Profile Updated:
Summary: This is a voluntary afterschool program for middle school aged youths to inform them about substance use and prevent them from starting or continuing alcohol use. The program is rated Effective for reducing alcohol use frequency, and Ineffective for reducing heavy alcohol use and improving alcohol resistance self-efficacy (the self-confidence to resist alcohol). (Review the full program description).
| Title | Rating | Details | Outcome Category | Study(ies) |
|---|---|---|---|---|
| Alcohol use (multisite) |
Effective | One Study |
Overall, students in treatment schools had lower alcohol use frequency compared with students in control schools based on multiple measures from the study. This difference was statistically significant. |
Drugs and substance abuse; Use of legal substances; Alcohol use | D’Amico, Elizabeth J., Joan S. Tucker, Jeremy N. V. Miles, Annie J. Zhou, Regina A. Shih, and Harold D. Green. 2012. “Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students: Results from a Cluster Randomized Controlled Trial of CHOICE.” Prevention Science 13:415–25 See evaluation methods. |
| Heavy drinking in the past month (multisite) |
Ineffective | One Study |
There was no statistically significant difference in heavy drinking behavior in the past month between students in treatment schools and students in control schools. |
Drugs and substance abuse; Severe alcohol use | D’Amico, Elizabeth J., Joan S. Tucker, Jeremy N. V. Miles, Annie J. Zhou, Regina A. Shih, and Harold D. Green. 2012. “Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students: Results from a Cluster Randomized Controlled Trial of CHOICE.” Prevention Science 13:415–25 See evaluation methods. |
| Alcohol resistance self-efficacy (multisite) |
Ineffective | One Study |
There was no statistically significant difference on self-efficacy to resist alcohol between students in treatment schools and students in control schools. |
Attitudes/beliefs/knowledge; Self-efficacy; Resistance self-efficacy | D’Amico, Elizabeth J., Joan S. Tucker, Jeremy N. V. Miles, Annie J. Zhou, Regina A. Shih, and Harold D. Green. 2012. “Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students: Results from a Cluster Randomized Controlled Trial of CHOICE.” Prevention Science 13:415–25 See evaluation methods. |
Program Goals
CHOICE was a voluntary afterschool program for middle school aged youths that focused on enhancing protective factors and reducing risk factors for alcohol use. The goals were to inform students about substance use and prevent them from starting or continuing alcohol use.
Program Theory
CHOICE was based on components of social learning theory (Bandura 1977), decision-making theory (Kahneman and Tversky 2000), and self-efficacy theory (Bandura 1997). Social learning theory suggests that youths make assumptions (which are at times inaccurate) about their peers’ alcohol use and then engage in alcohol use themselves. To address this, the CHOICE curriculum provides students with facts on youth alcohol use from Monitoring the Future statistics (D’Amico et al. 2012). Self-efficacy theory (Bandura 1997) suggests that people who have more confidence in their ability to change behaviorally are more likely to actually engage in behavior change (D’Amico et al. 2005), and role playing to resist substance use was a key session in the program. A motivational interviewing approach (Miller and Rollnick 2002) was also used to present the intervention curriculum material, as research suggested that this type of nonjudgmental, interactive approach is successful in helping teenagers to change their drinking behavior (D’Amico and Fromme 2002; Monti et al. 1999).
Program Activities
CHOICE consisted of five 30-minute sessions offered once a week after school. Sessions were rotated weekly throughout the school year and focused on providing normative feedback on substance use, discussing unrealistic beliefs about substances, resisting pressure through role play, discussing benefits of cutting back or abstaining from substance use, and discussing risky situations and appropriate coping mechanisms (D’Amico et al. 2012; D’Amico et al. 2005). CHOICE was implemented in a group format because group interventions were developmentally relevant for this age group (Brown and D’Amico 2003).
Study Title: Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students Results from a Cluster Randomized Controlled Trial of CHOICE (which is associated with outcomes Alcohol use, Heavy drinking in the past month , and Alcohol resistance self-efficacy )
Research Design
D’Amico and colleagues (2012) evaluated the impact of participation in CHOICE on 6th through 8th grade students’ behaviors and attitudes toward alcohol, using a cluster randomized controlled design in 16 middle schools (8 treatment and 8 control) from three school districts in southern California.
