Table 1 Descriptive characteristics of studies eligible for secondary analysis
Study | Setting | Population | Intervention | Primary outcome(s) | SES measure at baseline | Effect | Risk of Bias |
|---|---|---|---|---|---|---|---|
Bodin and Leifman 2011 [54] | Community, Sweden | 128 recruited, 65 to intervention, 63 to control | Adult mentoring over the course of one year | Alcohol use Drunk in the last month Delinquency Substance use in the last 6 months Tobacco user Depressive symptoms | Parental degree | No significant outcome differences between the groups. Low statistical power preclude definite conclusions. |
|
Raising Healthy Children Brown et al 2005 [55] | Schools in Washington, USA | 1,040 students from 10 schools, 5 schools to intervention and 5 to control. | Prevention strategies that address risk and protective factors that consisted of teacher development workshops, student after-school tutoring sessions and parenting workshops for families. | Substance use: alcohol, marijuana and tobacco use. | Household income status | There were significant intervention effects in growth trajectories for frequency of alcohol and marijuana use but not for use versus non-use. |
|
Family Check-Up Connell et al 2007 [56] | Middle Schools, Oregon USA | 998 recruited from 3 middle schools, 500 to intervention 498 to control | Universal classroom-based intervention, the Family Check-Up and family management treatment | Adolescent substance use: tobacco, alcohol, drugs Problem behaviour: antisocial behaviour and offending | Free school meal eligibility | Relative to controls, adolescents whose parents engaged in the Family Check-Up exhibited less growth in alcohol, tobacco, and marijuana use and problem behaviour during ages 11 through 17. There was also a decreased risk for substance use and arrests by age 18. |
|
DARE-A and RSTP D'Amico 2002 [57] | One high school, USA | 300 recruited from 1 school. 75 to intervention arm 1, 75 to intervention arm 2, 150 control. | Risk skills training programme interactive group session and DARE-A drug abuse and resistance education programme. | Tobacco Alcohol use Marijuana use Violence Victimisation | Family income | RSTP participants decreased participation in several risk behaviours as post-test, but reductions were not maintained at 6-month follow-up. Both the control and the DARE-A groups decreased negative alcohol expectancies and the control group increased alcohol consumption. |
|
LIFT DeGarmo et al 2009 [58] | Schools in North West USA | 671 recruited from 12 schools | Parent management training, child social and problem solving skills and school recess component | Alcohol use Cannabis use Tobacco use Arrests | Annual household income | LIFT had a significant effect on reducing the rate of growth in use of tobacco, alcohol and illicit drugs. Average tobacco use reductions were mediated by increases in family problem solving. |
|
All Stars Gottfredson et al 2010 [43] (included in subgroup analysis) | Schools in Maryland, USA | 447 from 5 schools. 224 participants to intervention 223 to control | All Stars programme with lessons about substance use prevention, violence prevention and “plus” lessons reinforcing attitudes to behaviour change. Programme delivered in an after school setting. | Alcohol initiation Tobacco initiation Marijuana initiation Drug use in the past 30 days School attendance | Free school meal eligibility, Parent income | Results show no difference between the treatment and control students and post-test at any outcomes or mediators. No positive effects were found for youths receiving higher dosage. |
|
Parents who care Haggerty et al 2007 [59] | Seattle, USA | 331 youths and parents, 107 to intervention 1, 118 to intervention 2 and 106 to control | SA group - 10 week programme including video and workbook, family consultant contact by phone. | Violence in the past 30 days Alcohol use Initiation of sex Illegal drug use Marijuana use Cigarette use | Household income and parental education | No intervention effect was found on rate of change in attitudes about drug use or frequency of delinquent behaviour. Regression analysis with multiple imputation found a reduction in favourable attitudes to drug use and significantly less violent behaviour than the controls. No effects were found for drug use or delinquency. Both intervention groups were found to be less likely to initiate substance use and/or sexual activity than those in the control arm. |
|
Keepin’ it Real Hecht et al 2003 [59] | Elementary schools, USA | 1,556 students from 23 schools. 10 schools to intervention and 13 schools to control. | Originally an intervention for 7th grade students adapted for young students in 5th grade. The program consists of 10, 45-minute lessons which incorporate 5 videos and content on enhancing anti-drug expectancies, normative beliefs and refusal self-efficacy and facilitating decision-making and resistance skills. | Tobacco use Alcohol use Marijuana use | Free school meal eligibility | The intervention generally appeared no more effective than the control schools’ programming in changing students’ resistance or decision-making skills; substance use intentions, expectations, normative beliefs or life time and recent substance use. |
|
Family Schools Partnership and Classroom Centred Ialango et al 1999 [60] | Primary schools Maryland, USA | 230 to CC, 229 to FSP and 219 to control | CC- Curriculum enhancement and behaviour management and weekly meeting to promote problem solving skills. FSP – training for teachers in parent communication, weekly home-school learning, nine workshops and a school psychologist. | Aggressive and shy behaviour Substance use Affective disorder Conduct disorder | Free school meal eligibility | CC and FSP participants were found to have significantly fewer problem behaviours than control participants as rated by teachers. |
|
