Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis.

J Subst Abuse Treat. 2015 Apr;51:1-18. doi: 10.1016/j.jsat.2014.09.001. Epub 2014

Sep 16.

Tanner-Smith EE, Lipsey MW.

This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11-18) and young adults (age 19-30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g = 0.27 and g = 0.19) and young adults (g = 0.17 and g = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.

School-based education programmes for the prevention of child sexual abuse.

Walsh K, Zwi K, Woolfenden S, Shlonsky A.

Cochrane Database Syst Rev. 2015 Apr 16;4:CD004380. [Epub ahead of print]

BACKGROUND: Child sexual abuse is a significant global problem in both magnitude

and sequelae. The most widely used primary prevention strategy has been the

provision of school-based education programmes. Although programmes have been

taught in schools since the 1980s, their effectiveness requires ongoing scrutiny.

OBJECTIVES: To systematically assess evidence of the effectiveness of

school-based education programmes for the prevention of child sexual abuse.

Specifically, to assess whether: programmes are effective in improving students'

protective behaviours and knowledge about sexual abuse prevention; behaviours and

skills are retained over time; and participation results in disclosures of sexual

abuse, produces harms, or both.

SEARCH METHODS: In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE

 and 11 other databases. We also searched two trials registers and screened the

reference lists of previous reviews for additional trials.

SELECTION CRITERIA: We selected randomised controlled trials (RCTs),

cluster-RCTs, and quasi-RCTs of school-based education interventions for the

prevention of child sexual abuse compared with another intervention or no

intervention.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the

eligibility of trials for inclusion, extracted data, and assessed risk of bias.

We summarised data for six outcomes: protective behaviours; knowledge of sexual

abuse or sexual abuse prevention concepts; retention of protective behaviours

over time; retention of knowledge over time; harm; and disclosures of sexual

abuse.

MAIN RESULTS: This is an update of a Cochrane Review that included 15 trials (up

to August 2006). We identified 10 additional trials for the period to September

2014. We excluded one trial from the original review. Therefore, this update

includes a total of 24 trials (5802 participants). We conducted several

meta-analyses. More than half of the trials in each meta-analysis contained unit

of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective

behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval

(CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37,

df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when

we made adjustments using intraclass correlation coefficients (ICCs) to correct

errors made in studies where data were analysed without accounting for the

clustering of students in classes or schools.2. Meta-analysis of 18 trials (n =

4657) evaluating questionnaire-based knowledge favoured intervention

(standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was

substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%,

Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1

SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3.

Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured

intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial

heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08).

The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95%

CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four

trials in the meta-analysis for retention of knowledge over time. The effect of

intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI

0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months

(SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929).

The results did not change when adjustments were made using ICCs.5. We included

three studies in the meta-analysis for adverse effects (harm) manifesting as

child anxiety or fear. The results showed no increase or decrease in anxiety or

fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and

there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not

change when adjustments were made using ICCs.6. We included three studies (n =

1788) in the meta-analysis for disclosure of previous or current sexual abuse.

The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no

heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of

clustering had the effect of widening the confidence intervals around the OR

(ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to

12.61).Insufficient information was provided in the included studies to conduct

planned subgroup analyses and there were insufficient studies to conduct

meaningful analyses.The quality of evidence for all outcomes included in the

meta-analyses was moderate owing to unclear risk of selection bias across most

studies, high or unclear risk of detection bias across over half of included

studies, and high or unclear risk of attrition bias across most studies. The

results should be interpreted cautiously.

AUTHORS' CONCLUSIONS: The studies included in this review show evidence of

improvements in protective behaviours and knowledge among children exposed to

school-based programmes, regardless of the type of programme. The results might

have differed had the true ICCs or cluster-adjusted results been available. There

is evidence that children's knowledge does not deteriorate over time, although

this requires further research with longer-term follow-up. Programme

participation does not generate increased or decreased child anxiety or fear,

however there is a need for ongoing monitoring of both positive and negative

short- and long-term effects. The results show that programme participation may

increase the odds of disclosure, however there is a need for more programme

evaluations to routinely collect such data. Further investigation of the

moderators of programme effects is required along with longitudinal or data

linkage studies that can assess actual prevention of child sexual abuse.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004380.pub3/full