Top

Substance Abuse Treatment, Prevention, and Policy

Published in:

Open Access 01-12-2014 | Review

Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials

Authors: Henriette Kyrrestad Strøm, Frode Adolfsen, Sturla Fossum, Sabine Kaiser, Monica Martinussen

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2014

Abstract

Background

Preventive interventions for adolescents are an important priority within school systems. Several interventions have been developed, but the effectiveness of such interventions varies considerably between studies. The purpose of this study was to assess the effectiveness of universal school-based prevention programs on alcohol use among adolescents by using meta-analytic techniques.

Method

A systematic literature search in the databases, PubMed (Medline), PsycINFO (Ovid), EMBASE (Ovid) and WEB of Science (ISI) was conducted to search for empirical articles published in the period January 1990 to August 2014.

Results

In total, 28 randomized controlled studies with 39,289 participants at baseline were included. Of these 28 articles, 12 studies (N = 16279) reported continuous outcomes (frequency of alcohol use and quantity of alcohol use), and 16 studies (N = 23010) reported categorical data (proportion of students who drank alcohol). The results of the random effects analyses showed that the overall effect size among studies reporting continuous outcomes was small and demonstrated a favorable effect from the preventive interventions (Hedges’

\bar{g}

= 0.22, p < .01). The effect size among studies reporting categorical outcomes was not significant (

\bar{OR}

= 0.94, p = .25). The level of heterogeneity between studies was found to be significant in most analyses. Moderator analyses conducted to explore the heterogeneity showed neither significant difference between the different school levels (junior high schools and high schools), nor between the varied program intensities (low, medium and high intensity programs). The meta-regression analyses examining continuous moderators showed no significant effects for age or gender.

Conclusions

The findings from this meta-analysis showed that, overall, the effects of school-based preventive alcohol interventions on adolescent alcohol use were small but positive among studies reporting the continuous measures, whereas no effect was found among studies reporting the categorical outcomes. Possible population health outcomes, with recommendations for policy and practice, are discussed further in this paper.

Available only for authorised users

Belcher HE, Shinitzky HE: Substance abuse in children: prediction, protection, and prevention. Arch Pediatr Adolesc Med. 1998, 152: 952-960.CrossRefPubMed

Maggs JL, Schulenberg JE: Initiation and course of alcohol consumption among adolescents and young adults. Recent Dev Alcohol. 2005, 17: 29-47. 10.1007/0-306-48626-1_2.CrossRefPubMed

Pitkanen T, Lyyra AL, Pulkkinen L: Age of onset of drinking and the use of alcohol in adulthood: a follow-up study from age 8–42 for females and males. Addiction. 2005, 100: 652-661. 10.1111/j.1360-0443.2005.01053.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

Social Determinants of Health and Well-Being Among Young People. Health Behaviour in School-Aged Children (HBSC) Study: International Report from the 2009/2010 Survey. Edited by: Currie C, Zanotti C, Morgan A, Currie D, Looze M de, Roberts C, Samdal O, Smith ORF, Barnekow V. 2012, Copenhagen: WHO Regional Office for Europe

Spoth R, Greenberg MT, Turrisi R: Preventive interventions addressing underage drinking: state of the evidence and steps toward public health impact. Pediatrics. 2008, 121: 311-336. 10.1542/peds.2007-2243E.CrossRef

World Health Organization: Global Status Report on Alcohol and Health. 2014, Geneva: World Health Organization

Cuijpers P: Effective ingredients of school-based drug prevention programs. A systematic review. Addict Behav. 2002, 27: 1009-1023. 10.1016/S0306-4603(02)00295-2.CrossRefPubMed

Caulkins JP, Pacula RL, Paddok S, Chiesa J: What we can- and cannot expect from school-based drug prevention. Drug Alcohol Rev. 2004, 23: 79-87. 10.1080/09595230410001645574.CrossRefPubMed

10.

WHO: European Action Plan to Reduce the Harmful use of Alcohol 2012–2020. World Health Organization Regional Committee for Europe Sixty First Session. Edited by: Organization WH. 2011, Baku: Azerbaijan

11.

Barry MM, Jenkins R: Implementing Mental Health Promotion. 2007, Edinburgh: Churchill Livingstone

12.

