Winkleby Lab In the Prevention Research Center

Teen Advocates for Community Change and Leadership Education

            The traditional and most commonly used method for educating youth about health is classroom education.  Although many school curricula have not been evaluated systematically, only a small percentage have achieved meaningful short-term behavior change, let alone sustained effects.  It is unrealistic to expect school-based programs to address effectively all of the influences that affect the health behaviors of youth.  Health-related behavior occurs in numerous community settings outside of school that often support unhealthy action and thus counteract the effects of school-based programs.  Thus, the inconsistency between what is typically taught in school (e.g., resist pressures to engage in unhealthy behaviors) and the messages and cues that youth encounter in their community (e.g., advertising encouraging them to engage in unhealthy behavior; widespread availability of unhealthy products) results in youth being inundated with mixed messages.

            Substance use continues to be a significant problem among adolescents.  For example, in a 1992 national probability sample of high school seniors, 30-day prevalence rates were: 51% for alcohol, 30% for being drunk, 28% for smoking cigarettes, 11% for smokeless tobacco, 12% for marijuana, and 1% to 3% each for cocaine, LSD, other hallucinogens, inhalants, and tranquilizers. In our own studies of 1447 tenth graders in schools adjacent to the communities to be served by the proposed project, the 30-day prevalences for boys were 47% for alcohol, 22% for cigarettes, 11% for smokeless tobacco, 23% for marijuana, 5% for cocaine, and 2% for LSD, PCP or heroin.  Girls' 30-day prevalences were: 45% for alcohol, 30% for cigarettes, 20% for marijuana, 5% for cocaine and less than 0.5% for smokeless tobacco and LSD, PCP or heroin.  Unfortunately, successful prevention efforts have yet to be widely implemented.

            Research has demonstrated that adolescents who are at greatest risk of practicing negative health behaviors share many of the same characteristics.  These include living in social environments where there is pervasive modeling of unhealthy behaviors, being disadvantaged economically, having limited formal education, and having low aspirations for the future.  In addition, high risk youth are more likely than other youth to be alienated from positive role models in the community.  These positive role models play key roles in transmitting society’s norms and expectations for healthy, responsible behavior.  Research on resilient youth, that is, those who practice healthy lifestyles despite influences to the contrary, illustrates the important role played by active engagement in the surrounding environment.  Thus, experiences that facilitate active participation in activities requiring problem-solving, decision-making, planning, goal setting, and altruism have significant beneficial effects. The skills and perceptions that help young people develop independence and efficacy, which are the focus of this project, include perceptions of personal capability, significant primary relationships, personal influence over the environment, and social influence skills.

            We propose that broad-based community participation about health related issues can complement traditional school curricula interventions, especially for youth at high risk for unhealthful behavior.  Furthermore, we hypothesize that youth participation in community change will influence positively both individual health behavior and the larger community environment.  It is important to recognize, however, that many youth are unfamiliar with the experience of trying to affect change in the environments in which they live, play, and attend school (especially those from ethnic minority or low income groups).  Indeed, few have ever had the opportunity to "diagnose" these community influences, let alone realize that they have a choice to develop effective ways to change them.  Developing an intervention that builds youth confidence in community participation is key to the success of the proposed project.


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