Reducing youth access to alcohol: findings from a community-based randomized trial.

Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se.

Supporting Adolescents with Guidance and Employment (SAGE).

Supporting Adolescents with Guidance and Employment (SAGE) is a multifaceted, community-based violence-prevention program. Its target is African-American male adolescents in Durham, North Carolina. Public health professionals, county government officials, and local businessmen collaborated in its development and implementation. The program is based on the paradigm of risk and protective factors, in which various risk factors for youth violence are buffered by modifiable, protective psychosocial processes. SAGE includes an eight-month African-American Rites of Passage program (adult mentoring, African-American culture and history lessons, and manhood and conflict-resolution training), a six-week summer employment component, and a 12-week entrepreneurial experience. Of the 260 youth recruited, 88 were randomly assigned to receive all three program components, 85 were assigned to the summer employment and entrepreneurial components only, and 87 were assigned to a delayed program or control condition. We compared these three groups' psychosocial and behavioral outcomes using survey data and archival records. Program implementation data include attendance records; mentor-youth activity logs pre- and postprogram focus group discussions; and telephone interviews with parents, program staff, and participants. The mean age of the adolescents recruited into the program was 14. Half reported receiving free lunches at school; half were not living with a father; and one quarter reported that their mothers had not completed high school. During the previous year, many had engaged in various violence-related behaviors, including fighting (49%) and carrying a gun (22%). Youths in each program condition were similar with respect to key demographic and behavioral characteristics. The key components of the SAGE program represent increasingly popular but untested approaches. Preliminary results reveal that these youths are involved in violent behavior both as perpetrators and as victims.

Effects of neighborhood and family stressors on African American male adolescents' self-worth and propensity for violent behavior.

Multilevel data were used to examine the effects of neighborhood poverty on family stress and conflict, African American male adolescents' self-worth, and their propensity for violent behavior. Block group-level census data were linked with survey data from 188 African American male adolescents and their mothers. Path analyses indicated that neighborhood poverty did not directly affect adolescents' propensity for violent behavior but may have had an indirect effect through family stress and conflict and adolescents' self-worth. Subgroup analyses revealed that adolescents who had lived in their neighborhoods for more than 5 years were more susceptible to the potentially detrimental effects of neighborhood-level poverty and family stress and conflict. Implications for future research and prevention programming are discussed.

The use of one- versus two-tailed tests to evaluate prevention programs.

Investigators have used both one- and two-tailed tests to determine the significance of findings yielded by program evaluations. While the literature that addresses the appropriate use of each type of significance test should be used is historically inconsistent, almost all authorities now agree that one-tailed tests are rarely (if ever) appropriate. A review of 85 published evaluations of school-based drug prevention curricula specified on the National Registry of Effective Programs and Practices revealed that 20% employed one-tailed tests and, within this subgroup, an additional 4% also employed two-tailed tests. The majority of publications either did not specify the type of statistical test employed or used some other criterion such as effect sizes or confidence intervals. Evaluators reported that they used one-tailed tests either because they stipulated the direction of expected findings in advance, or because prior evaluations of similar programs had yielded no negative results. The authors conclude that one-tailed tests should never be used because they introduce greater potential for Type I errors and create an uneven playing field when outcomes are compared across programs. The authors also conclude that the traditional threshold of significance that places α at .05 is arbitrary and obsolete, and that evaluators should consistently report the exact p values they find.

Measuring intermediate outcomes of violence prevention programs targeting African-American male youth: an exploratory assessment of the psychometric properties of six psychosocial measures.

This study examined the psychometric properties of six psychosocial measures that may be useful indicators of intermediate outcomes of violence prevention programs targeting African-American male youth. Baseline and 6 month follow-up survey data are used from 223 African-American male 12-16 year olds participating in a violence prevention program evaluation study. The constructs of interest are beliefs supporting aggression, aggressive conflict-resolution style, hostility, ethnic identity, self-esteem and hopelessness. Each construct is measured as a multi-item scale. Exploratory factor analysis results provided limited support for the unidimensionality of these scales, thus suggesting that further scale development is warranted. Reliability coefficients for the scales ranged from 0.55 to 0.80. Bivariate analyses with baseline data indicate that all six measures have construct and criterion-related validity, as they are associated with each other and with four behavioral criteria in the expected directions. Predictive validity was also demonstrated for beliefs supporting aggression, aggressive conflict-resolution style, hostility and hopelessness which were associated with weapon-carrying behaviors measured in the 6 month follow-up survey both before and after controlling for corresponding behaviors measured in the baseline survey.

Alcohol misuse in young adulthood: effects of race, educational attainment, and social context.

We analyzed survey data collected from 1,582 African-American and White young adults to determine 1) whether the relationship between educational attainment and alcohol misuse would vary by race, and 2) what social and psychological factors might explain the differential effects of educational attainment on alcohol misuse. Low educational attainment was positively associated with alcohol misuse among African-American young adults, while high educational attainment was positively associated with alcohol misuse among Whites. Selected social and psychological factors (e.g., unemployment, emotional distress) did not explain the differential effect of low educational attainment of alcohol misuse, but college status and attitudes favorable toward alcohol use accounted for racial differences in the effect of high educational attainment on alcohol misuse. This study may help to explain why disproportionately higher rates of alcohol-related health and social problems have been observed in the African-American adult population, but additional research is needed to better understand the long-term and differential effects of educational attainment on alcohol misuse.