Universal multi-component alcohol misuse prevention for young people can be effective

We conducted a Cochrane systematic review of 20 randomised controlled trials that examined the effectiveness of universal multi-component programs for the prevention of alcohol misuse in young people. Multi-component prevention programs are defined as those prevention efforts that deliver interventions in multiple settings, for example in both school and family settings, typically combining school curricula with a parenting intervention.

A majority of the studies included in this review reported positive effects of multi-component programs for the prevention of alcohol misuse in young people, with effects persisting into the medium- and longer-term. But a notable proportion of trials reported no statistically significant effects. In seven studies we were able to assess the impact of single versus multiple components, and only 1 out of the 7 studies clearly showed a benefit of components delivered in more than one setting.

In conclusion, there is some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, there is little evidence that interventions with multiple components are more effective than interventions with single components.

Authors' conclusions: 

There is some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, there is little evidence that interventions with multiple components are more effective than interventions with single components.

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Background: 

Alcohol misuse in young people is a cause of concern for health services, policy makers, prevention workers, and criminal justice system, youth workers, teachers, and parents.

Objectives: 

To systematically review evidence on the effectiveness of universal multi-component prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age. To update a part of a previously published Cochrane systematic review.

Search strategy: 

Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO.

Selection criteria: 

Randomized trials evaluating universal multi-component prevention programs (intervention delivered in more than one setting) and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records.

Data collection and analysis: 

Two reviewers extracted relevant data independently using an a priori defined extraction form. Risk of bias was assessed.

Main results: 

20 parallel-group trials were included. The reporting quality of trials was poor, only 25% and 5% of them reporting adequate method of randomisation and program allocation concealment, respectively. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 20% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.

12 of the 20 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects ranging from 3 months to 3 years. Of the remaining 8 trials, one trial reported significant effects using one-tailed tests and 7 trials reported no significant effects of the multi-component interventions for reducing alcohol misuse.

Assessment of the additional benefit of multiple versus single component interventions was possible in 7 trials with multiple arms. Only one of the 7 trials clearly showed a benefit of components delivered in more than one setting.

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