).

One prevention approach that has been proven effective with adolescents is the use of peer education programs in which health education is delivered to students by other students of the same age or slightly older. According to Ma et al. (1998b; 1998c), middle school students felt FAS prevention is an important topic in school health education and emphasized the important role peers play in teaching and role modeling. Also, a meta-analysis comparing peer-led and adult-led drug prevention programs indicated that the peer-led programs were somewhat more effective than the adult-led programs (Cuijpers, 2002). However, these findings were inclusive of adolescents of all ages and both genders. Studies are lacking that examine data to determine if the effectiveness of the prevention messages differ by age or gender.

Recommendations by prevention specialists (Green et al., 1997; Ma et al., 1998a) and the adolescents themselves (Ma et al., 1998b; 1998c) indicate that schools should collaborate with community programs to design and implement comprehensive and developmentally-appropriate curricula that provide prevention messages from middle school through high school levels. The specialists recommend beginning with the 6th through 8th grades because, although students at this age are vulnerable to high risk behaviors, they are also open to learning and able to make mature decisions regarding high risk behaviors. These messages should provide an in-depth understanding of the nature of FAS, and a discussion of the relationship between alcohol use and fetal development. Moreover, effective middle school and high school prevention programs should be peer led, involve both males and females, and include music, posters, media and other communication technology avenues appropriate to adolescents. The purpose of this pilot study, therefore, was to determine if a multimedia presentation by peers and college students about Fetal Alcohol Syndrome and other drug-related effects on the child during pregnancy would significantly change male and female middle school and high school students' knowledge of Fetal Alcohol Syndrome and Fetal Alcohol Effects.

METHOD

Participants

A total of 642 students (267 males, 375 females) from five different middle schools and one high school in a southeastern city participated in this study. All participants were 7th grade middle school students (267 males, 279 females) and 9th grade high school students (96 females) enrolled in a Health and Physical Education class. The majority (68%) of the students were Caucasian, 23% were African American, 7% were Hispanic and 2% were Asian American or "Other". A control group was not used because the goals of the study were to pilot a FAS prevention program for adolescents, and to educate as many middle school and high school students as possible about the effects of alcohol on prenatal development.

Due to continuous conflicts with class schedules and athletic events, only 9th grade women's Health/P.E. classes from one high school were able to participate in the study. Also, mid-way through the semester, participants in the half-semester Health/P.E. classes were dispersed to other half-semester classes before the end of the six-week waiting period when the follow-up assessment could be administered. Thus, many of the original participants in the Health/P.E. classes could not be located, causing a significant reduction in the number of students who were able to complete the follow-up assessment. Therefore, only 263 middle school students and 76 of the high school females (113 males, 150 females; 64% Caucasian, 24% African American, 9% Hispanic, 3% Asian or Other) were able to complete the follow-up phase of the study. However, researchers were able to collect follow-up data from each of the six schools and there were no significant differences between the male/female ratio or ethnicity between the original sample of participants and the follow-up group.

Materials

The FAS presentation involved the following materials created or purchased by The ARC, a local United Way agency that provides programs and services for people with mental retardation and developmental disabilities:

* A raw egg, a clear glass and one ounce of pure alcohol.

* PowerPoint slides of 10 multiple choice questions adapted from a survey provided by the FASCRS website (Kellerman, 1999). Survey questions are listed in the Appendix.

* A video of information about FAS and the effect of alcohol on prenatal development provided by high-school-age students, medical professionals and parents of a child born with FAS. The video contained answers to all of the multiple choice questions.

* A display of three life-size infant dolls representing a normal infant, an infant born with FAS, and an infant that simulates the appearance, crying and tremors of a real drug-affected infant. Presenters pointed out and discussed the drug-related physical and behavioral disorders that could be observed on the dolls, allowed students to pass around the dolls, and answered the students' questions.

* A follow-up assessment of the 10 multiple choice questions in a paper/pencil format and three additional open-ended questions developed by the researchers and ARC staff: (1) What is the reason we want you to know information about Fetal Alcohol Syndrome? (2) Tell us something NEW that you learned during the presentation that is NOT on this multiple choice test. (3) What part of the presentation should we ALWAYS include?

