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Project ALERT

Project ALERT is a school-based prevention program for middle or junior high school students that focuses on alcohol, tobacco, and marijuana use. It seeks to prevent adolescent nonusers from experimenting with these drugs, and to prevent youths who are already experimenting from becoming more regular users or abusers. Based on the social influence model of prevention, the program is designed to help motivate young people to avoid using drugs and to teach them the skills they need to understand and resist prodrug social influences. The curriculum is comprised of 11 lessons in the first year and 3 lessons in the second year. Lessons involve small-group activities, question-and-answer sessions, role-playing, and the rehearsal of new skills to stimulate students' interest and participation. The content focuses on helping students understand the consequences of drug use, recognize the benefits of nonuse, build norms against use, and identify and resist prodrug pressures.

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: December 2006
1: Substance use (alcohol, tobacco, and marijuana)
2: Attitudes and resistance skills related to alcohol, tobacco, and other drugs
Outcome Categories Alcohol
Drugs
Education
Family/relationships
Mental health
Tobacco
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Two major evaluations of Project ALERT have been undertaken, both by Dr. Phyllis Ellickson and colleagues at RAND Corporation. The first major evaluation (data set 1) involved 30 middle schools in 8 urban, suburban, and rural communities in California and Oregon. The schools were randomly assigned to two treatment conditions (teacher-led, teacher plus teen leaders) and one control condition. The second major evaluation (data set 2) involved 55 middle schools in South Dakota, representing a wide variety of Midwestern communities. These schools were randomly assigned to one treatment and one control condition. Broad dissemination of Project ALERT began in 1995. Since then, more than 50,000 teachers have been trained to deliver the intervention in an estimated 3,500 U.S. school districts.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations Project ALERT curriculum materials are available in Spanish. A Peer Teen Leader Component also is available and can be downloaded free of charge from the Project ALERT Web site (http://www.projectalert.com/). This implementation approach involves high school students in the delivery of the middle school program. Overall, Project ALERT is designed to be adaptive to the background and experiences of students in each classroom and to the changes in the broader social and cultural climate that surrounds them. Because the curriculum is highly participatory (students are asked questions and are involved in group activities and skits), it can vary from one classroom to another. Teachers are trained to respond to the changing input and feedback of students over time and from group to group. Designed adaptation therefore can take place in the hands of adept teachers.
Adverse Effects The most committed smokers reacted negatively to an early version of the curriculum, smoking more than their counterparts in the control condition. In response to this observed boomerang effect, the curriculum was revised to include a smoking cessation lesson designed to bring these more committed smokers back into the classroom psychologically and to improve their response to the program. Results show that the revised curriculum (the only version that has ever been distributed to schools) has no adverse effects and, in fact, has a positive impact on these high-risk early smokers.
IOM Prevention Categories Universal
Selective

Quality of Research
Review Date: December 2006

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

Ellickson, P. L., & Bell, R. M. (1990). Drug prevention in junior high: A multi-site longitudinal test. Science, 247, 1299-1305. (data set 1)  Pub Med icon

Study 2

Ellickson, P. L., Bell, R. M., & Harrison, E. R. (1993). Changing adolescent propensities to use drugs: Results from Project ALERT. Health Education Quarterly, 20(2), 227-242. (data set 1)  Pub Med icon

Study 3

Ellickson, P. L., Bell, R. M., & McGuigan, K. (1993). Preventing adolescent drug use: Long-term results of a junior high program. American Journal of Public Health, 83(6), 856-861. (data set 1)  Pub Med icon

Study 4

Ellickson, P. L., Bell, R. M., Thomas, M. A., Robyn, A. E., & Zellman, G. L. (1988). Designing and implementing Project ALERT: A smoking and drug prevention experiment. The RAND Corporation, R-3754-CHF, December. (data set 1)

Study 5

Ellickson, P. L., McCaffrey, D. F., Ghosh-Dastidar, B., & Longshore, D. L. (2003). New inroads in preventing adolescent drug use: Results from a large-scale trial of Project ALERT in middle schools. American Journal of Public Health, 93(11), 1830-1836. (data set 2)  Pub Med icon

