Preventing adolescent health-risk behaviors by strengthening protection during childhood

Objective: To examine the long-term effects of an intervention combining te acher training, parent education, and social competence training for childr en during the elementary grades on adolescent health-risk behaviors at age 18 years. Design: Nonrandomized controlled trial with follow-up 6 years after interve ntion. Setting: Public elementary schools serving high-crime areas in Seattle, Was h. Participants: Of the fifth-grade students enrolled in participating schools , 643 (76%) were given written parental consent for the longitudinal study and 598 (93%) were followed up and interviewed at age 18 years. Interventions: A full intervention provided in grades 1 through 6 of 5 days of in-service training for teachers each intervention year, developmentall y appropriate parenting classes offered to parents when children were in gr ades 1 through 3 and 5 through 6, and developmentally adjusted social compe tence training for children in grades 1 and 6. A late intervention, provide d in grades 5 and 6 only, paralleled the full intervention at these grades. Main Outcome Measures: Self-reported violent and nonviolent crime, substanc e use, sexual activity, pregnancy, bonding to school, school achievement, g rade repetition and school dropout, suspension and/or expulsion, and school misbehavior; delinquency charges from court records; grade point average: California Achievement Test scores; and disciplinary action reports from sc hool records. Results: Fewer students receiving full intervention than control students r eported violent delinquent acts (48.3% vs 59.7%; P=.04), heavy drinking (15 .4% vs 25.6%; P=.04), sexual intercourse (72.1% vs 83.0%: P=.02), having mu ltiple sex partners (49.7% vs 61.5%;, P=.04), and pregnancy or causing preg nancy (17.1% vs 26.4%; P=.06) by age 18 years. The full intervention studen t group reported more commitment (P=.03) and attachment (P=.006) to school, better academic achievement (P=.01), and less school misbehavior (P=.02) t han control students. Late intervention in grades 5 and 6 only did not sign ificantly affect health-risk behaviors in adolescence. Conclusions: A package of interventions with teachers, parents, and childre n provided throughout the elementary grades san have enduring effects in re ducing violent behavior, heavy drinking, and sexual intercourse by age 18 y ears among multiethnic urban children. Results are consistent with the theo retical model guiding the intervention and support efforts to reduce health -risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods.