Author: Jennifer A. Epstein, G.J. Botvin
Title: Media resistance skills and drug skill refusal techniques: What is their relationship with alcohol use among inner-city adolescents?
Journal: Addictive Behaviors, 2008, 33, 528-537.


Objective: To examine the impact of media resistance skills and drug skill refusal techniques (Knowing how to say no to alcohol and other drug) on drinking behaviour in adolescents.
Design: Longitudinal study
Setting: inner-city schools inn regions of New York City, US.
Participants: 1318 of the 2228 respondents filled in the questionnaires at both the baseline as well as the follow-up (response rate=59%). The drop-out students drank more often and were drunk more frequently. Average age of respondents at baseline was 12.9 years old and minority ethnic groups were over-represented in the sample.
Structural equation modelling was used to examine whether the effect of Generic Media Resistance on drinking at the follow-up was mediated by Drug Refusal Skill Techniques (Knowing how to say no to alcohol and other drug). This relationship is controlled for drinking behaviour at the baseline.
The analysis shows that the direct effect of generic media resistance becomes insignificant after including Drug refusal skill techniques as a mediator in the model (from b= -.08 to b=-.05). Generic Media Resistance increase Drug Refusal Skill techniques (b=.17 with p<.001) and Knowing how to say no to alcohol and other drug decreases drinking (b=-.27, with p<.001). 
Conclusions Authors: 
Generic media resistance skills are the first step towards competence enhancement in combating adolescent drinking. The mechanism generic media resistance skills work is through drug refusal techniques. Consequently, the authors advice that prevention programs should include the promotion of media resistance skills and drug refusal techniques.

Remarks EUCAM: 
The effect of media literacy on drinking behaviour is not examined extendedly in scientific research. This article examines one possible mechanism through which media literacy works. An important strength of this study is its longitudinal design. However, the study has some important limitations which decrease the value of this study considerably:
The authors mention a few limits of the study themselves:
– The low number of variables tested in the model: The relationships are not controlled for alcohol advertisement exposure, drinking behaviour friends, other drug use. These factors, however, are probably strongly correlated with the variables in the model. Not including these confounders could lead to over estimation of the effects.
– Low response rate: The drop-out students drank more often and were drunk more frequently. Consequently, the results are not generalizable to all students in the schools.
– Self-report of the data.
Another limitation of this report is the measurement of Drug Refusal Techniques. This is measured by five items regarding what the respondent would do ‘If someone asked you to smoke, drink, or use other drugs: tell them “no” or “no thanks, tell them not now, change the subject, tell them you don’t want to do it, and make up an excuse and leave. Responses were indicated on five-point Likert scales ranging from “definitely would” (1) to “definitely would not” (5). An important disadvantage of this way of questioning is that two things are measured: (1) Is the respondent willing to drink, smoke or use other drug; and (2) if not, will the respondent be able to say no to his/her friends. Especially when smoking and drug use are not included as confounders, this can lead to measurement errors, e.g. not smoking could explain the likelihood of not drinking instead of knowing how to say no to smoking.

The authors applaud including both media literacy as well as drug refusal techniques in alcohol prevention programs. However, the analysis shows that media literacy is fully mediated by drug refusal techniques. This means that Media literacy can be used in prevention strategies to increase the ability to refuse drug, but that it has no direct protective effect on drinking behaviour. Media literacy only protects youngsters from drinking alcohol by increasing drug refusal skill techniques.

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