Skip to main content
Top
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

The influence of socioeconomic environment on the effectiveness of alcohol prevention among European students: a cluster randomized controlled trial

Authors: Maria Paola Caria, Fabrizio Faggiano, Rino Bellocco, Maria Rosaria Galanti

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

Although social environments may influence alcohol-related behaviours in youth, the relationship between neighbourhood socioeconomic context and effectiveness of school-based prevention against underage drinking has been insufficiently investigated. We study whether the social environment affects the impact of a new school-based prevention programme on alcohol use among European students.

Methods

During the school year 2004-2005, 7079 students 12-14 years of age from 143 schools in nine European centres participated in this cluster randomised controlled trial. Schools were randomly assigned to either control or a 12-session standardised curriculum based on the comprehensive social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. Data were analysed using multilevel models, separately by socioeconomic level.

Results

At baseline, adolescents in schools of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness (OR = 0.60, 95% CI = 0.44-0.83), intention to get drunk (OR = 0.60, 95% CI = 0.45-0.79), and marginally alcohol-related problem behaviours (OR = 0.70, 95% CI = 0.46-1.06). No significant programme's effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools, although the estimates did not attain statistical significance in any subgroup.

Conclusions

It is plausible that comprehensive social influence programmes have a more favourable effect on problematic drinking among students in underprivileged social environments.

