Assessing Community Coalition Capacity and its Association with Underage Drinking Prevention Effectiveness in the Context of the SPF SIG.

Community coalitions are a prominent organizational structure through which community-based substance abuse prevention efforts are implemented. There is little empirical evidence, however, regarding the association between coalition attributes and success in achieving community-level reductions in substance abuse behaviors. In this study, we assessed the relationship between coalition capacity, based on coalition coordinator responses to 16 survey items, and reductions in underage drinking prevalence rates. The coalitions were funded through the federally sponsored Strategic Prevention Framework State Incentive Grant (SPF SIG). We first examined whether coalition capacity increased over the life of the projects. Mean capacity scores increased for all 16 capacity items examined (N = 318 coalitions), the majority of which were statistically significant. Analysis of the associations between capacity and reductions in underage drinking was limited to coalitions that targeted underage drinking and provided usable outcome measures based on student survey data for either past 30-day alcohol use (N = 129) or binge drinking (N = 100). Bivariate associations between the capacity items and prevalence reductions for each outcome were consistently positive, although many were not statistically significant. Composite measures of correlated items were then created to represent six different capacity constructs, and included in multivariate models to predict reductions in the targeted outcomes. Constructs that significantly predicted reductions in one or both outcome measures included internal organization and structure, community connections and outreach, and funding from multiple sources. The findings provide support for the expectation that high functioning community coalitions can be effective agents for producing desirable community-level changes in targeted substance abuse behaviors.

Sustainability of State-Level Substance Abuse Prevention Infrastructure After the Completion of the SPF SIG.

Recent national substance abuse prevention efforts that have been disseminated at the state level have provided fertile ground for addressing the dearth of systematic research on state-level substance abuse prevention infrastructure. The Strategic Prevention Framework State Incentive Grant Program (SPF SIG), a national public health initiative sponsored by the US Substance Abuse and Mental Health Services Administration and its Center for Substance Abuse Prevention, is one such effort, providing an opportunity to examine state-level substance abuse prevention infrastructure across the country. The aims of the SPF SIG initiative include reducing substance abuse and its related problems, as well as enhancing state and local prevention infrastructure and capacity. In this article, we describe the status of state-level substance abuse prevention infrastructure and capacity 1 year after the first 26 funded states ended their projects, based on follow-up interviews with state prevention decision-makers. We found that, in five of the six prevention domains we measured, prevention infrastructure capacity increased during the 12-month period after the grants ended. The evidence for further SPF capacity development even after the conclusion of the grants suggests that states recognized the benefits of using the SPF and took deliberate steps to sustain and enhance the integration of this framework into their state prevention systems. In addition, the findings suggest that state agencies and organizations can benefit from time-limited resources aimed at increasing their capacity and that such efforts can have a lasting impact on measures of state prevention system capacity.

Effects of the Strategic Prevention Framework State Incentives Grant (SPF SIG) on state prevention infrastructure in 26 states.

The Strategic Prevention Framework State Incentive Grant (SPF SIG) program is a national public health initiative sponsored by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention to prevent substance abuse and its consequences. State grantees used a data-driven planning model to allocate resources to 450 communities, which in turn launched over 2,200 intervention strategies to target prevention priorities in their respective populations. An additional goal was to build prevention capacity and infrastructure at the state and community levels. This paper addresses whether the state infrastructure goal was achieved, and what contextual and implementation factors were associated with success. The findings are consistent with claims that, overall, the SPF SIG program met its goal of increasing prevention capacity and infrastructure across multiple infrastructure domains, though the mediating effects of implementation were evident only in the evaluation/monitoring domain. The results also show that an initiative like the SPF SIG, which could easily have been compartmentalized within the states, has the potential to permeate more broadly throughout state prevention systems.

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.

Violence victimization of young men in heterosexual relationships: does alcohol outlet density influence outcomes?

This study examined whether alcohol outlet density is associated with male physical and sexual victimization by a female partner. Data were from the National Longitudinal Study of Adolescent Health (Add Health). A total of 3,179 young adult men identified a current heterosexual relationship and had complete intimate partner violence (IPV) victimization data. Almost 16% of this sample reported being the victim of physical only IPV in their relationship over the previous 12 months; an additional 6.4% were victims of sexual only or sexual and physical IPV. Multivariate analyses indicated high alcohol outlet density was associated with greater odds of experiencing physical IPV only (odds ratio [OR] = 2.07). Heavy drinkers experienced increased odds of physical and sexual IPV victimization. Alcohol outlet density should be addressed in prevention efforts.

