Community prevention of alcohol problems.
Interventions were delivered in various settings including the child's school or family home and via the Internet or print material. Interventions varied in intensity, duration, and approach, but all targeted alcohol or other drug use by promoting positive parenting approaches or enhancing parent-child relationships.
The interventions focused on communication , family dynamics, rule-setting, and risk management. The total number of participants in the included studies was 39,, and the young people targeted ranged from 5 to 17 years of age. Participant ethnicity was mixed, with 12 studies targeting ethnic minority groups specifically.
Overall, we found no evidence for the effectiveness of family-based interventions on the prevalence , frequency, or volume of alcohol use among young people. Some analyses focusing on specific subgroups of studies e. Some studies reported positive intervention effects on secondary outcomes parental supply of alcohol, family involvement, alcohol misuse, and alcohol dependence but with small numbers; these studies could not be pooled, so the evidence is insufficient.
No adverse effects were reported. Overall, only very low- or low-quality evidence shows the small effects found in this review. We downgraded the quality of evidence due to the heterogeneity variability between studies and imprecision variation in results. These problems with study quality could result in inflated estimates of intervention effects, so we cannot rule out the possibility that slight effects observed in this review may be overstated.
Three studies provided no information about funding, and only 13 papers had a clear conflict of interest statement. The results of this review indicate that there are no clear benefits of family-based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity , and number of analyses performed preclude any conclusions about intervention effects.
Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. Alcohol use in young people is a risk factor for a range of short- and long-term harms and is a cause of concern for health services, policy-makers, youth workers, teachers, and parents.
To assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children up to 18 years of age. Specifically, on these outcomes, the review aimed:. We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies.
We included randomised controlled trials RCTs and cluster RCTs C- RCTs involving the parents of school-aged children who were part of the general population with no known risk factors universal interventions , were at elevated risk of alcohol use or problem drinking selective interventions , or were already consuming alcohol indicated interventions.
Psychosocial or educational interventions involving parents with or without involvement of children were compared with no intervention , or with alternate e. We included 46 studies 39, participants , with 27 classified as universal, 12 as selective, and seven as indicated. We performed meta-analyses according to outcome , including studies reporting on the prevalence , frequency, or volume of alcohol use. Many of the programs that have been studied were designed to prevent a broad spectrum of substance abuse problems, including smoking, underage drinking and illegal drug use.
Results of these programs vary. Fortunately, research and experience have confirmed that some effective strategies already exist to prevent or curb underage drinking. Other promising strategies have not yet been evaluated, but appear to be effective and may be validated in the future. This Community How to Guide will discuss strategies in both categories. As in other fields of study, expanding research and practice sometimes require that old strategies be discarded in favor of newer, more effective approaches.
This is certainly true of some of the underage drinking prevention strategies that became popular in the last twenty years and that must now be reevaluated by underage drinking prevention coalitions and organizations. In the early s, some school-based anti-drug programs focused on providing extensive information about drugs, including reasons why people were attracted to drug and alcohol use. Having individuals in recovery from drug and alcohol abuse speak to youth was another well intentioned, but misguided, strategy that has been popular.
A panel of experts convened by the Center for Substance Abuse Prevention in reviewed all the available evidence and concluded that improving adolescent self-esteem does not necessarily protect them against substance abuse and that poor self-esteem alone is not predictive of future substance abuse. During the last fifteen years, theories and practices in prevention have evolved dramatically.
Effective prevention programs no longer focus only on reaching individuals and providing knowledge about alcohol and drugs. Newer efforts emphasize programs and policies that shape knowledge, beliefs and behavior by changing the environment in which the target audience lives, as well as providing information. In substance abuse prevention, the environment is not the natural environment of land and seas, but the community, school, family, and cultural environments.
The timing of prevention efforts has changed dramatically during the last ten years. In the past, many prevention programs did not recognize that alcohol and other drug use frequently begins long before children enter high school. Today, experts recognize that efforts to prevent substance abuse should begin early and continue through adolescence.
Research into prevention has identified an array of biological, psychological, social, economic, and other factors that may contribute to whether or not an individual uses or abuses alcohol or other drugs.
These factors are known as risk and protective factors. The risk and protective factor approach to prevention has become central to prevention planning for many communities and government agencies. They also provide the framework for the strategies discussed in this booklet. Risk and protective factors first came to prominence as a result of the Framingham Heart Study launched in the s to examine how and why some people suffer cardiovascular disease. Researchers in mental health have discovered that certain factors appear to protect individuals from behavioral health problems even though they appear to be at high risk.
