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Meta-Analysis
. 2014;2014(12):CD003020.
doi: 10.1002/14651858.CD003020.pub3. Epub 2014 Dec 1.

Universal school-based prevention for illicit drug use

Fabrizio Faggiano  1 , Silvia Minozzi, Elisabetta Versino, Daria Buscemi
Affiliations
Meta-Analysis

Universal school-based prevention for illicit drug use

Fabrizio Faggiano et al. Cochrane Database Syst Rev. 2014.

Abstract

Background: Drug addiction is a chronic, relapsing disease. Primary interventions should aim to reduce first use or to prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions.

Objectives: To evaluate the effectiveness of universal school-based interventions in reducing drug use compared to usual curricular activities or no intervention.

Search methods: We searched the Cochrane Drugs and Alcohol Group's Trials Register (September 2013), the Cochrane Central Register of Controlled Trials (2013, Issue 9), PubMed (1966 to September 2013), EMBASE (1988 to September 2013) and other databases. We also contacted researchers in the field and checked reference lists of articles.

Selection criteria: Randomised controlled trials (RCT) evaluating school-based interventions designed to prevent illicit drugs use.

Data collection and analysis: We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results: We included 51 studies, with 127,146 participants. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA. Social competence approach versus usual curricula or no intervention Marijuana 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, 9456 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.Marijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2678 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.Hard drug use at < 12 months: we found no difference (RR 0.69; 95% CI 0.40 to 1.18, one study, 2090 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.Hard drug use at 12+ months: we found no difference (mean difference (MD) -0.01; 95% CI -0.06 to 0.04), one study, 1075 participants, high quality evidence). One study with no data for meta-analysis showed comparable results for the intervention and control group.Any drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2512 participants, moderate quality evidence). One study with 1566 participants provided continuous data showing no difference (MD 0.02; 95% CI -0.05 to 0.09, moderate quality evidence). Social influence approach versus usual curricula or no intervention Marijuana use at < 12 months: we found a nearly 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).Marijuana use at 12+ months: we found no difference (RR 0.95; 95% CI 0.81 to 1.13, one study, 5862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed nearly 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.Hard drug use at 12+ months: one study not providing data for meta-analysis found a significant protective effect of the social influence approach.Any drug use: no studies assessed this outcome. Combined approach versus usual curricula or no intervention Marijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8701 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).Marijuana 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.Hard 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.Hard drug use at 12+ months: we found no difference (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.Any drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6362 participants).Only 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.

Authors' conclusions: 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.Since the effects of school-based programmes are small, they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.

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Conflict of interest statement

FF is an author of an included study (UNPLUGGED 2008). He did not participate in the evaluation of and data extraction for the related papers.

SM EV,DB have no conflicts of interest

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 1 Marijuana use < 12 months.
1.2
1.2. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 2 Marijuana use < 12 months.
1.3
1.3. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 3 Marijuana use ≥ 12 months.
1.4
1.4. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 4 Marijuana use ≥ 12 months.
1.5
1.5. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 5 Hard drug use < 12 months.
1.6
1.6. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 6 Hard drugs use ≥ 12 months.
1.7
1.7. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 7 Other drug use < 12 months.
1.8
1.8. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 8 Other drugs use < 12 months.
1.9
1.9. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 9 Any drug use < 12 months.
1.10
1.10. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 10 Any drug use < 12 months.
1.11
1.11. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 11 Drug knowledge < 12 months.
1.12
1.12. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 12 Intention to use marijuana < 12 months.
1.13
1.13. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 13 Intention to use hard drugs < 12 months.
1.14
1.14. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 14 Intention to use other drugs < 12 months.
1.15
1.15. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 15 Intention to use any drug < 12 months.
1.16
1.16. Analysis
Comparison 1 Social competence versus usual curricula, Outcome 16 Intention to use any drug < 12 months.
2.1
2.1. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 1 Marijuana use < 12 months.
2.2
2.2. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 2 Marijuana use < 12 months.
2.3
2.3. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 3 Marijuana use ≥ 12 months.
2.4
2.4. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 4 Marijuana use ≥12 months.
2.5
2.5. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 5 Other drug use < 12 months.
2.6
2.6. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 6 Other drugs use ≥ 12 months.
2.7
2.7. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 7 Drug knowledge < 12 months.
2.8
2.8. Analysis
Comparison 2 Social influence versus usual curricula, Outcome 8 Drug knowledge ≥ 12 months.
3.1
3.1. Analysis
Comparison 3 Combined versus usual curricula, Outcome 1 Marijuana use < 12 months.
3.2
3.2. Analysis
Comparison 3 Combined versus usual curricula, Outcome 2 Marijuana use < 12 months.
3.3
3.3. Analysis
Comparison 3 Combined versus usual curricula, Outcome 3 Marijuana use ≥ 12 months.
3.4
3.4. Analysis
Comparison 3 Combined versus usual curricula, Outcome 4 Marijuana use ≥12 months.
3.5
3.5. Analysis
Comparison 3 Combined versus usual curricula, Outcome 5 Hard drug use < 12 months.
3.6
3.6. Analysis
Comparison 3 Combined versus usual curricula, Outcome 6 Hard drug use < 12 months.
3.7
3.7. Analysis
Comparison 3 Combined versus usual curricula, Outcome 7 Hard drug use ≥ 12 months.
3.8
3.8. Analysis
Comparison 3 Combined versus usual curricula, Outcome 8 Hard drug use ≥ 12 months.
3.9
3.9. Analysis
Comparison 3 Combined versus usual curricula, Outcome 9 Any drugs use < 12 months.
4.1
4.1. Analysis
Comparison 4 Knowledge versus usual curricula, Outcome 1 Drug knowledge < 12 months.
4.2
4.2. Analysis
Comparison 4 Knowledge versus usual curricula, Outcome 2 Intention to use hard drugs < 12 months.
See this image and copyright information in PMC

Update of

References

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KEEPIN' IT REAL 2003 {published data only}
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MOTIVATIONAL INTERV 2011 {published data only}
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NAPA 1984 {published data only}
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PATHS 2012 {published data only}
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PROJECT ACTIVE 2011 {published data only}
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PROJECT SPORT 2005 {published data only}
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TND 1998 {published data only}
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TND 2001 {published data only}
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TND 2002 {published data only}
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UNPLUGGED 2008 {published data only}
    1. Faggiano F, Galanti MR, Bohrn K, Burkhart G, Vigna‐Taglianti F, Cuomo L, et al. The effectiveness of a school based substance abuse prevention program: EU‐DAP cluster randomised controlled trial. Preventive Medicine 2008;47:537‐43. - PubMed
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UNPLUGGED 2012 {published data only}
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References to studies excluded from this review

Ambtman 1990 {published data only}
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Moskowitz 1983 {published data only}
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References to studies awaiting assessment

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References to ongoing studies

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References to other published versions of this review

Cochrane 2005
    1. Faggiano F, Vigna‐Taglianti FD, Versino E, Zambon A, Borraccino A, Lemma P. School‐based prevention for illicit drugs' use. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD003020.pub2.] - DOI - PubMed

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