Stigler MH, Neusel E, Perry CL: School-based programs to prevent and reduce alcohol use among youth. Alcohol Res Health. 2011, 34: 157-162.PubMedCentralPubMed

13.

Komro KA, Toomey TL: Strategies to prevent underage drinking. Alcohol Res Health. 2002, 26: 5-14.PubMed

14.

Berg RC, Underland V: The Effectiveness of Primary Interventions to Prevent the use of Tobacco, Alcohol and Other Drugs Among Children and Adolescents. Report from Kunnskapssenteret. 2012, Oslo: Norwegian Knowledge Centre for the Health Services

15.

White D, Pitts M: Educating young people about drugs: a systematic review. Addiction. 1998, 93: 1475-1487. 10.1046/j.1360-0443.1998.931014754.x.CrossRefPubMed

16.

Foxcroft DR, Tsertsvadze A: Universal school-based prevention programs for alcohol misuse in young people. Cochrane Db Syst Rev. 2011, 1-124.

17.

Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV, Stackpole KM: School-based adolescent drug prevention programs: 1998 meta-analysis. J Prim Prev. 2000, 20: 275-336. 10.1023/A:1021314704811.CrossRef

18.

Rundall TG, Bruvold WH: A meta-analysis of school-based smoking and alcohol use prevention programs. Health Educ Behav. 1988, 15: 317-334. 10.1177/109019818801500306.CrossRef

19.

Tobler NS, Stratton HH: Effectiveness of school-based drug prevention programs: a meta-analysis of the research. J Prim Prev. 1997, 18: 71-128. 10.1023/A:1024630205999.CrossRef

20.

Hennessy E, Tanner-Smith E: Effectiveness of brief school-based interventions for adolescents: a meta-analysis of alcohol Use prevention programs. Prev Sci. 2014, 1-12.

21.

Gottfredson DC, Wilson DB: Characteristics of effective school-based substance abuse prevention. Prev Sci. 2003, 4: 27-38. 10.1023/A:1021782710278.CrossRefPubMed

22.

Perry CL, Williams CL, Veblen-Mortenson S, Toomey TL, Komro KA, Anstine PS, McGovern PG, Finnegan JR, Forster JL, Wagenaar AC, Wolfson M: Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence. Am J Public Health. 1996, 86: 956-965. 10.2105/AJPH.86.7.956.PubMedCentralCrossRefPubMed

23.

Griffin KW, Botvin GJ, Nichols TR, Doyle MM: Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation. Prev Med. 2003, 36: 1-7. 10.1006/pmed.2002.1133.CrossRefPubMed

24.

Miller PM, Smith GT, Goldman MS: Emergence of alcohol expectancies in childhood: a possible critical period. J Stud Alcohol Drugs. 1990, 51: 343-349.CrossRef

25.

Stueve A, O’Donnell LN: Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths. Am J Public Health. 2005, 95: 887-10.2105/AJPH.2003.026567.PubMedCentralCrossRefPubMed

26.

Room R, Babor T, Rehm J: Alcohol and Public Health. Lancet. 2005, 365: 519-530. 10.1016/S0140-6736(05)17870-2.CrossRefPubMed

27.

Paglia A, Room R: Preventing substance Use problems among youth: a literature review and recommendations. J Prim Prev. 1999, 20: 3-50. 10.1023/A:1021302302085.CrossRef

28.

Pape H: School-based programmes that seem to work: useful research on substance use prevention or suspicious stories of success?. Nordic Alc Drug. 2009, 26: 521-535.

29.

Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, Grube JW, Hill AJ, Holder H, Homel R, Gruenewald P, Hill L, Livingston M, Österberg E, Rehm J, Room R, Rossow I: Alcohol: No Ordinary Commodity: Research and Public Policy. 2010, Oxford: Oxford University Press, 2CrossRef

30.

Wilson D, Gottfredson D, Najaka S: School-based prevention of problem behaviors: a meta-analysis. J Quant Criminol. 2001, 17: 247-272. 10.1023/A:1011050217296.CrossRef

31.

Shadish WR, Cook TD, Campbell DT: Experimental and Quasi-Experimental Designs for Generalized Causal Inference. 2002, Boston: Houghton Mifflin

32.

