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EFFECTIVE AND COST-EFFECTIVE MEASURES TO REDUCE ALCOHOL MISUSE
IN SCOTLAND: A LITERATURE REVIEW
CHAPTER SIX PREVENTION
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Summary
This chapter reviews the effectiveness and cost-effectiveness evidence
relating to the prevention of problem drinking and alcohol abuse. The
main findings are;
- there is only weak evidence of effectiveness for school-based interventions;
- evaluations tend to show changes in knowledge rather than behaviour;
- characteristics which contribute to success are interactive design,
parental, community and peer involvement;
- health promoting schools have some positive impacts but less on alcohol;
- mass media campaigns affect knowledge and attitudes rather than behaviour;
- screening and counselling adolescents was not cost-effective in one
US study; and
- thiamine supplementation of beer was shown to be cost-effective in
preventing Wernicke-Korsakoff encephalopathy in an Australian study.
- Better research designs are needed to provide more robust evidence
in the area of prevention.
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Introduction
6.1 This chapter concerns interventions to prevent alcohol misuse. The majority
of the literature is concerned with school-based interventions and these are
summarised first. The limited evidence relating to other interventions, including
mass media campaigns, is then presented. The studies reviewed are summarised
briefly in tables 6.1 (effectiveness) and 6.2 (cost-effectiveness) at the end
of the chapter.
School-based interventions
Introduction
6.2 Most school-based programmes are aimed at the prevention of substance
misuse generally and do not target alcohol alone. However, most evaluations
report separate results for the different substances of interest and the results
for alcohol have been summarised below. Much of the literature is drawn from
the US and it is important to note that the aims with respect to alcohol may
be rather different. US programmes tend to focus on non-drinking and not sensible
drinking.
Types of intervention
6.3 Interventions have been developing over time, with a movement away from
facts based teaching towards teaching social skills that will help in resisting
social and peer pressure. As well as the content of the programme, the style
of delivery can also be important. The main distinction drawn is between:
- interactive programmes, which include social influence and comprehensive
life skills;
- interactive delivery, which requires elements such as participation, student
to student communication, small group activities and corrective feedback;
and
- non-interactive programmes, which are based on delivery of knowledge through
mainly didactic teaching.
6.4 One of the most widely evaluated programmes is Project DARE (Drug Abuse
Resistance Education), a widely used program in the US using trained police
officers to teach a drug prevention curriculum (Ennet et al 1994). It comprises
17 weekly lessons of 45-60 minutes teaching skills to recognise and resist social
pressures to use drugs.
6.5 Another approach, used in Australia, involves parents and peers in the
programme. The Illawarra Drug Education Programme is targeted at 10-11 year
olds and begins with a parents’ evening. Children are introduced to the
programme by peers; children who completed the programme the year before. The
teaching phase is followed by group work and a drama production (described in
Lloyd et al 2000).
6.6 The health promoting schools initiative is a relatively recent development
and takes a holistic and whole school approach to health promotion. It requires
a commitment to a safe and health-enhancing environment, as well as specific
health promotion interventions (Lister-Sharp et al 1999).
Effectiveness
6.7 Evaluations of school-based interventions have produced relatively weak
evidence of effectiveness, mainly showing changes in knowledge rather than behaviour.
Reviews suggest that half or less are partially effective in producing change
on a range of outcome measures (Foxcroft et al 1997; Gorman 1996).
6.8 Interactive programmes have been shown to be more effective than non-interactive
programmes and Project DARE (Black et al 1998; Ennet et al 1994). Other characteristics
of programmes which appear to contribute to success are parental or community
involvement and peer involvement. Media literacy training has been evaluated
separately in 2 studies and was shown to be effective (NIAAA 2000).
6.9 The Illawarra Drug Education Programme has had a delayed effect on level
of alcohol use 41/2 years after exposure to the project
(Lloyd et al 2000).
6.10 The health promoting schools approach has been shown to have some positive
impacts but is less successful at changing health damaging behaviours, such
as alcohol misuse (Lister-Sharp et al 1999).
Population groups
6.11 All interventions target school age children but the age groups vary
and results for particular interventions may not translate to other age groups.
The majority of interventions are aimed at the 11-14 age range.
Settings
6.12 No studies were found comparing alternative settings for the delivery
of programmes to the target group.
Providers
6.13 Mental health clinicians, teachers and peers have all been shown to
be effective providers of interactive interventions, provided proper training
is given (Black et al 1998). Choice of peers is an important factor.
Intensity of intervention
6.14 No studies have been undertaken to address this question directly.
Whilst the intensity of interventions, in terms of contact hours, is variable,
other aspects of the interventions also vary.
Quality and relevance of evidence
6.15 There are concerns about the quality of the evaluations. In particular,
the lack of information about comparison schools makes the results difficult
to interpret. It is likely that some form of drug use education was taking place
in control schools and this would tend to reduce the effect of the programmes
being evaluated. Longer-term follow up is required to establish impact on behaviour.
Other health promotion interventions
Introduction
6.16 This section is concerned with other forms of health promotion that
are not exclusively school-based. It includes mass media campaigns, community
prevention initiatives and other interventions.
Types of intervention
6.17 Mass media campaigns aim to communicate health promotion messages to
the general population through a variety of media. They are rarely carried out
within a research design that allows robust evaluation to take place. Media
campaigns can also form part of enforcement programmes.
6.18 There have been relatively few evaluations of community prevention
initiatives. Project Northland was a school and community intervention that
combined education with community action related to under-age drinking. Communities
Mobilizing for Change on Alcohol (CMCA) aimed to reduce under-age drinking and
related problems through reducing access to alcohol. The Communities Trials
Project (CTP) aimed to reduce alcohol-related injuries and deaths. Given the
type of initiatives pursued, there is some overlap with the legislation and
enforcement literature but the focus of interest here is the community setting.
6.19 One review of health promotion for teenagers refers to a well adolescent
clinic.
Effectiveness
6.20 In general, mass media campaigns relating to alcohol, tobacco or illicit
drugs show some effects on knowledge and attitudes but little on behaviour (Raistrick
et al 1999). Mass media campaigns can be successful if they model specific behaviours
or target particular risks, such as drink driving.
6.21 Project Northland resulted in reductions in alcohol use at 3 years.
The other community interventions had mixed results. CMCA produced changes in
the desired direction that were not statistically significant. Some but not
all of the components of CTP were effective.
6.22 The well adolescent clinic was shown to be effective in increasing
knowledge about alcohol but behaviour was not evaluated (Walker and Townsend
1999).
Population groups
6.23 Apart from mass media campaigns, only CTP was aimed at a general population.
The other interventions were aimed at teenagers and minors.
Settings
6.24 No studies were found comparing alternative settings for the delivery
of programmes.
Providers
6.25 No studies were found comparing alternative providers for the delivery
of programmes.
Intensity
6.26 The intensity of intervention was not addressed in the reviews. However,
there may be a cumulative effect in health promotion interventions.
Quality and relevance of evidence
6.27 There is a lack of good quality evaluations of community prevention
and other health promotion activities relating to alcohol misuse.
Cost-effectiveness
6.28 No studies relating to schools programmes or community prevention programmes
were found in the literature. The economic evaluations of preventive interventions
are summarised below.
Adolescent counselling
6.30 In a US study, Downs and Klein (1995) analysed the cost-effectiveness
of implementing office-based preventive services for adolescents. A cost-effectiveness
model of adolescents’ risky behaviours compared standard practice with
a programme of screening visits for all adolescents and counselling visits for
youths identified as 'high risk'. A range of effectiveness estimates was used
to compute the estimated cost-effectiveness of the programmes.
6.31 Adolescents aged 15-19 were the treatment population and the costing
was undertaken from a societal study perspective. One screening visit for all
adolescents and three counselling sessions for those screened as 'high risk'
were compared to a simple 'no intervention' strategy. In a multiple risk intervention
strategy, the outcome that related to alcohol abuse was motor vehicle crashes.
The cost of each screening was $50 a session ($250 for 5 screening events over
5 years) although it was not stated how this was derived, as unit costs of inputs
to care were not provided.
6.32 The results showed that at 5% efficacy the cost of preventing a motor
vehicle crash was $12,070 (£8,220) and the cost of preventing a death due to
a motor vehicle crash was $12 million (£8.17 million). The programme would prevent
roughly one death from an alcohol related motor vehicle crash. Therefore, in
terms of preventing alcohol problems, the programme does not appear cost-effective.
It should be noted that these results are of limited use outside the area in
which the study was undertaken, since not only are the risky behaviours different
but so are the motor vehicle statistics which generate the costs of accidents.
Prevention of Wernicke-Korsakoff syndrome
6.33 Connelly and Price (1996) examined the cost-effectiveness of thiamine-supplementation
alternatives in preventing the Wernicke-Korsakoff syndrome (WKE) in Australia.
Based on 40 dietary and beverage histories, the conditions under which the individuals
would benefit from thiamine supplements were defined. The incidence of WKE was
calculated in Australia and the number of people expected to benefit from three
schemes was estimated. The three schemes were different degrees of thiamine
supplementation; fortifying beer, fortifying beer and wine, and fortifying all
bread making flours. Three possible scenarios for the physiological benefits
of thiamine were applied to forty subjects’ histories. This gave the number
of potential cases of WKE averted from the improvements. The total costs of
fortifying beverages including equipment, additives, and assay costs were AUS$1
662 390 for beer only, for beer and wines AUS$2 834 918 and for bread making
flours AUS$4 821 121.
6.34 The cost per case averted, based on projections between 1992 and 2031,
ranged from AUS$662 (£235) (fortifying just beer) to AUS$19 553 (£6900) (fortifying
all bread making flours) (discounted at 0%). Alternative assumptions regarding
the physiological benefit and absorption rates for thiamine, showed costs to
range from AUS$1 104 (beers) to AUS$39 106 (bread). The most cost-effective
strategy for preventing WKE is fortifying full strength beer with thiamine.
The cost per case of WKE averted is least when beer alone is fortified. The
second most cost-effective strategy is supplementing beer and some wines, whilst
the least cost-effective is to supplement bread making flours with thiamine.
Further research
6.35 There is inadequate evidence concerning the effectiveness and cost-effectiveness
of interventions to prevent alcohol misuse. The main requirement is for better
designed studies, particularly with respect to the comparison groups, although
in some areas there is a dearth of any kind of study.
6.36 Much of the school-based health promotion literature reports results
in terms of the effect size relating to changes in the distribution of knowledge
or attitude scores. However, evidence of a significant effect size needs to
be further translated to understand whether the change is important, in the
same way that therapeutic studies may consider the clinical importance of differences
in outcome. The reported effect sizes are often small but whether the effect
size is worthwhile is unknown. Another area for research is the potential benefit
of targeting high-risk groups for health promotion. However, screening and intervening
with high-risk adolescents has been shown not to be cost-effectiveness in one
study. Such research would need to be carefully designed to avoid the danger
of labelling effects.
6.37 There is little research evidence relating to the costs and benefits
of community interventions. Evaluations should also consider the generalisability
of community programmes and their sustainability when resources to facilitate
the community action are withdrawn.
6.38 There is a continuing need to develop and evaluate novel interventions
in health promotion. Research is also required to consider whether there is
a cumulative effect of exposure to health promotion messages.
Table 6.1 Summary of Prevention Effectiveness Studies Reviewed
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Author(s) and Date
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Search Strategy
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Inclusion / Exclusion Criteria
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Quality Assessed
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Number of studies
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Target Group
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Main Findings
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Bagnall G and Fossey E Alcohol education initiatives in Scotland - a
current perspective. Drugs: education, prevention and policy 1996; 3(3):
249-265
|
Not reported
|
Not reported
|
Not reported
|
Not reported
|
Not reported
|
Descriptive review of initiatives in Scotland. Discusses content of school
curriculum and types of materials produced for use in schools. Innovative
schemes include involvement of health project workers in two schools,
workplace schemes, Grampian Server Training Initiative and designated
driver schemes. A scheme for training and supporting GPs in the provision
of brief interventions is described (Drinking Reasonably and Moderately
with Self-control (DRAMS)). No evaluation results are provided for any
of the schemes.
|
|
Belcher HME, Shinitzky HE. Substance Abuse in Children: Prediction, protection,
and prevention. Archives of Paediatric and Adolescent Medicine. 1998;
152: 952-60.
|
Yes.
|
Studies included were controlled, prospective and/or longitudinal of
either protective or risk factors for the development of substance abuse
or response to substance abuse prevention programs.
|
Not reported.
|
Number of studies not reported, but 18 different prevention programs
were included.
|
Young, Under age, included ethnic groups and various social classes.
|
Studies have found there is a genetic predisposition for alcohol abuse.
Biological children of alcohol-dependent parents who have been adopted
continue to have an increased risk (2- to 9- fold) of developing alcoholism.
Gender also appears to be a predictive factor for alcohol use. Heavy alcohol
use is almost 3 times more frequent in men. Childhood abuse has been implicated
as a significant risk factor for later substance abuse. Factors that contribute
to the emergence of substance abuse in the paediatric population are multi-factorial.
Behavioural, emotional, and environmental factors that place children
at risk for development of substance abuse may be remediated through prevention
and intervention programs that use research-based, comprehensive, culturally
relevant, social resistance skills training and normative education in
an active school-based learning format.
|
|
Black DR et al Peer helping/ involvement: an efficacious way to meet
the challenge of reducing alcohol, tobacco and other drug use amongst
youth? Journal of School health 1998; 68(3): 87-93
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Not reported
|
Included studies that concurrently addressed multiple substance use.
|
Not reported
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120
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Young people, school children (grades 6-8; age 11-14)
|
Based on a meta-analysis reported separately, this paper is concerned
with the general lessons for school-based drug prevention programmes.
Interactive peer interventions are more effective than non-interactive
programmes in minimising alcohol and other substance use in school children.
This is shown in both high quality experimental studies (56) and the total
set of studies (120). Interactive programmes were also superior to DARE.
Mental health clinicians, teachers and peers were all shown to be effective
as leaders provided that proper training was given. Cites two studies
where peer led groups were more effective. Most studies were conducted
at ages where drug use is lower and may not be generalisable to older
age groups. Recommends research to develop screening tests to target programmes
at high-risk groups.
|
|
Bruvold WH. A meta-analysis of the California school-based risk reduction
program. Journal of Drug Education. 1990; 20(2):139-52.
|
Not reported.
|
Studies included had a control or comparison group; pre-intervention
assessment of intervention and comparison groups on knowledge and behaviours;
and measurements that tracked individual change on each construct assessed
|
The inclusion criteria used ensured only studies with sound methods were
included in the review.
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8 studies.
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Young, School pupils.
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The aim was to determine whether interventions based upon different models
have different effects on knowledge, attitudes, and behaviour regarding
alcohol and tobacco products.
Effect sizes averaged over alcohol analyses for knowledge, attitude and
behavioural outcomes indicate that rational programs have larger effect
sizes for knowledge (0.61) than do developmental programs (0.26). The
reverse is indicated for attitude and behaviour outcomes where developmental
programs have larger average effect sizes. (-0.01, 0.02 - rational programs
and 0.04, 0.20 — developmental programs) respectively. It is important
to know which of the 4 theoretical approaches (rational, social learning,
development, and social norms) is most efficacious in deterring adolescents
from the use of alcohol. Developmental interventions (aimed at changing
attitude and behaviour) seem to be more effective when based on clearly
identified theoretical basis. It appears that the informational or rational
approach has little systematic impact on behaviour and that alternative
approaches, such as the developmental approach, have more promise for
actually deterring drug use.
Tobler NS 1986, found similar results.
|
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Ennett ST et al How effective is drug abuse resistance education? A meta-analysis
of Project DARE outcome evaluations. American Journal of Public Health
1994; 84(9): 1394-1401
|
Not reported
|
Included studies with control or comparison group, before and after design
or post intervention with random assignment and quantitative outcome measures.
|
Yes
|
8 studies out of 18 met the inclusion criteria.
|
School age children
|
This review provides a meta-analysis of evaluations of DARE programs
and a comparison of the effect size for DARE with other school-based drug
use prevention programmes. Only 3 of the 8 DARE studies had any randomisation
in allocation of schools; half the studies matched schools on demographic
characteristics. All studies adjusted for pretest differences in outcome
measures.
Effect size was greatest for knowledge (0.42) and smallest and not significant
for drug use (0.06). Across the areas of knowledge, attitudes, social
skills and drug use, effect sizes for DARE were less than for other interactive
programmes.
Evaluations lacked information on interventions that may have taken place
in control groups and it is likely that some drug education took place.
|
|
Foxcroft DR et al Alcohol misuse prevention for young people: a systematic
review reveals methodological concerns and lack of reliable evidence of
effectiveness. Addiction 1997; 92(5): 531-537
|
Yes
|
Included evaluations of primary or secondary prevention programmes with
experimental or quasi-experimental design.
|
Yes
|
48 papers covering 33 studies. 22 were general drug misuse and 11 targeted
alcohol
|
Young people aged 8-25
|
Only 10 studies met all 4 core requirements on quality criteria. Overall,
no programme was judged to be convincingly effective. Half the programmes
were partially effective, in that some of the self report measures were
positively influenced in follow up at one year. One of these was a social
skills programme with young offenders in Scotland. One study with long
term follow up (6 years) was partially effective. This Life Skills Training
intervention produced a 10% drop in prevalence of self reported drunkenness.
Most of the studies reviewed were of US origin and their aim was non-drinking
rather than sensible drinking.
|
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Gorman DM. Do school-based social skills training programs prevent alcohol
use among young people? Addiction Research 1996; 4(2): 191-210.
|
Not reported. |
Studies were excluded if they did not employ an experimental or quasi-experimental
design with both baseline and post-test assessment and if they did not
report program effects on actual alcohol use.
|
Not reported
|
12 studies
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Under age, Young (under 18 years).
|
Six of the 12 evaluations of social skills training prevention programs
found little or no effect on participants’ alcohol use and related
behaviour. Only 3 studies reported consistently positive results. These
studies involved the fewest subjects (n=239, n=102 and n=137), and each
presented difficulties in the interpretation of findings. It is suggested
that resistance skills training may actually increase adolescents’
perception of the prevalence of alcohol use by overstating the extent
to which there is pressure to use, and hence be counterproductive. It
is also argued that school-based programs must be refined in terms of
the strategies through which they are delivered, and move away from the
"universal" approach and toward "targeting" or "matching"
interventions more appropriately to the profile of risk factors evident
among subgroups within broad populations.
|
|
Gorman DM, Speer PW. Preventing Alcohol Abuse and Alcohol-related Problems
through Community Interventions: A review of evaluation studies. Psychology
and Health. 1996; 11: 95-131.
|
Not reported.
|
Included: evaluations of projects concerned with alcohol abuse prevention
and the prevention of both alcohol abuse and illicit drug use; programs
which included components designed to affect the knowledge, attitudes
and/or behaviour of the general populace of a community; reports dealing
with the design, implementation and evaluation of a specific prevention
program were included.
|
Yes.
|
8 studies, including 3 large-scale projects recently commenced in the
USA.
|
Men, Women, Young, Under age. People living in Rural and Urban areas.
