• By Kevin Mount
  • Posted on Wednesday 22nd October, 2008

After Chicago is Project Northland going west?

Suspicions that a Blueprints Promising Program on the verge of joining an elite group of “model" interventions is failing to stand the tests of time and social change are adding weight to the argument that communities under stress need to be involved directly in prevention research. Project Northland is a universal program that usually runs for six years. The curriculum of tasks and training is designed to change the personal, environmental and social factors that make alcohol misuse possible and acceptable. Designed by Cheryl Perry and Carolyn Williams of the US Hazelden Foundation, it was originally implemented in 1991 among rural middle-class and predominantly white children living in north-eastern Minnesota. Alongside the implementation, an evaluation study was set up which duly found benefits in terms of the misuse of alcohol, cigarettes and marijuana. The evaluation was well-designed by scientific standards and so Project Northland earned its passage into the Blueprints Promising Programs club.However, a recent replication study, which took Project Northland out of rural middle-class America and into inner-city Chicago, has cast some doubt on how well the program works.Writing in Addiction, Kelli Komro reports that compared to "prevention as usual" in Chicago schools, Project Northland had no statistically significant effect on outcomes. Komro and her co-researchers from the University of Florida conducted a large and impressive randomized controlled trial in Chicago that involved 61 schools. Twenty-nine implemented Project Northland for students in 6th grade and up until they reach 8th grade (three years). The other 32 schools made no changes to “prevention as usual” and did not roll out the program.Effects on alcohol (and other drug) use were assessed via a classroom-based survey. Analysis of the results showed no significant effects on alcohol use between the control and intervention groups during each of the three years that Project Northland was attended by the Chicago students.Furthermore, Komro’s team is confident that the failure to identify any positive impact fifteen years after the original implementation has nothing to do with how the program was delivered in Chicago. A process evaluation of the implementation revealed that fidelity to the original model was very strong and highly comparable to the original study. The numbers of students who dropped out of the program during the three years was higher than for the original study, but Komro argues that this does not explain the poor results either.Instead, she explores the possible influence of the changing socio-historical context. She reasons that children have been exposed to more evidence-based programs than their counterparts 15 years ago and that for many community members alcohol use is not a priority concern. Students in the “control” schools experienced all of the alcohol and drug prevention ministrations that have become part and parcel of everyday life in US schools. Therefore they might not have acted as a control in the true sense of the word. It might be that, as effective as Project Northland was at the outset in preventing a surge in under-age drinking, the ground conditions it was designed for no longer apply.The fact that the Chicago study failed to replicate the original Minnesota findings is by no means an uncommon problem among promising programs. Many others have struggled to replicate good effects with different populations, particularly among minority, urban, low-income communities such as the one studied in this research. Komro rounds off her paper in Addiction by saying that communities under stress need to be engaged directly in the business of prevention science and research so that issues of importance to them are addressed. She also notes that “replications and adaptation studies are critical for prevention science”.ReferenceKomro K, Perry C, Veblen-Mortensen S, Farbakhsh K, Toomey T, Stigler M, Jones-Webb R, Kugler K, Pasch K, Williams C (2008) “Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: Project Northland Chicago”, Addiction, 103, pp606-618.

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