Researchers in substance abuse prevention have examined how risk, protective, and resiliency factors relate to substance abuse, including underage drinking.
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A child of an alcoholic, for instance, is at heightened risk of engaging in negative alcohol-related behavior. Male children of alcoholics appear to be at particular risk of becoming alcoholics themselves. Risk and protective factors are related not only to alcohol and other drug use, but also to other negative behaviors, including violence. Children who are exposed to violence in their homes, for instance, are at higher risk to become involved in crimes and violence as adults, as well as more likely to abuse alcohol. The concept of risk and protective factors is not new to many of the key target groups involved in underage drinking.
For instance, a bar owner requires food servers to wash their hands. This is a protective factor to reduce the risk of disease.
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Explaining the concept of risk and protective factors to the bar owner in those terms makes it easier for that individual to understand that checking IDs reduces the risk of impaired driving by underage youth. Risk and protective factors are organized into four general categories and include the following:.
Community prevention of alcohol problems.
Underage drinking prevention coalitions and organizations can use this chart to conduct an assessment of the risk and protective factors in their community as well as examine the risk, protective, and potential resiliency factors for specific groups of young people and incorporate them into their planning. It will also help examine the resources that are available for prevention programs. Research into risk and protective factors indicates that strengthening families, improving parenting skills, and helping families to establish strong, consistent norms about alcohol and other drug use can help prevent substance abuse, including underage drinking, as well as violence and other related problems.
For many years, underage drinking prevention programs tended to focus on just two of the three major elements of the public health model: the agent alcohol or the host the young person. Prevention research has developed a new way of describing prevention programs. Called the Institute of Medicine IOM model, prevention programs are described as universal programs that target everyone , selective programs that target specific, defined groups of people , or indicated programs directed at individuals and their families.
Since the majority of current prevention programs use the universal, selective or indicated description, following are the general characteristics for each area:. Appendix 1 is a Prevention Program Classification Checklist that will help coalitions and organizations determine what level of prevention program they need.
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Most communities will employ a variety of programs. Following is a description of a variety of prevention strategies that are categorized according to the risk and protective factor framework. Underage drinking community based prevention strategies need to address the following issues.
Organizations with limited resources will need to determine which strategies are most important and prioritize these activities. Again, it will be necessary to prioritize based on available resources. There is a wealth of data and information that supports the effectiveness of these strategies and practices.
Availability is a great predictor of alcohol use. If large numbers of alcohol outlets are located in a given area, alcohol-related problems will generally increase. Conducting these checks and publicizing the findings has proven to reduce sales of alcohol to minors. The officer trains the clerk s to detect false, altered, or fraudulent identification and if a minor attempts to purchase alcohol, the law enforcement officer cites the minor.
States or local jurisdictions can enact laws to hold adults, who are in charge of the premises, responsible for any illegal drinking which takes place while they are present. They can also vigorously enforce laws related to providing alcohol for minors or contributing to the delinquency of a minor. This education is most effective when used in conjunction with compliance checks. The classes provide information on how to avoid confrontation and peer pressure as well as management skills and responsible alcohol service. The training involves off-sale and package good establishments, hotels, country clubs, caterers, and restaurants.
Citing clerks and shop owners who break the law is only effective if serious consequences are imposed by the board of license commissioners, liquor board, or other alcohol licensing authority. Dram shop liability laws hold merchants accountable when intoxicated drivers they serve cause crashes after leaving their establishment. Keg registration laws require that an adult who takes a keg out of an alcohol outlet must fill out a form that contains their name, address, and other information.
Although keg registration offers enforcement agencies an additional tool, it is primarily designed to reduce the availability of alcohol to minors by discouraging adults from providing kegs for minors and by making it less attractive for youth to attempt to secure kegs by presenting fake IDs. Party patrols and other enforcement strategies to break up parties and cite the youth involved signal strong community disapproval of underage drinking and seek to reduce the opportunities for drinking.
Publicizing these efforts helps to build awareness of the underage drinking problem and the efforts underway to curb it. In many communities, local beer distributors or manufacturers sponsor events for adults and youth. Some communities have been successful in preventing alcohol-industry sponsorship of large sports activities.
The Troy Community Coalition in Troy, Michigan learned that an alcohol-industry-sponsored sports event was scheduled for their town and succeeded in preventing the activity from taking place until alternate sponsors could be recruited.