Sample
Schools were selected and matched with comparable neighboring schools on multiple measures before being randomized into treatment or control conditions. While close to 15,000 students were originally recruited for the study, 9,828 students received parental permission to participate, and 8,932 students (4,243 treatment school students and 4,689 control school students) completed the baseline survey. Treatment group students were 51 percent female, 52 percent Hispanic, 17 percent white, 17 percent Asian, 10 percent another race, and 4 percent Black. Control group students were 50 percent female, 56 percent Hispanic, 16 percent Asian, 14 percent white, 11 percent another race, and 3 percent Black. After controlling for grade, there were no statistically significant differences between treatment and control students at baseline. Final outcome analysis was based on data from 9,528 students in two waves of the study. Students could choose to attend as many of the CHOICE sessions as they preferred. Students attended an average of three sessions and one third of the treatment students attended all five sessions.
Data Collection
Baseline surveys were completed in September–October 2008 and follow-up surveys were completed in May–June 2009. Surveys were completed in physical education classes during the school day. Outcomes were assessed using the California Healthy Kids Survey, Monitoring the Future, and scales developed from Project ALERT.
Outcome Measures
Outcomes included alcohol use (measured by lifetime and past-month alcohol use frequency); heavy drinking in the past month; and alcohol resistance self-efficacy (the confidence in one’s ability to resist alcohol). Frequency of alcohol use was assessed by asking students “During your life [or past month], how many times [or days] have you tried alcohol?” Heavy drinking in the past month was assessed by asking students how frequently they had drunk “five or more drinks of alcohol in a row, that is, within a couple of hours” where a “drink” was defined as one whole drink of alcohol (not including a few sips of wine for religious purposes). To assess resistance self-efficacy, students were asked: “Suppose you are offered alcohol and you do not want to use it. What would you do in these situations: a) your best friend is drinking alcohol; b) you are bored at a party; and c) all your friends at a party are drinking alcohol?” These three items were rated on a scale ranging from 1 “I would definitely drink” to 4 “I would definitely not drink.”
Statistical Analysis
Data were analyzed using an intent-to-treat approach in which students were analyzed in the groups to which they were assigned (all respondents in control schools were compared with all respondents in treatment schools, regardless of attendance at CHOICE). Generalized estimating equation regression models were used to account for the clustering of individuals within schools. Outcomes were estimated in an adjusted multivariate analysis which included the following covariates: baseline level of the variable and current school grade, sex, and race. No subgroup analysis was conducted.
Citation:
D’Amico, Elizabeth J., Joan S. Tucker, Jeremy N. V. Miles, Annie J. Zhou, Regina A. Shih, and Harold D. Green. 2012. “Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students: Results from a Cluster Randomized Controlled Trial of CHOICE.” Prevention Science 13:415–25
This study is a high-quality randomized controlled trial.
In the study by D’Amico and colleagues (2012), facilitators were bachelor- and master-level project staff who received 30 hours of training over 4 weeks in CHOICE session topics and the motivational interviewing approach. To ensure program fidelity, evaluators employed practices such as weekly supervision of facilitators and two session observations a year by trained observers for adherence to program components. They used the Motivational Interviewing Treatment Integrity (MITI 3.1) scale to measure overall adherence.
These sources were used in the development of the program profile:
Bandura, Albert. 1977. Social Learning Theory. Englewood Cliffs, N.J.: Prentice Hall.
Bandura, Albert. 1997. Self-Efficacy: The Exercise of Control. New York: Freeman.
Brown, Sandra A., and Elizabeth J. D’Amico. 2003. “Outcomes of Alcohol Treatment for Adolescents.” In Recent Developments in Alcoholism, Vol. 16, ed. Marc Galanter (New York, NY: Kluwer Academic/Plenum Publishers), 289–312.
