It was 2015 and my mind was blown. I was attending a professional development session related to the New York State legislation requiring Heroin and Opioid content in health. The speaker from the Office of Alcoholism and Substance Abuse Services (OASAS) had just told us that there were multiple (yep, multiple) substance abuse prevention programs for schools that had been proven effective and none of us, really not one of us, had used them.
I was livid thinking Wait a minute. I’ve been teaching health since 2003, and there are programs I could have been using that WE KNOW WORK and I didn’t have them. Why the heck not? What’s the point of having these effective programs if they never made it to the schools?
Nationally, the What Works Clearinghouse is a database of evidence-based programs on a wide range of topics. There you can find information about Too Good for Drugs, Too Good for Violence, and Positive Action. Each of these programs comes at a substantial annual cost that make them impractical for most schools to implement. This is true of other nationally recognized programs like Safe Dates and the Olweus Bullying Prevention Program. In addition to being cost-prohibitive, nearly every one of these programs requires more time than the average health educator has available for any given topic. And, when you dive a little deeper, most of these programs are effective at changing students’ attitudes about the topic but not necessarily changing their behavior. Additionally, many of them were evaluated in populations that were predominantly white.
So how can we ensure that what we’re doing in our classrooms (with our tiny budgets and our limited time) actually works? I’ve tried to research strategies that can actually impact student behavior (not just their attitudes). Good news! I’ve found 3 strategies that, according to the research, work.
- The Social Norms Approach
- Auditing Connections
- Engaging Trusted Adults
Read on to learn what each approach is, how to use it in your classroom, what standards it meets and where you can find additional information.
The Social Norms Approach
When employed, this approach has been shown to cause a statistically significant decrease in tobacco use, alcohol use and sexual risk taking. Most studies are of college students, but the Social Norms Approach has also been used effectively in middle schools and high schools.
It’s pretty simple. Most teens overestimate how many of their peers are involved in health-risk behaviors. They think that most teens use drugs or have sex, when in reality, many of them don’t. The Social Norms Approach attempts to correct their normative beliefs. Here’s why…
If I believe that most of my peers vape, when I’m offered a vape (even if I don’t really want to), I’m more likely to vape.
Conversely, if I believe that most of my peers do NOT vape, when I’m offered a vape, I’m more likely NOT to vape (even if I do want to).
This approach monopolizes the fact that peers are a powerful influence on adolescent behavior.
How can I use the Social Norms Approach?
First, you need to find data on actual teen behavior that your students will trust. The Youth Risk Behavior Survey and Monitoring the Future are both great resources. If your school participates in either survey – that’s the one to use. If you don’t, please, please, see if you can conduct the YRBS at your school (here’s the guide on how to do it). When your students have actually participated in the survey, it’s easier to get them to buy into the results.
Next, find out what students think. Have them guess how many teens use alcohol, vape, use marijuana, and have sex. Then, show them the survey data. No doubt, students will second-guess the results.
“Kids definitely lie on the survey,” they’ll say.
Ask them to consider if they lied or not and importantly, concede that some kids probably did lie. Some may have said they didn’t do things they actually do and others may have said they do things they actually don’t.
For example, the 2021 YRBS results show that 18% of high school teens currently vape (they vaped in the last 30 days). That means that 82% (the vast majority of teens) do NOT currently vape. Even if 20% of the students lied (that’s one in five of them), the percentage would be 38%. That means that 62% don’t vape – that’s still the majority.
Lastly, find a way to advertise this to everyone at school, not just the students currently taking health class. I have my students create flyers where they flip the stat to the positive…82% of US teens do NOT vape. I also have them include their personal reason for not vaping which helps personalize the message. Then, I plaster them everywhere I can…particularly the restrooms where they may actually take the time to read it.
Check out this free lesson to get started.
What standards will the Social Norms Approach meet?
SHAPE America Standard 2 and National Consensus for School Health Education Standard 2 (both are related to analyzing influences)
SHAPE America Standard 8 and National Consensus for School Health Education Standard 8 if you extend to a student project advertising the social norm (both are related to advocacy)
What else do I need to know about the Social Norms Approach?
While this approach has been shown effective, it is important that you choose the right time to use it. For example, if your local data reveals that the majority of students engage in a particular risk behavior, this is NOT the right approach.
Some of the research I did revealed that many campaigns that seek to raise awareness may normalize unsafe situations inadvertently. For example, sharing that as many as 65% of teens report being psychologically abused (in dating relationships), may make a student feel that the abuse they experience is normal. As a result, the teen may be less likely to seek support.
What resources support the use of the Social Norms Approach?
The National Social Norms Center at Michigan State University
Social Norms Approach: A Health Promotion Strategy to Preventing Youth Risk Behaviors. August 2022.
Behavioral Change Models: Social Norms Theory. November 2022.
The Social Norms Approach to Student Substance Abuse Prevention. September 2015.
Auditing Connections
Adolescents who feel connected at home or at school are 66% less likely to engage in risk behaviors related to substance use, violence and sex, and have better mental health than their less connected peers. But, how do we know if our students feel connected? One simple strategy is to do conduct a connections audit.
Quick confession: I’m pretty sure I invented the term connections audit (at least, its use in this context). Earlier in my career I had learned about Relationship Mapping from Harvard’s Making Caring Common Project. It is a fantastic tool, I highly recommend, but it can be difficult to use in a large school setting, especially if you don’t have a supportive administration or faculty. I created the connections audit to meet the same goal without needing anyone else’s help.
