The results of this study suggest that SAAF participation slowed the growth in alcohol use over a period of 4.7 years after the conclusion of prevention training. Youths who participated in SAAF reported, 65 months after the pretest, drinking half as often during the past month than did similar youths in the control condition. This finding is important to public health professionals, scientists, practitioners, and clinical psychologists. To our knowledge, nowhere else in the literature is the efficacy of an alcohol use prevention program for African American youths demonstrated across the time span covered in this report. The alcohol use prevention literature includes few accounts of long-term effects; a notable exception is the work of Spoth and his colleagues (Spoth, Redmond, Shin, & Azevedo, 2004
; Spoth et al., 2009
), in which robust prevention effects emerged for the Iowa Strengthening Families Program (ISFP) across 6 years with Caucasian families in the Midwestern United States. SAAF shares many characteristics with ISYP, such as a focus on enhancement of protective family, caregiving, and communication processes. Together, these programs demonstrate the power of family-centered preventive interventions in deterring alcohol use in two diverse populations.
The reduction in past-month alcohol use that SAAF sponsors has important clinical and public health implications. From a public health perspective, the goal of programs for adolescents, like SAAF, is to shift the alcohol consumption curve so that fewer youths in the population distribution are frequent drinkers. This shift not only will lead to decreases in drunk driving fatalities but also will reduce other threats that adolescent alcohol use poses to mental health, academic engagement and achievement, and family relationships.
From a clinical perspective, the results suggest that an inoculation of protective parenting processes and self-regulatory skills during preadolescence may contribute to a self-sustaining trajectory of disinterest in, and avoidance of, alcohol use during adolescence when friends and acquaintances begin to model and sanction it. An advantage of imparting these protective processes via a universal prevention program such as SAAF is its avoidance of stigma. Neither youths nor their caregivers are enrolled in SAAF on the basis of pre-existing youth behavior problems, such as impulsivity, conduct problems, or academic difficulties. Caregivers and youths thus take part to promote youth well-being, a purpose that participants are more likely to embrace.
SAAF was designed to be developmentally well-timed. The intervention began when the youths were entering preadolescence, a time when preoccupation with peer group acceptance increases (Collins, 1990
). One of the program’s goals was to provide parents and youths with skills that contribute to the development of protective factors at a time when adolescents must adapt to their autonomy strivings. Equipping youths at this developmental juncture with a set of self-regulatory skills that includes planfulness, a future orientation, and negative attitudes toward alcohol use (Brody, Murry, Gerrard et al., 2006
; Brody et al., 2004
) increased their likelihood of avoiding risk-conducive contexts and selecting like-minded peers as friends. Provision of these protective capacities at this developmentally sensitive time was responsible for preventing alcohol use initiation, which carried forward over time.
This study was also designed to test the proposition that preventive intervention effects on deterrence of alcohol use initiation would carry forward to lower rates of alcohol use across adolescence. This hypothesis was confirmed. Consistent with the study’s mediational hypothesis, the direct effect of SAAF participation did not directly forecast alcohol use when its prevention effect on initiation of use was included in the structural model. These result buttress the notion that deterring alcohol use initiation during preadolescence may be partially responsible for long-term effects that family-centered preventive interventions achieve. These results are also relevant to initiatives proposed by the U.S. Surgeon General to stop underage drinking (U.S. Department of Health and Human Services, 2007
). The Surgeon General contended youths who initiate drinking during preadolescence are at heightened risk for escalation of drinking during adolescence and for substance use disorders in adulthood, an assertion that epidemiological research supports (Hingson, Heeren, & Winter, 2006
). The results of this study demonstrate, using an experimental design, that deterring the onset of alcohol use during preadolescence decreases use in subsequent years.
We do not know whether SAAF would be effective outside of the rural Southern areas for which it was developed because some of the prevention components it includes were selected in response to the particular needs of youths in that region. It would be possible to adapt SAAF for youth living in other areas, for example, urban settings, then evaluate its efficacy. Although we do not know how much adaptation would be necessary, we believe that only modest changes would be needed. It is also not known whether nonspecific factors, such as the disparities in time and personal attention devoted to the SAAF group and the control group, may have carried forward across 5 years to be responsible for the long-term effects that emerged. Although this seems unlikely, it remains an empirical question for prevention scientists to address. These issues notwithstanding, the present results document the long-term impact of a preventive intervention designed to deter alcohol use among African American youths who live in challenging rural contexts.