UNC study shows family-directed program can reduce adolescent tobacco, alcohol use

CHAPEL HILL - After the documented failure of the well-known and widely used DARE program and other efforts to prevent the start of alcohol, tobacco and drug use among teen-agers, parents and health professionals sometimes wonder if any such program can work.

Yes, and let's keep working on them, say public health experts at the University of North Carolina at Chapel Hill with good reason. A family program they designed, implemented and evaluated reduced first use of tobacco among adolescents by about 25 percent in white teens for at least a year and possibly a lot longer, they say. When all teens in the study were included, the reduction was 16.4 percent.

The effort also helped discourage alcohol use.

"We had a national sample of pairs of adolescents and parents, which we randomly assigned to receive the program or not receive it," said Dr. Karl E. Bauman, professor of health behavior and health education at the UNC School of Public Health. "We gathered data from all the pairs before the program began and then at two points after it was finished, at three months and again at 12 months. The intervention had substantial effects in reducing beginning tobacco use among adolescents."

Related findings suggested the program also substantially reduced the number of adolescents who drank alcohol and smoked cigarettes, Bauman said.

A report on the continuing research appears in the April issue of the American Journal of Public Health. Besides Bauman, authors are Dr. Vangie A. Foshee, Dr. Susan T. Ennett and graduate student Katherine A. Hicks of the health behavior and health education department. Other authors are Drs. Gary G. Koch, professor of biostatistics at UNC, Michael Pemberton, now of the Research Triangle Institute, and Tonya S. King, now of Pennsylvania State University.

"Smoking has been identified as the single most preventable cause of premature death in the United States, and most people begin using tobacco products during adolescence," Bauman said. "Programs currently or recently in use in the vast majority of school systems in the U.S. have been found not to have any behavioral effects at all or effects that are modest. That's why it's important to look for other ways to impact adolescent tobacco and alcohol use."

The UNC-designed program, which is home-based rather than school-based, is named "Family Matters." Better communication is the heart of it, Bauman said. Family matters involves telephone calls from health educators and a series of four work booklets designed to offer useful information to parents and adolescents about the dangers of tobacco and alcohol, improving family communication skills, tips for avoiding peer pressure and the like.

"This is the first study of a family intervention of smoking and drinking that uses a national population and a rigorous experimental design," Bauman said. "That we found substantial effects is very encouraging."

"Involving families has been a key obstacle to successful implementation of family-directed programs not closely tied to the adolescent's school homework assignments," Bauman said. "Participation in our program, however, compared favorably with that in other programs, presumably because the demands on the family for participation were relatively low."

Could Family Matters be used widely?

"Although costs for comparable programs are unavailable, the $140.42 per eligible case required for implementing Family Matters does not appear excessive," he said. "Moreover, implementation costs may be able to be reduced."

The cost per adolescent reached and dissuaded from starting to smoke pales by comparison to the long-term cost of cigarettes, tobacco-related health care later in life and lost productivity, the scientist added.

The National Institute on Drug Abuse supported the UNC study, which the researchers said demonstrated that family-directed programs are worth further development, evaluation and use.

Note: Bauman can be reached at (919) 929-6572 or [email protected]

School of Public Health