Project ALERT: a cluster randomized trial

Arch Pediatr Adolesc Med. 2009 Jul;163(7):625-32. doi: 10.1001/archpediatrics.2009.88.


Objective: To evaluate the effects of Project ALERT on adolescents' lifetime and 30-day use of cigarettes, alcohol, marijuana, and inhalants.

Design: Cluster randomized trial.

Setting: Schools from 11 states were enrolled in 2 successive cohorts from 2004 to 2008.

Participants: All public schools in the United States that included grades 6 through 8 and enrolled at least 100 students in sixth grade were recruited. Of the 40 schools that began the study, 34 (17 per condition) completed it. Data were analyzed from 5883 unique participants. Intervention Project ALERT, a manualized classroom-based substance use prevention curriculum for the middle grades, was taught to sixth and seventh graders.

Main outcome measures: Students were surveyed before the onset of the intervention, as sixth graders, and after the completion of the 2-year intervention, as seventh graders. Outcome measures included lifetime and 30-day use of cigarettes, alcohol, marijuana, and inhalants.

Results: At baseline, students in the intervention condition were slightly to moderately more likely to report use for each of the 8 measures examined than were students in the control condition. For all measures except lifetime use of cigarettes, these differences were less pronounced at follow-up and therefore were in the direction of favorable program effects. These changes were statistically significant, however, for only 1 outcome measure, past 30-day use of alcohol (reduction in the adjusted odds ratio from 2.07 at baseline to 1.32 at follow-up; P = .006).

Conclusion: Project ALERT was not effective when delivered to the sixth grade population we targeted.

Trial registration: NCT00650585.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adolescent Behavior*
  • Alcohol Drinking / epidemiology
  • Alcohol Drinking / prevention & control
  • Algorithms
  • Cluster Analysis
  • Curriculum
  • Female
  • Health Education / organization & administration*
  • Humans
  • Male
  • Marijuana Smoking / epidemiology
  • Marijuana Smoking / prevention & control
  • Outcome Assessment, Health Care*
  • School Health Services / organization & administration*
  • Smoking / epidemiology
  • Smoking Prevention
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / prevention & control*
  • United States / epidemiology

Associated data