There is increasing public and political concern regarding underage drunkenness and associated problems which include anti-social behaviour, accidents, violence, and unsafe sexual behaviour. In the WHO HBSC surveys, undertaken every 4 years since 1986, the incidence of reported drunkenness among adolescents in Wales is consistently higher than in any of the other participating countries in Europe. However, there is no reliable evidence to suggest that any current programmes used with young people to prevent alcohol misuse are effective. The Teenage Alcohol Project (TAP) was an exploratory trial, based in Wales, that aimed to develop and evaluate a peer-led, schools-based intervention to reduce the incidence of binge drinking. TAP was not designed to identify the effectiveness of the intervention, but aimed to identify whether the intervention was of sufficient promise to merit a further large scale effectiveness trial.
The TAP intervention was based on ASSIST, a peer-led anti-smoking intervention which was found in an earlier exploratory trial and a subsequent full scale trial to have some effect on smoking uptake among adolescents. The ASSIST and TAP interventions are unlike the majority of peer-led interventions, in which typically older students are trained to deliver classroom-based sessions to an audience of younger children. In TAP, the most influential students were identified using a peer nomination questionnaire completed by all students in the year group. These students were then given two days specialist training off the school premises, on the risks associated with alcohol misuse, and on the peer supporter role that they were asked to take on. As peer supporters, the students were asked to have conversations with their friends and wider peer group, to informally diffuse the messages they were given in the training. They were asked to do this over a ten week period, during which TAP trainers visited each intervention school on three occasions to provide support and encouragement, and to review the diaries of conversations that peer supporters were asked to maintain over this period.
Nine secondary schools participated in the TAP project. In three, the intervention was delivered to Year 8 pupils, and in three others, to pupils in Year 9. In three further schools, pupils in Year 8 and 9 did not receive the intervention, but were asked to complete questionnaires on their knowledge and behaviour regarding alcohol, which were compared to those of pupils in the six schools receiving the intervention, at six-month follow-up.
The intervention was found to be feasible and acceptable to schools and students: 199 students were invited to attend peer supporter training, of which 146 did so, equivalent to 15% of pupils in each of the target year groups. 117 of these peer supporters attended at least 2 of the 3 follow-up sessions, and 106 handed in a completed diary of conversations. Year 9 students were less likely to agree to participate in training, and less likely to complete diaries, than their Year 8 counterparts. In data collected immediately after the end of the intervention period, 42% of students in intervention schools reported that they had talked with a peer supporter, of whom 82% had thought about consequences of drinking and 53% said that they had cut down on drinking. The peer supporters themselves had higher knowledge scores and a lower frequency of drinking and drunkenness than non-peer supporters. However, in terms of knowledge and behaviour at six-month follow-up, there were no differences between intervention and control school students.
The process evaluation built into the study identified that two days training had not been sufficient to satisfactorily cover the more complex alcohol message. Whereas in ASSIST, the message regarding the risks associated with smoking was clear and the message for the peer supporters to convey in their conversations was relatively straightforward – don’t smoke – in TAP the messages were more complex. TAP did not aim to discourage drinking per se, but focussed on regular binge drinking, and the health risks associated with drunkenness. Peer supporters were not asked to promote abstinence among their friends and wider peer group, but to promote a more sensible approach to alcohol and discourage regular binge drinking and drinking to get drunk. Interviews with peer supporters suggested that they had not fully taken on board this more complex message, and that it was difficult for them to convey such a complex message in their conversations.
The identification and training of influential pupils to act as peer supporters, disseminating messages and normative behaviours through their informal social networks, has been found to be feasible and acceptable to schools and students. Whereas this approach has had some impact on adolescent smoking uptake, the greater complexity of the alcohol harm reduction message proved to be problematic in the training of the peer supporters, and in their ability to convey such a complex message in their conversations.
Evidence from the TAP project does not justify investment in a larger scale trial. Further research should investigate the possibility of more intensive training for the peer supporters in preparation for their role.
Further research is required on validated measures of alcohol consumption suitable for use in large scale trials of young adolescents. Studies of interventions to prevent problem drinking in adolescents will also require longer term follow-up.
The work was co-sponsored by the U. K. Alcohol Education and Research Council and the Wales Office of Research and Development for Health and Social Care.
It was carried out by Professor Laurence Moore (Cardiff University), Miss Melanie Chalder (University of Bristol), Professor Mick Bloor (University of Glasgow) and Dr Meraj Hasan (Pontypridd and Rhondda NHS Trust).