Procedure

Pretest, Posttest and Presentation. The 40-minute presentations were scheduled during Health and Physical Education classes by the Adolescent Pregnancy Prevention Coordinator for the County Adolescent and Family Enrichment Council and followed her classes on pregnancy prevention. Pairs of trained upper-class psychology majors, supervised by a College faculty member, gave the presentations in a series of sequential steps. The presenters began with a physical demonstration of the effect of alcohol on an infant's brain by breaking the raw egg into the glass and adding the alcohol. The presenters asked the students to watch the clear part of the egg develop white streaks as the alcohol "cooked" it and to watch the "cooking" process throughout the class period. Second, the presenters asked the students to take out a piece of paper, number it from 1-10 and do their best to answer the multiple choice "pretest" questions shown on powerPoint. The students watched the video, which was followed by a repeat of the multiple choice questions as the "posttest." The presenters projected each of the multiple choice questions a third time, asked the students to voice what they thought was the best answer to each question, and then highlighted the correct choice. Finally, the presenters brought out the three life-size infant dolls, identified characteristic features of each, allowed the students to pass the babies around, and conducted a brief question/answer session. The presenters informed the students that they could refuse to complete

the pretests and/or posttests and could leave the presentation at any time. No parents denied permission for their child to participate.

Follow Up Assessment. Approximately six weeks after the presentation, the researchers returned to the class and asked the students to circle the correct answer to the same ten multiple choice questions in a paper/pencil format, plus respond to the open-ended questions. The students were informed that they had the right to refuse to participate.

RESULTS

Pretest/posttest Analysis

Paired t-tests compared mean scores to determine if the mean score over all pretest questions differed significantly from the mean score over all posttest questions, and whether the mean pretest score differed significantly from the mean posttest score for each of the ten test questions considered individually. An alpha level of .05 was used for all statistical tests. The results indicated that the mean score over all posttest questions was significantly higher than the mean score over all pretest items. Analysis of mean scores for each question revealed that students scored significantly higher on the posttest for all but two of the questions (see Table 1). The mean score for Question 9 ("What is the most debilitating aspect of prenatal alcohol exposure?") did not change and the mean score for Question 2 ("A father can cause Fetal Alcohol Syndrome/Effects when:") actually decreased significantly from prettest to posttest.

Follow-up Assessment Analysis

Paired t-tests revealed a significant increase in the mean score over all follow-up multiple-choice questions from the mean score over all posttest questions and for six of the ten multiple choice questions analyzed separately (see Table 2). Mean scores for Question 6 ("Liquor store warning signs about drinking while pregnant were mandated by the Surgeon General to:") decreased significantly, and no significant changes in mean scores were observed for Question 7 ("Which alcohol drink contains the most alcohol?"), Question 8 ("What type of problems are children with Fetal Alcohol Syndrome/Effects likely to have?"), or Question 10 ("What is the leading preventable cause of mental retardation?").

Gender and School Level Analysis

A one-way analysis of variance comparing follow-up mean scores by gender revealed that female students' mean scores were significantly higher than male students' scores, F(1,338) = 31.08, p < .001, [[eta].sup.2] = 8%. Since the high school sample consisted entirely of female students and a significant number of the middle students could not complete the follow-up assessment, a preliminary one-way analysis of variance was computed comparing the middle school and high school female students' mean scores on the follow-up multiple choice questions to explore possible age-related differences. Results of this analysis indicated that high school female students scored significantly higher than middle school female students, F(1,158) = 7.38, p < .01, [[eta].sup.2] = 9%, suggesting an increase in retention of information with age.

Open-ended Question Analysis

Open-ended questions were used to determine the percent of students who provided responses that reflected content in the presentation and to assist in evaluating the students' reactions to parts of the demonstration. Examination of the responses for the question that asked students to indicate "the reason we want you to know information about FAS," revealed that 87% of the students were able to write a reason that reflected presentation content. The most frequent responses focused on avoiding alcohol during pregnancy (37%), the need to be aware of the negative effects of drinking alcohol on the baby during pregnancy (24%), the importance of preventing FAS and having a healthy baby (13%), and "telling people who are pregnant not to drink because of what could happen." (13%). The most frequent responses by the students who wrote "something new that they learned" revealed students' lack of knowledge about the effect of alcohol on the developing fetus in general (30%) and on the baby's developing brain in particular (illustrated by the "egg demonstration") (26%), the nature and characteristics of FAS (12%), the lack of a cure (8%), and that 50% of women will drink before knowing they are pregnant (6%). Finally, in response to the third open-ended question asking them to identify the part of the demonstration "we should always include," 28% of the students recommended the video, 25% prioritized the information on the extreme effects of FAS, 14% stated that "the babies" or "the shaking baby" should be continued, 13% requested that the egg demonstration remain and 13% felt the message that women should not drink while pregnant should be the top priority in future presentations.

