The personal and social consequences of underage drinking are extensive, ranging from injury to impaired psychosocial and cognitive development. This proposal addresses the need for a transformation in current thinking regarding the primary prevention of alcohol use among adolescents in general, and rural African American youth in particular. To date, the implementation and evaluation of alcohol use prevention has been limited by an exclusive focus on delivering efficacious interventions during the transition to earl adolescence. This paradigm is based on the assumption that a single inoculation of an efficacious preventive intervention prior to entering middle school is sufficient to deter alcohol use through the high school years. Inclusive reviews reveal, however, that primary prevention programs implemented in preadolescence fail to achieve robust, long-term results. These programs do not address the fact that many youth will begin using alcohol in high school, often rapidly escalating in their use. A preadolescent inoculation of prevention is not sufficient to equp youth for the novel risk processes they will encounter in high school. In contrast, we propose that achievement of public health impact requires a "dual-inoculation" prevention strategy, one that addresses the onset of use in both early adolescence and mid-adolescence and provides developmentally tailored curricula at each developmental stage. Based on longitudinal studies with rural African American families that documented the changing context of alcohol use risk and protective processes from late childhood through adolescence, scientists at the Center for Family Research developed a series of developmentally appropriate, family- centered preventive interventions that have proven efficacious in in preventing alcohol use: the SAAF program for youth age 10-12 and the SAAF-Teen program for youth age 14-16. These programs afford a unique opportunity to test dual-inoculation hypotheses. We propose to test the relative efficacy of a dual inoculation (SAAF + SAAF-Teen) versus a preadolescent inoculation (SAAF only), a mid-adolescent inoculation (SAAF- Teen only), or no inoculations (control) in a four-arm trial with 460 rural African American youth and their parents. This design permits the evaluation of the relative superiority of the dual inoculation as well as providing information about the mechanisms through which intervention-targeted protective processes affect alcohol use behavior. This study represents the first evaluation of a dual-inoculation strategy, one that has the potential to enhance significantly the practice of primary prevention. To further enhance the potential for widespread dissemination of the approach, we propose to conduct cost-effectiveness analysis alongside the prevention trial.
The most common approach to preventing alcohol use involves providing a well-designed program in preadolescence just prior to or upon entering middle school. This approach does not have long-lasting effects or address the risk factors that lead many youth to use alcohol in high school. We propose to test a strategy that compares offering effective programs at the transition to middle school and the transition to high school with only offering a program at either one of the transitions or no programs at all.