Preventing Substance Abuse Through Community Outreach and Health Promotion Programs Targeting Youth

Preventing substance abuse is a challenge not only for healthcare workers, but for individuals, families, communities, and society as a whole. Numerous studies indicate that the younger a person is when he or she begins experimenting with alcohol, tobacco, or drugs, the more likely that person is to engage in increasingly destructive behavior later in life. In fact, early use of these substances has been linked to a variety of antisocial activities including violence, crime, and addiction. It therefore stands to reason that prevention programs targeting children and young adults can have a significant impact on the future health and well-being of an entire community.

While such programs are being implemented, many early intervention strategies focusing on young adults start too late or are too one-dimensional to be optimally effective, according to Alvera Stern, acting director of the Division of Public Affairs and Education at the US Center for Substance Abuse Prevention (CSAP). Instead of concentrating on just one cause or aspect of substance abuse, Stern explains, "We should target not only all age groups-even at the elementary school level-but also all relevant organizations within the community in an effort to link prevention and treatment strategies."

Any number of factors can exert negative influence on an adolescent's decision to abuse drugs or alcohol (see Fig. 1), but community outreach and education programs seeking to prevent these behaviors can counterbalance the harmful effects, Stern explains. "Really, though, it is still the family that has the greatest influence on a child's decision to take the first step-no matter which direction-either toward or away from substance use."

The most effective and sustainable programs involve a cross section of community-based organizations, agencies, and groups including health professionals and policymakers, schools and other educational institutions, area legal and justice systems, businesses, the media, religious leaders, families, and concerned citizens, according to Stern. "Ask community stakeholders to form a coalition to build both a universal strategic plan and model programs that target specific groups, then use the media to get your message out to the public and develop school-based programs that place substance abuse in a broader social context, education plans that include factual information on the ramifications of substance abuse, and creative alternatives such as sporting events and art and music activities that will help attract and engage young people."

Another key element for success is to develop prevention programs that focus on building caring and supportive relationships that can help young people avoid the web of influence that closely links substance abuse with other negative social phenomena such as violence, crime, teen pregnancy, and dropping out of school, according to Stephen E. Gardner, acting deputy director of CSAP's Division of Knowledge, Development, and Evaluation.

Analyzing both the risk and protective elements in a community is one of the first steps in developing a comprehensive substance abuse plan. Once community needs and resources are evident, leaders can formulate a plan of action specifying how various individuals and organizations can work together to address the situation.¹

To successfully implement a community-based substance abuse prevention program it is necessary to carefully evaluate potential curricula and select those that are easily replicable and adaptable to the needs of an individual community, Gardner explains, noting, "The theories behind the programs, the specific type of interventions called for, and strategies for monitoring and evaluating the program, as well as its outcomes, are all things that should be considered before deciding to go ahead with the process of implementation."

Model Programs

Substance abuse prevention programs that foster strong interpersonal relationships-whether between children and mentors, children and parents, or peers-can dramatically decrease problem behavior by instilling a sense of self-worth and positive outlook in high-risk youth. CSAP has identified a number of model prevention programs that have proven effective in curtailing substance abuse among young populations at the greatest risk for developing problems with alcohol, tobacco, and other drugs. Three of these programs are described below.^{1, 2}

Dare To Be You

Designed to be a primary prevention program for children ages 2 to 5 and their families, the Dare To Be You program has been successfully implemented in urban, suburban, and rural communities throughout the United States. Studies indicate that this program results in dramatic improvements in both the ability of parents to use positive, nurturing family management strategies, and the developmental levels of children who participated as compared with their peers.

Based on education and social activities for parents, children, and families, as well as training and support for childcare workers and community volunteers, the program model consists of three main elements:

• a family component, which provides training for parents, children, and the family unit, and teaches self-responsibility;
• effective parenting; and communication, social, decision-making, and problem-solving skills;
• a school component, which provides training and support for childcare providers; and
• a community component, which provides training in the Dare To Be You strategies for community members who interact with the target population.

Across Ages

Focusing on adolescents between the ages of 10 and 13, Across Ages is a successful mentoring program that pairs high-risk youth with concerned community members who are at least 55 years old. The program, which can be implemented in urban, suburban, and rural communities, targets youth who live in poverty, consistently experience difficulty in school, and have family members who abuse alcohol or drugs. Studies have shown that Across Ages results in improvements in social competence, school attendance, and performance; increased ability to resist alcohol, tobacco, and drug use; and heightened feelings of self-esteem among its young participants.

The basic structure of Across Ages involves elders providing positive, nurturing role models for at-risk adolescents, while teaching children the value of community service and the importance of problem-solving and resistance skills. The program focuses on:

• one-on-one intergenerational mentoring;
• engaging youth in community service activities;
• training classroom teachers to administer the Across Ages life skills curriculum;
• providing weekend and evening activities to engage families, mentors, and youth.

Across Ages strategies for intervention include supplying participants with information on alcohol and drugs, parent support, and offering youth life skills and coping classes.

Creating Lasting Connections

Building strong, healthy families capable of providing high-risk youth the supportive environment they need to resist peer pressure and other social factors that often lead to substance abuse is the goal of Creating Lasting Connections. Targeting young adults between the ages of 11 and 15, this community-based program mobilizes groups including schools, churches, and social service organizations. Studies indicate that Creating Lasting Connections results in improvements in the ability of young participants to resist alcohol, tobacco, and drug use and increased communication and bonding between parents and children.

Identifying and recruiting high-risk families for training and team-building activities, as well as referral to appropriate community services, are integral components of this program, which involves:

• selecting groups or organizations within the community to serve as the focal point of services and activities;
• training a small cadre of community volunteers to act as advocates for youth in high-risk environments and their families, and to aid in recruiting and retaining those families in the program; and
• engaging parents and adolescents in a number of highly interactive training courses that help them to cope with difficult situations and problems.

Effective prevention programs address the specific needs of their target audience and incorporate intervention strategies that include relationship-building activities, social and life-skills training, and substance abuse education. Regardless of the model used, the goal remains the same-instilling the positive outlook that forms the basis of a young person's ability to resist the temptation to begin destructive habits that can have a negative impact on individuals, families, and entire communities.

1. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Understanding Substance Abuse Prevention-Toward the 21st Century, 1999.
2. For more information on these and other successful models, contact the US National Clearinghouse for Alcohol and Drug Information at ncadi.samhsa.gov.

Kathryn Utan is AIHA's staff writer.