Department of Psychology and REACH Institute, Arizona State University, Tempe.
Center for Developmental Science, University of North Carolina at Chapel Hill, Chapel Hill.
JAMA Psychiatry. 2018 May 1;75(5):429-437. doi: 10.1001/jamapsychiatry.2018.0058.
Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations.
To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with a Mexican American sample.
DESIGN, SETTING, AND PARTICIPANTS: A previous randomized clinical trial was conducted with 516 Mexican American 7th graders and at least 1 parent who identified as having Mexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school.
The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish.
Primary outcomes were diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey.
Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11).
Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders among Mexican American high school students and implementation of universal middle school interventions to reach Latino communities.
药物滥用预防干预措施通常针对中学生，并证明能预防早期开始和使用酒精和非法药物。然而，缺乏预防后来出现的酒精滥用模式和更严重的酒精滥用障碍的持续结果的证据，特别是针对美国拉丁裔人群。
测试一项普遍的中学预防计划是否可以在实施 5 年后降低墨西哥裔美国青少年的酒精滥用频率和酒精使用障碍的发生率。
设计、设置和参与者：一项先前的随机临床试验是在 516 名墨西哥裔 7 年级学生和至少有 1 名自称具有墨西哥血统的家长中进行的。从 4 所中学的名册中招募了三批年度家庭，并随机分配到 9 节 Bridges/Puentes 以家庭为重点的小组干预或一个讲习班对照组。每个队列的招募、筛选、前测和随机化都在同一学年进行：2003-2004 年、2004-2005 年和 2005-2006 年。对青少年后期酒精滥用的随访评估进行了数据采集，这些评估未包含在最初的随机临床试验中，从 2009 年 9 月到 2014 年 9 月进行；分析在 2016 年 8 月至 2017 年 7 月之间进行。在这次评估中，样本中的 420 名儿童（81.4%）被纳入，其中大多数人处于高中的最后一年。
9 节 Bridges/Puentes 干预措施整合了青少年、家长和家庭干预课程，这些课程在每个学校的春季学期进行，为英语主导和西班牙语主导的家庭分别提供单独的小组。对照组讲习班在每个学校的同一学期以英语和西班牙语提供。
主要结果是基于儿童诊断访谈表和基于 2001 年青少年风险行为调查的过去一年的酒精使用频率、 binge drinking 和 drunkenness，在 12 年级时进行的终身酒精使用障碍的诊断评估，在干预后 5 年进行。
在 420 名参与者中，有 215 名（51.2%）是女孩（平均[SD]年龄，17.9 [0.62]岁）。干预降低了发生酒精使用障碍的可能性（β=−0.93；SE，0.47；P=0.047；优势比，0.39）。干预与过去一年的酒精使用频率、 binge drinking 和 drunkenness 的关联受到基线物质使用的调节。干预减少了酒精使用频率（β=−0.51；SE，0.24；P=0.04；Cohen d=0.43）和醉酒（β=−0.51；SE，0.26；P=0.049；Cohen d=0.41），对于基线时报告有任何先前物质使用的青少年（T1 启动者），但对于基线时没有开始任何物质使用的青少年（T1 节制者）则没有。对于过去一年的 binge drinking，干预的发现在 T1 启动者（β=−0.40；SE，0.23；P=0.09）或 T1 节制者（β=−0.23；SE，0.14；P=0.11）中均未达到统计学意义。
研究结果支持在墨西哥裔美国高中生中，普遍的中学干预措施与酒精滥用和酒精使用障碍之间存在关联，并支持实施普遍的中学干预措施以覆盖拉丁裔社区。