Trial registration

Appendix
Available only for authorised users
Literature
1.
go back to reference Jernigan DH: Global Status Report: Alcohol and Young People. 2001, World Health Organization Jernigan DH: Global Status Report: Alcohol and Young People. 2001, World Health Organization
2.
go back to reference Rehm J, Gmel G: Average volume of alcohol consumption, patterns of drinking and mortality among young Europeans in 1999. Addiction. 2002, 97: 105-109. 10.1046/j.1360-0443.2002.0050k.x.CrossRefPubMed Rehm J, Gmel G: Average volume of alcohol consumption, patterns of drinking and mortality among young Europeans in 1999. Addiction. 2002, 97: 105-109. 10.1046/j.1360-0443.2002.0050k.x.CrossRefPubMed
3.
go back to reference Hingson R, Heeren T, Winter MR, Wechsler H: Early age of first drunkenness as a factor in college students' unplanned and unprotected sex attributable to drinking. Pediatrics. 2003, 111: 34-41. 10.1542/peds.111.1.34.CrossRefPubMed Hingson R, Heeren T, Winter MR, Wechsler H: Early age of first drunkenness as a factor in college students' unplanned and unprotected sex attributable to drinking. Pediatrics. 2003, 111: 34-41. 10.1542/peds.111.1.34.CrossRefPubMed
4.
go back to reference Hingson RW, Heeren T, Jamanka A, Howland J: Age of drinking onset and unintentional injury involvement after drinking. JAMA. 2000, 284: 1527-1533. 10.1001/jama.284.12.1527.CrossRefPubMed Hingson RW, Heeren T, Jamanka A, Howland J: Age of drinking onset and unintentional injury involvement after drinking. JAMA. 2000, 284: 1527-1533. 10.1001/jama.284.12.1527.CrossRefPubMed
5.
go back to reference Ellickson PL, McCaffrey DF, Ghosh-Dastidar B, Longshore DL: New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools. Am J Public Health. 2003, 93: 1830-1836. 10.2105/AJPH.93.11.1830.CrossRefPubMedPubMedCentral Ellickson PL, McCaffrey DF, Ghosh-Dastidar B, Longshore DL: New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools. Am J Public Health. 2003, 93: 1830-1836. 10.2105/AJPH.93.11.1830.CrossRefPubMedPubMedCentral
6.
go back to reference Hingson R, Heeren T, Zakocs R: Age of drinking onset and involvement in physical fights after drinking. Pediatrics. 2001, 108: 872-877. 10.1542/peds.108.4.872.CrossRefPubMed Hingson R, Heeren T, Zakocs R: Age of drinking onset and involvement in physical fights after drinking. Pediatrics. 2001, 108: 872-877. 10.1542/peds.108.4.872.CrossRefPubMed
7.
go back to reference Wichstrom L: Alcohol intoxication and school dropout. Drug Alcohol Rev. 1998, 17: 413-421. 10.1080/09595239800187251.CrossRefPubMed Wichstrom L: Alcohol intoxication and school dropout. Drug Alcohol Rev. 1998, 17: 413-421. 10.1080/09595239800187251.CrossRefPubMed
8.
go back to reference Lerner RM, Galambos NL: Adolescent development: challenges and opportunities for research, programs, and policies. Annu Rev Psychol. 1998, 49: 413-446. 10.1146/annurev.psych.49.1.413.CrossRefPubMed Lerner RM, Galambos NL: Adolescent development: challenges and opportunities for research, programs, and policies. Annu Rev Psychol. 1998, 49: 413-446. 10.1146/annurev.psych.49.1.413.CrossRefPubMed
9.
go back to reference Grant BF, Stinson FS, Harford TC: Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. J Subst Abuse. 2001, 13: 493-504. 10.1016/S0899-3289(01)00096-7.CrossRefPubMed Grant BF, Stinson FS, Harford TC: Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. J Subst Abuse. 2001, 13: 493-504. 10.1016/S0899-3289(01)00096-7.CrossRefPubMed
10.
go back to reference Andersen A, Due P, Holstein BE, Iversen L: Tracking drinking behaviour from age 15-19 years. Addiction. 2003, 98: 1505-1511. 10.1046/j.1360-0443.2003.00496.x.CrossRefPubMed Andersen A, Due P, Holstein BE, Iversen L: Tracking drinking behaviour from age 15-19 years. Addiction. 2003, 98: 1505-1511. 10.1046/j.1360-0443.2003.00496.x.CrossRefPubMed
11.
go back to reference Bonomo YA, Bowes G, Coffey C, Carlin JB, Patton GC: Teenage drinking and the onset of alcohol dependence: a cohort study over seven years. Addiction. 2004, 99: 1520-1528. 10.1111/j.1360-0443.2004.00846.x.CrossRefPubMed Bonomo YA, Bowes G, Coffey C, Carlin JB, Patton GC: Teenage drinking and the onset of alcohol dependence: a cohort study over seven years. Addiction. 2004, 99: 1520-1528. 10.1111/j.1360-0443.2004.00846.x.CrossRefPubMed
12.
go back to reference Currie C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D, Picket W, Richter M, Morgan A, Barnekow V: Inequalities in Young People's Health: Health Behaviour in School-Aged Children. International Report from the 2005/2006 Survey. 2008, World Health Organization Regional Office for Europe Currie C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D, Picket W, Richter M, Morgan A, Barnekow V: Inequalities in Young People's Health: Health Behaviour in School-Aged Children. International Report from the 2005/2006 Survey. 2008, World Health Organization Regional Office for Europe