Good Behaviour Game Kellam et al 2014 [61] | Primary Schools in Maryland, USA | 1196 from 19 schools. 238 to intervention 169 to control. | Classroom team-based behaviour management strategy. Children assigned to teams and rewarded for good behaviour. | Alcohol abuse Drug use Smoking High school graduation Condom use | Free/reduced school meal status | By young adulthood significant impact was found among males in intervention group in reduced drug and alcohol abuse, regular smoking and antisocial personality disorder. |
|
Prevencanadol Lana et al 2014 [31] (included in subgroup analysis) | Secondary schools in Spain and Mexico | 2001, 1014 to intervention 987 to control | Website to learn how to prevent and treat main cancer risk behaviours. Weekly texts to encourage compliance with healthy behaviours. | Smoking Dietary fat Alcohol Sedentarism Not enough fruits Overweight/obesity | Parental degree | At 9 month follow up, the prevalence of students who did not eat fruit reduced significantly in both intervention groups. Being overweight reduced in intervention group 2. Overall cancer behavioural risk score decreased in both intervention groups. |
|
Michigan Model for Health O’Neill et al 2011 [62] | Schools in Michigan and Indiana, USA | 2512 from 52 schools. 1345 in intervention schools, 1167 in control schools. | 52 lessons delivered over a 2-year period. Content included social and emotional health, alcohol, tobacco, other drugs, safety, nutrition and physical activity. | Social and Emotional Skills Drug refusal skills Alcohol use Anti-social behaviour Tobacco use | Proportion of school eligible for free/reduced school meal | Students in the intervention group had better interpersonal communication skills, social and emotional skills and drug refusal skills than control students. Intervention students reported lower intentions to use alcohol and tobacco and less alcohol and tobacco use initiated in the last 30 days, as well as reduced levels of aggression. |
|
Healthy for Life Piper et al 2000 [63] (included in subgroup analysis) | Secondary schools, Wisconsin USA | 2,483 from 21 schools, 827 to age appropriate intervention 758 to intensive intervention and 898 to control. | 54-lesson curriculum delivered in either an intensive twelve week block or in three four-week segments (age appropriate). Use of peer leaders, parent-adult interviews, parent orientation, health advocacy, students making public commitments to health behaviours. | Nutrition Alcohol use Sexual intercourse Marijuana use Tobacco use | Maternal education | The intervention had minimal effect on participating students relative to control schools. The Intensive version was more effective than the Age Appropriate version, with small positive results on four measures (frequency of meals, perceptions of peer use, cigarettes and marijuana) and small negative effects on alcohol use. |
|
Life Skills Training plus Strengthening Families Program: For Parents and Youth 10-14. Spoth et al 2008 [64] | Schools in Midwest USA | 1677 students from 36 schools. 543 students were assigned to intervention 1 which combine two elements (LST + SFP 10-14), 622 were assigned to LST only and 489 went to the control group. | Together the two intervention programmes targeted family, individual, school and peer related factors associated with adolescent substance use. The intervention is a 15-session classroom based programme (LST) based on social learning theory. The primary goal is to promote skill development concerning the avoidance of substance use. The additional 7-session SFP: 10-10 program targets factors in the family environment with goals of enhancing parenting skills as well as peer resistance skills. | Alcohol use Marijuana use Tobacco use | Free/reduced school lunch | For all substance initiation outcomes one or both the intervention groups showed significant differences at 12th grade and growth trajectory outcomes compared with the control group. |
|
Walker et al 2002 [65] | General Practice Surgeries, Hertfordshire UK | 1488, 746 to intervention and 742 to control | 20 minute discussion with a practice nurse making plans to live a healthier lifestyle. | Alcohol use Physical activity Tobacco use Unhealthy diet | Parental occupation | More intervention students reported positive change for diet and exercise and at least one of four behaviours (diet, exercise, smoking, drinking alcohol) at 3-month follow-up, but this did not persist at 12 months. |
|
Fourth R: Skills for Youth Relationships Wolfe et al 2012 [30] (iB.) | Secondary schools, Ontario, Canada | 1722 from 10 schools. 968 to intervention 754 in control. | Program taught in place of existing health curriculum. A 21 lesson curriculum delivered by teachers with specialism in health and physical education. | Physical dating violence Physical peer violence Condom use Problem substance use | Parental education | Physical dating violence was greater in control students than intervention students. The intervention effect was greater in boys than girls. The main effects for other outcomes did not have statistically strong evidence. However, boys who received the intervention show in a significant difference in condom use. |
|
- Descriptive characteristics of studies eligible for secondary analysis including: Study name, author names and reference; setting; population; intervention; primary outcome(s); SES measure at baseline; effect; risk of bias assessment. Table 1 key for the risk of bias assessment:
Risk of bias assessment refers to the following seven domains, in the order they appear in the table, as instructed by Cochrane:- 1. Random sequence generation (selection bias)
- 2. Allocation concealment (selection bias)
- 3. Blinding of participants and personnel (performance bias)
- 4. Blinding of outcome assessment (detection bias)
- 5. Incomplete outcome data (attrition bias)
- 6. Selective reporting (reporting bias)
- 7. Other bias
Risk of bias assessment refers to the following seven domains, in the order they appear in the table, as instructed by Cochrane: