A systematic literature review of alcohol education programmes in middle and high school settings (2000-2014)

Towards a conceptual framework for the prevention of gambling-related harms: Findings from a scoping review

The global gambling sector has grown significantly over recent years due to liberal deregulation and digital transformation. Likewise, concerns around gambling-related harms-experienced by individuals, their families, their local communities or societies-have also developed, with growing calls that they should be addressed by a public health approach. A public health approach towards gambling-related harms requires a multifaceted strategy, comprising initiatives promoting health protection, harm minimization and health surveillance across different strata of society. However, there is little research exploring how a public health approach to gambling-related harms can learn from similar approaches to other potentially harmful but legal sectors such as the alcohol sector, the tobacco sector, and the high in fat, salt and sugar product sector. Therefore, this paper presents a conceptual framework that was developed following a scoping review of public health approaches towards the above sectors. Specifically, we synthesize strategies from each sector to develop an overarching set of public health goals and strategies which-when interlinked and incorporated with a socio-ecological model-can be deployed by a range of stakeholders, including academics and treatment providers, to minimise gambling-related harms. We demonstrate the significance of the conceptual framework by highlighting its use in mapping initiatives as well as unifying stakeholders towards the minimization of gambling-related harms, and the protection of communities and societies alike.

Efficacy of theory-based interventions aimed at reducing binge drinking in adolescents: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND AND AIMS

Binge drinking is a widespread practice among adolescents worldwide and is associated with various harmful consequences. Theory-based interventions are a promising approach to prevent this drinking behaviour in this population. The aim of the present review was to determine: (1) the characteristics of theory-based interventions targeting binge drinking in adolescents, (2) the impact of such interventions on binge drinking, and (3) the quality of theoretical implementation.

METHODS

For this systematic review, randomised controlled trials were eligible for inclusion if the binge drinking-targeting intervention was based at least on one theoretical framework, and if the population's mean age was between 10 and 18 years. Two authors extracted relevant data. A meta-analysis was conducted to evaluate the effect of interventions on binge drinking. Effect sizes were calculated with the Hedges's g. Binge drinking was measured as a continuous or dichotomous outcome. The quality of theoretical implementation of interventions was measured using an existing "theory coding scheme".

RESULTS

Sixteen studies were identified. Ten were based on a single theory, and six on a combination of theories. The number and type of behaviour change techniques used in each intervention varied greatly. Theory-based interventions led to a small but significant decrease in binge drinking (Hedges's g = 0.10; 95% confidence interval = 0.04, 0.16). The quality of theoretical implementation was globally low, and the reciprocal link between behaviour change techniques and theoretical constructs was unclear for most studies.

CONCLUSIONS

Theory-based interventions have a small but significant beneficial impact on decreasing binge drinking in adolescents. Future research should try to be more effective in matching theoretical determinants of behaviour with the content of the intervention.

Integrating student and teacher insights to a school-based alcohol program through co-design

School-based programs may be more effective when an array of stakeholders, including users, are involved during the relevant stages of program co-creation-specifically during key development stages such as design, implementation and evaluation. How such programs can be operationally co-created and tested is less known and is therefore the purpose of this article. Two sequential co-design phases underpin this study. First, a co-design session with 20 health and physical education (HPE) teachers focussed on reviewing, testing and critically discussing initial prototype online modules for an alcohol education program. Teacher insights were assessed and incorporated, and the updated online modules were tested with secondary school students (n = 120) capturing their experience in a classroom setting. Insights from each group were analysed using thematic analysis. Teachers and students serve important roles in program co-creation. Teachers remain an underutilized stakeholder group whom are however critical in delivering important insights to enhance educational program design. Teachers demanded more relevance to the national curriculum, further alignment with curriculum assessment standards, and age appropriate content. Student feedback focussed largely on realistic content, personalization and gamification elements. This study represents an application of the seven-step co-design process and advances understanding of the 'fuzzy back-end' of the process, namely reflecting on feasibility of integrating teacher and student feedback and ideas. More specifically, how these key-yet distinct-stakeholder groups can be involved, and the merits of their involvement are discussed.

A systematic review of parent based programs to prevent or reduce alcohol consumption in adolescents

BACKGROUND

Adolescent alcohol consumption is an issue of ongoing concern and programs targeting parents have been identified as an important component in minimizing and preventing alcohol related harm in adolescents. This paper aims to evaluate existing parent based alcohol education programs with a focus on understanding parent specific outcomes including parental attitudes, parent-child communication, alcohol specific rule setting and parental monitoring; study quality, the extent of stakeholder engagement in program design and the level of theory application.

METHOD

A systematic review of electronic databases EBSCO, Emerald, ProQuest, PubMed, Ovid, ScienceDirect, Taylor and Francis and Web of Science was conducted from database inception to August 2019. A total of 4288 unique records were retrieved from the eight databases. Studies were included if they evaluated school based alcohol education programs that included a parent component and detailed outcome measures associated with parent data. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

RESULTS

In total 17 studies qualified for assessment, detailing 13 individual parent programs. Of these, ten programs demonstrated positive effects in at least one parent reported outcome measure. Stakeholder engagement during the design of programs was lacking with the majority of programs. One third of the programs did not report theory use and when theory was used reporting was weak with three programs applying theory, five testing theory and none building theory. According to the EPHPP tool, overall ten programs were rated as weak, three as moderate and none as strong.

