One of SAMHSA's first acts was to establish the Interagency Committee on the Prevention of Underage Drinking. Part of the work of this committee has been to identify promising practices in reducing underage drinking. SAMHSA then issued its first report in April, 2004, summarizing all federal agency activities focused on the problem.

For federal agencies, collaboration is the key to success.

In addition to a host of federal agencies working on this problem, SAMHSA is also looking for input from many other interested parties, including advocacy groups and the alcohol beverage industry itself. The Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) has representatives from the National Institute on Alcohol Abuse and Alcoholism, the Office of Juvenile Justice and Delinquency Prevention, the Office of Safe and Drug Free Schools, the National Highway Traffic Safety Administration, the Office of National Drug Control Policy, the Office of the Surgeon General, and the Centers for Disease Control and Prevention. This committee coordinates federal efforts and acts as a resource for the development of SAMHSA's plan for combating underage drinking.

A number of advocacy groups are also collaborating with the committee. These include: Mothers Against Drunk Driving, the Center for Science in the Public Interest, the Center on Alcohol Marketing and Youth, Students Against Destructive Decisions, National Liquor Law Enforcement Association, and the Leadership to Keep Children Alcohol Free. The alcohol beverage industry groups include the American Beverage Institute, the Beer Institute, the Beer Wholesalers Association, the Century Council, and the Distilled Spirits Council of the United States.

In November 2005, the U.S. Department of Health and Human Services (HHS) in partnership with the Ad Council, launched a national public service advertising (PSA) campaign designed to prevent underage drinking. The campaign aims to encourage parents to speak to their children about alcohol in an effort to prevent and reduce underage drinking. "Over the years we have made great progress in reducing tobacco and illicit drug use among our nation's young people," said HHS Secretary Mike Leavitt. "Underage alcohol use has been a tougher and more persistent problem. However, I think the solutions are well within our grasp. These new ads will help us create and sustain a strong national commitment to prevent and reduce underage drinking" (NIAAA PSA press release 10/31/05).

Throughout this event you'll see more about all of these groups and how they're working to reduce underage drinking.

The Role of Schools in Preventing Underage Drinking

Like other forms of substance abuse, alcohol use and abuse contributes to academic problems for students, and discipline and safety problems for schools. Fortunately, schools clearly play a key role in preventing underage alcohol use and should be included in all comprehensive, community-based efforts to reduce underage drinking. There is a wide range of activities that schools can undertake to prevent underage drinking that include, policy development, implementing alcohol prevention curricula, creating a safe and supportive school environment, developing after-school programs, and working in partnership with the community on alcohol prevention.

As a prevention coordinator, one of your primary roles is to continually "make the case" to administrators, teachers, parents, and community members, that safe and drug-free school will enhance effective learning and teaching. You must identify concrete ways that prevention programming will provide students with the knowledge and skills they need to succeed. By highlighting the intrinsic connections between healthy behavior, academic achievement, and school safety, you will be better able to garner the programmatic support you need to implement and sustain your prevention programs.

This five day event examines the issue of underage drinking and provides participants with examples, tips and resources on how to address this issue in their schools and communities. The training will identify "best practices" and highlight effective programs. The training will also provide suggestions for engaging law enforcement and the judicial system as active partners in the effort to reduce underage drinking. A variety of resources for parents, teachers and community groups will also be provided for your use.

During this event, you will have the opportunity to do the following:

• Understand the origins and impact of underage drinking.
• Become aware of and familiar with the vast resources available to you through government agencies.
• Explore the factors that promote alcohol use among youth.
• Recognize the proven links between underage drinking and other problems, including adult alcoholism, failure in school, and other health problems.
• Review the latest research on underage drinking.
• Learn about model approaches and strategies that schools can take to address this issue.
• Examine policy issues and national efforts to reducing underage drinking.
• Explore ways to involve students in evidenced-based substance abuse prevention activities.

References for this page:

Curie, Charles G. "SAMHSA Report to Congress -- Development of a Plan for Combating Underage Drinking." ICCPUD_Report_42002.pdf. April 2004. Leadership to Keep Children Alcohol Free. 3 March 2005. Website: http://www.alcoholfreechildren.org/en/emplibrary/ICCPUD_Report_42004.pdf

Curie, Charles G. "Chapter 1: Prevention of Underage Drinking: Federal Agency Programs Currently in Operation." Report.pdf. April 2004. The Center on Alcohol Marketing and Youth. Website: http://camy.org/washington/iccpud/Report.pdf

U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration (SAMHSA), Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). (2005). Start talking before they start drinking. Available: http://www.stopalcoholabuse.gov/

U.S. Department of Health and Human Services

Administration for Children, Youth, and Families (ACF)/Family and Youth Services Bureau (FYSB)

Centers for Disease Control and Prevention (CDC)

National Institutes of Health/National Institute on Alcohol, Alcohol Abuse, and Alcoholism (NIAAA)

Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention (CSAP)

Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment (CSAT)

U.S. Department of Education/Office of Safe and Drug-Free Schools

Department of Transportation/National Highway Traffic Safety Administration (NHTSA)

Office of National Drug Control Policy (ONDCP)

Department of Justice/Office of Juvenile Justice and Delinquency Prevention (OJJDP)

U.S. Department of Health and Human Services

Administration for Children, Youth, and Families (ACF)/Family and Youth Services Bureau (FYSB) -
FYSB is a grant-making agency within ACF that administers programs for runaway and homeless youth, victims of domestic violence, and children of prisoners.

Activities Related to Underage Drinking:

Underage drinking is not a separate issue that FYSB focuses on, however it is an issue addressed through their comprehensive youth programs reaching children at-risk for numerous problems, including substance abuse. All of the programs FYSB provides incorporate a positive youth development approach.

• Runaway and Homeless Youth Program: This program provides funding to local communities to support young people, particularly runaway and homeless youth, and their families through the Runaway and Homeless Youth Program. Basic Center Program (BCP) grants offer assistance to at-risk youth in need of immediate shelter. They provide family and youth counseling and refer them to services like substance abuse treatment. Through the Street Outreach Program (SOP), FYSB awards grants to private, nonprofit agencies to conduct outreach designed to build relationships between grantee staff and street youth. The goal of these efforts is to help young people leave the streets. Alcohol is not allowed at any of the FYSB grantee sites and it is expected that after participating in these programs, youth will be prepared to make better choices regarding alcohol use.

• Mentoring Children of Prisoners: FYSB supports the Mentoring Children of Prisoners Program. The living conditions, family configurations, and problems faced by incarcerated parents make it likely that significant numbers of children of prisoners will suffer emotional and behavioral difficulties. Data indicates that mentoring programs have reduced first time alcohol use by 33 percent.

• National Youth Summit: Each year, FYSB sponsors a National Youth Summit to promote leadership opportunities for youth and to provide them with alternatives to risky behavior. The National Youth Summit celebrates America's youth and their achievements, strengths, and leadership. This year, the Summit theme is Youth Leadership in America's Communities.

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Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) is recognized as the lead federal agency for protecting the health and safety of people - at home and abroad, providing credible information to enhance health decisions, and promoting health through strong partnerships. CDC serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States.

Surveillance Activities Specific to Underage Drinking:

• Youth Risk Behavioral Survey System: Collects data on age at first drink of alcohol, frequency of drinking, frequency of binge drinking, and drinking on school property for high school students.

• Behavioral Risk Factor Surveillance System (BRFSS): Collects data on the number of drinking days in the past 30 days, average number of drinks per occasion, and frequency of binge drinking. Although the system does not specifically cover the underage population, it does include persons 18 to 21 years old. BRFSS currently has a binge-drinking module collecting more detailed information on a person's most recent binge drinking episode, including beverage type, location of drinking, and source of alcohol.

• Pregnancy Risk Assessment Monitoring System: Collects information on women aged 13 years or older who recently had a live birth. The survey asks about alcohol consumption in the pre-conception period, during pregnancy, and postpartum.

• Pregnancy Nutrition Surveillance System: Covers women of childbearing age, whether pregnant or postpartum, and assess alcohol consumption during pregnancy.

• National Health Interview Survey: Collects information on alcohol consumption among adults, to include those 18 to 21 years old.

• National Health and Nutrition Examination Survey: Collects information on lifetime alcohol use, current alcohol use, and binge drinking among adults, to include those 18 to 21 years old.

Activities Specific to Underage Drinking:

• Project BALANCE (Birth Control and Alcohol Awareness: Negotiating Choices Effectively): Preventing Alcohol-Exposed Pregnancies in Adolescents: The goal of this program is to design, implement, and evaluate intervention strategies to prevent alcohol-exposed pregnancies in young women.

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National Institutes of Health/National Institute on Alcohol, Alcohol Abuse, and Alcoholism (NIAAA)

Activities Specific to Underage Drinking:

Motivated by new research findings, NIAAA has redoubled its efforts in the area of underage drinking prevention. Staff has embarked on a long-term endeavor to develop the next generation of interventions to address underage alcohol consumption through a careful consideration of this problem within a developmental context. Furthermore, NIAAA has long supported and continues to support an extensive array of projects that pertain to underage drinking. These grants and contracts fund research activities based in universities, treatment organizations, community agencies, and with private contractors. Supported projects include but are not limited to investigations in the following areas: epidemiology, neurobiology, psychology, prevention, and treatment. A few key activities are highlighted below:

• Underage drinking initiative: An internal "team" established in October 2003 at NIAAA will oversee development and evaluation of new prevention and intervention methods for underage drinking based on the most current scientific understanding of developmental neurobiology. These activities will also be informed by studies addressing the unique interplay of biology, psychology, and socio-cultural influences during adolescence that affects how young people respond to alcohol.

• Studies to examine the brain mechanisms of adolescent alcohol abuse and alcoholism: It is now understood that adolescence is a time of powerful developmental forces that go well beyond the traditional conceptualization of "raging hormones," and include significant changes to the brain and nervous system. These changes include increased myelination of neural cells and "pruning" of synapses and neural pathways that are infrequently used. Due to these processes of neural development, adolescence may be a particularly vulnerable time for exposure to alcohol. The newly funded studies build on findings in animal studies that show that: (1) heavy binge-like episodes of ethanol consumption produce damage in areas of the brain affecting cognition and memory; and (2) adolescent alcohol drinking in genetically predisposed rats has long-lasting effects into adulthood, potentially increasing alcohol-seeking behavior, making it more difficult to stop drinking, and increasing the probability of relapse.

• Studies to examine cognitive changes associated with adolescence that may influence risk for alcohol abuse: Adolescents are more likely to have logical thinking disrupted by emotional activity, thereby leading to poor decision-making. The influence of such processes on risk for alcohol abuse is being studied. Changing expectations of outcomes from drinking in adolescents are also being investigated, along with methods for altering these expectations as part of prevention efforts.

• Project Northland: Project Northland is a comprehensive universal prevention program tested in 22 school districts in northeastern Minnesota in a randomized trial. The intervention, delivered to a single cohort in grades six through 12, included: innovative social behavioral school curricula; peer leadership; parental involvement programs; and community-wide task force activities to address community norms and alcohol availability. Significant differences were observed between intervention and comparison communities during each project period for "tendency to use alcohol" (a composite measure that combined items about intentions to use alcohol and actual use) and "five or more in a row." Growth rates were lower in the intervention communities during phase 1; higher during the interim period (suggesting a "catch-up" effect while intervention activities were minimal); and lower again during phase 2 when intervention activities resumed. Based on its success, Project Northland has been designated a model program by SAMHSA, and its materials have been adapted for a general audience and marketed by Hazeldon. Project Northland is now being replicated in ethnically diverse urban neighborhoods.

• Adolescent Treatment Research Program: NIAAA initiated an adolescent treatment research program in 1998. Since then, 18 clinical projects have been funded, most of which are clinical trials. Fifteen are behavioral projects and three are pharmacotherapy trials. The objective of this initial wave of studies is to design and test innovative, developmentally tailored interventions that provide evidence-based knowledge to improve alcohol treatment outcomes in adolescents. Results for many of these projects will be forthcoming over the next few years, and will yield a broad perspective on the potential efficacy of family-based, cognitive behavioral, brief motivational, and guided self-change interventions in a range of settings.

• Leadership to Keep Children Alcohol-Free: Beginning in March 2000, NIAAA's Leadership to Keep Children Alcohol Free enlisted the support of US governors' spouses to combat underage drinking, increasing awareness of and attention to alcohol consumption among children 9 to 15 years old. The Leadership to Keep Children Alcohol Free is a public-private partnership with The Robert Wood Johnson Foundation (RWJ) and federal agencies across several departments. The goal of this initiative is to educate the public about the dangers of early alcohol use and to mobilize action to prevent it. Since previous research has made it clear that community involvement can be beneficial in decreasing alcohol-related risk in children and adolescents, NIAAA initiated this important work with Governors' spouses, other Federal agencies, and public and private organizations to prevent the use of alcohol by youth 9 to 15 years old.

• Research Partnership Awards for Rapid Response to College Drinking Problems: In August 2003, NIAAA issued RFA AA- 03-008 that facilitates collaboration between alcohol researchers and universities/colleges to support intervention studies on college campuses that can capitalize on natural experiments (e.g. unanticipated adverse events, policy changes, new media campaigns). Next steps will include matching these researchers and their designed intervention to a natural environment on a college/ university campus that is experiencing a college drinking related issue. This cooperative agreement will continue until July 2008; a Policy Steering Committee of federal partners will be constituted in spring, 2004.

• NIAAA's college drinking initiative: Undertaken in FY 2000-2002, this initiative continues to support and stimulate studies of the epidemiology and natural history of college student drinking and related problems with the ultimate goal of designing and testing interventions to prevent or reduce alcohol-related problems among college students. Currently NIAAA's portfolio in this area includes more than 30 projects.

• Enforcing Underage Drinking Laws (EUDL) evaluation: OJJDP is funding four states to conduct EUDL activities in three to five sites. NIAAA will be funding and managing an evaluation of those sites. This effort pulls together a community coalition to create an environment to reduce underage drinking.

Activities Related to Underage Drinking:

• Alcohol Policy Information System: APIS is an electronic resource that provides authoritative, detailed, and comparable information on alcohol-related policies in the United States, at both State and Federal levels. Designed primarily as a tool for researchers, APIS is intended to encourage and facilitate research on the effects and effectiveness of alcohol-related policies. Although not dedicated to underage drinking policies, APIS does provide information on all alcohol policies relevant to underage drinking, for example policies and procedures in retail alcohol outlets for preventing alcohol sales and service to minors.

• National Alcohol Screening Day: The goal of National Alcohol Screening Day is to create public awareness and education about alcohol problems and provide the opportunity to screen and refer, when indicated, for assessment of alcohol treatment. NASD screening programs are held on college campuses, in community settings, and in private and public primary care practices to reach college students, adults, and older adults. When the results of the screening test indicate, participants are referred to local alcohol treatment through the treatment Referral Locator program funded by SAMHSA. Since its inception in 1999, nearly 100,000 people from 50 States have participated in the educational component of NASD. Of the 100,000 participants over 55,000 persons have been screened. Of those persons screened more that 13,000 have been referred for further assessment and diagnosis. In 2003, approximately 750 people were trained on "How to Conduct a NASD Event" in various cities across the country. In 2003, screening occurred on almost 900 college campuses; nearly 1000 colleges and universities have signed up for 2004.

• Ongoing Research Studies: Longitudinal studies still following subjects ascertained when they were adolescents, genetic epidemiology studies, as well as, NIAAA's National Epidemiologic Survey of Alcohol Related Conditions which includes people aged 18 to 21, are particularly pertinent to the question of underage drinking. These studies all have the potential to enhance our understanding of the etiology, extent and consequences of underage alcohol consumption.

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Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention (CSAP)

Activities Specific to Underage Drinking:

• Youth Underage Drinking Prevention Campaign - Too SMART to START (TSTS): Too Smart to Start is a national community education program targeting children and youth, ages 9-13. This public education initiative, tried and tested in 9 communities nationwide, provides professionals, volunteers, and parents with tools and materials that can help shape healthy behaviors regarding alcohol use for a lifetime. TSTS includes a web page, technical assistance, and a community action kit to help plan, develop, promote and support local underage alcohol use prevention. The program includes materials and strategies that are flexible for use in communities of all sizes and actively involves entire communities in sending clear, consistent messages about why children should reject underage drinking.

