Program Profile: CHOICE

Study Title: Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students Results from a Cluster Randomized Controlled Trial of CHOICE (which is associated with Outcome 1, Outcome 2, and Outcome 3)

Research Design

D’Amico and colleagues (2012) evaluated the impact of participation in CHOICE on 6th through 8th grade students’ behaviors and attitudes toward alcohol, using a cluster randomized controlled design in 16 middle schools (8 treatment and 8 control) from three school districts in southern California.

Sample

Schools were selected and matched with comparable neighboring schools on multiple measures before being randomized into treatment or control conditions. While close to 15,000 students were originally recruited for the study, 9,828 students received parental permission to participate, and 8,932 students (4,243 treatment school students and 4,689 control school students) completed the baseline survey. Treatment group students were 51 percent female, 52 percent Hispanic, 17 percent white, 17 percent Asian, 10 percent another race, and 4 percent Black. Control group students were 50 percent female, 56 percent Hispanic, 16 percent Asian, 14 percent white, 11 percent another race, and 3 percent Black. After controlling for grade, there were no statistically significant differences between treatment and control students at baseline. Final outcome analysis was based on data from 9,528 students in two waves of the study. Students could choose to attend as many of the CHOICE sessions as they preferred. Students attended an average of three sessions and one third of the treatment students attended all five sessions.

Data Collection

Baseline surveys were completed in September–October 2008 and follow-up surveys were completed in May–June 2009. Surveys were completed in physical education classes during the school day. Outcomes were assessed using the California Healthy Kids Survey, Monitoring the Future, and scales developed from Project ALERT.

Outcome Measures

Outcomes included alcohol use (measured by lifetime and past-month alcohol use frequency); heavy drinking in the past month; and alcohol resistance self-efficacy (the confidence in one’s ability to resist alcohol). Frequency of alcohol use was assessed by asking students “During your life [or past month], how many times [or days] have you tried alcohol?” Heavy drinking in the past month was assessed by asking students how frequently they had drunk “five or more drinks of alcohol in a row, that is, within a couple of hours” where a “drink” was defined as one whole drink of alcohol (not including a few sips of wine for religious purposes). To assess resistance self-efficacy, students were asked: “Suppose you are offered alcohol and you do not want to use it. What would you do in these situations: a) your best friend is drinking alcohol; b) you are bored at a party; and c) all your friends at a party are drinking alcohol?” These three items were rated on a scale ranging from 1 “I would definitely drink” to 4 “I would definitely not drink.”

Statistical Analysis

Data were analyzed using an intent-to-treat approach in which students were analyzed in the groups to which they were assigned (all respondents in control schools were compared with all respondents in treatment schools, regardless of attendance at CHOICE). Generalized estimating equation regression models were used to account for the clustering of individuals within schools. Outcomes were estimated in an adjusted multivariate analysis which included the following covariates: baseline level of the variable and current school grade, sex, and race. No subgroup analysis was conducted. 

Citation:

D’Amico, Elizabeth J., Joan S. Tucker, Jeremy N. V. Miles, Annie J. Zhou, Regina A. Shih, and Harold D. Green. 2012. “Preventing Alcohol Use with a Voluntary After-School Program for Middle School Students: Results from a Cluster Randomized Controlled Trial of CHOICE.” Prevention Science 13:415–25

This study is a high-quality randomized controlled trial.