How can I conduct a connections audit?
Just like the Social Norms Approach, a connections audit is pretty simple. All you need to do is collect the following data from your students:
- Who is an adult you trust at school (someone you could go talk to if you needed help)?
- Who is an adult you trust at home (someone you could go talk to if you weren’t at school – not necessarily someone in your house)?
- Who is a friend you trust? (someone your age, from our school or your neighborhood you could go talk to)
I do this during my mental health and stress management unit right after students identify resources/services in our building, community and country, and discuss the importance of close connections. It’s important to let students know that if they don’t have an answer for any of the 3 questions (listed above) they can leave them blank or write, I don’t know.
Then, review student responses. Keep a list of any student who has left a question blank.
Finally, share your list with your school counselor(s). Students who are not able to identify an adult at school would be excellent candidates for a Check In Check Out program, if your school has one. Counselors may recommend clubs, groups or teams to students who are not able to identify a trusted friend and may choose to check in with students who don’t have a trusted adult at home.
What standards will a Connections Audit meet?
Helping students understand the value of connections can help them to seek support and keep them safe. A sense of connectedness is a powerful protective factor. Protective factors influence our health.
SHAPE America Standard 2 and National Consensus for School Health Education Standard 2 (both are related to analyzing influences)
What else do I need to know about Auditing Connections?
This strategy can help identify students who are not connected, but it will be most powerful if combined with the next strategy, engaging trusted adults. Students who practice connecting with their trusted adults will be more likely to do so in times of need. A connections audit without any further action (such as practicing connecting with trusted adults, sharing the results with school counselors, and recommending students to a Check In Check Out program) doesn’t serve much purpose.
What resources support the use of a connections audit?
Making Caring Common Project: Relationship Mapping
Adolescent connectedness: cornerstone for health and wellbeing. October 2022.
School Connectedness Helps Students Thrive. July 2023.
Engaging Trusted Adults
When adolescents have positive relationships with trusted adults it helps mitigate the impact of Adverse Childhood Experiences and improves mental health. These relationships can also result in lower rates of risk-taking behavior. In fact, kids who have conversations with their parents about alcohol and drugs are 50% less likely to use them. Teens say that parents are the most powerful influence in their decisions about sex and research has show that teens who have conversations with their parents about sex are more likely to delay sex and to use condoms when they do have sex.
How can I engage trusted adults?
As a health educator, communicating consistently and often with students’ families can help open the door for important conversations at home. But to ensure students are actually talking to their trusted adults about health content, you have to require it, which can be a little tricky.
I let families know at the beginning of the year that there will be two assignments that require students to conference with a trusted adult. These assignments are always accompanied with an explanation of why we’re doing the assignment and of additional resources that may be helpful in having the conversation.
Early in the year, I send home a family health history optional assignment as a primer. During our decision making unit, students are required to have a conversation with a trusted adult about how to stay safe from the dangers of drugs and alcohol. Later in the year, they do a similar assignment related to sexual health.
For this to be successful:
- Students need to know that the assignment needs to be completed with a trusted adult, NOT necessarily a parent. Don’t assume that every student has a parent they can trust.
- Teachers need to provide safe alternatives. Let students know that if they’re struggling to find a trusted adult, they can come to you. You can schedule a time to do the assignment together or determine a different adult (counselor, teacher, coach, teaching assistant).
- Students need a lot of time. Schedules are busy and these conversations shouldn’t be rushed. I give students at least a week to complete these assignments.
- Students need to know the assignment is required. If conversations with trusted adults help them to be safe then I need to make sure every student has the conversation.
- Teachers need to follow up. I schedule a time to meet with students who have not completed the assignment to determine a way to get it done, whether they have the conversation with me, another adult at school or an adult at home. It’s not a punishment, it’s a way to show care for every single student.
What else do I need to know about Auditing Connections?
Not every family is going to appreciate these opportunities. While I don’t often get resistance, I’m prepared for it. Part of the assignment is documenting the conversation. If an adult isn’t comfortable with that part, don’t force it. Ask them just to sign off on the assignment, acknowledging that they’ve had the conversation. You will face less resistance if you leave the assignments very open-ended, provide lots of choices and include resources for those who want some guidance. Highlight the fact that this is an opportunity for families to discuss their values and expectations.
If you’re able to, encourage a discussion about what services are available in your community. The recommendation of a trusted adult can be influential in helping students actually make use of these services.
What standards will engaging trusted adults meet?
SHAPE America Standard 3 and National Consensus for School Health Education Standard 3 (both are related to accessing resources and services)
SHAPE America Standard 4 and National Consensus for School Health Education Standard 4 (both are related to interpersonal communication)
What resources support engaging trusted adults?
National Council on Alcohol and Drug Dependence: Talking with Children July 2015
CDC: Talking With Your Teens About Sex. November 2019
SAMHSA: Why You Should Talk With Your Child About Alcohol and Other Drugs
Relationships First: Creating Connections That Help Young People Thrive 2017
One Last Thing…
One of the things I noticed that all of the evidence-based programs had in common was that they were skills-based. In addition to using the Social Norms Approach, conducting a Connections Audit and Engaging Trusted Adults, I encourage you to focus on teaching skills like interpersonal communication, decision making, analyzing influences, accessing resources and advocacy. If you need some help, please check out the 5 Steps to Transition to Skills-Based Health.