DeWit DJ, Adlaf EM, Offord DR, Ogborne AC: Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatry. 2000, 157: 745-750. 10.1176/appi.ajp.157.5.745.CrossRefPubMed

33.

Jones BT, Corbin W, Fromme K: A review of expectancy theory and alcohol consumption. Addiction. 2001, 96: 57-72. 10.1046/j.1360-0443.2001.961575.x.CrossRefPubMed

34.

Borsari B, Murphy JG, Barnett NP: Predictors of alcohol use during the first year of college: implications for prevention. Addict Behav. 2007, 32: 2062-2086. 10.1016/j.addbeh.2007.01.017.PubMedCentralCrossRefPubMed

35.

Hellandsjø Bu ET, Watten RG, Foxcroft DR, Ingebrigtsen JE, Relling G: Teenage alcohol and intoxication debut: the impact of family socialization factors, living area and participation in organized sports. Alcohol Alcoholism. 2002, 37: 74-80. 10.1093/alcalc/37.1.74.CrossRefPubMed

36.

Adolfsen F, Strøm HK, Martinussen M, Natvig H, Eisemann M, Handegård BH, Koposov R: Early drinking onset: a study of prevalence and determinants among 13-year-old adolescents in Norway. Scand J Psychol. 2014, 55: 505-512. 10.1111/sjop.12151.CrossRefPubMed

37.

Nelson SJ, Schopen M, Savage AG, Schulman JL, Arluk N: The MeSH translation maintenance system: structure, interface design, and implementation. Stud Health Technol Inform. 2004, 107: 67-69.PubMed

38.

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR: Comprehensive Meta-Analysis. Professional Edition. 2005, Englewood, NJ: Biostat, ISBN Professional edition, 2

39.

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR: Introduction to Meta-Analysis. 2009, Chichester, UK: John Wiley & Sons, LtdCrossRef

40.

Lipsey MW, Wilson BD: Practical Meta-Analysis, Volume 49. 2000, Thousand Oaks: Sage Publications

41.

Hedges LV, Olkin I: Statistical Methods for Meta-Analysis. 1985, Orlando: Academic

42.

Cohen J: Statistical Power Analysis for the Behavioral Sciences. 1977, Hillsdale, NJ: Lawrence Erlbaum Associates, 2

43.

Chen H, Cohen P, Chen S: How Big is a big odds ratio? interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simulat. 2010, 39: 860-864. 10.1080/03610911003650383.CrossRef

44.

Koning IM, Vollebergh WA, Smit F, Verdurmen JE, Van Den Eijnden RJ, Ter Bogt TF, Stattin H, Engels RC: Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously. Addiction. 2009, 104: 1669-1678. 10.1111/j.1360-0443.2009.02677.x.CrossRefPubMed

45.

D’Amico EJ, Fromme K: Brief prevention for adolescent risk-taking behavior. Addiction. 2002, 97: 563-574. 10.1046/j.1360-0443.2002.00115.x.CrossRefPubMed

46.

Ellickson PL, Bell RM: Drug prevention in junior high: a multi-site longitudinal test. Science. 1990, 247: 1299-1305. 10.1126/science.2180065.CrossRefPubMed

47.

Rosenthal R: The file drawer problem and tolerance for null results. Psychol Bull. 1979, 86: 638-641.CrossRef

48.

Warren JR, Hecht ML, Wagstaff DA, Elek E, Ndiaye K, Dustman P, Marsiglia FF: Communicating prevention: the effects of the keepin’ it REAL classroom videotapes and televised PSAs on middle-school students’ substance use. J Appl Commun Res. 2006, 34: 209-227. 10.1080/00909880600574153.CrossRef

49.

Furr-Holden C, Ialongo NS, Anthony JC, Petras H, Kellam SG: Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial. Drug Alcohol Depend. 2004, 73: 149-158. 10.1016/j.drugalcdep.2003.10.002.CrossRefPubMed

50.

McCambridge J, Hunt C, Jenkins RJ, Strang J: Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention. Drug Alcohol Depend. 2011, 114: 177-184.PubMed

51.

Werch CE, Anzalone DM, Brokiewicz LM, Felker J, Carlson JM, Castellon-Vogel EA: An intervention for preventing alcohol use among inner-city middle school students. Arch Fam Med. 1996, 5: 146-152. 10.1001/archfami.5.3.146.CrossRefPubMed

52.

Griffin JP, Holliday RC, Frazier E, Braithwaite RL: The brave (building resiliency and vocational excellence) program: evaluation findings for a career-oriented substance abuse and violence preventive intervention. J Health Care Poor U. 2009, 20: 798-816. 10.1353/hpu.0.0174.CrossRef

53.

Reddy K, Arora M, Perry CL, Nair B, Kohli A, Lytle LA, Stigler M, Prabhakaran D: Tobacco and alcohol use outcomes of a school-based intervention in New Dehli. Am J Health Behav. 2002, 26: 173-181. 10.5993/AJHB.26.3.2.CrossRefPubMed

54.

Ringwalt C, Ennett ST, Holt KD: An outcome evaluation of Project DARE (Drug Abuse Resistance Education). Health Educ Res. 1991, 6: 327-337. 10.1093/her/6.3.327.CrossRef

55.

Spoth RL, Redmond C, Trudeau L, Shin C: Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychol Addict Behav. 2002, 16: 129-134.CrossRefPubMed

56.

Bond L, Patton G, Glover S, Carlin JB, Butler H, Thomas L, Bowes G: The Gatehouse Project: Can a multilevel school intervention affect emotional wellbeing and health risk behaviours?. J Epidemiol Community H. 2004, 58: 997-1003. 10.1136/jech.2003.009449.CrossRef

57.

Newton NC, Andrews G, Teesson M, Vogl LE: Delivering prevention for alcohol and cannabis using the Internet: a cluster randomised controlled trial. Prev Med. 2009, 48: 579-584. 10.1016/j.ypmed.2009.04.009.CrossRefPubMed

58.

Werch C, Moore MJ, DiClemente CC, Bledsoe R, Jobli E: A multihealth behavior intervention integrating physical activity and substance Use prevention for adolescents. Prev Sci. 2005, 6: 213-226. 10.1007/s11121-005-0012-3.CrossRefPubMed

59.

Ringwalt CL, Clark HK, Hanley S, Shamblen SR, Flewelling RL: Project ALERT: a cluster randomized trial. Arch Pediatr Adolesc Med. 2009, 163: 625-632. 10.1001/archpediatrics.2009.88.CrossRefPubMed

60.

Bodin MC, Strandberg AK: The Orebro prevention programme revisited: a cluster-randomized effectiveness trial of programme effects on youth drinking. Addiction. 2011, 106: 2134-2143. 10.1111/j.1360-0443.2011.03540.x.CrossRefPubMed

61.

Vogl L, Teesson M, Andrews G, Bird K, Steadman B, Dillon P: A computerized harm minimization prevention program for alcohol misuse and related harms: randomized controlled trial. Addiction. 2009, 104: 564-575. 10.1111/j.1360-0443.2009.02510.x.CrossRefPubMed

62.

Clark HK, Ringwalt CL, Hanley S, Shamblen SR, Flewelling RL, Hano MC: Project SUCCESS’ effects on the substance use of alternative high school students. Addict Behav. 2010, 35: 209-217. 10.1016/j.addbeh.2009.10.004.CrossRefPubMed

63.

Shope JT, Dielman TE, Butchart AT, Campanelli PC, Kloska DD: An elementary school-based alcohol misuse prevention program - A follow-up evaluation. J Stud Alcohol. 1992, 53: 106-121.CrossRefPubMed

64.

Peleg A, Neumann L, Friger M, Peleg R, Sperber AD: Outcomes of a brief alcohol abuse prevention program for Israeli high school students. J Adolesc Health. 2001, 28: 263-269. 10.1016/S1054-139X(00)00216-0.CrossRefPubMed

65.

Wilhelmsen BU, Laberg JC, Klepp KI: Evaluation of two student and teacher involved alcohol prevention programmes. Addiction. 1994, 89: 1157-1165. 10.1111/j.1360-0443.1994.tb02792.x.CrossRefPubMed

66.

Caplan M, Weissberg RP, Grober JS, Sivo PJ, Grady K, Jacoby C: Social competence promotion with inner-city and suburban young adolescents: effects on social adjustment and alcohol use. J Consult Clin Psychol. 1992, 60: 56-63.CrossRefPubMed

67.

Schinke SP, Tepavac L, Cole KC: Preventing substance use among Native American youth: Three-year results. Addict Behav. 2000, 25: 387-397. 10.1016/S0306-4603(99)00071-4.CrossRefPubMed

68.

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. 2011, 48: 182-188. 10.1016/j.jadohealth.2010.06.003.CrossRef

69.

Sun P, Sussman S, Dent CW, Rohrbach LA: One-year follow-up evaluation of Project Towards No Drug Abuse (TND-4). Prev Med. 2008, 47: 438-442. 10.1016/j.ypmed.2008.07.003.PubMedCentralCrossRefPubMed

70.

Clayton RR, Cattarello AM, Walden KP: Sensation seeking as a potential mediating variable for school-based prevention intervention: a two-year follow-Up of DARE. Health Commun. 1991, 3: 229-239. 10.1207/s15327027hc0304_5.CrossRef

71.

McBride N, Farringdon F, Midford R, Meuleners L, Phillips M: Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP). Addiction. 2004, 99: 278-291. 10.1111/j.1360-0443.2003.00620.x.CrossRefPubMed

72.

St. Pierre TL, Osgood DW, Mincemoyer CC, Kaltreider DL, Kauh TJ: Results of an independent evaluation of project ALERT delivered in schools by cooperative extension. Prev Sci. 2005, 6: 305-317. 10.1007/s11121-005-0015-0.CrossRefPubMed

73.

Altman DG, Royston P: The cost of dichotomising continuous variables. BMJ. 2006, 332: 1080-PubMedCentralCrossRefPubMed

74.

Cohen J: The cost of dichotomization. Appl Psych Meas. 1983, 7: 249-253. 10.1177/014662168300700301.CrossRef

75.

Flay BR, Biglan A, Boruch RF, Castro FG, Gottfredson DC, Kellam S, Mościcki EK, Schinke S, Valentine JC, Ji P: Standards of evidence: criteria for efficacy, effectiveness and dissemination. Prev Sci. 2005, 6: 151-175. 10.1007/s11121-005-5553-y.CrossRefPubMed

76.

Norström T, Pape H: Associations between adolescent heavy drinking and problem drinking in early adulthood: implications for prevention. J Stud Alcohol Drugs. 2012, 73: 542-548.CrossRefPubMed

77.

Rey JM, Saltz RF: Preventing and Responding to Alcohol Misuse in Specific Context: Schools, Colleges, the Military. Young People and Alcohol: Impact, Policy, Prevention, Treatment. edn. Edited by: Saunders JB, Rey JM. 2011, Wiley-Blackwell, 170-193.

78.

Skara S, Sussman S: A review of 25 long-term adolescent tobacco and other drug use prevention program evaluations. Prev Med. 2003, 37: 451-474. 10.1016/S0091-7435(03)00166-X.CrossRefPubMed

79.

Gottfredson DC, Gottfredson GD: Quality of school-based prevention programs: results from a national survey. J Res Crime Delinq. 2002, 39: 3-35. 10.1177/002242780203900101.CrossRef

80.

Pasch KE, Perry CL, Stigler MH, Komro KA: Sixth grade students who use alcohol: do we need primary prevention programs for “tweens”?. Health Educ Behav. 2009, 36: 673-695. 10.1177/1090198107308374.PubMedCentralCrossRefPubMed

81.

World Health Organization: European Action Plan to Reduce the Harmful use of Alcohol 2012 - 2020. 2012, Copenhagen: WHO Regional office for Europe

Title: Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials
Authors: Henriette Kyrrestad Strøm
Frode Adolfsen
Sturla Fossum
Sabine Kaiser
Monica Martinussen
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Substance Abuse Treatment, Prevention, and Policy / Issue 1/2014
Electronic ISSN: 1747-597X
DOI: https://doi.org/10.1186/1747-597X-9-48

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

The effects of participation level on recidivism: a study of drug treatment courts using propensity score matching

When higher doses in opioid replacement treatment are still inadequate – association to multidimensional illness severity: a cohort study

A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada

Differential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatment

Gender differences in subjective discontinuation symptoms associated with ketamine use

Examining attrition rates at one specialty addiction treatment provider in the United States: a case study using a retrospective chart review