A Dual Inoculation Approach to Alcohol Prevention Among African American Youth

说明(申请人提供)：未成年人饮酒的个人和社会后果是广泛的，从伤害到心理社会和认知发展受损。这项提案涉及到需要改变目前对青少年，特别是农村非裔美国青年饮酒的初级预防的想法。迄今为止，预防饮酒工作的实施和评估一直局限于在过渡到早期青春期期间提供有效的干预措施。这一范式是基于这样的假设，即在进入中学之前接种一次有效的预防性干预足以阻止在高中期间使用酒精。然而，包容性审查显示，在青春期前实施的初级预防方案未能取得强有力的长期结果。这些计划没有解决这样一个事实，即许多年轻人将从高中开始使用酒精，而且使用酒精的情况往往会迅速升级。青春期前的预防接种不足以使年轻人适应他们在高中将遇到的新的风险过程。相反，我们认为，要实现对公共健康的影响，就需要一种“双重接种”预防战略，即在青春期早期和青春期中期开始使用疫苗，并在每个发育阶段提供适合发展需要的课程。根据对非洲裔美国农村家庭的纵向研究，记录了从童年后期到青春期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育、以家庭为中心的预防干预措施，事实证明，这些干预措施在防止酒精使用方面是有效的：针对10-12岁青少年的SAAF计划和针对14-16岁青少年的SAAF-Teen计划。这些项目为检验双重接种假说提供了一个独特的机会。我们建议在对460名农村非裔美国青年及其父母进行的四臂试验中，测试双重接种(SAAF+SAAF-Teen)与青春期前接种(仅SAAF)、青春期中期接种(仅SAAF-Teen)或不接种(对照)的相对有效性。这一设计允许评估双重接种的相对优势，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估，该战略有可能显著加强初级预防的实践。为了进一步加强该方法广泛传播的可能性，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.