DISCUSSION

Pregnant women and women who might become pregnant, including middle school- and high school-age adolescents, continue to consume alcohol, placing themselves at risk of having a child with the effects of prenatal alcohol exposure. However, current prevention programs employing universal interventions that attempt to increase public awareness and knowledge of FAS and related disorders have had limited success. Also, most of these prevention strategies, such a warning labels on alcoholic beverages, were inappropriate for 11 through 17-year-old youth. Based on recommendations from previous studies (Cuijpers, 2002; Greene et al, 1997; Ma et al., 1998a, 1998b), this pilot program was incorporated into the middle school and high school health education programs and a presentation was implemented by peers and slightly older college students. Posttests and follow-up assessments were compared to pretest scores to measure change in pre-existing knowledge of information related to the effects of alcohol consumption on prenatal development. Open-ended questions in the follow-up assessment also measured understanding of the overall purpose of the program, and elicited content strengths.

Pretest/posttest Analysis

The findings of this study suggest that the FAS presentation effectively increased middle school and high school students' knowledge of the effects of alcohol consumption during pregnancy. In general, students' overall knowledge and understanding of presentation content increased from pretest to posttest. Analysis of specific questions revealed that, after the presentation, more students knew that no amount of alcohol is safe, more than half of women in the early weeks of pregnancy are consuming alcohol, the debilitating physical, cognitive and behavioral effects of FAS and FAE, the purpose of liquor store warning signs, that the alcohol content in various alcoholic beverages is really the same, and that there is no cure for FAS. The decrease in correct responses to 2 (whether fathers can cause FAS/FAE) may be due to somewhat conflicting information about the effect of drugs on the father's sperm presented in the video. Also, few students knew the most debilitating aspect of FAE (Question 9) before the presentation, and most still had difficulty identifying the answer on the posttest. One possible explanation may be that the presentation did not make a clear connection between the baby's tremors or other neurological disorders and "lack of impulse control" (the correct answer), or clearly connect lack of impulse control to FAE (versus FAS or other drugs). Also, the students may not have known the meaning of "debilitating."

Follow-up Assessment Analysis

After six weeks, overall follow-up scores showed that students' retention of the presentation information had increased since the posttest. Possible reasons for this retention are 1) the immediate feedback after the posttest when the correct answers to the multiple choice questions were discussed, 2) the explanation and comparison of the drug-related physical and behavioral disorders observed in the dolls, and 3) the interactive question/answer session following the posttest, particularly while the participants passed around the dolls.

Analysis of the mean score for each question on the follow-up assessment revealed that retention of information on all but one of the multiple choice questions was either maintained or increased. The most dramatic change in mean score was the increase in correct responses for Question 2. Once the misguiding statement regarding the role of the father was clarified during the discussion following the posttest, the students were able to identify the correct answer. Another dramatic but unexpected change in mean score was the decrease in correct responses for Question 6 (the purpose of liquor store warning signs). Perhaps the students confused the purpose of the warning sign labels with the overall purpose of the presentation.

Gender and School Level Analysis

The higher scores for females than males suggest a greater inherent interest in the content on the part of the female students. The young women may have been more attentive during the presentation because the content tends to be more relevant to women's interests and concerns such as pregnancy and giving birth to healthy babies. The age-related increase in scores was consistent with developmental theory. High school students, in general, have more flexible and efficient intellectual abilities than most middle school students (Ginsburg & Opper, 1988), enabling them to understand and remember the information in the presentation that requires more complex reasoning rather than simple recall, including the finer distinctions between FAS and FAE, the relative similarity of alcohol content in various alcoholic beverages, concepts and terms such as "teratogen," "risk factors," "psychotherapy," and "debilitating," and the implications of binge drinking or consuming even a small amount of alcohol. Also, high school females are expected to be more interested in the presentation than middle school females since more have reached physical maturity and are closer to the traditional childbearing age.

Open-ended Question Analysis

Most of the students were able to articulate in writing the overall messages of the FAS presentation, and did not confuse the need for awareness of FAS/FAE with other drug and alcohol-related messages already conveyed in the health education program. Responses to the other two open-ended questions provided feedback on the components of the content and activities in the presentation that were the most memorable and meaningful. Consistent with previous studies (Ma, 1998b, 1998c), the significant content-related items listed for the "new information that they learned" during the presentation revealed that the majority of the students knew very little about FAS, FAE and the effects of prenatal exposure. The indication that they felt they had learned this information, and evidence that they had retained the main points over time suggests that they felt this content was interesting and important.