13.
go back to reference Hanson MD, Chen E: Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med. 2007, 30: 263-285. 10.1007/s10865-007-9098-3.CrossRefPubMed Hanson MD, Chen E: Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med. 2007, 30: 263-285. 10.1007/s10865-007-9098-3.CrossRefPubMed
14.
go back to reference Goodman E, Huang B: Socioeconomic status, depressive symptoms, and adolescent substance use. Arch Pediatr Adolesc Med. 2002, 156: 448-453.CrossRefPubMed Goodman E, Huang B: Socioeconomic status, depressive symptoms, and adolescent substance use. Arch Pediatr Adolesc Med. 2002, 156: 448-453.CrossRefPubMed
15.
go back to reference Richter M, Vereecken CA, Boyce W, Maes L, Gabhainn SN, Currie CE: Parental occupation, family affluence and adolescent health behaviour in 28 countries. Int J Public Health. 2009, 54: 203-212. 10.1007/s00038-009-8018-4.CrossRefPubMed Richter M, Vereecken CA, Boyce W, Maes L, Gabhainn SN, Currie CE: Parental occupation, family affluence and adolescent health behaviour in 28 countries. Int J Public Health. 2009, 54: 203-212. 10.1007/s00038-009-8018-4.CrossRefPubMed
16.
go back to reference Droomers M, Schrijvers CT, Casswell S, Mackenbach JP: Occupational level of the father and alcohol consumption during adolescence; patterns and predictors. J Epidemiol Community Health. 2003, 57: 704-710. 10.1136/jech.57.9.704.CrossRefPubMedPubMedCentral Droomers M, Schrijvers CT, Casswell S, Mackenbach JP: Occupational level of the father and alcohol consumption during adolescence; patterns and predictors. J Epidemiol Community Health. 2003, 57: 704-710. 10.1136/jech.57.9.704.CrossRefPubMedPubMedCentral
17.
go back to reference Isohanni M, Oja H, Moilanen I, Koiranen M: Teenage alcohol drinking and non-standard family background. Soc Sci Med. 1994, 38: 1565-1574. 10.1016/0277-9536(94)90118-X.CrossRefPubMed Isohanni M, Oja H, Moilanen I, Koiranen M: Teenage alcohol drinking and non-standard family background. Soc Sci Med. 1994, 38: 1565-1574. 10.1016/0277-9536(94)90118-X.CrossRefPubMed
18.
go back to reference Lundborg P: Young people and alcohol: an econometric analysis. Addiction. 2002, 97: 1573-1582. 10.1046/j.1360-0443.2002.00231.x.CrossRefPubMed Lundborg P: Young people and alcohol: an econometric analysis. Addiction. 2002, 97: 1573-1582. 10.1046/j.1360-0443.2002.00231.x.CrossRefPubMed
19.
go back to reference Lowry R, Kann L, Collins JL, Kolbe LJ: The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA. 1996, 276: 792-797. 10.1001/jama.276.10.792.CrossRefPubMed Lowry R, Kann L, Collins JL, Kolbe LJ: The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA. 1996, 276: 792-797. 10.1001/jama.276.10.792.CrossRefPubMed
20.
go back to reference Mackenbach JP, Bakker MJ: Tackling socioeconomic inequalities in health: analysis of European experiences. Lancet. 2003, 362: 1409-1414. 10.1016/S0140-6736(03)14639-9.CrossRefPubMed Mackenbach JP, Bakker MJ: Tackling socioeconomic inequalities in health: analysis of European experiences. Lancet. 2003, 362: 1409-1414. 10.1016/S0140-6736(03)14639-9.CrossRefPubMed
21.
go back to reference Botticello AL: School contextual influences on the risk for adolescent alcohol misuse. Am J Community Psychol. 2009, 43: 85-97. 10.1007/s10464-008-9226-4.CrossRefPubMedPubMedCentral Botticello AL: School contextual influences on the risk for adolescent alcohol misuse. Am J Community Psychol. 2009, 43: 85-97. 10.1007/s10464-008-9226-4.CrossRefPubMedPubMedCentral
22.
go back to reference Chuang YC, Ennett ST, Bauman KE, Foshee VA: Neighborhood influences on adolescent cigarette and alcohol use: mediating effects through parent and peer behaviors. J Health Soc Behav. 2005, 46: 187-204. 10.1177/002214650504600205.CrossRefPubMed Chuang YC, Ennett ST, Bauman KE, Foshee VA: Neighborhood influences on adolescent cigarette and alcohol use: mediating effects through parent and peer behaviors. J Health Soc Behav. 2005, 46: 187-204. 10.1177/002214650504600205.CrossRefPubMed
23.
go back to reference Song EY, Reboussin BA, Foley KL, Kaltenbach LA, Wagoner KG, Wolfson M: Selected community characteristics and underage drinking. Subst Use Misuse. 2009, 44: 179-194. 10.1080/10826080802347594.CrossRefPubMed Song EY, Reboussin BA, Foley KL, Kaltenbach LA, Wagoner KG, Wolfson M: Selected community characteristics and underage drinking. Subst Use Misuse. 2009, 44: 179-194. 10.1080/10826080802347594.CrossRefPubMed
25.
