Influencing Adolescent Social Perceptions of Alcohol Use to Facilitate Change through a School-Based Intervention


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The current study examines the effectiveness of a voluntary high school-based alcohol intervention by investigating one proposed mechanism of change in adolescent alcohol involvement: perception of peer use. High school students reporting lifetime
   PLEASE SCROLL DOWN FOR ARTICLE This article was downloaded by:On: 10 November 2010  Access details: Access Details: Free Access  Publisher Routledge  Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Child Adolescent Substance Abuse Publication details, including instructions for authors and subscription information: Influencing Adolescent Social Perceptions of Alcohol Use to FacilitateChange through a School-Based Intervention Marya T. Schulte a ; Teresa K. Monreal b ; Maryam Kia-Keating c ; Sandra A. Brown da  San Diego State University/University of California, San Diego, CA, USA b  University of California,San Diego, San Diego, CA, USA c  University of California, Santa Barbara, Santa Barbara, CA, USA d Veterans Affairs San Diego Healthcare System; University of California, San Diego, CA, USAOnline publication date: 03 November 2010 To cite this Article  Schulte, Marya T. , Monreal, Teresa K. , Kia-Keating, Maryam and Brown, Sandra A.(2010) 'InfluencingAdolescent Social Perceptions of Alcohol Use to Facilitate Change through a School-Based Intervention', Journal of Child & Adolescent Substance Abuse, 19: 5, 372 — 390 To link to this Article: DOI: 10.1080/1067828X.2010.515877 URL: Full terms and conditions of use: article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.  Influencing Adolescent Social Perceptionsof Alcohol Use to Facilitate Change through a School-Based Intervention  MARYA T. SCHULTE San Diego State University  = University of California, San Diego, CA, USA TERESA K. MONREAL University of California, San Diego, San Diego, CA, USA MARYAM KIA-KEATING University of California, Santa Barbara, Santa Barbara, CA, USA SANDRA A. BROWN Veterans Affairs San Diego Healthcare System; University of California, San Diego, CA, USA The current study examines the effectiveness of a voluntary high school-based alcohol intervention by investigating one proposed mechanism of change in adolescent alcohol involvement: percep-tion of peer use. High school students reporting lifetime drinking (N  ¼ 2055) completed fall and spring surveys that assessed demo- graphic information, substance use, risk factors, and interventionattendance (N  ¼  327). The motivational enhancement-based intervention used school and grade-specific normative data to facilitate change in adolescent perceptions regarding the frequency and quantity of peer alcohol use. Results indicate that intervention participants were more likely to increase the accuracy of their peer  frequency estimates over the course of the year in comparison tothe general student body. Furthermore, students demonstrating decreases in peer perceptions of alcohol use exhibited a greater reduction in number of binge episodes, lower maximum number of drinks consumed per episode, and average number of drinks  The authors would thank the schools, staff, and participants involved with this study. Thisresearch was supported by National Institute on Alcohol Abuse and Alcoholism (NIAAA)grants AA07033 and AA12171 (S. Brown), and NIAAA grant T32 AA013525. Address correspondence to Sandra A. Brown, PhD, University of California, San Diego,Department of Psychology, 9500 Gilman Drive (MC 0109), San Diego, CA 92093-0109, USA.E-mail:  Journal of Child & Adolescent Substance Abuse  , 19:372–390, 2010Copyright # Taylor & Francis Group, LLCISSN: 1067-828X print = 1547-0652 onlineDOI: 10.1080/1067828X.2010.515877372  D o w nl o ad ed  A t : 18 :26 10  N o v e mb e r 2010  consumed per drinking occasion (ps  < .05); teens with the greatest alcohol use history demonstrated the largest reductions. Althoughwe found no significant main effect for intervention attendance, findings support the role of reduced peer drinking estimates indecreasing alcohol involvement among teen drinkers. KEYWORDS adolescent, alcohol, intervention, normative feedback, social perceptions  INTRODUCTION  Alcohol use during adolescence continues to warrant concern for America’s youth. With one-quarter to one-third of students reporting hazardous drinking(i.e., five