The written recommendations for the third open-ended question asking for "the part of the demonstration that we should always include" will serve as valuable feedback for the revision of the presentation. The most frequent recommendations by participants were (1) to continue the video and other media, (2) maintain "the (drug-affected) babies" and engaging demonstrations (i.e., egg demonstration), and (3) the continue to emphasize the central themes that a woman must not drink while pregnant, and the serious consequences if she does. These recommendations corroborated earlier suggestions made by middle school students for creating interesting and meaningful presentations reported by Ma et al. (1998b).

Limitations and Recommendations

This pilot study explored the effectiveness of an intervention program in middle and high schools, and was subject to a number of limitations. The use of a convenience sample and the first-time usage of these particular items may limit generalizability of the findings to other middle and high school populations. Second, this initial study consisted of a single group pretest-posttest design and lacked a control group that would have allowed for a comparative analysis with a group that did not receive the intervention. Third, the loss of 47% of the initial sample, resulting in only 53% of the students being able to complete the follow-up assessment, prevented meaningful comparisons between posttest scores and follow-up scores due to possible bias in the follow-up sample. Finally, the inability to obtain a representative sample of high school participants and the lack of male high school participants prevented meaningful gender and age comparisons.

These findings, plus the recommendations by prevention specialists (Ma et al, 1998a) and middle school youth (Ma et al., 1998b, 1998c) suggest important modifications and additions to future FAS/FAE prevention programs. Presentations should be initiated as early as the 6th grade and continue through high school, randomly sampling subjects and controlling for gender and age. Also, a control group of participants randomly sampled from middle and high schools, balanced for gender and age, should complete the pretest and posttest in order to provide a baseline against which the effects of the FAS presentations may be evaluated. Content and language should vary with age/grade level and attitude change should be measured as well as change in knowledge. Examples of questions needed to measure attitude change include values-related items regarding the responsibility of both males and females in the prevention of FAS, dilemmas involving peer pressure, and items requiring decisions that reflect healthy choices. In order to retain subjects, the time between the presentation and follow-up should be reduced to four weeks, enabling researchers to re-visit the Health/P.E. classes before the mid-semester rotation.

The preliminary findings of this study indicate that peer-led presentations in an educational setting using media and active interaction with participants effectively increased middle school and high school students' knowledge of prenatal alcohol exposure, plus other alcohol- and drug-related facts. The findings also suggest that incorporating peer-led presentations about FAS and FAE into the middle school and high school health education programs is an effective prevention strategy with adolescents and should be continued. Although most school systems provide sufficient information about the dangers of alcohol and other drug use, the current study, consistent with the reports of previous research (Ma et al., 1998a, 1998b) found that most students have very little knowledge of the nature, causes and effects of FAS and FAE. School systems, therefore, should team with college and community programs and take the next step in health education by developing engaging presentations to inform students that alcohol is a powerful teratogen that can cause lifelong damage to an unborn child.

APPENDIX

Multiple Choice Questions used in the PowerPoint Presentation and Follow-Up Assessment

1. The safest amount of alcohol for a pregnant woman to drink is:

   a. No more than 2 glasses per day.
   b. Not more than 1 oz. per day.
   c. None.
   d. One glass of wine only.
   e. Moderate drinking in late pregnancy only.

2. A father can cause Fetal Alcohol Syndrome/Effects when:

   a. He is an alcoholic.
   b. He drinks alcohol at conception.
   c. He has Fetal Alcohol Syndrome.
   d. He is on drugs.
   e. None of the above.

3. What percentage of women will drink alcohol before realizing
   they are pregnant?

   a. 10%
   b. 40%
   c. 100%
   d. 50%
   e. None

4. A characteristic of Fetal Alcohol Syndrome is:

   a. Low birth weight.
   b. Facial defects.
   c. Behavior problems.
   d. Mental retardation.
   e. All of the above.

5. Fetal Alcohol Syndrome and Fetal Alcohol Effects may be
   treated and cured with:

   a. A specialist's care.
   b. Specialized drugs.
   c. There is no cure for FAS.
   d. Massage and stimulation therapy.
   e. Psychotherapy.

