Aims: Alcohol misuse by young people causes significant health and social harm, including death and disability. Therefore, prevention of youth alcohol misuse is a policy aim in many countries. Our aim was to examine the effectiveness of (1) school-based, (2) family-based and (3) multi-component universal alcohol misuse prevention programmes in children and adolescents.
Methods: Three Cochrane systematic reviews were performed: searches in MEDLINE, EMBASE, PsycINFO, Project CORK and the Cochrane Register of Controlled Trials up to July 2010, including randomised trials evaluating universal alcohol misuse prevention programmes in school, family or multiple settings in youths aged 18 years or younger. Two independent reviewers identified eligible studies and any discrepancies were resolved via discussion.
Results: A total of 85 trials were included in the reviews of school (n = 53), family (n = 12) and multi-component (n = 20) programmes. Meta-analysis was not performed due to study heterogeneity. Most studies were conducted in North America. Risk of bias assessment revealed problems related to inappropriate unit of analysis, moderate to high attrition, selective outcome reporting and potential confounding. Certain generic psychosocial and life skills school-based programmes were effective in reducing alcohol use in youth. Most family-based programmes were effective. There was insufficient evidence to conclude that multiple interventions provided additional benefit over single interventions.
Conclusions: In these Cochrane reviews, some school, family or multi-component prevention programmes were shown to be effective in reducing alcohol misuse in youths. However, these results warrant a cautious interpretation, since bias and/or contextual factors may have affected the trial results. Further research should replicate the most promising studies identified in these reviews and pay particular attention to content and context factors through rigorous evaluation.
FoxcroftDIrelandDLister-SharpDJLoweGBreenR.Primary prevention for alcohol misuse in young people. Cochrane Database of Systematic Reviews2002; Issue 3: Art. no.: CD003024. DOI: 10.1002/14651858.CD003024.pub210.1002/14651858.CD003024.pub2
AndersonPBaumbergB. Alcohol in Europe. London: Institute of Alcohol Studies, 2006
4.
RehmJRoomRvan den BrinkWJacobiF. Alcohol use disorders in EU countries and Norway: An overview of the epidemiology. European Neuropsychopharmacology2005; 15: 377–88
5.
PitkanenTLyyraA-LPulkkinenL. Age of onset of drinking and the use of alcohol in adulthood: A follow-up study from age 8–42 for females and males. Addiction2005; 100: 652–61
6.
WarnerLAWhiteHR. Longitudinal effects of age at onset and first drinking situations on problem drinking. Substance Use and Misuse2003; 38: 1983–2016
7.
ZakrajsekJSShopeJT. Longitudinal examination of underage drinking and subsequent drinking and risky driving. Journal of Safety Research2006; 37: 443–51
8.
DawsonDAGoldsteinRBChouSPRuanWJGrantBF. Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders. Alcoholism: Clinical and Experimental Research2008; 32: 2149–60
9.
HingsonRHeerenTWinterMRWechslerH. Early age of first drunkenness as a factor in college students’ unplanned and unprotected sex attributable to drinking. Pediatrics2003; 111: 34–41
10.
HingsonRHeerenTZackosRWinterMWechslerH. Age of first intoxication, heavy drinking, driving after drinking, and risk of unintentional injury among US college students. Journal of Studies on Alcohol2003; 64: 23–31
11.
HingsonRWHeerenTWinterMR. Age at drinking onset and alcohol dependence: Age at onset, duration, and severity. Archives of Pediatrics and Adolescent Medicine2006; 160: 739–46
12.
FoxcroftDRTsertsvadzeA. Universal multi-component prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews. 2011; Issue 9: Art. no.: CD009307. DOI: 10.1002/14651858.CD00930710.1002/14651858.CD009307
13.
FoxcroftDRTsertsvadzeA. Universal family-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews2011; Issue 9: Art. No.: CD009308. DOI: 10.1002/14651858.CD00930810.1002/14651858.CD009308
14.
FoxcroftDRTsertsvadzeA. Universal school-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews2011; Issue 5: Art. No.: CD009113. DOI: 10.1002/14651858.CD00911310.1002/14651858.CD009113
15.