• Reach Out Now Fifth and Sixth Grade Scholastic Supplements: SAMHSA and Scholastic Magazine have developed a special edition targeting ten and eleven year olds and their parents. Known as Reach Out Now: Talk with Your Fifth Graders about Underage Drinking, these materials have been focus group-tested with parents and teachers, and include a classroom discussion guide for teachers, activity sheet for students, and a take-home packet for parents. In March 2002, the package was sent for the first time to every fifth grade class in the country and to the States participating in the Leadership to Keep Children Alcohol Free Initiative. In spring 2004, packages are being sent to every fifth and sixth grade class in the country.

• Reach Out Now Teach-In: To further alert children, parents, and teachers about the dangers of underage alcohol use, and to reinforce the messages in these school-based materials, SAMHSA is encouraging prominent national, State, and local leaders to conduct teach-ins for fifth grade classrooms nationwide during the week of April 26-30, 2004, the last week of Alcohol Awareness Month. Experience has shown that these teach-ins raise awareness of the problem of underage drinking and encourage greater use of the materials. The teach-ins have expanded from the First Spouses of States who participated in the past two years to a national effort that includes community-based organizations and schools in all 50 States and the District of Columbia.

• Governors' Spouses Initiative - The Leadership to Keep Children Alcohol Free: This initiative is a unique coalition of Governors' spouses, Federal agencies, public and private organizations, to prevent the use of alcohol by children ages 9 to 15. The goal of this initiative is to educate the public about the dangers of early alcohol use and to mobilize action to prevent it. In addition to supporting the Leadership initiative itself through an interagency agreement with NIAAA, SAMHSA funds an effort to link this initiative with prevention programs funded by the Substance Abuse Prevention and Treatment Block Grant in the States and with certain SAMHSA programs, such as Too Smart to Start and the Reach Out Now Teach-Ins.

• Preventing Underage and Binge Drinking and Alcohol Problems Among Youth and College Students in El Paso and Brownsville, Texas: In 1997, "Operation Safe Crossing" was developed in San Diego/Tijuana to reduce the number of youth ages 18-25 from crossing the US/Mexico border to drink in Mexico. In 2001, a series of replications was developed using the San Diego environmentally oriented prevention approach began in El Paso and Brownsville, Texas. Laredo, Texas was added this year. An additional goal along the US/Mexico border is to reduce the harm associated with cross-border and binge drinking behaviors (e.g., impaired driving, date rape, and fights). The original program was highly successful, reducing cross-border drinking by 37 percent and was named a SAMHSA Model Program in 2002. Funding additionally supports community coalitions in each city, including law enforcement, local policy-makers, alcohol beverage workers (bartenders and bar owners) and representatives from prevention, who manage and ensure overall program effectiveness.

Activities Related to Underage Drinking:

• Substance Abuse Prevention and Treatment (SAPT) Block Grant: The SAPT Block Grant contains a prevention set-aside that reserves a minimum of 20% of each State's block grant allocation for prevention activities. While the majority of the programs supported by these funds are designed to prevent substance abuse in general, many can be expected to have an impact on the reduction of underage drinking. The SAPT Block Grant application has historically asked States to report voluntarily on underage drinking strategies. Examples include State's implementation of public education and/or media campaigns; State laws against consuming alcohol on college campuses; policies or enforcement of laws reducing access to alcohol by minors, including event restrictions, product price increases, or penalties for sales to minors; estimated age of drinking onset; and statutes restricting alcohol promotions to underage audiences. Data on States' answers to these questions are in CSAP's "e-prevention" Block Grant database.

• Fetal Alcohol Spectrum Disorders (FASD): The largest of CSAP's alcohol programs addresses Fetal Alcohol Spectrum Disorders (FASD). Programs include a Center for Excellence, a FASD Materials Development Center for Excellence, and Alaska's Five-Year FAS Cooperative Agreement, which is jointly funded by CSAP and CSAT. While these programs do not specifically target underage drinkers, they can be expected to reach this population as well as adults.

• Building Blocks for a Healthy Future: Building Blocks for a Healthy Future is an early childhood substance abuse prevention program that educates parents and caregivers about the basics of risk and protective factors, ways to reduce risk factors, and how to reinforce skills that will enable caregivers to better nurture and protect their children in order to promote healthy lifestyles. Designed for parents and caregivers of children ages 3 to 6, Building Blocks is designed to help open up the lines of communication with young children and make it easier to keep those lines of communication open as they grow older. Building Blocks collaborates with the National Head Start Association, the National Association for Elementary School Principals, the League of Cities, and the American Medial Association Alliance to facilitate the training and dissemination efforts of the materials and products.

• Outreach to Children of Parents in Treatment (OCPT): In collaboration with the National Association for Children of Alcoholics (NACoA), the OCPT project has developed a kit that includes prevention materials that target the children of parents in substance abuse treatment. The materials are being disseminated to substance abuse treatment centers to use for staff in-services and for children of parents in treatment. The kit includes a promising practices program list which identifies existing prevention and support services to children of substance abusing parents in various settings (e.g., treatment centers, faith/community settings, private voluntary organizations); a practice manual and resource packet; videos; and colorful announcement posters.

• Environmental Prevention of College Alcohol Problems: This SAMHSA/ CSAP/NIAAA five-year program, begun in FY 1999, evaluates a comprehensive environmental prevention strategy aimed at reducing binge drinking and resulting alcohol problems at San Diego State University and New Mexico State University.

Surveillance Activities:

• SAMHSA's National Survey on Drug Use and Health (NSDUH) [formerly called the National Household Survey on Drug Abuse (NHSDA)]: Conducted by SAMHSA's Office of Applied Studies (OAS), this survey is the primary source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug use and abuse in the general U.S. civilian non- institutionalized population, age 12 and older. While the NSDUH is not alcohol- specific, it does track a variety of information on underage alcohol use and provides a database for special studies related to alcohol use and alcohol use disorders.

• The Drug and Alcohol Services Information System (DASIS): The primary source of national data on substance abuse treatment. The Office of Applied Studies, SAMHSA, conducts DASIS. While not specific to youth, it does provide information on adolescent substance abuse treatment facilities as well as adolescent treatment in correctional facilities. DASIS has three components:

  • The Inventory of Substance Abuse Treatment Services (I-SATS) is a listing of all known public and private substance abuse treatment facilities in the United States and its territories. Before 2000, the I-SATS was known as the National Master Facility Inventory.

  • The National Survey of Substance Abuse Treatment Services (N-SSATS) is an annual survey of all facilities in the I-SATS that collects information on location, characteristics, services offered and utilization. Information from the N-SSATS is used to compile and update the National Directory of Drug and Alcohol Abuse Treatment Programs and the online Substance Abuse Treatment Facility Locator. The N-SSATS includes a periodic survey of substance abuse treatment in adult and juvenile correctional facilities. Before 2000, the N-SSATS was known as the Uniform Facility Data Set (UFDS).

  • The Treatment Episode Data Set (TEDS) is a compilation of data on the demographic and substance abuse characteristics of admissions to substance abuse treatment. Information on treatment admissions are routinely collected by State administrative systems and then submitted to SAMHSA in a standard format.

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Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment (CSAT)

CSAT operates a number of programs designed to both screen and assess for alcohol problems and provide alcohol treatment services for persons with alcohol abuse and alcohol dependence. The alcohol treatment program encompasses the SAPT Block Grant program; screening, assessment, and referral; and knowledge application programs. The populations reached include youth under the age of 21, college students who may be participating in risky drinking behaviors, and adults, including older adults, who may have received a diagnosis of alcohol abuse and dependence that are receiving alcohol treatment services.

Activities Specific to Underage Drinking:

• Treatment of Adolescent Alcohol Abuse and Alcoholism Replication of Effective Alcohol Treatment Interventions for Youth: In FY 2003, CSAT developed the Adopt/Expand Effective Adolescent Alcohol and Drug Abuse Treatment program. This grant program builds on effective interventions for youth experiencing alcohol or other drug problems. Twenty-two sites were funded to provide training and certification on using Motivational Enhancement Therapy/Cognitive Behavioral Therapy, a proven effective intervention–This program will increase the availability and effectiveness of treatment for youth with alcohol and drug problems and will treat approximately 2,000 teens and their families per year.

• Potential Interventions for Underage Drinkers in Emergency Rooms: A white paper about the interventions that could be used with underage drinkers admitted to emergency rooms has been developed. The paper includes next steps/recommendations, the barriers to recruiting underage drinkers into adolescent emergency room brief intervention programs, variables that increase participation rates in these interventions, whether or how these interventions impact adolescents' movement through the continuum of the stages of change, and the role of significant others.

Activities Related to Underage Drinking:

• SAPT Block Grant: This block grant is a primary source of funding for alcohol treatment in the United States. While there is no set-aside for adolescent treatment, states have the option of using this resource to treat alcohol use disorders among youth.

• National Association of Insurance Commissioners Effort: CSAT provided experts to educate State legislators who also serve as State insurance commissioners about the repeal of a model insurance law that does not support reimbursement for medical care following an alcohol-related traffic crash resulting in injury. The existing and now repealed Model Law was based on the 1950s premise that alcohol problems were due to a moral failing rather than the current disease model of alcohol problems. With the repeal of this Model, State insurance laws will provide for reimbursement of alcohol-related events and the opportunity for the attending emergency room provider to conduct a brief intervention surrounding the person's injury and drinking pattern.

• National Alcohol Screening Day: CSAT is a co-sponsor of National Alcohol Screening Day with NIAAA and CSAP. The goal of National Alcohol Screening Day is to create public awareness and education about alcohol problems and provide the opportunity to screen and refer, when indicated, for assessment of alcohol abuse or dependence. The NASD screening programs are held on college campuses, in community settings, and in private and public primary care practices to reach college students, adults, and older adults. When the results of the screening test indicate, participants are referred to local alcohol treatment through the treatment Referral Locator program funded by SAMHSA.

• Targeted Capacity Expansion Program: CSAT's Targeted Capacity Expansion Program (TCE) addresses emerging substance abuse trends and the disparity in some areas between the demand for and the availability of appropriate treatment. It is designed to address gaps in treatment capacity by supporting rapid and strategic responses to demands for both alcohol and drug treatment services in communities with serious, emerging drug problems as well as communities with innovative solutions to unmet needs. Adolescents are one of the target populations for the TCE grants.

• Screening, Brief Intervention, Referral, and Treatment (SBIRT) Grants: SBIRT involves implementation of a system within community and specialist settings that screens for and identifies individuals with substance use-related problems. Depending on the level of problems identified, the system either provides for a brief intervention within the generalist setting, when appropriate, or motivates and refers the individual with a high level of problems and probable diagnosis of a substance dependence disorder to the specialist setting for assessment and diagnosis and either brief or long-term treatment. This includes training in self-management and involvement in mutual help groups, as appropriate. (Workgroup on Substance Abuse Self-Help Organizations, 2003) Several SBIRT grantees have developed programs that are available to individuals under 21 years of age.

• Programs for Improving Addiction Treatment: CSAT supports a variety of programs to improve transfer of science to services and improve addiction treatment nationally. For example, the Addiction Technology Transfer Center (ATTC) Network is dedicated to identifying and advancing opportunities for improving addiction treatment. The Network is designed to upgrade the skills of existing practitioners and other health professionals and to disseminate the latest science to the treatment community. The ATTC Network provides both academic (pre-service) and continuing education opportunities as well as technical assistance to multiple disciplines working in the addictions field. In addition several Treatment Improvement Protocols (TIPS) address these concerns (e.g., 16: Alcohol and Drug Screening of Hospitalized Trauma Patients, 24: A Guide to Substance Abuse Services for Primary Care, 26: Substance Abuse Among Older Adults, 31: Screening and Assessing Adolescents for Substance Use Disorders, 32: Treatment of Adolescents With Substance Use Disorders, 34: Brief Interventions and Brief Therapies for Substance Abuse.

• SAMHSA National HELPLINE - 1-800-662-HELP: Individuals in need of treatment for alcohol or illicit drug problems can call the SAMHSA National HELPLINE for referral to appropriate treatment services. In addition individuals seeking treatment can go to the SAMHSA website www.samhsa.gov to locate treatment services in their area.

• Partnership for Drug-Free America: In conjunction with Partnership for Drug-Free America, CSAT is working on the development of a consumer-related interactive website. The site, an interactive online treatment resource, will be targeted to friends, family and other caring influencers of dependent youth and young adults. Using SAMHSA resources, attention will be paid to culturally appropriate information and culturally specific links and resources. The site will seek to assist the influencer to find encouragement, access to general expertise on substance use disorders and information to help them navigate their way towards additional help and resources. The overall strategy of the site is "the earlier you seek help for an individual with a substance abuse disorder you care about the better. Don't wait. Learn more about how you CAN help now".

• NIAAA Intra-Agency Agreement: CSAT provided funds for the NIAAA Underage College Drinking Initiative, which began in August 2003, to facilitate the cooperative efforts of CSAT and NIAAA to support quality studies of services interventions on college campuses that can capitalize on natural experiments; e.g. unanticipated adverse events, policy changes, new media campaigns, etc. NIAAA published RFA #AA-03-008 to solicit the field for applications for "Research Partnership Awards for Rapid Response to College Drinking Problems." From this, five responses and researchers have been selected. Next steps will include matching these researchers and their designed intervention to a natural environment on a college/ university campus that is experiencing a college drinking related issue. Since this is a cooperative agreement that will last until July 2008, participation by federal partners will be through a Policy Steering Committee that will be formed in spring 2004.

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U.S. Department of Education/Office of Safe and Drug-Free Schools

In FY 2002, the Office of Safe and Drug Free Schools awarded grants to 47 local educational agencies (LEAs) to develop and implement innovative and effective alcohol abuse prevention programs for secondary school students.

Activities Specific to Underage Drinking:

Grantees are required to implement, as part of their overall program, one or more of the proven strategies for reducing underage alcohol abuse as determined by the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition, they are required as part of the application process to explain how other activities to be carried out under the grant will be effective in reducing underage alcohol abuse, including references to the past effectiveness of the activities. In addition to the discretionary grants, ED uses an Inter-Agency Agreement with SAMHSA, to provide alcohol abuse resources and start-up assistance to grantees through a technical assistance network operated by DHHS/SAMHSA's Center for Substance Abuse Prevention.

Activities Related to Underage Drinking:

During the past nine years, funding has been provided for the Department's major initiatives related to alcohol and other drug abuse and violence prevention among college students.

• Higher Education Center for Alcohol and Other Drug Prevention: The Center's purpose is to help college and community leaders develop, implement, and evaluate programs and policies to reduce student problems related to alcohol and illicit drug use and interpersonal violence. The Center also promotes innovative program development to improve student education, campus-based media campaigns, screening and treatment referral, and enforcement.

• National Meeting on Alcohol and Other Drug Abuse and Violence Prevention in Higher Education: Each year, the Department sponsors the National Meeting to assist grantees and other campus communities share information on effective strategies related to drug abuse and violence prevention in higher education.

• Grant Competition to Prevent High-Risk Drinking or Violent Behavior Among College Students: In FY01 and FY03, the goal of this grant competition was to provide funds to individual institutions of higher education, consortia thereof, as well as public and private nonprofit organizations (including faith-based organizations), or individuals to develop or enhance, implement, and evaluate campus- and/or community-based prevention strategies. Grantees focused attention on and developed solutions to reduce high-risk drinking or violent behavior among college students.

• Alcohol and Other Drug Prevention Models on College Campuses Grant Competition: In FY99-FY01, the goals of this funding opportunity were to identify models of innovative and effective alcohol and other drug abuse prevention programs at institutions of higher education, and disseminate information about these programs to parents of prospective college students and to other colleges and universities where similar efforts may be adopted. This grant competition was not offered during FY02 or FY03; however, it is being offered again in FY04. A summary of projects awarded under these two grant competitions is as follows:

  • National College Alcohol, Drug, and Violence Survey: In August 1998, the Department of Education contracted with the Core Institute, part of Southern Illinois University, to conduct a national probability sample survey of alcohol and other drug use and violence on college campuses. The data obtained from this survey can be used to assess the level of alcohol and other drug use and violent behavior among college students, thereby helping to plan, set policy, and design programs to best meet the needs of college campuses and their communities.

