AIHA Partners Work in Schools to Curb Adolescent Drinking and Smoking

By Victoria Merkel

Several AIHA partners have taken their healthy lifestyles promotion into the community. Recognizing that they can often be more successful in changing young people's lifestyle habits than changing those of adults, and taking into account surveys that show risky behaviors by adolescents are on the rise in the NIS/CEE region, some partners have brought their programs to schools.

Project Northland

One partnership that is working to influence the behavior of youths in the CEE region is Split/New Jersey.

After conflict near Croatia led to a rise of unemployment and a growing sense of hopelessness for the future, NGOs working with teenagers in the city of Split and its suburbs identified alcohol as a growing concern. Data from the City of Split's 2002 Youth Risk Behavior Survey shows that 44 percent of the 1,000 adolescents polled had had at least one drink in the past 30 days. Of that 44 percent, 12 percent reported drinking at least three to five days in one month and seven percent drank 10 days or more per month. Eighty-two percent had their first drink (other than a few sips) between the ages of eight and 16, and 16 percent reported having had five or more drinks (commonly considered binge drinking in the United States) on at least two to five days during the 30-day period.

Using the information gained from the survey, US partners from the University of Medicine and Dentistry of New Jersey's School of Public Health researched American alcohol intervention programs. Searching for a multi-layered program that would reach youths as well as their parents and the community, partners chose Project Northland, which was developed by the University of Minnesota's School of Public Health and is promoted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Project Northland, which was launched in 1990, has been shown to produce a 20 percent reduction in alcohol use among adolescents.

Project Northland is a three-year intervention program targeting sixth through eight graders. The goal of the program is to delay the age at which adolescents begin to drink and to change how parents communicate with their children, how peers influence each other, and how communities respond to adolescent alcohol use. The program addresses environmental factors that might cause adolescents to drink, such as community norms and standards related to adolescent drinking; intrapersonal factors, such as personal values and attitudes; and behavioral factors, such as the skills to resist alcohol.

The sixth grade curriculum is four weeks in length and presents a central story through a series of four comic books, activities, tips for parents, and a scorecard of participation. The comic workbooks-which are to be completed by parents and children-involve positive role models as well as characters who engage in negative actions. Parents and children discuss drinking as they read the comics and answer the questions. Because many of the character names were designed to be a "play on words" with meanings only culturally relevant in English, the Croatian partners came up with their own names when they translated the materials. For instance, one of the names, Luka Vril, means "clever and virtuous."

Seventh-graders work to develop their interpersonal and refusal skills and to build positive peer relationships, through a curriculum called "Amazing Alternatives!" The curriculum consists of peer-led experiential activities including audio tapes made by other adolescents, group discussions, and role plays. Eighth-graders learn about professional and political groups that affect alcohol use in their communities, through "PowerLines," a program that requires students to work on small group projects to familiarize themselves with intervention tools available in their community. For example, students may conduct a poll of community members' thoughts on alcohol-related ordinances, compile the data, and present the information to the class and community.

Representatives of Project Northland provided training for the US partners in September, and then US partners trained 10 Split teachers during an October exchange to Croatia. The Split trainees will transfer their skills to other teachers in the 13 schools that were selected to take part in the program's first year, which will begin this spring. Another 13 schools in Split will serve as the control group. The program was presented to school administrators and representatives of the Croatian Ministry of Health (MOH) at a press conference in October, and many school administers are anxious to enroll their schools in the program. MOH officials had positive reactions to the idea and said they are considering expanding the initiative to the larger region of Dalmatia, and eventually, the country as a whole.

The Split/New Jersey partners are following in the footsteps of other AIHA partners who have implemented similar programs.

"Kids for Kids"

After analyzing youth education projects already in place in Russia, Sarov/Los Alamos partners designed a cooperative task force with teachers, healthcare providers, and 15 volunteer students to implement an adolescent volunteer program called Kids for Kids.

The formation of the adolescent health team made up of Sarov residents is one way that partners plan to sustain the work of the partnership. Already, the work of the team has resulted in the creation of a domestic violence crisis department in the city administration, as well as an article in the city newspaper on adolescent relationships, pregnancy prevention, and STDs.

As part of the Kids for Kids program, 1,350 10- to 16-year-olds attended a 21-day summer camp during which a gynecologist, pediatrician, and psychologist discussed alcohol, tobacco, drug abuse, and HIV/AIDS. Partners also work with students in first through seventh grade using a curriculum titled "Useful Habits and Useful Skills," in which they discuss healthy habits and skills that can help them to resist alcohol and drugs.

Additionally, partners held a workshop on alcohol and drug abuse prevention, at which 25 teachers were trained to teach schoolchildren about alcohol and drugs, the female and male reproductive systems, and STIs including HIV/AIDS.

Health Education and Lifestyle Program

Representatives of the Lori/Los Angeles partnership are bringing healthy lifestyles education to 10 schools in the Lori region through participation in a project called the Health Education and Lifestyle Program (HELP), sponsored by the organization Analysis Research and Planning for Armenia (ARPA). HELP consists of weekly one-hour classes for junior high school students that cover addiction, narcotics, smoking, alcohol abuse, STDs, unhealthy eating habits and lifestyle choices, personal responsibility for health, and self-esteem. The course is supplemented with a 22-chapter book that explains health risk factors through a style of discovery and learning rather than a "doctor-patient" approach.

According to a 2002 end-of-school year evaluation conducted by Salpy Akaragian, US partnership coordinator, 80 percent of the students participating in the program received excellent to good marks on their post-test.

Uzhgorod Peer Mentor Group

To help Ukrainian adolescents develop healthy lifestyles, in 2001, partners from AIHA's Uzhgorod/Corvallis partnership implemented the Uzhgorod Peer Mentor Group. Through the program, tenth, eleventh, and twelfth-grade students are trained as volunteer mentors, to serve as assistants and role models in ninth grade classrooms. Peer mentors support younger teenagers academically, as well as by making a personal connection with the students. The program's success is due partly to the fact that in many cases, students can reach their peers on a level that adults cannot. In classrooms, mentors provide information, make referrals, assist with study skills, and offer tutoring.

Looking to expand their work with adolescents, five Uzhgorod partners traveled to Corvallis last spring and defined a strategy for a healthy lifestyles curriculum to implement in schools located in Uzhgorod and Velykyi Bereznyi. Using knowledge gained from visits to health education classes in Corvallis schools, a high school peer mentoring program, and university health education classes, partners developed lesson plans addressing sexuality, STI prevention, and substance abuse prevention.

In June 2002, partners held conferences for teachers in Uzhgorod and Velikyi Bereznyi, where US Partnership Coordinator Louise Muscato, professor of public health at Western Oregon University, presented statistics on risk factors leading to morbidity and mortality in Ukraine. She pointed out that Ukraine has the second highest incidence of alcoholism and drug abuse in the NIS. Muscato then led teachers through a curriculum development process based on a learner-centered approach to teaching. While the traditional approach is content-driven and instructor-centered, she explained, the learner-centered approach focuses on the outcomes that learners will have after they complete the program.

The high point of the conference was when partners unveiled their healthy lifestyles curriculum. The curriculum covers dental care, physical activity, nutrition, road safety, mental health, smoking, alcohol, and STDs. It was presented to the Ukrainian Ministry of Health and is now used in local schools. To ensure its success, the partnership also established a school health education coalition to act as a guide in curriculum implementation.

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