Abstract
Background:
Considerable attention has been focused on the impact of young people’s alcohol use. To address this, schools often implement alcohol and drug education and there are many potential programmes to choose from.
Objective:
The aim of this study was to identify evidence-based alcohol education programmes for schools.
Methods:
A systematic review was undertaken of school-based programmes that targeted alcohol within a school setting and included at least one alcohol behaviour or knowledge change outcome. Six-hundred seventy-five abstracts were screened resulting in 454 studies assessed for eligibility, with 70 studies, evaluating 40 individual programmes, included in the final review.
Results:
Of the 40 programmes, 3 had good evidence of a positive effect. They included CLIMATE Schools (Australia), Project ALERT (USA) and All Stars (USA). Of the others, 4 showed some evidence of positive effect, 1 had no evidence of effect, 29 were inconclusive and 2 showed negative outcomes, such as increases in alcohol use. Although many programmes were evaluated, very few had sufficient evidence to be able to endorse their widespread implementation in schools.
Conclusion:
Three programmes included in the review had sufficient positive outcomes to be recommended for implementation, and four showed good outcomes in some areas. Schools should consider these results when deciding on introducing alcohol education. Overall, the evidence base is broad but relatively weak and further research is required, focusing on programmes identified as having good or potentially good outcomes.
Introduction
Alcohol is the leading risk factor for years lost due to disability and death among young people (Gore et al., 2011). Considerable attention has been focused on the impact of young people’s alcohol use, including unintentional injuries and violence (Hughes et al., 2008), traffic accidents (Voas et al., 2012), unwanted sexual encounters (Scott-Sheldon et al., 2010), sexting (Dir et al., 2013) and early onset of risky drinking (Hicks et al., 2010). Many programmes have been developed to reduce these risks especially among school-aged children (Conrod et al., 2013).
Early approaches to alcohol and drug education focused mainly on deficits in knowledge alcohol effects, affect or personality (e.g. low self-esteem, poor communication and interpersonal skills; Kuntsche et al., 2006) and social skills (Gorman, 1996). Earlier systematic reviews of these programmes found that it was difficult to reach conclusions about their effectiveness, in the short- or long-term (Loxley et al., 2004).
More recently, interventions have extended beyond knowledge to include the influence of parents, school policies, curriculum, social and physical environments and links with health and community services (Tang et al., 2009). More influential psychosocial (Durlak et al., 2011) and ecological theories (Stormshak et al., 2011) have led to programmes that consider the interaction between the individual, drug and social and cultural environment within which young people operate.
A recent Cochrane review (Foxcroft and Tsertsvadze, 2011, 2012) of school-based prevention programmes for alcohol misuse found that the quality of evaluation studies was variable, with many showing no effect at all. The reviews concluded that generic psychosocial and development programmes that considered the prevention of multiple drugs and included psychosocial interventions (rather than alcohol specific interventions) could be effective for longer. However, this review only included randomised controlled trials (RCTs).
Given the small number of RCTs in this area, this limits consideration of the ‘gold standard’ programmes that could potentially hold practical value for decision-makers in schools, who are implementing programmes now.
The present systematic review expands on previous reviews examining school-based alcohol programmes to provide guidance on potentially helpful and potentially harmful school-based alcohol education programmes to better support school decision-makers.
Methods
Protocol
A systematic review was undertaken to examine school-based alcohol programmes. The methods and results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Moher et al., 2010). Due to the heterogeneity of measures, a meta-analysis (Liberati et al., 2009) was not possible and a narrative analysis was used (Joanna Briggs Institute, 2011).
Inclusion criteria were specified in advance and agreed by the researchers using a predefined protocol (available from the authors) including data extraction and quality checking process.
Eligibility criteria
Studies were included/excluded in the review if they met the following criteria:
Australian National Health and Medical Research Council (NHMRC) criteria for level of evidence I (systematic reviews) to evidence IV (case series or pre-post designs)
Published between 1998 and 2013 in the English language
Evaluated a school-based programme that specifically targeted alcohol
Outcome measures with at least one alcohol behaviour change and/or alcohol knowledge or attitude
The exclusion criteria were as follows:
Non-English language manuscripts;
Studies published prior to 1998;
Qualitative studies or cases studies that focused on acceptability of programmes or process evaluation only;
Studies that included a school-based programme not focusing on alcohol;
Studies that were community of family-based programmes.
Only published articles that met these criteria and contained sufficient information to allow for the data extraction were included in the review.
Information sources and search
Studies were identified using string searches in the databases: PubMed, PsycINFO, Web of Science, CINAHL, ERIC and the Cochrane Database of Systematic Reviews. Hand searching of study reference lists, websites and the grey literature was also conducted using conventional electronic search engines, such as Google and Google scholar. Electronic forums or eForums and eLists were also canvassed.
An example of the search terms used is provided in Figure 1.
Example of systematic review string search.
Study selection and data collection process
Duplicates were removed and two reviewers checked the title and abstract to ensure studies met inclusion criteria. Of 454 full-text studies retrieved, 386 were excluded. Two reviewers extracted data from 70 studies (Figure 2).
Systematic review flow diagram.
Data items
The data extracted included study identifiers (citation, name/type of programme, name/type of control, length of programme, number of sessions, details of the programme), demographics (age, gender) and outcome identifiers (validated or self-reported outcome measures with at least one alcohol behaviour change [e.g. changes in drinking frequency, binge drinking, quantity and frequency of alcohol consumption and abstinence] and/or alcohol knowledge [e.g. changes in attitude or knowledge in relation to alcohol]).
Risk of bias in individual studies
Two reviewers completed the data extraction and quality check.
The data extraction was transposed directly into an evidence table, with each paper also subject to assessment based on a number of criteria that focus on study design elements that research has shown to have a significant effect on the risk of bias in the results reported (Scottish Intercollegiate Guidelines Network [SIGN], 2014). The study type determined the checklist used; copies are available from the Scottish Intercollegiate Guidelines Network (SIGN) 1 website. As recommended by SIGN (SIGN, 2014), the studies were appraised by two reviewers.
In addition, we used the Australian NHMRC methodology to appraise and grade evidence (NHMRC, 2000). The evidence is weighted towards more scientifically robust studies. There were three steps (see NHMRC, 2009) in this. First, each study was assessed against five criteria:
Level of evidence 2
Consistency of findings
Practical impact of the findings
Generalisability of the findings
Applicability of the findings to setting
Second, the combined body of evidence was assessed against the following four criteria:
Grade A: body of evidence can be trusted to guide practice
Grade B: body of evidence can be trusted to guide practice in most situations
Grade C: body of evidence provides some support but care should be taken with application
Grade D: body of evidence is weak and should be applied with caution
Third, to simplify presentation and facilitate translation, a symbol-based rating system was used to indicate overall effect, combining both grade of evidence and outcomes.
To receive three stars, programmes needed to be well-conducted, Grade A or B rated, and demonstrate consistently positive outcomes.
Two-star programmes were well or reasonably well-conducted, with Grade A or B rating and some evidence of positive effect.
One-star programmes were well conducted, Grade A or B rating, but demonstrated little or no evidence of positive effect.
Question-marked programmes had inconclusive evidence because either the research was of poor quality, there were inconsistent effects in multiple studies, or only one study was available.
X-marked programmes in Online Appendix S1 were those that demonstrated negative outcomes (i.e. harms, risky drinking increases). (Online Appendix S1 is available on the journal website.)
Results
Study selection
In all, 70 studies were reviewed, detailing 40 different programmes.
Study characteristics
A brief summary of study characteristics of the 40 programmes is given in Online Appendix S1.
Of the 40 programmes, 3 had good evidence of positive effect, 4 showed some evidence of positive effect, 1 showed no evidence of positive effect, 30 were inconclusive and 2 showed negative outcomes. Only programmes with good evidence of positive effect are detailed here. All programme details are available elsewhere (Lee et al., 2014). A detailed descriptive summary of included programmes is provided in Online Appendix S2. (Online Appendix S2 is available on the journal website.)
Programmes with good evidence of effect on alcohol outcomes
Climate Schools (four published studies, Grade A)
Climate Schools is an Australian computerised alcohol prevention programme consisting of two sets of six 40-minute lessons, using a cartoon storyline of teenagers in real-life situations with alcohol and cannabis. Each lesson includes an activity delivered by teachers to reinforce the information.
There were four studies; three were from the same large-scale study. A cluster RCT was conducted with 764 13-year-olds from 10 secondary schools. Schools were randomly allocated to the prevention programme (n = 397) or to their usual health classes (n = 367). Participants were assessed pre/post programme and 6 months after. Compared to the control group, the intervention group showed significant improvements in alcohol and cannabis knowledge, as well as reduction in average weekly alcohol consumption and frequency of cannabis use at 6 months. No differences between groups were found on alcohol beliefs, cannabis attitudes or alcohol- or cannabis-related harms (Newton et al., 2009b).
A second analysis of the same study of the alcohol module found similar results. There were significant improvements in knowledge regarding alcohol use; average weekly alcohol consumption was reduced immediately after the intervention and there were no differences in alcohol beliefs, frequency, excess or harms related to alcohol (Newton et al., 2009a). A 12-month follow-up found that the intervention group maintained significant effects for alcohol/cannabis knowledge and reductions in alcohol consumption and frequency. There were no differences between groups on alcohol or cannabis attitudes or harms. CLIMATE was acceptable to teachers and students (Newton et al., 2010).
Vogl et al. (2009) included 16 high schools (n = 1,466) randomly allocated to the programme (n = 611, eight schools) or usual classes (n = 855, eight schools). They found the programme was more effective than usual classes in increasing alcohol-related knowledge, decreasing positive social expectations and increasing safer choices. The behavioural effect was not significant for boys. For girls, the programme reduced consumption, frequency and drinking to excess.
Project ALERT (five published studies, Grade B)
Project ALERT uses a social influence model and provides skills to develop resistance behaviours based on theories of behaviour change, including cognitive behaviour, social learning and self-efficacy theories. It uses interactive question and answer techniques with small group activities. The project comprises 11 lessons over two school years and focuses on smoking cessation and alcohol use. Parent activities are included.
Project ALERT was examined in five studies (Ellickson et al., 2003; Ghosh-Dastidar et al., 2004; Longshore et al., 2007; Orlando et al., 2005; St Pierre et al., 2007). Ellickson et al. (2003) found that intervention schools had significantly lower alcohol use and less drinking that resulted in negative consequences. They were less likely (but not significantly) to engage in high-risk drinking. There was no impact on alcohol initiation. Ghosh-Dastidar et al. (2004) evaluated Project ALERT and found significant effects on risk factors including cigarette and marijuana, but had modest impacts on alcohol risk factors. Orlando et al. (2005) found positive beliefs about consequences of drinking-mediated alcohol misuse. St Pierre et al. (2007) found that leaders who were more conscientious and sociable were more likely to experience positive effects. Longshore et al. (2007) evaluated a modified form of Project ALERT and found significantly lower rates of weekly alcohol use for girls (32% reduction compared to control), and significant outcomes (for girls only) were found on negative consequences, beliefs and high-risk use.
All Stars (two published studies, Grade B)
All Stars consists of 24 sessions, 14 are required and 10 optional. The programme is delivered by teachers or trained specialist using interactive lessons, small group peer support, one-on-one with facilitators, debates, games and general discussion. Homework allows parents to play an active role. Each session focuses on one of the programme’s mediating variables including normative beliefs, lifestyle incongruence, commitment not to use drugs and bonding to school.