go back to reference Macintyre S, Ellaway A: Neighborhoods and health. Neighborhoods and health. Edited by: Kawachi LB. 2003, New York: Oxford University Press Macintyre S, Ellaway A: Neighborhoods and health. Neighborhoods and health. Edited by: Kawachi LB. 2003, New York: Oxford University Press
26.
go back to reference Emmons KM: Health behaviors in a social context. Social Epidemiology. Edited by: LF Berkman IK. 2000, New York: Oxford University Press Emmons KM: Health behaviors in a social context. Social Epidemiology. Edited by: LF Berkman IK. 2000, New York: Oxford University Press
27.
go back to reference Faggiano F, Vigna-Taglianti F, Burkhart G, Bohrn K, Cuomo L, Gregori D, Panella M, Scatigna M, Siliquini R, Varona L, van der Kreeft P, Vassara M, Wiborg G, Galanti MR: The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial. Drug Alcohol Depend. 2010, 108: 56-64. 10.1016/j.drugalcdep.2009.11.018.CrossRefPubMed Faggiano F, Vigna-Taglianti F, Burkhart G, Bohrn K, Cuomo L, Gregori D, Panella M, Scatigna M, Siliquini R, Varona L, van der Kreeft P, Vassara M, Wiborg G, Galanti MR: The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial. Drug Alcohol Depend. 2010, 108: 56-64. 10.1016/j.drugalcdep.2009.11.018.CrossRefPubMed
28.
go back to reference Caria MP, Faggiano F, Bellocco R, Galanti MR: Effects of a school-based prevention program on European adolescents' patterns of alcohol use. J Adolescent Health. DOI: 10.1016/j.jadohealth.2010.06.003. Caria MP, Faggiano F, Bellocco R, Galanti MR: Effects of a school-based prevention program on European adolescents' patterns of alcohol use. J Adolescent Health. DOI: 10.1016/j.jadohealth.2010.06.003.
29.
go back to reference Sirin S: Socioeconomic Status and Academic Achievement: A Meta-Analytic Review of Research. Rev Educ Res. 2005, 75: 417-453. 10.3102/00346543075003417.CrossRef Sirin S: Socioeconomic Status and Academic Achievement: A Meta-Analytic Review of Research. Rev Educ Res. 2005, 75: 417-453. 10.3102/00346543075003417.CrossRef
30.
go back to reference Leventhal T, Brooks-Gunn J: The neighborhoods they live in: the effects of neighborhood residence on child and adolescent outcomes. Psychol Bull. 2000, 126: 309-337.CrossRefPubMed Leventhal T, Brooks-Gunn J: The neighborhoods they live in: the effects of neighborhood residence on child and adolescent outcomes. Psychol Bull. 2000, 126: 309-337.CrossRefPubMed
31.
go back to reference Sussman S, Earleywine M, Wills T, Cody C, Biglan T, Dent CW, Newcomb MD: The motivation, skills, and decision-making model of "drug abuse" prevention. Subst Use Misuse. 2004, 39: 1971-2016. 10.1081/JA-200034769.CrossRefPubMed Sussman S, Earleywine M, Wills T, Cody C, Biglan T, Dent CW, Newcomb MD: The motivation, skills, and decision-making model of "drug abuse" prevention. Subst Use Misuse. 2004, 39: 1971-2016. 10.1081/JA-200034769.CrossRefPubMed
32.
go back to reference van der Kreeft P, Wiborg G, Galanti MR, Siliquini R, Bohrn K, Scatigna M, Lindahl AM, Melero J, Vassara M, Faggiano F: "Unplugged": A new European school program against substance abuse. Drugs Educ Prev Policy. 2009, 16: 167-181. 10.1080/09687630701731189.CrossRef van der Kreeft P, Wiborg G, Galanti MR, Siliquini R, Bohrn K, Scatigna M, Lindahl AM, Melero J, Vassara M, Faggiano F: "Unplugged": A new European school program against substance abuse. Drugs Educ Prev Policy. 2009, 16: 167-181. 10.1080/09687630701731189.CrossRef
33.
go back to reference Galanti MR, Siliquini R, Cuomo L, Melero JC, Panella M, Faggiano F: Testing anonymous link procedures for follow-up of adolescents in a school-based trial: the EU-DAP pilot study. Prev Med. 2007, 44: 174-177. 10.1016/j.ypmed.2006.07.019.CrossRefPubMed Galanti MR, Siliquini R, Cuomo L, Melero JC, Panella M, Faggiano F: Testing anonymous link procedures for follow-up of adolescents in a school-based trial: the EU-DAP pilot study. Prev Med. 2007, 44: 174-177. 10.1016/j.ypmed.2006.07.019.CrossRefPubMed
34.
go back to reference Faggiano F, Richardson C, Bohrn K, Galanti MR: A cluster randomized controlled trial of school-based prevention of tobacco, alcohol and drug use: the EU-Dap design and study population. Prev Med. 2007, 44: 170-173. 10.1016/j.ypmed.2006.09.010.CrossRefPubMed Faggiano F, Richardson C, Bohrn K, Galanti MR: A cluster randomized controlled trial of school-based prevention of tobacco, alcohol and drug use: the EU-Dap design and study population. Prev Med. 2007, 44: 170-173. 10.1016/j.ypmed.2006.09.010.CrossRefPubMed
35.
go back to reference Caria MP, Faggiano F, Bellocco R, Galanti MR: Effects of a school-based prevention program on European adolescents' patterns of alcohol use. J Adolescent Health. Caria MP, Faggiano F, Bellocco R, Galanti MR: Effects of a school-based prevention program on European adolescents' patterns of alcohol use. J Adolescent Health.