  • Interagency Agreements: Since FY99, the Department provided funds to the National Institute on Alcohol Abuse and Alcoholism to support grants with activities that have the potential of preventing or reducing alcohol abuse and associated problems among college students. Since the original Interagency Agreement did not specify a particular grant to support, ED funding has been used in five of the following grants:

    • Barry Caudill, Westat, Alcohol Risk Prevention in a National Fraternity

    • Robert Turrisi, Boise State University, Idaho, Early Intervention to Prevent Student Binge Drinking

    • Mary Larimer, University of Washington, Social Norms and Skills-Training: Motivating Campus Change

    • William DeJong, EDC, Can Social Norms Marketing Reduce High-Risk Drinking?

    • Kate Carey, Syracuse University, Brief Interventions for Binge Drinking College Students

• To contribute to the efforts of reaching the national goal of reducing alcohol-related traffic fatalities to no more than 11,000 by the year 2005, the Department of Transportation's National Highway Traffic Safety Administration (DOT/NHTSA) provided funds to the Department, as part of a two-year Interagency Agreement. In FY04, an underage drinking and impaired driving prevention manual titled Safe Lanes on Campus, which was the result of this partnership, was made available to help college campuses and their surrounding communities to implement effective impaired driving and underage drinking prevention programs.

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Department of Transportation/National Highway Traffic Safety Administration (NHTSA)

The following is a list of NHTSA activities directed at underage drinking.

Activities Specific to Underage Drinking:

• Alcohol Prevention Handbook for Colleges and Universities: NHTSA and the US Department of Education, with the Higher Education Center for Alcohol and Other Drug Prevention, released the Safe Lanes on Campus: A Guide for Preventing Impaired Driving and Underage Drinking. Grounded in research literature, the 60-page guidebook describes strategies for combating underage drinking and impaired driving.

• Latino Strategies: NHTSA and ASPIRA will utilize the ASPIRANTE (Youth) program around the country to research, develop, test and promote specific Latino youth underage drinking and impaired driving information.

• Focus Groups for Teens Across All Safety Issues: This project will create the framework for effective public education programs designed to counteract the dangerous driving behaviors among teenage motorists. Teenage focus group discussions will be held throughout the country.

• Underage Drinking Enforcement: NHTSA and the National Liquor Law Enforcement Association (NLLEA) are developing a best practices manual and training program to assist State and local alcohol beverage control and law enforcement agencies in enforcing underage drinking laws.

• State Grant Programs

  • Section 402 authorizes NHTSA to provide funding for a broad range of traffic safety activities, including underage drinking. Funding levels are based on a formula using population and roadway miles.

  • Section 410 provides incentive for States to adopt laws and implement effective programs that address impaired driving. To be eligible, States must adopt or demonstrate efforts in at least five of seven areas, including underage drinking programs.

  • Section 154 encourages States to enact Open Container laws. States are subject to lose certain Federal-aid highway funds for failure to enact a law that prohibit the possession of any open alcoholic beverage container or the consumption of an alcoholic beverage in the passenger area of any motor vehicle located on a public highway or the right-of-way.

  • Section 163 encourages the establishment of .08 percent blood alcohol concentration (BAC) as the legal limit for drunk driving offenses.

  • Section 164 encourages States to enact Repeat Intoxicated Driver laws. The law must provide minimum penalties for individuals convicted of a second or subsequent offense for driving under the influence after a previous conviction for within five years.

Activities Related to Underage Drinking:

• Impaired Driving Communications: The Ad Council and NHTSA will consolidate impaired driving prevention communications into a coordinated and effective social marketing campaign. The campaign's aim is to influence behavior in high-risk populations, including underage drinkers. Messages will be primarily delivered through three complementary campaigns: "You Drink and Drive. You Lose." "Buzzed Driving is Drunk Driving," and the "Zero Tolerance Means Zero Chances."

• Campus Community Demonstration Project: NHTSA and the BACCHUS and GAMMA Peer Education Network will demonstrate combined strategies to combat high-risk and underage drinking among the 18-24 year age population. Launched this fall, the 18-month project will focus on enforcement, local policy, and peer education strategies at the University of California at Riverside, University of Tampa, and Texas A&M University.

• College Binge Drinking Prevention Initiative: NHTSA is working with the North American Interfraternity Conference to develop programs focused on reducing high-risk and underage drinking on campuses. Alcohol summits have been conducted on college 18 campuses. As a result, various programs, activities, events and policies were developed and implemented. The results and experiences of the participating fraternities and sororities will be featured in a new publication, The Alcohol Summit: A Roadmap for Fraternities and Sororities, scheduled for release in summer 2004.

• Juvenile Holdover Program: NHTSA is working with the Community Anti-Drug Coalitions of America (CADCA) to promote the Juvenile Holdover Program as an alternative to the use of traditional juvenile detention, jails, or lockups when such facilities are inappropriate, unnecessary, or unavailable. CADCA provides training to its member coalitions on how to implement the program in their communities.

• Drug Impairment Training for Educational Professionals: NHTSA and the International Association of Chiefs of Police (IACP) developed an educational training program designed to recognize drug abuse among students and provide appropriate intervention. The program offers school administrators and nurses a systematic approach to recognizing and evaluating drug abuse.

• Underage Drinking Enforcement: The IACP developed a training program to assist mid-level law enforcement managers address youth impaired driving problem in their community. IACP will form a cadre of course facilitators to deliver the Youth Enforcement Resource Kit.

• Native American Strategies: NHTSA and the National Indian Education Association (NIEA) are developing leadership training for Native Americans. Training for Road Warriors: Indian Youth for Traffic Safety will be provided at several key conferences in 2002-2004. Mini grants will facilitate dissemination.

• Teachable Moment: Project U-Turn: Turning a Tragedy into a Teachable Moment is a web-based campaign developed by National Organizations for Youth Safety (NOYS). The campaign focuses on teaching local media, school and community officials, and other volunteers to turn a "tragic" event into a teachable moment. The online package provides youth ready-to-use templates and information on how to communicate their positive safety message to other teens, the media, government officials, and community groups. NOYS will demonstrate the project in at least two communities.

• Traffic Safety Curriculum for School Resource Officers: NHTSA and National Association of School Resource Officers are developing a traffic safety school curriculum for 15 to 18 year olds for delivery by School Resource Offices. The curriculum emphasizes impaired driving and occupant protection issues.

• Peer-to-Peer Strategies: NHTSA and Students Against Destructive Decisions (SADD) are supporting the Think About It campaign, a peer-to-peer student awareness program focused on underage drinking and impaired driving. A SADD and the Law campaign encourages student support of enforcement mobilizations. SADD is also establishing a cadre of youth student leaders to initiate anti-drinking and driving activities at the local level.

• Teen/Youth Court Program and Training: Youth Courts are programs in which their peers sentence juvenile offenders. NHTSA is developing National Youth Court Guidelines in conjunction with the U.S. Department of Education, Office of Elementary and Secondary Education, the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (OJJDP), and the American Probation and Parole Association. The national guidelines were designed to help elevate the standard of youth court program operations and practices. OJJDP took the lead in continued support for teen/youth court programs.

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Office of National Drug Control Policy (ONDCP)

The Office of National Drug Control Policy (ONDCP) coordinates the efforts of a wide range of federal agencies in reducing the use of illicit drugs among all Americans, as well as alcohol and tobacco use among youth. In addition, ONDCP maintains certain programs that seek to reduce underage drinking. Those are listed below along with details of their underage drinking initiatives.

Activities Related to Underage Drinking:

• Drug Free Communities Program (DFC): The DFC Program is involved in many strategies and projects related to underage drinking prevention. Drug-Free Community Coalitions are broad-based community organizations with varying foci and missions, often focused on youth anti-drug or anti-alcohol programs. In 2003, ONDCP asked the approximately 400 DFC grantees to detail their efforts to reduce underage alcohol use and received more than 260 responses. Nearly all reported that "reducing underage alcohol use" was one of their highest priority objectives.

• The National Youth Anti-Drug Media Campaign (Campaign) The Campaign addresses underage drinking prevention in the context of illicit drug use through websites (theantidrug.com, freevibe.com, drugstory.org) and brochures, including the popular booklet titled "Keeping Your Kids Drug Free—A How To Guide for Parents and Caregivers." In addition, ad time and space has been donated for underage drinking-related advertising as part of the Campaign's media match program, benefiting such groups as MADD, National Council on Alcoholism and Drug Dependence, Alateen and Al Anon. With the start of the Early Intervention Initiative in February 2004, the Campaign references underage drinking in advertising, as well as non-advertising efforts in order to make the messages powerful and credible with the Campaign's target audiences – teens and parents.

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Department of Justice/Office of Juvenile Justice and Delinquency Prevention (OJJDP)

Activities Specific to Underage Drinking:

Enforcing the Underage Drinking Laws (EUDL): OJJDP's Enforcing the Underage Drinking Laws (EUDL) initiative offers block and discretionary grant programs made available to States and the District of Columbia through an agency in each State designated by the governor and a D.C. agency designated by the mayor. Annually since 1998, the block grant program supports development of a State strategy to address the growing problem of underage drinking in every State by establishing or expanding a statewide task force, implementing public advertising efforts, and establishing innovative programs to curtail underage alcohol access and consumption. The discretionary grant program supports communities within those States that have successfully won awards to implement the EUDL program at the local level through a comprehensive program approach, with a special emphasis on enforcing the underage drinking laws. Since 1998, approximately 30 states have established discretionary EUDL programs in over 200 communities.

The EUDL national training and technical assistance provider has disseminated training, technical assistance and knowledge to help bring significant progress in the enforcement of underage drinking laws around the country. The EUDL national evaluator is continuing to conduct a national evaluation of EUDL designed to provide timely, scientifically sound evidence on the implementation of the program and its effects on law enforcement activities and youth alcohol consumption and alcohol-related problems in local communities.

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Source: "Chapter 1: Prevention of Underage Drinking: Federal Agency Programs Currently in Operation." Substance Abuse and Mental Health Services Administration Report to Congress, online http://camy.org/washington/iccpud/Report.pdf

Return to Home

Before beginning Day 1, please read this page to learn the answers to the following frequently asked questions about online learning:

• Why Do You Offer This Training online?
• What Will I Learn from This Event?
• How Is This Web Site Organized?
• How Much Time Is Required Each Day?
• Can I Print These Materials?
• Where Can I Go for Help?

Why Do You Offer This Training online?

Conducting training online has numerous benefits! online or distance learning allows professionals working in different locations within a district, throughout a state, or even across the country to come together around a topic of interest and form a community of practitioners.

Specifically, online learning offers these advantages:

• It saves time and money for participants who would otherwise have to travel to a training.

• It provides access to information for participants who live and work in places where resources may be unavailable or difficult to locate.

• It increases participants' familiarity and comfort with technology.

• It provides flexibility, allowing participants to access information at the time and pace most convenient for them.

• It gives participants an opportunity to engage thoughtfully in a topic of interest by allowing them time to reflect before responding.

• It provides materials that participants can print for future reference or share with colleagues and community members.

What Will I Learn from This Event?

Reducing Underage Drinking: A School-based Approach is a five-part workshop designed to be completed over five days. This workshop takes a tiered approach to learning, presenting multiple levels of information, actual examples of the application of this information, and extensive additional resources. It is divided into the following sections:

Day 1 - What's the Problem with Underage Drinking?
This session explores the scope of the problem and takes a look at several assessment tools and fact sheets.

Day 2 - Contributing Factors and Consequences: Why Do Kids Drink?
This session provides an overview of the biological, psychological, social, economic, and other factors that may contribute to whether or not an individual uses or abuses alcohol or other drugs.

Day 3 - Approaches to the Prevention of Underage Drinking
This session looks at what makes an effective prevention program.

Day 4 - Is Your School Ready to Implement an Effective Program to Reduce Underage Drinking?
This session provides an overview of the five stages of effective planning: assessment, capacity building, strategic planning, implementation, and evaluation. You'll also find links to summaries of the laws and regulations on underage drinking, and other law enforcement issues.

Day 5 - An In-Depth Look
This session presents additional resources that might further inform underage drinking initiatives in your school and community.

How Is This Web Site Organized?

This site is composed of the following sections:

Home

This is the page you see when you first access the site. It includes a welcome to all participants, the event’s learning objectives, and information about the steps you should have completed prior to beginning this event.

Getting Started

You are currently viewing this section, which provides a detailed introduction to and overview of the event.

Daily Materials

This is the heart of the event; you will acquire a basic understanding of the event topic from the daily materials. Materials appear in a variety of formats and can be printed for future reference. Each day, you will also be asked to answer two or three discussion questions that will help you reflect on and apply the information that you are learning.

Resources & Links

This section houses three types of resources: session, general, and additional. Session resources supplement the main text for each day of the event; examples are tip sheets and practical tools. General resources help you participate in this online training. Additional resources include links to other organizations and publications with information about the event topic.

Event Support

This section includes an online form you can submit for technical assistance. If you have any problems during this event, please do not hesitate to use this form. National Center staff will promptly address all requests for assistance.

Discussion Area

This area houses the online discussion among participants. In addition to sharing your responses to the discussion questions found at the end of each session, you may also post questions or comments about event content. The National Center's director of continuing education will facilitate this discussion.

How Much Time Is Required Each Day?

Week 1: We expect that it will take you approximately one hour per day to review materials, complete activities, and contribute to the event discussion. We ask that you visit the Discussion Area at least once each day to share your ideas and experiences, as well as to review and respond to the messages posted by your fellow participants and National Center staff. If possible, it is beneficial to visit the Discussion Area more than once each day; participants in previous online workshops have found that more frequent visits allowed them to better monitor and contribute to the online discussion.

You will have a more accurate sense of how much time you will need to set aside for this event after you complete the first session. Please make sure to allow enough time each day to complete all event tasks; your full participation is the key to the success of this training.

Week 2: During the second week of this event, we encourage you to continue your exploration of event materials as well as your online discussion with fellow event participants. National Center staff will periodically monitor your discussion during this week, and any critical questions left unanswered by your peers will be forwarded to gang experts at two points: on Tuesday and Thursday. You will receive a response to those questions as soon as National Center staff hear back from the experts.

Can I Print These Materials?

All event materials can be printed for future reference. However, we strongly suggest that you review the materials online before you print them, so that you can see how the various sections fit together and participate more readily in the online discussion among event participants and National Center staff.

There are two ways to print event materials. The easiest way is to look for this box at the end of each day's materials and follow the instructions:

While the PDF files include all of the main text and supporting materials for each day of the event, the formatting will be a bit off. If you prefer to maintain the formatting that you see online, please try the second printing method (described below).

You can also print the event materials directly from your Internet browser. To print a specific page, go to that page, place your cursor on File (at the top of the page), go to Print, and then press OK. Everything on the screen in front of you will print. Please note that, if you select this option, you will need to choose the "Landscape" orientation under Page Setup in order to fit all the text on the page. To print only the text (minus the title and navigation bars at the top and side of the screen), place your cursor on the page you want to print, right-click your mouse, select Print, and choose OK.

Unfortunately, it is impossible to print the entire site with a single click of the mouse.

Where Can I Go for Help?

This event has concluded. You may find answers to your questions in the Resources & Links section.

Underage drinking is widespread throughout the United States. More than 13 million underage youth drink each year. In fact, according to recent research conducted by the Institute of Medicine (IOM), actual drinking patterns in the US suggest that "almost all young people use alcohol before they are 21" (Reducing Underage Drinking: A Collective Responsibility, 2004). The average age of first alcohol use has generally decreased since 1965. This in itself is troubling, because the age of the youth at the onset of drinking strongly predicts the development of alcohol dependence over the course of an individual's lifetime (Reducing Underage Drinking: A Collective Responsibility, 2004).

This early onset of alcohol use has triggered tragic health, social and economic problems for youths and their families: homicide, suicide, traumatic injury, drowning, burns, violent and property crime, high risk sex, fetal alcohol syndrome, alcohol poisoning, and a need for treatment for alcohol abuse and dependence (Understanding Underage Drinking, National Institute on Alcohol Abuse and Alcoholism, 2002).

As a prevention coordinator, it is likely that you are quite well-versed on the topic of alcohol prevention. However, it is also likely that many members of your school community are not as well versed as you. As you address the issue of underage drinking in your schools, it is important to keep in mind that many people have only just begun to understand that underage drinking is not just a matter of kids being kids -- but that underage drinking actually can lead to serious and enduring problems. These problems may include: academic failure, attendance issues, behavioral problems including social and emotional issues, suspension and incarceration, and even school violence (Dwyer, Osher, & Warger, 1998).