or more drinks in a row during the prior two weeks) by high schoolgraduation (Johnston, O’Malley, Bachman, & Schulenberg, 2006), these teensare at an increased risk for impaired academic performance, risky sexual beha- vior, initiation of other substance use, automobile accidents, physical and men-tal health problems, and later alcohol dependence (Brown & Tapert, 2004;Hussong & Chassin, 1994; Lewinsohn, Hops, Roberts, & Seeley, 1993; O’Malley et al., 2004). Thus, developing alcohol interventions that effectively producechange in high-dose drinking are of great importance.Historically, few school-based interventions have proven efficacious(Hser et al., 2001; Pentz, 1998), with questions being raised as to their devel-opmental appropriateness and concern over inciting rebellious attitudestoward the program messages (Brown, 1993; Kelly et al., 2000; Marlatt & Witkiewitz, 2002; Wagner, Brown, Monti, Myers, & Waldron, 1999). It appearsthat traditional approaches aimed at reducing or stopping alcohol use amongteens that have already begun drinking or have experienced alcohol-relatedproblems lack critical components involved in purposeful change efforts of  youths (Brown, 2001). Given that a considerable number (i.e., 15–20 % ) of adolescent drinkers successfully reduce or stop drinking without any formaltreatment (Brown, 2001; Fillmore, 1998; Sobell, Ellingstad, & Sobell, 2000; Stice et al., 1998), identifying these mechanisms of change among youths may leadto more viable interventions and increase motivation to seek treatment.Our model of de-escalation of alcohol involvement (e.g., Brown, 2001)through motivated purposeful change is grounded in cognitive social learn-ing theory  (Bandura, 1986; Smart & Stoduto, 1997) and proposes that teens choose to reduce or stop using based on cognitive appraisal (e.g., perceiveddrinking norms) and evaluation processes (e.g., alcohol use and cessationexpectancies; Klingemann, 1991; Metrik et al., 2004; Tucker, Vuchinich, & Gladsjo, 1991). From a developmental perspective, this two-stage, socialinformation processing model (e.g., Brown, 2001; Brown, Anderson, Schulte,Sintov, & Frissell, 2005) states that drinking decisions depend upon proximal Social Perceptions of Alcohol Use   373  D o w nl o ad ed  A t : 18 :26 10  N o v e mb e r 2010  cognitive and emotional states in the immediate social environment and within the context of one’s own personal risk profile. Therefore, interven-tions for this age group must focus on enhancing motivation to change by taking into account distortions in perceptions of alcohol use created by peerdiscussions, the salience of personal alcohol experience in social contexts,and the media, which normalize heavy dose alcohol use without displayingtypical negative consequences teen drinkers experience (e.g., Johnston et al.,2006; Wagner et al., 1999).Research examining brief interventions utilizing motivational enhance-ment techniques indicates that substantial change can occur within only afew intervention sessions (Miller, 2000; Monti et al., 1999). For example, Pro- ject MATCH (1997) found that for adults, reductions in alcohol use producedby four motivationally focused sessions were comparable to changes withgreater therapeutic dose of other behavioral interventions. Monti and collea-gues (1999) investigated motivational interviewing (MI) with adolescentstreated during emergency room visits for alcohol-related problems and foundthat youths receiving MI had significantly fewer subsequent alcohol-relatedinjuries and problems in comparison to teens receiving standard emergency room care. Thus, changes in alcohol use and adverse consequences canoccur within a brief therapeutic framework.Since several studies have demonstrated that adolescents overestimatepeer frequency and quantity of alcohol use (Baer, Stacy, & Larimer, 1991; Jacobs & Johnston, 2005; Perkins & Craig, 2003), understanding how alcoholinvolvement is related to perceptions and expectations regarding peer useprovides an opportunity to extend personal and normative feedback intoadolescent alcohol prevention efforts. Misperceptions have been shown toinfluence decisions regarding alcohol use (Barkin, Smith, & DuRant, 2002;Graham, Marks, & Hansen, 1991; Jacobs & Johnston, 2005; Marks, Graham,& Hansen, 1992; Thombs, Wolcott, & Farkash, 1997), with overestimationsof peer involvement related to earlier age of onset and more extensive alco-hol involvement (Marks