School-based programmes for the prevention of drinking and driving: Issues and results

Accid. And. & Prev. Vol. 18. No. 4. pp. 325-337. Printed in Great Britain.

om-4575/86 0 1986 Pergamon

1986

$3.00 + .Kl Journals Ltd.

SCHOOL-BASED PROGRAMMES FOR THE PREVENTION OF DRINKING AND DRIVING: ISSUES AND RESULTS* R. E. MANN, E. R. VINGILIS, G. LEIGH, L. ANGLIN and H. BLEFGEN Addiction Research Foundation, 33 Russell Street, Toronto M5S 2S1, Canada Abstract--In an effort to decrease alcohol-related driving accidents and fatalities among youth, many school-based programmes to prevent drinking and driving have been developed. These programmes would seem to have many important advantages, including being able to foster appropricte attitudes and behaviours at critical times before and during the formation of driving behaviours and drinking behaviours. The didactic assumptions of these programmes are examined in this paper, and evaluations are reviewed. Programmes based on accurate provision of information and non-threatening attempts to change attitudes, and on behavioural peer intervention techniques, consistently demonstrate knowledge gains, and in some cases appropriate changes in attitudes and self-reported behaviours, immediately following programme exposure. These effects often tend to dissipate with time. Since the impact of these programmes on traffic safety measures has not been examined, their development should be carefully monitored and evaluated until traffic safety benefits can be documented.

Several countermeasures have been developed to cope with the drinking-driving problem, ranging from increased enforcement of laws and severity of penalties to rehabilitation for convicted drinking drivers, with varying degrees of success [e.g. Jonah and Wilson, 1983; Mann, Leigh, Vingilis ef al., 1983; Ross, 1982; Vingilis and De Genova, 19841. Most measures, however, have been seen as short-term, limited impact efforts; that is, either through design or subsequent evaluation, their impact is of temporary duration or only with certain segments of the drinking-driving population. These observations have prompted a search for countermeasures which will have a long-term impact on the entire population. One group of countermeasures which has the potential for such an impact is school-based programmes. Proponents of these alcohol and traffic safety programmes stress their preventive aspects, and argue that they may be able to change the attitudes and behaviours of new generations of drivers at the time when such attitudes and behaviours are most amenable to external influence [e.g. Bishop, 1973; O.E.C.D., 1976; Waller, 19681. As well, the alcohol-crash problem is particularly tragic among younger age groups, and school-based programmes may have the significant short-term benefit of reducing this problem among youth [Mayhew, Warren, Simpson et al., 1981; Vegega, 19841. Many programmes for the prevention of drinking and driving in students have been developed in recent years by government bodies, corporate consultants, traffic safety specialists, alcohol problem specialists, and individual schools. Milgram [1975], in a bibliography of alcohol education materials published in North America between 1950 and 1973, reported that those books, pamphlets and leaflets aimed at elementary and secondary students devoted an average of between 3.9% to 7.2% of content to alcohol and highway safety. It seems likely that those percentages would be much higher today. However, as yet no review of school-based programmes to prevent drinking and driving has appeared in the research literature. This deficiency is likely due to the recent development of the majority of the programmes and the consequent scarcity of evaluations. This paper will review these programmes with respect to the following topics: (1) underlying didactic and behaviour-change assumptions, (2) models for evaluation, (3) results of evaluations of existing programmes, (4) issues suggested by programmes in related areas, and (5) considerations for further programme development. *The views expressed in this document are those of the authors and do not necessarily reflect those of the Addiction Research Foundation. 325

R. E. MANN et al.

326 PROGRAMME

MODELS

AND

MEASURES

School-based alcohol and traffic safety programmes seem to be a result of the converging influence of three factors: (1) the movement for alcohol and drug education in the schools, (2) the movement for traffic safety education, and (3) the growing awareness of drinking and driving as a major public health problem, particularly among youth. Their development has been closely linked to the above factors, and the planning of content and orientation has borrowed heavily from experiences with alcohol and drug education. Thus, the assumptions underlying the programmes, and the processes by which they are expected to influence drinking-driving behaviour, currently seem identical to those underlying alcohol and drug education programmes in general. Several reviewers of alcohol and drug education programmes examining these assumptions conclude that in many programmes they are poorly identified [e.g. Braucht and Braucht, 1984; Durell and Bukoski, 1984; Goodstadt, 19781. However, the programmes appear to be based on three common didactic orientations. It is important to note, though, that alcohol and traffic safety programmes often represent a combination of orientations, and while it is possible to identify a programme with a particular orientation, much overlap occurs. The first orientation is information. According to the informational orientation, provision of information about drinking and driving will lead to subsequent changes in attitudes and relevant behaviours [e.g. Goodstadt, 19781. Typically these programmes use a variety of techniques, including lectures, audiovisual presentations and reading materials, to provide the relevant information. While many such programmes have, in the past, been devised for alcohol and drug education, their assumptions and effectiveness have been strongly criticised [e.g. Braucht and Braucht, 1984; Goodstadt, 19781. A second model considers affective processes as important links to behaviour change. Within this model two different approaches to programme design can be discerned. The first affect-based approach emphasizes affective arousal through presentations of the negative consequences of behaviour (e.g. films depicting the consequences of automobile accidents). While such programmes are common, they have seldom been evaluated and there is little theoretical basis, as yet, to justify their use [Braucht and Braucht, 1984; Richards, 19711. The second affect-based approach stresses affective involvement. Such programmes emphasize actual student participation, group discussions, values examination and clarification, and decision-making strategies [Braucht and Braucht, 1984; Goodstadt, 19781. Goodstadt [1978] has indicated that while the underlying theoretical model for these programmes can be stated with some precision, the actual links between the model and behaviour have, as yet, been poorly studied. The third model employs learning theory as a basis for programme development. These programmes employ principles derived from conditioning, learning and social learning theories in an effort to develop the skills or responses which are believed necessary to achieve the desired behaviours [e.g. Botvin, Eng and Williams, 1980; Marcus, undated]. While preliminary evaluations of such programmes are promising [Durell and Bukoski, 19841, it is too soon to state that they represent an improvement over programmes based on other models. A potentially important consequence of adopting a particular didactic model relates to choice of measures for evaluation of effectiveness. While adoption of a didactic model does not per se present problems for evaluations of programmes, it can result in restriction of the evaluation to a narrow focus on the presumed links between programme material and behavioural change. As a consequence, the measures employed in evaluation may have at best only a tenuous link to target behaviours and traffic safety impact. The informational and affect-based models typically emphasize the importance of changes in knowledge and attitudes as indices of success [e.g. Malfetti, McGrath and De Meo, 19751, and these changes in knowledge and attitudes are presumed to be a critical link to the behaviours which are of ultimate concern. Thus, programmes based on these models typically adopt measures of knowledge and attitude change as indices of success [e.g. Malfetti et al., 19751. Measures of knowledge and attitudes have three major benefits

School-based programmes for drinking and driving prevention

321

for evaluative purposes. First, they can be easily designed and administered. Second, their psychometric properties (reliability and validity) can be readily determined [e.g. M&night, Preusser, Psotka et al., 19791. Third, they appear to have high levels of sensitivity to the types of changes which appear to be induced by programmes. However, changes in knowledge and attitudes often do not appear to be related to the measures of greatest interest, i.e. behavioural and traffic safety measures [e.g. Mann et al., 1983; McGuire, 19741. In fact, in related areas of research, positive programme impacts on knowledge/attitude measures and negative impacts on behaviour/traffic safety measures have occasionally been observed [e.g. Goodstadt, 19801. The discrepancies between programme effects based on the different types of measures may simply reflect differential sensitivity or an inappropriate measure. However, they may also suggest that the informational and attitudinal models underlying the programmes and measures are not suitable. Thus, while knowledge and attitude measures may be sensitive indicators of impact, these measures cannot be assumed to be accurate indices of eventual effects on traffic safety. Programmes based on a behavioural model emphasize behavioural measures of impact [e.g. Botvin et al., 19801. These measures presumably reflect, more closely than knowledge and attitude measures, a programme’s ability to influence the subsequent activities of participating students. Thus, behavioural measures have the benefit of being conceptually and empirically closer to the ultimate desired impact of a programme. However, there are some potential problems in the use of these measures. First, it is unlikely that an accurate measure of impact can be obtained immediately upon programme completion. A sufficient period of time must pass to permit the opportunity for the behaviours to occur (e.g. six months or more). Second, these measures may be less sensitive to programme impact than knowledge and attitude measures, thus requiring more resources for an adequate evaluation (e.g. larger sample size). A third difficulty in the use of behavioural measures lies in the manner in which they are usually collected, i.e. through self-report, since direct observation of the behaviours of concern is typically not feasible. Although under some circumstances these measures appear to be accurate indices of alcohol and drug use and driving behaviour [e.g. Chipman, 1982; Single, Kandel and Johnson, 1975; Whitehead and Smart, 19721, other studies have found instances where their validity is questionable [e.g. Popham and Schmidt, 1981; Vingilis, 19831. Until the validity of these measures can be established in the context of school-based prevention programmes for drinking-driving, they should be viewed as important, but not absolute, indicators of programme impact. Traffic safety indices (e.g. numbers of alcohol-involved violations and accidents) are the most valuable indicators of programme impact, since these programmes are implemented to reduce traffic safety problems, but they are also not without problems. First, as with behavioural measures, traffic safety measures require a lengthy follow-up period for programme evaluation. Second, traffic safety measures appear to be less sensitive than knowledge/attitude and behavioural measures, and require larger sample sizes to demonstrate programme effects. These two factors often discourage the use of traffic safety measures of effectiveness. However, without an assessment of traffic safety impact, there is as yet no indisputable basis to suggest whether or not these programmes are having beneficial effects.

EVALUATION

OF PROGRAMME

IMPACT

In view of the numbers of school programmes for prevention of drinking-driving that recently have been developed and implemented, it might be assumed that substantial evidence exists to indicate beneficial effects. However, few studies have evaluated impact. The relevant studies are summarized in Table 1. In an early study, Jenkins [1970] compared two programmes based on informational models. The control programme consisted of traditional instruction with textbooks, lectures and class discussion. The experimental programme differed from the control pro-

1) InformationaLand affective involvement programme requiring 3 class periods to present (IF4941

Malfetti, McGrath and De Mea, 1975

Haste", 1979

Malfetti, sinon and Xomer, 1977

1) Informationalana affective involvement programme requiring 3 class periods to present (n=approx.1,400) 2) No-&~xJ~?x”,w COntrol (n=ap&XOX. 800)

1) Informationaland affective l"v5lveme"t programme requ*ri"g 135 minutes to present (n=4,671) 2) No-programme control ("=1,465) I.____ 1) Informationaland affective involvement M&night, Preusser, Psotka, Katz and programme requiring 8 l/4 hours to present Edwards, 1979 (n=237! 2) No-proqramme driver education control Cn=125) 3) NO-programne "on-driver education control cn=117;

Non-random

1) Informationalprogramme, presentation time not specrfled (n=48) 21 Affective involvement programme, presentation time not specified ("=48) 3f No-progr-e control (rI=QRf

lurnauar, 1973

MSASuws1

RESULTS

Non-random

Pzete*t and immediate pOstteSt on K/A mea*ures

Positive effects oE 1 on K/A mea*ures at POStteSt

Positive effects of 1 on Pretest, immediate postK/A measures at posttest test and 4aonth follow-up 0" K/A measures. B measures obtained at followup only. Non-random

Posxtive effects oE 1 on K/A mea5ures at pasttest and follow-up

Positive effects of programme on K/A meaS"res

Positive effects Of programme on K/A mea*ures

Positive effects of 2, bat not 1, an K/A meas*res

Pretest, immediate posttest and &week follow-up o" K/A measures

Pretest and immediate posttest on K/A meas"res

Prxtest, jarmediate posttest and 3-week follow-up on K/A measures

Pretest and inrmediate pasttest on K/A measures

Non-random

(one-group design)

Non-random

1) Informationalprograwne requiring 165 minutes to present in=181 2) Enriched informationalprogranme requirlng 165 minutes to present (n=18)

STUDY

METHOD OP ASSIGNMEN? M GROW’S

Jenkua, 1970

PRSRAMMES AND SAMPLE SIZES

Table 1. Summary of evaluations of school-based programmes to prevent drinking and driving

Positive effects of 1 on K/A measures at posttest. Possible negative effects of 1 on B measures at posttest Positive effects of 1 and 2 on K/A measures at posttest and follow-up. Positive effects of 1 and 2 on B measures at posttest; at follow-up, positive effects of 1 only

Pretest and imnediate posttest on K/A measures

Pretest and imediate posttest on K/A measures. B measures obtained at posttest only. Pretest, ixmediate posttest and 2-6 month followup on K/A and B measures

Non-randan

Non-randm

Random

1) Informationaland affective involvement prograrmtesdesigned for each of 7 elementary school grades requiring 5 class periods to present (Total N in the 7 grade levels =3,051) 2) No-prcqrannne co"trols (Total N in the 7 grade levels=2,636)

1) Informationaland affective involvement programme requiring 120 minutes to present (N=121) 2) No-programme control (N=93)

Donova", m&gall, Bomx, Kennel1 and Malfetti, 1982

Albert

1 -

= Knowledge/Attitudemeasures B = Behavioural self-reportmeasures

K/A

McKnight and McPherson, 1986

Simpson, 1985

1) Behavioural programne requiring 9 hours to present 2) Informationaland affective involvement progranrmerequiring 9 hours to present (Total N=667)

Positive effects of 1 on K/A measures at posttest

Pretest, immediate posttest and 6-month followup on K/A measures. B measures obtained at follow-up only

Ran&D

1) Informationaland high affect arousal film lasting 20 minutes 2) Informationaland medium affective arousal film lasting 20 minutes 3) Informationaland low affective arousal film lasting 20 minutes 4) Control film unrelated to alcohol and highway safety lasting 20 minutes (Total N=441)

Kahn, Gmdstadt, Cook, Sheppard and Chan, 1982

and

Mixed positive and negative effects of 1, 2 and 3 on K/A measures at posttest

Imediate posttest and I-month follow-up on K/A measures

Positive effects of 1 and 2 on K/A measures at posttest and follow-up. AlSO at follow-up, effects of 1 significantlymore positive than 2

RESULTS

Randan

MEASDBBSl

1) Informational film requiring 3 l/2 minutes to present, pius "reinforcing"test questions 2) Informational film only 3) No-film control &al N=3,641)

METHOD OF ASSIGNMENT TOGFauPS

Barnesand Petrucelli, 1980

STUDY

PRmRAMMES AND SAMPLE SIZES

330

R. E. MANN et al.

gramme in using audiovisual aids to supplement instruction. Each programme required three 55-min class periods to present, and was administered as part of a driver education course. Ten male and eight female tenth grade students participated in each programme; assignment of students to programmes was not random. One attitude and two knowledge tests were administered at the beginning and the end of the programmes. Analysis of gain scores revealed significant improvement in one of the knowledge tests for the experimental group, but not the control group. No significant differences were observed on the other measures, and the data were not analysed in a manner which would permit evaluation of changes from pretest to posttest. Turnauer [1973] compared the impact of an information-based programme and a programme based on affective involvement with a no-programme control condition. The information-based programme consisted of traditional lectures and reading assignments. while the affective involvement programme relied on audiovisual presentations, role playing, sociodramas and group discussion. A total of 144 tenth grade students enrolled in driver education classes participated (n = 48 per group). Assignment was non-random, and the length of the programmes was not provided. Two drinking-driving attitude scales were administered prior to, immediately following, and three weeks after programme completion. The affective involvement programme, but not the informational programme or the control condition, had a significant positive impact on attitudes at both the immediate posttest and three weeks later. A programme based on both information and affective involvement processes was developed by Malfetti et al. [1975]. It required three class periods to complete, and involved lectures, student reading and homework assignments, audiovisual presentations, group discussions and role playing. Malfetti ef al. [1975] conducted a preliminary evaluation of the programme using a simple one group pretest-posttest design, i.e. no control group was used. A total of 494 students at 16 high schools and one college in four American states were exposed to the programme in their driver education classes. Analysis of the results revealed significant improvements in both knowledge and attitudes after the programme. A programme for junior high school (grades seven and eight) based on information and affective involvement models was developed and evaluated by Malfetti, Simon and Homer [1977]. Teaching methods included lectures, games and values clarification exercises, and the programme required three 45-min lessons to administer. In seven states, 4671 students received the programme and a non-randomly selected control group of 1465 did not. Measures of knowledge, attitudes and behaviour were administered immediately prior to and following the programme; additionally, a follow-up posttest was administered to approximately 20% of the experimental sample eight weeks following programme completion. The behavioural measures assessed behaviours thought to be related to drinking and driving, and not self-reported drinking and driving, since the students were too young to have driver’s licences. The results indicated that the programme had significant positive effects on knowledge and attitudes, but not on behaviours, at the immediate posttest. At the eight-week follow-up measure, positive effects were still observed in knowledge, but not on attitude and behaviour. In the process of developing and validating knowledge, attitudinal and behavioural measures of the effects of school-based alcohol safety programmes, McKnight. Preusser, Psotka er al. [1979] employed these measures to evaluate the National Highway and Traffic Safety Administration alcohol safety programme [McPherson, McKnight and Knipper, 19771. This programme was based on both informational and affective involvement models. The course involved lectures, student readings, audiovisual presentations. group discussion and values clarification activities presented in ten class periods totalling 8.25 hours. 478 students from two high schools, between the ages 14 and 17, participated; smaller numbers of students completed the research. The alcohol and traffic safety programme was part of a driver education course; some students were required to attend the course while others did so voluntarily. Two control groups were formed. One consisted of students attending a driver education course, either voluntarily or as a requirement, without the alcohol and traffic safety component. The second was composed of students

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in English and Health Education courses. Assignment to groups was not random. Measures of knowledge and attitudes were obtained prior to and following the course. Additionally, measures of attitude and self-reports of drinking and driving were obtained at a follow-up test approximately four months following completion of the experimental programme. The time intervals between the pretest, exposure to the experimental programme, the posttest and the follow-up test were not specified. Analysis of the results indicated that exposure to the experimental programme resulted in’significant knowledge gains on the posttest, in comparison with the experimental groups. No significant impact on attitude was observed. Analysis of the follow-up behavioural measure revealed no significant differences on any of the four subscales of the measure. However, separate examination of the 37 individual items in the behavioural measure revealed significant differences on 5 of the 17 items pertaining to the drinking-driving behaviour of others. These differences suggested that the experimental group was more likely to intervene in the drinking-driving behaviour of other individuals, a potentially positive behavioural impact of the programme. However, these observations must be interpreted cautiously, since the design was quasi-experimental and no pretest behaviour measures were obtained. Masten [1979] modified the alcohol and traffic safety curriculum developed by Malfetti et al. [ 19751, primarily by deleting sections of the curriculum dealing with alcoholism, effects of alcohol on the home and efforts to reduce the drinking behaviour of participants. As in the Malfetti et al. [1975] programme, Masten’s [1979] programme was based on a combination of information and affective involvement models, involving lectures, reading assignments, audiovisual presentations, group discussion, group problem solving and role playing. The programme required three classroom periods to complete, and was implemented in 59 driver education classes; 32 driver education classes without the programme served as controls. Each class contained 20-30 students in grades 10, 11 or 12; ranging in age from 15 to 18 years. Non-random assignment procedures were used. Programme effects were assessed with pretest and immediate posttest administrations of the knowledge and attitude measures developed by Malfetti et al. [1975]. The results revealed significant knowledge gains for the experimental group in comparison with the control group, but no effects on attitude were observed. Hames and Petrucelli [1980] developed a short film (3.5 min in length) presenting basic information on alcohol for driver education courses. Subsequently, 3641 students in high school driver education classes in three American states participated in an evaluation of the film. Instructors in each class randomly assigned students to one of three groups in a posttest-only design. A control group did not view the film prior to completing a knowledge test. Two experimental groups viewed the film and completed the knowledge test; for one group some items were designed to “reinforce” information learned from the film, while for the other the reinforcing questions were omitted. About four months later, participants were again asked to complete a knowledge test, and “more than 40%” complied. Few details of the results were provided; the authors indicated that a more complete description of the results was available in an unpublished technical report. According to Hames and Petrucelli [1980], the two experimental groups obtained significantly higher knowledge test scores than the control groups at both follow-up tests. However, while the two experimental groups did not differ on the immediate posttest, on the four-month follow-up test the group which received the “reinforcing” questions scored significantly higher than the other experimental group. The authors suggested that this finding revealed the importance of testing as an adjunct to other learning activities. The impact of affective arousal procedures was examined by Kohn, Goodstadt, Cook et al. [1982]. Students in grades 9-13 taking Health and Physical Education courses in six high schools participated (n = 441), and were assigned in a quasi-random fashion to one of four conditions. The three experimental groups were shown a film which contained basic information. The film had three endings, in which the seriousness of the consequences of drinking and driving was manipulated. In the low-threat condition, a crash was narrowly averted. In the medium-threat condition, a fatal crash occurred but the effects of the crash were not shown. In the high-threat condition, a fatal crash occurred and the effects on the vehicle occupants were vividly depicted. In the control condition

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the students watched a film not related to drinking and driving. Knowledge and attitudes were measured prior to, immediately following and six months after exposure to the film. Self-reported drinking-driving behaviour was also measured at the six-month posttest. All three experimental programmes had a significant positive impact on knowledge at the immediate posttest, but not at the six-month posttest. The high-threat and low-threat conditions had significant adverse effects on attitudes (i.e. opposite in direction to the desired effect) at the immediate posttest; the groups did not differ at the six-month posttest. No significant effects on self-reported behaviour were found. Donovan, Hagen, Homer et al. [1982] developed and evaluated a multilevel programme for elementary school students (kindergarten through sixth grade). Each of the seven grade-level modules required five sessions or classes to present, with the time per session ranging from 30 min to 45 min. The programme combined information on alcohol and alcohol problems, e.g. identifying alcoholic beverages (kindergarten), and identifying symptoms of alcohol abuse (sixth grade), with information more directly related to alcohol and highway safety, e.g. information on effects of alcohol on behaviour (several grades), and information on the alcohol and highway safety problem (several grades). Both information and affective involvement principles guided the development of the lessons. A total of 3051 students in eight American states received the programme, while 2636 students in matched classes did not receive the programme. Pretests and immediate posttests were administered to all students. Items on the tests were chosen to reflect specific goals of the programme (e.g. identification of reasons that people give for drinking, and demonstration of skills in coping with alcohol-related traffic safety problems); these goals assessed both knowledge and attitudes. Analysis of the data revealed positive effects at all grade levels. In some instances, i.e. for certain goals at specific grade levels in some states, no significant differences were observed. Albert and Simpson [1985] evaluated the impact of a drinking-driving prevention programme based on the Health Belief model [e.g. Iverson, 19781. The model emphasizes both affective involvement and informational processes, and the mode of presentation emphasized sequence of information provision. The programme was presented in two 60-min classes of a Health Education course. Grade 11 students in two schools (N = 121) received the programme and constituted the experimental group. A second group of grade 11 students (n = 93) in two other schools did not receive the programme and thus served as controls. Students were tested one week before and one week after the programme. Participation resulted in significant improvements in knowledge and attitudes for the experimental group in comparison with controls. However, the experimental group also reported a significant increase in drinking frequency, a behavioural measure, compared with controls. The authors suggest that this observation may have been due to the non-random nature of assignment to groups. Based on their previous observations that exposure to an alcohol and traffic safety programme seemed to result in increases in self-reported interventions in the drinkingdriving behaviour of others [McKnight er al., 19791, McKnight and McPherson [1986] developed and evaluated a programme based on peer intervention training. This behaviourally-based, 9-hr programme was designed for implementation in a variety of contexts [e.g. McPherson, 19851. In the first hour, information on alcohol and highway safety was presented. In the remaining eight hours, structured and student-initiated role playing occurred, designed to provide intervention techniques and to make the students feel comfortable in applying these techniques. Students enrolled in driver education in five high schools participated in the evaluation. A total of 667 students were randomly assigned to receive either the experimental programme, or a control alcohol and highway safety programme emphasizing informational and affective involvement processes [McKnight et al., 19791. Knowledge, attitudes and self-reported behaviours were measured immediately before and after the programme and at a follow-up test administered two to six months after programme completion. Both programmes had a significant positive impact, of similar magnitude, on knowledge at the posttest and follow-up test. Analysis of the attitude measures revealed some evidence that the experimental group was more positively influenced than the controls on the posttest and follow-up measures, but the authors suggest that these results are probably due to factors other than programme impact. The self-

School-based programmes for drinking and driving prevention

333

reported behavioural measures revealed significant positive effects on both groups on the immediate posttest; at the follow-up measure these gains were maintained by the experimental group but not by the controls. ISSUES

RAISED

BY RELATED

RESEARCH

AREAS

As indicated previously, school-based programmes for drinking-driving prevention have borrowed concepts, curricula and methods from driver education and alcohol/drug education programmes. There is a greater body of evaluative literature on these two areas than for alcohol and traffic safety programmes. Thus, an examination of the results in these areas may reveal important issues for consideration. Several evaluative reviews of alcohol and drug education programmes have appeared [Braucht and Braucht, 1984; Durell and Bukoski, 1984; Goodstadt, 1978 and 1980; Hanson, 1980; Kinder, Pape and Walfish, 1980; Schaps, DiBartolo, Moskowitz et al., 1981; Sexter, Sullivan, Wepner et al., 1984; Staulcup, Kenward and Frigo, 1979; Swisher, 19741. Some programmes reveal positive results [e.g. Botvin, Baker, Renick et al., 19841, but many appear to have no impact [e.g. Morgan and Hayward, 19761. However, others appear to have deleterious effects [e.g. Stuart, 19741, or appear to result in mixed positive and deleterious effects [e.g. Goodstadt, Sheppard and Crawford, 19781. Attempts to understand why deleterious effects occur suggest that methodological factors in evaluation are involved. Schaps et al. [1981] rated programmes according to both the rigor of evaluation design and intensity of service, i.e. duration, scope and overall quality. Of the ten high quality studies identified, eight revealed positive drug-specific effects, one showed no effect, and one showed a negative effect on attitudes towards drug use. This review, then, suggested that positive effects are more likely to be found where designs and procedures are rigorously controlled. Goodstadt [1980] found many of the reported negative findings were based upon surveys and correlational studies rather than experimental studies, and also that reported negative findings were often associated with positive findings in the same study where experimental evidence was given. Similarly, studies of the impact of driver education suggest mixed levels of effectiveness on participants [cf. Page-Valin, Simpson and Warren, 1977; Schuman and McConochie, 19711. However, regardless of effects on individual drivers, it has been suggested that compulsory driver education for all adolescents when they approach the age when they can be licenced may have a net deleterious effect on traffic safety. Shaoul [1975] examined total crash involvement of 16-17-year-old students assigned to compulsory driver education or a no-programme control condition. The results indicated a higher total crash involvement among students who participated in the programme; this result appeared to be caused by higher numbers of participating than non-participating students obtaining their driver’s licences. Subsequent American studies have provided some support for the hypothesis that mandatory driver education for unlicenced adolescents increases likelihood of licencing, and thus subsequent exposure to traffic hazards. It was found that the presence of compulsory high school driver training was associated with higher numbers of licenced young drivers [Robertson and Zador, 19781, and that removal of this training was associated with lower numbers of licenced young drivers, and possibly a decrease in the numbers of young drivers involved in crashes [Robertson, 19801. This brief consideration of research from related areas may have important implications for alcohol and traffic safety programmes, in that there seem to be instances where such programmes might appear to exert deleterious effects. While the precise cause of these apparent deleterious effects is not yet known, there is evidence that, at least in some instances, they result from methodological problems with evaluation or the context in which programmes are presented. Thus, programme context and evaluation design may be important issues for alcohol and traffic safety programmes as well. CONSIDERATIONS

FOR

FUTURE

WORK

An examination of school-based alcohol and traffic safety programmes, and their evaluation, reveals both strengths and weaknesses. These programmes are a promising way to attack the alcohol-crash problem, but it is not yet possible to state with any

334

R. E. MANN et al.

certainty how effective they are. Before such a statement can be made, several development and evaluation issues should be considered in future studies.

METHODOLOGICAL

ISSUES

Evaluations provide the indices of success, and can indicate areas in which programmes can be strengthened. The evaluation procedures used can also influence the apparent outcome of a programme, independent of its actual impact. It is therefore important that evaluation procedures be employed which provide an accurate index of impact. The most important methodological issue at the current state of development and evaluation of school-based alcohol and traffic safety programmes is the choice of measures of effects. All studies to date have employed knowledge/attitude measures of impact; a small number have also employed behavioural indices. However, the final arbiter of the effectiveness of a traffic safety programme is its impact on traffic safety measures; it is not yet possible to assume that impact on knowledge/attitude or behavioural measures will be reflected in traffic safety indices [e.g. Mann et al., 1983; McGuire, 19741. An important stage in the further development of these programmes, then, is to assess their impact on traffic safety measures. Related to the issue of traffic safety measures is the continued refinement of other measures of impact. Specifically, if indices with known relationships to traffic safety impact can be found, these measures could then provide a rapid and sensitive index of a programme’s desired effects. The development of measures with known psychometric properties has been a major strength of the studies reviewed here [e.g. Albert and Simpson, 1985; Malfetti et al., 1975; McKnight et al., 19791. An important validation study was reported by McKnight et al. [1979], who obtained a sample of youths with known drinkingdriving problems for comparison with the students who participated in the school programme, and who also correlated knowledge and attitude measures with self-reported drinking-driving and related behavioural measures. There are several other related issues in the design of programmes and their evaluation. Random assignment, where possible, is an essential component of the most rigorous and sensitive evaluation procedures, but with the exception of three studies [Hames and Petrucelli, 1980; Kohn et al., 1982; McKnight and McPherson, 19861 evaluations of these programmes have used non-random methods of assignment. Additionally, many of the evaluations described have employed little or no follow-up period beyond immediate posttests. Increased length of follow-up intervals will provide a more accurate index of programme effects, and, where traffic safety measures are employed, are necessary to permit sufficient sensitivity to detect impact.