By looking at local, state and national data, you can gain a more complete understanding of the education, health, and safety issues, as well as high risk behaviors that are part of growing up in America. As stated earlier, numerous agencies and data collection systems at the state and national levels routinely gather and publicize a wealth of information around underage drinking. It is important for you as a coordinator to review these reports, and present the findings to your Advisory Committee. By doing this, your Advisory Committee can make informed decision about how to address the problem of underage drinking in your school and community. Be sure to keep in mind that some of the data may be a year or more old since it takes time to complete data collection, analysis, and compilation.

Reasons to Review National Data

• National or regional data can give you a broad idea of the scope of a problem beyond your community. For example, if national survey data reveal a marked increase in alcohol use among eighth graders, and state data show this trend as well, then alcohol use among middle school students in your community may also have increased.

• Comparing local data to state or national data can offer a different perspective on the rates of substance use and violence in your community. It can help you ascertain whether the problem in your community is worse, about the same, or less than it is elsewhere.

• Comparing your local data to larger populations can provide you with information that can help you evaluate your efforts. For example, if a city teen alcohol prevention project evaluated its multi-year efforts and no significant changes appeared in alcohol use, and a comparison of city rates to statewide rates revealed that while rates of statewide alcohol use had increased, city rates had remained unchanged. This suggests that the alcohol prevention project might have had a positive effect after all.

• National and state-level data collection instruments can serve as models for your own data collection. You can use these surveys for ideas about how to frame your own survey questions and, if you use the same questions, you can make comparisons between your community and other localities.

Assessing the Problem
There are several national assessment surveys that study trends in underage drinking. This section will give you a brief overview of the three of the most prominent assessments: the Youth Risk Behavior Survey (YRBS), Monitoring the Future (MTF), and the National Survey on Drug Use and Health (NSDUH).

• Youth Risk Behavior Surveillance Survey (YRBSS)
  The Youth Risk Behavior Survey was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth. YRBSS includes a national school-based survey conducted by the CDC as well as state and local school-based surveys conducted by education and health agencies. Conclusions in the latest report are based on the responses of 15,214 students in grades 9 through 12. Most of these surveys were conducted in the spring of 2003. Students completed a self-administered questionnaire during a regular class period.

• Monitoring the Future (MTF)
  The Monitoring the Future (MTF) project, begun in 1975, studies changes in the beliefs, attitudes, and behavior of young people in the United States. The current study focuses on youth and tracks drug use trends and related attitudes among America's adolescents. It is conducted annually by the Institute for Social Research at the University of Michigan. MTF surveys a nationally representative sample of students in public and private secondary schools throughout the United States. In 2004, MTF surveyed nearly 50,000 students in 406 secondary schools. Students completed these surveys in a regular class period.

  It is composed of three sub studies:

  • An annual survey of high school seniors;
  • Ongoing panel studies of representative samples from each graduating class since 1976
  • Annual surveys of eighth and tenth graders.
    
    

• National Survey on Drug Use and Health (NSDUH)
  The National Survey on Drug Use and Health provides estimates of trends in drug use. The survey provides yearly national and state level estimates of alcohol, tobacco, illicit drug, and non-medical prescription drug use. Other health-related questions also appear from year to year, including questions about mental health. The design also oversampled youths and young adults, so that each State's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

  The 2004 NSDUH report has separate chapters that discuss the national findings on eight topics: use of illicit drugs; use of alcohol; use of tobacco products; trends in lifetime use of substances; trends in initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health.

Scope of the Problem
Due to differences in data collection, the results of assessment tools vary somewhat, but the trends are clear. Here's what we know:

• According to the NIAAA, alcohol is the drug of choice among youth. "A higher percentage of youth 12-17 use alcohol (28.7%) than use tobacco (11.9%), or illicit drugs (10.6%)" (National Survey on Drug Use and Health, 2004). Equally disturbing is the fact that tobacco and drug use for this age group is declining while alcohol use is staying fairly constant (NSDUH, 2004). Many young people are experiencing the consequences of drinking too much, at too early an age. As a result, underage drinking is now a leading public health problem in this country.

• About half (50.3 percent) of Americans aged 12 or older reported being current drinkers of alcohol in 2004. This translates to an estimated 121 million people and is similar to the 2002 and 2003 estimates (National Survey on Drug Use and Health, 2004).

• More than three-fourths of twelfth graders, two-thirds of tenth graders, and nearly half of eighth graders have drunk alcohol at some point in their lives (Monitoring the Future Study, University of Michigan, 2004).

• 34.3 percent of youths reported they have consumed alcohol in the past year. (Table E.1, SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002). This data has remained constant in the 2004 survey.

• More young people use alcohol than tobacco or other drugs.Young adults aged 18 to 25 continued to have the highest rate of past month cigarette use (39.5 percent). The rate did not change significantly between 2002 and 2004. The rate of cigarette use among youths aged 12 to 17 declined from 13.0 percent in 2002 to 11.9 percent in 2004 (National Survey on Drug Use and Health, 2004).

• In 2004, the rate of current illicit drug use was approximately 8 times higher among youths aged 12 to 17 who smoked cigarettes (47.5 percent) than it was among youths who did not smoke cigarettes (5.6 percent) (National Survey on Drug Use and Health, 2004).

• Illicit drug use also was associated with the level of alcohol use. Among youths aged 12 to 17 who were heavy drinkers (i.e., drank five or more drinks on the same occasion on at least 5 different days in the past 30 days), 65.6 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.0 percent (National Survey on Drug Use and Health, 2004).

• 20 percent of eighth graders, 35 percent of tenth graders, and 48 percent of twelfth graders reported binge drinking in the month prior to the 2002 survey. In 2004, use decreased for eighth graders, leveled for tenth graders, and increased some for twelfth graders (Monitoring the Future Study, University of Michigan, 2004).

• Binge drinking is defined as consuming five or more alcoholic beverages in one drinking session. Due to differences in metabolism, this number drops to 4 or more drinks for females (Monitoring the Future Study, University of Michigan, 2004).

• Binge drinking is not perceived as a significant risk by 44 percent of the twelfth graders (Monitoring the Future Study, University of Michigan, 2004).

• In 2004, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 16.7 million people. These figures are similar to those of 2002 and 2003, when 6.7 and 6.8 percent, respectively, reported heavy drinking (National Survey on Drug Use and Health, 2004).

• 95 percent of twelfth graders say they have ready access to alcohol (Monitoring the Future Study, University of Michigan, 2004).

Underage drinking can result in a range of adverse short- and long-term consequences.

Whether the consequences are acute in the form of a car crash or accumulated over a longer period of time, the underlying cause is the same - alcohol impairs one's decision-making capacity. In Reducing Underage Drinking, the Institute of Medicine reports that "young people who drink are more likely to engage in risk-taking behavior that can lead to illness, injury, and death. And these consequences appear to be more severe for those who start drinking at a young age." Peter M. Monti, professor of medical sciences and director of the Center for Alcohol and Addiction Studies at Brown University, tells us that alcohol can disrupt the adolescent brain's ability to learn life skills that can help one avoid trouble as an adult.

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has supported research on underage drinking including the effect of alcohol on the brain. You can find the latest information on this topic in NIAAA's journal, Alcohol Research and Health, "The Effects of Alcohol on Physiological Processes and Biological Development." The full text of the article, titled "Alcohol and Development in Youth: A Multidisciplinary Overview" is also available on the NIAAA website.

"We want to send a wake-up call to parents that any use of alcohol for teens involves risk, not just binge drinking or drinking and driving. Alcohol can affect the developing adolescent brain," said Charles Curie, Administrator of Substance Abuse and Mental Health Services Administration (SAMHSA), in a press release announcing a new public service ad campaign focused on underage drinking. "Parents of children and teens must change their attitudes toward teen drinking from acceptance to abstinence, and recognize the importance of talking to their children early and often about alcohol, especially before they've started drinking."

Short-term problems linked to alcohol use include the following:

• Alcohol-related car crashes and other unintentional injuries such as burns, falls, and drowning
  Motor vehicle crashes were the leading cause of death among young persons aged 16 to 20 in 2002. In addition, 19 percent of drivers aged 15 to 20 who were killed in motor vehicle crashes in 2002 had been drinking alcohol (NSDUH, 2002). Each year about 1900 persons under 21 die in motor vehicle crashes that involve underage drinking (NHTSA, 2003). Alcohol is also involved in about 1600 homicides and 300 suicides among persons under age 21 (CDC, 2004; Smith et. al., 1999; Levy, Miller, Cox, 1999; Hingson and Kenkel, 2004).

• Physical problems such as hangovers or illnesses

• Unwanted, unintended, and unprotected sexual activity
  "Significant numbers of young people . . . report engaging in risky sexual behaviors because of alcohol or drugs. More than a third (36%) of sexually active young people 15 to 24 say that drinking or drug use has influenced their decisions about sex — including more than a quarter (29%) of teens 15 to 17 and 37 percent of young adults 18 to 24.

  Twenty-nine percent of sexually active young people 15 to 24 say they have "done more" sexually than they had planned while drinking or using drugs.

  Almost one quarter (23%) sexually active young people 15 to 24 report having had unprotected sex because they were drinking or using drugs — including 12 percent of teens 15 to 17 and twenty-five percent of young adults 18 to 24.

  Because of something they did while drinking or using drugs, 26 percent of sexually active teens 15 to 17 have worried about STDs or pregnancy" (Kaiser Family Foundation survey, 2002).

• Physical and sexual assault

Problems related to the accumulated effects of long-term alcohol use include the following:

• Academic and/or social problems ranging from excessive absences and disciplinary problems to school failure and dropping out of school.
• Memory problems. Alcohol-induced memory impairments, such as "blackouts," are particularly common among young drinkers (Brown 2005).
• Increased risk of suicide and homicide. Alcohol has been reported to be involved in 36 percent of homicides, 12 percent of male suicides, and 8 percent of female suicides involving people under 21 (Bonnie 2004). Homicide is the second leading cause of death for 15- to 24-year-olds (Alcohol Fact Sheet 2004).

Debunking the Myths of Underage Drinking

There are many misconceptions concerning adolescents and alcohol use. These issues confuse not only young people, but their parents and other responsible adults. Following are some of these myths. Click on the link to go to a related fact sheet with the real story about underage drinking.

• Myth: It's only a phase, a rite of passage to adulthood.
  Fact: Early alcohol use is a strong predictor of lifetime alcohol abuse and dependence.

• Myth: Everybody does it.
  Fact: 80 to 90 percent of middle school students don't drink.

• Myth: "Alcohol relaxes me so I can do better in school."
  Fact: Drinking alcohol negatively affects students’ academic performance.

• Myth: Drinking will make me feel better about myself.
  Fact: Alcohol use in adolescence is associated with psychological distress and depression.

• Myth: Drinking helps me form meaningful relationships with people.
  Fact: Underage drinking is linked to an increase in risky sexual behavior.

• Myth: There are no long-term consequences of underage drinking.
  Fact: Individuals who begin drinking before the age of 15 are four times more likely to become alcohol dependent than those who begin drinking at age 20 or older.

• Myth: It doesn't really hurt anyone.
  Fact: Alcohol has disinhibiting effects that increase the likelihood of unsafe activities.

The Youth Risk Behavior Surveillance Survey (YRBSS) has more data about how alcohol influences a variety of health risk behaviors. The information is available online and is readily searchable by state, topic, specific question, gender, survey year, and more.

References for Day 1 Materials:

Bonnie, Richard J., and O'Connell, Mary Ellen. (Eds.) (2004). Reducing Underage Drinking: A Collective Responsibility. Washington: National Research Council, Institute of Medicine, The National Academies Press. Available: http://www.nap.edu/books/0309089352/html/

Centers for Disease Control and Prevention. General Alcohol Information. (2004). Alcohol Fact Sheet -- Measures of Alcohol Consumption and Alcohol–Related Health Effects from Excessive Consumption. Available http://www.cdc.gov/alcohol/factsheets/general_information.htm

Centers for Disease Control and Prevention. HIV/AIDS Prevention. (1994). Facts About: Adolescents and HIV/AIDS. Available: http://www.aegis.com/pubs/Cdc_Fact_Sheets/1993/CDC93118.html.

Centers for Disease Control and Prevention. (2003). YRBSS: Youth Risk Behavior Surveillance System. Available: http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf

Centers for Disease Control and Prevention. (2003). YRBSS: Youth Online: Comprehensive Results. Available: http://apps.nccd.cdc.gov/yrbss/

Dwyer, K., Osher, D., & Warger, C. (1998). Early warning, timely response: A guide to safe schools. Washington, DC: U.S. Department of Education.

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2005). Monitoring the Future national survey results on drug use, 1975-2004. Volume I: Secondary school students (NIH Publication No. 05-5727). Bethesda, MD: National Institute on Drug Abuse.

The Henry J. Kaiser Family Foundation and The National Center on Addiction and Substance Abuse at Columbia University. (2002). Substance Use and Risky Sexual Behavior: Attitudes and Practices Among Adolescents and Young Adults. Available: http://www.kff.org/youthhivstds/loader.cfm?url=/
commonspot/security/getfile.cfm&PageID=14907

Leadership to Keep Children Alcohol Free. Youth. Available: http://www.alcoholfreechildren.org/en/audiences/youth.cfm

Monti, Peter M. Center for Alcohol and Addiction Studies. (2005). Alcohol's damaging effects on adolescent brain function. Available: http://www.eurekalert.org/pub_releases/2005-02/
ace-ade020705.php

Morgan, Gregory. (2003) What Your Kids Are Not Telling You: The real story on underage drinking. DRIVEN. Available: http://www.madd.org/news/0,1056,7558,00.html

National Association of State Boards of Education. (2000). Fit, Healthy, and Ready to Learn: A School Health Policy Guide. Virginia: National Association of State Boards of Education.

National Center for Statistics & Analysis of the National Highway Traffic Safety Administration. (2003). Traffic safety facts 2002: alcohol. Available: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/
TSF2002/2002alcfacts.pdf

National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol and development in youth — A multidisciplinary overview. Alcohol Research and Health. 28(3): 107-175, 2004/2005.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2002). NIAAA Initiative on Underage Drinking. Available: http://www.niaaa.nih.gov/about/underage.htm

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2003). Underage Drinking: A Major Public Health Challenge. Available: http://www.niaaa.nih.gov/publications/aa59.htm

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1997). Youth Drinking: Risk Factors and Consequences. Available: http://www.niaaa.nih.gov/publications/aa37.htm

Strunin, L., and Hingson, R. Alcohol, drugs, and adolescent sexual behavior. International Journal of the Addictions 27(2):129-146, 1992.

Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Prevention. (2002) Making the Link factsheets:

Underage Drinking and Academic Performance. Available:
http://www.alcoholfreechildren.org/en/stats/
Fct%20Sht-Acdmc%20Prfrmnc.pdf

Underage Drinking and Mental Health. Available: http://www.alcoholfreechildren.org/en/stats/
Fct%20Sht-Mntl%20Hlth.pdf

Underage Drinking and Risky Behavior. Available: http://www.alcoholfreechildren.org/en/stats/
Fct%20Sht-Rsky%20Bhvr.pdf

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. "Start Talking before they start drinking." Press release announcing Public Service Advertising campaign, 2005.

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Report to Congress. (2004). Development of a Plan for Combating Underage Drinking. Available: http://www.alcoholfreechildren.org/en/emplibrary/
ICCPUD_Report_42004.pdf

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2004). Summary of findings from the 2004 national survey on drug use and health (NSDUH). Rockville, MD: Author. Available: https://nsduhweb.rti.org/

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Table E.1 Use of Specific Substances in Lifetime, Past Year, and Past Month among 8th, 10th, and 12th Graders in NSDUH and MTF: Percentages, 2002

*Low precision; no estimate reported.
-- Not available.
MTF = Monitoring the Future.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
The Monitoring the Future Study, University of Michigan, 2002.

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The 2003 Youth Risk Behavior Surveillance Survey (YRBSS) gives you detailed data results instantly by location and health topic for all surveys from 1991-2003. Click here to see the rest of the data concerning risky sexual behavior.

Of students who had sexual intercourse during the past three months, the percentage who drank alcohol or used drugs before last sexual intercourse

Source: Centers for Disease Control and Prevention. (2003). YRBSS: Youth Risk Behavior Surveillance System. Available: http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf

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Journalist Gregory Morgan spent time with teens who regularly drink. Here's the full article “What Kids Are Not Telling You: The Real Story on Underage Drinking,” originally published in MADD Online: DRIVEN magazine, Fall 2003.

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As a prevention coordinator, it is important to remember there are no simple explanations for why some kids drink and others do not. We all know people who grew up in horrible conditions without ever using or abusing alcohol. On the flip side, we also know people who lived in what we thought were optimal conditions who had serious problems with alcohol throughout their lives. What is the trigger? Reducing Underage Drinking tells us that "it is impossible to isolate one factor as the primary cause" (Bonnie, p. 86). Instead, research has identified an array of biological, psychological, social, economic, and other factors that may contribute to whether or not an individual uses or abuses alcohol or other drugs (Halpern-Felsher and Biehl, NIAAA, et al).

In Reducing Underage Drinking: A Collective Responsibility, the Institute of Medicine draws on extensive research to look even deeper at the reasons underage youth drink. If we can understand the reasons for youth drinking, we can better take action to protect them from drinking and the consequences of underage drinking.

The report points out that adolescents are going through rapid changes, including a wish to practice adult roles. In the U.S., alcohol use is an important symbol of adult status. These adolescents also want to try on decision-making as they explore their "real selves." During this period, adolescents report having a "true self" (who they really are inside) and a "false self" (who they want other people to think they are, to impress or please them) (Harter et al., 1996).

"At this point, adolescents may knowingly make choices that…they may later regret 'just to see what it is like,' to act more like an adult, or to impress others" (Moffit, 1993). Some of these choices are likely to involve alcohol consumption.

Teens are also likely to be influenced by their friends' values and standards rather than an amorphous peer group. If the friends they hang out with don't want to drink, chances are they won't either. But if their friends include drinking as a regular part of their social life, it will be much harder for them to resist drinking. In other words, it is "friend pressure", not "peer pressure" that most influences adolescents to drink (Prinstein, 1996).

Adolescents who have better refusal skills are less likely to drink than those with poor refusal skills. Researchers refer to those skills as self-efficacy, which is a belief in one's ability to resist urges or social pressures to drink, drink in particular situations, or consume large amounts of alcohol at one time. The construct of self-efficacy has grown out of social cognitive theory (Bandura, 1977). Perceived self-efficacy refers to "a judgment of one’s ability to organize and execute given types of performances" (Bandura, 1997, p. 21). Personal beliefs about capabilities are a vital and yet too-often ignored part of attempts to create learning. Indeed, measures of self-efficacy may be better predictors of behavior than what one is actually capable of achieving (Bandura, 1989). "There is evidence that adolescents can be taught drinking refusal self-efficacy skills and that such skills can then result in less substance use" (Bell, 1993).

In Day 3, we will look at several model programs that have been demonstrated to be effective in reducing underage drinking.

Surrounded by Alcohol

Practically everywhere they look, adolescents are bombarded by messages that promote alcohol. One study found that alcohol use was depicted, usually in a positive light, in more than 70 percent of a sample of episodes in prime-time television (Christensen et al., 2000) and in more than 90 percent of the two hundred most popular movie rentals for 1996-1997 (Roberts et al., 1999b).

Teens are inundated with alcohol advertising in the media. Studies conducted by the Center on Alcohol Marketing and Youth (CAMY) analyzed alcohol product advertising on television and in the media. Their findings were eye-opening:

Many agencies, ranging from the Federal Trade Commission to the National Institute on Alcohol Abuse and Alcoholism, have called for changes in how and where the alcohol industry advertises its products. "The industry has the prerogative -- indeed, the social obligation -- to regulate its own practices and to refrain from marketing products or engaging in promotional activities that have a particular appeal to youngsters, irrespective of whether such practices can be proven to 'cause' underage drinking" (Reducing Underage Drinking, p.135).

According to the Federal Trade Commission, Self Regulation in the Alcohol Industry, "economic theory predicts, and various empirical research studies confirm, that advertising can influence consumer demand for products" (Evans and Kelly, 1999).

Alcohol and the Community

The drinking environment of a community may contribute to drinking as well. "A 'wet' community is one in which drinking is prevalent and common, public opinion is generally tolerant or positive, and alcohol is readily available both commercially and at private social occasions and is advertised as available," according to Reducing Underage Drinking. A 'dry' community would be one in which drinking at social occasions is not the norm and is generally frowned on, and alcohol outlets are relatively scarce (pp. 79-81). Other research suggests that a 'wetter' environment may provide adolescents with more social occasions to drink, more positive attitudes about drinking, more advertising and outlets, and more lenient regulations concerning the sale and consumption of alcohol. In short, such environments have an enabling effect on underage drinking (Chaloupka and Wechsler, 1995).

Changes in the environment can have an affect on drinking. For example, increases in the beer tax, which raises the price of beer, generally tend to lower drinking. Adolescents are influenced by the advertising that most all see most days, by the standards in . . . communities, by their friends, and finally by the most local community of all -- their family. Researchers have found the strongest association with adolescents' refraining from drinking are parent norms against underage drinking. Similarly, having parents who sanction use (even in their own houses) for their children is related to heavier drinking among adolescents. These teens are more likely to binge drink if their parents or friends' parents provide alcohol at their home for a party (Barnes et al., 1995; Peterson et al., 1994).

Parental approval of underage alcohol use is surprisingly prevalent," said Kristie Foley, Ph.D., a researcher at Wake Forest Baptist and the principal investigator of the study. Approximately 1 in 4 respondents, ages 16 to 20, attended a party where alcohol was supplied by a parent. "Parents have good intentions, thinking the teenagers won't drink and drive, that they are safer staying at home, but it sends the wrong message. Adolescents interpret this behavior as an approval to drink alcoholic beverages. Our study showed that teenagers whose parents provided alcoholic beverages for their children and their peers at a party were two times more likely to binge drink and to use alcohol within a 30 day period."

Strict consequences of breaking the house rules regarding drinking also helped deter underage drinking among teens, the study found. "If a teen thinks he or she will receive severe punishment (as perceived by the teen) if they are caught drinking, they are less likely to consume alcoholic beverages," Foley said (Adults' Approval and Adolescents' Alcohol Use, Journal of Adolescent Health).

Alcohol and School Culture

During adolescence, one of the cognitive changes that occur is the development of a social perspective -- "the ability to recognize how the thoughts and actions of one person influences those of another and to imagine how others might perceive them" (Steinberg and Cauffmann, 1996). This, in turn, develops into friend pressure. As older teens join groups of teens with similar values and life-styles, "some . . . groups include drinking as part of how they spend their time, and an adolescent's choice to be involved in that crowd will include the knowledge that drinking is a typical activity for that group" (Prinstein, 1996). This makes prevention initiatives and the culture of our schools a critical component in the battle to reduce underage drinking.

Safe, Supportive, and Successful Schools Step by Step lists these four key elements of a comprehensive schoolwide plan to support a healthy, positive school culture:

• Creating a caring school community in which all members feel connected, safe, and supported
• Teaching appropriate behaviors and social problem-solving skills
• Implementing positive behavior support systems
• Providing appropriate academic instruction

When these interdependent elements are present in a school, student behavior and grades improve and promotion rates and graduation rates increase (Osher et al., p. 63).

In Improving the Odds: The Untapped Power of Schools to Improve the Health of Teens, Robert Blum and Clea McNeely write, "When middle and high school students feel cared for by people at their school and when they feel like they are part of school, they are less likely to engage in unhealthy behaviors. When they feel connected to school, they also report higher levels of emotional well-being."

These findings were initially reported in the National Longitudinal Study of Adolescent Health (Add Health). Add Health surveyed a representative sample of students from 80 high schools and 52 middle schools from the United States. Data at the individual, family, school, and community levels were collected in two waves between 1994 and 1996. In 2001 and 2002, Add Health respondents, 18 to 26 years old, were re-interviewed in a third wave to investigate the influence that adolescence has on young adulthood.

The Add Health study found that students who feel connected to school are:

• Less likely to use alcohol and illegal drugs
• Less likely to engage in violent or deviant behavior
• Less likely to become pregnant
• Less likely to experience emotional distress and suicidal thoughts or attempts

References for Day 2 materials:

Bandura, Albert. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman

Bandura, Albert. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Barnes, G.M., Farrell, M.P., and Banerjee, S. (1995). Family influences on alcohol abuse and other problem behaviors among black and white Americans. In Boyd, G.M., Howard, J., and Zucker, R.A. Alcohol problems among adolescents. Hillsdale, NJ: Lawrence Erlbaum.

Bell, R.M., Ellickson, P.L., and Ko, M. (1995). Do drug prevention effects persist into high school? How Project ALERT did with ninth graders. Preventive Medicine: An International Journal Devoted to Practice and Theory, 22, 463-483.

Berkowitz, A.D. (2004) The Social Norms Approach: Theory, Research and Annotated Bibliography. Newton, MA: Higher Education Center. Available: http://www.alanberkowitz.com/articles/social_norms.pdf

Blum, R.W., McNeely, C.A., & Rinehart, P.M. (2002). The Untapped Power of Schools to Improve the Health of Teens. Minneapolis, MN: Center for Adolescent Health and Development, University of Minnesota. Available: http://www.allaboutkids.umn.edu/presskit/monograph.pdf

Bonnie, Richard J., and O'Connell, Mary Ellen. (Eds.) (2004). Reducing Underage Drinking: A Collective Responsibility. Washington: National Research Council, Institute of Medicine, The National Academies Press. Available: http://www.nap.edu/books/0309089352/html/

The Center on Alcohol Marketing and Youth. (2005). Summary Brochure: Alcohol Marketing and Youth. Available: http://camy.org/factsheets/index.php?FactsheetID=24

Chaloupka, F.J., and Wechsler, H. (1995) Price, tobacco control policies, and smoking among young adults. Working Paper 5012 (National Bureau of Economic Research). Available: http://dnichols.wustl.edu/352sp2005/
chaloupka%20and%20wechcler%20govt %20intervention%20smoking.pdf

Christensen, P.G., Henrikesen, L., and Roberts, D.F. (2000). Substance use in popular prime-time televeision. Washington, DC: Office of National Drug Control Policy.

Connell, J.P., and Halpern-Felscher, B.L. (1997). How neighborhoods affect educational outcomes in middle childhood and adolescence: Conceptual issues and an empirical example. In Brooks-Gunn, J., Duncan, G., and Aber, J.L. Neighborhood poverty volume 1: Context and consequences for children (pp. 174-199). New York: Russell Sage Foundation.

Evans, J., and Kelly, R. (1999). Self-regulation in the alcohol industry. A review of industry efforts to avoid promoting alcohol to underage consumers. Report to the Federal Trade Commission.

Foley, K. L., Altman, D., & DuRant, R.H. (2004). Adults' Approval and Adolescents' Alcohol Use. Journal of Adolescent Health, volume 35, issue 4, 345.e17-e26.

Halpern-Felsher, B.L., & Biehl, M. Developmental and Environmental Influences on Underage Drinking: A General Overview. (2005). Reducing Underage Drinking. CD: pages 402-416.

Harter, S., Marold, D.B., Whitesell, N.R., and Cobbs, G. (1996). A model of the effects of perceived parent and peer support on adolescent false self behavior. Child Development, 67, 360-374.

Hawkins, J.D., Catalano, R.R., and Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance-abuse prevention. Psychological Bulletin, 112(1), 64-105.

Millstein, S.G., Ellen, J., Adler, N., Tschann, J., & Biehl, M. (2001). The Role of Behavioral Experience in Judging Risks. Health Psychology, 20, 120-126.

National Center on Addiction and Substance Abuse. (1999). Survey of American Attitudes and Substance Abuse V: Teens and Their Parents. New York: Columbia University.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2003). Underage Drinking: A Major Public Health Challenge. Available: http://www.niaaa.nih.gov/publications/aa59.htm.

Osher, David, Dwyer, Kevin, & Jackson, Stephanie. (2004). Safe, Supportive, and Successful Schools Step by Step. Colorado: Sopris West.

Ott, C. H., & Doyle, L. H. (2005). An Evaluation of the Small Group Norms Challenging Model: Changing Substance Use Misperceptions in Five Urban High Schools. The High School Journal, 88, 45-55.

Peterson, P.L., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. (1994). Disentangling the effects of parent drinking, family management, and parental alcohol norms on current drinking by Black and White adolescents. Journal of Research on Adolescence, 4, 203-228.

Prinstein, M. J., Fetter, M. D., & La Greca, A, M. (1996, March). Can you judge adolescents by the company they keep? Peer group membership, substance use, and risk-taking behaviors. Paper presented at the meeting of the Society for Research on Adolescence, Boston, MA.

Resnick, M.D., Bearman, P.S., Blum, R.W., Bauman, K.E., Harris, K.M., Jones, J., Tabor, K., Beuhring, T., Sieving, R.E., Shaw, M., Ireland, M., Bearinger, L.I., & Udry, J.R. (September 10, 1997). Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association, 278 (10), 823-832.

Roberts, D.F., Henrikesen, L., and Christensen, P.G. (1999b). Substance use in popular movies and music. Washington, DC: Office of National Drug Control Policy.

Steinberg, L., and Cauffman, E. (1996). Maturity of judgment in adolescence: Psychosocial factors in adolescent decision making. Law and Human Behavior, 20, 249-272.

Udry, J. R. 2003. The National Longitudinal Study of Adolescent Health (Add Health), Waves I & II, 1994–1996; Wave III, 2001–2002 [machine-readable data file and documentation]. Chapel Hill, NC: Carolina Population Center, University of North Carolina at Chapel Hill.

The "risk and protective factor" model for prevention was pioneered by Dr. David Hawkins and Dr. Richard Catalano at the Social Development Research Group at the University of Washington. Assessing a community's risk and protective factors is an integral part of a needs assessment.

Source: Hawkins, J.D., Catalano, R.R., and Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance-abuse prevention. Psychological Bulletin, 112(1), 64-105.

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This ad for St. Pauli Girl beer appeared in Sports Illustrated, May 31, 2004, Maxim, Aug 2004, and other publications regularly read by youths.

"St. Pauli Girl Ad." Marketing Gallery. The Center on Alcohol Marketing and Youth. Available: http://camy.org/gallery/display.php?GalleryID=562

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Researchers in the Add Health study measured school connectedness based on responses to the following:

How strongly do you agree or disagree with each of the following statements:

I feel close to people at this school.
I am happy to be at this school.
I feel like I am part of this school.
The teachers at this school treat students fairly.
I feel safe in my school.

Students responded on a five-point scale from "strongly agree" to "strongly disagree."

Source: Blum, R.W., McNeely, C.A., & Rinehart, P.M. (2002). Improving the odds: The untapped power of schools to improve the health of teens. Minneapolis, MN: Center for Adolescent Health and Development, University of Minnesota.

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Schools need to get serious about underage drinking prevention efforts. Why? Because, as we noted on Day 2, the risk factors that influence underage drinking also impact academic performance and social interactions. Historically, communities and organizations have explored different ideas to reduce underage drinking. Most have not been terribly effective to date. Those that have had measurable impact have some elements in common. One of those common elements is a comprehensive approach that includes individuals, parents, schools, and the community (Reducing Underage Drinking, p.2).

Ineffective Programs

According to Reducing Underage Drinking, "programs relying on provision of information alone, fear tactics, or messages about not drinking until one is 'old enough' have consistently been found to be ineffective in reducing alcohol use and, in some cases, produce boomerang effects" -- an increased use of alcohol (Botvin, 1995; Swisher et al., 1971). These studies speculate that this may occur because the information provided increased the youths' curiosity about alcohol, or because teens believe many other young people drink (Cialdini et al., 1990).

In addition, programs that focus on strategies to only resist peer pressure have been ineffective. That is in part because peer influence is usually subtle and does not take the form of direct pressure, which these strategies focus on (Donaldson, 1995). Another ineffective approach is to identify youth who are drinking alcohol and engaging in other risky behaviors and put them in groups with similar adolescents. There have been mixed results from this approach. Some research has indicated that high-risk behaviors actually increase in these groups, which again highlights the boomerang effect (Paglia and Room, 1999), and this is consistent with research on the harmful effects of some group interventions (Dishion et al., 1999).

Effective School Programs/Effective School Components

In general, current research indicates effective prevention programs should be designed with a focus on the risk protective factors we looked at in Day 2. The National Highway Traffic Safety Administration Community How to Guide on Prevention sums it up best: "Prevention programs no longer focus only on reaching individuals and providing knowledge about alcohol and drugs. Newer efforts emphasize programs and policies that shape knowledge, beliefs and behavior by changing the environment in which the target audience lives . . . the community, school, family, and cultural environments." That means providing support to young people to enhance their risk protective factors. Strengthening families, improving parenting skills, and helping families to establish strong, consistent norms about alcohol and other drug use can help prevent substance abuse, including underage drinking, as well as violence and other related problems.