CONCLUSION

Future studies are recommended to further enhance the effectiveness of parental programs by improving study quality, increasing stakeholder engagement and increasing the level of theory application and reporting.

The Impact of Serious Educational Gameplay on Adolescent Binge Drinking Intentions: A Theoretically Grounded Empirical Examination

INTRODUCTION

Game On: Know Alcohol, a school-based alcohol education program, aimed to educate adolescents on the harmful effects of (excessive) alcohol consumption. The program included two user-centered serious educational games, Perfect Pour and Dumb Driver.

PURPOSE

To evaluate the objective effect of playing Perfect Pour and Dumb Driver on the key psychosocial determinants of adolescent binge drinking intentions in the context of the theory of reasoned action (TRA).

METHODS

Data were drawn from four Game On: Know Alcohol program schools ( N = 303 adolescents aged 14-16 years), and two TRA models incorporating four game metrics were analyzed using structural equation modeling.

RESULTS

The theoretically guided TRA models linked to gameplay data explained 66% of variance in adolescents' binge drinking intentions. Average game duration and average score of Perfect Pour were significantly associated with adolescents' attitudes toward binge drinking, whereas no objective effect on the key psychosocial determinants was observed for Dumb Driver.

CONCLUSIONS

Inconclusive findings suggest that further research is needed to fully understand how serious educational games may be designed to effectively influence adolescents' binge drinking intentions. Opportunities to extend theory application beyond evaluation are noted in addition to other opportunities for future research.

Reciprocal Influences of Drinking Motives on Alcohol Use and Related Consequences: A Full Cross-Lagged Panel Study Among Young Adult Men

Using a full cross-lagged model, this study investigates the extent to which drinking motives predict alcohol use and related consequences, and vice versa. At baseline and 15 months later, 4575 men (mean age = 19.4 years) in Switzerland completed a questionnaire assessing drinking motives, average weekly consumption, risky single-occasion drinking, and alcohol-related consequences. Results indicated that social and enhancement motives more strongly influenced alcohol use over time than the other way round. Coping motives predicted an increase in alcohol-related consequences, and vice versa. Higher social motives predicted an increase in coping motives while higher coping motives predicted a decrease in enhancement motives. These results suggest that social and enhancement motives amplify each other in early adulthood and predict increases in risky drinking. Structural measures aimed at reducing opportunities to engage in heavy drinking are recommended. Additionally, the detection of young adult men vulnerable to maladaptive coping behaviors appears important for alcohol prevention strategies.

Adolescents’ perceptions of alcohol

Purpose

Rising trends in alcohol consumption and early drinking initiation pose serious health risks especially for adolescents. Learner’s prior knowledge about alcohol gained from the social surroundings and the media are important sources that can impact the learning outcomes in health education. The purpose of this paper is to map adolescents’ perceptions of alcohol in Punjab, India and how these perceptions are related to their attitudes towards their social surroundings and the media.

Design/methodology/approach

The questionnaire was created after informal discussions with local people who consume alcohol and discussions with alcohol-related experts. Students from five schools (n=379, average age=13.6 years) in the urban region of Punjab, India, filled in a questionnaire. Quantitative tests were performed on the questionnaire data. Summative content analysis was performed for the textbook content about alcohol from classes 1 to 10.

Findings

Data suggest that students gain knowledge about alcohol from multiple sources, including society, the media and education. While society and the media can give misinformation, education did not provide them with factual scientific information about alcohol. Students from financially marginalized social surroundings experience the presence and use of alcohol more frequently; they trust the media and celebrities somewhat unquestioningly and, hence, are more at-risk.

Research limitations/implications

All participants in informal discussions as well as all participating schools in the study were from urban regions. Data about individual’s socio-economic conditions was not collected.

Originality/value

This research investigates perceptions of alcohol that are derived from adolescents’ social surroundings, perceptions of the media and perceptions gained through educational guidance in a developing country. Such multi-dimensional investigations have not been conducted earlier.

Social marketing interventions aiming to increase physical activity among adults

Purpose

A significant proportion of the world’s adult population is insufficiently active. One approach used to overcome barriers and facilitate participation in physical activity is social marketing. The purpose of this paper are twofold: first, this review seeks to provide a contemporary review of social marketing’s effectiveness in changing physical activity for the better; and second, it seeks to ascertain the extent that Andreasen’s (2002) six social marketing benchmark criteria have been applied in social marketing interventions targeting physical activity.

Design/methodology/approach

In total, 94 articles covering 26 social marketing interventions were identified following systematic literature review procedures.

Findings

None of the interventions gave evidence that they addressed all six social marketing benchmark criteria, and only four interventions addressed five criteria. The results indicate that three of the benchmark criteria, namely, behavioural objectives, formative research, and marketing mix are well utilised in social marketing interventions. Inclusion of market segmentation, exchange and competition offers potential to extend further on social marketing’s effectiveness in increasing physical activity.

Originality/value

The results of the current study indicate that increasing the number of benchmark criteria used in an intervention to at least four increases the chances of achieving positive behavioural outcomes.