A Dual Inoculation Approach to Alcohol Prevention Among African American Youth

描述（由申请人提供）：未成年人饮酒的个人和社会后果是广泛的，从伤害到受损的心理和认知发展。该提案提出了需要转变目前关于青少年，特别是农村非洲裔美国青年酗酒的一级预防的思想。迄今为止，酒精使用预防的实施和评估一直受到限制，因为只关注在向青春期过渡期间提供有效的干预措施。这种模式是基于这样的假设，即在进入中学之前进行一次有效的预防性干预接种足以阻止高中期间的酒精使用。然而，包容性审查显示，在青春期前实施的一级预防计划未能取得稳健，长期的结果。这些计划没有解决这样一个事实，即许多青少年将开始使用酒精在高中，往往迅速升级，在他们的使用。青春期前的预防接种不足以使青年人适应他们将在高中遇到的新的风险过程。相比之下，我们建议，实现公共卫生的影响，需要一个“双接种”的预防策略，一个解决的发病使用在青春期早期和青春期中期，并提供发展定制的课程，在每个发展阶段。基于对农村非裔美国人家庭的纵向研究，记录了从童年后期到青春期的酒精使用风险和保护过程的变化背景，家庭研究中心的科学家开发了一系列适合发展的，以家庭为中心的预防干预措施，这些干预措施已被证明在预防酒精用途：方面有效：针对10-12岁青少年的SAAF方案和针对14-16岁青少年的SAAF-Teen方案。这些计划提供了一个独特的机会来测试双接种假说。我们建议测试的相对有效性的双重接种（SAAF + SAAF-青少年）与青春期前接种（SAAF只），青春期中期接种（SAAF-青少年只），或没有接种（对照）在四臂试验与460农村非洲裔美国青年和他们的父母。这种设计允许评价双重接种的相对优越性，并提供有关干预靶向保护过程影响酒精使用行为的机制的信息。这项研究是对双重接种战略的第一次评价，这种战略有可能大大加强初级预防的做法。为了进一步提高广泛推广该方法的潜力，我们建议在进行预防试验的同时进行成本效益分析。

DESCRIPTION (provided by applicant): 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.