D’Amico, Elizabeth J., Phyllis L. Ellickson, Eric F. Wagner, Rob Turrisi, Kim Fromme, Bonnie Ghosh-Dastidar, Douglas L. Longshore, Daniel F. McCaffrey, Marilyn J. Montgomery, Matthias Schonlau, and Dale Wright. 2005. “Developmental Considerations for Substance Use Interventions from Middle School through College.” Alcoholism: Clinical and Experimental Research 29(3):474–83.
D’Amico, Elizabeth J., and Kim Fromme. 2002. “Brief Prevention for Adolescent Risk-Taking Behavior.” Addiction 97(5):563–574.
Kahneman, D., and A. Tversky. 2000. Choices, Values, and Frames. New York: Cambridge University Press.
Kilmer, B., James R. Burgdorf, Elizabeth J. D’Amico, Joan S. Tucker, and Jeremy N. V. Miles. 2011. “A Multi-Site Cost Analysis of a School-Based Voluntary Alcohol and Drug Prevention Program.” Journal of Studies on Alcohol and Drugs 72(5):823-832.
Miller, William R., and Stephen Rollnick. 2002. Motivational Interviewing: Preparing People for Change, 2nd ed. (New York, NY: Guilford Press).
Monti, Peter M., Suzanne M. Colby, Nancy Barnett, Anthony Spirito, Damaris J. Rohsenow, Mark G. Myers, Robert Woolard, and William Lewander. 1999. “Brief Intervention for Harm Reduction with Alcohol-Positive Older Adolescents in a Hospital Emergency Department. Journal of Consulting and Clinical Psychology 67(6):989 –994.
Following are CrimeSolutions-rated programs that are related to this practice:
This practice consists of time-limited, low-dose therapeutic programs delivered in a school or educational setting that teach skills and encourage motivation to change or prevent substance use in youth participants. This practice is rated Effective for reducing alcohol use but was rated Ineffective for reducing marijuana use.
Evidence Ratings for Outcomes
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Drugs & Substance Abuse - Alcohol |
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Drugs & Substance Abuse - Marijuana |
This practice seeks to reduce alcohol use or alcohol-related problems for adolescents and young adults via a short-term intervention (one to five sessions). The practice is rated Effective for reducing alcohol consumption and alcohol-related problem outcomes for adolescents and young adults.
Evidence Ratings for Outcomes
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Drugs & Substance Abuse - Alcohol consumption by adolescents |
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Drugs & Substance Abuse - Alcohol-related problems of adolescents |
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Drugs & Substance Abuse - Alcohol-related problems of young adults |
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Drugs & Substance Abuse - Alcohol consumption by young adults |
Following are CrimeSolutions-rated programs that are related to this program:
This was a mindfulness education and substance abuse prevention program for fourth- and fifth-grade students, which was designed to build self-regulatory skills and reduce intentions to use alcohol or tobacco. This program was rated Promising. There were statistically significant increases in measures of executive functioning, social problems, and aggression. There were no statistically significant effects on attention problems and intentions to use substances.
This is an alcohol misuse prevention curriculum for 10- to 18-year-olds that emphasized resistance training, knowledge of the immediate effects of alcohol use, identification of the risks of alcohol misuse, and recognition of social pressures that lead to alcohol misuse. The program is rated Ineffective. There were no statistically significant effects found on alcohol use, alcohol misuse, serious offenses, or refusal skills.
This is a health promotion program designed to prevent alcohol use among at-risk middle and junior high school youth. The goal is to postpone alcohol use until adulthood. The program seeks to identify the various risk factors that youth are exposed to and offer them targeted information concerning underage alcohol use. The program is rated Ineffective. There were no statistically significant effects on frequency of alcohol use, quantity of alcohol consumption, or heavy alcohol use.
This is a school-based, universal substance abuse prevention program for middle school students. The program is rated Ineffective. Intervention students self-reported greater use of alcohol and cigarettes and more binge drinking, compared with control group students, at the 5-year follow up. These differences were statistically significant. There were no statistically significant differences between groups in marijuana use.
This program was originally rated Ineffective. It has been re-reviewed based on the change in the program rating instrument. Under the new instrument, CrimeSolutions ow now rates individual program outcomes and no longer assigns an overall rating.
Rating Process
Program Status
This program is Not Active.