Outlet density as a predictor of alcohol use in early adolescence.

INTRODUCTION: Recent national youth surveys suggest that alcohol availability plays a role in determining use. One measure of availability receiving recent attention is outlet density; however, few studies have examined the effects of outlet density in younger populations. METHODS: Data were collected from a national sample of the United States (N = 5,903) followed between 6th and 8th grades, as part of a study funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP). Measures of outlet density were also acquired. RESULTS: Students in high off-site density communities increased their alcohol use; however, students attending schools in low outlet density communities had higher initial levels of alcohol use that remained relatively stable. DISCUSSION: The implications and limitations of these findings are discussed.

The effects of Project ALERT one year past curriculum completion.

School-based drug prevention curricula constitute the nation's most prevalent strategy to prevent adolescent drug use. We evaluated the effects of one such curriculum, Project ALERT, on adolescent substance use. In particular, we sought to determine if a single effect on 30-day alcohol use, noted shortly following the completion of the 2-year program, could be detected 1 year later. We also looked for delayed effects on other outcomes of interest, namely lifetime alcohol use, and 30-day and lifetime use of cigarettes, marijuana, and inhalants. We employed a randomized controlled trial that used school as the unit of assignment. Thirty-four schools with grades 6-8 from 11 states completed the study. Seventy-one Project ALERT instructors taught 11 core lessons to sixth graders and 3 booster lessons to seventh graders. Students were assessed prior to the onset of the intervention, as sixth graders, after the completion of the 2-year curriculum, as seventh graders, and again 1 year later as eighth graders. This paper examines data from the pretest and final posttest. Using hierarchical nonlinear modeling, we found that our earlier effect on 30-day alcohol use did not persist. Further, we continued to find no effects for lifetime alcohol use and both the lifetime and 30-day use of cigarettes, marijuana, and inhalants. Our findings do not support the long-term effectiveness of Project ALERT, when delivered to sixth graders.

Racial/Ethnic differences in the association between college attendance and heavy alcohol use: a national study.

OBJECTIVE: This study examined racial/ethnic differences in the association between college attendance and heavy alcohol use and factors that may underlie this relationship. METHOD: Interview data collected from 12,993 young adults who participated in the National Longitudinal Study of Adolescent Health were analyzed to determine if 4- or 2-year college status is differentially associated with heavy alcohol use for five racial/ethnic groups (white, black, Hispanic, Asian, Other) and to assess the explanatory value of selected social and psychological factors. RESULTS: Four-year college status was positively associated with heavy alcohol use among white young adults but inversely related to heavy drinking among blacks and Asians. Two-year college status also was inversely associated with heavy drinking among blacks, Hispanics and Others. Among whites, the association between 4-year college attendance and heavy drinking was partially explained by living away from parents, friends' heavy drinking and time socializing with friends. Among blacks, the inverse relationship between college attendance and heavy alcohol use was partially explained by lower levels of friends' heavy drinking, depression and delinquency. Friends' heavy drinking also partially explained observed relationships between college attendance and heavy drinking among Asians and Others. CONCLUSIONS: Four-year college attendance increases the likelihood of heavy alcohol use among white young adults but may decrease the likelihood of heavy drinking among blacks and Asians. Two-year college attendance also may reduce the risk for heavy drinking among blacks, Hispanics and young adults who are Native American or multi-ethnic. Social and psychological factors partly explain these relationships and also differ for racial/ethnic groups.

Why is work intensity associated with heavy alcohol use among adolescents?

PURPOSE: To examine and explain the relationship between work intensity (number of hours worked per week) and heavy alcohol use among adolescents. METHODS: Analyses were conducted with two waves of in-home interview data provided by a representative sample of adolescents who participated in the National Longitudinal Study of Adolescent Health. Multinomial logistic regression analyses were conducted to determine whether a higher level of work intensity at Wave 1 predicted a higher level of past-year heavy drinking approximately 1 year later at Wave 2, and the degree to which the relationship between work intensity and heavy drinking persisted after adjusting for demographic characteristics, alcohol use before Wave 1, and psychosocial risk and protective factors in family, school, and peer-individual domains. RESULTS: Higher levels of work intensity at Wave 1 (11-20 or more than 20 hours/week) were predictive of heavy drinking at Wave 2. However, these effects were substantially attenuated after adjusting for demographic characteristics and prior alcohol use. Risk and protective factors such as school commitment, friends' drinking, and delinquency also partially explained the effects of work intensity and background variables on heavy drinking, suggesting that these factors may act as confounders and/or mediators. CONCLUSIONS: This study suggests that working more than 10 h/week increases the likelihood of heavy alcohol use among adolescents, and that the effect of work intensity is largely, but not completely attributable to demographic characteristics (e.g., age, race/ethnicity, personal income), prior alcohol use, and family, school, and peer-individual factors.

