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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute of Health and Care Excellence. Alcohol-use disorders: prevention PH24. \nLondon: NICE; 2010.\n\nAvailable here.\n\nReviewed May 2014. \n\n\n\n\n","Commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors.","The guideline covers alcohol problems in those over the age of 10. It includes a mix of universal and targeted interventions.\n\nThe guideline makes recommendations on:\n• Price, availability and marketing\n• Licensing\n• Supporting children and young people aged 10-15 years thought to be at risk from their use of alcohol\n• Screening young people aged 16 and 17 years thought to be at risk from their use of alcohol\n• Screening adults\n• Referral\n\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. Available here. \n\nUnderpinning evidence reviews available here. ","This guideline is for local authorities responsible for education and public health. Teachers, school governors, academy trusts and otehrs (including school and public health nurses and healthy school leads) in secondary education, including special schools and further education settings. Health and social care practitoners. Providers of alcohol education. Members of the public, including parents or carers of children and young people in full time education and people working with children in the voluntary sector. ","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school. \n\nThis guideline includes recommendations on:\n - Planning alcohol education\n - Delivering universal alcohol education\n - Targeted interventions\n\n"]
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[null,"National Institute of Health and Care Excellence. Drug misuse prevention. QS165. London: NICE; 2018.\n\nAvailable here.\n",null,"This quality standard covers the prevention or delay of harmful use of drugs by children, young people and adults most likely to start using drugs, or already experimenting or using drugs occasionally. This includes illegal psychoactive substances, solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines. \n\nThe quality statements cover: \nStatement 1: Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.\nStatement 2: Care leavers having a health assessment as part of planning to leave care are assessed for vulnerability to drug misuse.\nStatement 3: Children and young people having a young offender assessment are assessed for vulnerability to drug misuse.\nStatement 4: Adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.\n"]
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[null,"Adolygiadau Systemataidd Cochrane\n"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","Adults","This Cochrane review aimed 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). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","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. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 2044 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR, Tsertsvadze A. Universal multi-component prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev 2011, Issue 9 Art. No.: CD009307. DOI:10.1002/14651858.CD009307.\n\nAvailable here.\n","Children and adolescents up to the age of 18 years attending school.","Twenty parallel-group trials were included. The reporting quality of trials was poor, only 25 per cent and 5 per cent of them reporting adequate methods of randomisation and program allocation concealment, respectively. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 20 per cent of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.\n\nTwelve of the 20 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects ranging from three months to three years. Of the remaining eight trials, one trial reported significant effects using one-tailed tests and seven trials reported no significant effects of the multi-component interventions for reducing alcohol misuse.\n\nAssessment of the additional benefit of multiple versus single component interventions was possible in seven trials with multiple arms. Only one of the seven trials clearly showed a benefit of components delivered in more than one setting.\n","The authors found some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, they reporteds little evidence supporting interventions with multiple components ato be more effective than interventions with single components."]
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[null,"Faggiano F et al. Universal school‐based prevention for illicit drug use. Cochrane Database Syst Rev 2014, Issue 12. Art. No.: CD003020. DOI: 10.1002/14651858.CD003020.pub3\n\nAvailable here.\n","Primary or secondary school pupils.","Fifty-one studies, with a total of 127,146 participants were included. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA.\n\nSocial competence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months follow‐up: the results favoured the social competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9,456 participants, moderate quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a positive significant effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.\n\nMarijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2,678 participants, high quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a significant positive effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.\n\nHard drug use at < 12 months: no difference found (RR 0.69; 95% CI 0.40 to 1.18, one study, 2,090 participants, moderate quality evidence). Two studies assessed this outcome (no data for meta‐analysis): one showed comparable results for the intervention and control group; one found a statistically non‐significant trend in favour of the social competence approach.\n\nHard drug use at 12+ months: no difference found (mean difference (MD) ‐0.01; 95% CI ‐0.06 to 0.04), one study, 1,075 participants, high quality evidence). One study with no data for meta‐analysis showed comparable results for the intervention and control group.\n\nAny drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2,512 participants, moderate quality evidence). One study with 1,566 participants provided continuous data showing no difference (MD 0.02; 95% CI ‐0.05 to 0.09, moderate quality evidence).\n","The authors reported that school programmes based on a combination of social competence and social influence approaches showed, on average, small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on the social competence approach also showed protective effects for some outcomes.\n\nSince the effects of school-based programmes are small, the authors recommend that they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.\n"]
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[null,null,null,"Social influence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: near statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716 participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence intervention (MD ‐0.26; 95% CI ‐0.48 to ‐0.04).\n\nMarijuana use at 12+ months: no difference found (RR 0.95; 95% CI 0.81 to 1.13, one study, 5,862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed near statistically significant results in favour of the social influence intervention (MD ‐0.22; 95% CI ‐0.46 to 0.02). Of the four studies not providing data for meta‐analysis a statistically significant protective effect was only found by one study.\n\nHard drug use at 12+ months: one study not providing data for meta‐analysis found a significant protective effect of the social influence approach.\n\nAny drug use: no studies assessed this outcome.\n"]
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[null,null,null,"Combined approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8,701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD ‐1.90; 95% CI ‐5.83 to 2.03).\n\nMarijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910 participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD ‐0.80; 95% CI ‐4.39 to 2.79). Two studies not providing data for meta‐analysis did not find a significant effect.\n\nHard drug use at < 12 months: one study with 693 participants provided both dichotomous and continuous data and showed conflicting results: no difference for dichotomous outcomes (RR 0.85; 95% CI 0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD ‐3.10; 95% CI ‐5.90 to ‐0.30). The quality of evidence was high.\n\nHard drug use at 12+ months: no difference found (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI ‐1.36 to 1.96). Two studies not providing data for meta‐analysis showed a significant effect of treatment.\n\nAny drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6,362 participants).\n\nOnly one study assessed the effect of a knowledge‐focused intervention on drug use and found no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesise. \n"]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2\n\nAvailable here.\n","Children and young people aged four to 18 years attending schools or colleges (including special schools). Studies which covered both pre‐school and school‐aged students were excluded. ","Sixty-seven eligible cluster trials were included, randomising 1,443 schools or districts. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). \n\nThe quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nPositive effects were found for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. Little evidence of effectiveness was found for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta‐analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school‐related outcomes. \n","The results of this review provide evidence for the effectiveness of some interventions based on the health promoting schools framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Thomas RE, Lorenzetti D, Spragins W. Mentoring adolescents to prevent drug and alcohol use. Cochrane Database Syst Rev 2011, Issue 11. Art. No.: CD007381. DOI: 10.1002/14651858.CD007381.pub2.\n\nAvailable here.\n","Adolescents aged 13 to 18.","Four randomised controlled trials (RCTs) (1,194 adolescents) were included. No RCT reported enough detail to assess whether a strong randomisation method was used or allocation was concealed. Blinding was not possible as the intervention was mentoring. Three RCTs provided complete data. No selective reporting.\n\nThree RCTs provided evidence about mentoring and preventing alcohol use. Two RCTs were pooled (RR for mentoring compared to no intervention = 0.71 (95% CI = 0.57 to 0.90, p-value = 0.005). A third RCT found no significant differences.\n\nThree RCTs provided evidence about mentoring and preventing drug use, but could not be pooled. One found significantly less use of “illegal\" drugs,\" one did not, and one assessed only marijuana use and found no significant differences.\n\nOne RCT measured “substance use” without separating alcohol and drugs, and found no difference for mentoring.\n","The authors reported that: All four RCTs were in the US, and included “deprived” and mostly minority adolescents. Participants were young (in two studies age 12, and in two others 9‐16). All students at baseline were non‐users of alcohol and drugs. Two RCTs found mentoring reduced the rate of initiation of alcohol, and one of drug usage. The ability of the interventions to be effective was limited by the low rates of commencing alcohol and drug use during the intervention period in two studies (the use of marijuana in one study increased to 1% in the experimental and to 1.6% in the control group, and in another study drug usage rose to 6% in the experimental and 11% in the control group). However, in a third study there was scope for the intervention to have an effect as alcohol use rose to 19 per cent in the experimental and 27 per cent in the control group. The studies assessed structured programmes and not informal mentors."]
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[null,"Carney T et al. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016, Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\n\nAvailable here.\n","Participants were adolescents under the age of 19 who were attending high school, secondary school, or a further education training college that provided alternative schooling or vocational training for adolescents between 16 and 18 years of age, and who used alcohol or other drugs, or both, but did not meet the criteria for substance dependence. In addition, adolescents had faced negative behavioural consequences due to their substance use.","This review included six trials with 1,176 adolescents that measured outcomes at different follow‐up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nReview authors generally found moderate‐quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. They also did not have a significant effect on delinquent‐type behaviour outcomes among adolescents. When compared to assessment‐only controls, they found low‐ or very low‐quality evidence that BIs reduced cannabis frequency at short‐term follow‐up in one study (standardised mean difference (SMD) ‐0.83; 95% CI ‐1.14 to ‐0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD ‐0.91; 95% CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95% CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95% CI ‐0.9 to ‐0.26, n = 190), and cannabis abuse (SMD ‐0.34; 95% CI ‐0.65 to ‐0.02, n = 190) at medium‐term follow‐up in one study. At long‐term follow‐up, BIs also reduced alcohol abuse (SMD ‐0.72; 95% CI ‐1.05 to ‐0.40, n = 181), cannabis frequency (SMD ‐0.56; 95% CI ‐0.75 to ‐0.36, n = 181), abuse (SMD ‐0.62; 95% CI ‐0.95 to ‐0.29, n = 181), and dependence (SMD ‐0.96; 95% CI ‐1.30 to ‐0.63, n = 181) in one study. \n\nHowever, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long‐term follow‐up on these outcomes in the assessment‐only comparison was significant (SMD ‐0.78; 95% CI ‐1.11 to ‐0.45).\n","The authors found low‐ or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. They found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. They deemed it premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use and identified that further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4\n\nAvailable here.\n","Students in university or college settings.","A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nOutcomes at four or more months post‐intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I2 < 50%).\n\nAlcohol‐related problems at four or more months: Individual face-to-face normative feedback (IFF) SMD ‐0.14, 95% CI ‐0.24 to ‐0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69‐point alcohol problems scale score. No effects were found for web/computer normative feedback (WF) or mailed normative feedback (MF).\n\nBinge drinking at four or more months: results pooled across delivery modes: SMD ‐0.06, 95% CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30‐day prevalence is 43.9%.\n\nDrinking quantity at four or more months: results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95% CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD ‐0.21, 95% CI ‐0.31 to ‐0.10 (participants = 1,464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face-to-face normative feedback (GFF) or  normative marketing campaign (MC).\n\nEstimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.17 to 0.00 (participants = 7,198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, the authors interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\n\nAvailable here. \n","Young adults aged up to 25.","Eighty-four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of motivational interviewing (MI) for the quantity of alcohol consumed (SMD −0.11, 95% CI −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95% CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95% CI −0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence).\n\nA marginal effect in favour of MI for alcohol problems (SMD −0.08, 95% CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95% CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95% CI −0.18 to 0.08; moderate quality evidence). We also considered other alcohol‐related behavioural outcomes, and at four or more months follow‐up, we found no effects on drink‐driving (SMD −0.13, 95% CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95% CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n\nNone of the studies reported harms related to MI.\n","The authors conclude the results of this review indicating that there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol use, misuse or alcohol‐related problems. Although they found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Ferri M et al. Media campaigns for the prevention of illicit drug use in young people. Cochrane Database Syst Rev 2013, Issue 6. Art. No.: CD009287. DOI: 10.1002/14651858.CD009287.pub2.\n\nAvailable here. \n","Young people under the age of 26. ","Twenty-three studies involving 188,934 young people, conducted in the USA, Canada and Australia between 1991 and 2012 were included. Twelve studies were RCT, two were prospective cohort studies (PCS), one study was both a RCT and a PCS, six were interrupted time series (ITS) and two were controlled before and after (CBA) studies. The RCTs had an overall low risk of bias, along with the ITS (apart from the dimension 'formal test of trend'), and the PCS had overall good quality, apart from the description of loss to follow‐up by exposure.\n\nSelf-reported or biomarker‐assessed illicit drug use was measured with an array of published and unpublished scales making comparisons difficult. Pooled results of five RCTs (N = 5,470) show no effect of media campaign intervention (SMD ‐0.02; 95% l CI ‐0.15 to 0.12).\n\nFive ITS studies (N = 26,405) focusing specifically on methamphetamine use were pooled. Out of four pooled estimates (two endpoints measured in two age groups), there was evidence of a reduction only in past‐year prevalence of methamphetamine use among 12 to 17 year olds.\n\nA further five studies (designs = one RCT with PCS, two PCS, two ITS, one CBA, N = 151,508), which could not be included in meta‐analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case and reduction of use in another.\n","The authors reported that the overall available evidence does not allow conclusions about the effect of media campaigns on illicit drug use among young people and that further studies are needed."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\n\nAvailable here. \n","Those aged 10 years and above.","One small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS (general population studies in Canadian provinces conducted in the 1970s and 80s) were included.\n\nThe RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95% CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95% CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE), the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95% CI ‐5.26, 7.47; p value = 0.43; I2 = 83%, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI ‐36.83, ‐8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.\n\nNo other pre-specified outcomes (including economic loss or hardship due to decreased alcohol sales) were addressed in the included studies and no adverse effects were reported in any of the studies. None of the studies were funded by the alcohol or advertising industries.\n","The authors identified a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. They concluded that advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base."]
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[null,"Kaner EFS et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations. Cochrane Database Syst Rev 2017, Issue 9. Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2\n\nAvailable here.\n","Participants were people living in the community whose alcohol consumption had been screened as hazardous or harmful (WHO 1992) and who were directed toward any digital intervention including web‐based, mobile phone text messaging, smartphone apps, social networking, or stand-alone computer‐based technologies (including CD‐ROMs).","Fifty-seven studies were included in the review which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty-one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence).\n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3,587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9,791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence).\n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI ‐24.59 to 25.63; low‐quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.\n\nA median of nine behaviour change techniques (BCTs) were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B ‐43.94, 95% CI ‐78.59 to ‐9.30), problem solving (B ‐48.03, 95% CI ‐77.79 to ‐18.27), information about antecedents (B ‐74.20, 95% CI ‐117.72 to ‐30.68), behaviour substitution (B ‐123.71, 95% CI ‐184.63 to ‐62.80) and credible source (B ‐39.89, 95% CI ‐72.66 to ‐7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B ‐95.12, 95% CI ‐162.90 to ‐27.34), problem solving (B ‐45.92, 95% CI ‐90.97 to ‐0.87), and credible source (B ‐32.09, 95% CI ‐60.64 to ‐3.55) were associated with reduced alcohol consumption.\n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","The authors found moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions.\n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.\n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.\n"]
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[null,"Stade BC et al. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. Cochrane Database Syst Rev 2009, Issue 2. Art. No.: CD004228. DOI: 10.1002/14651858.CD004228.pub2\n\nAvailable here.\n","Pregnant women or women planning pregnancy who consume alcohol. Excludes women participating in treatment programmes for alcohol dependence or abuse.","Four studies met the inclusion criteria (715 pregnant women), and reported on at least one of the outcomes of interest. No meta‐analyses was undertaken as the interventions and outcomes measured in the studies were not sufficiently similar. For most outcomes there were no significant differences between groups; and results relating to abstaining or reducing alcohol consumption were mixed. Results from individual studies suggest that interventions may encourage women to abstain from alcohol in pregnancy. There was very little information provided on the effects of interventions on the health of mothers and babies.","The authors reported that evidence from the limited number of studies suggests that psychological and educational interventions may result in increased abstinence from alcohol, and a reduction in alcohol consumption among pregnant women. However, results were not consistent, and the paucity of studies, the number of total participants, the high risk of bias of some of the studies, and the complexity of interventions limits our ability to determine the type of intervention which would be most effective in increasing abstinence from, or reducing the consumption of, alcohol among pregnant women."]
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[null,"McQueen J et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011, Issue 8. Art. No.: CD005191. DOI: 10.1002/14651858.CD005191.pub3.\n\nAvailable here.\n","Adults and adolescents (people 16 years and older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment, where inclusion criteria for the study identified participants as regularly consuming alcohol above the recommended safe weekly/daily amounts for the country in which the study took place.","Fourteen studies involving 4,041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD ‐69.43 (95% CI ‐128.14 to ‐10.72) and nine month follow up, MD ‐182.88 (95% CI ‐360.00 to ‐5.76) but this is not maintained at one year. Self-reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD ‐0.26 (95% CI ‐0.50 to ‐0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening and asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour.","The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","One new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.\n\nOverall, 53 of the 122 participants from the three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups RR 0.62, 95% CI 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.\n\nIn-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for\nreview authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications.\nData were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of\nstay, and no studies addressed the prevalence of risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and\nassessed, the one ’ongoing’ study identified may alter the conclusions of this review.\n"]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Patnode, CD et al. Screening for Unhealthy Drug Use in Primary Care in Adolescents and Adults, Including Pregnant Persons: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 186. AHRQ Publication No. 19-05255-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. \nAvailable here.","Adolescents, young adults and adults, and pregnant and postpartum women.","The review was conducted to support the U.S. Preventive Services Task Force in updating its 2008 recommendation on screening adolescents and adults, including pregnant women, for illicit drug use.\nNo evidence was found that addressed the benefits and harms of screening for drug use.\nRegarding screening instruments for drug use, studies were mainly detecting cannabis use among adolescents. They found that sensitivity for detecting any cannabis use or unhealthy cannabis use of frequency-based and risk assessment screen tools (all validated against structured clinical interview alone) ranged from 0.68 to 0.98 (95% CI range, 0.64 to 0.99) and specificity ranging from 0.82 to 1.00 (95% CI range, 0.80 to 1.00).\nAmong adults, frequency-based and risk assessment drug screening tools (all but two validated against structured clinical interview alone) showed sensitivity for detecting unhealthy use of any drug ranging from 0.71 to 0.94 (95% CI range, 0.62 to 0.97) and specificity ranging from 0.87 to 0.97 (95% CI range, 0.83 to 0.98).\nFor identifying drug use disorders among adults, sensitivity ranged from 0.85 to 1.00 (95% CI range, 0.67 to 1.00) and specificity ranged from 0.67 to 0.93 (95% CI, 0.58 to 0.95) when using the same cut-offs. \nSensitivity for detecting any prenatal drug use using frequency-based and risk assessment (all validated against hair or urine analyses) was lower than the estimates for any drug use in non-pregnant adults (only rarely based on validation against biologic samples) and ranged from 0.37 to 0.76 (95% CI range, 0.24 to 0.86). Specificity was comparable and ranged from 0.68 to 0.83 (95% CI range, 0.55 to 0.91).\nSome trials addressed the effectiveness of a counselling intervention on changes in drug use or improved health, social, or legal outcomes among a screen-detected population. In general, there was no consistent effect of the interventions on rates of self-reported or biologically confirmed drug use at 3- to 12-month follow up. Similarly, across 13 trials reporting the effects of the interventions on health, social, or legal outcomes (n-analysed=4304), none of the trials found a statistically significant difference between intervention and control groups on any of these measures at 3- to 12-month follow-up. \nOf four trials providing information regarding potential harms, none found any evidence of harm.","Several screening instruments with acceptable sensitivity and specificity have been developed to screen for drug use and drug use disorders in primary care, although in general, the accuracy of each tool has not been evaluated in more than one study and there is no evidence on the benefits or harms of screening versus no screening for drug use. \nBrief interventions for reducing the use of illicit drugs or the nonmedical use of prescription drugs in screen-detected primary care patients are unlikely to be effective for decreasing drug use or drug use consequences. \nGiven the burden of drug use, more research is needed on approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use in primary care."]
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[null,"O’Connor et al. (2020). Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323 (20):20672079.doi:10.1001/jama.2020.1432.\nAvailable here.","Children, adolescents and young adults up to 25 years of age. ","This review examined the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force.\nHealth, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. \nThe effects on illicit drug use in 26 trials among non-pregnant youth (n = 17,811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, −0.08 [95%CI, −0.16 to 0.001]; 24 effects [from 23 studies]; n = 12,801; I2 = 57.0%). \nThe percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months’ follow-up. The median absolute risk difference between groups was –2.8%, favouring the intervention group (range, –11.5% to 14.8%).","The evidence for behavioural counselling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements."]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7 (8)\nAvailable here","General population","The amount and strength of evidence varies across the six topics. There was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics. Illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. \nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"Tancred T, Melendez-Torres GJ, Paparini S, Fletcher A, Stansfield C, Thomas J, et al. Interventions integrating health and academic education in schools to prevent substance misuse and violence: a systematic review. Public Health Research 2019;7(17)\nAvailable here","Schools serving those aged 4–18 years","There was clear evidence that interventions are facilitated by supportive senior management and alignment with the schools’ ethos, collaborative and supportive teaching environments, and positive pre-existing student, teacher and parent attitudes towards interventions. The barriers were overburdened teachers who had little time to both learn and implement integrated curricula. The strongest evidence for effectiveness was found for the reduction of substance use in school key stages (KSs) 2 and 3. For example, a meta-analysis for substance use at KS3 reported a mean difference of –0.09 (95% confidence interval –0.17 to –0.01). A meta-analysis for effectiveness in reducing violence victimisation in KS2 found no effect. There was mixed evidence for effects on academic outcomes, with meta-analysis precluded by methodological heterogeneity.","These interventions are undertheorised but involve multiple forms of boundary erosion. There is clear evidence of characteristics affecting implementation. Interventions are likely to have the greatest impact on substance use. These programmes may be effective in reducing substance use but do not appear to reduce violence and findings on educational impacts are mixed."]
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[null,"Bonell C, Dickson K, Hinds K, Melendez-Torres GJ, Stansfield C, Fletcher A, et al. The effects of Positive Youth Development interventions on substance use, violence and inequalities: systematic review of theories of change, processes and outcomes. Public Health Research 2016;4(5)\nAvailable here\n","Adolescents","Effectiveness and cost-effectiveness in reducing substance use\nComparing PYD with usual or no treatment, our meta-analyses found a small effect for substance-use outcomes overall, which was significant neither statistically nor in terms of public health relevance. Meta-analyses found no effect for an omnibus measure of substance use across all time points but did find a small, statistically significant effect for this outcome in the short term (0–4 months post intervention). Meta-analyses of illicit drug-use and alcohol outcomes found no significant effects either across all time points or in the short term.\nConcerning the overall effects of PYD interventions on substance use, two interpretations are possible. The first is that studies pointed to a small effect for substance-use outcomes that was significant neither in terms of statistics nor public health (i.e. that there is evidence of no effect). Another interpretation is that there is no evidence of the effectiveness of PYD interventions on substance use outcomes.","How PYD might promote health is currently undertheorised. Implementation can be challenging. The authors found little evidence that current PYD interventions delivered outside school reduce substance use or violence. However, these may not constitute a test of the effectiveness of the PYD model, as some included interventions that, although meeting their inclusion criteria, were not exemplars of PYD."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Prevention strategies for substance misuse: A review of the clinical evidence. Ottawa: CADTH; 2012.\n\nAvailable here.\n","Adults (> 18 years of age) Children (review also included first nations, Inuit and metis (of all ages), findings specific to these groups have not been replicated here).","Children and adolescents:\nTwo SRs of family or parental support programs provided evidence that these interventions can reduce substance use. Universal family-based programs with educational and psychosocial components showed statistically significant positive effects across multiple outcomes of alcohol use. The most effective parenting programs required active parental participation and developed social competence, self-regulation and overall parenting skills. School-based programs were evaluated in two SRs. Certain psychosocial or life skills programs were reported to reduce the risk of alcohol misuse. The evidence was strongest for general programs targeting multiple factors including misuse of drugs, tobacco, alcohol and antisocial behaviour. Skills-focused school programs also showed statistically significant reductions in drug use compared to usual curriculum. Mentoring by peers or adults showed modest impact on the initiation of drug or alcohol use in adolescents primarily from disadvantaged or minority groups in the US. A systematic review of educationally oriented pre-school programs reported evidence that early childhood interventions improve health behaviours. Three RCTs showed a lower risk of marijuana use when children reached adulthood, but mixed effects on other drugs or alcohol. The review authors found no consistent evidence of the impact of pre-school programs on health services utilisation.\n\nAdults:\nSocial norms interventions, delivered either face-to-face or via the web or computer reduced the use of alcohol and alcohol related problems among college or university students. The evidence was strongest for a short term effect (< 0.05). The apparent inconsistency between the two SRs may be explained by differences in inclusion criteria. One review used broader inclusion criteria for the intervention and therefore reviewed more RCTs. There was some overlap between SRs in the studies included. \n","The authors reported that numerous studies evaluating the effectiveness of programs to prevent substance misuse in general adult and youth populations, are available.\n\nFamily or parental support programs can be effective in reducing or preventing substance misuse in adolescents. \n\nSchool-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. \n\nEvidence supporting the mentoring and preschool programs for primary prevention of substance misuse are less clear. \n\nIn adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population.  \n\nNone of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. \nOther limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options.\n"]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older.","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell Systematic Reviews 2017;6 DOI: 10.4073/csr.2017.6\n\nAvailable here.\n","Eligible participants were young people between 15 and 25 years of age who were defined as high or risky consumers of alcohol or cannabis, or both.","Sixty studies were included that had randomised 33,316 participants in this review. \n\nThe studies were mostly from the United States and targeted high and risky alcohol use among university students. Some of the studies lacked clear descriptions of how the randomisation sequence was generated and concealed. Many of the studies did not blind the participants. Some of the studies suffered from high loss to follow-up, and few studies had a pre-registered protocol. \n\nFor alcohol, moderate quality evidence was found that multi-dose assessment and feedback was more effective than a single-dose assessment. There was low quality evidence that assessment and feedback might be more effective than no intervention. Assessment and feedback might also be more effective than assessment alone (low quality evidence). Short-term effects (< 6 months) were mostly larger than long-term (≥6 months) effects. \n\nFor cannabis, assessment and feedback might slightly reduce short term consumption compared to no intervention. Adding feedback to assessment may have little or no effect on short-term cannabis consumption. Moreover, there may be little or no difference between assessment plus feedback and education on short-term and long-term cannabis consumption. The review did not find evidence of any adverse effects of the interventions.\n","The authors concluded that computerised brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerised interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research."]
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[null,"Patnode CD et al. Primary care behavioral interventions to prevent or reduce illicit drug use and nonmedical pharmaceutical use in children and adolescents: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2014; 160(9):612-620\n\nAvailable here.\n","Adolescents.","Six trials were included, four of which examined the effect of the intervention on a health or social outcome. One trial found no effect of the intervention on marijuana-related consequences or driving under the influence of marijuana; three trials generally found no reduction in depressed mood at 12 or 24 months.\n\nFour of the five trials assessing self-reported marijuana use found statistically significant differences favouring the intervention group participants (such as a between-group difference of 0.10 to 0.17 use occasions in the past month). Three trials also reported positive outcomes in nonmedical prescription drug use occasions.\n","The authors concluded that the evidence is inadequate on the benefits of primary care relevant behavioural interventions in reducing self-reported illicit and pharmaceutical drug use among adolescents."]

{"sheet":"Nice Guidelines","index":3,"n_rows":98,"n_cols":4,"rows_kept":98,"cut":false,"hidden":false,"merged":[[97,3,108,4],[26,1,26,4],[28,2,76,2],[97,1,108,1],[97,2,108,2],[28,1,76,1],[28,3,76,4],[77,1,96,1],[77,2,96,2],[77,3,96,4]]}
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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute of Health and Care Excellence. Alcohol use disorders: prevention PH24. \nLondon: NICE; 2010.\n\nAvailable here.\n\nReviewed May 2014.\n\n\n\n\n","Commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors.","The guideline covers alcohol problems in those over the age of 10. It includes a mix of universal and targeted interventions.\n\nThe guideline makes recommendations on:\n• Price, availability and marketing\n• Licensing\n• Supporting children and young people aged 10-15 years thought to be at risk from their use of alcohol\n• Screening young people aged 16 and 17 years thought to be at risk from their use of alcohol\n• Screening adults\n• Referral\n\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. Available here. \n\nUnderpinning evidence reviews available here. ","This guideline is for local authorities responsible for education and public health. Teachers, school governors, academy trusts and otehrs (including school and public health nurses and healthy school leads) in secondary education, including special schools and further education settings. Health and social care practitoners. Providers of alcohol education. Members of the public, including parents or carers of children and young people in full time education and people working with children in the voluntary sector. ","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school. \n\nThis guideline includes recommendations on:\n - Planning alcohol education\n - Delivering universal alcohol education\n - Targeted interventions\n\n"]
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[null,"National Institute of Health and Care Excellence. Drug misuse prevention. QS165. London: NICE; 2018.\n\nAvailable here.\n",null,"This quality standard covers the prevention or delay of harmful use of drugs by children, young people and adults most likely to start using drugs, or already experimenting or using drugs occasionally. This includes illegal psychoactive substances, solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines. \n\nThe quality statements cover: \nStatement 1: Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.\nStatement 2: Care leavers having a health assessment as part of planning to leave care are assessed for vulnerability to drug misuse.\nStatement 3: Children and young people having a young offender assessment are assessed for vulnerability to drug misuse.\nStatement 4: Adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.\n"]

{"sheet":"Cochrane SRs","index":4,"n_rows":425,"n_cols":5,"rows_kept":425,"cut":false,"hidden":false,"merged":[[339,1,372,1],[339,2,372,2],[339,3,372,3],[339,4,372,4],[95,1,110,1],[95,2,110,2],[95,3,110,3],[95,4,110,4],[290,1,318,1],[290,2,318,2],[290,3,318,3],[290,4,318,4],[319,1,338,1],[319,2,338,2],[319,3,338,3],[319,4,338,4],[231,1,256,1],[231,2,256,2],[231,3,256,3],[231,4,256,4],[257,1,289,1],[257,2,289,2],[257,3,289,3],[257,4,289,4],[184,1,205,1],[184,2,205,2],[184,3,205,3],[184,4,205,4],[206,1,230,1],[206,2,230,2],[206,3,230,3],[206,4,230,4],[111,1,183,1],[111,2,183,2],[111,3,140,3],[111,4,183,4],[141,3,156,3],[157,3,183,3],[27,1,27,4],[66,1,94,1],[66,2,94,2],[66,3,94,3],[66,4,94,4],[42,1,57,1],[42,2,45,2],[42,3,65,3],[42,4,65,4],[29,2,41,2],[29,1,41,1],[29,3,41,3],[29,4,41,4],[424,1,464,1],[424,2,464,2],[424,3,464,3],[424,4,464,4],[373,1,408,1],[373,2,408,2],[373,3,408,3],[373,4,408,4],[409,1,423,1],[409,2,423,2],[409,3,423,3],[409,4,423,4]]}
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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed 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). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","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. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 2044 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR, Tsertsvadze A. Universal multi-component prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev 2011, Issue 9 Art. No.: CD009307. DOI:10.1002/14651858.CD009307.\n\nAvailable here.\n","Children and adolescents up to the age of 18 years attending school.","Twenty parallel-group trials were included. The reporting quality of trials was poor, only 25 per cent and 5 per cent of them reporting adequate methods of randomisation and program allocation concealment, respectively. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 20 per cent of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.\n\nTwelve of the 20 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects ranging from three months to three years. Of the remaining eight trials, one trial reported significant effects using one-tailed tests and seven trials reported no significant effects of the multi-component interventions for reducing alcohol misuse.\n\nAssessment of the additional benefit of multiple versus single component interventions was possible in seven trials with multiple arms. Only one of the seven trials clearly showed a benefit of components delivered in more than one setting.\n","The authors found some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, they reporteds little evidence supporting interventions with multiple components ato be more effective than interventions with single components.."]
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[null,"Faggiano F et al. Universal school‐based prevention for illicit drug use. Cochrane Database Syst Rev 2014, Issue 12. Art. No.: CD003020. DOI: 10.1002/14651858.CD003020.pub3\n\nAvailable here.\n","Primary or secondary school pupils.","Fifty-one studies, with a total of 127,146 participants were included. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA.\n\nSocial competence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months follow‐up: the results favoured the social competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9,456 participants, moderate quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a positive significant effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.\n\nMarijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2,678 participants, high quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a significant positive effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.\n\nHard drug use at < 12 months: no difference found (RR 0.69; 95% CI 0.40 to 1.18, one study, 2,090 participants, moderate quality evidence). Two studies assessed this outcome (no data for meta‐analysis): one showed comparable results for the intervention and control group; one found a statistically non‐significant trend in favour of the social competence approach.\n\nHard drug use at 12+ months: no difference found (mean difference (MD) ‐0.01; 95% CI ‐0.06 to 0.04), one study, 1,075 participants, high quality evidence). One study with no data for meta‐analysis showed comparable results for the intervention and control group.\n\nAny drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2,512 participants, moderate quality evidence). One study with 1,566 participants provided continuous data showing no difference (MD 0.02; 95% CI ‐0.05 to 0.09, moderate quality evidence).\n","The authors reported that school programmes based on a combination of social competence and social influence approaches showed, on average, small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on the social competence approach also showed protective effects for some outcomes.\n\nSince the effects of school-based programmes are small, the authors recommend that they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.\n"]
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[null,null,null,"Social influence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: near statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716 participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence intervention (MD ‐0.26; 95% CI ‐0.48 to ‐0.04).\n\nMarijuana use at 12+ months: no difference found (RR 0.95; 95% CI 0.81 to 1.13, one study, 5,862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed near statistically significant results in favour of the social influence intervention (MD ‐0.22; 95% CI ‐0.46 to 0.02). Of the four studies not providing data for meta‐analysis a statistically significant protective effect was only found by one study.\n\nHard drug use at 12+ months: one study not providing data for meta‐analysis found a significant protective effect of the social influence approach.\n\nAny drug use: no studies assessed this outcome.\n"]
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[null,null,null,"Combined approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8,701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD ‐1.90; 95% CI ‐5.83 to 2.03).\n\nMarijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910 participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD ‐0.80; 95% CI ‐4.39 to 2.79). Two studies not providing data for meta‐analysis did not find a significant effect.\n\nHard drug use at < 12 months: one study with 693 participants provided both dichotomous and continuous data and showed conflicting results: no difference for dichotomous outcomes (RR 0.85; 95% CI 0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD ‐3.10; 95% CI ‐5.90 to ‐0.30). The quality of evidence was high.\n\nHard drug use at 12+ months: no difference found (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI ‐1.36 to 1.96). Two studies not providing data for meta‐analysis showed a significant effect of treatment.\n\nAny drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6,362 participants).\n\nOnly one study assessed the effect of a knowledge‐focused intervention on drug use and found no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesise. \n"]
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[null,"Langford  R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2\n\nAvailable here.\n","Children and young people aged four to 18 years attending schools or colleges (including special schools). Studies which covered both pre‐school and school‐aged students were excluded. ","Sixty-seven eligible cluster trials were included, randomising 1,443 schools or districts. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). \n\nThe quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nPositive effects were found for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. Little evidence of effectiveness was found for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta‐analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school‐related outcomes. \n","The results of this review provide evidence for the effectiveness of some interventions based on the health promoting schools framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Thomas RE, Lorenzetti  D, Spragins W. Mentoring adolescents to prevent drug and alcohol use. Cochrane Database Syst Rev 2011, Issue 11. Art. No.: CD007381. DOI: 10.1002/14651858.CD007381.pub2.\n\nAvailable here.\n","Adolescents aged 13 to 18.","Four randomised controlled trials (RCTs) (1,194 adolescents) were included. No RCT reported enough detail to assess whether a strong randomisation method was used or allocation was concealed. Blinding was not possible as the intervention was mentoring. Three RCTs provided complete data. No selective reporting.\n\nThree RCTs provided evidence about mentoring and preventing alcohol use. Two RCTs were pooled (RR for mentoring compared to no intervention = 0.71 (95% CI = 0.57 to 0.90, P value = 0.005). A third RCT found no significant differences.\n\nThree RCTs provided evidence about mentoring and preventing drug use, but could not be pooled. One found significantly less use of “illegal\" drugs,\" one did not, and one assessed only marijuana use and found no significant differences.\n\nOne RCT measured “substance use” without separating alcohol and drugs, and found no difference for mentoring.\n","The authors reported that: All four RCTs were in the US, and included “deprived” and mostly minority adolescents. Participants were young (in two studies age 12, and in two others 9‐16). All students at baseline were non‐users of alcohol and drugs. Two RCTs found mentoring reduced the rate of initiation of alcohol, and one of drug usage. The ability of the interventions to be effective was limited by the low rates of commencing alcohol and drug use during the intervention period in two studies (the use of marijuana in one study increased to 1% in the experimental and to 1.6% in the control group, and in another study drug usage rose to 6% in the experimental and 11% in the control group). However, in a third study there was scope for the intervention to have an effect as alcohol use rose to 19 per cent in the experimental and 27 per cent in the control group. The studies assessed structured programmes and not informal mentors."]
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[null,"Carney T et al. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016, Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\n\nAvailable here.\n","Participants were adolescents under the age of 19 who were attending high school, secondary school, or a further education training college that provided alternative schooling or vocational training for adolescents between 16 and 18 years of age, and who used alcohol or other drugs, or both, but did not meet the criteria for substance dependence. In addition, adolescents had faced negative behavioural consequences due to their substance use.","This review included six trials with 1,176 adolescents that measured outcomes at different follow‐up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nReview authors generally found moderate‐quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. They also did not have a significant effect on delinquent‐type behaviour outcomes among adolescents. When compared to assessment‐only controls, they found low‐ or very low‐quality evidence that BIs reduced cannabis frequency at short‐term follow‐up in one study (standardised mean difference (SMD) ‐0.83; 95% CI ‐1.14 to ‐0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD ‐0.91; 95% CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95% CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95% CI ‐0.9 to ‐0.26, n = 190), and cannabis abuse (SMD ‐0.34; 95% CI ‐0.65 to ‐0.02, n = 190) at medium‐term follow‐up in one study. At long‐term follow‐up, BIs also reduced alcohol abuse (SMD ‐0.72; 95% CI ‐1.05 to ‐0.40, n = 181), cannabis frequency (SMD ‐0.56; 95% CI ‐0.75 to ‐0.36, n = 181), abuse (SMD ‐0.62; 95% CI ‐0.95 to ‐0.29, n = 181), and dependence (SMD ‐0.96; 95% CI ‐1.30 to ‐0.63, n = 181) in one study. \n\nHowever, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long‐term follow‐up on these outcomes in the assessment‐only comparison was significant (SMD ‐0.78; 95% CI ‐1.11 to ‐0.45).\n","The authors found low‐ or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. They found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. They deemed it premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use and identified that further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4\n\nAvailable here.\n","Students in university or college settings.","A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nOutcomes at four or more months post‐intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I2 < 50%).\n\nAlcohol‐related problems at four or more months: Individual face-to-face normative feedback (IFF) SMD ‐0.14, 95% CI ‐0.24 to ‐0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69‐point alcohol problems scale score. No effects were found for web/computer normative feedback (WF) or mailed normative feedback (MF).\n\nBinge drinking at four or more months: results pooled across delivery modes: SMD ‐0.06, 95% CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30‐day prevalence is 43.9%.\n\nDrinking quantity at four or more months: results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95% CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD ‐0.21, 95% CI ‐0.31 to ‐0.10 (participants = 1,464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face-to-face normative feedback (GFF) or  normative marketing campaign (MC).\n\nEstimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.17 to 0.00 (participants = 7,198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, the authors interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\n\nAvailable here. \n","Young adults aged up to 25.","Eighty-four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of motivational interviewing (MI) for the quantity of alcohol consumed (SMD −0.11, 95% CI −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95% CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95% CI −0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence).\n\nA marginal effect in favour of MI for alcohol problems (SMD −0.08, 95% CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95% CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95% CI −0.18 to 0.08; moderate quality evidence). We also considered other alcohol‐related behavioural outcomes, and at four or more months follow‐up, we found no effects on drink‐driving (SMD −0.13, 95% CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95% CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n\nNone of the studies reported harms related to MI.\n","The authors conclude the results of this review indicating that there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol use, misuse or alcohol‐related problems. Although they found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Ferri M et al. Media campaigns for the prevention of illicit drug use in young people. Cochrane Database Syst Rev 2013, Issue 6. Art. No.: CD009287. DOI: 10.1002/14651858.CD009287.pub2.\n\nAvailable here. \n","Young people under the age of 26. ","Twenty-three studies involving 188,934 young people, conducted in the USA, Canada and Australia between 1991 and 2012 were included. Twelve studies were RCT, two were prospective cohort studies (PCS), one study was both a RCT and a PCS, six were interrupted time series (ITS) and two were controlled before and after (CBA) studies. The RCTs had an overall low risk of bias, along with the ITS (apart from the dimension 'formal test of trend'), and the PCS had overall good quality, apart from the description of loss to follow‐up by exposure.\n\nSelf-reported or biomarker‐assessed illicit drug use was measured with an array of published and unpublished scales making comparisons difficult. Pooled results of five RCTs (N = 5,470) show no effect of media campaign intervention (SMD ‐0.02; 95% l CI ‐0.15 to 0.12).\n\nFive ITS studies (N = 26,405) focusing specifically on methamphetamine use were pooled. Out of four pooled estimates (two endpoints measured in two age groups), there was evidence of a reduction only in past‐year prevalence of methamphetamine use among 12 to 17 year olds.\n\nA further five studies (designs = one RCT with PCS, two PCS, two ITS, one CBA, N = 151,508), which could not be included in meta‐analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case and reduction of use in another.\n","The authors reported that the overall available evidence does not allow conclusions about the effect of media campaigns on illicit drug use among young people and that further studies are needed."]
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[null,"Siegfried  N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\n\nAvailable here. \n","Those aged 10 years and above.","One small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS (general population studies in Canadian provinces conducted in the 1970s and 80s) were included.\n\nThe RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95% CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95% CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE), the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95% CI ‐5.26, 7.47; p value = 0.43; I2 = 83%, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI ‐36.83, ‐8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.\n\nNo other pre-specified outcomes (including economic loss or hardship due to decreased alcohol sales) were addressed in the included studies and no adverse effects were reported in any of the studies. None of the studies were funded by the alcohol or advertising industries.\n\n","The authors identified a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. They concluded that advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base."]
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[null,"Kaner EFS et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations. Cochrane Database Syst Rev 2017, Issue 9. Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2\n\nAvailable here.\n","Participants were people living in the community whose alcohol consumption had been screened as hazardous or harmful (WHO 1992) and who were directed toward any digital intervention including web‐based, mobile phone text messaging, smartphone apps, social networking, or stand-alone computer‐based technologies (including CD‐ROMs).","Fifty-seven studies were included in the review which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty-one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence).\n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3,587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9,791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence).\n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI ‐24.59 to 25.63; low‐quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.\n\nA median of nine behaviour change techniques (BCTs) were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B ‐43.94, 95% CI ‐78.59 to ‐9.30), problem solving (B ‐48.03, 95% CI ‐77.79 to ‐18.27), information about antecedents (B ‐74.20, 95% CI ‐117.72 to ‐30.68), behaviour substitution (B ‐123.71, 95% CI ‐184.63 to ‐62.80) and credible source (B ‐39.89, 95% CI ‐72.66 to ‐7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B ‐95.12, 95% CI ‐162.90 to ‐27.34), problem solving (B ‐45.92, 95% CI ‐90.97 to ‐0.87), and credible source (B ‐32.09, 95% CI ‐60.64 to ‐3.55) were associated with reduced alcohol consumption.\n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","The authors found moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions.\n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.\n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.\n"]
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[null,"McQueen J et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011, Issue 8. Art. No.: CD005191. DOI: 10.1002/14651858.CD005191.pub3.\n\nAvailable here.\n","Adults and adolescents (people 16 years and older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment, where inclusion criteria for the study identified participants as regularly consuming alcohol above the recommended safe weekly/daily amounts for the country in which the study took place.","Fourteen studies involving 4,041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD ‐69.43 (95% CI ‐128.14 to ‐10.72) and nine month follow up, MD ‐182.88 (95% CI ‐360.00 to ‐5.76) but this is not maintained at one year. Self-reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD ‐0.26 (95% CI ‐0.50 to ‐0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening and asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour.","The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","One new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.\n\nOverall, 53 of the 122 participants from the three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups RR 0.62, 95% CI 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.\n\nIn-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for\nreview authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications.\nData were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of\nstay, and no studies addressed the prevalence of risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and\nassessed, the one ’ongoing’ study identified may alter the conclusions of this review.\n"]

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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth: ","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Patnode, CD et al. Screening for Unhealthy Drug Use in Primary Care in Adolescents and Adults, Including Pregnant Persons: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 186. AHRQ Publication No. 19-05255-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. \nAvailable here.","Adolescents, young adults and adults, and pregnant and postpartum women.","The review was conducted to support the U.S. Preventive Services Task Force in updating its 2008 recommendation on screening adolescents and adults, including pregnant women, for illicit drug use.\nNo evidence was found that addressed the benefits and harms of screening for drug use.\nRegarding screening instruments for drug use, studies were mainly detecting cannabis use among adolescents. They found that sensitivity for detecting any cannabis use or unhealthy cannabis use of frequency-based and risk assessment screen tools (all validated against structured clinical interview alone) ranged from 0.68 to 0.98 (95% CI range, 0.64 to 0.99) and specificity ranging from 0.82 to 1.00 (95% CI range, 0.80 to 1.00).\nAmong adults, frequency-based and risk assessment drug screening tools (all but two validated against structured clinical interview alone) showed sensitivity for detecting unhealthy use of any drug ranging from 0.71 to 0.94 (95% CI range, 0.62 to 0.97) and specificity ranging from 0.87 to 0.97 (95% CI range, 0.83 to 0.98).\nFor identifying drug use disorders among adults, sensitivity ranged from 0.85 to 1.00 (95% CI range, 0.67 to 1.00) and specificity ranged from 0.67 to 0.93 (95% CI, 0.58 to 0.95) when using the same cut-offs. \nSensitivity for detecting any prenatal drug use using frequency-based and risk assessment (all validated against hair or urine analyses) was lower than the estimates for any drug use in non-pregnant adults (only rarely based on validation against biologic samples) and ranged from 0.37 to 0.76 (95% CI range, 0.24 to 0.86). Specificity was comparable and ranged from 0.68 to 0.83 (95% CI range, 0.55 to 0.91).\nSome trials addressed the effectiveness of a counselling intervention on changes in drug use or improved health, social, or legal outcomes among a screen-detected population. In general, there was no consistent effect of the interventions on rates of self-reported or biologically confirmed drug use at 3- to 12-month follow up. Similarly, across 13 trials reporting the effects of the interventions on health, social, or legal outcomes (n-analysed=4304), none of the trials found a statistically significant difference between intervention and control groups on any of these measures at 3- to 12-month follow-up. \nOf four trials providing information regarding potential harms, none found any evidence of harm.","Several screening instruments with acceptable sensitivity and specificity have been developed to screen for drug use and drug use disorders in primary care, although in general, the accuracy of each tool has not been evaluated in more than one study and there is no evidence on the benefits or harms of screening versus no screening for drug use.\n \nBrief interventions for reducing the use of illicit drugs or the nonmedical use of prescription drugs in screen-detected primary care patients are unlikely to be effective for decreasing drug use or drug use consequences. \n\nGiven the burden of drug use, more research is needed on approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use in primary care."]
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[null,"O’Connor et al. (2020). Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020; 323(20):20672079.doi:10.1001/jama.2020.1432. \nAvailable here.","Children, adolescents and young adults up to 25 years of age. ","This review examined the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force.\nHealth, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. \nThe effects on illicit drug use in 26 trials among non-pregnant youth (n = 17,811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, −0.08 [95%CI, −0.16 to 0.001]; 24 effects [from 23 studies]; n = 12,801; I2 = 57.0%).\nThe percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months’ follow-up. The median absolute risk difference between groups was –2.8%, favouring the intervention group (range, –11.5%to 14.8%).\n","The evidence for behavioural counselling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements."]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","General population","The amount and strength of evidence varies across the six topics. There was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics. Illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. \nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"Tancred T, Melendez-Torres GJ, Paparini S, Fletcher A, Stansfield C, Thomas J, et al. Interventions integrating health and academic education in schools to prevent substance misuse and violence: a systematic review. Public Health Research 2019;7(17)\nAvailable here\n","Schools serving those aged 4–18 years","There was clear evidence that interventions are facilitated by supportive senior management and alignment with the schools’ ethos, collaborative and supportive teaching environments, and positive pre-existing student, teacher and parent attitudes towards interventions. The barriers were overburdened teachers who had little time to both learn and implement integrated curricula. The strongest evidence for effectiveness was found for the reduction of substance use in school key stages (KSs) 2 and 3. For example, a meta-analysis for substance use at KS3 reported a mean difference of –0.09 (95% confidence interval –0.17 to –0.01). A meta-analysis for effectiveness in reducing violence victimisation in KS2 found no effect. There was mixed evidence for effects on academic outcomes, with meta-analysis precluded by methodological heterogeneity.","These interventions are undertheorised but involve multiple forms of boundary erosion. There is clear evidence of characteristics affecting implementation. Interventions are likely to have the greatest impact on substance use. These programmes may be effective in reducing substance use but do not appear to reduce violence and findings on educational impacts are mixed."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Prevention strategies for substance misuse: A review of the clinical evidence. Ottawa: CADTH; 2012.\n\nAvailable here.\n","Adults (> 18 years of age) Children (review also included first nations, Inuit and metis (of all ages), findings specific to these groups have not been replicated here).","Children and adolescents:\nTwo SRs of family or parental support programs provided evidence that these interventions can reduce substance use. Universal family-based programs with educational and psychosocial components showed statistically significant positive effects across multiple outcomes of alcohol use. The most effective parenting programs required active parental participation and developed social competence, self-regulation and overall parenting skills. School-based programs were evaluated in two SRs. Certain psychosocial or life skills programs were reported to reduce the risk of alcohol misuse. The evidence was strongest for general programs targeting multiple factors including misuse of drugs, tobacco, alcohol and antisocial behaviour. Skills-focused school programs also showed statistically significant reductions in drug use compared to usual curriculum. Mentoring by peers or adults showed modest impact on the initiation of drug or alcohol use in adolescents primarily from disadvantaged or minority groups in the US. A systematic review of educationally oriented pre-school programs reported evidence that early childhood interventions improve health behaviours. Three RCTs showed a lower risk of marijuana use when children reached adulthood, but mixed effects on other drugs or alcohol. The review authors found no consistent evidence of the impact of pre-school programs on health services utilisation.\n\nAdults:\nSocial norms interventions, delivered either face-to-face or via the web or computer reduced the use of alcohol and alcohol related problems among college or university students. The evidence was strongest for a short term effect (< 0.05). The apparent inconsistency between the two SRs may be explained by differences in inclusion criteria. One review used broader inclusion criteria for the intervention and therefore reviewed more RCTs. There was some overlap between SRs in the studies included. \n","The authors reported that numerous studies evaluating the effectiveness of programs to prevent substance misuse in general adult and youth populations, are available.\n\nFamily or parental support programs can be effective in reducing or preventing substance misuse in adolescents. \n\nSchool-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. \n\nEvidence supporting the mentoring and preschool programs for primary prevention of substance misuse are less clear. \n\nIn adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population. \n\nNone of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. \nOther limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options.\n"]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older.","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell Systematic Reviews 2017;6 DOI: 10.4073/csr.2017.6\n\nAvailable here.\n","Eligible participants were young people between 15 and 25 years of age who were defined as high or risky consumers of alcohol or cannabis, or both.","Sixty studies were included that had randomised 33,316 participants in this review. \n\nThe studies were mostly from the United States and targeted high and risky alcohol use among university students. Some of the studies lacked clear descriptions of how the randomisation sequence was generated and concealed. Many of the studies did not blind the participants. Some of the studies suffered from high loss to follow-up, and few studies had a pre-registered protocol. \n\nFor alcohol, moderate quality evidence was found that multi-dose assessment and feedback was more effective than a single-dose assessment. There was low quality evidence that assessment and feedback might be more effective than no intervention. Assessment and feedback might also be more effective than assessment alone (low quality evidence). Short-term effects (< 6 months) were mostly larger than long-term (≥6 months) effects. \n\nFor cannabis, assessment and feedback might slightly reduce short term consumption compared to no intervention. Adding feedback to assessment may have little or no effect on short-term cannabis consumption. Moreover, there may be little or no difference between assessment plus feedback and education on short-term and long-term cannabis consumption. The review did not find evidence of any adverse effects of the interventions.\n","The authors concluded that computerised brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerised interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research."]
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[null,"Bonell C, Dickson K, Hinds K, Melendez-Torres GJ, Stansfield C, Fletcher A, et al. The effects of Positive Youth Development interventions on substance use, violence and inequalities: systematic review of theories of change, processes and outcomes. Public Health Research 2016;4(5)\nAvailable here","Adolescents","Effectiveness and cost-effectiveness in reducing substance use\nComparing PYD with usual or no treatment, our meta-analyses found a small effect for substance-use outcomes overall, which was significant neither statistically nor in terms of public health relevance. Meta-analyses found no effect for an omnibus measure of substance use across all time points but did find a small, statistically significant effect for this outcome in the short term (0–4 months post intervention). Meta-analyses of illicit drug-use and alcohol outcomes found no significant effects either across all time points or in the short term.\nConcerning the overall effects of PYD interventions on substance use, two interpretations are possible. The first is that studies pointed to a small effect for substance-use outcomes that was significant neither in terms of statistics nor public health (i.e. that there is evidence of no effect). Another interpretation is that there is no evidence of the effectiveness of PYD interventions on substance use outcomes.","How PYD might promote health is currently undertheorised. Implementation can be challenging. The authors found little evidence that current PYD interventions delivered outside school reduce substance use or violence. However, these may not constitute a test of the effectiveness of the PYD model, as some included interventions that, although meeting their inclusion criteria, were not exemplars of PYD."]
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[null,"Patnode CD et al. Primary care behavioral interventions to prevent or reduce illicit drug use and nonmedical pharmaceutical use in children and adolescents: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2014; 160(9):612-620\n\nAvailable here.\n","Adolescents.","Six trials were included, four of which examined the effect of the intervention on a health or social outcome. One trial found no effect of the intervention on marijuana-related consequences or driving under the influence of marijuana; three trials generally found no reduction in depressed mood at 12 or 24 months.\n\nFour of the five trials assessing self-reported marijuana use found statistically significant differences favouring the intervention group participants (such as a between-group difference of 0.10 to 0.17 use occasions in the past month). Three trials also reported positive outcomes in nonmedical prescription drug use occasions.\n","The authors concluded that the evidence is inadequate on the benefits of primary care relevant behavioural interventions in reducing self-reported illicit and pharmaceutical drug use among adolescents."]

