A Community-Based Strategy for Preventing Underage Drinking
Condition: Alcohol Abuse
MeSH terms: Alcoholism; Underage Drinking
Study type: Interventional

Summary: 
      This project evaluates a combination of policy and social influence interventions to reduce
      adolescent alcohol use and its sequelae.
    

Detailed description: 
      1. In this community-wide intervention, we will evaluate a comprehensive underage alcohol
           use reduction intervention that combines policy and enforcement elements focused on 1)
           reducing social and commercial access to alcohol, and 2) increasing the likelihood of
           legal sanctions associated with use and misuse, and 3) mobilize parental and peer
           influences not to use. We will work with 6 communities in Lane County. Schools in the 6
           communities will be randomly assigned to receive the intervention immediately, or to be
           part of a wait list control group. If the results of the intervention are promising, we
           will partner with Lane County Prevention to bring the intervention to the wait list
           schools after 2 years.

           Our project aims to encourage the participation of youth in a number of different
           activities that will be conducted, for the most part, outside of school hours. These
           activities will help youth to discover, on their own, some of the risks and issues
           related to excessive alcohol use. Teams of youth will interview community members (e.g.,
           law enforcement, health care workers, business leaders, etc.) about some of the problems
           that can accompany excessive alcohol use. The youth will present their results to the
           City Council, School Board, the student body, etc., and attempt to build support for
           more aggressive city ordinances against underage drinking (e.g., increased penalties for
           serving to minors) and for stepped-up enforcement of existing laws (e.g., drunk
           driving). Youth will also interview parents regarding their beliefs and expectations
           related to alcohol use, and will advocate for alcohol-free social events organized by
           the school or community members. Teams will post updates on their progress on social
           media, increasing awareness among the student body, and will compete for various awards
           and prizes. In prior work done in school districts throughout Oregon over the past
           twenty-five years, we have found that these strategies are effective in preventing youth
           use of tobacco, alcohol, and other drugs.

           This project has several key elements:

           Community and Youth Engagement in Prosocial Alcohol-Free Activities Project staff will
           work with school and community representatives to help organize diverse teams of youth
           volunteers who will lead activities related to (a) learning about and increasing
           awareness about the dangers of alcohol use, (b) pushing for policy change and
           enforcement with the goal of reducing alcohol access, use and consumption (e.g., tougher
           laws for DUII) and (c) creating fun, alcohol-free recreational opportunities for all
           youth . Youth volunteers will be actively consented to participate teams. We will work
           with existing community coalitions, where possible, to promote sustainability. We will
           use social media to spread the news about the progress of the youth teams and
           activities. A project-monitored Facebook page will be part of each community's effort to
           communicate about recreation activities, reward prosocial youth behavior, and promote
           safer norms and behavior around alcohol use. Further description of Team Activities is
           attached.

           Reducing Access to Alcohol in the Community Project staff will work with local law
           enforcement and youth to focus on the enforcement of laws and the promotion of norms
           that can reduce the problems of alcohol misuse in the community. ORI will work with Lane
           County Prevention to conduct purchase surveys in which young-looking 21-year olds
           attempt to purchase alcohol, and track whether or not clerks are willing to sell at
           various outlets in the recruited communities. In intervention communities, youth teams
           may be involved in soliciting local businesses to provide rewards for clerks who obey
           the law and do not sell. This "Reward and Reminder" program has been successfully used
           to reduce illegal sales of tobacco and alcohol to minors in communities in Oregon and
           Wyoming. Lane County is currently preparing to test the use of Reward and Reminder in
           reducing illegal alcohol, tobacco and lottery sales. In control communities, we will
           conduct purchase surveys. Surveys will take place once a year.

           Current Youth Alcohol Use and Proximal Measures Bi-monthly student surveys of Alcohol
           Access and Attitudes: Students in 9th - 11th grade will complete a 20-minute survey on
           alcohol use and intentions to use, perceived access to alcohol, perceptions of the
           dangers of alcohol misuse, and perceptions of peer, parent and community attitudes about
           youth misuse of alcohol, every two months for two years. (See attached proposed
           measure). Student data will be tracked over time. Parents will be mailed a letter in
           advance to provide information about the project, and they will have an option to have
           their child opt out of the survey.

           Baseline and follow up anonymous data on youth alcohol use will be obtained from the
           state of Oregon from the Oregon Student Wellness Survey and the OSAS survey (formerly
           Oregon Healthy Teens Survey). These two anonymous statewide surveys alternate each year,
           but items related to alcohol use and attitudes are asked in both surveys. We will work
           with the Oregon Department of Education and the superintendents of schools in each
           community to have access to this secondary data source. The survey is taken in 6th, 8th
           and 11th grades all over the state of Oregon. We will use both 8th and 11th grade survey
           data to get a snapshot of current alcohol use and intentions to use in our communities
           (8th grade data from spring of 2014 is a baseline for 9th graders in the 2014-2015
           school year). The data is anonymous and will give us a good snapshot of current use and
           intentions to use.

        2. Describe the research hypothesis (es) or the specific aims(s). The specific aims of the
           project are to: a) experimentally evaluate a comprehensive strategy to reduce underage
           drinking and alcohol-related problems in 6 communities; b) assess the effects of the
           intervention on intermediate outcomes that represent proximal outcomes of the
           interventions, such as sales to minors, perceived alcohol availability, perceive
           community norms, alcohol expectancies, and perceptions of the social attractiveness
           non-drinking teens; and c) analyze the extent to which intermediate outcomes mediate the
           observed effects of the prevention strategies on alcohol use and problems.

        3. Describe the relevance of the research to previous and/or continuing work in the field.
           This proposal aligns with the movement to integrate policy-oriented interventions with
           programs targeting individual psychological functioning. Evidence shows that fully
           implementing policies to increase the costs of obtaining and using alcohol (e.g.,
           penalty for use, difficulty obtaining) has preventive effects, although some of that may
           result from changes in the normative beliefs and attitudes of people. Ample evidence
           indicates that substance use can be deterred by increasing the degree to which parents
           communicate expectations and set limits and by school-based programs targeting social
           influences and relevant attitudes. It is thus natural to develop and test interventions
           that marshal as many of the known influences on the problem as we can. Considering that
           these intervention effects, though empirically established, are modest, it is vital to
           explore whether combining them can produce additive effects resulting in a greater
           impact on adolescent alcohol use than these types of interventions can produce on their
           own. At the same time, we need efficient strategies that can be maintained. This project
           will combine a policy-focused intervention with an innovative and efficient strategy to
           mobilize peer and parental influences to not drink. The policy component is designed to
           reduce youth access to alcohol and increase the perceived likelihood of sanctions via
           intensified enforcement and rewards for compliance with underage drinking laws.
    

Intervention name(s): Youth Access
Intervention type(s): Behavioral
Intervention description(s): Community youth will participate in various school-and-community-wide pro-social, anti-alcohol activities.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention