Objective: This article summarizes the literature on alcohol initiation outcomes of universal family interventions and examines the long-term effects of the Iowa Strengthening Families Program (ISFP) on these outcomes.
Method: A longitudinal, controlled efficacy study of the ISFP was conducted with 446 families from 22 rural school districts in a Midwestern state. Alcohol initiation behaviors were measured by a four-item index (Alcohol Initiation Index [AII]), with low scores representing a lower level of alcohol initiation. The AII was examined using mixed-model analyses of covariance. Relative reduction rates for individual initiation behaviors and initiation differences among higher- and lower-dosage intervention groups were calculated.
Results: AII scores were significantly lower among intervention group adolescents than among control group adolescents at 1- and 2-year follow-up assessments. Relative-reduction rate differences between intervention and control groups on specific alcohol initiation behaviors (e.g., onset of drinking without parental permission, onset of drunkenness) ranged from approximately 30% to 60%. Dosage-related initiation differences were evident only at the 1-year follow-up.
Conclusions: Studies indicating the public health benefits of universal interventions that delay the initiation of alcohol use also underscore the importance of the current line of investigation. All effect sizes and relative reduction rates of specific alcohol initiation behaviors suggest the practical significance of the findings. The gap in the prevention outcome knowledge base in this area of investigation could be filled with more rigorous universal family-focused intervention studies that address a wide range of implementation and methodological issues.