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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. Available here. \n\nUnderpinning evidence reviews available here. ","This guideline is for local authorities responsible for education and public health. Teachers, school governors, academy trusts and otehrs (including school and public health nurses and healthy school leads) in secondary education, including special schools and further education settings. Health and social care practitoners. Providers of alcohol education. Members of the public, including parents or carers of children and young people in full time education and people working with children in the voluntary sector. ","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school. \n\nThis guideline includes recommendations on:\n - Planning alcohol education\n - Delivering universal alcohol education\n - Targeted interventions\n\n"]
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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 2044 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Faggiano  F et al. Universal school‐based prevention for illicit drug use. Cochrane Database Syst Rev 2014, Issue 12. Art. No.: CD003020. DOI: 10.1002/14651858.CD003020.pub3\n\nAvailable here.\n","Primary or secondary school pupils.","Fifty-one studies, with a total of 127,146 participants were included. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA.\n\nSocial competence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months follow‐up: the results favoured the social competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9,456 participants, moderate quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a positive significant effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.\n\nMarijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2,678 participants, high quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a significant positive effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.\n\nHard drug use at < 12 months: no difference found (RR 0.69; 95% CI 0.40 to 1.18, one study, 2,090 participants, moderate quality evidence). Two studies assessed this outcome (no data for meta‐analysis): one showed comparable results for the intervention and control group; one found a statistically non‐significant trend in favour of the social competence approach.\n\nHard drug use at 12+ months: no difference found (mean difference (MD) ‐0.01; 95% CI ‐0.06 to 0.04), one study, 1,075 participants, high quality evidence). One study with no data for meta‐analysis showed comparable results for the intervention and control group.\n\nAny drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2,512 participants, moderate quality evidence). One study with 1,566 participants provided continuous data showing no difference (MD 0.02; 95% CI ‐0.05 to 0.09, moderate quality evidence).\n","The authors reported that school programmes based on a combination of social competence and social influence approaches showed, on average, small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on the social competence approach also showed protective effects for some outcomes.\n\nSince the effects of school-based programmes are small, the authors recommend that they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.\n"]
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[null,null,null,"Social influence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: near statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716 participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence intervention (MD ‐0.26; 95% CI ‐0.48 to ‐0.04).\n\nMarijuana use at 12+ months: no difference found (RR 0.95; 95% CI 0.81 to 1.13, one study, 5,862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed near statistically significant results in favour of the social influence intervention (MD ‐0.22; 95% CI ‐0.46 to 0.02). Of the four studies not providing data for meta‐analysis a statistically significant protective effect was only found by one study.\n\nHard drug use at 12+ months: one study not providing data for meta‐analysis found a significant protective effect of the social influence approach.\n\nAny drug use: no studies assessed this outcome.\n"]
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[null,null,null,"Combined approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8,701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD ‐1.90; 95% CI ‐5.83 to 2.03).\n\nMarijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910 participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD ‐0.80; 95% CI ‐4.39 to 2.79). Two studies not providing data for meta‐analysis did not find a significant effect.\n\nHard drug use at < 12 months: one study with 693 participants provided both dichotomous and continuous data and showed conflicting results: no difference for dichotomous outcomes (RR 0.85; 95% CI 0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD ‐3.10; 95% CI ‐5.90 to ‐0.30). The quality of evidence was high.\n\nHard drug use at 12+ months: no difference found (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI ‐1.36 to 1.96). Two studies not providing data for meta‐analysis showed a significant effect of treatment.\n\nAny drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6,362 participants).\n\nOnly one study assessed the effect of a knowledge‐focused intervention on drug use and found no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesise. \n"]
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[null,"Langford  R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2\n\nAvailable here.\n","Children and young people aged four to 18 years attending schools or colleges (including special schools). Studies which covered both pre‐school and school‐aged students were excluded. ","Sixty-seven eligible cluster trials were included, randomising 1,443 schools or districts. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). \n\nThe quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nPositive effects were found for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. Little evidence of effectiveness was found for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta‐analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school‐related outcomes. \n","The results of this review provide evidence for the effectiveness of some interventions based on the health promoting schools framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Carney  T et al. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016, Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\n\nAvailable here.\n","Participants were adolescents under the age of 19 who were attending high school, secondary school, or a further education training college that provided alternative schooling or vocational training for adolescents between 16 and 18 years of age, and who used alcohol or other drugs, or both, but did not meet the criteria for substance dependence. In addition, adolescents had faced negative behavioural consequences due to their substance use.","This review included six trials with 1,176 adolescents that measured outcomes at different follow‐up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nReview authors generally found moderate‐quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. They also did not have a significant effect on delinquent‐type behaviour outcomes among adolescents. When compared to assessment‐only controls, they found low‐ or very low‐quality evidence that BIs reduced cannabis frequency at short‐term follow‐up in one study (standardised mean difference (SMD) ‐0.83; 95% confidence interval (CI) ‐1.14 to ‐0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD ‐0.91; 95% CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95% CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95% CI ‐0.9 to ‐0.26, n = 190), and cannabis abuse (SMD ‐0.34; 95% CI ‐0.65 to ‐0.02, n = 190) at medium‐term follow‐up in one study. At long‐term follow‐up, BIs also reduced alcohol abuse (SMD ‐0.72; 95% CI ‐1.05 to ‐0.40, n = 181), cannabis frequency (SMD ‐0.56; 95% CI ‐0.75 to ‐0.36, n = 181), abuse (SMD ‐0.62; 95% CI ‐0.95 to ‐0.29, n = 181), and dependence (SMD ‐0.96; 95% CI ‐1.30 to ‐0.63, n = 181) in one study. \n\nHowever, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long‐term follow‐up on these outcomes in the assessment‐only comparison was significant (SMD ‐0.78; 95% CI ‐1.11 to ‐0.45).\n","The authors found low‐ or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. They found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. They deemed it premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use and identified that further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Tancred T, Melendez-Torres GJ, Paparini S, Fletcher A, Stansfield C, Thomas J, et al. Interventions integrating health and academic education in schools to prevent substance misuse and violence: a systematic review. Public Health Research 2019;7(17)\nAvailable here","Schools serving those aged 4–18 years","There was clear evidence that interventions are facilitated by supportive senior management and alignment with the schools’ ethos, collaborative and supportive teaching environments, and positive pre-existing student, teacher and parent attitudes towards interventions. The barriers were overburdened teachers who had little time to both learn and implement integrated curricula. The strongest evidence for effectiveness was found for the reduction of substance use in school key stages (KSs) 2 and 3. For example, a meta-analysis for substance use at KS3 reported a mean difference of –0.09 (95% confidence interval –0.17 to –0.01). A meta-analysis for effectiveness in reducing violence victimisation in KS2 found no effect. There was mixed evidence for effects on academic outcomes, with meta-analysis precluded by methodological heterogeneity.","These interventions are undertheorised but involve multiple forms of boundary erosion. There is clear evidence of characteristics affecting implementation. Interventions are likely to have the greatest impact on substance use. These programmes may be effective in reducing substance use but do not appear to reduce violence and findings on educational impacts are mixed."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Prevention strategies for substance misuse: A review of the clinical evidence. Ottawa: CADTH; 2012.\n\nAvailable here.\n","Adults (> 18 years of age) Children (review also included first nations, Inuit and metis (of all ages), findings specific to these groups have not been replicated here).","Children and adolescents:\nTwo SRs of family or parental support programs provided evidence that these interventions can reduce substance use. Universal family-based programs with educational and psychosocial components showed statistically significant positive effects across multiple outcomes of alcohol use. The most effective parenting programs required active parental participation and developed social competence, self-regulation and overall parenting skills. School-based programs were evaluated in two SRs. Certain psychosocial or life skills programs were reported to reduce the risk of alcohol misuse. The evidence was strongest for general programs targeting multiple factors including misuse of drugs, tobacco, alcohol and antisocial behaviour. Skills-focused school programs also showed statistically significant reductions in drug use compared to usual curriculum. Mentoring by peers or adults showed modest impact on the initiation of drug or alcohol use in adolescents primarily from disadvantaged or minority groups in the US. A systematic review of educationally oriented pre-school programs reported evidence that early childhood interventions improve health behaviours. Three RCTs showed a lower risk of marijuana use when children reached adulthood, but mixed effects on other drugs or alcohol. The review authors found no consistent evidence of the impact of pre-school programs on health services utilisation.\n\nAdults:\nSocial norms interventions, delivered either face-to-face or via the web or computer reduced the use of alcohol and alcohol related problems among college or university students. The evidence was strongest for a short term effect (< 0.05). The apparent inconsistency between the two SRs may be explained by differences in inclusion criteria. One review used broader inclusion criteria for the intervention and therefore reviewed more RCTs. There was some overlap between SRs in the studies included. \n","The authors reported that numerous studies evaluating the effectiveness of programs to prevent substance misuse in general adult and youth populations, are available.\n\nFamily or parental support programs can be effective in reducing or preventing substance misuse in adolescents. \n\nSchool-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. \n\nEvidence supporting the mentoring and preschool programs for primary prevention of substance misuse are less clear. \n\nIn adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population.  \n\nNone of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. \nOther limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options.\n"]

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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed 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). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","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. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 2044 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Canadian Agency for Drugs and Technologies in Health. Prevention strategies for substance misuse: A review of the clinical evidence. Ottawa: CADTH; 2012.\n\nAvailable here.\n","Adults (> 18 years of age) Children (review also included first nations, Inuit and metis (of all ages), findings specific to these groups have not been replicated here).","Children and adolescents:\nTwo SRs of family or parental support programs provided evidence that these interventions can reduce substance use. Universal family-based programs with educational and psychosocial components showed statistically significant positive effects across multiple outcomes of alcohol use. The most effective parenting programs required active parental participation and developed social competence, self-regulation and overall parenting skills. School-based programs were evaluated in two SRs. Certain psychosocial or life skills programs were reported to reduce the risk of alcohol misuse. The evidence was strongest for general programs targeting multiple factors including misuse of drugs, tobacco, alcohol and antisocial behaviour. Skills-focused school programs also showed statistically significant reductions in drug use compared to usual curriculum. Mentoring by peers or adults showed modest impact on the initiation of drug or alcohol use in adolescents primarily from disadvantaged or minority groups in the US. A systematic review of educationally oriented pre-school programs reported evidence that early childhood interventions improve health behaviours. Three RCTs showed a lower risk of marijuana use when children reached adulthood, but mixed effects on other drugs or alcohol. The review authors found no consistent evidence of the impact of pre-school programs on health services utilisation.\n\nAdults:\nSocial norms interventions, delivered either face-to-face or via the web or computer reduced the use of alcohol and alcohol related problems among college or university students. The evidence was strongest for a short term effect (< 0.05). The apparent inconsistency between the two SRs may be explained by differences in inclusion criteria. One review used broader inclusion criteria for the intervention and therefore reviewed more RCTs. There was some overlap between SRs in the studies included. \n","The authors reported that numerous studies evaluating the effectiveness of programs to prevent substance misuse in general adult and youth populations, are available.\n\nFamily or parental support programs can be effective in reducing or preventing substance misuse in adolescents. \n\nSchool-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. \n\nEvidence supporting the mentoring and preschool programs for primary prevention of substance misuse are less clear. \n\nIn adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population. \n\nNone of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. \nOther limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options.\n"]

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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4\n\nAvailable here.\n","Students in university or college settings.","A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nOutcomes at four or more months post‐intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I2 < 50%).\n\nAlcohol‐related problems at four or more months: Individual face-to-face normative feedback (IFF) standardised mean difference (SMD) ‐0.14, 95% confidence interval (CI) ‐0.24 to ‐0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69‐point alcohol problems scale score. No effects were found for WF or MF.\n\nBinge drinking at four or more months: results pooled across delivery modes: SMD ‐0.06, 95% CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30‐day prevalence is 43.9%.\n\nDrinking quantity at four or more months: results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: web/computer normative feedback (WF) SMD ‐0.11, 95% CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD ‐0.21, 95% CI ‐0.31 to ‐0.10 (participants = 1,464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face-to-face normative feedback (GFF) or  normative marketing campaign (MC).\n\nEstimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.17 to 0.00 (participants = 7,198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, the authors interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings."]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell Systematic Reviews 2017;6 DOI: 10.4073/csr.2017.6\n\nAvailable here.\n","Eligible participants were young people between 15 and 25 years of age who were defined as high or risky consumers of alcohol or cannabis, or both.","Sixty studies were included that had randomised 33,316 participants in this review. \n\nThe studies were mostly from the United States and targeted high and risky alcohol use among university students. Some of the studies lacked clear descriptions of how the randomisation sequence was generated and concealed. Many of the studies did not blind the participants. Some of the studies suffered from high loss to follow-up, and few studies had a pre-registered protocol. \n\nFor alcohol, moderate quality evidence was found that multi-dose assessment and feedback was more effective than a single-dose assessment. There was low quality evidence that assessment and feedback might be more effective than no intervention. Assessment and feedback might also be more effective than assessment alone (low quality evidence). Short-term effects (< 6 months) were mostly larger than long-term (≥6 months) effects. \n\nFor cannabis, assessment and feedback might slightly reduce short term consumption compared to no intervention. Adding feedback to assessment may have little or no effect on short-term cannabis consumption. Moreover, there may be little or no difference between assessment plus feedback and education on short-term and long-term cannabis consumption. The review did not find evidence of any adverse effects of the interventions.\n","The authors concluded that computerised brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerised interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research."]

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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"McQueen J et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011, Issue 8. Art. No.: CD005191. DOI: 10.1002/14651858.CD005191.pub3.\n\nAvailable here.\n","Adults and adolescents (people 16 years and older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment, where inclusion criteria for the study identified participants as regularly consuming alcohol above the recommended safe weekly/daily amounts for the country in which the study took place.","Fourteen studies involving 4,041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD ‐69.43 (95% CI ‐128.14 to ‐10.72) and nine month follow up, MD ‐182.88 (95% CI ‐360.00 to ‐5.76) but this is not maintained at one year. Self-reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD ‐0.26 (95% CI ‐0.50 to ‐0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening and asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour.","The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","One new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.\n\nOverall, 53 of the 122 participants from the three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups RR 0.62, 95% CI 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.\n\nIn-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for\nreview authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications.\nData were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of\nstay, and no studies addressed the prevalence of risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and\nassessed, the one ’ongoing’ study identified may alter the conclusions of this review.\n"]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Patnode, CD et al. Screening for Unhealthy Drug Use in Primary Care in Adolescents and Adults, Including Pregnant Persons: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 186. AHRQ Publication No. 19-05255-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. \nAvailable here.","Adolescents, young adults and adults, and pregnant and postpartum women.","The review was conducted to support the U.S. Preventive Services Task Force in updating its 2008 recommendation on screening adolescents and adults, including pregnant women, for illicit drug use.\nNo evidence was found that addressed the benefits and harms of screening for drug use.\nRegarding screening instruments for drug use, studies were mainly detecting cannabis use among adolescents. They found that sensitivity for detecting any cannabis use or unhealthy cannabis use of frequency-based and risk assessment screen tools (all validated against structured clinical interview alone) ranged from 0.68 to 0.98 (95% CI range, 0.64 to 0.99) and specificity ranging from 0.82 to 1.00 (95% CI range, 0.80 to 1.00).\nAmong adults, frequency-based and risk assessment drug screening tools (all but two validated against structured clinical interview alone) showed sensitivity for detecting unhealthy use of any drug ranging from 0.71 to 0.94 (95% CI range, 0.62 to 0.97) and specificity ranging from 0.87 to 0.97 (95% CI range, 0.83 to 0.98).\nFor identifying drug use disorders among adults, sensitivity ranged from 0.85 to 1.00 (95% CI range, 0.67 to 1.00) and specificity ranged from 0.67 to 0.93 (95% CI, 0.58 to 0.95) when using the same cut-offs. \nSensitivity for detecting any prenatal drug use using frequency-based and risk assessment (all validated against hair or urine analyses) was lower than the estimates for any drug use in non-pregnant adults (only rarely based on validation against biologic samples) and ranged from 0.37 to 0.76 (95% CI range, 0.24 to 0.86). Specificity was comparable and ranged from 0.68 to 0.83 (95% CI range, 0.55 to 0.91).\nSome trials addressed the effectiveness of a counselling intervention on changes in drug use or improved health, social, or legal outcomes among a screen-detected population. In general, there was no consistent effect of the interventions on rates of self-reported or biologically confirmed drug use at 3- to 12-month follow up. Similarly, across 13 trials reporting the effects of the interventions on health, social, or legal outcomes (n-analysed=4304), none of the trials found a statistically significant difference between intervention and control groups on any of these measures at 3- to 12-month follow-up. \nOf four trials providing information regarding potential harms, none found any evidence of harm.","Several screening instruments with acceptable sensitivity and specificity have been developed to screen for drug use and drug use disorders in primary care, although in general, the accuracy of each tool has not been evaluated in more than one study and there is no evidence on the benefits or harms of screening versus no screening for drug use.\n \nBrief interventions for reducing the use of illicit drugs or the nonmedical use of prescription drugs in screen-detected primary care patients are unlikely to be effective for decreasing drug use or drug use consequences. \n\nGiven the burden of drug use, more research is needed on approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use in primary care."]
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[null,"O’Connor et al. (2020). Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323 (20):20672079.doi:10.1001/jama.2020.1432.\nAvailable here.","Children, adolescents and young adults up to 25 years of age. ","This review examined the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force.\nHealth, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. \nThe effects on illicit drug use in 26 trials among non-pregnant youth (n = 17,811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, −0.08 [95%CI, −0.16 to 0.001]; 24 effects [from 23 studies]; n = 12,801; I2 = 57.0%). \nThe percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months’ follow-up. The median absolute risk difference between groups was –2.8%, favouring the intervention group (range, –11.5% to 14.8%).","The evidence for behavioural counselling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements."]
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[null,"Patnode CD et al. Primary care behavioral interventions to prevent or reduce illicit drug use and nonmedical pharmaceutical use in children and adolescents: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2014; 160(9):612-620\n\nAvailable here.\n","Adolescents.","Six trials were included, four of which examined the effect of the intervention on a health or social outcome. One trial found no effect of the intervention on marijuana-related consequences or driving under the influence of marijuana; three trials generally found no reduction in depressed mood at 12 or 24 months.\n\nFour of the five trials assessing self-reported marijuana use found statistically significant differences favouring the intervention group participants (such as a between-group difference of 0.10 to 0.17 use occasions in the past month). Three trials also reported positive outcomes in nonmedical prescription drug use occasions.\n","The authors concluded that the evidence is inadequate on the benefits of primary care relevant behavioural interventions in reducing self-reported illicit and pharmaceutical drug use among adolescents."]