The Substance Abuse and Mental Health Services Administration (SAMHSA) promotes these three strategies for prevention, which readily incorporate the risk and protective factors:

• Universal -- As the name implies, universal interventions are districtwide, schoolwide, and classroomwide interventions for every child in the district, school, or class. Universal interventions prevent risk factors from developing or intensifying and build a foundation that supports the efficiency and effectiveness of early and intensive interventions (Osher et al., p. 9). Universal programs:

  • Address the entire population with messages, skills and programs designed to prevent or delay the use and abuse of alcohol, tobacco, and other drugs.

  • Vary in type, design, structure, and delivery mechanisms. They can include school, family, and community-based programs.

  • Primarily reflect environmental influences such as community values, economic, and employment stability, school support and other issues.

• Selective -- Selective programs target specific, defined groups of people who are at risk for severe academic or behavioral difficulties:

  • Target subgroups of the population such as a fraternity or sorority on a college/ university campus or parents who belong to the PTA.

  • Recipients are recruited to participate, and program activities are generally more involved in the daily lives of the participants.

  • Risk factors only predict the increased likelihood of a poor outcome for members of a group. When targeting groups, it is important to avoid stigmatizing the groups or all members of the groups.

• Indicated -- Indicated programs target specific individuals and families, rather than entire groups. These programs target individuals who are already experiencing early signs of substance abuse such as youth who have been cited for an underage drinking offense or those who are exhibiting problems in school.

  • Focus more on the individual than on factors in the community and address issues such as alienation from parents, school and peers and various conduct disorders.

  • Individuals are specifically recruited based on an assessment of the individual's personal risk or related problem behaviors, rather than relying on membership in a subgroup (SAMHSA, SAMHSA Model Programs: IOM Classifications).

Click here to see examples of universal, selective, and indicated approaches in reducing underage drinking.

On Day 4 we'll take a look at how your needs assessment will guide your choice of key strategies as you begin to develop your prevention plan.

Effective Programs Engage the Community

Comprehensive prevention programs involve all segments of the community and infuse prevention into the community, family, and social environment. Alan Leshner, Director of the National Institute on Drug Abuse, underscored this point in his plenary address to the National Conference on Drug Abuse Prevention Research:

John Bunker, president of New Futures, a nonprofit, nonpartisan organization seeking to reduce underage alcohol problems and increase access to treatment, has worked in schools for 25 years. In a recent interview, Bunker recommends that schools take some key steps in addressing the problem of underage drinking.

First, he says schools need to have a comprehensive plan for addressing the problems. To do so, they need to know the scope of the problem of alcohol and other drug use and the consequences of such use. Consequences can include tardiness, juvenile arrests, drunk driving, etc. He recommends that schools conduct needs assessments to learn more about the problems and people's perceptions of alcohol and other drug issues. Once they have that information, school officials need to put policies in place and enforce them fairly.

"What happens in a lot of places is that the jocks get treated differently," Bunker said. "If the captain of the football team gets busted for drinking, he plays the next day. Any other kid would get suspended" (Bunker, personal communication).

Bunker and other practitioners say that it is critical to work with parents as well. Some parents believe that drinking is a rite of passage and even supply their children with alcohol. Research shows that parents are a key influence in when youth decide to drink. Parents need information to educate them and help guide their children. Students are also a critical component of any work.

"Kids have to be part of the solution," Bunker said. "Invite them to help. What can we do to create alcohol or drug free activities at school?" If it's only faculty or staff driven its not going to have a lot of staying power."

Finally, the community must be involved. That means reminding merchants about not selling to underage youth, working with police to develop solutions to drinking and driving and planning ways that the community sends a message against underage drinking. Most communities have coalitions against alcohol and drug abuse. The school should be part of that coalition, Bunker said.

Community How To Guides

The National Highway Traffic Safety and Administration (NHTSA) developed a series of Community How To Guides on Underage Drinking Prevention. The Prevention and Education Guide discusses the importance of preventing underage drinking and provides an overview of recent advances in prevention planning. Universal, selective and indicated prevention strategies are discussed within the framework of risk and protective factors to assist communities in developing successful programs. These are the strategies NHTSA recommends at each level of prevention and intervention:

Approaches That Schools Can Take

So, what does work in schools? Meta-analyses of school-based interventions show that they vary widely in their ability to affect alcohol-related outcomes. Positive effects are, in statistical terms, small to modest (e.g., Gottfredson and Wilson, 2003). Here's a quick summary of what research tells us works in school-based programs.

Effective Programs Schools Can Adopt

There are a great many programs being conducted in schools throughout the United States that are effectively impacting underage drinking. How do you know which to implement in your school? Based on the findings of your needs assessment, you will be able to identify problem areas in your school and community, and the probable risk factors behind those problems. To be effective, the program you select for your school needs to target those specific risk factors. "Change must be more than cosmetic. . . school community members and other stakeholders must ensure that improvements are deep and systemic, changing both the structure and the culture of the school" (Osher et al. p. 6).

Safe, Supportive, and Successful Schools has an extensive program matrix that analyzes these programs on four criteria: targeted grade level, level of intervention, environment of program implementation, and the targeted areas (Osher et al., pp.132-134). We're going to highlight a few of those programs here.

• Project Northland- Project Northland has been recognized as an outstanding program model by several agencies: Model Program -- Substance Abuse and Mental Health Services Administration; Exemplary Program -- U.S. Department of Education; Rated "A" -- Drug Strategies, Making the Grade.

Project Northland is a community-wide intervention designed to reduce alcohol use. The program spans seven academic years and involves students, parents, peers, community members businesses and organizations. The most intense intervention is in the first phase, which covers grades six through eight. In the second phase, which covers ninth and tenth grades, there are minimal interventions. Finally, the third phase, which covers eleventh and twelfth grades, resumes its intensity in programming.

The program components are:

• Classroom curricula.
• Parent Involvement and Education.
• Peer Leadership and Participation.
• Community Task Forces.
  

Field staff for Project Northland also recruited community-wide task forces. The task forces, whose members represented a cross-section of the community, concentrated on areas including: (1) promoting awareness of alcohol issues among teens; (2) the organization and implementation of alcohol-free recreational activities for adolescents; (3) discussions with local alcohol merchants about their alcohol-related policies concerning young people; and (4) distribution of materials that support policies such as ID checks and legal consequences for selling alcohol to minors.

The most dramatic effects of the program occurred at the end of Phase I. The eighth-grade intervention group showed a 29 percent reduction on past week drinking and a 19 percent reduction in past month use. Researchers attributed the reductions primarily to changes in peer norms, peer drinking behavior, parent-child communication that reinforced abstention, increase negative perceptions about the consequences of alcohol use and increase resistance skills, according to students' survey responses.

However, during the phase in ninth and tenth grade when interventions were minimal, there were no statistically significant differences between students in the intervention and control communities on any alcohol use measures. When the program resumed its intensity in grades 11 and 12, there some statistical differences in alcohol use, but not at the level of the first phase.

"The failure of the project to maintain its effectiveness during the interim phase demonstrates the importance of intervention throughout adolescence, and it also points to the significance of community-level policy and other actions that change community norms around youthful drinking," write the authors in the IOM report Reducing Underage Drinking: A Collective Responsibility. "The Project Northland team has increased their focus on community-level change in a replication of the program that is currently under way in 61 schools and communities in the Chicago area" (Reducing Underage Drinking, p. 221).

• Linking the Interests of Families and Teachers (LIFT) -- LIFT targets first and fifth grade children and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. LIFT is based on the developmental model of behavior. It focuses on how the interactions of children with parents, peers, and school staff contribute to or exacerbate conduct problems (Patterson, Reid, & Dishion, 1992).

LIFT is a ten-week program that combines classroom activities with parent training, a playground behavioral program, and systematic communication between teachers and parents. The focus is on changing specific behaviors of the children (opposition, defiance, and social ineptitude) and the parents' reactions to their behavior (discipline and monitoring of the children.)

Short term evaluations showed positive results: decreased aggression on the playground, and decreased aversive behavior in mothers. Three years later these children exhibited fewer increases in attention deficit disorder behaviors (inattentiveness, impulsivity, and hyperactivity). By fifth-grade, these students had fewer associations with delinquent peers and were less likely to initiate patterned alcohol use (Osher et al., p. 171).

Classroom instructors, school staff, and playground staff will require some training. A high level of parent involvement and strong parent commitment is essential to the successful implementation of this program.

• Project STAR: Students Taught Awareness and Resistance -- Project STAR is a community-based, multifaceted program for adolescent drug abuse prevention. Primarily a classroom initiative, STAR does extend to the family and the community.

STAR targets peer use of drugs and peer approval of drugs and drug use. The program helps youth about to enter middle school or junior high recognize the "tremendous social pressures to use drugs and provides training skills in how to avoid drug use and drug situations" (Osher et al., p. 206). In the first year of the program, teachers present 10-13 sessions on resistance skills. There are five additional sessions in the second year to bolster that message. These lessons employ student peer leaders and active social learning techniques including modeling, role playing, and discussions. Parents and other family members are involved through homework assignments. The parental program also involves a parent-principal committee which reviews school drug policy and parent-child communications training.

Project STAR has demonstrated considerable success in reducing drug use and abuse, and those gains have been maintained throughout high school and, in some cases, beyond:

• up to a 40 percent reduction in marijuana use and smaller reductions in alcohol use;
• effect on daily smoking, heavy marijuana use, and some hard drug use;
• increased parent-child communications about drug use;
• facilitated development of prevention programs, activities, and services among community leaders (Osher et al., p. 207).

• SOAR, The Seattle Social Development Project -- SOAR promotes the healthy development of young people by increasing opportunities for active involvement in family and school, improving skills for successful participation in family, school, peer groups, and community (Osher et al., p. 225).

SOAR targets several specific risk factors: lack of commitment to school, poor family management, family conflict, favorable parental attitudes towards drugs, alienation, friends who use drugs, early initiation of drug use, and early antisocial behaviors. SOAR also enhances protective factors, and sets healthy beliefs and standards for behavior.

Staff development is a major component of SOAR. Instructional improvement workshops and classroom coaching sessions is aimed at improving the students' academic achievement and bonding to the school. The parent component enhances parents' skills in helping their children succeed academically. The third component provides children with social and citizenship skills and allows them to practice social and emotional skills in the classroom.

Program outcomes to date have been very positive and extend over a long period of time. At age 18, for example, "fewer full-intervention students had engaged in violent . . . acts, heavy drinking, sexual activity. . . fewer SOAR students had become pregnant or had caused pregnancies" (Osher et al., p. 226). Academic achievement was markedly improved, and aggressive and self-destructive behaviors were reduced.

• Reach Out Now: Talk to Your Fifth Graders about Underage Drinking

Reach Out Now started as a collaboration between the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, and Scholastic, Inc., Now in its fourth year, the "Reach Out Now" program provides SAMHSA materials to fifth and sixth grade teachers to educate youngsters before they become teens about the dangers to young bodies associated with alcohol. The program provides classroom teachers with a set of underage drinking-related materials.

The classroom teaching packet includes:

• Understanding the effects of alcohol on the developing child
• A science experiment in which students observe the effects of pouring alcohol on an egg
• A unit on making healthy decisions by using critical-thinking skills and finding alternative activities to drinking

The take home packet includes:

• A Family Resource Guide filled with activities to help parents:
  • Maintain good lines of communication
  • Get involved in the child's life
  • Make and enforce clear and consistent rules
  • Serve as a positive role model for their child
  • Help a child know how to choose friends wisely
  • Be aware of the child's activities
  • Parents are also encouraged to create a family calendar to keep track of the activities of all the family members so that the parent is more involved in the child's life.

The materials are based on research supported by SAMHSA and the National Institute on Alcohol Abuse and Alcoholism at the National Institute of Health.

References for Day 3materials:

BEST Foundation. Project ALERT. Available: http://www.projectalert.best.org/

Bonnie, Richard J., and O'Connell, Mary Ellen. (Eds.) (2004). Reducing Underage Drinking: A Collective Responsibility. Washington: National Research Council, Institute of Medicine, The National Academies Press. Available: http://www.nap.edu/books/0309089352/html/

Botvin, G.J., Baker, E. Dusenbury, L. Botvin, E.M., and Diaz, T. (1995). Long-term followup results of a randomized drug abuse prevention trial in a white middle-class population. Journal of the American Medical Association, 273(14), 1106-1112.

Botvin, G.J., Botvin, E.M., Ruchlin, H. (1998). School-Based Approaches to Drug Abuse Prevention: Evidence for Effectiveness and Suggestions for Determining Cost-Effectiveness. In: Bukoski, W.J., editor. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph No. 176 59-82. Washington, DC: U.S. Department of Health and Human Services. Available: http://www.drugabuse.gov/pdf/monographs/
monograph176/059-082_Botvin.pdf

Bunker, John. (August 2005). Personal Communication.

Center for the Study and Prevention of Violence. Linking the Interests of Families and Teachers (LIFT). Available: http://www.colorado.edu/cspv/blueprints/promising/
programs/BPP09.html

Cialdini, R.B., Reno, R.R., and Kallgren, C.A. (1990). A focus theory of normative conduct: Recycling the concept of norms to reduce littering in public places. Journal of Personality and Social Psychology, 58, 1015-1026.

Dishion, T.J., McCord, J., and Poulin, F. (1999), When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755-764. Available: http://www.prevention.psu.edu/events/documents/
Dishionetal1999_WhenInterventionsHarm.pdf

Donaldson, S.I., Graham, J.W., Piccinin, A.M., and Hansen, W.B. (1995). Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools. Health Psychology, 14(4), 291-300.

Dusenbury, L. (2000). Family-based drug abuse prevention programs: A review. Journal of Primary Prevention, 20, 337-352.

Gottfredson, D.C., and Wilson, D.B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4(1), 23-38.

Hansen, W., and Graham, J.W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer resistance training versus establishing conservative norms. Preventive Medicine, 20, 414-430.

Hazelden Foundation. Project Northland. Available: http://www.hazelden.org/servlet/hazelden/cms/ptt/
hazl_7030_shade.html?sh=t&sf=t&page_id=27170

Holder, H.D., Gruenewald, P.J., Ponicki, W.R., Grube, J.W., Saltz, R.F., Voas, R.B., Reynolds, R., Davis, J., Sanchez, L., Gaumont, G., Roeper, P., and Treno, A.J. (200). Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of Studies on Alcohol, 54, 23-26.

Kersten, K. (September 17, 1997). Commentary: Is DARE Doing Kids More Harm? Star Tribune, Minneapolis, MN. Available: http://www.amexp.org/Publications/Archives/Kersten/kersten091797.htm

Komro, K.A., Perry, C.L., Beblen-Mortenson, S., and Williams, C.L. (1994). Peer participation in Project Northland: A community-wide alcohol use prevention project. Journal of School Health, 64, 318-322.

Leshner, Alan I., Ph.D. (1996). Plenary address: From the prevention research lab to the community. National Institute on Drug Abuse. Available: http://www.drugabuse.gov/MeetSum/CODA/Prevention.html

National Highway Traffic Safety and Administration. (2001). Community How to Guide on Education and Prevention. Available: http://www.nhtsa.dot.gov/people/injury/alcohol/
Community%20Guides%20HTML/Book4_Prevention.html

Osher, David, Dwyer, Kevin, & Jackson, Stephanie. (2004). Safe, Supportive, and Successful Schools Step by Step. Colorado: Sopris West.

Paglia, A., and Room, R. (1999). Preventing substance use problems among youth: A literature review and recommendations. Journal of Primary Prevention, 20(1), 3-50.

Patterson, G.R., Reid, J.B., and Dishion, T. J. (1992). Antisocial boys: A social interactional approach. Eugene, OR: Castalia Publishing.

Rohrbach, L.A., Johnson, C.A., Mansergh, G., Fishkin, S.A., and Neumann, F.B. (1997). Alcohol-related outcomes of the day one community partnership. Evaluation and Program Planning, 20(3), 315-322.

Swisher, J.D., and Hoffman, A. (1975). Information: The irrelevant variable in drug education. In B.W. Corder, R.A. Smith, and J.D. Swisher (Eds.), Drug Abuse prevention: Perspectives and approaches for educators. Dubuque, IA: William C. Brown.