Postsecondary education and heavy drinking by young adults: the moderating effect of race.

OBJECTIVE: This study examined racial differences in the relationship between postsecondary education (PSE) and heavy drinking among young adults who participated in the 1998 National Household Survey on Drug Abuse. METHOD: In-home survey data collected from 6,374 18-25 year olds were analyzed to examine black-white differences in the relationship between PSE and past-month heavy drinking (five or more consecutive alcoholic beverages). Logistic regression analyses were conducted to examine the interactive effect of PSE and race on heavy drinking, and the degree to which selected psychosocial risk and protective factors help to explain the differential association between PSE and heavy drinking. RESULTS: The prevalence of past-month heavy drinking was significantly higher among whites with at least some PSE than whites without any PSE (41% vs 30%/6), whereas no differences in past-month heavy drinking were observed among blacks who did and did not have at least some PSE (15% vs 16%). This differential relationship persisted when early initiation of alcohol use and demographic characteristics were adjusted for. The effect of PSE on heavy drinking among whites was substantially reduced by controlling for perceived drinking among friends, friends' social support and subjects' propensity for risk taking or sensation seeking. PSE was inversely, although not significantly, associated with heavy drinking among blacks, after adjusting for early alcohol use and demographic characteristics. This inverse relationship was no longer present after controlling for psychosocial factors (e.g., religiosity, perceived harm of heavy drinking) that were associated with PSE and heavy drinking among blacks. CONCLUSIONS: The apparent effect of college attendance on heavy drinking among young adults is driven by the fact that the majority of young adults who attend college are white. College attendance does not appear to increase the likelihood of heavy drinking among black young adults. Additional research with longitudinal data is needed to better understand how the college environment affects alcohol use among whites, and whether blacks who attend predominantly white colleges are more likely to drink heavily than those who attend traditionally black colleges.

Explaining higher levels of alcohol use among working adolescents: an analysis of potential explanatory variables.

OBJECTIVE: The purpose ofthis study was to explain higher rates of alcohol use observed among working adolescents relative to nonworking adolescents. METHOD: In-home survey data were collected from a representative sample of 4,497 (50% male) 14-17 year olds who participated in the 1998 National Household Survey on Drug Abuse (NHSDA). Multivariate logistic regression analyses were conducted to determine whether relationships between work status and past-month alcohol use and heavy drinking would persist after adjusting for demographic characteristics and selected risk and protective factors in the community, family, school and peer-individual domains. RESULTS: As anticipated, significantly higher rates of past-month alcohol use and heavy drinking were reported by working than nonworking adolescents. Multivariate analyses indicated that the higher rates of past-month alcohol use and heavy drinking among working adolescents were largely explained by demographic characteristics (e.g., age, race/ethnicity), together with perceived drinking norms among adults, other students and friends. CONCLUSIONS: Findings of this study suggest that the relationship between employment and alcohol use among adolescents is largely spurious, due to demographic differences between working and nonworking adolescents. Our findings also suggest, however, that working adolescents are more likely to be exposed to adults and peers who drink, which may be attributed in part to their work setting.

Effects of parenting, father absence, and affiliation with delinquent peers on delinquent behavior among African-American male adolescents.

This study examined the effects of different aspects of parenting, father absence, and affiliation with delinquent peers on delinquent behavior in a cohort of African-American male adolescents. One round of survey data was collected from the youths' mothers or mother surrogates (N = 175) and two rounds of survey data were collected from the adolescents themselves. Analyses revealed that mothers' perceived control of sons' behavior was a deterrent of delinquent behavior, while other aspects of parenting (e.g., mother-son communication and relations) were not. The effect of mothers' perceived control was not mediated by adolescents' affiliation with delinquent peers. The effects of mothers' parenting variables and peer affiliation did not vary significantly by family structure, but socioeconomic disadvantage was more strongly associated with delinquent behavior in father-absent families. Though parenting effects were modest, this study suggests that African-American male adolescents are less likely to engage in delinquent behavior if they are closely monitored and supervised by their parents.

Perpetration of intimate partner violence by young adult males: the association with alcohol outlet density and drinking behavior.