People who are heavy drinkers.
|
The programs considered in this review had limited impact. Suggested
reasons for this are that most attempts at preventing alcohol use and
abuse rely upon individual-level interventions, which have not been shown
to lead to substantial, long-term change in alcohol use and abuse; that
most prevention efforts take the form of standardised programs devised
by outside experts, with minimal citizen participation in their development
and little attention to the unique systems-level factors that generate
alcohol-related problems within the target community; and it has proved
difficult to generate community involvement in such programs. In many
parts of the USA, inner city residents have began to develop initiatives
designed, not to "inoculate" local youth against alcohol-related
problems, but rather to limit the availability of alcohol within their
communities and regulate the marketing and sales practices of local merchants.
Prevention research should move away from the use of standardised programs
and curricula towards a meaningful involvement of local citizens in the
design and implementation on community interventions.
|
|
Lister-Sharp D et al Health promoting schools and health promotion in
schools: two systematic reviews. Health Technology Assessment 1999; 3(22)
|
Yes
|
1. Review of health promoting schools included controlled or before and
after studies reporting all evaluated outcomes.
2. Studies included in review of reviews of effectiveness of health promotion
in schools had systematic searches, quality assessment of studies, comparison
groups in at least some studies and reported study details.
|
Yes
|
1. 12 studies met the inclusion criteria from 111 identified.
2. 32 reviews met the inclusion criteria from over 200 identified. 4 had
alcohol as their primary focus
|
School children
|
This was a review of all health promotion in schools. The results for
alcohol related to 63 programmes reporting alcohol outcomes. Of these,
25 reported some short-term beneficial effects, 30 had no effect and 7
had negative effects. 14 programmes had follow up periods of 6 months
or more and those which had an effect on behaviour remained effective
for up to 2 years. Two programmes had 5 year follow up and one of these
showed significant effects (Life Skills Training).
Factors which increased the success of programmes were peer involvement,
inclusion of resistance skills, stress management and / or norm setting,
and parental involvement.
The health promoting schools approach can have a positive impact but in
the studies reviewed was less likely to change behaviour relating to alcohol
misuse than other health behaviour.
The direct costs of health promoting schools initiatives in England are
reported as £6000 per school per year.
|
|
Lloyd C et al The effectiveness of Primary School Drug Education. Drugs:
education, prevention and policy 2000; 7(2): 109-126
|
Not reported
|
Included evaluations of programmes which included illicit drugs. Alcohol
only studies would be excluded
|
Not reported
|
3 studies in the UK and 8 elsewhere.
|
Children aged 3-15.
|
Evaluations tend to focus on process or intermediate outcomes; knowledge,
attitude and social skills. No alcohol related results are reported for
UK studies. In the US, Drug Abuse Resistance Education (DARE) shows some
short-term effects which disappear over longer-term follow up. Life Education
Centres have been popular with children and teachers but are not well-evaluated.
An Australian programme targeted at ages 10-11 showed a delayed effect
on level of alcohol use after 41/2 years. A 5 year
programme targeted at high risk youth showed a significant decrease in
the proportion ever using alcohol and in the proportion using alcohol
in the past 30 days.
|
|
May C Research on alcohol education for young people: a critical review
of the literature. Health Education Journal 1991; 50(4): 195-9
|
Not reported
|
Not reported
|
Not reported
|
Not reported
|
Young adults, adolescents
|
This is an early review of educational interventions, mainly delivering
facts about alcohol. These interventions provide knowledge but do not
change attitudes or behaviour. Whilst skills based approaches appear more
promising, the early evaluations reviewed here had disappointing results.
