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Intervention Summary

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Theater Troupe/Peer Education Project

The Theater Troupe/Peer Education Project (TTPEP) aims to prevent substance use and other unhealthy behaviors among school-aged youth through peer education. Participants, usually youth of middle school age, are presented with an interactive theatrical performance, followed by two workshops. The performance is conducted by a troupe of high school students who have been recruited and trained in the areas of theater, health, and peer education. The aim of the performance is to increase the audience members' knowledge of social norms; modify their attitudes, beliefs, and intentions about substance use; and provide them with peer refusal skills. The performance begins with a skit in which troupe members act out situations involving peer pressure, social acceptance, and substance use, as well as responses to these situations. Troupe members remain in character for a question-and-answer session with the audience to discuss their characters' histories and portrayals of the various situations in the skit. In the final component of the performance, the troupe members, now out of character, facilitate a peer discussion on the issues. At the end of the performance, audience members receive information about substances, including the prevalence of use by school-aged youth.

Within 1-2 weeks of the theatrical performance, a "reality" workshop is held, during which recovering young adults share their personal stories and answer questions from participants. One week after the reality workshop, a skill-building workshop is held to reinforce what participants learned through the performance and the first workshop. Participants also identify overt and covert pressures to use substances, learn about resistance skills through educational activities, and practice these skills through role-playing exercises.

Although TTPEP has been provided primarily to students in urban middle schools, it also has been provided at elementary and high schools and in residential centers, detention facilities, and other settings. In the study reviewed for this summary, the intervention was provided to 7th graders.

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: May 2010
1: Knowledge of the consequences of alcohol and marijuana use
2: Knowledge of social norms related to alcohol and marijuana use
3: Communication and resistance skills related to alcohol and marijuana use
Outcome Categories Alcohol
Drugs
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Implementation History The Corner Health Center in Ypsilanti, Michigan, has been training high school students to deliver TTPEP performances since 1982. The program initially focused on pregnancy prevention and included the interactive theatrical performance without the two follow-up workshops. TTPEP topics have expanded to other issues relevant to teens, such as use of tobacco, alcohol, and other drugs; dating violence, sexual assault, incest, sexually transmitted infections, and HIV; and teen depression. The program's target population initially was high school students, but it has since been broadened to include elementary and middle school students. In addition, TTPEP's performances have extended beyond the traditional school setting to reach high-risk adolescents in detention centers, alternative education programs, treatment centers, and federally subsidized housing. Starting in 2002, follow-up sessions were added to performances to increase the program's breadth and depth. More than 280 performances and corresponding workshops have been conducted since then, reaching over 5,000 youth. Substance use has been the focus of more than half of all performances and workshops. Overall, since 1982, TTPEP has reached more than 28,000 youth.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: May 2010

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Anasar, E., & Levin, D. (2007). The Theatre Troupe Peer Education Program evaluation report. Ypsilanti, MI: Corner Health Center.

Outcomes

Outcome 1: Knowledge of the consequences of alcohol and marijuana use
Description of Measures Knowledge of the consequences of alcohol and marijuana use was measured using 5 items on a paper-and-pencil, self-report survey:

  • "Smoking one cigarette is worse for my lungs than smoking one joint."
  • "Vomiting after drinking alcohol is a symptom of alcohol poisoning."
  • "How often is alcohol or weed involved in unwanted or forced sex?"
  • "If I start smoking weed, I could have trouble quitting."
  • "If I smoke weed, I may 'blackout' (not remember what happened later, when 'I wake up')."
Participants recorded their response for each item after it was read aloud to them by TTPEP staff or interns. All response choices were coded on a scale from 1 to 4, with the most desirable response coded as 1 for each item. Response codes for the 5 items were summed to determine the total score. Scores ranged from 5 to 20, with lower scores indicating greater knowledge.

The pretest survey was administered to participants before the theatrical performance, and the posttest survey was administered about 3 weeks later, on the same weekday and time, following the skill-building workshop.
Key Findings From pre- to posttest, the intervention group had significant improvement in knowledge of the consequences of alcohol and marijuana use compared with the control group (p < .001).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.2 (0.0-4.0 scale)
Outcome 2: Knowledge of social norms related to alcohol and marijuana use
Description of Measures Knowledge of social norms related to alcohol and marijuana use was measured using 2 items on a paper-and-pencil, self-report survey:

  • "How many high school students do you think currently drink beer, wine coolers or liquor?"
  • "How many high school students do you think currently smoke weed?"
Participants recorded their response for each item after it was read aloud to them by TTPEP staff or interns. All response choices were coded on a scale from 1 to 4, with the most desirable response coded as 1 for each item. Response codes for the 2 items were summed to determine the total score. Scores ranged from 2 to 8, with lower scores indicating greater knowledge.

The pretest survey was administered to participants before the theatrical performance, and the posttest survey was administered about 3 weeks later, on the same weekday and time, following the skill-building workshop.
Key Findings From pre- to posttest, the intervention group had significant improvement in knowledge of social norms related to alcohol and marijuana use compared with the control group (p < .001).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.2 (0.0-4.0 scale)
Outcome 3: Communication and resistance skills related to alcohol and marijuana use
Description of Measures Communication and resistance skills related to alcohol and marijuana use were measured using 2 items on a paper-and-pencil, self-report survey:

  • "I know what to say to a friend who has a problem with alcohol or weed." This item had a desired response of "strongly agree" (on a 4-point Likert scale).
  • "What would you do if a friend keeps pressuring you to drink or smoke even after you say no?" This multiple-choice item had desired responses of "change the subject," "suggest something else to do," or "ignore the person."
Participants recorded their response for each item after it was read aloud to them by TTPEP staff or interns. The measure was scored by counting the number of desired responses selected across both items. Scores ranged from 0 to 4, with higher scores indicating greater communication and resistance skills related to alcohol and marijuana use.

The pretest survey was administered to participants before the theatrical performance, and the posttest survey was administered about 3 weeks later, on the same weekday and time, following the skill-building workshop.
Key Findings From pre- to posttest, the intervention group had significant improvement in communication and resistance skills related to alcohol and marijuana use compared with the control group (p < .001).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.2 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 53% Female
43% Male
68% White
18% Race/ethnicity unspecified
17% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Knowledge of the consequences of alcohol and marijuana use 1.3 1.8 2.8 1.5 2.8 3.0 2.2
2: Knowledge of social norms related to alcohol and marijuana use 1.3 1.8 2.8 1.5 2.8 3.0 2.2
3: Communication and resistance skills related to alcohol and marijuana use 1.3 1.8 2.8 1.5 2.8 3.0 2.2

Study Strengths

The measure, a self-report survey developed by researchers for use in this study, was pilot tested with middle school students similar to the study participants, and questions were adjusted on the basis of feedback from the pilot test. Efforts to implement the intervention with fidelity included extensive training, use of a standardized curriculum for peer training, use of a script for the theatrical performance, and consistent timing of workshops. Quality control of the data collection was thorough. A paired t-test analysis was used, which was sufficient.

Study Weaknesses

The self-report survey was not standardized, and no psychometric properties were provided for it. Researchers based the final analysis on data from students who attended all sessions (66%), but they did not conduct attrition analysis. Four of the six schools included in the study had both intervention and control groups within the school, introducing potential confounds.

Readiness for Dissemination
Review Date: May 2010

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Hanson, L. H., Albright, J., & Anasar, E. (2010). The Corner Theater Troupe implementation guide: Substance abuse prevention. Ypsilanti, MI: Corner Health Center.

Hanson, L. H., Albright, J., & Anasar, E. (2010). The Corner Theater Troupe training manual: Substance abuse prevention. Ypsilanti, MI: Corner Health Center.

Program Web site, http://www.cornerhealth.org/theater.php

Support Resources and Assistance

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 2.8 3.0 3.1

Dissemination Strengths

The program materials are detailed and easy to read. A sample, videotaped skit available on the program Web site and numerous templates can enhance capacity for implementation. Program materials offer guidance on how to build the theater troupe and how to address the feelings of troupe members when sensitive issues arise from the subject matter. A detailed manual is available to guide implementers in training troupe members. In-person, phone, and email guidance is available from the developer upon request to support implementation.

Dissemination Weaknesses

No information is provided on the ideal troupe size or the qualifications for the adult leaders of the troupe. Potential implementers without experience delivering theatrical performances may benefit from additional, formal implementation guidance or training. Little direction is given on how to collect data with the quality assurance tools provided and how to use the data to improve program delivery. Pre- and posttraining surveys for troupe members measure content in areas that are not covered in the training manual.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Implementation guide (includes quality assurance tools) $5 Yes
Training manual (includes quality assurance tools) $5 Yes
In-person, phone, or email consultation Free for the first hour, $30.40 for each additional hour No
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Craig VanKempen, M.P.H., LMSW
(734) 714-2241
cvankempen@cornerhealth.org

To learn more about research, contact:
Peggy Wiencek, M.A.
(734) 487-0372
pwiencek@emich.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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