Two cluster randomised control studies examined All Stars (McNeal et al., 2004; Ringwalt et al., 2007). McNeal et al. (2004) examined its effect across 14 schools (N = 1,822 students). All Stars achieved reductions in substance use when the teachers were involved in the delivery of the programme and were able to successfully address the mediators of substance use. The programme was not as successful when not delivered by teachers. Ringwalt et al. (2007) study evaluated an additional component of coaching teachers with the usual All Stars programme but found no additional positive effect.
Programmes with some evidence of effect on alcohol outcomes
Life Skills Programme (two published studies, Grade B)
Life Skills Programme (IPSY) combines interpersonal life skills (e.g. communication, problem solving, coping) with skills related to substance use (e.g. refusal skills). Two studies (Spaeth et al., 2010; Wenzel et al., 2009) showed some significant positive outcomes on alcohol and drug outcomes, including lower levels of alcohol consumption in the past month (Wenzel et al., 2009), and among those who followed a normative drinking trajectory, ISPY buffered the increase in alcohol use on a typical occasion. However, it was not as successful with students who already used alcohol (Spaeth et al., 2010).
Life Skills Training (four published studies, Grade C)
Life Skills Training (LST) promotes resisting social influences on use drugs and promotes social skills for increasing overall capability. The programme techniques include group discussion, modelling, behaviour rehearsal, feedback, reinforcement and behavioural ‘homework’ for out-of-classroom practice. Studies (Anderson and Moore, 2008; Botvin et al., 1995, 2001; MacKillop et al., 2006) demonstrated significantly lower prevalence for weekly drinking, heavy drinking, binge drinking and problem drinking. There were significant changes in overall knowledge, life skills knowledge, drug knowledge, perceived adult substance use, pro-smoking attitudes, pro-drinking attitudes, assertiveness skills and anxiety reduction skills and views of substance use.
School Health and Harm Alcohol Harm Reduction Project (three published studies, Grade B)
School Health and Harm Alcohol Harm Reduction Project (SHAHRP) aims to reduce alcohol-related harm by enhancing students’ ability to deal with high-risk drinking situations. It has been the subject of two trials McBride et al. (2003); (McBride et al., 2004) comparing SHAHRP with a control across three drinker types: non-drinkers, supervised drinkers and unsupervised drinkers. Unsupervised drinkers in SHAHRP were significantly less likely to experience harms compared to the control group, and the effects were maintained 17 months after completion. Another evaluation combined two programmes SHAHRP and GetWISE (the latter, a classroom-based drug education programme). While drinking to get drunk increased significantly, frequency of drinking to get drunk was significantly lower in the intervention group and harms were greater in the control group.
Unplugged-EU (two studies, Grade B)
Unplugged targets experimental and regular use of alcohol, tobacco and illicit drugs. Using a social influence approach, it incorporates critical thinking, decision-making, problem-solving, creative thinking, communication, interpersonal skills, self-awareness, empathy, stress, normative beliefs and knowledge about drugs. It includes 12 one-hour units and is delivered in three formats: basic or with the addition of peers or with parent activities by trained teachers. There have been two cluster randomised control studies (Caria et al., 2011; Faggiano et al., 2008). The results demonstrated reduced episodes of drunkenness in the past 30 days and significantly lowered alcohol-related behavioural problems; the results were less positive for those who were already drinking.
Programmes with little or no evidence of effect on alcohol outcomes
Drug Abuse Resistance Education (three published studies, Grade A)
Project Drug Abuse Resistance Education (DARE) is the most widely used programme in the USA. The programme teaches skills to resist social pressure to use drugs and encourages healthy choices, positive decision-making and building esteem. Two meta-analyses of earlier DARE evaluations (Ennett et al., 1994) demonstrated virtually no effect, with effect sizes ranging from .00 to .11. Lynam et al. (1999) concluded that DARE’s short-term effect for was small and lower than other programmes. A 10-year follow-up study confirmed these results and declared that DARE was ineffective (West and O’Neal, 2004).
Programmes with inconclusive evidence on alcohol outcomes
There were 30 programmes whose outcomes were inconclusive (Table S2).
Programmes with evidence of negative effect on alcohol outcomes
Peer Acceleration Social Network (Project TND) (one published study, Grade C)
Project TND is an adaptation of Towards No Drug Abuse. The evaluation results were variable depending on the peer environment and the authors concluded that this programme was high risk (Valente et al., 2007).
Take Charge of Your Life (two published studies, Grade B)
Take Charge of Your Life (TCYL) focuses on the personal, social and legal risks of tobacco, alcohol and illicit drug use, as well as life skills such as communication, decision-making, assertiveness and refusal skills. Two reports (Sloboda et al., 2009; Teasdale et al., 2009) using data from the same study found increase in drinking and cigarette smoking for those participating in the programme. Compared to controls, more TCYL students who did not use alcohol at baseline were drunk in the past 30 days or had binged in the preceding 14 days at follow-up. The authors concluded that TCYL had an iatrogenic impact on students’ use of alcohol and tobacco.
Discussion
Many programmes have been evaluated; however, few have sufficient evidence to endorse their widespread implementation.
Of the 70 studies reviewed, of 40 programmes, 3 were well-conducted and replicated similar positive effects. They were CLIMATE Schools, Project ALERT and All Stars. The effects of these programmes were particularly strong for girls. All three are based on social learning principles that are embedded in real-life social situations, with social interactive components and out-of-classroom tasks. While these programmes showed consistent evidence of effect from more than one well-conducted study, the number of studies was still relatively small. However, reasonably robust results from the limited available evidence suggest they are most likely to be effective out of the range of possible programmes and are potentially targets for further research.
A number of programmes showed some evidence of effect, including ISPY, LST, SHAHRP and Unplugged-EU. These had more than one well-conducted study, but with variable outcomes. The studies were of lower quality and the weight of evidence was not sufficient to recommend them for general use, but controlled studies of these programmes would help to clarify their potential effectiveness.
Twenty-nine programmes were inconclusive due to poor methodology, inconsistent outcomes or too few studies.
One programme showed no evidence of effect (DARE) and two other programmes showed evidence of harm Project TND and TCYL. These studies while well conducted had some negative outcomes.
Alcohol education programmes had a number of common characteristics regarding effective implementation. These included the following:
Being based on accurate information and supported by empirical research (Wagner et al., 2004)
Being based on theoretical understandings of adolescent behaviour (Wagner et al., 2004)
Going beyond providing factual information about alcohol to allow young people to develop more sophisticated understandings of the social context of alcohol use (Cuijpers, 2002)
Providing feedback on social acceptability and normative expectations, highlighting that drug use is not as widespread as young people might think (Cuijpers, 2002)
Focusing on harm minimisation and skill development, not on resisting social/peer pressure (Cuijpers, 2002; McBride et al., 2004)
Using interactive styles and methods that focus on increasing awareness and understanding of issues relating to alcohol consumption (Nation et al., 2003)
Maximising students’ interest using up-to-date materials, skills, knowledge and cultural norms for the target group (McBride et al., 2004; Nation et al., 2003; Wagner et al., 2004)
Providing opportunities for students to interact with peers and practice new skills (Wagner et al., 2004)
Having clear, appropriate, achievable goals that are measureable (Nation et al., 2003)
Being accompanied by evaluation that will add to the evidence base of school-based programmes (Wagner et al., 2004)
Being supported by adequate teacher training, with a focus on ensuring that teachers who implement the programme are confident about their role (McBride, 2003; Nation et al., 2003)
Being supported by training which covers programme content and effective delivery (Nation et al., 2003)
Being consistent with a whole-of-school approach that promotes student resilience, social connectedness, encouraging strong relationships and communication between students, parents and staff (Cuijpers, 2002; Flay, 2000; McBride, 2003; Nation et al., 2003; Ostaszewski and Zimmerman, 2006)
One-off presentations delivered by experts, media personalities or individuals personally affected by alcohol do not appear to be effective. Despite the appeal, there is no evidence to suggest that having guest speakers influence young people’s alcohol-related behaviour. In addition, caution is needed when considering alcohol programmes that focus on factual aspects of alcohol (such as physical effects), particularly if these are delivered in a didactic manner (Foxcroft et al., 2003; Tobler et al., 2000; White and Pitts, 1998).
Programmes that primarily enhance self-esteem, psychological well-being and/or social competence sports participation, or resistance skills without providing normative education do not appear to be as effective (Ashton, 1999; Cuijpers, 2002; Scheier et al., 1999; Tobler, 1997).
Evidence about the effectiveness of negative, risk-focused messages is mixed. Graphical images that are too disturbing are more easily ignored by target audiences and those that are at odds with students’ own experiences can be rejected as unrealistic. Showing students scenarios or the serious harms that may occur from risky use of alcohol does not deter them or result in decreased use (Tobler, 1997).
Limitations of the evidence base
Much of the research undertaken in this area has generally been, at best, of only moderately good quality. Despite a large number of programmes identified in this review, each programme has only a handful of studies, resulting in a relatively limited evidence base to evaluate effectiveness of school-based alcohol education programmes. Furthermore, high-quality research on these programmes is required, especially for those programmes that show promise.
In addition, studies did not include economic analyses, which is an important consideration; resources, teacher training and experience were not well defined; and process outcomes, such as programme fidelity, implementation and acceptability of the programme to teachers and students, were rarely assessed.
Modifying the attitudes of young people does not always translate to behaviour change; however, only two of the included studies reported on attitude change only.
Measures of self-reported alcohol outcomes were inconsistent and included various ways of measuring consumption, intentions to drink, attitudes towards drinking, beliefs about negative consequences, normative beliefs about peers’ drinking and a range of other behaviours related to alcohol use, such as violence, unprotected sex, aggression, bullying and other socially unacceptable behaviours.
The changes in many of the relevant outcomes may not become apparent for some time after a programme, yet few studies assessed longer-term outcomes. Furthermore, most research in this area has been conducted in the USA, where the primary outcome measure of ‘success’ was often abstinence, neglecting other harm reduction outcomes.
There is a need to establish outcome measures that predict risky alcohol use and alcohol-related harms, with improved analyses (e.g. attrition rates, intention-to-treat analyses and economic analyses) (Foxcroft et al., 2003; Midford et al., 2012).
Conclusion
Only 3 of the 40 programmes included were of sufficient quality and had sufficiently positive outcomes to be widely used by schools. A number of other programmes showed some good outcomes but were subject to less robust methodologies. Schools seeking evidence-based alcohol (and drug) education programmes should ideally choose from the three programmes that showed more consistently good outcomes. If utilising one of the programmes that showed some positive effects, monitoring individual school outcomes may be warranted to ensure that the programme is achieving expected outcomes. Other programmes should be avoided until further research has confirmed they can produce consistently good outcomes.
Footnotes
Appendix
Summary of included programmes.
| Programme | Brief programme description | Overall effect rating | Evidence grading | Number of papers | Country |
|---|---|---|---|---|---|
| Programmes with good evidence of effect on alcohol outcomes | |||||
| CLIMATE Schools | A computer-focused alcohol prevention programme based on a harm minimisation approach. | *** | A | 4 | Australia |
| Project ALERT | Project ALERT aims to motivate students against using drug and give them skills to develop effective resistance behaviours. | *** | B | 5 | USA |
| All Stars | The primary focus of All Stars is on reducing adolescent risk behaviour, particularly tobacco, alcohol, marijuana and inhalant use and sexual activity. | *** | B | 2 | USA |
| Programmes with some evidence of positive effect on alcohol outcomes | |||||
| ISPY | ISPY is a comprehensive programme for the prevention of adolescent misuse of legal substances such as alcohol and tobacco. | ** | B | 2 | Germany |
| SHAHRP | A classroom-based programme with the aim of reducing alcohol-related harm. | ** | B | 2 | Australia |
| Unplugged EU-DAP | This programme targeted students aged 12–14 years and was designed to tackle both experimental and regular use of alcohol, tobacco and illicit drugs. | ** | B | 2 | Europe |
| LST | This programme has a focus on teaching of information and skills for resisting social influences to use drugs and generic personal and social skills for increasing overall competence and promoting the development of characteristics associated with decreased risk for using drugs. | ** | C | 4 | USA |
| Programmes with little or no evidence of effect on alcohol outcomes | |||||
| DARE | Focuses on social pressure to use drugs as well as information on drugs, decision-making, self-esteem and healthy alternatives to drug use. | * | A | 3 | USA |
| Programmes with inconclusive evidence on alcohol outcomes | |||||
| Keeping It REAL | The intervention uses knowledge, motivation and skills needed to resist drug offers. | ? | C | 4 | USA |
| Towards No Drug Abuse | This programme comprises two theory-based thematic content components, cognitive misperception correction and behavioural skills instruction. Cognitive perception information is used to change youths’ attitudes or beliefs regarding their drug use. | ? | C | 3 | USA |
| SFA | A comprehensive array of strategies to teach social competency and refusal skills. | ? | C | 2 | USA |
| SEL | The intervention includes classroom instruction and management and child skill development and parent workshops. | ? | D | 2 | USA |
| Positive Adolescent Life Skills | A cognitive behavioural, skill-building intervention that aims to improve social skills in a general population rural environment. | ? | D | 2 | USA |
| AMPS | This programme focused on the immediate effects of alcohol, risks of alcohol misuse and social pressures to misuse alcohol. | ? | B | 4 | USA |
| Gatehouse | A primary prevention programme, which includes both institutional and individual focused components to promote the emotional and behavioural well-being of young people in secondary schools. | ? | B | 3 | Australia |
| Personality Risk Factors | A manualised intervention designed to intervene at the level of personality risk and associated maladaptive coping strategies, including alcohol misuse. | ? | B | 1 | Canada |
| AAPT | Students received educational information only, education plus resistance training, education plus normative information or a combination of all three components. | ? | C | 1 | USA |
| CHOICE | A voluntary after school programme for adolescents to prevent AOD use. | ? | C | 1 | USA |
| Healthy Schools and Drugs | This programme includes a range of intervention components including a coordinating committee, a classroom-based intervention, school regulations on drug use, a system of early detection of students with drug problems and involvement of parents in drug abuse prevention at the school. | ? | C | 1 | The Netherlands |
| LEV | This programme aims to delay student experimentation with or initiation into smoking, discourages under age drinking and encourages students to avoid drinking and advocates that students avoid analgesics unless for legitimate health reasons. | ? | C | 1 | Australia |
| PYD | This programme is a comprehensive programme to promote well-being and prevent substance use among adolescent. It emphasises a strength-based approach to the promotion of positive outcomes for adolescents. | ? | C | 1 | USA |
| Olweus Prevention | The Olweus prevention programme aims to create a school and home environment characterised by positive interest and engagement on the part of adults and firm boundaries between acceptable and unacceptable behaviour. | ? | C | 1 | Norway |
| PY/PM | An alcohol prevention and vehicle safety programme to target children in school, beginning in first grade. | ? | C | 1 | USA |
| RRISK | RRISK aims to give students skills to make informed decisions about risk taking associated with drug and alcohol use driving and celebrating. | ? | C | 1 | Australia |
| School-Based Education | The focus of this programme was working on beliefs about consequences of alcohol use, media/advertising literacy, resistance skills and alcohol-related normative beliefs. | ? | C | 1 | Germany |
| School-Based Resilience Intervention | This is a resilience theory-based school intervention that is curriculum based and includes modification of policies and programmes, partnerships with local services. | ? | C | 1 | Australia |
| SNAP | Using social norms theory the focus of the intervention is the extent to which young peoples’ perceptions of their peers’ behaviour and attitudes influence their own drinking behaviours. | ? | C | 1 | Australia |
| DAW | The programme aims to reduce alcohol, tobacco, inhalants, marijuana and other drugs use – it uses a class-based simulation exercise. | ? | D | 1 | USA |
| Peer Led FAS/FAE | Multimedia presentation by peers and college student about foetal alcohol syndrome and other drug effects on the child during pregnancy. | ? | D | 1 | USA |
| Peer Support | The Peer Support programme aims to positively influence students’ knowledge, attitudes and use of drugs. | ? | D | 1 | Australia |
| Prime For Life | An alcohol risk reduction programme that has been used and refined in the USA for over 20 years. | ? | D | 1 | Sweden |
| Project PRIDE | A primary prevention programme intended to intervene at or before the early stages of drug and alcohol abuse. | ? | D | 1 | USA |
| RAP | Based on evidence-based guidelines for effective school-based programming, as well as for the needs and desires of the local school system to maximise impact in schools. | ? | D | 1 | USA |
| Say Yes First | This is a comprehensive, multicomponent approach for the prevention of ATOD use in high-risk youth in rural areas. Includes prevention, parents’ education, case management and family involvement. | ? | D | 1 | USA |
| Talk About Alcohol | The Talk About Alcohol programme takes a harm minimisation approach and gives teachers, young people and their parents’ tools to encourage students to make informed decisions and tactics to help them manage difficult situations regarding alcohol use. | ? | D | 1 | UK |
| Transtheoretical Model | An Internet-based intervention based on the Transtheoretical Model of Behaviour Change was delivered to middle-school students to reduce alcohol, tobacco and other drug use. | ? | D | 1 | USA |
| Wise Mind | An Alcohol/Tobacco/Drug prevention programme with Healthy Eating and Exercise obesity prevention programme. | ? | D | 1 | USA |
| STEP II | A pilot initiative for use in 25 schools in Mumbai and was further expanded by adding an alcohol abuse education component and denoted as STEP II. | ? | D | 1 | India |
| Programmes with evidence of negative effect on alcohol outcomes | |||||
| Peer Acceleration Social Network (Project TND) | This is a modified version of Towards No Drug Abuse with increased group activities and peer leaders. | X | C | 1 | USA |
| TCYL | Focuses on demonstrating students that there are personal, social and legal risks and consequences involved in the use of substances including tobacco, alcohol and illicit drugs. | X | B | 2 | USA |
ISPY: Life Skills Programme; SHAHRP: School Health and Harm Alcohol Harm Reduction Project; LST: Life Skills Training; DARE: Drug Abuse Resistance Education; SFA: Skills for Adolescence; SEL: Social and Emotional Learning; AMPS: Alcohol Misuse Prevention; AAPT: Adolescent Alcohol Prevention Trial; LEV: Life Education Victoria; PYD: Positive Youth Development; PY/PM: Protecting You Protecting Me; RRISK: Reduce Risk Increase Student Knowledge; SNAP: Social Norms Analysis Project; DAW: Drugs At Work; RAP: Reinforcing Alcohol Prevention; TCYL: Take Charge Of Your Life; AOD: Alcohol and other drug; FAS: Fetal alcohol syndrome; FAE: Fetal alcohol effects; ATOD: Alcohol, tobacco and other drugs; ? : inconclusive.
little of no evidence of effect.
some evidence of effect.
good evidence of positive effect.
Acknowledgements
The authors would like to acknowledge the contribution of Victoria Kostadinov who provided support in developing this paper.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was developed from an original study commissioned and funded by the former Australian Government Department of Education, Employment and Workplace Relations (DEEWR).
Notes
References
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