Mass media campaigns also impact on knowledge rather than behaviour. Structural
constraints on alcohol consumption may be more effective.
|
|
Murphy-Brennan, M G and Oei T P S Is there evidence to show that fetal
alcohol syndrome can be prevented ? Journal of Drug Education 1999 29(1)
: 5-24
|
Not reported
|
Primary and secondary prevention programmes about alcohol use during
pregnancy
|
Not reported
|
5 studies
|
Pregnant women and other population groups
|
Prevention strategies have been aimed at raising awareness of FAS across
all groups and have been effective in this. This awareness has not been
translated into behaviour changes in high risk drinkers. The future priority
should be teaching strategies for behaviour change.
|
|
National Institute on Alcohol Abuse and Alcoholism, 10th Special
Report to the US Congress on Alcohol and Health June 2000.
|
|
|
|
|
|
Project Northland was a school and community based intervention targeted
at 11-14 year olds. After 3 years, students in the intervention sites
had lower rates of alcohol use. Rates of use did not change for children
who were already using alcohol at the start of the study.
Communities Mobilizing for Change on Alcohol was an initiative in which
communities were encouraged to develop their own specific interventions
to reduce under-age access to alcohol. Interventions varied across communities.
Although changes occurred in the desired direction, they were not statistically
significant.
The Community Trials Project had 5 interacting components aimed at reducing
alcohol related injuries and deaths. Results were mixed; for example,
voluntary server training was not effective at the community level but
outlets in intervention sites were half as likely to sell alcohol to an
apparent minor.
Media literacy interventions may be a component of school education programmes
but 2 evaluations have shown the effectiveness of this approach. Alcohol
specific training was more effective than general media literacy intervention.
The effect was greater on girls than boys.
|
|
Raistrick D et al Tackling Alcohol Together The Evidence Base for UK
Alcohol Policy.1999 Free Association Books London
|
|
|
|
|
|
Personal development programmes do not appear to be effective in preventing
alcohol misuse amongst adolescents. 5 out of 16 studies of resistance
skills training reported positive findings but the evidence is not strong;
for example, controls were not well matched.
Evaluations of mass media education campaigns show some effects on knowledge
and attitudes but little on behaviour. Media campaigns may be more effective
if targeted at specific behaviours, such as drink driving, and when they
support community action. Little is known about the cumulative effect
of campaigns.
|
|
Rundall TG and Bruvold WH A meta-analysis of school-based smoking and
alcohol use prevention programs. Health Education Quarterly 1988; 15(3):
317-334
|
Not reported
|
Included evaluations of school-based programmes with a comparison or
control group and reporting quantitative results relating to behaviour,
attitudes or knowledge.
|
Yes
|
19 alcohol programmes
|
School children
|
This is an older review and the programmes covered may not reflect current
practice. All of the alcohol studies showed increases in knowledge. Most
of the alcohol studies changed student attitudes but effect sizes were
smaller. Effect sizes for behaviour change were also small. Innovative
interventions (social reinforcement, social norms and developmental behavioural
models) are more effective than traditional awareness programmes.
|
| Spoth R, Redmond C, Lepper H. Alcohol initiation
outcomes of universal family-focused preventative interventions: One and
two year follow-ups of a controlled study. Journal of Studies on Alcohol
1999; 13: 103-11. |
Not reported. |
Not reported. |
Yes |
4 studies were identified from other reviews. One
related to the project reported in the paper. |
Men, Women, Young, Under age, Rural. |
This study gives an overview of the literature on family focused interventions
and reports results from a specific intervention (the Iowa Strengthening
Families Project (ISFP)). Family context factors have been shown to be
important in explaining variation in adolescent alcohol outcomes but there
is a lack of good quality evaluations of freestanding family interventions.
Family components of wider studies, such as Project Northland, could not
be separately evaluated. For the ISFP, the intervention reduced the proportion
of children becoming alcohol users at 1 and 2 years. At 1 year, effect
sizes were greater for families attending at least half of the sessions
but this could be explained by self-selection and motivation.
|
|
Tobler NS. Meta-analysis of 143 adolescent drug prevention programs:
Quantitative outcome results of program participants compared to a control
or comparison group. The Journal of Drug Issues. 1986; 16(4): 537-67.
|
Published and unpublished literature was searched from 1972—1984.
|
Included studies had quantitative measurements on relevant outcome measures;
a control / comparison group; age level inclusive of secondary school
population, grades 5-12; and primary prevention as the goal.
|
Not reported
|
98 studies were included, which involved 143 different program modalities.
|
Young people social class, ethnic groups, urban and rural locations.
|
The aim was to identify specific modalities or combinations of modalities
which have been effective in reducing the high incidence of teenage drug
abuse.
