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. 2020 Jul 04;:
Authors: Slade T, Newton NC, Mather M, Barrett EL, Champion KE, Stapinski L, Conrod PJ, Teesson M
AIM: To compare the long-term universal outcomes of the Climate Schools program, the selective Preventure program and their combined implementation to standard substance use education in reducing the uptake of alcohol use, engagement in binge drinking and alcohol-related harms over a 3-year period.
DESIGN: A cluster randomized controlled trial.
SETTING: Substance use prevention programs delivered in Australian secondary schools.
PARTICIPANTS: Students from 26 Australian secondary schools (n = 2,190), mean age at baseline 13.3 years (SD 0.48), 57.4% male. Schools were recruited between September 2011 and February 2012.
INTERVENTIONS: Schools were block randomized to one of four groups; universal prevention (Climate;12 x 40min lessons); selective prevention (Preventure; 2 x 90min sessions); 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 program to the entire year group and the Preventure program to the high-risk students.
MEASUREMENTS: Participants were all consenting 8th grade students (in 2012) assessed at baseline, 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, obtained from all students regardless of whether or not they received intervention. Intervention effects at 36 months post-baseline were estimated from generalized multilevel mixed models using data from all timepoints and accounting for school level clustering. Exploratory analyses examined intervention effects among low- and high-risk adolescents.
FINDINGS: 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, 95%CI=0.50-0.82 for Climate; OR=0.55, 95%CI=0.43-0.71 for Preventure and OR=0.67, 95%CI=0.53-0.84 for CAP), to engage in binge drinking (OR=0.60, 95%CI=0.44-0.82 for Climate; OR=0.59, 95%CI=0.44-0.80 for Preventure and OR=0.68, 95%CI=0.51-0.92 for CAP), and to experience alcohol harms (OR=0.63, 95%CI=0.49-0.82 for Climate; OR=0.55, 95%CI=0.43-0.71 for Preventure and OR=0.64, 95%CI=0.50-0.81 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.
CONCLUSIONS: The universal Climate Schools program and the selective Preventure program 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.
PMID: 32621555 [PubMed – as supplied by publisher]
Source: ncbi 2