Study 6

Ghosh-Dastidar, B., Longshore, D. L., Ellickson, P. L., & McCaffrey, D. F. (2004). Modifying pro-drug risk factors in adolescents: Results from Project ALERT. Health Education & Behavior, 31(3), 318-334. (data set 2)  Pub Med icon

Supplementary Materials

Data collection forms

Educators Guide

Grade 7 Monitoring Form, Session 1

Grade 7 Student Survey

Grade 8 Student Survey

Teacher Checklist

Outcomes

Outcome 1: Substance use (alcohol, tobacco, and marijuana)
Description of Measures For alcohol, cigarettes, and marijuana, student questionnaires asked about lifetime use, frequency of use within the past month and year, and the amount used. Students were also asked if they had suffered negative consequences due to the use of these drugs (e.g., missed school, did something they later felt sorry for, got into trouble at home or at school).
Key Findings In multiple randomized control group studies, Project ALERT produced lasting outcomes for participants from a variety of ethnic and economic backgrounds who were at low, moderate, or high risk for alcohol, tobacco, or marijuana use. Overall, Project ALERT was equally effective when taught solely by classroom leaders and when teen leaders were included in classroom delivery.

Analyses at the end of grade 8 (15 months after baseline) assessed students by risk level for future drug use. Among students who had tried neither cigarettes nor marijuana at the beginning of 7th grade, Project ALERT participants were nearly 50% less likely than other students to become current marijuana users by 8th grade. After incorporation of the 8th-grade booster sessions, this figure increased to more than 60%. Project ALERT participants were 30% less likely than other students to begin using marijuana. All of these findings were statistically significant (p < .05).

For alcohol use, Project ALERT initially produced only modest, short-lived reductions. However, the revised Project ALERT, which incorporated additional material on alcohol, reduced the likelihood of alcohol use by 24%. Participants in the revised Project ALERT schools were also less likely to suffer alcohol-related consequences such as fighting and getting in trouble at home or school because of drinking (p < .05). These effects continued into the 8th grade.

The revised Project ALERT curriculum also had preventive effects on alcohol, cigarette, and marijuana use among students who had tried these substances by 7th grade (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3, Study 4, Study 5, Study 6
Study Designs Experimental
Quality of Research Rating 4.0 (0.0-4.0 scale)
Outcome 2: Attitudes and resistance skills related to alcohol, tobacco, and other drugs
Description of Measures This outcome was measured by student surveys. The surveys inquired about risk and protective factors such as student awareness of consequences of substance use, beliefs about the prevalence of substance use and its acceptability to others, resistance self-efficacy, and expectations of substance use in the next 6 months.
Key Findings In multiple randomized control group studies, analyses of program effects on attitudinal risk factors showed that Project ALERT dampened prodrug beliefs about cigarette and marijuana use (low resistance self-efficacy, low perceived consequences of use, tolerance of drugs, expectations of future use, and low estimates of peer drug use). Effect sizes for beliefs about cigarette and marijuana use, calculated as the standardized adjusted mean difference between groups, were small for all students combined (0.07-0.17) and for students at different risk levels (0.07-0.27). The curriculum had a more limited impact on beliefs about alcohol.

Although Project ALERT's effects on drug use dissipate in high school, its effects on knowledge and beliefs persist during the high school years. In 10th grade, former ALERT participants were more likely than other students to believe that drug use has negative social consequences and produces dependency, that resistance has benefits, and that fewer peers use and approve of use. Effects on beliefs about the risk of dependency, social consequences of use, and lower peer use continued into 12th grade.
Studies Measuring Outcome Study 1, Study 2, Study 3, Study 4, Study 5, Study 6
Study Designs Experimental
Quality of Research Rating 4.0 (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) 51% Female
49% Male
71% White
10% Asian
9% Hispanic or Latino
8% Black or African American
2% American Indian or Alaska Native
Study 2 13-17 (Adolescent) 51% Female
49% Male
71% White
10% Asian
9% Hispanic or Latino
8% Black or African American
2% American Indian or Alaska Native
Study 3 13-17 (Adolescent) 51% Female
49% Male
71% White
10% Asian
9% Hispanic or Latino
8% Black or African American
2% American Indian or Alaska Native
Study 4 13-17 (Adolescent) 51% Female
49% Male
71% White
10% Asian
9% Hispanic or Latino
8% Black or African American
2% American Indian or Alaska Native
Study 5 13-17 (Adolescent) 50% Female
50% Male
87.5% White
8.6% American Indian or Alaska Native
3.9% Race/ethnicity unspecified
Study 6 13-17 (Adolescent) 50% Female
50% Male
87.5% White
8.6% American Indian or Alaska Native
3.9% Race/ethnicity unspecified

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: Substance use (alcohol, tobacco, and marijuana) 4.0 4.0 4.0 4.0 4.0 4.0 4.0
2: Attitudes and resistance skills related to alcohol, tobacco, and other drugs 4.0 4.0 4.0 4.0 4.0 4.0 4.0

Study Strengths

The measures and items are well described based on extensive literature review. Most items have been commonly and successfully used in previous research. The items were adjusted for the age of respondents, and five survey versions were pretested. The use of saliva cotinine for truth in tobacco reporting was excellent.

The materials reviewed describe extensive measures to ensure intervention fidelity, including a teacher guide and checklist, and monitoring forms to document further support. Steps were taken to minimize attrition and account for missing data and the developers conducted analyses to assess the impact of attrition. Sample sizes were large. Attrition rates approached 10% but did not surpass this level and therefore were not a threat to internal validity.

Schools were blocked by district, and restricted assignment was used in randomization to enhance comparability between intervention and control schools and minimize potential confounding variables. Intervention effects can be attributed to the Project ALERT intervention outcomes reported in the publications reviewed. Data were analyzed both at the student and school levels and by students' risk levels. Adjustments were made for baseline differences and intraschool correlation.

Study Weaknesses

No weaknesses were noted by reviewers.

Readiness for Dissemination
Review Date: December 2006

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.

BEST Foundation. (2005). Project ALERT: A supplemental resource manual.

Ellickson, P., Miller, L., Robyn, A., Wildflower, L., & Zellman, G. (2004). Project ALERT: A drug prevention program for middle grades.

Project ALERT Peer Teen Leader Manual

Project ALERT program posters and sample newsletters

Project ALERT program Web site, http://www.projectalert.com

Project ALERT Readiness for Dissemination (overview document submitted to NREPP)

Project ALERT Training Workshop Manual

Project ALERT videos:

  • Project ALERT: Eight Classroom Lesson Videos & Guided Tour (2006)
  • Project ALERT: Substance Abuse Prevention That Works! (2004)
  • Project ALERT Training Video: Lessons 1, 4, and 8 (2004)

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
4.0 4.0 3.5 3.8

Dissemination Strengths

Implementation materials are comprehensive, well articulated, and cogently structured. The videos and classroom poster realistically depict situations and should be engaging for young adolescents. Implementation materials are also available in Spanish. Videos are closed-captioned for the hearing impaired. The Project ALERT Web site is easy to navigate. On-site training is available both before and during implementation, and training can also be completed online. Fidelity measures, pre- and postintervention measures, and scoring information are provided to support quality assurance.

Dissemination Weaknesses

Additional training, support, and/or technical assistance may be required for administrators to support implementation fidelity.

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
Curriculum in e-reader format with online videos and files for posters that can be projected Free Yes
Online training Free No
Toll-free phone support, online resources, and ALERT Educator newsletter Free No
Fidelity instrument and alignment and assessment tools Free No
Contact Information

To learn more about implementation, contact:
Christy Inberg
(800) 253-7810
cinberg@projectalert.best.org

Leslie Thompson Aguilar
(800) 253-7810
ltaguilar@projectalert.best.org

To learn more about research, contact:
Phyllis Ellickson, Ph.D.
(310) 393-0411 ext 7638
phyllis_ellickson@rand.org

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

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