Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students

Results from a Cluster Randomized Controlled Trial of CHOICE

Published In: Prevention Science, v. 13, no. 4, Aug. 2012, p. 415-425

Posted on RAND.org on August 01, 2012

by Elizabeth J. D'Amico, Joan S. Tucker, Jeremy N. V. Miles, Annie Jie Zhou, Regina A. Shih, Hank Green

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Research Questions

  1. Does CHOICE, a voluntary after-school program for preventing alcohol and drug (AOD) use, reduce alcohol use among younger adolescents?
  2. Does it have a school-wide effect regardless of the number of program participants?

There are many mandated school-based programs to prevent adolescent alcohol and drug (AOD) use, but few are voluntary and take place outside of class time. This cluster randomized controlled trial evaluates CHOICE, a voluntary after-school program for younger adolescents, which reduced both individual- and school-level alcohol use in a previous pilot study. We evaluated CHOICE with 9,528 students from 16 middle schools. The sample was 51% female; 54% Hispanic, 17% Asian, 15% white, 9% multiethnic and 3% African American. Fifteen percent of students attended CHOICE. All students completed surveys on alcohol beliefs and use at baseline and 6–7 months later. We conducted intention-to-treat (ITT) school-level analyses and propensity-matched attender analyses. Lifetime alcohol use in the ITT analysis (i.e., school level) achieved statistical significance, with an odds ratio (OR) of 0.70 and a NNT of 14.8. The NNT suggests that in a school where CHOICE was offered, 1 adolescent out of 15 was prevented from initiating alcohol use during this time period. Although not statistically significant (p = .20), results indicate that past month alcohol use was also lower in CHOICE schools (OR = 0.81; NNT = 45). Comparisons of attenders versus matched controls yielded results for lifetime use similar to school-wide effects (OR = 0.74 and NNT = 17.6). Initial results are promising and suggest that a voluntary after-school program that focuses specifically on AOD may be effective in deterring alcohol use among early adolescents; however, further research is needed as program effects were modest.

Key Findings

The CHOICE program was effective in deterring alcohol use.

  • Students who attended the program were less likely to initiate alcohol use than their peers who did not.
  • African American and multi-ethnic students, as well as alcohol and marijuana users, were more likely to attend CHOICE.
  • Students at the eight middle schools that offered CHOICE were less likely to initiate alcohol use during the academic year compared to students at the eight control schools where the program was not offered, regardless of the number of program participants.
  • The program's effects were modest, suggesting the need for further research.

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