Foxcroft David R, Moreira Maria Teresa, Almeida Santimano Nerissa M L, Smith Lesley A
Department of Psychology, Social Work and Public Health, Oxford Brookes University, Marston Road, Jack Straws Lane, Marston, Oxford, England, UK, OX3 0FL.
Cochrane Database Syst Rev. 2015 Jan 26;1:CD006748. doi: 10.1002/14651858.CD006748.pub3.
Drinking is influenced by youth (mis)perceptions of how their peers drink. If misperceptions can be corrected, young people may drink less.
To determine whether social norms interventions reduce alcohol-related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.
The following electronic databases were searched up to May 2014: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (only to March 2008). Reference lists of included studies and review articles were manually searched.
Randomised controlled trials or cluster-randomised controlled trials that compared a social normative intervention versus no intervention, alcohol education leaflet or other 'non-normative feedback' alcohol intervention and reported on alcohol consumption or alcohol-related problems in university or college students.
We used standard methodological procedures as expected by The Cochrane Collaboration. Each outcome was analysed by mode of delivery: mailed normative feedback (MF); Web/computer normative feedback (WF); individual face-to-face normative feedback (IFF); group face-to-face normative feedback (GFF); and normative marketing campaign (MC).
A total of 66 studies (43,125 participants) were included in the review, and 59 studies (40,951 participants) in the meta-analyses. Outcomes at 4+ 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 (I(2) < 50%). Alcohol-related problems at 4+ months: IFF standardised mean difference (SMD) -0.16, 95% confidence interval (CI) -0.31 to -0.01 (participants = 1065; studies = 7; moderate quality of evidence), equivalent to a decrease of 1.5 points in the 69-point alcohol problems scale score. No effects were found for WF or MF. Binge drinking at 4+ months: results pooled across delivery modes: SMD -0.06, 95% CI -0.11 to -0.02 (participants = 11,292; studies = 16; moderate quality of evidence), equivalent to 2.7% fewer binge drinkers if 30-day prevalence is 43.9%. Drinking quantity at 4+ months: results pooled across delivery modes: SMD -0.08, 95% CI -0.12 to -0.05 (participants = 20,696; studies = 33; moderate quality of evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week. Drinking frequency at 4+ months: WF SMD -0.12, 95% CI -0.18 to -0.05 (participants = 9456; studies = 9; moderate quality of evidence), equivalent to a decrease of 0.19 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD -0.21, 95% CI -0.31 to -0.10 (participants = 1464; studies = 8; moderate quality of evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for GFF or MC. Estimated blood alcohol concentration (BAC) at 4+ months: peak BAC results pooled across delivery modes: SMD -0.08, 95% CI -0.17 to 0.00 (participants = 7198; studies = 13; low quality of evidence), equivalent to a reduction in peak PAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF.
AUTHORS' CONCLUSIONS: 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, we 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 statistically 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.
饮酒受到年轻人对同龄人饮酒方式的（错误）认知的影响。如果能纠正这些错误认知，年轻人可能会减少饮酒量。
与对照组（范围从仅评估/无干预到其他教育或心理社会干预）相比，确定社会规范干预措施是否能减少大学生酒精相关的负面后果、酒精滥用或酒精消费。
截至2014年5月，检索了以下电子数据库：考克兰对照试验中心注册库（CENTRAL）、医学期刊数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、心理学文摘数据库（PsycINFO）以及护理与健康照护领域累积索引数据库（CINAHL）（仅检索至2008年3月）。对纳入研究和综述文章的参考文献列表进行了手工检索。
随机对照试验或整群随机对照试验，比较社会规范干预与无干预、酒精教育传单或其他“非规范反馈”酒精干预，并报告大学生的酒精消费或酒精相关问题。
我们采用了考克兰协作网预期的标准方法程序。每个结果按干预方式进行分析：邮寄规范反馈（MF）；网络/计算机规范反馈（WF）；个体面对面规范反馈（IFF）；小组面对面规范反馈（GFF）；以及规范营销活动（MC）。
本综述共纳入66项研究（43125名参与者），荟萃分析纳入59项研究（40951名参与者）。干预后4个月及以上的结果对于评估效果在短期之外是否持续尤为重要。我们仅针对那些不同干预方式间异质性不大（I² < 50%）的分析报告了不同干预方式的合并效应。干预后4个月及以上与酒精相关的问题：个体面对面规范反馈标准化均数差（SMD）为 -0.16，95%置信区间（CI）为 -0.31至 -0.01（参与者 = 1065；研究 = 7；证据质量中等），相当于在69分的酒精问题量表得分中降低1.5分。未发现网络/计算机规范反馈或邮寄规范反馈有效果。干预后4个月及以上的暴饮：不同干预方式合并结果：SMD为 -0.06，95%CI为 -0.11至 -0.02（参与者 = 11292；研究 = 16；证据质量中等），如果30天患病率为43.9%，相当于暴饮者减少2.7%。干预后4个月及以上的饮酒量：不同干预方式合并结果：SMD为 -0.08，95%CI为 -0.12至 -0.05（参与者 = 20696；研究 = 33；证据质量中等），相当于每周饮酒量从基线的每周13.7杯减少0.9杯。干预后4个月及以上的饮酒频率：网络/计算机规范反馈SMD为 -0.12，95%CI为 -0.18至 -0.05（参与者 = 9456；研究 = 9；证据质量中等），相当于每周饮酒天数从基线的每周2.74天减少0.19天；个体面对面规范反馈SMD为 -0.21，95%CI为 -0.31至 -0.10（参与者 = 1464；研究 = 8；证据质量中等），相当于每周饮酒天数从基线的每周2.74天减少0.32天。未发现小组面对面规范反馈或规范营销活动有效果。干预后4个月及以上的估计血液酒精浓度（BAC）：不同干预方式合并的峰值BAC结果：SMD为 -0.08，95%CI为 -0.17至0.00（参与者 = 7198；研究 = 13；证据质量低），相当于峰值PAC从平均0.144%降至0.135%。个体面对面规范反馈在典型BAC方面未发现效果。
本综述结果表明，社会规范干预措施对预防大学生酒精滥用并无实质性的显著益处。尽管发现了一些显著效果，但鉴于本综述纳入研究中使用的测量量表，我们认为效应量过小，与政策或实践无关。此外，并非所有滥用指标在统计上都有显著一致的效果，在一些分析中异质性是个问题，且不能排除偏倚是这些结果的潜在原因。