{"sheet":"Adolescents","index":10,"n_rows":485,"n_cols":5,"rows_kept":485,"cut":false,"hidden":false,"merged":[[215,1,236,1],[215,2,236,2],[215,3,236,3],[215,4,236,4],[237,1,261,1],[237,2,261,2],[237,3,261,3],[237,4,261,4],[126,1,141,1],[126,2,141,2],[126,3,141,3],[126,4,141,4],[142,1,214,1],[142,2,214,2],[142,3,171,3],[142,4,214,4],[172,3,187,3],[188,3,214,3],[484,1,518,1],[484,2,518,2],[484,3,518,3],[484,4,518,4],[262,1,287,1],[262,2,287,2],[262,3,287,3],[262,4,287,4],[405,1,420,1],[405,2,420,2],[405,3,420,3],[405,4,420,4],[288,1,307,1],[288,2,307,2],[288,3,307,3],[288,4,307,4],[27,1,27,4],[29,1,37,1],[29,2,37,2],[29,3,37,4],[38,1,57,1],[38,2,57,2],[38,3,57,4],[58,1,69,1],[58,2,69,2],[58,3,69,4],[71,1,71,4],[97,1,125,1],[97,2,125,2],[97,3,125,3],[97,4,125,4],[73,1,88,1],[73,2,76,2],[73,3,96,3],[73,4,96,4],[468,1,483,1],[468,2,483,2],[468,3,483,3],[468,4,483,4],[342,1,356,1],[342,2,356,2],[342,3,356,3],[342,4,356,4],[421,4,467,4],[358,1,358,4],[421,1,467,1],[421,2,467,2],[421,3,467,3],[308,1,341,1],[308,2,341,2],[308,3,341,3],[308,4,341,4],[390,1,404,1],[390,3,404,3],[390,4,404,4],[360,1,389,1],[360,2,389,2],[360,3,389,3],[360,4,389,4],[390,2,404,2]]}
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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute of Health and Care Excellence. Alcohol use disorders: prevention PH24. \nLondon: NICE; 2010.\n\nAvailable here.\n\nReviewed May 2014.\n\n\n\n\n","Commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors.","The guideline covers alcohol problems in those over the age of 10. It includes a mix of universal and targeted interventions.\n\nThe guideline makes recommendations on:\n• Price, availability and marketing\n• Licensing\n• Supporting children and young people aged 10-15 years thought to be at risk from their use of alcohol\n• Screening young people aged 16 and 17 years thought to be at risk from their use of alcohol\n• Screening adults\n• Referral\n\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. Available here. \n\nUnderpinning evidence reviews available here. ","This guideline is for local authorities responsible for education and public health. Teachers, school governors, academy trusts and otehrs (including school and public health nurses and healthy school leads) in secondary education, including special schools and further education settings. Health and social care practitoners. Providers of alcohol education. Members of the public, including parents or carers of children and young people in full time education and people working with children in the voluntary sector. ","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school. \n\nThis guideline includes recommendations on:\n - Planning alcohol education\n - Delivering universal alcohol education\n - Targeted interventions\n\n"]
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[null,"National Institute of Health and Care Excellence. Drug misuse prevention. QS165. London: NICE; 2018.\n\nAvailable here.\n",null,"This quality standard covers the prevention or delay of harmful use of drugs by children, young people and adults most likely to start using drugs, or already experimenting or using drugs occasionally. This includes illegal psychoactive substances, solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines. \n\nThe quality statements cover: \nStatement 1: Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.\nStatement 2: Care leavers having a health assessment as part of planning to leave care are assessed for vulnerability to drug misuse.\nStatement 3: Children and young people having a young offender assessment are assessed for vulnerability to drug misuse.\nStatement 4: Adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.\n"]
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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed 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). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","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. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 2044 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR, Tsertsvadze A. Universal multi-component prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev 2011, Issue 9 Art. No.: CD009307. DOI:10.1002/14651858.CD009307.\n\nAvailable here.\n","Children and adolescents up to the age of 18 years attending school.","Twenty parallel-group trials were included. The reporting quality of trials was poor, only 25 per cent and 5 per cent of them reporting adequate methods of randomisation and program allocation concealment, respectively. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 20 per cent of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.\n\nTwelve of the 20 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects ranging from three months to three years. Of the remaining eight trials, one trial reported significant effects using one-tailed tests and seven trials reported no significant effects of the multi-component interventions for reducing alcohol misuse.\n\nAssessment of the additional benefit of multiple versus single component interventions was possible in seven trials with multiple arms. Only one of the seven trials clearly showed a benefit of components delivered in more than one setting.\n","The authors found some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, they reporteds little evidence supporting interventions with multiple components ato be more effective than interventions with single components."]
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[null,"Faggiano  F et al. Universal school‐based prevention for illicit drug use. Cochrane Database Syst Rev 2014, Issue 12. Art. No.: CD003020. DOI: 10.1002/14651858.CD003020.pub3\n\nAvailable here.\n","Primary or secondary school pupils.","Fifty-one studies, with a total of 127,146 participants were included. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA.\n\nSocial competence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months follow‐up: the results favoured the social competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9,456 participants, moderate quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a positive significant effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.\n\nMarijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2,678 participants, high quality evidence). Seven studies assessed this outcome (no data for meta‐analysis): two showed a significant positive effect of intervention, three showed a non‐significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.\n\nHard drug use at < 12 months: no difference found (RR 0.69; 95% CI 0.40 to 1.18, one study, 2,090 participants, moderate quality evidence). Two studies assessed this outcome (no data for meta‐analysis): one showed comparable results for the intervention and control group; one found a statistically non‐significant trend in favour of the social competence approach.\n\nHard drug use at 12+ months: no difference found (mean difference (MD) ‐0.01; 95% CI ‐0.06 to 0.04), one study, 1,075 participants, high quality evidence). One study with no data for meta‐analysis showed comparable results for the intervention and control group.\n\nAny drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2,512 participants, moderate quality evidence). One study with 1,566 participants provided continuous data showing no difference (MD 0.02; 95% CI ‐0.05 to 0.09, moderate quality evidence).\n","The authors reported that school programmes based on a combination of social competence and social influence approaches showed, on average, small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on the social competence approach also showed protective effects for some outcomes.\n\nSince the effects of school-based programmes are small, the authors recommend that they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.\n"]
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[null,null,null,"Social influence approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: near statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716 participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence intervention (MD ‐0.26; 95% CI ‐0.48 to ‐0.04).\n\nMarijuana use at 12+ months: no difference found (RR 0.95; 95% CI 0.81 to 1.13, one study, 5,862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed near statistically significant results in favour of the social influence intervention (MD ‐0.22; 95% CI ‐0.46 to 0.02). Of the four studies not providing data for meta‐analysis a statistically significant protective effect was only found by one study.\n\nHard drug use at 12+ months: one study not providing data for meta‐analysis found a significant protective effect of the social influence approach.\n\nAny drug use: no studies assessed this outcome.\n"]
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[null,null,null,"Combined approach versus usual curricula or no intervention:\nMarijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8,701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD ‐1.90; 95% CI ‐5.83 to 2.03).\n\nMarijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910 participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD ‐0.80; 95% CI ‐4.39 to 2.79). Two studies not providing data for meta‐analysis did not find a significant effect.\n\nHard drug use at < 12 months: one study with 693 participants provided both dichotomous and continuous data and showed conflicting results: no difference for dichotomous outcomes (RR 0.85; 95% CI 0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD ‐3.10; 95% CI ‐5.90 to ‐0.30). The quality of evidence was high.\n\nHard drug use at 12+ months: no difference found (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI ‐1.36 to 1.96). Two studies not providing data for meta‐analysis showed a significant effect of treatment.\n\nAny drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6,362 participants).\n\nOnly one study assessed the effect of a knowledge‐focused intervention on drug use and found no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesise. \n"]
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[null,"Langford  R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2\n\nAvailable here.\n","Children and young people aged four to 18 years attending schools or colleges (including special schools). Studies which covered both pre‐school and school‐aged students were excluded. ","Sixty-seven eligible cluster trials were included, randomising 1,443 schools or districts. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). \n\nThe quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nPositive effects were found for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. Little evidence of effectiveness was found for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta‐analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school‐related outcomes. \n","The results of this review provide evidence for the effectiveness of some interventions based on the health promoting schools framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Thomas RE, Lorenzetti  D, Spragins W. Mentoring adolescents to prevent drug and alcohol use. Cochrane Database Syst Rev 2011, Issue 11. Art. No.: CD007381. DOI: 10.1002/14651858.CD007381.pub2.\n\nAvailable here.\n","Adolescents aged 13 to 18.","Four randomised controlled trials (RCTs) (1,194 adolescents) were included. No RCT reported enough detail to assess whether a strong randomisation method was used or allocation was concealed. Blinding was not possible as the intervention was mentoring. Three RCTs provided complete data. No selective reporting.\n\nThree RCTs provided evidence about mentoring and preventing alcohol use. Two RCTs were pooled (RR for mentoring compared to no intervention = 0.71 (95% CI = 0.57 to 0.90, P value = 0.005). A third RCT found no significant differences.\n\nThree RCTs provided evidence about mentoring and preventing drug use, but could not be pooled. One found significantly less use of “illegal\" drugs,\" one did not, and one assessed only marijuana use and found no significant differences.\n\nOne RCT measured “substance use” without separating alcohol and drugs, and found no difference for mentoring.\n","The authors reported that: All four RCTs were in the US, and included “deprived” and mostly minority adolescents. Participants were young (in two studies age 12, and in two others 9‐16). All students at baseline were non‐users of alcohol and drugs. Two RCTs found mentoring reduced the rate of initiation of alcohol, and one of drug usage. The ability of the interventions to be effective was limited by the low rates of commencing alcohol and drug use during the intervention period in two studies (the use of marijuana in one study increased to 1% in the experimental and to 1.6% in the control group, and in another study drug usage rose to 6% in the experimental and 11% in the control group). However, in a third study there was scope for the intervention to have an effect as alcohol use rose to 19 per cent in the experimental and 27 per cent in the control group. The studies assessed structured programmes and not informal mentors."]
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[null,"Carney T et al. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016, Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\n\nAvailable here.\n","Participants were adolescents under the age of 19 who were attending high school, secondary school, or a further education training college that provided alternative schooling or vocational training for adolescents between 16 and 18 years of age, and who used alcohol or other drugs, or both, but did not meet the criteria for substance dependence. In addition, adolescents had faced negative behavioural consequences due to their substance use.","This review included six trials with 1,176 adolescents that measured outcomes at different follow‐up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nReview authors generally found moderate‐quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. They also did not have a significant effect on delinquent‐type behaviour outcomes among adolescents. When compared to assessment‐only controls, they found low‐ or very low‐quality evidence that BIs reduced cannabis frequency at short‐term follow‐up in one study (standardised mean difference (SMD) ‐0.83; 95% CI ‐1.14 to ‐0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD ‐0.91; 95% CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95% CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95% CI ‐0.9 to ‐0.26, n = 190), and cannabis abuse (SMD ‐0.34; 95% CI ‐0.65 to ‐0.02, n = 190) at medium‐term follow‐up in one study. At long‐term follow‐up, BIs also reduced alcohol abuse (SMD ‐0.72; 95% CI ‐1.05 to ‐0.40, n = 181), cannabis frequency (SMD ‐0.56; 95% CI ‐0.75 to ‐0.36, n = 181), abuse (SMD ‐0.62; 95% CI ‐0.95 to ‐0.29, n = 181), and dependence (SMD ‐0.96; 95% CI ‐1.30 to ‐0.63, n = 181) in one study. \n\nHowever, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long‐term follow‐up on these outcomes in the assessment‐only comparison was significant (SMD ‐0.78; 95% CI ‐1.11 to ‐0.45).\n","The authors found low‐ or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. They found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. They deemed it premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use and identified that further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Ferri M et al. Media campaigns for the prevention of illicit drug use in young people. Cochrane Database Syst Rev 2013, Issue 6. Art. No.: CD009287. DOI: 10.1002/14651858.CD009287.pub2.\n\nAvailable here. \n","Young people under the age of 26. ","Twenty-three studies involving 188,934 young people, conducted in the USA, Canada and Australia between 1991 and 2012 were included. Twelve studies were RCT, two were prospective cohort studies (PCS), one study was both a RCT and a PCS, six were interrupted time series (ITS) and two were controlled before and after (CBA) studies. The RCTs had an overall low risk of bias, along with the ITS (apart from the dimension 'formal test of trend'), and the PCS had overall good quality, apart from the description of loss to follow‐up by exposure.\n\nSelf-reported or biomarker‐assessed illicit drug use was measured with an array of published and unpublished scales making comparisons difficult. Pooled results of five RCTs (N = 5,470) show no effect of media campaign intervention (SMD ‐0.02; 95% l CI ‐0.15 to 0.12).\n\nFive ITS studies (N = 26,405) focusing specifically on methamphetamine use were pooled. Out of four pooled estimates (two endpoints measured in two age groups), there was evidence of a reduction only in past‐year prevalence of methamphetamine use among 12 to 17 year olds.\n\nA further five studies (designs = one RCT with PCS, two PCS, two ITS, one CBA, N = 151,508), which could not be included in meta‐analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case and reduction of use in another.\n","The authors reported that the overall available evidence does not allow conclusions about the effect of media campaigns on illicit drug use among young people and that further studies are needed."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\n\nAvailable here. \n","Those aged 10 years and above.","One small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS (general population studies in Canadian provinces conducted in the 1970s and 80s) were included.\n\nThe RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95% CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95% CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE), the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95% CI ‐5.26, 7.47; p value = 0.43; I2 = 83%, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI ‐36.83, ‐8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.\n\nNo other pre-specified outcomes (including economic loss or hardship due to decreased alcohol sales) were addressed in the included studies and no adverse effects were reported in any of the studies. None of the studies were funded by the alcohol or advertising industries.\n","The authors identified a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. They concluded that advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base."]
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[null,"McQueen J et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011, Issue 8. Art. No.: CD005191. DOI: 10.1002/14651858.CD005191.pub3.\n\nAvailable here.\n","Adults and adolescents (people 16 years and older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment, where inclusion criteria for the study identified participants as regularly consuming alcohol above the recommended safe weekly/daily amounts for the country in which the study took place.","Fourteen studies involving 4,041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD ‐69.43 (95% CI ‐128.14 to ‐10.72) and nine month follow up, MD ‐182.88 (95% CI ‐360.00 to ‐5.76) but this is not maintained at one year. Self-reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD ‐0.26 (95% CI ‐0.50 to ‐0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening and asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour.","The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics."]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Patnode, CD et al. Screening for Unhealthy Drug Use in Primary Care in Adolescents and Adults, Including Pregnant Persons: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 186. AHRQ Publication No. 19-05255-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. \nAvailable here.","Adolescents, young adults and adults, and pregnant and postpartum women.","The review was conducted to support the U.S. Preventive Services Task Force in updating its 2008 recommendation on screening adolescents and adults, including pregnant women, for illicit drug use.\nNo evidence was found that addressed the benefits and harms of screening for drug use.\nRegarding screening instruments for drug use, studies were mainly detecting cannabis use among adolescents. They found that sensitivity for detecting any cannabis use or unhealthy cannabis use of frequency-based and risk assessment screen tools (all validated against structured clinical interview alone) ranged from 0.68 to 0.98 (95% CI range, 0.64 to 0.99) and specificity ranging from 0.82 to 1.00 (95% CI range, 0.80 to 1.00).\nAmong adults, frequency-based and risk assessment drug screening tools (all but two validated against structured clinical interview alone) showed sensitivity for detecting unhealthy use of any drug ranging from 0.71 to 0.94 (95% CI range, 0.62 to 0.97) and specificity ranging from 0.87 to 0.97 (95% CI range, 0.83 to 0.98).\nFor identifying drug use disorders among adults, sensitivity ranged from 0.85 to 1.00 (95% CI range, 0.67 to 1.00) and specificity ranged from 0.67 to 0.93 (95% CI, 0.58 to 0.95) when using the same cut-offs. \nSensitivity for detecting any prenatal drug use using frequency-based and risk assessment (all validated against hair or urine analyses) was lower than the estimates for any drug use in non-pregnant adults (only rarely based on validation against biologic samples) and ranged from 0.37 to 0.76 (95% CI range, 0.24 to 0.86). Specificity was comparable and ranged from 0.68 to 0.83 (95% CI range, 0.55 to 0.91).\nSome trials addressed the effectiveness of a counselling intervention on changes in drug use or improved health, social, or legal outcomes among a screen-detected population. In general, there was no consistent effect of the interventions on rates of self-reported or biologically confirmed drug use at 3- to 12-month follow up. Similarly, across 13 trials reporting the effects of the interventions on health, social, or legal outcomes (n-analysed=4304), none of the trials found a statistically significant difference between intervention and control groups on any of these measures at 3- to 12-month follow-up. \nOf four trials providing information regarding potential harms, none found any evidence of harm.","Several screening instruments with acceptable sensitivity and specificity have been developed to screen for drug use and drug use disorders in primary care, although in general, the accuracy of each tool has not been evaluated in more than one study and there is no evidence on the benefits or harms of screening versus no screening for drug use.\n \nBrief interventions for reducing the use of illicit drugs or the nonmedical use of prescription drugs in screen-detected primary care patients are unlikely to be effective for decreasing drug use or drug use consequences. \n\nGiven the burden of drug use, more research is needed on approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use in primary care."]
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[null,"O’Connor et al. (2020). Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020; 323(20):20672079.doi:10.1001/jama.2020.1432. \nAvailable here.","Children, adolescents and young adults up to 25 years of age. ","This review examined the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. Interventions mainly consisted of behavioural counselling.\nHealth, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. \nThe effects on illicit drug use in 26 trials among non-pregnant youth (n = 17,811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, −0.08 [95%CI, −0.16 to 0.001]; 24 effects [from 23 studies]; n = 12,801; I2 = 57.0%).\nThe percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months’ follow-up. The median absolute risk difference between groups was –2.8%, favouring the intervention group (range, –11.5%to 14.8%).","The evidence for behavioural counselling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements."]
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[null,"Bonell C, Dickson K, Hinds K, Melendez-Torres GJ, Stansfield C, Fletcher A, et al. The effects of Positive Youth Development interventions on substance use, violence and inequalities: systematic review of theories of change, processes and outcomes. Public Health Research 2016;4(5)\nAvailable here\n","Adolescents","Effectiveness and cost-effectiveness in reducing substance use\nComparing PYD with usual or no treatment, our meta-analyses found a small effect for substance-use outcomes overall, which was significant neither statistically nor in terms of public health relevance. Meta-analyses found no effect for an omnibus measure of substance use across all time points but did find a small, statistically significant effect for this outcome in the short term (0–4 months post intervention). Meta-analyses of illicit drug-use and alcohol outcomes found no significant effects either across all time points or in the short term.\nConcerning the overall effects of PYD interventions on substance use, two interpretations are possible. The first is that studies pointed to a small effect for substance-use outcomes that was significant neither in terms of statistics nor public health (i.e. that there is evidence of no effect). Another interpretation is that there is no evidence of the effectiveness of PYD interventions on substance use outcomes.","How PYD might promote health is currently undertheorised. Implementation can be challenging. The authors found little evidence that current PYD interventions delivered outside school reduce substance use or violence. However, these may not constitute a test of the effectiveness of the PYD model, as some included interventions that, although meeting their inclusion criteria, were not exemplars of PYD."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Prevention strategies for substance misuse: A review of the clinical evidence. Ottawa: CADTH; 2012.\n\nAvailable here.\n","Adults (> 18 years of age) Children (review also included first nations, Inuit and metis (of all ages), findings specific to these groups have not been replicated here).","Children and adolescents:\nTwo SRs of family or parental support programs provided evidence that these interventions can reduce substance use. Universal family-based programs with educational and psychosocial components showed statistically significant positive effects across multiple outcomes of alcohol use. The most effective parenting programs required active parental participation and developed social competence, self-regulation and overall parenting skills. School-based programs were evaluated in two SRs. Certain psychosocial or life skills programs were reported to reduce the risk of alcohol misuse. The evidence was strongest for general programs targeting multiple factors including misuse of drugs, tobacco, alcohol and antisocial behaviour. Skills-focused school programs also showed statistically significant reductions in drug use compared to usual curriculum. Mentoring by peers or adults showed modest impact on the initiation of drug or alcohol use in adolescents primarily from disadvantaged or minority groups in the US. A systematic review of educationally oriented pre-school programs reported evidence that early childhood interventions improve health behaviours. Three RCTs showed a lower risk of marijuana use when children reached adulthood, but mixed effects on other drugs or alcohol. The review authors found no consistent evidence of the impact of pre-school programs on health services utilisation.\n\nAdults:\nSocial norms interventions, delivered either face-to-face or via the web or computer reduced the use of alcohol and alcohol related problems among college or university students. The evidence was strongest for a short term effect (< 0.05). The apparent inconsistency between the two SRs may be explained by differences in inclusion criteria. One review used broader inclusion criteria for the intervention and therefore reviewed more RCTs. There was some overlap between SRs in the studies included. \n","The authors reported that numerous studies evaluating the effectiveness of programs to prevent substance misuse in general adult and youth populations, are available.\n\nFamily or parental support programs can be effective in reducing or preventing substance misuse in adolescents. \n\nSchool-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. \n\nEvidence supporting the mentoring and preschool programs for primary prevention of substance misuse are less clear. \n\nIn adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population. \n\nNone of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. \nOther limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options.\n"]
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[null,"Patnode CD et al. Primary care behavioral interventions to prevent or reduce illicit drug use and nonmedical pharmaceutical use in children and adolescents: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2014; 160(9):612-620\n\nAvailable here.\n","Adolescents.","Six trials were included, four of which examined the effect of the intervention on a health or social outcome. One trial found no effect of the intervention on marijuana-related consequences or driving under the influence of marijuana; three trials generally found no reduction in depressed mood at 12 or 24 months.\n\nFour of the five trials assessing self-reported marijuana use found statistically significant differences favouring the intervention group participants (such as a between-group difference of 0.10 to 0.17 use occasions in the past month). Three trials also reported positive outcomes in nonmedical prescription drug use occasions.\n","The authors concluded that the evidence is inadequate on the benefits of primary care relevant behavioural interventions in reducing self-reported illicit and pharmaceutical drug use among adolescents."]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older.","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]

{"sheet":"Young adults","index":11,"n_rows":183,"n_cols":5,"rows_kept":183,"cut":false,"hidden":false,"merged":[[27,1,27,4],[29,1,37,1],[29,2,37,2],[29,3,37,4],[38,1,49,1],[38,2,49,2],[38,3,49,4],[182,1,200,1],[182,2,200,2],[182,3,200,3],[182,4,200,4],[136,1,136,4],[168,1,181,1],[168,2,181,2],[168,3,181,3],[168,4,181,4],[138,1,167,1],[138,2,167,2],[138,3,167,3],[138,4,167,4],[115,1,134,1],[115,2,134,2],[115,3,134,3],[115,4,134,4],[51,1,51,4],[53,1,85,1],[53,2,85,2],[53,3,85,3],[53,4,85,4],[86,1,114,1],[86,2,114,2],[86,3,114,3],[86,4,114,4]]}
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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute of Health and Care Excellence. Alcohol use disorders: prevention PH24. \nLondon: NICE; 2010.\n\nAvailable here.\n\nReviewed May 2014.\n\n\n\n\n","Commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors.","The guideline covers alcohol problems in those over the age of 10. It includes a mix of universal and targeted interventions.\n\nThe guideline makes recommendations on:\n• Price, availability and marketing\n• Licensing\n• Supporting children and young people aged 10-15 years thought to be at risk from their use of alcohol\n• Screening young people aged 16 and 17 years thought to be at risk from their use of alcohol\n• Screening adults\n• Referral\n\n"]
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[null,"National Institute of Health and Care Excellence. Drug misuse prevention. QS165. London: NICE; 2018.\n\nAvailable here.\n",null,"This quality standard covers the prevention or delay of harmful use of drugs by children, young people and adults most likely to start using drugs, or already experimenting or using drugs occasionally. This includes illegal psychoactive substances, solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines. \n\nThe quality statements cover: \nStatement 1: Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.\nStatement 2: Care leavers having a health assessment as part of planning to leave care are assessed for vulnerability to drug misuse.\nStatement 3: Children and young people having a young offender assessment are assessed for vulnerability to drug misuse.\nStatement 4: Adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.\n"]
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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4\n\nAvailable here.\n","Students in university or college settings.","A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nOutcomes at four or more months post‐intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I2 < 50%).\n\nAlcohol‐related problems at four or more months: Individual face-to-face normative feedback (IFF) SMD ‐0.14, 95% CI ‐0.24 to ‐0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69‐point alcohol problems scale score. No effects were found for web/computer normative feedback (WF) or mailed normative feedback (MF).\n\nBinge drinking at four or more months: results pooled across delivery modes: SMD ‐0.06, 95% CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30‐day prevalence is 43.9%.\n\nDrinking quantity at four or more months: results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95% CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD ‐0.21, 95% CI ‐0.31 to ‐0.10 (participants = 1,464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face-to-face normative feedback (GFF) or  normative marketing campaign (MC).\n\nEstimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD ‐0.08, 95% CI ‐0.17 to 0.00 (participants = 7,198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, the authors interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\n\nAvailable here. \n","Young adults aged up to 25.","Eighty-four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of motivational interviewing (MI) for the quantity of alcohol consumed (SMD −0.11, 95% CI −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95% CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95% CI −0.20 to 0.05, or a reduction from 0.144% to 0.131%; moderate quality evidence).\n\nA marginal effect in favour of MI for alcohol problems (SMD −0.08, 95% CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95% CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95% CI −0.18 to 0.08; moderate quality evidence). We also considered other alcohol‐related behavioural outcomes, and at four or more months follow‐up, we found no effects on drink‐driving (SMD −0.13, 95% CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95% CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n\nNone of the studies reported harms related to MI.\n","The authors conclude the results of this review indicating that there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol use, misuse or alcohol‐related problems. Although they found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Ferri M et al. Media campaigns for the prevention of illicit drug use in young people. Cochrane Database Syst Rev 2013, Issue 6. Art. No.: CD009287. DOI: 10.1002/14651858.CD009287.pub2.\n\nAvailable here. \n","Young people under the age of 26. ","Twenty-three studies involving 188,934 young people, conducted in the USA, Canada and Australia between 1991 and 2012 were included. Twelve studies were RCT, two were prospective cohort studies (PCS), one study was both a RCT and a PCS, six were interrupted time series (ITS) and two were controlled before and after (CBA) studies. The RCTs had an overall low risk of bias, along with the ITS (apart from the dimension 'formal test of trend'), and the PCS had overall good quality, apart from the description of loss to follow‐up by exposure.\n\nSelf-reported or biomarker‐assessed illicit drug use was measured with an array of published and unpublished scales making comparisons difficult. Pooled results of five RCTs (N = 5,470) show no effect of media campaign intervention (SMD ‐0.02; 95% l CI ‐0.15 to 0.12).\n\nFive ITS studies (N = 26,405) focusing specifically on methamphetamine use were pooled. Out of four pooled estimates (two endpoints measured in two age groups), there was evidence of a reduction only in past‐year prevalence of methamphetamine use among 12 to 17 year olds.\n\nA further five studies (designs = one RCT with PCS, two PCS, two ITS, one CBA, N = 151,508), which could not be included in meta‐analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case and reduction of use in another.\n","The authors reported that the overall available evidence does not allow conclusions about the effect of media campaigns on illicit drug use among young people and that further studies are needed."]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Patnode, CD et al. Screening for Unhealthy Drug Use in Primary Care in Adolescents and Adults, Including Pregnant Persons: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 186. AHRQ Publication No. 19-05255-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. \nAvailable here.","Adolescents, young adults and adults, and pregnant and postpartum women.","The review was conducted to support the U.S. Preventive Services Task Force in updating its 2008 recommendation on screening adolescents and adults, including pregnant women, for illicit drug use.\nNo evidence was found that addressed the benefits and harms of screening for drug use.\nRegarding screening instruments for drug use, studies were mainly detecting cannabis use among adolescents. They found that sensitivity for detecting any cannabis use or unhealthy cannabis use of frequency-based and risk assessment screen tools (all validated against structured clinical interview alone) ranged from 0.68 to 0.98 (95% CI range, 0.64 to 0.99) and specificity ranging from 0.82 to 1.00 (95% CI range, 0.80 to 1.00).\nAmong adults, frequency-based and risk assessment drug screening tools (all but two validated against structured clinical interview alone) showed sensitivity for detecting unhealthy use of any drug ranging from 0.71 to 0.94 (95% CI range, 0.62 to 0.97) and specificity ranging from 0.87 to 0.97 (95% CI range, 0.83 to 0.98).\nFor identifying drug use disorders among adults, sensitivity ranged from 0.85 to 1.00 (95% CI range, 0.67 to 1.00) and specificity ranged from 0.67 to 0.93 (95% CI, 0.58 to 0.95) when using the same cut-offs. \nSensitivity for detecting any prenatal drug use using frequency-based and risk assessment (all validated against hair or urine analyses) was lower than the estimates for any drug use in non-pregnant adults (only rarely based on validation against biologic samples) and ranged from 0.37 to 0.76 (95% CI range, 0.24 to 0.86). Specificity was comparable and ranged from 0.68 to 0.83 (95% CI range, 0.55 to 0.91).\nSome trials addressed the effectiveness of a counselling intervention on changes in drug use or improved health, social, or legal outcomes among a screen-detected population. In general, there was no consistent effect of the interventions on rates of self-reported or biologically confirmed drug use at 3- to 12-month follow up. Similarly, across 13 trials reporting the effects of the interventions on health, social, or legal outcomes (n-analysed=4304), none of the trials found a statistically significant difference between intervention and control groups on any of these measures at 3- to 12-month follow-up. \nOf four trials providing information regarding potential harms, none found any evidence of harm.","Several screening instruments with acceptable sensitivity and specificity have been developed to screen for drug use and drug use disorders in primary care, although in general, the accuracy of each tool has not been evaluated in more than one study and there is no evidence on the benefits or harms of screening versus no screening for drug use.\n \nBrief interventions for reducing the use of illicit drugs or the nonmedical use of prescription drugs in screen-detected primary care patients are unlikely to be effective for decreasing drug use or drug use consequences. \n\nGiven the burden of drug use, more research is needed on approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use in primary care."]
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[null,"O’Connor et al. (2020). Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323 (20):20672079.doi:10.1001/jama.2020.1432.\nAvailable here.","Children, adolescents and young adults up to 25 years of age. ","This review examined the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force.\nHealth, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. \nThe effects on illicit drug use in 26 trials among non-pregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, −0.08 [95%CI, −0.16 to 0.001]; 24 effects [from 23 studies]; n = 12,801; I2 = 57.0%). \nThe percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months’ follow-up. The median absolute risk difference between groups was –2.8%, favouring the intervention group (range, –11.5% to 14.8%).","The evidence for behavioural counselling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell Systematic Reviews 2017;6 DOI: 10.4073/csr.2017.6\n\nAvailable here.\n","Eligible participants were young people between 15 and 25 years of age who were defined as high or risky consumers of alcohol or cannabis, or both.","Sixty studies were included that had randomised 33,316 participants in this review. \n\nThe studies were mostly from the United States and targeted high and risky alcohol use among university students. Some of the studies lacked clear descriptions of how the randomisation sequence was generated and concealed. Many of the studies did not blind the participants. Some of the studies suffered from high loss to follow-up, and few studies had a pre-registered protocol. \n\nFor alcohol, moderate quality evidence was found that multi-dose assessment and feedback was more effective than a single-dose assessment. There was low quality evidence that assessment and feedback might be more effective than no intervention. Assessment and feedback might also be more effective than assessment alone (low quality evidence). Short-term effects (< 6 months) were mostly larger than long-term (≥6 months) effects. \n\nFor cannabis, assessment and feedback might slightly reduce short term consumption compared to no intervention. Adding feedback to assessment may have little or no effect on short-term cannabis consumption. Moreover, there may be little or no difference between assessment plus feedback and education on short-term and long-term cannabis consumption. The review did not find evidence of any adverse effects of the interventions.\n","The authors concluded that computerised brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerised interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research."]

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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute of Health and Care Excellence. Alcohol use disorders: prevention PH24. \nLondon: NICE; 2010.\n\nAvailable here.\n\nReviewed May 2014.\n\n\n\n\n","Commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors.","The guideline covers alcohol problems in those over the age of 10. It includes a mix of universal and targeted interventions.\n\nThe guideline makes recommendations on:\n• Price, availability and marketing\n• Licensing\n• Supporting children and young people aged 10-15 years thought to be at risk from their use of alcohol\n• Screening young people aged 16 and 17 years thought to be at risk from their use of alcohol\n• Screening adults\n• Referral\n\n"]
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[null,"National Institute of Health and Care Excellence. Drug misuse prevention. QS165. London: NICE; 2018.\n\nAvailable here.\n",null,"This quality standard covers the prevention or delay of harmful use of drugs by children, young people and adults most likely to start using drugs, or already experimenting or using drugs occasionally. This includes illegal psychoactive substances, solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines. \n\nThe quality statements cover: \nStatement 1: Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.\nStatement 2: Care leavers having a health assessment as part of planning to leave care are assessed for vulnerability to drug misuse.\nStatement 3: Children and young people having a young offender assessment are assessed for vulnerability to drug misuse.\nStatement 4: Adults assessed as vulnerable to drug misuse are given information about local services and where to find further advice and support.\n"]
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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\n\nAvailable here. \n","Those aged 10 years and above.","One small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS (general population studies in Canadian provinces conducted in the 1970s and 80s) were included.\n\nThe RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95% CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95% CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE), the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95% CI ‐5.26, 7.47; p value = 0.43; I2 = 83%, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI ‐36.83, ‐8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.\n\nNo other pre-specified outcomes (including economic loss or hardship due to decreased alcohol sales) were addressed in the included studies and no adverse effects were reported in any of the studies. None of the studies were funded by the alcohol or advertising industries.\n","The authors identified a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. They concluded that advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base."]
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[null,"Kaner EFS et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations. Cochrane Database Syst Rev 2017, Issue 9. Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2\n\nAvailable here.\n","Participants were people living in the community whose alcohol consumption had been screened as hazardous or harmful (WHO 1992) and who were directed toward any digital intervention including web‐based, mobile phone text messaging, smartphone apps, social networking, or stand-alone computer‐based technologies (including CD‐ROMs).","Fifty-seven studies were included in the review which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty-one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence).\n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3,587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9,791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence).\n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI ‐24.59 to 25.63; low‐quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.\n\nA median of nine behaviour change techniques (BCTs) were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B ‐43.94, 95% CI ‐78.59 to ‐9.30), problem solving (B ‐48.03, 95% CI ‐77.79 to ‐18.27), information about antecedents (B ‐74.20, 95% CI ‐117.72 to ‐30.68), behaviour substitution (B ‐123.71, 95% CI ‐184.63 to ‐62.80) and credible source (B ‐39.89, 95% CI ‐72.66 to ‐7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B ‐95.12, 95% CI ‐162.90 to ‐27.34), problem solving (B ‐45.92, 95% CI ‐90.97 to ‐0.87), and credible source (B ‐32.09, 95% CI ‐60.64 to ‐3.55) were associated with reduced alcohol consumption.\n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","The authors found moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions.\n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.\n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.\n"]
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[null,"McQueen J et al. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011, Issue 8. Art. No.: CD005191. DOI: 10.1002/14651858.CD005191.pub3.\n\nAvailable here.\n","Adults and adolescents (people 16 years and older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment, where inclusion criteria for the study identified participants as regularly consuming alcohol above the recommended safe weekly/daily amounts for the country in which the study took place.","Fourteen studies involving 4,041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD ‐69.43 (95% CI ‐128.14 to ‐10.72) and nine month follow up, MD ‐182.88 (95% CI ‐360.00 to ‐5.76) but this is not maintained at one year. Self-reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD ‐0.26 (95% CI ‐0.50 to ‐0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening and asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour.","The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","One new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.\n\nOverall, 53 of the 122 participants from the three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups RR 0.62, 95% CI 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.\n\nIn-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for\nreview authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications.\nData were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of\nstay, and no studies addressed the prevalence of risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and\nassessed, the one ’ongoing’ study identified may alter the conclusions of this review.\n"]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Patnode, CD et al. Screening for Unhealthy Drug Use in Primary Care in Adolescents and Adults, Including Pregnant Persons: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 186. AHRQ Publication No. 19-05255-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. \nAvailable here.","Adolescents, young adults and adults, and pregnant and postpartum women.","The review was conducted to support the U.S. Preventive Services Task Force in updating its 2008 recommendation on screening adolescents and adults, including pregnant women, for illicit drug use.\nNo evidence was found that addressed the benefits and harms of screening for drug use.\nRegarding screening instruments for drug use, studies were mainly detecting cannabis use among adolescents. They found that sensitivity for detecting any cannabis use or unhealthy cannabis use of frequency-based and risk assessment screen tools (all validated against structured clinical interview alone) ranged from 0.68 to 0.98 (95% CI range, 0.64 to 0.99) and specificity ranging from 0.82 to 1.00 (95% CI range, 0.80 to 1.00).\nAmong adults, frequency-based and risk assessment drug screening tools (all but two validated against structured clinical interview alone) showed sensitivity for detecting unhealthy use of any drug ranging from 0.71 to 0.94 (95% CI range, 0.62 to 0.97) and specificity ranging from 0.87 to 0.97 (95% CI range, 0.83 to 0.98).\nFor identifying drug use disorders among adults, sensitivity ranged from 0.85 to 1.00 (95% CI range, 0.67 to 1.00) and specificity ranged from 0.67 to 0.93 (95% CI, 0.58 to 0.95) when using the same cut-offs. \nSensitivity for detecting any prenatal drug use using frequency-based and risk assessment (all validated against hair or urine analyses) was lower than the estimates for any drug use in non-pregnant adults (only rarely based on validation against biologic samples) and ranged from 0.37 to 0.76 (95% CI range, 0.24 to 0.86). Specificity was comparable and ranged from 0.68 to 0.83 (95% CI range, 0.55 to 0.91).\nSome trials addressed the effectiveness of a counselling intervention on changes in drug use or improved health, social, or legal outcomes among a screen-detected population. In general, there was no consistent effect of the interventions on rates of self-reported or biologically confirmed drug use at 3- to 12-month follow up. Similarly, across 13 trials reporting the effects of the interventions on health, social, or legal outcomes (n-analysed=4304), none of the trials found a statistically significant difference between intervention and control groups on any of these measures at 3- to 12-month follow-up. \nOf four trials providing information regarding potential harms, none found any evidence of harm.","Several screening instruments with acceptable sensitivity and specificity have been developed to screen for drug use and drug use disorders in primary care, although in general, the accuracy of each tool has not been evaluated in more than one study and there is no evidence on the benefits or harms of screening versus no screening for drug use.\n \nBrief interventions for reducing the use of illicit drugs or the nonmedical use of prescription drugs in screen-detected primary care patients are unlikely to be effective for decreasing drug use or drug use consequences. \n\nGiven the burden of drug use, more research is needed on approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use in primary care."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Prevention strategies for substance misuse: A review of the clinical evidence. Ottawa: CADTH; 2012.\n\nAvailable here.\n","Adults (> 18 years of age) Children (review also included first nations, Inuit and metis (of all ages), findings specific to these groups have not been replicated here).","Children and adolescents:\nTwo SRs of family or parental support programs provided evidence that these interventions can reduce substance use. Universal family-based programs with educational and psychosocial components showed statistically significant positive effects across multiple outcomes of alcohol use. The most effective parenting programs required active parental participation and developed social competence, self-regulation and overall parenting skills. School-based programs were evaluated in two SRs. Certain psychosocial or life skills programs were reported to reduce the risk of alcohol misuse. The evidence was strongest for general programs targeting multiple factors including misuse of drugs, tobacco, alcohol and antisocial behaviour. Skills-focused school programs also showed statistically significant reductions in drug use compared to usual curriculum. Mentoring by peers or adults showed modest impact on the initiation of drug or alcohol use in adolescents primarily from disadvantaged or minority groups in the US. A systematic review of educationally oriented pre-school programs reported evidence that early childhood interventions improve health behaviours. Three RCTs showed a lower risk of marijuana use when children reached adulthood, but mixed effects on other drugs or alcohol. The review authors found no consistent evidence of the impact of pre-school programs on health services utilisation.\n\nAdults:\nSocial norms interventions, delivered either face-to-face or via the web or computer reduced the use of alcohol and alcohol related problems among college or university students. The evidence was strongest for a short term effect (< 0.05). The apparent inconsistency between the two SRs may be explained by differences in inclusion criteria. One review used broader inclusion criteria for the intervention and therefore reviewed more RCTs. There was some overlap between SRs in the studies included. \n","The authors reported that numerous studies evaluating the effectiveness of programs to prevent substance misuse in general adult and youth populations, are available.\n\nFamily or parental support programs can be effective in reducing or preventing substance misuse in adolescents. \n\nSchool-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. \n\nEvidence supporting the mentoring and preschool programs for primary prevention of substance misuse are less clear. \n\nIn adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population. \n\nNone of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. \nOther limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options.\n"]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older.","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]

{"sheet":"General pop","index":13,"n_rows":180,"n_cols":5,"rows_kept":180,"cut":false,"hidden":false,"merged":[[41,1,74,1],[41,2,74,2],[41,3,74,3],[41,4,74,4],[75,1,110,1],[75,2,110,2],[75,3,110,3],[75,4,110,4],[39,1,39,4],[27,1,27,4],[29,1,37,1],[29,2,37,2],[29,3,37,4],[177,1,177,4],[179,1,189,1],[179,2,189,2],[179,3,189,3],[179,4,189,4]]}
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[null,"Canllawiau NICE"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute of Health and Care Excellence. Alcohol use disorders: prevention PH24. \nLondon: NICE; 2010.\n\nAvailable here.\n\nReviewed May 2014.\n\n\n\n\n","Commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors.","The guideline covers alcohol problems in those over the age of 10. It includes a mix of universal and targeted interventions.\n\nThe guideline makes recommendations on:\n• Price, availability and marketing\n• Licensing\n• Supporting children and young people aged 10-15 years thought to be at risk from their use of alcohol\n• Screening young people aged 16 and 17 years thought to be at risk from their use of alcohol\n• Screening adults\n• Referral\n\n"]
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[null,"Adolygiadau Systemataidd Cochrane"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\n\nAvailable here. \n","Those aged 10 years and above.","One small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS (general population studies in Canadian provinces conducted in the 1970s and 80s) were included.\n\nThe RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95% CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95% CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE), the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95% CI ‐5.26, 7.47; p value = 0.43; I2 = 83%, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI ‐36.83, ‐8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.\n\nNo other pre-specified outcomes (including economic loss or hardship due to decreased alcohol sales) were addressed in the included studies and no adverse effects were reported in any of the studies. None of the studies were funded by the alcohol or advertising industries.\n","The authors identified a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. They concluded that advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base."]
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[null,"Kaner EFS et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations. Cochrane Database Syst Rev 2017, Issue 9. Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2\n\nAvailable here.\n","Participants were people living in the community whose alcohol consumption had been screened as hazardous or harmful (WHO 1992) and who were directed toward any digital intervention including web‐based, mobile phone text messaging, smartphone apps, social networking, or stand-alone computer‐based technologies (including CD‐ROMs).","Fifty-seven studies were included in the review which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty-one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence).\n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3,587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9,791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence).\n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI ‐24.59 to 25.63; low‐quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.\n\nA median of nine behaviour change techniques (BCTs) were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B ‐43.94, 95% CI ‐78.59 to ‐9.30), problem solving (B ‐48.03, 95% CI ‐77.79 to ‐18.27), information about antecedents (B ‐74.20, 95% CI ‐117.72 to ‐30.68), behaviour substitution (B ‐123.71, 95% CI ‐184.63 to ‐62.80) and credible source (B ‐39.89, 95% CI ‐72.66 to ‐7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B ‐95.12, 95% CI ‐162.90 to ‐27.34), problem solving (B ‐45.92, 95% CI ‐90.97 to ‐0.87), and credible source (B ‐32.09, 95% CI ‐60.64 to ‐3.55) were associated with reduced alcohol consumption.\n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","The authors found moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions.\n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.\n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.\n"]
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[null,"Adolygiadau Systemataidd Eraill "]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here","General population","The amount and strength of evidence varies across the six topics. There was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics. Illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. \nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]