36.
go back to reference Goldstein H: Multilevel Statistical Models. 2003, London: Edward Arnold Goldstein H: Multilevel Statistical Models. 2003, London: Edward Arnold
37.
go back to reference Rasbash J, Steele F, Browne W, Prosser B: A user's Guide to MLwiN, version 2.0. 2004, Centre for Multilevel Modelling. Institute of Education. University of London Rasbash J, Steele F, Browne W, Prosser B: A user's Guide to MLwiN, version 2.0. 2004, Centre for Multilevel Modelling. Institute of Education. University of London
38.
go back to reference Botvin GJ, Schinke SP, Epstein JA, Diaz T, Botvin EM: Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse prevention among minority adolescents: Two-year follow-up results. Psychol addict behav. 1995, 9: 183-194.CrossRef Botvin GJ, Schinke SP, Epstein JA, Diaz T, Botvin EM: Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse prevention among minority adolescents: Two-year follow-up results. Psychol addict behav. 1995, 9: 183-194.CrossRef
39.
go back to reference Botvin GJ, Griffin KW, Diaz T, Ifill-Williams M: Drug abuse prevention among minority adolescents: posttest and one-year follow-up of a school-based preventive intervention. Prev Sci. 2001, 2: 1-13. 10.1023/A:1010025311161.CrossRefPubMed Botvin GJ, Griffin KW, Diaz T, Ifill-Williams M: Drug abuse prevention among minority adolescents: posttest and one-year follow-up of a school-based preventive intervention. Prev Sci. 2001, 2: 1-13. 10.1023/A:1010025311161.CrossRefPubMed
40.
go back to reference Vicary JR, Smith EA, Swisher JD, Hopkins AM, Elek E, Bechtel LJ, Henry KL: Results of a 3-year study of two methods of delivery of life skills training. Health Educ Behav. 2006, 33: 325-339. 10.1177/1090198105285020.CrossRefPubMed Vicary JR, Smith EA, Swisher JD, Hopkins AM, Elek E, Bechtel LJ, Henry KL: Results of a 3-year study of two methods of delivery of life skills training. Health Educ Behav. 2006, 33: 325-339. 10.1177/1090198105285020.CrossRefPubMed
41.
go back to reference Hecht ML, Marsiglia FF, Elek E, Wagstaff DA, Kulis S, Dustman P, Miller-Day M: Culturally grounded substance use prevention: an evaluation of the keepin' it R.E.A.L. curriculum. Prev Sci. 2003, 4: 233-248. 10.1023/A:1026016131401.CrossRefPubMed Hecht ML, Marsiglia FF, Elek E, Wagstaff DA, Kulis S, Dustman P, Miller-Day M: Culturally grounded substance use prevention: an evaluation of the keepin' it R.E.A.L. curriculum. Prev Sci. 2003, 4: 233-248. 10.1023/A:1026016131401.CrossRefPubMed
42.
go back to reference Ellickson PL, Bell RM: Drug prevention in junior high: a multi-site longitudinal test. Science. 1990, 247: 1299-1305. 10.1126/science.2180065.CrossRefPubMed Ellickson PL, Bell RM: Drug prevention in junior high: a multi-site longitudinal test. Science. 1990, 247: 1299-1305. 10.1126/science.2180065.CrossRefPubMed
43.
go back to reference Yabiku S, Kulis S, Marsiglia FF, Lewin B, Nieri T, Hussaini S: Neighborhood effects on the efficacy of a program to prevent youth alcohol use. Subst Use Misuse. 2007, 42: 65-87. 10.1080/10826080601094264.CrossRefPubMedPubMedCentral Yabiku S, Kulis S, Marsiglia FF, Lewin B, Nieri T, Hussaini S: Neighborhood effects on the efficacy of a program to prevent youth alcohol use. Subst Use Misuse. 2007, 42: 65-87. 10.1080/10826080601094264.CrossRefPubMedPubMedCentral
44.
go back to reference Currie C, Elton R, Todd J, Platt S: Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Educ Res. 1997, 12: 385-397. 10.1093/her/12.3.385.CrossRefPubMed Currie C, Elton R, Todd J, Platt S: Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Educ Res. 1997, 12: 385-397. 10.1093/her/12.3.385.CrossRefPubMed
45.
go back to reference van Lenthe FJ, de Bourdeaudhuij I, Klepp KI, Lien N, Moore L, Faggiano F, Kunst AE, Mackenbach JP: Preventing socioeconomic inequalities in health behaviour in adolescents in Europe: background, design and methods of project TEENAGE. BMC Public Health. 2009, 9: 125-10.1186/1471-2458-9-125.CrossRefPubMedPubMedCentral van Lenthe FJ, de Bourdeaudhuij I, Klepp KI, Lien N, Moore L, Faggiano F, Kunst AE, Mackenbach JP: Preventing socioeconomic inequalities in health behaviour in adolescents in Europe: background, design and methods of project TEENAGE. BMC Public Health. 2009, 9: 125-10.1186/1471-2458-9-125.CrossRefPubMedPubMedCentral
Metadata
Title
The influence of socioeconomic environment on the effectiveness of alcohol prevention among European students: a cluster randomized controlled trial
Authors
Maria Paola Caria
Fabrizio Faggiano
Rino Bellocco
Maria Rosaria Galanti
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-312

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue