The long-term effectiveness of universal, selective and combined prevention for alcohol use during adolescence
The long-term universal outcomes of two substance use prevention programmes delivered in Australian secondary schools were assessed in a study published in the journal Addiction. The effectiveness of the programmes in reducing the uptake of alcohol use, engagement in binge drinking and alcohol-related harms over a 3-year period was measured. Pupils who received either the Climate Schools programme, the selective Preventure programme or their combined implementation were compared to those who received standard substance use education.
2,190 Students from 26 Australian secondary schools with a mean age at baseline of 13.3 years were included in the study. Schools were block randomised to universal prevention (Climate); selective prevention (Preventure); combined prevention (Climate and Preventure; CAP); or health education as usual (Control). The Climate intervention delivered 12 x 40-minute lessons aimed at reducing alcohol and cannabis use and related harms. The Preventure intervention delivered 2 x 90-minute group sessions to high-risk students. The CAP group implemented the Climate programme to the entire year group and the Preventure programme to the high-risk students.
Participants were all assessed at baseline in 2012, post intervention (6–9 months post baseline), and at 12, 24 and 36 months post baseline, on measures of alcohol use, knowledge and related harms. Primary outcomes were alcohol use, binge drinking (5+ standard drinks) and alcohol-related harms. Intervention effects at 36 months post-baseline were estimated. Exploratory analyses examined intervention effects among low- and high-risk adolescents.
Compared with students in the Control condition, students in the Climate, Preventure and CAP groups demonstrated significantly slower increases in their likelihood to drink any alcohol (OR=0.64 for Climate; OR=0.55 for Preventure and OR=0.67 for CAP), to engage in binge drinking (OR=0.60 for Climate; OR=0.59 for Preventure and OR=0.68 for CAP), and to experience alcohol harms (OR=0.63 for Climate; OR=0.55 for Preventure and OR=0.64 for CAP). There was no strong evidence that the combined approach showed advantages over universal prevention. The direction and magnitude of effects were consistent in low- and high-risk adolescents.
The findings indicate that the universal Climate Schools programme and the selective Preventure programme were effective in reducing alcohol consumption and alcohol problems compared with standard Australian health education, when trialled individually and together over a 3-year period.
Source: Slade, T., Newton, N. C., Mather, M., Barrett, E. L., Champion, K. E., Stapinski, L., Conrod, P. J., and Teesson, M. (2020) The long-term effectiveness of universal, selective and combined prevention for alcohol use during adolescence: 36-month outcomes from a cluster randomized controlled trial. Addiction.