and specifically youth-oriented alcohol products, use of media campaigns targeted at parents, and creation of community coalitions; two policy reports also call for continued research on developmental considerations and early alcohol use (National Research Council and Institute of Medicine, 2002; U.S. Public Health Service, 2007). The Task Force on College Drinking concluded that evidence was strongest for indicated interventions that included cognitive skills training, norms or values clarification, motivational enhancements, or challenging of expectancies, but it recommended comprehensive integrated community coalitions targeting individuals, the student population as a whole, and the college and surrounding community (National Institute on Alcohol Abuse and Alcoholism, 2001).

A review of interventions in nonschool settings designed to prevent substance abuse among those under age 25 found insufficient evidence to draw conclusions about the effectiveness of these programs (Gates, McCambridge, et al., 2006). The authors were able to identify only 17 randomized controlled trials, which varied greatly in their program components and included four types of interventions: MI or brief interventions, education or skills training, family interventions, and multicomponent community interventions. Some interventions, including three family interventions, MI, and two interventions with both community and school components, showed potential benefit in reducing marijuana use. Compared with the more robust data on school-based substance abuse prevention programs, existing research is insufficient to determine the effectiveness of efforts to prevent substance abuse through interventions in other settings.

A review of the impact of universal prevention programs on alcohol use (Foxcroft, Ireland, et al., 2002) found a lack of clear evidence for effectiveness in the short or medium term. This analysis, which included school-based, family, and community interventions, found the most promising effects for long-term outcomes of a culturally focused school and community skills-based intervention with American Indians, which reduced the likelihood of weekly drinking over 3.5 years, and the Strengthening Families Program (described in Chapter 6), which reduced alcohol initiation behaviors over four years.

Almost none of the community interventions aimed at preventing adolescent tobacco, alcohol, or other drug use have been in the subject of more than one experimental evaluation. However, the emphasis on these more broad-based approaches in national recommendations and the progress that has been made since 1994 in this area warrant some discussion of a few example programs that include a significant community and policy component.

The Midwestern Prevention Program (MPP), a multimodal community-wide drug prevention program, evaluated effects on high-risk and general youth populations (Chou, Bentler, and Pentz, 1998; Johnson, Pentz, et al.,



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