Preventing alcohol use with a voluntary after-school program for middle school students: results from a cluster randomized controlled trial of CHOICE.
There are many mandated school-based programs to prevent adolescent alcohol and drug (AOD) use, but few are voluntary and take place outside of class time. This cluster randomized controlled trial evaluates CHOICE, a voluntary after-school program for younger adolescents, which reduced both individual- and school-level alcohol use in a previous pilot study. We evaluated CHOICE with 9,528 students from 16 middle schools. The sample was 51% female; 54% Hispanic, 17% Asian, 15% white, 9% multiethnic and 3% African American. Fifteen percent of students attended CHOICE. All students completed surveys on alcohol beliefs and use at baseline and 6-7 months later. We conducted intention-to-treat (ITT) school-level analyses and propensity-matched attender analyses. Lifetime alcohol use in the ITT analysis (i.e., school level) achieved statistical significance, with an odds ratio (OR) of 0.70 and a NNT of 14.8. The NNT suggests that in a school where CHOICE was offered, 1 adolescent out of 15 was prevented from initiating alcohol use during this time period. Although not statistically significant (p = .20), results indicate that past month alcohol use was also lower in CHOICE schools (OR = 0.81; NNT = 45). Comparisons of attenders versus matched controls yielded results for lifetime use similar to school-wide effects (OR = 0.74 and NNT = 17.6). Initial results are promising and suggest that a voluntary after-school program that focuses specifically on AOD may be effective in deterring alcohol use among early adolescents; however, further research is needed as program effects were modest.
RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. damico@rand.org
Elizabeth J
EJ
D'Amico
Joan S
JS
Tucker
Jeremy N V
JN
Miles
Annie J
AJ
Zhou
Regina A
RA
Shih
Harold D
HD
Green
D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control*; D016000:Cluster Analysis; D003625:Data Collection; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D011322:Primary Prevention / Q000379:methods; D016730:Program Development / Q000379:methods*; D015397:Program Evaluation / Q000379:methods; D011582:Psychological Theory; D012574:Schools