Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Rebecca Kate Hodder; Megan Freund; Luke Wolfenden; Jenny Bowman; Smriti Nepal; Julia Dray; Melanie Kingsland; Sze Lin Yoong; John Wiggers

doi:10.1016/j.ypmed.2017.04.003

Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Prev Med. 2017 Jul:100:248-268. doi: 10.1016/j.ypmed.2017.04.003. Epub 2017 Apr 6.

Authors

Rebecca Kate Hodder¹, Megan Freund², Luke Wolfenden³, Jenny Bowman⁴, Smriti Nepal⁵, Julia Dray⁶, Melanie Kingsland⁷, Sze Lin Yoong⁸, John Wiggers⁹

Affiliations

¹ Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: Rebecca.hodder@hnehealth.nsw.gov.au.
² School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: megan.freund@newcastle.edu.au.
³ Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: luke.woflenden@hnehealth.nsw.gov.au.
⁴ Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; School of Psychology, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia. Electronic address: Jenny.Bowman@newcastle.edu.au.
⁵ School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: smriti.nepal@uon.edu.au.
⁶ Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; School of Psychology, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia. Electronic address: Julia.dray@hnehealth.nsw.gov.au.
⁷ School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: melanie.kingsland@hnehealth.nsw.gov.au.
⁸ Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: Serene.Yoong@hnehealth.nsw.gov.au.
⁹ Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Electronic address: john.wiggers@hnehealth.nsw.gov.au.

PMID: 28390835
DOI: 10.1016/j.ypmed.2017.04.003

Abstract

Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau²=0.0, I²=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.

Keywords: Adolescent; Alcohol drinking; Clinical trials; Illicit drugs; Psychological resilience; Schools; Systematic review; Tobacco use.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adolescent
Alcohol Drinking / prevention & control*
Humans
Randomized Controlled Trials as Topic
Resilience, Psychological*
Substance-Related Disorders / prevention & control*
Tobacco Use / prevention & control*