OBJECTIVE: This study examined the association between alcohol outlet density and male to female intimate partner violence (IPV). METHOD: Data were analyzed from a national probability sample of males who reported a current heterosexual relationship (N=3194). Multinomial logistic regression was used to examine the likelihood of having perpetrated IPV. RESULTS: High alcohol outlet density was associated with having perpetrated physical only IPV (odds ratio [OR]=2.51; 95% confidence interval [CI]: 1.21-5.20). Outlet density was not associated with greater odds of sexual IPV perpetration. CONCLUSIONS: Alcohol outlet density was found to be associated with perpetration of physical IPV. Developing environmental strategies with respect to alcohol outlets could potentially reduce perpetration of male-to-female physical IPV.

Alcohol Outlet Density and Young Women's Perpetration of Violence Toward Male Intimate Partners.

This paper examines the relationships between alcohol outlet density, alcohol use, and perpetration of intimate partner violence (IPV) among young adult women in the US. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health; N = 4,430 in present analyses). Multinomial logistic regression was used to examine occurrence of past year IPV perpetration toward a male partner based on tract-level on-premise and off-premise alcohol outlet density, controlling for individuals' demographic, alcohol use, and childhood abuse characteristics and neighborhood socio-demographic factors. Higher off-premise alcohol outlet density was found to be associated with young women's perpetration of physical only IPV, controlling for individual-level and ecological factors. Alcohol use had an independent association with IPV perpetration but was not a mediator of the outlet density-IPV relationship. Findings suggest that considering alcohol-related environmental factors may help efforts aimed at preventing young women's use of physical violence toward partners.

Relationships among alcohol outlet density, alcohol use, and intimate partner violence victimization among young women in the United States.

Greater access to alcohol has been widely found to be associated with many negative outcomes including violence perpetration. This study examines the relationship between alcohol outlet density, alcohol use, and intimate partner violence (IPV) victimization among young women in the United States. A direct association between alcohol outlet density in one's neighborhood and the likelihood of IPV victimization was examined. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health), which followed a nationally representative sample of adolescents into adulthood. Participants were young adult females age 18 to 26 at Wave III. Of the 4,571 female respondents who reported a current heterosexual relationship and had IPV data, 13.2% reported having been the victim of physical violence only and 6.5% experienced sexual only or physical and sexual violence in the relationship during the past year. In the regression models tested, there was no significant direct association between neighborhood alcohol outlet density and IPV victimization nor was there an association between outlet density and drinking behaviors, thus eliminating the possibility of an indirect association. Results of fully adjusted models indicate females who drank heavily, whether infrequently or frequently, were at significant risk for experiencing sexual only IPV or sexual and physical IPV. Asians and Native Americans were at significantly greater odds of experiencing sexual only or sexual and physical IPV compared with non-Hispanic Whites, while non-Hispanic Blacks were at significantly greater odds for physical only IPV. We conclude that a continuous measure of alcohol outlet density was not associated with IPV in models controlling for individual and other neighborhood characteristics. Young women who drink heavily, whether infrequently or frequently, have greater odds of experiencing sexual only or sexual and physical compared to abstainers. Similar to previous study findings, young women living with or married to their partner were at far greater risk of experiencing physical only and/or sexual only or sexual and physical IPV. The study adds to the growing body of literature that examines how community characteristics such as outlet density influence the likelihood of IPV.

Are substance use prevention programs more effective in schools making adequate yearly progress? A study of Project ALERT.

This exploratory study sought to determine if a popular school-based drug prevention program might be effective in schools that are making adequate yearly progress (AYP). Thirty-four schools with grades 6 through 8 in 11 states were randomly assigned either to receive Project ALERT (n = 17) or to a control group (n = 17); of these, 10 intervention and nine control schools failed to make AYP. Students completed three self-report surveys. For lifetime cigarette use and 30-day alcohol use, Project ALERT was more effective in schools that made AYP. However, in these schools, Project ALERT negatively affected students' lifetime marijuana use. This study provided some preliminary evidence that prevention programming may not work as well in poorer performing schools; however, further exploration is needed.

Project SUCCESS' effects on the substance use of alternative high school students.

Project SUCCESS is a selective and indicated substance use prevention program that targets high risk students in secondary school settings. We evaluated the effects of Project SUCCESS on adolescents' substance use immediately following program implementation, and again one year later. Two successive cohorts of alternative high schools were randomly assigned to an intervention or control group, yielding seven schools per condition. Main outcomes included 30-day use of alcohol, marijuana, and illegal drugs excluding marijuana, and drinking to intoxication. We conducted exploratory analyses on 30-day cigarette use. Using Hierarchical Linear Modeling, we found that students in the control schools reported significantly less use of illegal drugs excluding marijuana than those in the intervention group at the first posttest; however, this effect did not persist one year later. There were no other outcome effects of even a marginal nature. While results of this study do not provide evidence of Project SUCCESS' effectiveness, students' program exposure was low. It is possible that Project SUCCESS would perform better in schools with higher and more regular rates of attendance.

