Preventing alcohol abuse and alcohol-related problems through community interventions: A review of evaluation studies

City-based action to reduce harmful alcohol use: review of reviews

Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol.     Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.

City-based action to reduce harmful alcohol use: review of reviews

Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol.     Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.

Alcohol use and abuse in adolescence: proposal of an alternative analysis

BACKGROUND

A national, representative, school-based sample of Portuguese youths was used to examine the prevalence of alcohol use in this population and to analyse differences between demographic variables such as gender and age, as well as to propose a statistical procedure that optimally quantifies categorical variables.

METHODS

Data on 6109 state school students from Portugal, in the 6th, 8th and 10th grades, aged 11-18, who participated in the 2002 (Health Behaviour in School-aged Children/WHO) survey of adolescent health, were analysed. Adolescents aged between 11 and 14 were placed in the younger group, and those 15-18 years old were placed in the older group. Optimal scaling was used to optimize the computation of factor scores, which were subsequently submitted to multiple regression analysis in order to analyse the impact of gender and age on alcohol use.

RESULTS

The results of this study show that the majority of Portuguese school-aged adolescents attending regular school at 6th, 8th and 10th grades do not drink alcoholic beverages (beer, wine or spirits) on a regular basis (at least once a month). However, about 8% of these adolescents do drink beer, 3% do drink wine and 12% do drink spirits on a regular basis. With regard to age and gender, about a quarter of the older boys stated that they drink beer or spirits regularly. The multiple regression analysis showed that age and gender had a significant impact on alcohol use.

CONCLUSION

Alcohol - in particular spirits - is a substance used by some Portuguese adolescents. Alcohol use and abuse is more frequent in boys and increases with age. The importance of these findings for health promotion strategies is discussed.

Teasing apart a multiple component approach to adolescent alcohol prevention: what worked in Project Northland?

This paper presents the results of a post hoc component analysis designed to tease apart the effects of different intervention strategies used in Project Northland, a group-randomized, community-wide, multi-level intervention trial originally conducted in the 1990's to prevent and reduce alcohol use among a cohort of mainly White students in rural Minnesota. This study focuses on Phase I, when students were in 6th-8th grade. The intervention during this phase included five components: classroom curricula, peer leadership, youth-driven/led extra-curricular activities, parent involvement programs, and community activism. Student exposure to/participation in these components was followed over time using reliable process measures. These measures were used as time-varying covariates in growth curve analyses to estimate the effects of the intervention components over time. Multi-item scales from annually-administered student surveys were used to measure relevant outcome variables, like alcohol use. The impact of the components appears to have been differential. The strongest effects were documented for the planners of extra-curricular activities and parent program components. The classroom curricula proved moderately effective, but no effects were associated with differential levels of community activism. The interactions tested here did not provide support for synergistic effects between selected intervention components. Care must be taken when selecting and combining intervention strategies meant to reduce adolescent alcohol use.

Prevention of adolescent alcohol problems in special populations

Research on the prevention of alcohol abuse in America has only recently begun to consider the needs of special populations. This chapter will consider alcohol prevention as a function of four major special population divisions: gender, ethnicity, region (population density), and socioeconomic status. Specific ethnic groups examined will include Hispanics, African-Americans, Asian-Americans, and Native Americans. In general, there is some support for the utility of current alcohol prevention approaches on special populations. Much population-specific work completed to date has not been rigorously designed or evaluated, though it appears likely that partnering with population gatekeepers and showing cultural respect and sensitivity to the population, and providing material that is relevant to the population's adaptation to their environment are essential.

Youth, drugs and resilience education

Billions of dollars are spent annually on school-based drug education programs, with youthful drug use remaining near peak levels since the 1980s. Institutional, policy, and program evidence presented here suggests that although primarily delivered in schools, the educational community rarely participates in the development of drug education; and despite the finding that "no-use" programs such as Drug Abuse Resistance Education (D.A.R.E.) or Life-Skills Training (LST) are likely ineffective, they continue to thrive in schools. This may be explained by insufficient educational participation and scientific discourse considering these issues; and the role of interest group politics, such as the symbiotic relationship between government, researchers, and the tobacco industry, in drug education. In addition to this evidence, resilience based program alternatives, evaluation, and implications are discussed.

Alcohol availability and domestic violence

The purpose of this study was to examine the relationship among sociodemographic variables, alcohol outlet density, and rate of domestic violence in New Jersey. Data were obtained for the 223 largest municipalities in the state and were examined using factor analysis and bivariate and multivariate analyses. Three sociodemographic factors were extracted through factor analysis. These explained 58% of the variance among municipalities in rates of domestic violence. One factor--termed social disadvantage--explained the greatest amount of unique variance (42%). Alcohol outlet density added nothing to the sociodemographic model and did not interact with any of the three sociodemographic factors. The findings show that, in the state of New Jersey, higher levels of alcohol outlet density are not geographically associated with higher rates of domestic violence. These findings may be due to limitations in the data sets employed in the study, limitations of the macrolevel analysis employed, and/or the complex nature of the relationship between alcohol use and domestic violence.

The irrelevance of evidence in the development of school-based drug prevention policy, 1986-1996

This article examines development in school-based drug prevention policy and programming since the Anti-Drug Abuse Act of 1986. Using data from national surveys and evaluations of school-based programs, it argues, first, that there was really no need for a massive infusion of money into school-based drug prevention in the late 1980s, and, second, that there was little or no evidence to indicate that a "new generation" of effective programs, based on the so-called social influence model, was emerging at this time. Despite the infusion of resources into school-based prevention efforts, adolescent drug use has risen in recent years. Moreover, evaluations continue to show that the effectiveness of social influence programs is very much in the eye of the beholder. Fundamental questions need to be asked of school-based drug prevention--just as they should be asked of other key components of our current drug control policy.

Longitudinal perspective on alcohol use and aggression during adolescence

While there is general agreement that alcohol use and aggression are related, few studies have examined this relationship among youth. This chapter reviews the literature on rates of alcohol use, aggression, and alcohol-related aggression among adolescents, as well as the cross-sectional and longitudinal associations among these behaviors. In general, the literature does not provide strong support for a unique association between alcohol use and aggressive behavior during adolescence. The observed relationship between alcohol use and aggression appears to be spurious because both behaviors are predicted by a similar set of individual, family, and environmental factors. Prevention programs that reduce these common risk factors should decrease both behaviors. Interventions with aggressive individuals, especially aggressive individuals who drink heavily, may be most indicated.

Etiological Theories and the Primary Prevention of Drug Use

Since the early 1980s, the social influence model has dominated the field of primary prevention research. Social influence programs generally take the form of standardized curricula, aimed at all members of broadly defined target populations. Evaluative research has employed a fundamentally inductive methodology, the goal of which is to generate successive “confirming instances” of program effectiveness among these broad populations. As a result, prevention research has largely stagnated, and has not availed itself of recent findings from basic research such as those reported in this issue. This research tells us that the relationship between peer group affiliation and drug use is reciprocal and not unidirectional as assumed in most social influence programs, that the scope of intervention efforts must be broadened because the processes involved in the initiation of drug use are far more complex than suggested by the theories on which current prevention efforts are based, and that programs should be targeted rather than universal as some individuals are at greater risk of developing a problem with drugs than others.