Journal of Primary Prevention.211).Fail, 1981

Toward A Systems-Ecological Approach To the Prevention of Adolescent Alcohol Abuse THOMAS F. BABOR and STEVEN BERGLAS ABSTRACT:Findings from a questionnaire survey of adolescent drinkers are discussed in t e r m s of developmental trends in alcohol a n d drug use, prevalence of drinking problems and the psychosocial correlates of problem drinking. Canonical correlation procedures are used to illustrate how multivariate statistical analysis can serve as a rational guide to the derivation of prevention goals and the formulation of prevention strategies. The basic elements of a "systems-ecological" approach are t h e n presented as a conceptual basis for prevention strategies designed to meet these goals.

Primary prevention of mental disorder and problem behavior has been heralded as an idea whose time has come (Klein & Goldston, 1977}. The popularity of this idea is reflected in a growing literature of conceptual models, intervention strategies, and evaluation research (Blane, 1976; Dohner, 1972; Room, 1974; Swisher, 1979; Whitehead, 1975.} Nowhere is this more apparent than in the field of adolescent substance abuse, where the advocates of health promotion and primary prevention have joined forces to redress an evil long festering in the body politic. As in any evolving field of inquiry, there is a general lack of consensus concerning assumptions, means and ends. That empirical data and the scientific method should guide prevention efforts is widely accepted, but to date social science has been less persuasive than personal ideology. The present essay will attempt to show that epidemiological survey research can make a vital contribution, not only to the estimation and explanation of adolescent alcohol abuse, but also to planning and evaluation of programmatic prevention activities. We will further describe how a comprehensive "systems-ecological" approach to prevention may have advantages over single factor models or non-systematic multimodal approaches. This research was supported in p a r t by Research Scientist Development G r a n t s 5 K01 A A 00025-02 and 1K01AA00050-01 from the National I n s t i t u t e on Alcohol A b u s e and Alcoholism. A shorter version of this paper was presented at the 25th I n t e r n a t i o n a l I n s t i t u t e on the Prevention and T r e a t m e n t of Alcoholism, Tours, France, 19 J u n e 1979. Requests for reprints m a y be addressed to the a u t h o r s a t the Alcohol a n d Drug Abuse Research Center, McLean Hospital a n d H a r v a r d Medical School, 115 Mill St., Belmont, M A 02178. 0278-095X(81)1500-0025500.95

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@1981HumanSciencesPress

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Journal of Primary Prevention

For illustrative purposes, the results of a recent survey of 485 adolescent drinkers, sampled from a suburban Massachusetts community (herein referred to as "River City," population 30,000}, will be described in some detail. The discussion is organized around data pertaining to developmental trends in alcohol and drug use patterns, prevalence of drinking problems, and the psychosocial correlates of problem drinking.

Developmental Trends Adolescence may be the most crucial period for the socialization of drinking practices, particularly in light of the dramatic increase in alcohol use during the formative years between 13 and 17 (Rachal et al., 1975}. It is therefore likely that prevention efforts would benefit from a careful study of developmental trends in alcohol consumption. Figures l a and lb show the prevalence of beer drinking {at least once a month or more often} for each sex and grade level sampled in the River City survey. Also plotted are prevalence data for use of marihuana {"once or twice" or more often} and cigarettes {"now and then" or more often}. Substance use increases as a linear function of time during this five-year period. Among both males and females beer drinking is more prevalent at all grade levels than marihuana use or cigarette smoking. The incidence rate of these latter substances lags about one year behind that of beer. Though few students reported more than experimental use of drugs other than marihuana there was a pronounced tendency for high school students to use alcohol in combination with other psychoactive substances. Even though the prevalence of drinking, smoking, and marihuana use increases progressively between the 7th and l l t h grades, this in itself may not constitute a public health problem of sufficient seriousness to warrant prevention or control efforts. Data relevant to this issue were obtained by analyzing age-grade trends i n the prevalence of "frequent" or regular substance use among River City adolescents. In the present discussion, substance use that occurred once a week or more often will be considered "frequent" or regular. For the great majority of students, regular use of beer, cigarettes and marihuana did not begin until high school. Regular beer drinking by males increased from 5% of the 8th graders to 50% of the l l t h graders. The percentages of females increased from 3% to 30% across the same grade range. Weekly marihuana use increased from 5% of the students at the 8th grade to more than 40% at the 10th. Daily cigarette smoking (one-half pack or more} was reported by 18% of the males and

Thomas F. Babor and Steven Berglas

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34% of the females at the l l t h grade level, compared with less than 5% of the junior high school students. It may be argued that while daily cigarette smoking and weekly marihuana intoxication are hazardous to health and safety, weekly beer drinking may represent nothing more than "responsible" drinking under parental sanction. Data relevant to this question were obtained by tabulating percentages of students who drink 5 or 6 cans of beer "nearly every time" they drink, as well as of those who get drunk or "high" on a weekly basis. To the extent that weekly intoxication and large amounts of intake per occasion are prevalent, we may infer that the reported drinking is a symptom of excess. The data showed that heavy drinking per occasion and weekly intoxication increased dramatically at the beginning of high school (10th grade). Weekly beer consumption to the point of intoxication was reported by one-fourth of the females and one-third of the males at the l l t h grade. The River City survey also showed that the context of drinking changes with frequency of use and age of drinker. Younger students drank most often under the supervision of parents and relatives. With increasing age, however, drinking at home is displaced by outside settings such as social events, friends' dwellings, and automobiles. Frequency of beer drinking by both males and females correlated significantly with frequency of cigarette smoking (r=.47, p

Toward a systems-ecological approach to the prevention of adolescent alcohol abuse.

Findings from a questionnaire survey of adolescent drinkers are discussed in terms of developmental trends in alcohol and drug use, prevalence of drin...
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