Project ALERT: a cluster randomized trial.

OBJECTIVE: To evaluate the effects of Project ALERT on adolescents' lifetime and 30-day use of cigarettes, alcohol, marijuana, and inhalants. DESIGN: Cluster randomized trial. SETTING: Schools from 11 states were enrolled in 2 successive cohorts from 2004 to 2008. PARTICIPANTS: All public schools in the United States that included grades 6 through 8 and enrolled at least 100 students in sixth grade were recruited. Of the 40 schools that began the study, 34 (17 per condition) completed it. Data were analyzed from 5883 unique participants. Intervention Project ALERT, a manualized classroom-based substance use prevention curriculum for the middle grades, was taught to sixth and seventh graders. MAIN OUTCOME MEASURES: Students were surveyed before the onset of the intervention, as sixth graders, and after the completion of the 2-year intervention, as seventh graders. Outcome measures included lifetime and 30-day use of cigarettes, alcohol, marijuana, and inhalants. RESULTS: At baseline, students in the intervention condition were slightly to moderately more likely to report use for each of the 8 measures examined than were students in the control condition. For all measures except lifetime use of cigarettes, these differences were less pronounced at follow-up and therefore were in the direction of favorable program effects. These changes were statistically significant, however, for only 1 outcome measure, past 30-day use of alcohol (reduction in the adjusted odds ratio from 2.07 at baseline to 1.32 at follow-up; P = .006). CONCLUSION: Project ALERT was not effective when delivered to the sixth grade population we targeted.

Alcohol outlet characteristics and alcohol sales to youth: results of alcohol purchase surveys in 45 Oregon communities.

Reducing youth access to commercial sources of alcohol is recognized as a necessary component of a comprehensive strategy to reduce underage drinking and alcohol-related problems. However, research on policy-relevant factors that may influence the commercial availability of alcohol to youth is limited. The present study examines characteristics of off-premise alcohol outlets that may affect alcohol sales to youth. Random alcohol purchase surveys (N = 385) were conducted in 45 Oregon communities in 2005. Underage-looking decoys who were 21 years old but did not carry IDs were able to purchase alcohol at 34% of the outlets approached. Purchase rates were highest at convenience (38%) and grocery (36%) stores but were relatively low (14%) at other types of outlets (e.g., liquor and drug stores). Alcohol purchases were less likely at stores that were participating in the Oregon Liquor Control Commission's Responsible Vendor Program (RVP), when sales clerks asked the decoys for their IDs, and at stores with a posted underage alcohol sale warning sign. Alcohol purchases were also inversely related to the number of sales clerks present in a store, but were not related to sales clerks' age and gender. Findings of this study suggest that more frequent compliance checks by law enforcement agents should target convenience and grocery stores, and owners of off-premise outlets should require training of all sales clerks to ensure reliable checks of young-looking patron IDs, and should post underage alcohol sales warning signs in clear view of patrons.

Ethnic differences in relationships between risk factors and adolescent binge drinking: a national study.

This study examines ethnic differences in relationships between a large number of risk factors and adolescent binge drinking with data collected from 14 to 17 year olds who participated in the 1999 National Household Survey on Drug Abuse (NHSDA). Logistic regression analyses were conducted to determine whether 39 risk factors in community, family, school, and peer-individual domains were differentially associated with past-30-day binge drinking among youth in ethnic minority groups (black, Hispanic and Asian) relative to whites. Forty-three percent (17) of the risk factors examined were differentially associated with binge drinking in at least one of the ethnic groups relative to whites. Most of these risk factors were more strongly associated with binge drinking among white adolescents than Hispanic and black youth, but not Asians. The direction of the relationships between these risk factors and binge drinking, however, was usually the same for whites and ethnic minority groups. A multivariate prediction model indicated that risk factors in the community, family, school, and peer-individual domains accounted for 27% of the variance in binge drinking for white adolescents, 22% for Hispanics, 10% for blacks, and 39% for Asians. These findings suggest that research is needed to identify additional risk factors that are associated with binge drinking among adolescents, particularly blacks, Hispanics and possibly other ethnic minority groups.