Tobler, N. S., and Stratton, H.H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of research. Journal of Primary Prevention, 18, 71-128.

University of Southern California. Project Star: Students Taught Awareness and Resistance. Available: http://www.projectstar.info

University of Washington. SOAR, The Seattle Social Development Project. Available: http://depts.washington.edu/ssdp/

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (n.d.). SAMHSA model programs. Rockville, MD: Author. Available: http://modelprograms.samhsa.gov/template.cfm?page=IOMClass

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2002). SAMHSA's reach out now. Rockville, MD: Author. Available: http://www.teachin.samhsa.gov/

Vicary, J.R., Snyder, A.R., and Henry, L.L. (2000). The effects of family variables and personal competencies on the initiation of alcohol use by rural seventh grade students. Adolescent and Family Health, 1(1), 11-20.

Based on 25 years of experience and the research literature, John Bunker, president of New Futures, developed this ten point strategy for schools to use in addressing underage drinking problems.

1. Comprehensive Plan
   • Scope of Alcohol, Tobacco and Other Drug (ATOD) Problems (use, consequences, perceptions)
   • Goals and Objectives (use, AOD related incidents)
   • Strategies
   • Evaluation
2. Needs Assessment
   • Prevalence of ATOD use
   • Prevalence of ATOD problems (violence, academic performance, drinking and driving, other risk behaviors)
   • ATOD Perception and attitudes (enforcement, access to alcohol and other drugs, scope of the problem)
3. Policy and Practices
   • Philosophy and Values (zero tolerance, learning moment, drug testing)
   • Update and revision
   • Clear and unambiguous written policies
   • Fair and consistent implementation & enforcement
   • Student, faculty, staff and parent education & training
   • School functions and alumni events (drinking day)
4. Prevention, Intervention, and Treatment
   • What are we doing now
   • What should we do in the future
   • Evidence-based best practices
   • Student Assistance Program
5. Curriculum
   • ATOD topics
   • Skill building (resistance and coping)
   • Getting ready for college (survival skills)
   • Classroom and extracurricular (athletic captains)
6. Students
   • General student population
   • High risk students (children of alcoholics)
   • Freshman and seniors
   • How do we engage students to address ATOD issues
   • Student leaders

7. Faculty and Staff
   • Scope of ATOD use and problems
   • Employee Assistance Program
   • ATOD Policies for faculty & staff
   • Education and training (prevention and intervention)
   • Health services professionals
   • Athletic coaches
8. Parents
   • Denial and stigma
   • Parents with ATOD problems
   • What parents can do
   • What parent's shouldn't do
   • Orientation
   • Code of conduct (safe homes model)
   • Resources for treatment
9. Community
   • Community coalition member
   • Working with merchants
   • Relationship with local police
   • Day student parents
10. Peer Institutions
    • What challenges do we all face
    • What lessons have we learned
    • How can we increase communication and collaboration
    • Summit or working group

Return to Day 3

Return to Day 3

Taking on the task of organizing and coordinating the development of your district's alcohol prevention plan can be overwhelming at first glance. But, with our help and some powerful tools developed for the Center for Substance Abuse Prevention (CSAP), an agency within the Substance Abuse and Mental Health Services Administration (SAMHSA), you'll find all the pieces fall into place quickly. There are five components to successful prevention planning:

• Assessment - determining your prevention needs
• Capacity - improving your capabilities
• Planning - developing a strategic plan
• Implementation and Sustainability- putting your plan into action and sustaining it
• Evaluation - documenting the outcomes of your work

Today we'll take a closer look at each of these components and some tools that will help you develop a successful program to reduce underage drinking.

Assessment Stage

Do you have a current needs assessment that gives you information on underage drinking in your community? If so, you're ready to go on to Building Capacity. Otherwise, your first step is to conduct a needs assessment. The better you understand your community and the more complete your data collection is, the more likely your prevention project will be successful. A comprehensive needs assessment includes the following:

• Collection and analysis of data
• Survey information
• Focus or discussion groups
• A public policy review
• A review of current programs, activities and resources (NHTSA Community How to Guide, 2001).

Appendix 1 of Community How to Guide on Needs Assessment and Strategic Planning has several examples of survey materials and data checklists that will help you conduct your needs assessment. Once you complete your needs assessment, you will be able to identify your target audience and the risk and protective factors your plan will focus on.

The National Institute on Drug Abuse (NIDA) has identified a set of prevention principles that impact underage drinking when incorporated into prevention planning. These 16 principles "have emerged from research studies on the origins of drug abuse behaviors and the common elements found in research on effective prevention programs (Preventing Drug Use among Children and Adolescents, NIDA 2003).

Build the Capacity to Make a Difference

In its broadest terms, capacity means having the knowledge and training, the staff, and the funding necessary to get the job done (Osher, p.6). One of the first steps in capacity building is forming your school-wide team.

Whenever possible, work with existing teams. Integrate program elements that are not part of the current team's plan: student support, student mental health, school safety, or family involvement (Osher et al., p.14). However, you may need to establish a new team if there is no functioning team in your system.

Selecting Team Members
Knowledge, perspective, technical skills, personal skills, and legitimacy are the five criteria you need to build into your team. Your team should be made up of members who are:

• Knowledgeable about your community, school safety, student support, mental health, and school reform (Osher et al., p. 15).
• Representative of all segments of your community. Think of the political makeup of your group. "Who are the sanctioned leaders, the power brokers, the persuaders, the dealmakers, the peacemakers, and the gatekeepers for support and resources?" Be sure your team includes parents, teachers, students, administrators, clergy, and so on (Osher et al., p. 16).
• Equipped with the technical skills to get the job done. "Who has skills in teaming, facilitation, and evaluation? Who is an effective communicator?" (p.16)
• Respected by the community for who they are. "Who is important, given the culture, history, and traditions of your school and community? Who . . . can garner support for your team and the plan?" (Osher et al., pp.14-16).

As part of the effort to represent the entire community on the team, be aware of other agencies and organizations that share common goals with you and also work with youths. Safe, Supportive, and Successful Schools (Osher et al., pp. 16-17) recommends that you include several of these organizations on your team:

• Local community anti-drug coalitions
• Youth centers
• Community-based organizations
• County recreation programs
• Universities and colleges
• Businesses
• Religious leaders and organizations
• Community mental health and health agencies
• Social service agencies
• Community police, juvenile justice, and the courts
• Parent groups, including PTAs, PTOs, and other groups
• Civil rights and advocacy organizations
• Foundations

Develop a Strategic Plan

The strategic plan is the vehicle for success. Once a needs assessment is complete, the next step in developing a comprehensive prevention program is to bring people together and agree on appropriate solutions. The planning process requires three steps:

• An examination of the needs assessment to determine the nature and extent of the underage drinking problem

• A review of alternative courses of action available to meet identified needs

• An allocation of resources to achieve solutions

During the strategic planning process, team members will define goals, identify measurable objectives and develop action steps to reach these goals and objectives (Guide 2, NHTSA, 2001). Click here to read a set of sample questions your strategic plan should address.

Implementation

Implementing your program involves much more than simply carrying out its components. Your strategic plan becomes the action plan that will guide your program development from this point on. It is another planning tool that establishes the initial direction and clarity of vision for the implementation group (Implement and Assess Programs, SAMSHA, 2001). "Planning helps increase the effectiveness of your effort by enabling you to focus energy, ensure that staff and other stakeholders are working toward the same goals, and assess and adjust programmatic direction, if needed. In short, planning is a structured effort to shape and guide your prevention efforts" (Implement and Assess Programs, p. 9).

Your primary goal now is to raise public awareness of underage drinking in your community and motivate the public to change those community norms that may encourage it. Communication is the key here. You need to determine your message and deliver it in an effective way to move the community to action. "The news media can be a critical partner in your effort to raise public awareness of underage drinking. . . .Developing a positive, on-going relationship with reporters who are interested in alcohol- or health-related events and information can be vitally important to your events, organization, and network" (Underage Drinking Prevention Action Guide and Planner, 2001). Start Talking Before They Start Drinking, a new public service ad campaign designed by the U.S. Department of Health and Human Services (HHS) in partnership with the Ad Council, provides you with a wealth of information and materials about the short- and long-term consequences of underage drinking; tips for parents on initiating conversations about alcohol; and a brochure created for the campaign.

But there's more to implementation than just spreading the word. The planning team has to collaborate with other agencies and programs, ensure that adequate training is available, identify resistance and develop strategies to overcome it, and document progress (Online: Middle School Coordinators as Change Agents).

Evaluation

Evaluation is a necessary step in any effective prevention program. Through evaluations, you can figure out what is working, what is not working, and why. Effective "evaluation will keep your focus on authentic goals and objectives, enabling you to select appropriate interventions that — when properly implemented, measured, and evaluated — will lead to behavioral change and, ultimately, substance abuse prevention and/or reduction" (Pathways to Effective Programs and Positive Outcomes, SAMHSA 2003).

SAMSHA outlines these steps for evaluation:

• Report Immediate and Intermediate Outcomes
  • Assemble immediate outcomes for final report
  • Assemble intermediate outcomes for final report
• Outline Process Measures
  • Assemble action plan data relative to process measures
• Measure Long-term Outcomes
  • Document change(s) compared to baseline measures of general substance abuse problem
  • Determine program sustainability and follow-up actions
  • Produce final report and share findings
• Communicate Outcomes to Key Stakeholders
• Re-Measure Long-term Outcomes
  • Re-measure outcomes at 12 and 18 months if possible
  • Supplement your report to the community with these longer-term outcomes

(SAMHSA, Chapter 5, Pathways to Effective Programs and Positive Outcomes)

The Western Center for Substance Abuse Prevention (CSAP) has also developed an extensive "how-to" guide to planning and implementing an evaluation of your prevention program. There are 7 major sections:

• What is Evaluation & Why Do It?
• Using a Logic Model for Evaluation Planning
• How to Build Your Program Logic Model
• How to Plan Your Evaluation
• Evaluating Your Program Using the Logic Model
• Analyzing, Using, and Interpreting Evaluation Information Implementing the Evaluation

Within each section you will find worksheets, tools, and examples of how to conduct user-friendly evaluations of substance abuse prevention programs using the risk and protective factors model.

Sustainability

Table 1 (see pp. 5-8) of Building capacity and sustainable prevention innovations: a sustainability planning model gives you the specific factors and objectives that make up a sustainability plan. There are two goals: to continue to build, support and strengthen infrastructure capacity (organizational, community, state, or federal) to ensure an adaptive prevention system that is receptive to change; to implement sustainable innovations that venefit diverse stakeholders for an extended period of time (p. 139-142). This planning tool lists the specific factors, objectives, and actions that need to be in place for your plan to be successful. It also lists specific criteria that indicate the program's "readiness" to succeed.

The sustainability action steps are illustrated here as a five-step process. It's important to remember that sustainability works as an ongoing cyclical process rather than a one-time sequential stage process. (Johnson et. al., 2004).

The Western CAPT is currently developing a Sustainability Tool Kit. This tool kit will be used by specially trained prevention specialists who will work with other prevention specialists to implement and sustain prevention innovations.

Online Resources

If you like to work online, the Center for Substance Abuse Prevention (CSAP) has developed an that will help you assess your prevention needs and determine the appropriate focus of your prevention project in order to reduce risks and increase protective factors.

Once you create your profile, start with the Prevention Readiness Tool. Answer these questions to get an assessment of your preparedness to begin prevention work. Completing this survey will take several minutes. Don't be alarmed if your response to many of the questions is "no" or "don't know." All of that is factored into the analysis and subsequent "road map." The road map is stored under your login and can be accessed whenever you need to refer to it to continue your planning. As you go through the road map, you'll be able to build a timeline and begin an organized approach to your task. The road map also links you to additional resources, both in print format or online, for each step in the process. You can also use other tools and resources with which you're already familiar as you complete each step.

Here's a sample road map to give you a preview of what you'll see after you complete the survey for your community.

References for Day 4 materials:

Bonnie, Richard J. (2003). Reducing Underage Drinking. Statement to the Subcommittee on Substance Abuse and Mental Health Services, Committee on Health, Education, Labor and Pensions, U.S. Senate. Available: http://www.alcoholfreechildren.org/en/emplibrary/
bonnie_statement.doc

Centers for Disease Control and Prevention (CDC). (1999). Framework for program evaluation in public health. Available: www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm

Johnson, K., Hays, C., Center, H., and Daley, C. (2004). Building capacity and sustainable prevention innovations: a sustainability planning model. Evaluation and Program Planning 27, 135–149. Available: http://captus.samhsa.gov//western/news/events/documents/audio-conf-Published-Version.pdf
audio-conf-Published-Version.pdf

Jones-Webb, R., Toomey, T.L., Short, B., Murray, D.M., Wagenaar, A., and Wolfson, M. (1997). Relationships among alcohol availability, drinking location, alcohol consumption, and drinking problems in adolescents. Substance Use and Misuse, 32, 1261-1285.

National Highway Traffic Safety Administration (NHTSA). (2003). Traffic Safety Facts 2003. Available: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/
NCSA/TSF2003/809774.pdf

National Highway Traffic Safety Administration (NHTSA). (2005). Community how to guide on public policy. Available:
http://www.nhtsa.dot.gov/people/injury/alcohol/
Community%20Guides%20HTML/Book6_PublicPolicy.html

National Highway Traffic Safety Administration (NHTSA). (2001). Community how to guide on law enforcement. Available: http://www.nhtsa.dot.gov/people/injury/alcohol/
Community%20Guides%20HTML/Book5_Enforcement.html

National Highway Traffic Safety Administration (NHTSA). (2001). Community how to guide needs assessment and strategic planning. Available:
http://www.nhtsa.dot.gov/people/injury/alcohol/
Community%20Guides%20HTML/Book2_NeedsAssess.html

National Highway Traffic Safety Administration (NHTSA). (n.d.). Sentencing and dispositions of youth dui and other alcohol offenses: A guide for judges and prosecutors. Available:
http://www.nhtsa.dot.gov/people/injury/alcohol/youthdui/index.html

Osher, David, Dwyer, Kevin, & Jackson, Stephanie. (2004). Safe, Supportive, and Successful Schools Step by Step. Colorado: Sopris West.

Preusser, D.F., Ulmer, R.G., and Preusser, C.W. (1993). Enforcement of Underage Impaired-Driving Laws. DOT HS 807 920. Washington, DC.: Insurance Institute for Highway Safety.

Schulenberg, J., O'Malley, P., Bachman, J., Wadsworth, K., and Johnston, L. (1996). Getting drunk growing up: Trajectories of frequent binge drinking during the transition to young adulthood. Journal of Studies on Alcohol, 57, 289-304.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2003). Chapter 4: Implement and Assess Programs. Pathways to Effective Programs and Positive Outcomes. Rockville, MD: Author. Available:
http://captus.samhsa.gov/southwest/resources/
documents/Pathways_8-03.pdf

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2003). Chapter 5: Complete an Evaluation. Pathways to Effective Programs and Positive Outcomes. Rockville, MD: Author. Available:
http://captus.samhsa.gov/southwest/resources/
documents/Pathways_8-03.pdf

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2001). Guide to science-based practices. Principles of substance abuse prevention. Rockville, MD: Author. Available: http://modelprograms.samhsa.gov/pdfs/pubs_Guide.pdf

U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration (SAMHSA), Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). (2005). Start talking before they start drinking. Available: http://www.stopalcoholabuse.gov/

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, National Institutes of Health. (2003). Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders. Betheseda, MD: Author.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2003). Prevention in your community. Available: http://preventionpartners.samhsa.gov/foc0414_alcohol_p5.asp

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. (2001). Underage drinking prevention action guide and planner. Available: http://media.shs.net/prevline/pdfs/phd858.pdf

These principles should form the foundation of an effective school-based prevention plan.

PRINCIPLE 2 - Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs.

PRINCIPLE 3 - Prevention programs should address the type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified protective factors.

PRINCIPLE 4 - Prevention programs should be tailored to address risks specific to population or audience characteristics, such as age, gender, and ethnicity, to improve program effectiveness.

PRINCIPLE 7 - Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills:

• self-control;
• emotional awareness;
• communication;
• social problem-solving; and
• academic support, especially in reading.

PRINCIPLE 8 - Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills:

• study habits and academic support;
• communication;
• peer relationships;
• self-efficacy and assertiveness;
• drug resistance skills;
• reinforcement of anti-drug attitudes; and
• strengthening of personal commitments against drug abuse.