FoxcroftDIrelandDLister-SharpDLoweGBreenR. Longer-term primary prevention for alcohol misuse in young people: A systematic review. Addiction2003; 98: 397–411
16.
HigginsJPTGreenS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. Oxford: The Cochrane Collaboration, 2009
17.
DuryeaEMohrPNewmanIMMartinGLEgwaojeE. Six-month follow-up results of a preventive alcohol education intervention. Journal of Drug Education1984; 14: 97–104
18.
GoodstadtMSSheppardMA. Three approaches to alcohol education. Journal of Studies on Alcohol1983; 44: 362–80
19.
NewmanIMAndersonCSFarrellKA. Role rehearsal and efficacy: Two 15-month evaluations of a ninth-grade alcohol education program. Journal of Drug Education1992; 22: 55–67
20.
SheehanMSchonfeldCBallardRSchofieldFNajmanJSiskindV. A three year outcome evaluation of a theory based drink driving education program. Journal of Drug Education1996; 26: 295–312
21.
WilliamsAFDiCiccoLMUnterbergerH. Philosophy and evaluation of an alcohol education programme. Quarterly Journal of Studies on Alcohol1968; 29: 685–702
22.
DielmanTEShopeJTButchartATCampanelliPC. Prevention of adolescent alcohol misuse: An elementary school programme. Journal of Pediatric Psychology1986; 11: 259–82
23.
McBrideNFarringdonFMidfordRMeulenersLPhillipsM. Early unsupervised drinking – reducing the risks. The School Health and Alcohol Harm Reduction Project. Drug and Alcohol Review2003; 22: 263–76
24.
MorgensternMWiborgGIsenseeBHanewinkelR. School-based alcohol education: Results of a cluster-randomized controlled trial. Addiction2009; 104: 402–12
25.
PerryCLGrantM. Comparing peer-led to teacher-led youth alcohol education in four countries (Australia, Chile, Norway and Swaziland). Alcohol Health & Research World. 1988;12: 322–6
26.
VoglLTeessonMAndrewsGBirdKSteadmanBDillonP. A computerized harm minimization prevention program for alcohol misuse and related harms: Randomized controlled trial. Addiction2009; 104: 564–75
27.
WilhelmsenBULabergJCKleppKI. Evaluation of two student and teacher involved alcohol prevention programmes. Addiction1994; 89: 1157–65
28.
BotvinGJBakerEDusenburyLBotvinEMDiazT. Long-term follow-up results of a randomized drug abuse prevention trial. Journal of the American Medical Association1995; 273: 1106–12
29.
BotvinGJBakerERenickNFilazzolaADBotvinEM. A cognitive behavioral approach to substance abuse prevention. Addictive Behaviors1984; 9: 137–47
30.
BotvinGJGriffinKWDiazTIfill-WilliamsM. Preventing binge drinking during early adolescence: One-and two-year follow-up of a school-based preventive intervention. Psychology of Addictive Behaviors2001; 15: 360–5
31.
CaplanMWeissbergRPGroberJSSivoPGradyKJacobyC. Social competence promotion with inner city and suburban young adolescents: Effects on social adjustment and alcohol use. Journal of Consulting and Clinical Psychology1992; 60: 56–63
32.
CookRLawrenceHMorseCRoehlJ. An evaluation of the alternatives approach to drug abuse prevention. International Journal of the Addictions1984; 19: 767–87
33.
EisenMZellmanGLMassettHAMurrayDM. Evaluating the Lions-Quest ‘Skills for Adolescence’ drug education program: First-year behavior outcomes. Addictive Behaviors2002; 27: 619–32
34.
EllicksonPLMcCaffreyDFGhosh-DastidarBLongshoreDL. New inroads in preventing adolescent drug use: Results from a large-scale trial of project ALERT in middle schools. American Journal of Public Health2003; 93: 1830–6
35.
FaggianoFRichardsonCBohrnKGalantiMR, EU-Dap Study Group. A cluster randomised controlled trial of school-based prevention of tobacco, alcohol and drug use: The EU-Dap design and study population. Preventive Medicine2007; 44: 170–3
36.