et al., 1992). Current theories suggest that inflatedalcohol use estimates of teens may be caused by the media’s portrayal of the prevalence of alcohol and drug use, youth stories regaling drinking epi-sodes which are more salient during adolescence, and the tendency for thesememorable stories to be attributed to others’ disposition rather than contex-tually limited instances (Perkins, 1997, 2003). It is further speculated thatperceived, or misperceived, social norms for alcohol involvement affectadolescent drinking behavior by eliciting a desire to conform to behaviorsthat are believed to be normative for one’s peer group (Perkins, 1994).The social norms approach to alcohol intervention purports that by correcting peer estimates, drinking will decrease in order to be more in line with the revised perceived norm (Perkins, 2003). The efficacy of interventionsthat focus on providing accurate normative feedback has been examined inmultiple studies on populations of varying age and severity of use and has 374  M. T. Schulte et al.  D o w nl o ad ed  A t : 18 :26 10  N o v e mb e r 2010  proven successful in changing misperceptions and subsequently reducing orpreventing use (Donaldson, Graham, & Hansen, 1994; Far & Miller, 2003;Haines, Barker, & Rice, 2003; Haines & Spear, 1996; Hansen & Graham,1991; Ott & Doyle, 2005; Perkins & Craig, 2003; Steffian, 1999). Haines and Spear(1996) found that a media campaign designed to correct college students’misperceptions about binge drinking proved to be more effective in reducingself-reported binge drinking than the traditional intervention designed to raiseawareness and educate students about dangerous drinking levels. In a study evaluating the social norms approach in a high school population, Hainesand colleagues (2003) found that students changed their estimations of peeruse to more accurately reflect base rates, and reported reductions in theirown alcohol and cigarette use. Thus, normative feedback may be a powerfultool in eliciting change in the beliefs surrounding peer alcohol use, and moreimportantly, result in considerable changes in drinking behaviors.The current study examines the effectiveness of a brief school-basedalcohol intervention (Project Options) designed to reduce adolescent alcoholinvolvement. The intervention is based on Motivational Enhancement andCognitive Behavioral approaches to alcohol abuse and incorporates norma-tive feedback on alcohol use, social expectancy challenge, and feedback onpeer reduction = cessation efforts. Project Options is designed to be a second-ary intervention, targeting students with limited to moderate alcohol experi-ence and motivation for self-change. Previous treatment studies investigatingthe utility of normative feedback in changing drinking behaviors have foundthat universal programs designed for both college (Haines & Spear, 1996)and junior high (Hansen & Graham, 1991) students are successful in estab-lishing accurate norms and preventing alcohol abuse. The purpose of thepresent study is to investigate the correction of peer use misperceptionsas a mechanism of change for hazardous alcohol use (i.e., number of binge-drinking episodes, maximum number of drinks per drinking occasion,and average number of drinks per drinking occasion) among high schoolstudents self-selecting into a school-based program.Based on previous research (Brown, 2001; Brown et al., 2005), severalhypotheses regarding the effectiveness of the intervention as well as themechanism eliciting such change were made. First, it was predicted thatstudents participating in Project Options would exhibit a lower alcohol usetrajectory in comparison to their no-intervention counterparts, with thoseparticipating displaying either less escalation in hazardous use or greaterdecrements in alcohol use variables at the end of the academic year. Second, we hypothesized that intervention participation would be related to lessoverestimation in peer quantity and frequency of use for other students intheir grade. It was also hypothesized that changes in peer perceptions wouldmediate the relationship between intervention participation and alcohol usesuch that Project Options participants with improved accuracy in peerperceptions would demonstrate the lowest use trajectories. More specifically, Social Perceptions of Alcohol Use   375  D o w nl o ad ed  A t : 18 :26 10  N o v e mb e r 2010
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