For 143 drug prevention programs a grand mean (effect size) of 0.30 was
measured over all the outcome measures. Two modalities were identified
as being effective. Peer Programs were found to show a definite superiority
for the magnitude of the effect size obtained on all outcome measures
(effect size 0.44). This was done with low intensity programmes making
them very cost-effective for the general school-based programs. Alternative
programs were equally successful for the special population groups, showing
superior results in increasing skills and changing behaviour in both direct
and indirect correlates of drug use. These programs were very intensive
and involved costly programming, but they did change the behaviour of
a nearly implacable population.
|
|
Tobler NS, Stratton HH. Effectiveness of school-based drug prevention
programs: A meta-analysis of the research. The Journal of Primary Prevention.
1997; 18(1):71-128.
|
Published and unpublished reports from public or private sponsorships
at the local, state, and national levels were searched for.
|
Studies included were: school-based drug prevention programs; used quantitative
drug use measures; had a control / comparison group; involved grades 6-13;
had goals of primary and/or secondary prevention and/or early intervention;
involved all ethnic groups that comprise the school’s population;
located in the US/Canada; and reported / published after 1977.
|
Not reported. A subset of high-quality experimental programs were chosen
to prevent over-estimation of program success and limit potential sources
of bias.
|
90 studies concerning 120 programs. Of the 120 programs, 28 (23.3%) concerned
alcohol.
|
Young people of various social class, ethnic group, and urban and rural
locations.
|
For the 28 studies concerning alcohol specific programs no significant
difference was found between the means of the non-interactive and interactive
programs. The interactive programs were significantly better than the
non-interactive programs p=0.000 (1st post-test) versus p=0.000
(mean across time). The interactive programs were significantly better
than non-interactive programs in the set of 56 programs; p=0.015 (1st
post-test) versus p=0.015 (across time). The superiority of the interactive
programs to the non-interactive programs was both clinically and statistically
significant for tobacco, alcohol, marijuana and illicit drugs and for
all adolescents including minority populations. The larger interactive
programs were less effective, although still significantly superior to
the non-interactive programs, which suggests implementation failures.
Currently, non-interactive programs are used by the overwhelming majority
of schools. Replacing the present programs would increase the effectiveness
of school-based programs by 8.5% (r = 0.085). It is important for the
schools to provide the necessary money, class time, extra personnel and
aggressive teacher training in the use of interactive group process skills.
Without the extra leaders to form small groups, the adolescents can interact
only a few times and the essential part of the interactive programs is
missing, that of involvement, exchange and validation of ideas with their
peers, and enough time to practice and truly acquire interpersonal skills.
|
|
Walker ZAK and Townsend J The role of general practice in promoting teenage
health: a review of the literature. Family Practice 1999; 16(2): 164-172
|
Yes
|
Not reported
|
Not reported
|
|
Teenagers
|
This was a general review of health promotion interventions. A well-adolescent
clinic for 13-18 year olds showed increases in knowledge for both alcohol
and marijuana when given either computer assisted instruction or physician
delivered guidance. Behavioural outcomes were not assessed.
|
|
White D and Pitts Marian Educating young people about drugs: a systematic
review. Addiction 1998; 93(10): 1475-1487
|
Yes
|
Included studies of psycho-educational prevention measures with control
or comparison groups and both baseline and outcome measures.
|
Yes
|
71 reports of 62 separate evaluations
|
Young people aged 8-25
|
Separate results for alcohol are not reported. Impact of programmes was
small and tended to diminish over time. The best that was achieved was
a short-term delay in onset of drug use and short-term reductions in level
of use by those already using. The issue of what effect size is a worthwhile
outcome of an intervention is raised but not answered.
|
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