Peer Network Counseling: A Socially Focused Intervention for Underserved Urban Adolescents

            Peer context is a very robust predictor of substance use. Microsocial process research has found that peer prosocial behaviors activate internal motivation of index participants providing protection against substance use. Although substantial evidence exists for peers affecting adolescent health behavior, specific peer-focused interventions are limited and underdeveloped.

            Peer Network Counseling (PNC) is a 20 minute, peer-focused substance use intervention. PNC is guided by Motivational Interviewing principles and clinically targets close peer relationships as a mechanism of change.  Unique to PNC is the focus on place-based peer networks, which raises awareness of both peers and place and has been shown to moderate the effects of both high-risk environments and peer networks and is especially relevant for urban youth. PNC is structured into four component parts each lasting for 5 minutes: 1) rapport building and discussion on health behavior & peers, 2) health behavior reviewed and compared with national norms using laptop graphical presentation 3) introduction of peer network information and graphical feedback, and 4) discuss discrepancy and ambivalence, consider action plans.  

            PNC has been tested in three randomized controlled trials within primary care settings with urban adolescents.  Results from the initial pilot study showed that at 1 month follow-up, adolescents in the experimental condition reported less substance use before sexual intercourse (p<.05), less trouble due to alcohol use (p<.05), less offers for marijuana use (p<.05), less social stress (p<.05), and increased readiness to start counseling compared to the adolescents in the control condition (p<.05), producing medium and large effect sizes.  

Results from the second study found that at 6 months follow-up PNC worked well with heavy cannabis users (p<.05) and with those who received frequent offers to use cannabis (p<.05), producing a significant and medium treatment effects. PNC also reduced offers for alcohol in the experimental condition (p<.05) compared to controls.    

Finally, PNC was adapted into a personalized, automated, and interactive five day texting tobacco cessation intervention.   At six months PNC decreased the number of days smoked cigarettes (p<0.05), number of cigarettes smoked per day (p<0.01), increased intentions not to smoke in the future (p<0.05), increased peer social support among girls (p<0.05), and reduced the number of close friends in their networks who smoke daily among boys (p<0.05). Mediational analysis provide insight into the mechanisms of change for PNC.

            In summary, Peer Network Counseling provides promising evidence in reducing substance use among hard-to-reach and underserved urban youth populations in primary care.