6. Liquor store warning signs about drinking while pregnant were
   mandated by the Surgeon General to:

   a. Protect the owner from lawsuits.
   b. Keep women from having babies.
   c. Prevent women from getting drunk.
   d. Warn men and women of the dangers of drinking while
      pregnant.
   e. Warn people not to serve alcohol to pregnant women.

7. Which alcohol drink contains the most alcohol?

   a. A 2 oz. shot glass of liquor?
   b. A 12 oz. wine cooler.
   c. A 5 oz. glass of wine.
   d. A 12 oz. beer.
   e. All of the above.

8. What type of problems are children with Fetal Alcohol
   Syndrome/Effects likely to have?

   a. Mental retardation.
   b. Low birth weight.
   c. Attention deficits.
   d. Organ defects.
   e. All of the above.

9. What is the most debilitating aspect of prenatal alcohol
   exposure?

   a. Growth retardation.
   b. Attention deficit disorder.
   c. Lack of impulse control.
   d. Memory deficits.
   e. IQ's below 70.

10. What is the leading preventable cause of mental retardation?

   a. Fetal Alcohol Effect.
   b. Cerebral Palsy.
   c. Spina Bifida.
   d. Fetal Alcohol Syndrome.
   e. DownSyndrome.

Answers: 1c, 2e, 3d, 4e, 5c, 6d, 7e, 8c, 9c, 10d.

AUTHOR NOTE

Lyn T. Boulter, Department of Psychology, Catawba College.

I would like to thank Sharon Lyons, Amanda Janas and Shelly Ward for giving the presentations and entering data, Tara McCallum, the Adolescent Pregnancy Prevention Coordinator for the County Adolescent and Family Enrichment Council, for scheduling the presentations and facilitating communication between the College presenters and the classroom teachers, and the County ARC Association for developing and loaning the presentation. I am especially grateful to David Wasieleski for his valuable comments on an earlier draft of this article. This research was supported in part by a Summer Project Completion Grant awarded by Catawba College.

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Substance Abuse and Mental Health Services Administration. (2002). Results from the 2001 National Household Survey on Drug Abuse: Volume 1. Summary of National Findings. Rockville, MD: Office of Applied Studies, NHSDA Series H17, DHHS Publication No. SMA 02-3758. Retrieved June 22, 2006 from htttp://oas.samhsa.gov/nhsda/2k1nhsda/voll/toc. htm.

Substance Abuse and Mental Health Services Administration. (2004). Results from the 2003 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-3964. Retrieved August 1, 2006 from http://www.oas. samhsa.ggv/NHSDA/2k3nsduh/2k3Results.html#ch9.

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Correspondence concerning this article should be addressed to Lyn T. Boulter, Department of Psychology, Catawba College, 2300 West Innes Street, Salisbury, North Carolina, 28144. E-mail: [e-mail]

Lyn T. Boulter

Catawba College

TABLE 1
Pretest and Posttest Means for Each Test Question and Across
all Test Questions

               Pretest       Posttest

Questions     M      SD      M     SD    t (642)

       1     .90    .296    .93    .250    -2.14 *
       2     .18    .388    .14    .346     2.55 *
       3     .34    .475    .40    .491    -2.58 *
       4     .74    .438    .82    .388    -3.86 *
       5     .51    .500    .73    .446    -9.11 *
       6     .64    .481    .75    .436    -5.29 *
       7     .42    .495    .86    .346   -20.16 *
       8     .74    .439    .84    .370    -5.09 *
       9     .19    .396    .19    .395      .08
       10    .38    .487    .57    .495    -7.85 *
Total       5.07   1.89    6.23   1.73    -16.45 *

* p < .05.

TABLE 2
Posttest and Follow-up Test-Question Means for each Test
Question and Across all Test Questions

            Posttest       Follow-up

Questions     M      SD     M      SD     t (339)

        1    .92    .265    .96    .195   -1.99 *
        2    .13    .335    .38    .487   -7.71 *
        3    .36    .481    .50    .501   -3.49 *
        4    .82    .389    .83    .375   -0.53
        5    .72    .450    .80    .404   -2.28 *
        6    .77    .422    .67    .471    2.62
        7    .84    .369    .79    .406    1.48
        8    .83    .375    .84    .363   -0.42
        9    .19    .391    .28    .448   -2.61 *
       10    .55    .498    .55    .498    0.00
Total       6.13   1.77    6.60   2.04    -3.08 *

* p <.05.