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Program Profile: CHOICE

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on June 29, 2015

Program Summary

A voluntary afterschool program for middle school aged youths to inform them about substance use and prevent them from starting or continuing alcohol use. The program is rated No Effects. The program was shown to have some effect on delaying the initiation of alcohol use but no effect on other measures of past or future alcohol use.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals
CHOICE is a voluntary afterschool program for middle school aged youths to inform them about substance use and prevent them from starting or continuing alcohol use. The program focuses on enhancing protective factors and reducing risk factors for alcohol use.

Program Theory
CHOICE is based on components of social learning theory (Bandura 1977), decision-making theory (Kahneman and Tversky 2000), and self-efficacy theory (Bandura 1997). For example, social learning theory suggests that youths make assumptions (which are at times inaccurate) about their peers’ alcohol use and then engage in alcohol use themselves. To address this, the CHOICE curriculum provides students with facts on youth alcohol use from Monitoring the Future statistics.

Program Activities
CHOICE consists of five 30-minute sessions offered once a week after school. Sessions are rotated weekly throughout the school year and focus on providing normative feedback on substance use, challenging unrealistic beliefs about substances, resisting pressure through role play, discussing benefits of cutting back or abstaining from substance use, and discussing risky situations and appropriate coping mechanisms.

Evaluation Outcomes

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Study 1
Overall, D’Amico and colleagues (2012) found that CHOICE had some effect on delaying the initiation of alcohol use but no effect on past month use, past month heavy drinking, perceived alcohol use among peers, future alcohol use, or self-efficacy in resisting alcohol.

Lifetime Alcohol Use
There was a statistically significant decrease in the odds of initiating alcohol use for treatment school students as compared with control school students. About 1 in 15 students were prevented from initiating alcohol use.

Past Month Alcohol Use
No significant differences were found between treatment and control school students on past month alcohol use.

Heavy Drinking in Past Month
No significant differences were found between treatment and control school students on heavy drinking in the past month.

Perceived Alcohol Use
No significant differences were found between treatment and control school students on perceived alcohol use among peers at school.

Alcohol Intentions
No significant differences were found between treatment and control school students on intentions to drink alcohol in the next 6 months.

Resistance Self-Efficacy
No significant differences were found between treatment and control school students on alcohol resistance self-efficacy.

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Evaluation Methodology

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Study 1
D’Amico and colleagues (2012) evaluated the impact of participation in CHOICE on 6th through 8th grade students’ behaviors toward alcohol, using a cluster randomized controlled design in 16 middle schools (8 treatment and 8 control) from three school districts in southern California.

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. Final outcome analysis was based on data from 9,528 students in two waves of the study. After controlling for grade, there were no significant differences between treatment and control students. The sample was mostly Hispanic (54 percent) and female (51 percent). Only 15 percent of treatment school students actually attended CHOICE during the school year (703 students). Students could choose to attend as many of the sessions as they preferred. Students attended an average of three sessions and one third of the treatment students attended all five sessions.

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 included lifetime and past month alcohol use frequency; intention to drink in the next 6 months; resistance self-efficacy; and perceived alcohol use among peers at school using measures from the California Healthy Kids Survey, Monitoring the Future, and Project ALERT.

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Cost

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There is no cost information available for this program.
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Implementation Information

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In the study by D’Amico and colleagues (2012), facilitators were bachelor- and master-level project staff who received 30 hours of training over 4 weeks in CHOICE session topics and the motivational interviewing approach. To ensure program fidelity, evaluators employed practices such as weekly supervision of facilitators and two session observations a year by trained observers for adherence to program components. They used the Motivational Interviewing Treatment Integrity (MITI 3.1) scale to measure overall adherence. CHOICE facilitators received a motivational interviewing adherence average of 93 percent.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
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.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353018/
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Additional References

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These sources were used in the development of the program profile:

Bandura, A. 1977. Social Learning Theory. Englewood Cliffs, N.J.: Prentice Hall.



Bandura, A. 1997. Self-Efficacy: The Exercise of Control. New York: Freeman.



D’Amico, Elizabeth J., Phyllis L. Ellickson, Eric  F. Wagner, Rob Turrisi, Kim Fromme, Bonnie Ghosh-Dastidar, Douglas L. Longshore, Daniel F. McCaffrey, Marilyn J. Montgomery, Matthias Schonlau, and Dale Wright. 2005. “Developmental Considerations for Substance Use Interventions from Middle School through College.” Alcoholism: Clinical and Experimental Research 29(3):474–83.



Kahneman, D., and A. Tversky. 2000. Choices, Values, and Frames. New York: Cambridge University Press.


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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

After-School Programs
After-school programs generally take place during after school hours and are designed decrease the amount of time youth are unsupervised. Examples of such programs may include recreation-based activities, mentoring, and tutoring services. The practice is rated Promising for child self-perceptions, school bonding, school grades, positive social behaviors, problem behaviors, readings scores, and mathematics scores; and No Effects for delinquency, drug use, and school attendance.

Evidence Ratings for Outcomes:
Promising - One Meta-Analysis Attitudes & Beliefs - Child Self-Perceptions
Promising - One Meta-Analysis Education - School Bonding
Promising - One Meta-Analysis Mental Health & Behavioral Health - Social Behaviors
Promising - One Meta-Analysis Mental Health & Behavioral Health - Externalizing behavior
Promising - One Meta-Analysis Education - Academic achievement/school performance
Promising - One Meta-Analysis Education - Reading Achievement
Promising - One Meta-Analysis Education - Math Achievement
No Effects - One Meta-Analysis Education - Attendance/truancy
No Effects - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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Program Snapshot

Age: 11 - 14

Gender: Both

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White, Other

Setting (Delivery): School

Program Type: Afterschool/Recreation, Motivational Interviewing, Alcohol and Drug Prevention

Current Program Status: Active

Listed by Other Directories: Model Programs Guide