PRINCIPLE 14 - Prevention programs should include teacher training on good classroom management practices, such as rewarding appropriate student behavior. Such techniques help to foster students' positive behavior, achievement, academic motivation, and school bonding.

PRINCIPLE 15 - Prevention programs are most effective when they employ interactive techniques, such as peer discussion groups and parent role-playing, that allow for active involvement in learning about drug abuse and reinforcing skills.

U.S. Department of Health and Human Services. (2003). Preventing Drug Use among Children and Adolescents: A Research-based Guide for Parents, Educators, and Community Leaders. Available: http://www.nida.nih.gov/Prevention/principles.html

Return to Day 4

Increasing public awareness of underage drinking in your community can be a major environmental strategy to change community norms. Communities can help address underage drinking by employing strategies to reduce the appeal and availability of alcohol to minors while enforcing laws designed to do so. Children draw conclusions about alcohol-related social norms from what they see and hear about alcohol in their families and communities. These norms strongly influence their own attitudes and behaviors regarding alcohol (SAMHSA Prevention Partners).

According to the Leadership to Keep Children Alcohol Free, successful community alcohol prevention programs focus on one or more of three key objectives: (1) reduce the availability of alcohol; (2) improve the effectiveness of law enforcement; and (3) change community norms and practices regarding alcohol. In your role as prevention coordinator you will need to ensure that your plans include these objectives.

Enforcement of underage drinking laws has a strong deterrent effect on underage drinking. In part, it helps reduce underage drinking by limiting access to alcohol, reducing the opportunities for youth to drink, and curbing impaired driving. Rigid enforcement reinforces the message that adults and youth must be responsible for their actions and that violating the law is unacceptable. Further, enforcement validates the activities of prevention specialists and can help treatment specialists identify youth in need of help.

To create effective enforcement strategies, enforcement officials and officers must learn the differences between adult and youth drinking habits.

• Young people and adults drink at different times and in different places.

  Time:

  • Young people drink most heavily on weekends, especially between 10 P.M. and 1 A.M. and after school.

  • Adults drink throughout the week. DUI citations usually occur between 2 and 3 A.M.

Place:

• Young people will generally drink at remote sights like beaches or fields, or in neighborhood homes without adults present. Very often they gather in large groups (Preusser,1993; Jones-Webb et al., 1997).

• Underage drinking drivers experience more fatalities at lower blood alcohol levels than adults do. In 2003, 25 percent of the young drivers 15 to 20 years old who were killed in crashes had a BAC of 0.08 g/dl or higher (NHTSA Traffic Safety Facts, 2003).

• Underage drinkers drink more heavily than the average adult drinker but they drink less often. On average, 12- to 20-year-olds drink about 6 days a month, compared with slightly more than 8 days for adults. However, while adults consumed less than three drinks a day, underage drinkers report they usually consume four-and-a-half drinks each time they drink (Schulenberg et al., 1996).

Sanctions for alcohol-related offenses

Both NHTSA and NIAAA have recommended the following sanctions for alcohol-related offenses:

• Incarceration
• Out-of-Home placement and weekend interventions
• Probation, which may include
  • Restricted access to an automobile
  • Forbidding the use of alcohol
  • Limited access to specific places and people
  • Mandatory participation in educational, medical, or counseling programs
  • Curfews
  • Attendance at school
  • Random blood or urine testing
• License suspension or revocation
• Mandatory community service
• Fines and restitution
• Parental involvement, which may include
  • Attendance at all court proceedings
  • Participation in rehabilitative programs
  • Participation in parenting skills classes (NHTSA, Sentencing and Dispositions of Youth DUI and Other Alcohol Offenses)

Successful Underage Drinking Enforcement Strategies

Enforcement strategies work to reduce underage drinking when laws are actually enforced. A successful prevention program requires the endorsement and whole-hearted participation of local law enforcement.

Successful enforcement strategies encourage alcohol vendors to fully comply with the law, effectively reduce the availability of alcohol, and frequently team youth volunteers with local law enforcement.

There are several programs of merit operating all over the United States that have proven to be successful in reducing underage drinking:

• Covert Underage Buyer -- Teen volunteers attempt to purchase alcohol from a variety of sources to ascertain if the seller will request an ID.

• Cops in Shops - Law enforcement officers deployed in retail shops throughout the community cite or arrest underage youth who attempt to purchase or do purchase alcohol illegally.

• Mr. Will You - Youth volunteers approach adults gathered outside liquor stores, convenience stores, or other alcohol outlets and ask them to purchase alcohol for them.

• Fake Ids - With the proliferation of computers, almost anyone can easily create false identification. This has led many states to alter their driver's licenses and institute other methods of tracing identification.

• Party Buster Hotlines - Some communities have instituted telephone numbers which adults or youth can anonymously call to report sales of alcohol to youths and parties at which underage drinking is a problem.

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1. Assess Prevention Infrastructure & Innovation Readiness (baseline) 5. Reassess and Modify Sustainability Plan (if necessary)   2. Develop Sustainability Plan (objectives, actions,protocols     4. Evaluate Sustainability Readiness (post-assessment)   3. Execute sustainability Actions The sustainability action steps

Source: Johnson, K., Hays, C., Center, H., and Daley, C. (2004). Building capacity and sustainable prevention innovations: a sustainability planning model. Evaluation and Program Planning 27, 135–149.

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Community How To Guide on Underage Drinking: Prevention and Education
NHTSA

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This section provides you with links to the full texts and briefs used throughout the event. It will also link to interactive online sites for teens and youths and other resources you will find useful in developing your local plans.

Additional Resources

On this final day of the event, please complete the following steps:

1. Review the list of additional resources located in the Resources & Links section. You will find links to several on-line publications and organizations with information about underage drinking.
2. Select one of the resources listed below and explore the full text.
   • Research and Publications
   • Interactive Web Sites for Kids (and School Coordinators)
   • Classroom and Coordinator Resources
3. Visit the Discussion Area to share with your fellow participants and the event facilitator the link you followed and any interesting tips you learned.

Results from the 2002 National Survey on Drug Use and Health: National Findings
http://www.oas.samhsa.gov/nhsda/
2k2nsduh/Results/2k2Results.htm
NSDUH is the primary source of statistical information on the use of illegal drugs by the U.S. population. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is planned and managed by SAMHSA's Office of Applied Studies (OAS).

Monitoring the Future
http://www.monitoringthefuture.org/pubs/
monographs/overview2003.pdf
First results from the Monitoring the Future study's 2003 nationwide survey of eighth, tenth, and twelfth grade students are given in this report. Recent trends in the use of licit and illicit drugs are emphasized. Also presented are trends in the levels of perceived risk and personal disapproval associated with each drug-which this study has shown to be particularly important in explaining trends in use-as well as trends in perceived availability of each drug. of differences between groups or for trends over time. The most recent such volume is always posted on the study's Web site.

Youth Risk Behavior Surveillance System
http://www.cdc.gov/HealthyYouth/yrbs/
The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults - behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity - plus overweight. YRBSS includes a national school-based survey conducted by CDC as well as state and local school-based surveys conducted by education and health agencies.

Community How To Guides on Underage Drinking
http://www.nhtsa.dot.gov/people/injury/alcohol/
Community%20Guides%20HTML/Guides_index.html
NHTSA has developed this set of nine community guides. You've seen excerpts from several of the guides throughout this week. These guides should be very helpful in developing your local community plan.

CASA: National Survey of American Attitudes on Substance Abuse VIII: Teens and Parents
http://www.casacolumbia.org/Absolutenm/
articlefiles/2003_Teen_Survey_8_19_03.pdf
CASA surveys attitudes of teens and those who most influence them--parents, teachers and school principals. While other surveys seek to measure the extent of substance abuse in the population, the CASA back to school survey probes substance-abuse risk and identifies factors that increase or diminish the likelihood that teens will abuse tobacco, alcohol or illegal drugs.

Alcohol Policy
http://www.marininstitute.org/alcohol_policy/
Alcohol policies are those regulations, laws and rules that govern the manufacture, promotion, distribution, sale, and use of alcohol. This site, maintained by the Marin Institute, presents alcohol policies that are intended to reduce alcohol problems through environmental prevention.

SAMSHA: Preventing Problems Related to Alcohol Availability: Environmental Approaches
http://www.health.org/govpubs/PHD822/aar.aspx
The Prevention Enhancement Protocols System (PEPS) series was initiated to systematically evaluate both research and practice evidence on substance abuse prevention and make recommendations for the field. In doing so, PEPS strives to maximize the prevention efforts of State substance abuse prevention agencies, practitioners, and local communities.

Institute of Medicine Report on Reducing Underage Drinking
http://www.iom.edu/report.asp?id=15100
Why is this dangerous behavior so pervasive? What can be done to prevent it? What will work and who is responsible for making sure it happens? Reducing Underage Drinking: A Collective Responsibility, a joint report by the National Research Council and Institute of Medicine, addresses these questions and proposes a new way to combat underage alcohol use. It explores the ways in which may different individuals and groups contribute to the problem and how they can be enlisted to prevent it.

How Does Alcohol Affect the World of a Child?
http://www.alcoholfreechildren.org/en/pubs/index.cfm
The Leadership to Keep Children Alcohol Free was established to make childhood drinking prevention a national health priority. A coalition of Governors' spouses, Federal agencies, and public and private organizations, the Leadership is the only national effort that specifically targets prevention of drinking in the 9- to 15-year-old age group. This link takes you to a statistical brochure for lay audiences that distills the most current research findings about early alcohol use and its effects.

NIAAA Initiative on Underage Drinking
http://www.niaaa.nih.gov/about/underage.htm#statistics
As the lead federal agency for supporting and conducting basic and applied research on alcohol problems, NIAAA is spearheading this initiative to intensify research, evaluation, and outreach efforts regarding underage drinking.

Enforcement Success Stories
http://www.udetc.org/SuccessStories.asp
The Underage Drinking Enforcement Training Center was established by the Office of Juvenile Justice and Delinquency Prevention (within the U.S. Department of Justice) to support its Enforcing Underage Drinking Laws Program. The Center mission is to provide science-based, practical, and effective training and technical assistance services to States and communities working to combat underage drinking through law enforcement and environmental strategies. Search the success stories by state or by year of enactment.

Healthy People 2010
http://www.healthypeople.gov/document/HTML/
Volume2/26Substance.htm#_Toc489757833
This report from the National Institutes of Health and the Substance Abuse and Mental Health Services Administration takes another look at the impact drinking has on health.

Center on Alcohol Marketing and Youth
http://camy.org/
The Center on Alcohol Marketing and Youth at Georgetown University monitors the marketing practices of the alcohol industry to focus attention and action on industry practices that jeopardize the health and safety of America's youth.

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The Cool Spot
http://www.thecoolspot.gov/
This site is designed for young teens and provides them with information on alcohol, peer pressure, and underage drinking.

If I drink alcohol, how much is too much?
http://www.alcoholscreening.org/
AlcoholScreening.org is a free service of Join Together, a project of the Boston University School of Public Health. AlcoholScreening.org helps individuals assess their own alcohol consumption patterns to determine if their drinking is likely to be harming their health or increasing their risk for future harm. Through education and referral, the site urges those whose drinking is harmful or hazardous to take positive action, and informs all adults who consume alcohol about guidelines and caveats for lower-risk drinking.

Blood Alcohol Calculator
http://www.ou.edu/oupd/bac.htm
"How much is too much?" The University of Oklahoma Police Department hosts this site. Use this online calculator to estimate just how little alcohol it takes to put you on the "wrong side of the law".

Sara's Quest
http://teens.drugabuse.gov/sarasquest/index.asp
Sara's Quest has been developed for use in schools or in the home for children to learn about the effects of drugs on their brain and body.

Alcohol Cost Estimator for Kids
http://www.alcoholcostcalculator.org/kids/
This tool is designed to help teachers, parents, lawmakers and child advocates calculate the toll serious alcohol problems are taking on their community. It calculates how many kids in your state or community have serious alcohol problems.

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SAMSHA's Reach Out Now
http://www.teachin.samhsa.gov/default.htm
The Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, and Scholastic Inc., provide school-based, underage alcohol use prevention materials each April. This two-part set of materials is designed especially for use by fifth-grade students, their families, and their teachers. The materials are sent to fifth-grade classroom teachers nationwide each year.

Underage Drinking Prevention Materials
http://www.niaaa.nih.gov/publications/PSA/underage.htm
Here's a collection of public education campaign materials created by NIAAA. These free materials are available for use in local community efforts to prevent underage alcohol use.

Understanding Alcohol: Investigations into Biology and Behavior
http://science.education.nih.gov/supplements/
nih3/alcohol/default.htm
This curriculum unit was developed by the National Institute of Health and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It is a creative, inquiry-based instruction program designed to promote active learning and stimulate student interest in medical topics for grades 7 and 8. On this page you'll find links to lesson plans, interactive student activities, and the teacher's guide.

Alcohol Use Masters
http://science.education.nih.gov/supplements/
nih3/alcohol/guide/nih_alch_masters.pdf
These masters were designed for the alcohol curriculum above but they may also be useful on their own.

Online Webcasts
http://store.health.org/catalog/media.aspx?topic=3&h=drugsL
SAMSHA stores Webcasts, ebooks, and audio/video programs on this site. Use of the programs online is free. Some Webcasts and audio/video programs may also be available on VHS or DVD for a small cost-recovery fee.

To assist prevention professionals in their efforts addressing underage drinking, the Center for Substance Abuse Prevention (CSAP) has developed several planning tools.

CSAP Searchable Database
http://casat.unr.edu/bestpractices/search.php
Search for practices and programs by specific criteria. A series of check boxes allow you to indicate the variable(s) you would like to conduct a search. You can search on as many attributes that interest you. The results will be ranked based on how many programs have matching attributes to the criteria you specify.

Prevention Works!
http://captus.samhsa.gov/western/resources/bp/index.cfm
This section of CSAP provides information on the steps to be conducted to create a comprehensive plan for prevention.

Underage Drinking Prevention Action Guide and Planner
http://download.ncadi.samhsa.gov/prevline/pdfs/phd858.pdf
The publication will help you identify strong messages, coordinate outreach efforts with other organizations and groups, and make youth alcohol prevention a priority. It includes a twelve-month calendar with activities, suggestions, and facts.

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This section provides a comprehensive list of the materials and resources presented in this event. Session Resources include the main text for each day of this event, as well as supplementary materials. General Resources include materials designed to facilitate your participation in this online training.

Session Resources

Day 1 - What's the Problem with Underage Drinking?

• Institute of Medicine Report on Reducing Underage Drinking
• Results from the 2004 National Survey on Drug Use and Health: National Findings
• Monitoring the Future
• Youth Risk Behavior Surveillance System
• Youth Online (YRBSS): Comprehensive Results
• NIAAA Initiative on Underage Drinking
• High Risk Behaviors
• Past Year Alcohol Use
• Sexual Risk Behaviors
• The Real Story on Underage Drinking
• Consequences of Underage Alcohol Use

Day 2 - Contributing Factors and Consequences: Why Do Kids Drink?

• Risk and Protective Factors
• Alcohol Advertising: Reaching Kids Where They Live
• Media Questionnaire

Day 3 - School Approaches to the Prevention of Underage Drinking

• A Ten-Point Plan for Schools in Addressing Underage Drinking
• Education Questionnaire
• Building Capacity and Sustainable Prevention Innovations: A Sustainability Planning Model
• SAMHSA Model Programs

Day 4 - Is Your School Ready to Implement an Effective Program to Reduce Underage Drinking?

• Underage Drinking Laws
• Alcohol and Other Drug Policy Checklist
• Partners for Substance Abuse Prevention
• Framework for Program Evaluation in Public Health

Day 5 - Take an In-Depth Look

• Community How To Guides on Underage Drinking
• CASA: National Survey of American Attitudes on Substance Abuse VIII: Teens and Parents
• Alcohol Policy Solutions
• SAMSHA: Preventing Problems Related to Alcohol Availability: Environmental Approaches
• How Does Alcohol Affect the World of a Child?
• Enforcement Success Stories
• Healthy People 2010
• SAMSHA's Reach Out Now
• Underage Drinking Prevention Materials
• Understanding Alcohol: Investigations into Biology and Behavior
• Alcohol Use Masters
• Online Webcasts
• Underage Drinking Prevention Action Guide and Planner
• The Cool Spot
• If I drink alcohol, how much is too much?
• Blood Alcohol Calculator
• Sara's Quest
• Alcohol Cost Estimator for Kids