GriffinJPHollidayRCFrazierEBraithwaiteRL. The BRAVE (Building Resiliency and Vocational Excellence) Program: Evaluation findings for a career-oriented substance abuse and violence preventive intervention. Journal of Health Care for the Poor & Underserved2009; 20: 798–816
37.
HechtMLMarsigliaFFElekEWagstaffDAKulisSDustmanP. Culturally-grounded substance use prevention: An evaluation of the keepin’ it REAL curriculum. Prevention Science2003; 4: 233–48
38.
KellamSReidJBalsterRL. Effects of a universal classroom behavior program in first and second grades on young adult outcomes. Drug and Alcohol Dependence2008; 95(Suppl 1): S5–S28
39.
ScaggsLS. A substance abuse awareness prevention program: Knowledge, attitudes and behaviours. Unpublished PhD dissertation, Ohio State University, 1985
40.
SchinkeSPTepavacLColeKC. Preventing substance use among Native American youth: Three-year results. Addictive Behaviours2000; 25: 387–97
41.
van LierPACHuizinkACrijnenA. Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years. Drug and Alcohol Dependence2009; 100: 228–33
42.
FaggianoFVigna-TagliantiFBurkhartGBohrnKCuomoLGregoriD. The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomised controlled trial. Drug and Alcohol Dependence2010; 108: 56–64
43.
BaumanKEEnnettSTFosheeVAPembertonMKingTSKochGG. Influence of a family program on adolescent smoking and drinking prevalence. Prevention Science2002; 3: 35–42
44.
BrodyGHMurryVMKoganSMGerrardMGibbonsFXMolgaardV. The Strong African American Families Program: A cluster-randomised prevention trial of long-term effects and a mediational model. Journal of Consulting and Clinical Psychology2006; 74: 356–66
45.
Loveland-CherryCJThomson-RossLKaufmanSR. Effects of a home-based family intervention on adolescent alcohol use and misuse. Journal of Studies on Alcohol1999; Suppl 13: 94–102
46.
O’DonnellLMyintUADuranRStueveA. Especially for daughters: Parent education to address alcohol and sex-related risk taking among urban young adolescent girls. Health Promotion Practice2010; 11: 70S–8S
47.
SchinkeSPColeKCFangL. Gender-specific intervention to reduce underage drinking among early adolescent girls: A test of a computer-mediated, mother-daughter program. Alcohol and Drugs2009; 70: 70–7
48.
SchinkeSPFangLColeKC. Computer-delivered, parent-involvement intervention to prevent substance use among adolescent girls. Preventive Medicine2009; 49: 429–35
49.
SchinkeSPFangLColeKC. Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother–daughter program. Addictive Behaviors2009; 34: 1060–4
50.
SpothRRedmondCLepperH. Alcohol initiation outcomes of universal family-focused preventive interventions: One-and two-year follow-ups of a controlled study. Journal of Studies on Alcohol1999; Suppl 13: 103–11
51.
WerchCCMooreMJDiclementeCC. Brief image-based health behavior messages for adolescents and their parents. Journal of Child and Adolescent Substance Abuse2008; 17: 19–40
52.
KoningIMVolleberghWSmitFVerdurmenJvan den EijndenRter BogtT. Preventing heavy alcohol use in adolescents (PAS): Cluster randomized trial of a parent and student intervention offered separately and simultaneously. Addiction2009; 104: 1669–78
53.
StevensMMOlsonALGaffneyCATostesonTDMottLAStarrP. A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics2002; 109: 490–7
54.
ShorttALHutchinsonDMChapmanRToumbourouJW. Family, school, peer and individual influences on early adolescent alcohol use: First-year impact of the Resilient Families programme. Drug and Alcohol Review2007; 26: 625–34
55.
ReddyKSAroraMPerryCLNairBKohliALytleLA. Tobacco and alcohol use outcomes of a school-based intervention in New Dehli. American Journal of Health Behavior2002; 26: 173–81
56.
BrownECCatalanoRFFlemingCBHaggertyKPAbbottRD. Adolescent substance use outcomes in the Raising Healthy Children project: A two-part latent growth curve analysis. Journal of Consulting & Clinical Psychology2005; 73: 699–710
57.
EddyJMReidJBFetrowRA. An elementary school based prevention program targeting modifiable antecedents of youth delinquency and violence: Linking the Interests of Families and Teachers (LIFT). Journal of Emotional and Behavioral Disorders2000; 8: 165–76
58.
HawkinsJDOesterleSBrownECArthurMWAbbottRDFaganAA. Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: A test of communities that care. Archives of Pediatrics and Adolescent Medicine2009; 163: 789–98
59.
PerryCLWilliamsCLVeblen-MortensonSToomeyTLKomroKAAnstinePS. Project Northland: Outcomes of a community wide alcohol use prevention program during early adolescence. American Journal of Public Health1996; 86: 956–65
60.
SchinkeSPSchwinnTMDi NoiaJColeKC. Reducing the risks of alcohol use among urban youth: Three-year effects of a computer-based intervention with and without parent involvement. Journal of Studies on Alcohol2004; 65: 443–9
61.
SlaterMDKellyKJEdwardsRWThurmanPJPlestedBAKeefeTJ. Combining in-school and community-based media efforts: Reducing marijuana and alcohol uptake among younger adolescents. Health Education Research2006; 21: 157–67
62.
WerchCPappasDCarlsonJEdgemontPSinderJDiClementeC. Evaluation of a brief alcohol prevention program for urban school youth. American Journal of Health Behavior2000; 24: 120–31
63.
WerchCCMooreMJDiClementeCCBledsoeRJobliE. A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents. Prevention Science2005; 6: 213–26
64.
WerchCEMooreMMDiclementeCCOwenDMCarlsonJMJobliE.Singlevs. multiple drug prevention: Is more always better? A pilot study. Substance Use and Misuse2005; 40: 1085–101
65.
WuYStantonBFGalbraithJKaljeeLCottrellLLiX. Sustaining and broadening intervention impact: A longitudinal randomised trial of 3 adolescent risk reduction approaches. Pediatrics2003; 111: 32–8
66.
SpothRRedmondCTrudeauLShinC. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviours2002; 16: 129–34
67.
WerchCMooreMDiClementeCCOwenDMJobliEBledsoeR. A sport-based intervention for preventing alcohol use and promoting physical activity among adolescents. Journal of School Health2003; 73: 380–8
68.
Furr-HoldenCDIalangoNSAnthonyJCPetrasHKellamSG. Developmentally inspired drug prevention: Middle school outcomes in a school-based randomized prevention trial. Drug and Alcohol Dependence2004; 73:149–58
69.
KomroKAPerryCLVeblen-MortensonSFarbakhshKKuglerKCAlfanoKA. Cross-cultural adaptation and evaluation of a home-based program for alcohol use prevention among urban youth: The ‘Slick Tracy Home Team Program’. Journal of Primary Prevention2006; 135–54
70.
PerryCLKomroKAVeblen-MortensenSBosmaLMFarbakhshKMunsonKA. A randomized controlled trial of the middle and junior high school DARE and DARE plus programs. Archives of Pediatrics and Adolescent Medicine2003; 157: 178–84
71.
Simons-MortonBHaynieDSaylorKCrumpADChenR. The effects of the going places program on early adolescent substance use and antisocial behavior. Prevention Science2005; 6: 187–97
72.
SpothRRedmondCShinCGreenbergMClairSFeinbergM. Substance-use outcomes at 18 months past baseline: The PROSPER Community–University Partnership Trial. American Journal of Preventive Medicine2007; 32: 395–402
73.
FoxcroftDRLister-SharpDLoweG. Alcohol misuse prevention for young people: A systematic review reveals methodological concerns and lack of reliable evidence of effectiveness. Addiction1997; 92: 531–7
FlayBRBiglanABoruchRFCastroFGGottfredsonDKellamS. Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science2005; 6: 151–75
76.
IoannidisJPA. Why most published research findings are false. PLoS Medicine2005; 2: 696–701
77.
AbrahamCMichieS. A taxonomy of behavior change techniques used in interventions. Health Psychology2008; 27: 379–87
78.
HansenWBDusenburyLBishopDDerzonJH. Substance abuse prevention program content: Systematizing the classification of what programs target for change. Health Education Research2007; 22: 351–60
79.
RyleG. The Concept of Mind. Chicago, IL: University of Chicago Press, 1949