CONCEPTUAL

AND

PROGRAMME

DEVELOPMENT

ISSUES

The development and further improvement of school-based alcohol and road safety programmes is closely tied to conceptual and information bases. While an examination of all the possible issues which might arise from a consideration of theoretical models of behaviour and of current knowledge on youth, alcohol and road safety is beyond the scope of this review, there are several areas which may be particularly relevant. With more research being devoted to the topic, understanding of hazardous alcohol consumption and drinking-driving behaviour by adolescents is increasing [e.g. Fingerman, Levine and Eisner, 1977; Mann, Vingilis, Adlaf et al., 1985; Mayhew, Warren, Simpson et al., 1981; Vingilis, 19811. This information may permit identification of high risk subpopulations of adolescents. If such subpopulations can be identified, alcohol and traffic safety programmes to meet the specific needs of these groups could be designed. Thus, programmes may be tailored more precisely to high-risk groups either within the context of general programmes for all members of a particular age group, or as separately developed programmes.

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The programmes reviewed here have been derived from a limited number of models for the influencing of human behaviour. While programmes based on other models exist [Vegega, 19841, they have not yet been evaluated, and only a few comparisons of programmes based on different models have been made. These comparisons are essential for selection of the most efficacious programmes. As well, increasing understanding of human development, particularly in adolescent years [e.g. Jessor and Jessor, 19771, should permit continued refinement of models and components. Two related issues which are currently unresolved are (1) in what context should these programmes be implemented and (2) how extensive should they be? With regard to the first issue, the majority of evaluated programmes have been implemented as part of high school driver education courses, while a few have been implemented in health education and other contexts. There are advantages and disadvantages associated with each of the various contexts in which programmes might be implemented, but there are as yet no data to indicate which context is preferable. Similarly, the optimal extent of exposure has not been determined. Current programmes have exposures ranging from a single presentation lasting a few minutes [Hames and Petrucelli, 19801 to multiple presentations over several years [Donovan et al., 19821. Presentations integrated into classroom activities over several years may appear to hold more promise for a lasting impact on behaviour, but again no empirical evidence on this issue is available. Finally, there is a growing recognition that drinking and driving is determined by complex patterns of environmental and individual factors [e.g. Mann and Vingilis, 1985; Vegega, 1984; Waller, 19831. Countermeasures which focus on the person as the “site” for the intervention may be limited in effectiveness because they ignore important environmental influences. Perhaps the long-term approach which has the most promise of reducing the drinking-driving problem is one which recognizes that the best way to change this complex behaviour is to implement integrated, complementary countermeasures aimed at both person and environmental factors. Furthermore, it is important to recognize that the North American environment offers youths inconsistent messages. Short-term education programmes could easily be overwhelmed by strong messages suggesting that drinking and driving is an acceptable behaviour [e.g. Wallach, in press]. Such perspectives might suggest that school-based alcohol and road safety programmes are likely to be most successful where they form a part of, and are integrated with, a set of countermeasures and societal values which consistently work to decrease drinking and driving. CONCLUSIONS

School-based prevention programmes for drinking and driving may hold significant promise for reducing alcohol involvement in the road safety problem over both the short and long term. Many agencies and jurisdictions are currently developing and implementing them with these goals in mind. Programme models and procedures have been adapted from alcohol and drug education and from driver education; thus most current programmes have adopted informational and affect-based models of behaviour change. Only a small number of these programmes have been evaluated. Results demonstrate that most are successful in inducing short-term positive changes in knowledge and attitudes. However, these changes tend to disappear over follow-up intervals. As well, their impact on behaviour has received little attention, although some promising results have been reported [McKnight and McPherson, 19861. Surprisingly, no studies have examined their impact on traffic safety indices, the measures they are designed to influence. Most studies also suffer from other methodological limitations (e.g. non-random assignment). There are several issues in the design of these programmes which are currently unresolved, but which may have an important influence on impact, e.g. the context of presentation, the underlying model of behaviour change. As well, it is not yet possible to indicate whether or not implementation of these programmes will influence drinkingdriving behaviour or crash risks of participants. Thus, the positive results seen in the small number of evaluations which have been reported underscore a pressing need for well-designed studies to examine the traffic safety impact of these programmes.

336 Acknowledgments-We wish to thank and valuable suggestions.

R. E. MANNet al Katherine

De Genova

and Deborah

Lindholm

for their generous

help

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